Luxation traumatique bilatérale de la hanche

Bilateral traumatic dislocation of the hip joint is very rare but not new; Marquardt in 1936 reported the first case; only 51 cases have been reported so far. Here is another case with over a 1-year follow-up period.     

Adaptation de la force isocinétique des muscles rotateurs de l’épaule à la pratique sportive

Physiological, anatomy and biomechanical adaptations of the shoulder joint to the stresses induced by the throwing gesture, which allow performance, could be the cause of “desadaptation” that can lead to injury by microtrauma. Thus, exploration of any adaptations or changes in internal (IR) and external (ER) muscle strength (and/or agonist/antagonist balance represented by the ratio ER/IR) to solicitations sports is relevant in order to better understand the pathophysiology of shoulder injury. Many studies have focused on identifying patterns of IR and ER muscle strength according to the practice of overhead sports. Despite the methodological limitations, although an increase in the IR strength of the dominant side was reported, it does not seem to exist an “imbalance” in muscle strength between the IR and ER, induced by overhead sports, which could be a “desadaptaion” in the origin of shoulder pathologies. There is no imbalance that could be implicated as a risk factor predisposing to shoulder pathologies.     

Fracture-avulsion négligée de la tubérosité tibiale antérieure

Avulsion-fracture of the tibial tubercle has been well described and its management is now well codified in standard orthopaedic textbooks. Diagnosis is based on clinical features and standard radiology. The authors present a case of a neglected type IIA avulsion-fracture of the tibial tubercle. Surgical treatment gives an excellent outcome despite intra operative difficulties.     

L’ostéome ostéoïde du col fémoral du sportif : intérêt de la résection percutanée scanno-guidée (À propos de 11 cas avec revue de la littérature)

Introduction

Treatment of the osteoid osteoma was based a long time on the surgical resection, but with a considerable frequency of complications. The percutaneous resection tomography-guided belongs to therapeutic progress of these last years, it became the method of choice for the treatment of osteoid osteoma in our institution. The purpose of our study is to evaluate effectiveness of this technic by analyzing the clinical evolution, the duration of convalescence and resumption of sports activities.

Patients and methods

It is a retrospective study concerning 11 observations of osteoid osteoma of the femoral neck, treated and followed to the service of Traumatology-Orthopedy II of the military hospital of the CHU Rabat between January 2004 and October 2009. Our series was composed of three professional athletes, two footballers exercising in national shampionship and six soldiers subjected to a constant and regular drive.

Results

This intervention was done in the day's hospital, all the patients left the hospital the same day with resumption of the total support in the 24 hours following operation. Nine patients (80%) observed a total disappearance of the pain a few hours after the intervention. With a minimal retreat one year, no case of complication was raised. And finally on the subjective level all the patients were satisfied and took again their sports activities on the same former level.

Discussion

The treatment for osteoid osteoma must be simple, precise, effective and the least expensive possible. In the light of our results and those brought back in the literature, the percutaneous resection tomography-guided is proven effective, sure, not very invasive and is associated with a reduction in the health expenditure. It can be recommended like the treatment of choice of osteoid osteoma as well for the femoral neck as for the other localisations. More aggressive and more expensive treatments are difficult to justify, in particular in sportsmen, thus allowing them a fast convalescence and an early recovery their sports activities.     

Épidémiologie des traumatismes orthopédiques liés à la pratique du rugby à XV. Revue de la littérature

Objective

To undertake a review of international epidemiological studies on match orthopedic injuries among rugby union players in order to define their frequency and some of their associated factors.

Method

Studies for this review were selected as identified by the PubMed medical database and/or published in reviewed journals. Only studies for which the methodology was described were selected at the final step.

Results

Most of the studies reviewed concerned anglo-saxon and male players. Despite the fact that the definition of injury was not the same between all studies, our review indicates that the traumatology in rugby union players is increasing since the coming of professionalism after the third IRB World Cup in 1995. Tackle was the most frequent game event cited when an injury occured but the risk for an injury was increased for scrum and collision. Muscular strains were identified as frequent injuries and prevention programs can help to reduce their incidence. Knee was the most injured localization cited for injuries with a subsequent indisponibility. As for muscle strains, prevention programs led to a decline of the frequency and the seriousness of head and spine injuries. Even though forbidden, foul play events were identified for 10 to 15% of the injuries.

Conclusion

Our review indicates that the traumatology in rugby union players is increasing since the coming of professionalism. A standardized (internal validity and reliability) and mastered methodology must be defined and applied in order to develop and to assess primary, secondary and tertiary prevention strategies.     

Avulsion de la tubérosité ischiatique chez l’adolescent : à propos de deux cas cliniques

Ischial avulsion, often diagnosed as a musculotendinous injury, is a traumatic pathology related to physical activity. Treatment of ischial avulsion fractures is not consensual. The authors present two case reports of adolescent football players with an ischial tuberosity avulsion submitted to a conservative rehabilitation programme, with different outcomes. One of the patients returned to competition but the other gave up football due to pain. In these case reports diagnosis, treatment and follow-up results are discussed.     

Avulsion de la tubérosité tibiale antérieure chez un jeune sportif

Avulsion fracture of the anterior tibial tuberosity is rare. This lesion occurs in the sportive adolescent. The authors report a case of 16-year-old sports amateur, who presents an avulsion of the anterior tibial tuberosity, treated by surgery. Epidemiologic, etiopathogenic, therapeutic and pronostic aspects are analysed.     

L’avulsion de la tubérosité tibiale antérieure chez l’adulte

The authors report two cases of patients operated for avulsion fracture of the tibial tubercle. The traumatisms occurred during sports activities (karate, basketball). The treatment consisted in open reduction of the tibial tubercle then fixing it by screwing. At the end, after rehabilitation, the functional results were good.     

Apport de l’exercice physique et du régime dans la prise en charge de la gonarthrose chez l’obèse

Objective

Our objective was to determine whether exercise and weight loss are more effective either separately or in combination, in improving pain and physical function in obese adults with moderate knee osteoarthritis (OA).

Patients and methods

Forty-five obese adults, with a body mass index greater than 35 kg/m² or 30 ≤ BMI < 35 associated to at least one cardiovascular risk factor, suffering from knee pain with evident radiographic signs of knee OA, were involved in our study. All patients were evaluated at baseline and at the end of the study. The assessment parameters were weight loss, the bioelectric impedance analysis, pain, six-minute walk distance, cardiovascular parameters, and muscular strength. The physical function was measured with the Womac and the Lequesne indexes. Patients were randomized into four groups, a control group (G1), exercise only group (G2), diet plus exercise group (G3) and diet only group (G4).

Results

There was no difference between the four groups at baseline. Significant improvement of function (Womac) was noticed in groups performing exercise only (G2) (26 %), diet plus exercise (G3) (37,89 %) and diet only (G4) (18,34 %). We also noticed an improvement in pain in G2 (p = 0.04), G3 (p < 0.001) and G4 (p = 0.02). The improvement of quadriceps strength was noted only in G2 (p = 0.01) et G3 (p = 0.001) without any change in control group and diet only group (G4). The improvement of cardiovascular parameters was observed only in G2 and G3. Weight loss, decreased BMI and waist circumference was more important in diet plus exercise group (G3).

Conclusion

The combination of weight loss and exercise provide better improvements in physical function and pain in obese adults with knee OA compared with either intervention alone. Exercise used alone or associated to dietary provides better improvements in physical capacity and muscle strength.     

Avulsion post-traumatique de la tubérosité ischiatique chez le sportif

The avulsion fractures of the ischium are rare lesions, which are often unnoticed. When they are not diagnosed and, consequently, not dealt with, they are at the origin of persistent pains and could stop the sports activity. We report the case of an avulsion–fracture ischiatic tuberosity in a 16-year-old sportsman patient. The diagnosis selected initially was a tendinitis of hamstring and a medicamentous treatment was given. The symptomatology did not regress and the patient was entrusted to us at the end of six months. The take-in-charge consisted of reduction and the osteosynthesis of the detached fragment with simple postoperative and retake of sports activeness after one year.     

Apport de l’isocinétisme dans les tendinopathies du sportif : revue de la littérature

Isokinetism is a relatively recent method for assessing muscle function which can be used for rehabilitation purposes. The purpose of this article was to review the role of isokinetism in the assessment and rehabilitation of patients with tendinopathies of the lower limbs. Evidence in the literature shows that isokinetism is a well-integrated evaluation method used for tendinomuscular injury. It can be used to monitor the effect of different therapeutic approaches, particularly surgical techniques, and to determine the appropriate time for resuming sports activities. Regarding its contribution to rehabilitation, isokinetism is also useful for the prevention of tendon injuries in athletes. Systematic evaluation and adapted rehabilitation exercises can thus be instituted before starting the sports season.     

Rôle de l’équipe paramédicale dans la réalisation du contrôle ciblé de la température après un arrêt cardiaque récupéré

Therapeutic hypothermia, also called targeted temperature management, is increasingly used in the intensive care unit (ICU), based on its assessed neuroprotective effects against ischemia-reperfusion-induced brain damage. Targeted temperature management is indicated in comatose adult patients after cardiac arrest if successfully resuscitated from a witnessed out-of-hospital cardiac arrest of presumed cardiac cause with an initial rhythm of ventricular fibrillation or non-perfusing ventricular tachycardia and in a stable hemodynamic condition. Patients after in-hospital cardiac arrest or with other initial rhythms may also benefit. When indicated, therapeutic hypothermia should be quickly performed and tightly controlled. Both surface and core cooling methods target a body temperature of 32 to 34 °C. Thus, it is mandatory to know how to simply manage the routinely available techniques in order to perform hypopthermia as soon as possible, being aware of all side-effects that may alter the expected benefits. Therefore, implementing hypothermia in the ICU involve the whole medical and paramedical staff.     

Instabilité méniscale par subluxation récurrente de la corne postérieure du ménisque latéral

A young football player presented several episodes of locking knee associated with pain of the lateral compartment while MRI was considered normal. The occurrence of an irreducible blocking requires performing arthroscopy with evidence of instability of the posterior horn of the lateral meniscus. After reviewing the literature, it appears that popliteomeniscal fasciculi play an important role in maintaining the stability of the posterior horn of the lateral meniscus. Disruption of these structures, either by default or rupture leads to hypermobility of the lateral meniscus. Clinical examination is not contributory; at most, one finds a pain when tensioning the posterolateral compartment at the “Figure-4 Test” and hypermobility in internal rotation of the knee. The popliteomeniscal fasciculi can be viewed on the “classic” MRI of the knee. We need to know the search during an episode of locking knee without meniscal lesion. The management is surgical with the aim of preserving the meniscus.     

Luxation traumatique négligée de la tête radiale chez l’adulte (à propos d’un cas et revue de la littérature)

The authors report the case of an isolated dislocation of the head radial road neglected during 2 months at a 28-year-old patient further to a fall on the right hand bends in extension and hyperpronation of the front arm. The treatment consisted of a bloody reduction of the head radial road by extern way of the elbow with one temporary embrochage pen radial road and a suture of the previous annular ligament by point's transosseux paletot with plastered brachio-antébrachiopalmaire fixed asset in 100° of flexion. For to remind the diagnostic and therapeutic difficulties of this pathology, we propose the study of an observation analyzed in the review of the literature.     

Modification de l’article 37 du code de déontologie médicale : pourquoi la commission d’éthique de la SRLF s’est-elle battue pour un adverbe ?

Recently, French parliament's committee, which was in charge of the evaluation of the law about patients’ rights at end of life, proposed that medical deontological code should be modified in order to promote terminal sedation. Even though supporting this idea, SRLF's ethical committee collaborated with French Society of palliative care in order to modify the text that was proposed by the French medical association. The aim of this text is to explain the reasons of this intervention.     

Luxation traumatique isolée de la tête radiale chez l’adulte : à propos d’un cas et revue de la littérature

The authors report a case of isolated dislocation of the head radial road at a patient of 34 years following an injury in pronation and extension of the left elbow in a match of handball. After reduction, as a matter of urgency, the patient is immobilized during 15 days by a brachio-ante-brachio palmaire plaster in 100°. At recession of one year, the clinical examination finds amplitudes comparable to the elbow controlatéral. Only 20 cases of dislocations of the head radial road at the adult were reported in 30 years, among which 13 of them were reduced without surgery and without recurrence. The mostly found mechanism is a hyperpronation, the typical clinical case is a complete blocking of the prono supination without important deficit of the flexion extension.     

Rupture post-traumatique négligée du retinaculum extensorum à la cheville. À propos d’un cas et revue de la littérature

Post-traumatic ruptures of the retinaculum extensorum (RE) to the ankle is rare and behind a tendinous luxation, of a rope effect, tiredness and weakening or loss of strength. We report the observation of a patient aged 35 practicing full contact for 20 years, victim of a sports accident two years before upon a foot kick in the kicking bag during a training session bringing about a rupture of the RE at the ankle. Imagery (echography and MRI) made sure the clinical exam and to call for the diagnosis of the rupture of the lower band of the retinaculum with subluxation of the tendons of the tibialis anterior and of the extensor hellucis longus. The take in charge consisted of a local plasty of the RE. On the relapse (6 months), the patient is satisfied with the outcome and taking back to his initial sports activity. Through our observation and a review of the literature, we attempt to review the anatomy of the RE to the ankle and to analyze the causes and the consequences of its rupture as well as the usefulness of the imagery in analyzing its anatomic structure. The rupture of the RE is a rare affection mainly affecting sports persons. They can be unseen and may compromise the sports career of athletes. A meticulous clinical exam and targeting imagery as well as an adequate take in charge allow avoiding this unwanted evolution.     

Épidémiologie des ruptures du ligament croisé antérieur du genou chez la joueuse de football de haut niveau : à propos de 66 cas

Our study focussed on the rupture of the anterior cruciate ligament in high level female soccer players in first and second national divisions. To this effect, we used a questionnaire to analyse 66 cases of anterior cruciate ligament injury according to the following criteria: age at the time of injury, the side injured, laterality, circumstances of the accident, the type of treatment (surgical or functional), the type of surgery, recovery time, the level of recovery, initial care in a rehabilitation centre. Rupture is generally due to a non-contact injury (65%), which is comparable with a male population of the same level. The risk of repeated rupture, in a player continuing her career, is significant (> 10%). The type of surgery does not affect return to sport. However, for high-level female soccer players, rehabilitation in a specialised centre improves the chances of returning at the same level (p < 0.025).     

Traitement de la gonarthrose du jeune sportif

In the practice of sports, it is the traumatisms more than the over-sollicitation that induce arthrosis. The main principles of rehabilitation rest upon the conservation of range motion, decompression of the knee, muscular renforcement but also the control of overweight in the same time as the control of statical disorder by plantar orthesis. It seems important to distinguish two groups of arthrosis: the synovial manifestation in arthrosis for which the insers of NSAI in first intention seems logical (ponctions and local injection of corticoid) and the arthrosis with major bone manifestations (with the help of images) should be considered as a real osteo-chondral disease. It is theses types without swelling that the visco-induction should be used.