Calcification post-traumatique du muscle ilio-psoas. À propos d’un cas et revue de la littérature

Post-traumatic iliopsoas calcifications are extremely rare affections. We report the case of a patient who presented a right hip discomfort after a wakeboard accident. A thick calcification of the right iliopsoas was visible on standard X-rays. Surgery was performed by the removal of the calcification associated to a non-steroidal anti-inflammatory treatment. The result after six months was excellent. The patient has resumed his sports activities at the same level without discomfort and no recurrence of the ossification.     

Ostéochondrites disséquantes rares du genou chez l’enfant. À propos d’un cas tibial et d’ un cas rotulien et revue de la littérature

Osteochondritis dissecans is a rare condition and often involves the medial femoral condyle. We are here reporting two uncommon localizations in children involving the lateral portion of the tibial plateau in one and the patella in the other. They were two fourteen-year-old boys with respectively 4 and 3 months history of a right knee pain and locking. No previous trauma had been noted. X-ray studies and MR images provided definitive diagnosis. However, in the tibial localization, osteochondritis was associated to a damaged lateral discoid menisci and in the patellar localization, the osteochondral fragment was detached in the joint. Regularization of the lateral menisci and removal of a loose body were respectively performed under arthroscopy in the two knees. Literature is reviewed with an emphasis particularly on pathogenesis of these rare localizations.     

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.     

Fracture de Mac Farland chez l’enfant. À propos de 15 cas

McFarland fractures are articular fractures of the ankle of the child, whose fracture line through the medial part of the growth cartilage of the lower end of the tibia. The treatment of these fractures remains problematic because of the risk of default or epiphysiodesis reduction intra-articular, with risks of malalignment and osteoarthritis. We report a series of 16 fractures including a bilateral McFarland collected over a period of six years between January 2004 and December 2009 in the service of trauma-orthopedic pediatric (CHU Hassan II of Fez). The average age of our patients was 12 years (five to 15 years) with female and eleven patients were operated: a screw in eight cases and a plug in three cases, the outcome was favorable with a mean of 23 months except for one patient who presented an epiphysiodesis.     

Fracture-avulsion de l’insertion tibiale du ligament croisé postérieur chez un enfant. À propos d’un cas et revue de la littérature

The isolated lesion of the posterior cruciate ligament (PCL) and in particular the tibial avulsion is a rarely reported entity on immature skeleton. We report a case of isolated avulsion fracture of the tibial insertion of PCL in a young athlete of 14 years old, treated surgically with good functional results 2 years later.     

Ressaut distal du biceps fémoral : à propos de 2 cas et revue de la littérature

Snapping of the biceps femoris over the fibular head is an uncommon condition. Reported causes include an anomalous insertionof the tendon, trauma at the insertion site of the tendon, and an abnormality of the fibular head. This article reports two cases of a painful snapping biceps femoris tendon. Medical management resulted in a complete resolution of symtoms.     

Les accidents musculo-squelettiques avec les consoles vidéos de nouvelle génération. À propos d’un cas et revue de la littérature

The rise of next generation consoles game, with their share of sport simulations, has caused appearance of new sport injuries. We present a case of a traumatic rupture of the calcaneal tendon, after a game of virtual sport. It concerned a non-athletic 40-year-old woman. The surgery was performed with a very good long-term result. Literature review demonstrated the extent of these pathologies, with a prevalence of musculoskeletal troubles.     

Fracture de fatigue du sésamoïde tibial. Présentation d’un cas et revue de la littérature

Sesamoids are accessory peripheral bones around the metatarsophalangial joint of the first toe. They are almost constant although some rare congenital absences have been described. They work like a pulley and increase the traction power of muscles during the last stage of the step. Clinical diagnosis of stress fracture is often difficult to establish because different pathologies are usually intertwined. Sensitive elective palpation of the sesamoids, local tumefaction, painful passive metatarsophalangial extension and walk with supination of the forefoot lead to one of the following diagnoses: static or microtraumatic pathologies, osteonecrosis, microcrystalline arthropathy, rheumatoid arthritis, infections, developmental abnormalities, perisesamoidal soft tissue injuries, or even less common etiologies. Radiologic examinations (Guntz view) allow for a precise evaluation of the sesamoid bones. According to the suspected diagnosis, computed tomodensitometry, magnetic resonance or scintigraphy can be performed. The initial treatment is a conservative one; if it is not responsive, surgical treatment can be suggested but usually leads to muscular instability.     

Hernie musculaire postérieure de la cuisse réparée par plaque non résorbable. À propos d’un cas et revue de la littérature

Muscle hernias in the hamstring (semitendinosus, semimembranosus and biceps femoris) area of the thigh are rarely described in the literature. We report a case of an athletic patient, an avid cyclist, who presented a daily discomfort in the posterior region of the left thigh with irradiation to the knee and it became intensive in one year. A soft reducible non-painful superficial mass could be palpated. Ultrasonography reveals the herniation of fatty tissue through the superior superficial fascia of the thigh at the base of the posterior cutaneous nerve. Since primary repair of the fascial dehiscence was not possible, the surgery was performed by implanting a non-degradable surgical mesh, routinely used to treat inguinal hernias. The results after 24 months of follow-up are highly satisfactory: the patient has been able to return to all his daily and sports activities without discomfort or recurrence of the hernia.     

Fracture ouverte de la clavicule et traitement par fixateur externe. À propos d’un cas et revue de la littérature

Introduction

Clavicular fractures are treated by orthopedic means or by surgery with internal fixation. Most open fractures are also treated surgically but the use of external fixator remains exceptional.

Clinical case

It is about a 23-year-old patient presenting secondary punctiform cutaneous opening within the framework of clavicule fracture. The fracture had remained exposed for more than 24 hours. After trimming of the wound and reduction, the stabilization of its fracture was carried out by an external fixator Percy Fx^®. The patient directly began rehabilitation for his upper limb. No infection was noted. On the third month, the callous was solid enough to allow hardware removal simple sedation.

Discussion

The cutaneous opening of the clavicule fractures is rare and represents less than one case over 1000. The open fractures in polytrauma patients are accompanied by other direct vascular, nervous even pulmonary complications. In the case of open fracture, surgery is indicated either by intramedullary nailing or with plate and screw fixation. However, the use of an external fixator is recommended by certain authors. The stabilization of this fracture was carried out by an external fixator whose flexibility, light character and radiotransparency, facilitated the follow up.

Conclusion

Although the installation of an external fixator remains exceptional for the treatment of an open clavicule fracture, this method could be under certain conditions an alternative technique to osteosynthesis.     

L'ostéotomie tibiale chez le rugbyman professionnel. À propos de six cas

We report our experience of tibial osteotomy on 6 professional Rugby players. At revision, one was lost because he lived too far from our center, but still plays rugby. Five experienced a functional IKDC score (International Knee Documentation Committee) between 86/100 and 99/100 (versus 55/100 to 71/100 pre operative) and all returned to their sport at the same level. Modification of HKA angle (Hip-Knee-Ankle) didn't modify the impulsions during playing. Chondromalacia seems to go on despite the procedure. In all cases, pre-op washing arthroscopies (± viscosupplementation) failed. In conclusion, tibial osteotomy appears to be a quite simple procedure in the management of symptomatic chondromalacia for high level sportmen. Because of a quite short term follow up, it's impossible to preview long-term results of these osteotomies on arthro evolution.     

Fracture bilatérale simultanée de rotule. À propos d’un cas

Bilateral simultaneous fractures of the patella occured with interruption of the apparatus bungee cord, in a young man is a exceptional occurrence. A mechanism in two times, without subjacent etiology, contributes to accentuate the originality of this observation. The authors propose to describe the assumptions of the organic mechanism and the physical therapeutic. The goal is the functional recovery most optimal and the restitution of a military efficiency.     

Ostéomyélite du pubis chez un athlète : à propos d’un cas et revue de la littérature

Osteomyelitis of the pubis has rarely been described. We report a case of pubic osteomyelitis with Staphylococcus aureus at sub periosteal abscess occurred in a custodial football aged 17. It was presented in a table feverish pain in the groin with a left and a functional sensitivity of the symphysis pubis. The diagnosis was based on blood cultures, biology, ultrasound and MRI performed in emergency. The surgical treatment was strongly associated with antibiotic therapy adapted to the germ. The pathogenesis of this entity is probably the location of bacteraemia secondary to a bone redesigned by micro trauma. The treatment is based on prolonged antibiotic therapy. Surgical drainage is required for infections to rebel or medical treatment in case of abscess.     

Laxité chronique antérieure du genou chez le sportif. À propos de 118 cas

The chronic anterior laxity of the knee is an evolutive disease owing to a rupture of the anterior crossed ligament which engages the functional prognosis of the lower member and compromise sportive activity. Many techniques of ligamentous plasty were described. Our study is about 118 sportsmen suffering from chronic anterior laxity treated by the modified Kenneth-Jones procedure between 1998 and 2002. After a main following-up of 25 months, we tried to value our results and determine the real place of ligamentous plasty using patellar tendon in the treatment of sportsmen chronic anterior laxity.     

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.     

Évaluations prédictives de l’entorse de cheville. À propos de 58 cas

When an injury comes out, it is seen like a fatality for a sportsman and the medical staff. The ankle sprain is from far the most common pathology. Preventions programs proved their efficiency in many fields. However, it is very hard to put them into practice because there is few or no tools to these persons. The goal of this work is to provide assessments reliable, reproducible and non-dependent operator that will identify potential topics victim of a sprain ankle in the medium term. We tested 58 youngs healthy athletes whose sport practice was up to 2 hours a week. We have made assessments on a motor coordination machine, on a posturography platform and we analysed the muscular benefits of each lower limbs thanks to a accelerometer. These analyses have been done in November 2007, January 2008 and March 2008. We sorted out five articulars instability. Topics victims of the ankle sprain during the study got a 13% coordination deficiency. The difference is statisticly significant. All the tests which have been done on the postuography plateform were not accepted because the evaluation results were not comparables with the 1985 norms of the French Association of Posturology. We were able to see a curve problem with wounded patients during the ground absorbtion phase and had a stabilisation time shorter than the one for the healthy subjects. This significative difference was up to 110 ms. Pope et al. find out on patients hit by a talocrural sprain, a significative diminution of the dorsiflexion during the previous traumatism report. Willems et al. find these facts and describe others intrinsic factors of predisposition which match our results. Our work proved that it is possible to warn, in a mid term, the sprain of the ankle. These warnings reports must be done in the beginning of the sporting season and will allow to determine the athletes weakness thanks to reliable and reproducible evaluations.     

Lésion isolée des muscles obturateurs chez le footballeur professionnel. À propos de trois cas

We report three cases of isolated acute strain of obturator muscle in professional soccer player. Short competition break, analgesics and physiotherapy lead to a rapid return in the competition.     

Luxation traumatique de l’appareil extenseur au dos de l’articulation métacarpophalangienne. À propos d’un cas et revue de la littérature

The authors report the case of a dislocation of the extensor tendon over the metacarpophalangeal joint of the long finger, resulting from posttraumatic rupture of the radial sagittal band. A surgical procedure was performed to improve functional rehabilitation. The outcome at six months was excellent and the patient returned to sports, without recurrence of extensor tendon instability.     

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.     

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.