Traitement des luxations récentes du coude : à propos de 30 cas

Elbow dislocations are encountered in contact sports and other extreme sports. This retrospective study included 30 cases of elbow dislocations, treated between 2007 and 2012. The average age of our patients was 36 years, all male and victims of violent trauma in local equestrian competitions. The dislocation was posterolateral in 23 cases and direct posterior in the other seven. This involvement was associated to a fracture of the radial head in six cases and a medial epicondyle tear in a patient. All subjects had a reduction under sedation or general anesthesia. Fractures of the radial head were treated by screwing in four cases and resection in two cases. We also made screwing for the epicondyle fracture. The treatment was completed by analgesic immobilization for about 10 days followed by active mobilization in 22 patients, in whom the elbow was considered perfectly stable. In eight patients, mobilization in the area of stability, protected by an articulated orthosis, was established for a minimum of 45 days. After a mean follow-up of 22 months, a range of motion for flexion-extension greater than 100° was achieved in 80% of patients and only two cases have kept a severe stiffness. The overall results, as assessed using the Mayo Elbow Performance Score, were good to very good in 25 patients, fair in three patients and poor in only two cases. The sport recovery was gradual and the return to competition was not allowed before the sixth month.     

Les kystes du ligament croisé antérieur : à propos de 24 cas

The purpose of this study is to present clinical and magnetic resonance imaging (MRI) features of ganglion cysts of the anterior cruciate ligament (ACL). Such cysts are rare and often unsuspected. We reviewed a series of 24 ganglion cysts of the ACL (7 females, 17 males) between 1998 and 2004. The mean age was 45 years old (25–74). All patients presented with knee pain. The mean follow-up was 25 months (6–48). All patients had a preoperative MRI, which confirmed the diagnosis. Seventeen patients had an arthroscopic treatment and 7 were treated with percutaneous aspiration and steroid injection under. Fourteen patients were evaluated with the International knee Documentation Committee (IKDC) subjective score. Computed tomography or ultrasound guidance. MRI demonstrated 16 mucoid degenerative cysts of the ACL and 8 well circumscribed ganglion cysts with a fluid collection. The surgical pathology confirmed 13 mucoid cysts and 4 ganglion cysts; 2 recurrences were observed after surgical treatment. After percutaneous aspiration, we observed 3 recurrences, 2 failures and one vascular complication. We observed two types of ACL cysts, which could be differentiated on the MRI. Percutaneous treatment was less reliable than surgical treatment. The percutaneous aspiration should be reserved to the ganglion cysts with fluid collection, while arthroscopy is indicated for the failure cases. We recommend resection for the mucoid cysts. An aggressive resection of the ACL may compromise the knee stability so that the patient must be informed preoperatively. In theses cases, aspiration was often inefficient.     

Que penser des ondes de choc dans le traitement des lésions tendinomusculaires en 2011 ?

After 11 years of using radial shockwave therapy, we obtain a real satisfaction in the treatment of various tendinopathies. We give the results of our day-to-day clinical use and we compare it to the literature about radial and focused shockwaves. Mechanisms of action are described. We realised a maximum of six sessions, once or twice a week and the results are appreciated at least six weeks after the last session. We always gave the advice to go on with sports practice in athletes, to the condition it was painless and avoiding explosive sports. We treated about 1800 patients and the results are as following: calcaneal tedinopathy (75%); calcaneal enthesopathy (65%); plantar fasciopathy (68%); hamstrings enthesopathy (76%); patellar tendinopathy (63%); rotator cuff pathology (70%); but for lateral and medial epicondylitis, only 59 and 54% respectively. The results of this open study are very similar to results reported about radial and focused shockwaves in the scientific literature. We also treated 30 patients with muscular pain after muscle strain: 80% were satisfied of the treatment.     

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.     

Intérêt du Télos dans l'évaluation de la laxité chronique antérieure du genou en pré- et en postopératoire

The objective of our work is to clarify the contribution of knee arthrometer in the diagnosis of the anterior laxity of the knee, to look for the factors of escalation of this pathology, to estimate the objective results and outcomes following of the anterior cruciate ligament surgery. It is about a retrospective study which concerned 78 patients presenting the anterior chronic laxity of the knee, investigated, treated and followed in the M.-T.-Kassab Institute of Orthopaedics over a period of 10 years. The average age of our patients was of 27.6 years with a male ascendancy. The anterior cruciate ligament surgery was realized according to the technique of Kenneth-Jones under arthroscopy. The arthrometer has been used to determine the outcome 6 months after the surgery. Before the surgery, the average anterior translation of the tibia was 15.3 mm, 95% of the patients had 8 mm previous absolute laxity, while the differential was about 4 mm in 87% of the cases in which comparative study could be made. There was a statistically significant correlation between the Lachman's test, the internal meniscus injuries and the delay accident — surgery with the anterior knee laxity in the arthrometer. The postoperative average laxity was bout 8.2 mm and earning was proportional to the importance of the initial tibial translation. The present study demonstrates that arthrometer tests may be an objective complement for the clinical exam, with a diagnostic, previous and therapeutic purpose.     

L’embrochage centromédullaire élastique stable des fractures diaphysaires du tibia chez l’enfant

Surgical stabilization is rarely indicated for tibial fractures in children. The purpose of this study was to determine the importance and the complications associated with elastic stable intramedullary nailing (ESIN) in pediatric tibial fractures. We retrospectively reviewed 12 tibias in 11 patients that were treated by ESIN between 2000 and 2007 in our institution. Children ranged in age from seven to 14 years. There were ten closed and two open fractures. The average time union was 11 weeks. Four patients (36%) had five complications: one major (malunion > 10°) and four minors (1 leg length discreparancy < 12 mm, 1 superficial infection, 1 delayed union and 1 malunion < 10°). We believe that ESIN of pediatric tibia fractures is an effective treatment option.     

Rugby à XV,sport de combat,rachis lombaire et croissance. Réflexion sur croissance,sport précoce de haut niveau et atteintes rachidiennes lombaires précoces

We conducted a retrospective analysis of the lumbar spine in young rugby players. The series included 62 young players enrolled in high-level training programs and 33 players in a training school. The medial files of these players showed a significant number with lumbar spine lesions, 42% and 85% respectively. We propose here an anatomic analysis focusing on temporary mechanical incompetence of the lumbar segment during periods of rapid growth. Based on data in the literature, we show that when practised intensively by young athletes, sports such as rugby implying spinal stress have a traumatic effect on the lumbar vertebro-discal system with subsequent deleterious mid-term effects. In our opinion, this problem should be examined closely for categories aged under 15 years so that the conditions of sports’ practice can be adapted using modern high-performance diagnostic methods to enable harmonious growth and avoid early disc and spine degeneration. The lesions we discovered started earlier to be visible in the current study and will evolve later. All were not symptomatic. This spinal involvement may not have a deleterious effect until a few years later. The risk is to compromise later participation in high-level professional sports. Undeniably, if complementary studies confirm these early findings, sports’ practice in growing youth will have to be adapted.     

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.     

La rééducation d'emblée des ischiojambiers après chirurgie du DIDT

Introduction

Following knee ligamentoplasty, the task of muscle restoration principally focuses on the hamstrings, which are the only active structure which can protect the graft and prevent detachment. However, specialists generally advise against work on these muscles for a period of 3–6 weeks following semi-tendinosus and gracilis surgery. The hamstrings are thus left resting during this period, which encourages their wasting and tightening.

Objective

Our team, guided by the principles of rehabilitation for muscular problems, has for more than 2 years been strengthening the hamstrings immediately following ligamentoplasty surgery, making use of the semi-tendinous and gracilis. The objective is not only muscle performance and the protection of the graft, but above all encouraging the healing of the semi-tendinous and gracilis in order to align the collagen fibres and improve their mechanical resistance.

Content

It is a single-focus study, continually rolled forward. This protocol was practised on 56 patients, two patients having to withdraw from the programme because of strain problems.

Methodology

During the hospitalisation of the patient, concentric contraction of the knee flexors was engendered using weak resistance operated manually. Later in our rehabilitation centre, our patients exercised in a hamstring « chair », in the eccentric mode below maximum charge, with an increasing load progression. This was done daily up to the sixth week.

Results

Our results, at the 3rd and 6th week post-surgery, showed a favourable change in articular amplitude and pain suffered, with a low rate of complications. Evidence of pain was found in 12.5% of cases (7/56). Of these 7 patients, 2 (3.5%) had incidents involving muscular strain, rendering the interruption of the physiotherapy necessary for more than 3 consecutive days. Isokinetic results carried out at 4.6 ± 0.7 months showed excellent muscular recuperation of the hamstrings with a deficit of 9.6 ± 14% at slow speed and of 6.8 ± 13.1% at fast speed compared with the heterolateral side.

Discussion

The number of painful occurrences in our study, at 12.5%, is lower than the 20% ad higher frequently found in other documented cases. However the definition of these painful occurrences is imprecise. The performance deficit of hamstrings measured by isokinetic tests after 6 months varied between 15 and 20% depending upon the published study. In our study the results at 4.6 months were better (< 10%).

Conclusion

There can no longer be any doubt about the benefits of strengthening the hamstrings in pathologies of an anterior cruciate ligament. Our work has shown that the early strengthening of these muscles is not disadvantageous. On the contrary we believe that our policy promotes the patient's muscular and functional recovery.     

User participation in district psychiatry. The social construction of ‘users’ in handovers and meetings

An ideal in mental health care is user participation. This implies inclusion and facilitation by clinicians to enable users to participate in decisions about themselves and in the design of suitable treatment. However, much of the work of clinicians consists of handovers and other meetings where patients are not present. It is therefore interesting to study how the patient perspective is handled in such meetings and whether it forms a basis for user participation. We conducted fieldwork in three different inpatient wards in Norwegian District Psychiatric Centres. We used an interactional perspective in our analysis, where speech acts, framing and footing were key concepts. The findings show that the talk in the handovers and meetings contained five main themes and that there was a clear correlation between what was said and how it was said, and whether clinicians related to the content in a decisive, person‐centred or indecisive manner. We discuss potential participation statuses for patients and their limited opportunity to influence the talk and possible decisions about themselves. Our conclusion is that handover meetings primarily function as an aid in organising clinicians' work and could ultimately be seen as counteracting user participation.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Instabilité antérieure récidivante de l'épaule chez le rugbyman. Résultats d'une série de 85 épaules opérées par la technique de Latarjet avec un recul moyen de sept ans

The stabilization of an unstable chronic shoulder is a difficult challenge in the contact sportsman especially the rugby player. We report our experience of the modified Latarjet procedure with a retrospective series of 85 shoulders (79 rugbymen at 75 months follow-up). It acted all young men with a prevalence of dominant shoulder, occupying all the stations (over-representation of the third lines). Eighty percent presented osseous lesions; the first luxation was traumatic during a tackle. We describe our technique and our postoperative protocol. Seven percent experienced recurrence of their instability after a new traumatism and 67% returned to rugby within 8 months by keeping for some of them a sport practice functional embarrassment (16 patients). Only two mechanical complications were observed, 93% of the patients were satisfied with their intervention.     

Le kyste méniscal médial intra-articulaire : à propos de cinq cas

The intraarticular medial meniscal cyst is a rare pathology, very little described in the medical literature. This pathology is often discovered fortuitously by the development of the imagery in particular by magnetic resonance. Its physiopathology is not still perfectly known. The authors report five observations of intra articular medial meniscal cyst treated by arthroscopy allowing the meniscal resection with evacuation of the contents of the cyst. The evolution was considered good in all the cases with a complete functional recovery.     

Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis

[Purpose] This study aimed to determine and compare the effectiveness of extracorporeal shock wave therapy and local corticosteroid injection in patients with lateral epicondylitis. [Subjects and Methods] Sixty-four patients with lateral epicondylitis were randomly divided into extracorporeal shock wave therapy and steroid injection groups. Patients were evaluated using hand grip strength, visual analog scale, and short-form McGill pain questionnaire at baseline and at 4 and 12 weeks post-treatment. [Results] Both groups showed statistically significant increase in hand grip strength and decreases on the visual analog scale and short form McGill pain questionnaire overtime. There was no statistically significant difference in the percentage of improvement in hand grip strength and on the short-form McGill pain questionnaire between groups at 4 weeks post-treatment, whereas the extracorporeal shock wave therapy group showed better results on the visual analog scale. The percentages of improvements in all 3 parameters were higher in the extracorporeal shock wave therapy group than in the injection group at 12 weeks post-treatment. [Conclusion] Both the extracorporeal shock wave therapy and steroid injection were safe and effective in the treatment of lateral epicondylitis. However, extracorporeal shock wave therapy demonstrated better outcomes than steroid injection at the long-term follow-up.Key words: Lateral epicondylitis, Corticosteroid injection, Extracorporeal shock wave therapy     

Influence des facteurs intrinsèques anatomiques dans la rupture du ligament croisé antérieur : étude anatomoradiologique comparative

Studies of knee-joint anatomy and biomechanics have demonstrated to main intrinsic factor shaving a negative impact on the anterior-cruciate ligament (ACL): a narrow intercondylar notch and a weak tibial slope. The purpose of this work was to study tibial slope and width of the intercondylar notch measured on plain X-rays and magnetic resonance imaging (MRI) in knees with and without ACL tears.     

Association tendinopathie des fibulaires et fracture de fatigue de la malléole latérale : à propos de trois cas

Among the pathologies of the athlete's ankle, tendon distress and bone stress pathologies may often occur. Through three cases report, we describe the association of the fibular tendinopathies and the presence of stress fractures of the external malleolus. This association is important to detect since the treatment of the tendinopathy can be different if the condition is isolated or if it associated with a bone stress fracture, notably in the presence of correction for static difficulties. We highlight also the interest of the paraclinical exams, in particular MRI which gives evidence for the two pathologies.     

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).     

Étude épidémiologique prospective des pathologies dans le XV de France féminin de rugby de juillet 2006 à septembre 2010

The objective of this prospective study is to determine the rate of injury on the population of the French women's rugby team. It was conducted over 50 months from July 2006 to September 2010. The medical staff of the French team collected data during training and match exposure. One of the main results of the study is the significant difference in the incidence of injury leading to a sports interruption greater than 8 days between female and male (5.99/1000 hours vs. 42,1/1000 hours). Lower limb injuries represent half of the injuries observed in our study but the articular lesions represent 80.43% of the injuries leading to an interruption superior to 8 days with an incidence of 4.62/1000 hours of exposure per position. This confirms the data found in the medical literature. The ruptures of the anterior cruciate ligament, following a tackle, are the most severe lesions of our study. The forwards had a higher rate of injury than backs. The three positions most exposed to injuries are the nos. 8, 9 and 14. The players are most vulnerable when they are being tackled, during the runs and during the rucks. The study described significant differences concerning a much higher number of severe articular lesions, a more significant vulnerability of women in sustained tackles in a match situation and a different exposure of certain position, particularly the scrum-half and the right-wing.     

Énucléation antéro-médiale pure du talus chez un sportif. À propos d’un cas

Dislocation of the talus is an extremely rare injury occurring after serious trauma. The functional prognosis is poor because of osteonecrosis of the talus, which occurs in the majority of cases. The authors report a case of anteromedial dislocation of the right talus (Cauchoix stage II) in a 21 years old young athletic, following a fall from a height. Dislocation was caused by an indirect mechanism. The patient underwent emergency reduction by external manipulations, with surgical repair of the capsular ligamentous structures. The talus was stabilized by transplantar and talonavicular pining. At 2 years, the right ankle was stable, painless and had satisfactory mobility, without radiological signs of necrosis. Despite this good progress, the patient could not continue the same sport (football).     

Nurse and parent partnership during children's vaccinations: a conversation analysis

Title.  Nurse and parent partnership during children's vaccinations: a conversation analysis.
Aim.  This paper is a report of a study conducted to examine the elements of partnership and communication between nurses and parents during actual events of immunization.
Background.  Childhood immunizations require collaboration with parents, who may be anxious about immunization safety or subjecting their children to painful procedures.
Methods.  Ten interactions during immunization events from six purposively selected general practices were videoed in 2005, giving 168 minutes of talk. Conversation analysis was conducted on talk during the short phase of injection administration.
Findings.  During the immunization event nurse and mother talked to the baby/toddler rather than each other. Concurrent talk acted as a chorus, marked by sing-sing prosody, shared laughter and talk or reassuring noises. In coordinated talk nurse and parent took turns. Although overlap might occur, the actions accomplished by each speaker were different. Nurses most commonly cued bravery or stoicism to the child and stressed the progress made in administering the injections. In the less common pattern when pain was recognized as inevitable and there was no stress on stoicism and progress towards completion, the child displayed more distress and began crying before the injection.
Conclusion.  Communication skills and rapport are core to nursing work. What happens at the micro-level of turn-taking, where prosody and the actions achieved in talk, is of key importance. Our study suggests 'small talk' is of major importance – a practical professional skill in which nurses not only align with parents but simultaneously cue both mother and child about how the immunization should be conducted.