Nouvelle classification des lésions cervicales pour l’aptitude au rugby professionnel

Rugby union is a collision sport exposing to a medullar risk through trauma but also by early degenerative lesions. The prevalency of cervical pathologies has grown with the onset of professionalism. These lesions often happen on a developmental narrow cervical canal, which increases the risk of serious neurological complication. A first classification of criterias of aptitude for professional rugby practice had been adopted by the French Ligue Nationale de Rugby in the early years of professionalism. Since cervical imaging and screening became mandatory, numbers of narrow or very narrow cervical canals on asymptomatic players have been detected. Meanwhile, the initially used Torg index appeared to be imperfect. These elements led to a necessary evolution of this classification. The new decision-making tool enables a precise evaluation of neurologic risk with data given by clinical examination and cervical IRM, and if necessary, cervical X-rays. New classification has been introduced with four groups of risk and aptitude (group 0 [G0]: no cervical pathology; group 1 [G1]: pathology without contraindication for professional rugby practice; group 2 [G2]: relative contraindication [known higher risk, to be accepted by the player]; group 3 [G3]: absolute contraindication). This new classification is presented and discussed. Nevertheless, as the structural risk related to the rugby practice will persist, sharing responsibilities with the player by implicating him in decision-making process remains necessary.     

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.     

Le rugby finger

The distal avulsion of the flexor profundus tendon of annular finger is so characteristic of Rugby that it even took the name of "rubgy finger". The forecast depends on an early diagnosis, which must lead to a surgical repair in emergency in a specialized hand center. The level of tendinous retraction and the association of an osseous avulsion or fracture determine the different types answering for each one of them a specific procedure. If the initial diagnosis was not accurate, only a palliative surgery could be proposed then leaving heavy after-effects not without consequences for a high-level sport practice.     

Comment prévenir l’altération rachidienne lombaire et les blessures chez le jeune sportif

Objectives

The discovery of lumbar damage early in the practice of high level sporting activity led us to propose a simple program for the protection of the lumbar spine, applicable to each training session, since the age of 10 years, to limit the deleterious effects of physical activity.

Patients and method

A previous study realized in 30 young patients with lumbar pain has evidenced the effectiveness of a simple functional restoration program. We used it to propose preventive lumbar injury exercises combined in a comprehensive program with exercises for the prevention of lower limbs injuries.

Discussion

No longitudinal study has been realised on the potentially deleterious effects of early high level sport activity and no program is currently offered in a systematic way to limit its possible harmful effects. The simplicity of the protocol that we propose, validated for the spine allows its integration into a prevention program during the training of youth, since the beginning of rachis growth phase.

Conclusion

The early disc degeneration is a reality in combat and contact sports. Careful clinical monitoring is necessary to detect and take care of these pathologies. But as a priority, it is necessary to integrate since the young age a program of protection of the spine and to adapt it to the growing constraints required in above age categories, depending on the level of practice and this until the age of 18 years. This program is effective in the school rugby of the Association Sportive Montferrandaise and in the training centre.     

Une estimation des décès traumatiques liés à la pratique sportive en France métropolitaine,en 2010

Introduction

Physical exercise presents numerous health benefits but it can also lead to accidents, of varying degrees of severity, some of which can result in death. The purpose of this study was to estimate, for the year 2010 in metropolitan France, the number of injury-related deaths linked to sporting practices.

Method

The study consisted in counting the injury-related deaths that occurred in 2010 in metropolitan France following a sporting practice, regardless of the context (professional, leisure or travel). Deaths linked to cycling, deaths in airplanes and deaths by drowning were not considered as sporting practices and so were not included in the study. The figures were collected from documentation compiled by government institutions or available in on-line media and the websites of associations and government organizations involved with sport.

Results

In 2010, 246 people died as a result of a sporting activity in metropolitan France. Mountain sports were the most dangerous (99 deaths), followed by water sports (50), hunting (27), aviation sports (23, of which 22 in ultralight/microlight aircraft), mechanical sports (23) and free flight sports (20, of which 10 were linked to paragliding and five to hang gliding). Seven times more men died than women. The most dangerous periods were summer and winter.

Discussion

Our study missed some cases, which led to an overly low figure for certain sports (horse riding and fishing, etc.), and missed those people who did not die immediately following their accident. This simple study, which remains to be completed, has provided an initial estimate of the number of injury-related deaths linked to sporting activities in metropolitan France.     

Arrachements des épines iliaques antérosupérieures et antéro-inférieures chez l’enfant et l’adolescent sportifs. À propos de dix cas

The avulsions of anterior-iliac spines in child and adolescent athletes are rare injuries. All children have been treated as orthopaedic with strict rest, nonsteroidal anti-inflammatory substances and dispensation of sport for three months. No subsequent sequelae has been reported, all patients who got back to a sporting activity identical to that practiced before accident. It seems that the orthopaedic treatment among adolescents and children victims of avulsions of anterior-iliac apophysis, superior or inferior, is sufficient and does not involve any subsequent sequelae.     

Coalitions du tarse ou « fausses entorses » de l’enfant et de l’adolescent. À propos d’un cas

Tarsal coalitions, also called synostoses, are a cause of pain and gait disturbance in children and adolescents. They are often diagnosed as tarsal sprains, leading to an inappropriate functional prognosis. This is the case of an 8-year-old child with talo-calcaneum synostosis, presenting pain, hind-foot stiffness and marked disability in daily life activities and sports.     

Fracture-avulsion de l’épine iliaque antéro-inférieure et du petit trochanter chez un jeune adolescent

The avulsion fractures of the anterior-inferior iliac spine and lesser trochanter are rare. They occur most often in adolescents during sports activities. The forms in adults are rare. We report a case in a young 15-year-old teenager. He had consulted for pelvic trauma with groin pain and functional impotence of the right lower limb occurred during a recent game in triple jump. Physical examination revealed pain in the mobilization of the right hip in extension. Standard radiography of the pelvis has highlighted an avulsion fracture of the anterior-inferior iliac spine avulsion of the right with small trochanter, which has been confirmed by computed tomography. The patient has been treated orthopedically by rest and landfilling lower limb trauma, evolution was marked the disappearance of pain a few weeks later and resumption of the sporting activity in order to 6 months.     

Évaluation à moyen terme d'une intervention type hémi-Castaing dans le traitement de l'instabilité chronique de cheville

Introduction

The purpose of this study is to evaluate the functional and subjective results of hemi-Castaing replacement ankleplasty associated with articular cleaning in the treatment of chronic instability of the ankle.

Material and method

The study is retrospective, monocentric and continuous. Fifty patients (50 ankles) underwent surgery by hemi-Castaing ligamentar ankleplasty associated with articular cleaning. An independent investigator on the basis of a radioclinical examination and an ankle scoring system made the assessment.

Results

After a period of 37 months, 44 patients were seen again. Ninety-one percent of them were satisfied; the average ankle score was 87.5%. Four patients had relapsed, 26 still had pain. Seventy percent had returned to sport activities, 97% had gone back to work. The main complications were: 6 cases of tendinitis (Achilles tendon), 6 algodystrophies, 3 nevromes of the external saphene nerve and 3 dysesthesis of the external side of the foot. No sign of arthrosis was found on the radiological records.

Discussion

The treatment of chronic instability of the ankle by hemi-Castaing ankleplasty associated with articular cleaning is a satisfactory intervention for the surgeon as well as for the patient. It makes possible the recovery of a stable and functional ankle. The pain, however, will not totally disappear, which the patient should be told before the operation. Mastering the tension of the plasty is the main difficulty of this intervention, which may fail, but not necessarily as a result of the plasty's being too loose. The cause for the failure should also be sought in other factors related to the region of this pathology (deltoidian ligament, neurologic trouble, proprioceptive).     

The effect of sporting events on emergency department attendance rates in a district general hospital in Northern Ireland

Background: Previous studies have reported a conflicting relationship between the effect of live and televised sporting events on attendance rates to emergency departments (ED). The objectives of this study were to investigate the relationship of major sporting events on emergency department attendance rates and to determine the potential effects of such events on service provision. Methods: A retrospective analysis of ED attendances to a district general hospital (DGH) and subsequent admissions over a 24‐h period following live and televised sporting activities was performed over a 5‐year period. Data were compiled from the hospital’s emergency record books including the number of attendances, patient demographics, clinical complaint and outcome. Review patients were excluded. Analysis of sporting events was compiled for live local, regional and national events as well as world‐wide televised sporting broadcasts. Results: A total of 137,668 (80,445 men) patients attended from April 2002 to July 2007. Mean attendance rate per day was 80 patients (men = 47). Mean admission rate was 13.6 patients per day. Major sporting events during the study period included; Soccer: 4 FA Cup and 1 World Cup (WC) finals; Rugby: 47 Six Nations, 25 Six nations games involving Ireland, 1 WC final, 2 WC semi‐finals, 2 WC quarter‐finals and 4 WC games involving Ireland; and Gaelic Football [Gaelic Athletic Association (GAA)]: 5 All‐Ireland finals, 11 semi‐finals, 11 quarter‐finals and 5 provincial finals. There was a significantly higher patient admission rate during the soccer FA Cup final, Rugby Six Nations and games involving Ireland and for GAA semi‐ and quarter‐final games (p = 0.001–0.01). There was no difference identified in total attendance or non‐admission rates for sporting events throughout the study period. Although there was no correlation identified between any of these sporting events and total emergency department attendances (r < 0.15, p > 0.07), multinomial logistic regression demonstrated that FA Cup final (p = 0.001), Rugby Six Nations (p = 0.019), Rugby WC games involving Ireland (p = 0.003), GAA All‐Ireland semi‐ and quarter‐finals (p = 0.016; p = 0.016) were predictors of patient admission rates. Conclusion: This study suggests that live or televised sporting events do not significantly affect ED attendances to a DGH. However, some events appeared to be predictors of patient admission rates. Although it may be beneficial to consider the effect of sporting events on service stratification during these periods, the overall effect is probably minimal and should not create a major concern for future service provision despite the implementation of the European Working Time Directive.     

La rupture du tendon calcanéen : à propos de 53 cas

The Achilles tendon is the most resistant of the tendons of the human body; its rupture is increasingly frequent in the world and our country because of the considerable development of the sporting activities. This retrospective study relates to 53 observations listed in the service of traumatology and orthopedics of the Hospital Avicenne of Rabat over a period of 5 years between 2005 and 2009. Each patient underwent monitoring protocolisé. Criteria for Comis were used for clinical evaluation. All patients received open surgery. The middle age was of 37 years. The clinical examination was sufficient to pose the diagnosis. All the patients profited from an open surgery. Three patients presented pain after surgery. Infection local skin was noted in two patients. One patient presented a rerupture and 88.6% of the patients have very good performances. The rupture of the Achilles tendon is much more frequent in men; this is explained by the frequency of sports activity in men. Three patients had a history of tendinitis. Clinical examination was easy enough for diagnosis. Open surgical treatment remains the method most widely and most used. In the classic controversy between the effectiveness of surgical and orthopedic treatment in the rupture of the Achilles tendon, the emergence and development of percutaneous techniques still currently did not make it possible to conclude to the superiority of treatment over another.     

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.     

Revue épidémiologique des blessures lors de la pratique du rugby à XV

Rugby is an increasingly popular sport. Full contact being a major characteristic of rugby, injuries are not uncommon. The incidence of injury in Rugby Union reaches 30–91 per 1,000 hours of game time. This epidemiological review of injuries in rugby players reports their localization, nature, causes, moment of occurrence in matches and seasonal trends as well as the influence of the player's position, field conditions, and duration of off time after injury.     

Acute abdominal pain

Acute abdominal pain is a daily problem in a busy pediatric practice and in hospital emergency rooms. An initial, carefully performed history and physical examination should differentiate the child who has a surgical disease from one who requires medical therapy or only reassurance. Whenever there is doubt about the diagnosis, the child must be admitted to the hospital for observation and appropriate laboratory examinations. This will allow for the early diagnosis of appendicitis and other diseases requiring an operation and will prevent needless operations on children with medical illnesses.     

L’ostéochondrite disséquante du genou chez l’enfant et l’adolescent. Notre expérience à propos de 32 cas

Osteochondritis dissecans (OCD) rarely involves the femoral condyle and affects especially the athletes. Etiology of OCD remains enigmatic. This retrospective study analyzed 32 cases (28 children) stemming from a paediatric series. All the concerned children exercised a sports activity. OCD can be grave on the functional plan and burden the sports future of the child. The clinical symptomatology was poor. The circumstances of discovery were essentially represented by an atypical pain of the knee. The diagnosis was confirmed by a standard radiography revealing a specific hurt of variable aspect, being able to go of a simple suspect line to a big loss of substance at the level of the femoral condyles. The used classifications were the ones of Bedouelle, Cahill, as well as Harding one. Mostly, the pathology was diagnosed at a premature stage I and II of Bedouelle. The examinations of imaging (Magnetic Resonance Imaging [MRI], CT scan) were individually decided to explore the lesion or for a choice of the therapeutics. The stake in simple discharge with a strict stop of the sport gave satisfactory results so clinical as radiological in our study. The surgery was exceptional. The forecast is usually good at the child's subject to an adapted coverage by not allowing passing the hour of the surgery. The sport practised in an excessive, intense way (competitive sport) is recognized as a major risk factor.     

Rupture haute des tendons ischiojambiers chez le sportif. À propos d'une série de neuf cas opérés

Objectives

Muscular pathology of the hamstring is frequent among athletes. On the other hand, complete rupture with avulsion at the proximal bone-tendon junction is a rare injury. Functional treatment of this injury gives no successful results. This study aims at providing information on the results of operations on 9 athletes.

Methods

Between 2002 and 2006, 9 male patients with an average age of 36.4 years (from 20 to 59) were operated on for a complete rupture of the hamstring at the proximal bone tendon junction due to sporting accidents — 4 rugby accidents, two soccer, one fencing and one aikido accident — and one domestic accident. Emergency magnetic resonance imaging was systematically employed. All nine were operated on using the same technique: by reinserting the tendons into the bone with several Mitek GII^® anchors (3.6 on average). A specific rehabilitation programme was set up. An isokinetic Biodex™test was done after 6 months.

Results

All 9 patients were reviewed after a mean period of 33 months (from 9 to 64). At the last review, all patients were satisfied with their functional results. Eight patients out of 9 had gone back to their sporting activities at the same level, a mean 5 months after the operation (from 4 to 7 months). The isokinetic tests related to the unimpaired member show a muscular deficit of less than 8% after the 6th month.

Conclusion

Complete rupture of the hamstring at the proximal bone tendon junction is a rare but serious injury. With an early diagnosis and rapid surgical treatment, normal functions can be recuperated with a rapid return to high level sporting activity.     

Paralysie cérébrale : organisation de la transition enfant-adulte et spécificités de la prise en charge MPR de l’adulte

The increase in life expectancy due to improvements in the quality of care has meant that children with cerebral palsy reach adulthood despite the burden of their illness. The implementation of a child to adult transition and adult monitoring has proven necessary. Adolescence is a transitional period towards adult life that has specific risks associated with it, and which marks the progression of the condition. Preparing for the transition towards adult care must take place as early as possible. Providing the child and their family with all the relevant information is essential. A transition meeting and good quality information transfer ensures that appropriate adjustments can be made to monitoring in an adult environment. Adult level monitoring is required in PM & R to coordinate medical and rehabilitation follow-ups, ideally in an illness specific consultation appointment. For adult patients, we will discuss the specific problems of the seating position, the neurological effects of scoliosis, multi-stage surgical procedures, the treatment of axial dystonia and cervical myleopathy, early degenerative complications to the joints and the possibility of prosthetics to the lower limbs.     

Ténorraphie percutanée pour rupture fraîche sous-cutanée du tendon calcanéen. À propos de 28 cas

The under cutaneous rupture of the tendon of Achilles is increasingly frequent because of the considerable development of the sports activities and the increase in their intensities. In the beginning, the treatment of the tendon of Achilles rupture was orthopedical, then it was supplanted by the advent of the surgery. The comparisons between the advantages and the disadvantages of the two methods made it possible to gradually develop a technique of percutaneous tenorraphy, which takes its place according to the risks or insufficiencies of the other therapeutic methods. Our study is related to 28 observations of recent under cutaneous ruptures, in full tendinous body, treated and followed in the service of traumatology-orthopedy II of Mohammed V military hospital of instruction between January 2002 and April 2009. Our series was composed of nine professional sportsmen and 19 soldiers subjected to a constant and regular drive. All our patients profited during this period from a percutaneous tenorraphy of the tendon of Achilles by using Ténolig^®. We obtained satisfactory functional results with resumption of the former sporting level for 25 patients. Concerning complications there was minor infections in four cases, namely the cutaneous excoriations under the discs, which responded to local care, no case of iterative rupture was brought back so far, neither thromboembolic accident nor major infections or nerve sural attacks.     

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.     

Chronic Struggle: An Institutional Ethnography of Chronic Pain and Marginalization

There have been several recent calls to re-think chronic pain in response to the growing awareness of social inequities that impact the prevalence of chronic pain and its management. This in turn has resulted in new explorations of suffering as it relates to pain. While laudable, many of these clinically oriented accounts are abstract and often fail to offer a critical theoretical understanding of social and structural inequities. To truly rethink pain, we must also reconsider suffering, beginning in the everyday expert knowledge of people with chronic pain who can offer insights in relation to their bodies and also the organization of the social circumstances in which they live. Our team undertook a sociological approach known as institutional ethnography (IE) to explicate the work of people in managing lives beset by chronic pain and the inequities that stem from marginalization. In keeping with our critical paradigm, we describe participant accounts as situated, rather than lived, to de-emphasize the individual in favour of the social and relational. Through our analysis, we offer a new concept of chronic struggle to capture how pain, illness, economic deprivation, and suffering constitute a knot of experience that people living with chronic pain are obliged to simplify in order to fit existing logics of medicine. Our goal is to identify the social organization of chronic pain care which underpins experience in order to situate the social as political rather than medical or individual.PerspectiveThis article explicates the health work of people living with chronic pain and marginalization, drawing on their situated experience. We offer the concept of chronic struggle as a conceptualization that allows us to bring into clear view the social organization of chronic pain in which the social is visible as political and structural rather than medical or individual.