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lntroduction: An isolated dislocation of the proximal tibiofibular joint is uncommon injury.The diagnosis can be easily missed. in this case report, we expose how avoid missing out on thediagnosis and we expose a special maneuverwhich facilitating the open reduction.Case Report: We report the case ofa 31-year-old man presented at emergency aft er right knee duringfootball game. lniti ally ph ysical examination objectives a moderate swelling and a local pain on the lateral side of the right knee. The anteroposte rior and lateral radiograph s was considered normal. The diagno sis o f lateral meniscal injury was admitt ed. After one week, reexami nation objective a tender bony prominence over the antero lateral aspect of the knee. Radiol ogical investigations confirms the diagnosis of a proximal tibiofibular dislocation. An open reduction was performed. At final follow-up, the patie nt don't presents any complaints, with complete range of motion ofthe knee and the ankle.Conclusion: The pro ximal tibiofibular joint dislocation is rare entity. The early diagno sis canbe missed easily if no awareness of thi sinjury is present. The clinical presentation can mimes a lateral meniscal or lateral ligaments injuries. CT cofirm s d iagnosis if X-r ay are insuffisent.Often, early diagnosis allow s a closed reduction without surgery.

Primary musculoskeletal echinococcosis is rare and accounts for 2-3% of the patients with hydatid disease. We report a case of giant primary hydatid cysts of the thigh and the gluteal region in an 82-year-old female, who presented with a painful multiple palpable mass. The diagnosis was confirmed by imaging and serology. Total resection was performed through an extended lateral approach of the thigh and intraoperative findings revealed infected giant hydatid cysts. The postoperative outcome was uneventful. Albendazole drug (400mg per day) was given for the next 3 months. At 6 months follow-up, the patient was satisfied with no complications or recurrence.

Distal clavicle fracture accompanied by coracoid process one is a rare injury. Surgical and/or conservative treatments are proposed. We report the case of a 49-year-old woman presenting a distal clavicle fracture associated with a coracoid process one due to a fall on the left shoulder. Both injuries are treated surgically. Per operatively, and through an anterior “strap” approach, the coracoclavicular ligament was seen intact. The distal clavicle fracture was fixed with K-wires and cerclage and the coracoid process was secured by a screw. Active-assisted rehabilitation of the shoulder was initiated 3 weeks after surgery. At the last follow-up of twelve months, the patient had painless full shoulder functions and X-rays show bony union. Early recovery to normal life is possible with surgical treatment in patients with distal clavicle fracture combined with coracoid fracture.

Resume La lesion isolee du ligament croise posterieur (LCP) et, en particulier, la desinsertion tibiale est une entite rarement decrite chez l’enfant. Nous rapportons un cas de fracture-avulsion isolee de l’insertion tibiale du LCP chez un jeune sportif de 14 ans, traitee chirurgicalement avec de bons resultats fonctionnels apres un recul de deux ans.

Li Fraumeni Syndrome (LFS) is a rare autosomal disorder characterized by a familial clustering of tumors. Analysis of several series of LFS families have shown that 70% of such families are attributable to germ-line mutations in TP53. We report the case of a patient who had a first degree family antecedent of cancer in young ages. At the age of 31 years, the patient was operated of bladder papillary superficial carcinoma; five years later, he was treated for a high grade pleomorphe sarcoma of the left thigh and treated by surgery, adjuvant chemotherapy and radiotherapy. At the age of 38 years, after abdominal pain, radiologic examination reveled pancreatic tumor with bone and lymphatic metastases. The patient died one month later from pulmonary embolism. Sequencing revealed a germiline mutation of this patient that was confirmed in a member of his family in codon 1009C>T, protein Arg337Cys, exon 10 of TP53 gene this mutation was revealed in his nephew (died at the age of 20 from bone sarcoma).

SummaryIntraosseous ganglion (IOG) cyst of the scaphoid is an infrequent cause of hand and wrist pain. Intraosseous ganglia located in the scaphoid have rarely been described in the literature. We report the case of a 30-year-old right-handed woman who presented with a more than 24-month history of progressive right-wrist pain. No history of trauma was reported. Conservative treatment with anti-inflammatory medications before referral was unsuccessful. Examination revealed a small palpable mass in the carpal navicular region with no limitation of normal wrist motion. An IOG cyst of the scaphoid was found on standard radiograph and CT-scan of the wrist. Treatment consisted in curettage of the cyst followed by packing of the defect with autologous cancellous bone graft harvested in the distal end of the radial metaphysis. Satisfactory functional recovery was achieved. The clinical, radiographic and therapeutic aspects of this rare condition are discussed by the authors.

Resume Le kyste synovial intra-osseux du scaphoide constitue une etiologie tres rare des douleurs du poignet et de la main. La localisation au niveau du scaphoide est exceptionnellement decrite dans la litterature. Nous rapportons une observation d’une femme de 30 ans, droitiere qui s’est presente pour des douleurs du poignet droit evoluant depuis 24 mois, sans notion de traumatisme. Cette douleur etait rebelle aux anti-inflammatoires. L’examen a objective la presence d’une legere tumefaction en regard du scaphoide sans limitation de la mobilite du poignet. La radiographie standard et la tomodensitometrie du poignet ont revele un kyste intra-osseux du scaphoide. Le curetage–comblement par greffon spongieux preleve sur la metaphyse inferieure du radius ipsilateral a permis la guerison avec une bonne recuperation fonctionnelle. Les aspects cliniques, radiologiques et therapeutiques seront discutes par les auteurs.

Total extrusion of the talus is an unusual injury, and the obvious risks of reimplantation of the extruded bone include infection and avascular necrosis. In this article, the authors present the case of a 34-year-old man who sustained an open ankle injury with complete extrusion of the talus. The talus was recovered at the scene of the accident, and subsequently reimplanted along with ankle stabilization with pins and an external fixator. At 6 weeks following the osseous surgery, final soft tissue reconstruction with a suralis flap was performed. At 3 years after the injury, radiographs revealed spontaneous fusion of the tibiotalar and subtalar joints, and the clinical examination and history indicated satisfactory weight-bearing function of the involved foot and ankle. The definitive treatment of this serious lower extremity injury remains controversial, and the use of large allogeneic bone grafts, vascularized bone grafts, and tibiocalcaneal fusion, as well as reimplantation of the extruded talus have been recommended.

Resume Le but de cette etude etait de rapporter des cas d’osteomyelite scapulaire de l’enfant afin d’etudier leurs specificites cliniques et radiologiques et de proposer une conduite therapeutique adaptee. Cette etude retrospective portait sur quatre patients, avec un âge moyen de huit ans au moment du diagnostic (extremes de cinq et 11 ans). Le tableau clinique non specifique etait fait d’un syndrome douloureux de l’epaule dans un contexte febrile. Le diagnostic de l’osteomyelite de la scapula a ete realise en se basant sur l’imagerie (echographie et tomodensitometrie). Le staphylocoque dore methi-s a ete isole dans les quatre cas. Le traitement a ete medicochirurgical dans les quatre cas permettant d’evacuer la collection purulente et de trepaner la scapula. Nos resultats ont ete analyses avec un recul moyen de 36 mois (16 a 60 mois). Sur le plan fonctionnel, le resultat etait satisfaisant avec une mobilite complete de l’epaule et disparition des douleurs. Sur le plan anatomique, nous n’avons pas note de sequelles.

Resume Les osteomyelites, infections osseuses d’origine hematogene, sont rares au niveau des os du bassin (2,3 %) et sont exceptionnelles au niveau de l’ischion. L’osteomyelite ischiatique se voit surtout chez l’enfant et l’adolescent, elle a ete plus rarement decrite chez l’adulte. Le tableau clinique est variable et le diagnostic repose sur l’imagerie par resonance magnetique nucleaire. Le germe le plus souvent isole est le staphylocoque, exceptionnellement l’Escherichia coli. Nous rapportons un cas d’une osteomyelite a E. coli chez une femme de 46 ans, revelee par une fievre prolongee. Le point de depart de cette septicemie etait digestif, en rapport avec des polypes coliques. Le tableau clinique etait egalement complique d’un syndrome des anticorps antiphospholipides (thrombose de la veine mesenterique superieure et du tronc splenomesaraique). L’evolution etait favorable grâce a une antibiotherapie adaptee et un drainage chirurgical. Niveau de preuve IV.

Resume Fondement Les fractures trochanteriennes constituent une cause majeure de mortalite et de morbidite et de perte fonctionnelle chez les sujets âges. Leur morbidite est intimement liee au degre d’instabilite et de comminution fracturaire ainsi qu’a la qualite de la reduction et de l’osteosynthese. L’âge avance et la presence de tares associees sont deux facteurs determinants dans la survenue de deces suite aux fractures trochanteriennes. Objectifs Le but de cette etude prospective etait d’etudier le profil epidemiologique de ces fractures et d’evaluer la mortalite et la morbidite afin d’etablir des criteres pour le choix therapeutique et d’ameliorer les moyens de prevention. Patients et methodes Cette etude prospective evaluait 100 patients dont l’âge moyen etait de 76 ans (60 a 96 ans). Le sexe masculin predominait (60 %). Une ou plusieurs tares etaient presentes dans 68 % des cas. L’accident faisait suite a une chute banale dans 90 % des cas. Les fractures ont ete classees selon les classifications de Ramadier et d’Ender. Elles etaient instables dans 65 % des cas. L’osteosynthese a ete realisee par un materiel a appui cortical externe type DHS dans tous les cas. Resultats Les resultats anatomofonctionnels ont ete analyses pour 82 patients (18 patients sont decedes au cours de la premiere annee). Le recul moyen de la serie etait de 24 mois (12 a 36 mois). La consolidation osseuse a ete obtenue dans 96 % des cas. Les suites operatoires ont ete grevees de nombreuses complications (quatre complications thromboemboliques, 14 complications de decubitus, deux infections, six demontages ou balayage du materiel, quatre pseudarthroses et neuf cals vicieux). Au terme de deux ans, 28 patients etaient decedes. La mortalite etait etroitement liee a l’âge (grands vieillards au-dela de 90 ans), a la presence de tares et aux fractures instables. Les bons resultats fonctionnels (72 %) dependaient de l’âge du patient (gerontins de 60 a 74 ans), de la stabilite de la fracture, de la bonne reduction et d’une osteosynthese stable. Discussion Dans les fractures trochanteriennes stables, l’osteosynthese par vis-plaque dynamique a prouve sa superiorite par rapport aux autres techniques (lame-plaque, clou-plaque, clous d’Ender et meme par rapport au clou trochanterien). Dans les fractures trochanteriennes instables, l’appui doit etre retarde afin d’eviter la survenue de complications mecaniques. Ces fractures instables ou a extension sous-trochanterienne peuvent constituer une bonne indication d’un clou trochanterien offrant une meilleure stabilite, mais parfois au prix d’une reduction insuffisante. L’objectif therapeutique doit etre une reprise de l’appui complet avec le minimum de complications et le plus rapidement possible. La prevention de ces fractures passe par la detection et le traitement de l’osteoporose et l’eradication des causes responsables de chutes chez les sujets âges (renforcement musculaire et correction des troubles neurosensoriels). Type d’etude Niveau III : prospective, etude de cohorte.

Resume Les auteurs rapportent l’association d’une fracture-luxation proximale du cinquieme metacarpien avec une luxation metacarpophalangienne (cinquieme metacarpien flottant) et d’une fracture du quatrieme metacarpien. La lesion decrite etait la resultante d’un choc direct au niveau du bord ulnaire de la main et d’une hyperextension forcee de la premiere phalange. Le traitement a consiste en une reduction orthopedique associee a un brochage percutane carpometacarpien et inter-metacarpien. A 12 mois, le resultat fonctionnel etait acceptable.

Palmar dislocation of the metacarpophalangeal joint of the long finger is a rare injury. The authors report a case of palmar dislocation of the metacarpophalangeal joint of the ring finger. The presumed mechanism is a combination of active flexion and forceful hyperextension. The dislocation was treated successfully by closed reduction shortly after injury. Closed reduction should be attempted in all cases of this injury.

Fractures of the ipsilateral femur and tibia are a devastating injury complex, usually as the consequence of high-energy traumatisme. We present a case of 42-year-old man, who sustained a simultaneous fracture of the femoral shaft and trifocal tibia. Our management consisted of treating both the femoral and the tibial fractures surgically, by intramedullary nailing and a percutaneous screw fixation of tibial and malleolar fracture. He was evaluated at 4 years of follow-up. With careful attention to some technical points, femoral fracture, ipsilateral tibial plateau, shaft and malleolar fractures can be managed successfully by combining two familiar techniques commonly employed for each injury in isolation.

We present a rare case of intramuscular haemangioma of the tibialis anterior adjacent to bone in a 32-year-old woman with the history suggestive of right tibial fracture. Plain radiographs showed an hypertrophic periosteal reaction and a thickening on the cortical shaft of the tibia. MRI revealed an intramuscular mass adjacent to the bone with inhomogeneous high signal intensity. The lesion was treated by resection of the soft-issue mass. The patient remained asymptomatic 30 months post-operatively with no signs of recurrence. These lesions mimic periosteal or parosteal tumours.

Fibroma of tendon sheath is an uncommon benign soft tissue tumor, intimately associated with tendons or tendon sheaths, with a predilection for the upper extremity. Fibroma of the tendon sheath around the knee is extremely rare. We report a case of a 51-year-old man who presented a tumor involving the posteromedial aspect of the left knee and which progressed in size for 7 years. Magnetic resonance imaging demonstrated a heterogeneous high-signal intensity in the mass on T1 and T2-weighted images. The tumor was excised en bloc. Macroscopically, it was lobulated and measured 13 cm in its largest diameter. Histology led to the diagnosis of fibroma of the tendon sheath. At 6 years’ follow-up, there was no local recurrence. To the best of our knowledge, the location and the size of this fibroma of the tendon sheath have never been described.

Transverse divergent dislocation of the elbow, in which the radius and ulna dislocate in diverging directions, is an extremely rare injury (19 cases have been reported in the literature). Usually, this type of elbow dislocation occurs in children, and an adult case is extremely rare. In this report, we present a case of a transverse divergent dislocation of elbow in a 20-year-old woman, treated with conservative method and long-arm cast immobilization. At 9 years, she had no pain in the elbow, returned to full activities and had normal function. The X-ray of the elbow was normal, except for a small nonunited bony fragment adjacent to the coronoid process of the ulna.

The authors report two cases of concomitant scaphoid and distal radial fractures, a rare combination of lesions in children. The first case was in a 14-year-old boy who presented a midscaphoid fracture associated with a distal forearm fracture. The second case concerned a 13-year-old boy who presented a midscaphoid fracture associated with a Salter type II distal radial fracture. Both fractures were reduced under general anaesthesia. The total period of immobilisation was 3 months, using a large arm thumb cast. Associated scaphoid fractures should be suspected with all types of distal forearm injuries in children. Reduction of the radius fracture should be done carefully to avoid possible displacement of the scaphoid fracture.

Acute osteomyelitis of the clavicle accounts for less than 3% of osteomyelitis cases, with its usual location in the middle third. It may be hematogenous, due to contiguity, or secondary to catheterization of the subclavian vein or neck surgery. The diagnosis is often delayed, and clinical symptoms may simulate obstetric brachial plexus palsy in young children. We report a new case of osteomyelitis of the clavicle in a 30-day-old newborn.

Resume Les auteurs presentent une serie de 22 cas de dos plat post-chirurgical traites par osteotomie trans-pediculaire de fermeture posterieure sur une periode de 3 ans (juillet 1999-juin 2002). Ils ont modifie la technique princeps en proposant l’impaction intracorporeale du spongieux ce qui permet une simplification du geste operatoire et une moindre morbidite. L’âge moyen au moment de l’intervention etait de 52 ans. Tous les malades presentaient des antecedents de chirurgie rachidienne avec arthrodese. La position penchee en avant avec difficulte a se redresser etait une plainte constante. Sur le plan radiologique, il existait des anomalies des parametres rachidiens et pelviens. En peroperatoire, nous avons confirme ou retrouve une pseudarthrose chez 5 patients. L’osteotomie a ete realisee au niveau de L4 dans 19 cas et au niveau de L3 dans 3 cas. L’osteosynthese a ete assuree avec une instrumentation rigide dans tous les cas. L’instrumentation a ete toujours implantee apres correction de la deformation sans prejudice particulier tant pour la stabilite du rachis que pour la reduction. La duree moyenne de l’intervention a ete de 180 minutes. La moyenne des pertes sanguines a ete de 1 680 ml. La voie anterieure a ete jugee necessaire dans un seul cas. Les complications peroperatoires ont ete rares. Il n’y a eu aucun deces. Le recul moyen est de 25 mois. Tous les operes de la serie ont ete ameliores en position debout et parvenaient a rester debout de facon prolongee sans difficulte, notamment sans flechir les genoux. La correction moyenne de la lordose lombaire a ete de 25,1° avec des extremes de 12 et 39°. La moyenne de la pente sacree postoperatoire etait de 33°. La correction moyenne de la position de C7 par rapport au promontoire ( plumb line ) a ete de 72 mm. Ce critere etait toujours perturbe en preoperatoire (95,6 mm), il a ete constamment ameliore de facon importante apres l’osteotomie. Au dernier recul, il n’y a eu qu’un seul cas de pseudarthrose, repris avec succes. La litterature est pauvre en ce qui concerne la realisation des osteotomies dans le traitement du dos plat postoperatoire. La planification pre et peroperatoire reste malgre tout un point imprecis.

We report an unusual case of a type I Monteggia equivalent lesion in a 6-year-old girl consisting of fracture of the ulnar diaphysis and fracture of the neck of the radius without dislocation of the radial head. Manual reduction and immobilization in a plaster cast were performed. At 10 years of follow-up, the patient had regained full flexion and extension of the elbow, and nearly full pronation and supination. In the literature, this lesion has been reported only in two paediatric patients indicating that this is an extremely rare trauma.

SummaryOsteomyelites, bone infections of a hematogenous origin, are rare in the pelvis (2.3%) and are extremely rare in the ischium. Ischiatic osteomyelitis is usually found in children and adolescents, but has rarely been described in adults. The clinical presentation varies and the diagnosis is based on magnetic resonance imaging (MRI). The most frequently isolated germ is the staphylococcus, while Escherichia coli has been found in a few cases. We report a case of osteomyelitis from E. coli in a 46-year-old woman revealed by persistent fever. The point of entry was a septicemia from gastrointestinal origin, related to colon polyps. The clinical picture was also complicated by an antiphospholipid antibody syndrome (superior mesenteric vein and splenomesenteric branch thrombosis). The course was favorable thanks to appropriate antibiotic treatment and surgical debridment of the infection.

Resume L’osteome osteoide est une tumeur osseuse benigne frequente. Il touche essentiellement le grand enfant et l’adolescent avec une predominance masculine. L’atteinte se fait preferentiellement sur la diaphyse d’un os long. Les localisations particulieres de l’osteome osteoide sont a l’origine d’errances diagnostiques. Dans certains cas, rien n’oriente cliniquement vers ce diagnostic. Nous rapportons l’observation d’un osteome osteoide du grand trochanter revele par une sciatalgie chez un jeune sportif. Nous insistons sur les difficultes diagnostiques dans les formes atypiques et l’interet des differentes techniques d’imagerie et le traitement de cette tumeur benigne.

While skin and soft-tissue complication of varicella are well known, osteomyelitis secondary to varicella is rarely reported in the literature. We describe a case of 3-year-child with varicella associated with pandiaphysal osteomyelitis caused by streptococcus type A β hemolytic.

Solitary osteochondroma is a rare benign tumour of the hand arising from the cortical surface. The important differential diagnoses, which should be considered, are Nora's lesion, florid reactive periostitis and Turret exostosis. The authors report an unusual case of osteochondroma of the metacarpal bone with a deficit of extension. The diagnosis was made using imaging techniques and confirmed by histological examination. The treatment is surgical, namely complete excision.

Resume Nous rapportons l’observation d’un osteochondrome de la branche iliopubienne gauche survenu chez un homme âge de 29 ans, suivi pour une maladie exostosante, qui s’est revele par une induration douloureuse a gauche de la base du penis. Cette induration augmentant de volume, elle genait le patient au cours des rapports sexuels et en position assise prolongee. La tomodensitometrie etait en faveur d’un osteochondrome pedicule de la branche iliopubienne gauche comprimant l’uretre. La resection chirurgicale de la tumeur a permis de confirmer le diagnostic d’un osteochondrome. Au recul de deux ans, tous les symptomes avaient regresse, sans recidive. Niveau IV : retrospectif ou serie historique.

Li Fraumeni Syndrome (LFS) is a rare autosomal disorder characterized by a familial clustering of tumors. Analysis of several series of LFS families have shown that 70% of such families are attributable to germ-line mutations in TP53. We report the case of a patient who had a first degree family antecedent of cancer in young ages. At the age of 31 years, the patient was operated of bladder papillary superficial carcinoma; five years later, he was treated for a high grade pleomorphe sarcoma of the left thigh and treated by surgery, adjuvant chemotherapy and radiotherapy. At the age of 38 years, after abdominal pain, radiologic examination reveled pancreatic tumor with bone and lymphatic metastases. The patient died one month later from pulmonary embolism. Sequencing revealed a germiline mutation of this patient that was confirmed in a member of his family in codon 1009CT, protein Arg337Cys, exon 10 of TP53 gene this mutation was revealed in his nephew (died at the age of 20 from bone sarcoma).

Traumatic hip dislocation is rare in children. The purpose of this study was to investigate the epidemiological features, dislocation types, treatments, and clinical and radiological outcomes. Seven cases of traumatic hip dislocation in children treated between 1996 and 2006 were included in this study. There were six boys and one girl with a mean age of 6.5 years. Six children had a low-energy injury. One child had a road traffic accident. All had a posterior dislocation of the hip without any associated fracture. All children underwent closed reduction of their dislocation. The mean time interval between dislocation and reduction was 4 hours and 50 minutes. Following reduction, they were immobilised for six weeks: skin traction was applied for 3 weeks, followed in six children by a hip spica cast and in one child by non weight bearing mobilization. The mean follow-up was 6.7 years. After clinical examination the hip was classified as normal in 6 children. One child had a stiff hip and a radiograph showed signs of avascular necrosis. The severity of injury was related to the age at the time of injury. Factors predisposing to avascular necrosis were delayed reduction and severity of trauma.

The authors report a case of shoulder bilateral posterior fracture dislocation in a 42-year-old man with osteogenesis imperfecta history. The importance of the communition, the large size of articular surface involved and the poor quality of the bone indicate a bilateral total shoulder arthroplasty. At midterm outcome, a good range of motion of both shoulders was registered.

This article describes a case of a 11-year-old boy with an osteochondroma of the peroneal head causing peroneal nerve palsy. Physical examination disclosed large exostoses palpated at the right fibular head. Neurological examination revealed paresis of the tibialis anterior, lateral peroneal, and extensor digitorum muscles with a muscle strength grade of 2. Electrophysiological studies confirmed denervation of the muscles supplied by the right peroneal nerve. Radiological examination showed an osteochondroma in the head of the right fibula. The patient underwent surgical decompression of the right peroneal nerve after resection of the bone tumor. At 36-month follow-up, there was a complete recovery of the deficits. Peroneal mononeuropathy in children is uncommon. Osteochondroma is a benign tumor consisting of projecting bone capped by cartilage. These tumors may be solitary or multiple and occur in hereditary multiple exostoses syndrome. The conjunction of this lesion with peroneal nerve palsy has been exceptionally reported for children, usually linked to hereditary multiple exostoses syndrome. Most peroneal nerve trauma occurs at the fibular head, where the common nerve has not yet divided into its deep and superficial peroneal nerve and where most peroneal nerve lesions, therefore, involve both branches, although motor deficits are more frequently involved than sensory ones. Surgical treatment should not be delayed because neurological improvement may be achieved if surgery is performed before severe neurological deficits become irreversible.

Congenital infantile fibrosarcoma is a rare soft tissue neoplasm in the infant of which only a few cases are reported as congenital. This tumor has a rapid growth and extensive local invasion, but metastasis rarely occurs. Distal extremities involvement is more common and metastasis are rare. We report a case of a congenital infantile fibrosarcoma of the forearm, which was initially confused with a hemangioma, treated successfully by surgical resection.

SummaryWe report the case of a left superior pubic ramus osteochondroma occurring in a 29-year-old man. The patient consulted for a multiple exostoses disease revealed by a painful induration at the base of his penis. This induration was increasing in volume and causing discomfort during sexual intercourse and when sitting for a prolonged period of time. CT-scan examination showed a pedunculated osteochondroma of the left superior pubic ramus compressing the urethra. Surgical resection of the tumor confirmed the diagnosis of osteochondroma. At a 2-year follow-up delay, all symptoms had regressed with no evidence of recurrence.Level IV: Case report.

Physical exercise has beneficial effects on a number of physiologic systems, including the skeleton. However, combined with potential risk factors, unwise training practises may harm theses systems. A stress fracture represents one from of breakdown in the skeletal system.Assess the usefulness of MRI and kinesitherapy.14 patients in military circles had a stress facture. Most of the fractures are located at the upper metaphysis of the tibia.The radiography was poor, the MRI was the investigation of choice. The images show a FREDERICSON grade 4 lesion. Treatment is mainly non or partially weight bearing until consolidation.Although stress fracture results from unbalance between the bone and the forces applied, the injury occurs as a result of summation of various extrinsic and intrinsic factors at a given point in time.

Introduction Les fractures comminutives de la tete radiale peuvent compromettre la fonction et la stabilite du coude. La tete radiale represente un element de stabilite secondaire apres le ligament lateral medial du coude. La reconstruction du pilier lateral peut resoudre le probleme d’instabilite. L’objectif de ce travail est d’evaluer les resultats cliniques, radiologiques et fonctionnels des protheses de la tete radiale (PTR) en pyrocarbone a moyen terme. Patients et methodes Il s’agit d’une serie prospective de 10 patients traites pour fracture comminutive de la tete radiale et ayant eu une mise en place d’une PTR en pyrocarbone. L’âge moyen etait de 36 ans, le sexe ratio F/H etait de 1/4. Parmi ces 10 fractures, 7 etaient dans le cadre d’une fracture-luxation du coude et 3 etaient isolees. Le delai operatoire etait entre 3 semaines et 5 ans par rapport au traumatisme initial. Les gestes associes a la mise en place de la PTR etaient 4 plasties du ligament annulaire, 2 arthrolyses du coude, 1 osteosynthese de l’olecrane, 1 osteosynthese du processus coronoide et 4 ablations de corps etrangers intra-articulaires. Resultats Au recul moyen de 37 mois, et selon le Mayo Evaluation Prognostic Score, nous avons obtenu 80 % de tres bons et bons resultats et 20 % de resultats moyens. Concernant les complications, nous n’avons note aucun descellement et aucune luxation de la prothese. Nous avons note 2 cas d’osteolyse autour de la tige (stress shilding) et un cas de raideur du coude. Deux patients presentant initialement des lesions osteo-chondrale du capitulum ont eu une usure de celui-ci. Discussion Nos resultats anatomo-fonctionnels sont satisfaisants mais restent legerement au-deca des resultats rapportes dans la litterature. Toutefois, le faible nombre de patients ne permet pas de comparer les populations de chaque etude surtout en termes de lesions associees. A la revue de la litterature, la prothese en pyrocarbone donne de bons resultats. Grace aux proprietes biomecaniques du pyrocarbone, et la bonne congruence articulaire, elle cause beaucoup moins d’usure du capitulum. Dans notre serie, nous rapportons une usure du capitulum dans 2 cas qui seraient plutot en rapport avec des lesions osteo-chondrales prealablement existantes. Conclusion Les PTR figurent actuellement parmi les moyens pertinents dans l’arsenal therapeutique devant une fracture complexe de la tete radiale. Certaines complications decrites peuvent etre evitees par une bonne technique de pose. L’utilisation de pyrocarbone a encore ameliore les resultats.

SummaryBackgroundTrochanteric fractures are a major source of mortality, morbidity and functional impairment in the elderly. Morbidity is closely related to the degree of instability and comminution and is substantially influenced by the quality of reduction and internal fixation. Advanced age and associated co-morbidities are two decisive factors of mortality secondary to trochanteric fracture.ObjectivesThis prospective study examined the epidemiological profile of trochanteric fractures and assessed mortality and morbidity with the aim of establishing management guidelines and improving prevention strategies.Material and methodsOne hundred patients were included; 60% were male. Mean age was 76 years (range, 60–96 yrs). One, or more than one, co-morbidities were present in 68% of cases. The fractures were caused by a simple fall in 90% of cases. Fractures were classified according to the criteria of Ramadier and the ones of Ender. Sixty-five percent of these fractures were unstable. A dynamic hip screw was systematically used as the standard means of internal fixation.ResultsAnatomic and functional results were analyzed in 82 patients (18 had died within the first year following fracture occurrence). Mean follow-up period was 24 months (range, 12–36 months). Bone healing was achieved in 96% of cases. There were numerous postoperative complications (four cases of thromboembolism, fourteen immobility-related complications, two infections, six secondary displacement combined to loss of fixation, four non-unions, and nine malunions). At 2 years follow-up, 28 patients had died. Mortality was strongly correlated with older age (over 90 years), associated co-morbidity and fracture instability. Good functional outcomes (72%) correlated with younger age (60–74 years), fracture stability, adequate reduction and internal fixation.DiscussionIn stable trochanteric fractures, osteosynthesis by dynamic screw-plate is more effective than alternative techniques (blade-plate, nail-plate, Ender nail or even trochanteric nail). In unstable trochanteric fractures, delayed weight-bearing should be prefered to avoid mechanical complications. In fractures that are unstable or extend far below the lesser trochanter, trochanteric nailing is indicated since providing enhanced stability, but sometimes at the cost of insufficient reduction. The treatment objective should be the complete resumption of weight-bearing as early as possible with the fewest possible complications. Prevention consists in detecting and treating osteoporosis and countering the causes of falls in elderly subjects (muscular reinforcement and correction of neurosensory deficit).Level of evidenceLevel III: Prospective diagnostic study.