Guyve Lamraski

Lateral femoral condyle osteochondral fracture combined to patellar dislocation: A case report

The authors report the case of an osteochondral fracture involving the weight-bearing portion of the lateral femoral condyle in a 23-year-old sportsman. The defect was concomitant to a lateral patellar dislocation involving a rare injury mechanism. Fixation of the osteochondral fragment was performed with bioabsorbable pins and healing was achieved within an acceptable time. Clinical and radiographic outcome at one year is highly satisfactory and bioabsorbable implant fixation reveals to be a worthwhile option in such a case. This rare lesion is diagnostically challenging and requires an adapted and prompt treatment.

Unusual upward closed tibiotalar dislocation without fracture: A case report

Pure tibiotalar dislocations without associated fracture are rare. The authors report a case of an unusual closed tibiotalar dislocation without fracture, involving proximal ascension of the talus. Despite immediate closed reduction, a tibiofibular diastasis remained, therefore two syndesmosis screws were inserted, followed by six weeks of plaster casting. After 5 years of follow-up, functional results were excellent, MRI showed slight arthritic degenerative changes.

Intérêt des radiographies ostéo-articulaires comparatives en traumatologie de l'enfant

Resume Dans le contexte de traumatismes osteo-articulaires de l’enfant, la prescription de radiographies comparatives de routine est controversee. Afin de reevaluer l’interet de ces cliches, une serie retrospective de 203 cas de traumatismes chez des enfants de moins de quinze ans a ete analysee. A l’aide d’une fiche patient et de radiographies, deux assistants en debut de formation, deux assistants en fin de formation d’Orthopedie et deux radiologues pediatriques ont pose un diagnostic, qu’ils ont eventuellement adapte a la lumiere des incidences comparatives. Les chirurgiens ont du proposer une attitude therapeutique pour chaque diagnostic et les radiologues ont du juger la validite des radiographies comparatives. Cette etude revele que les radiographies comparatives ne sont fiables que dans 87,2 % des cas, et n’aident au diagnostic que dans 8,8 % des cas, sans pour autant influencer de maniere notable l’attitude therapeutique puisque celle-ci ne change que dans 3,3 % des cas. On constate egalement des differences statistiquement significatives en fonction des localisations, de l’âge et de l’experience du praticien. La realisation systematique de cliches comparatifs est a decourager. Seuls les traumatismes touchant le coude chez les grands enfants, peuvent justifier la prescription de radiographies comparatives.

Les lésions ligamentaires intracarpiennes associées aux fractures du poignet: Étude prospective radio-clinique sur 40 cas

PURPOSE OF THE STUDY We performed a prospective study to search for arthrographic signs in favor of intracarpal ligament lesions occurring concomitantly with wrist fractures. We looked for a relationship between type of fracture and displacement and examined their impact on early functional outcome. MATERIAL AND METHODS The series included 40 patients treated over a 1-year period. All 40 patients had a displaced wrist fracture requiring surgical treatment. A three-phase arthrography was performed during the initial operation in order to search for injuries involving the scapho-lunate, luno-pyramidal or triangular complex ligaments. A second arthrography was performed at the time the osteosynthesis material was removed. All patients were followed one year postperatively. Functional outcome was recorded at one year. RESULTS Abnormal images were found in 57% of the patients at the first arthrography. Injury to the triangular complex predominated, followed by combined injuries. There was no statistical correlation between type of fracture, degree of displacement, and presence of ligament lesions (p > 0.05). Lesions of the triangular fibrocartilaginous complex (TFCC) were significantly increased (p = 0.04) in the event of intra-articular fracture. Age and gender did not influence ligament injury. At one year, the functional outcome was statistically comparable between patients with and without ligament injury. At the second arthrography, we observed only five cases where cure of the luno-pyramidal ligament had been achieved. DISCUSSION Intracarpal ligament injuries associated with wrist fractures are frequent. Age had no effect on occurrence of ligament injury in our series, similar to findings reported by others. Likewise, the type of fracture had no effect. Data in the literature show that intra-articular fractures and highly-displaced fractures aggravate ligament injury. Our functional results at one year did not demonstrate any significant difference in patients with and without ligament injury. A 3 or 5-year follow-up might provide further insight. Nevertheless, neglected scapho-lunate lesions still have a bad reputation in the literature, leading us to search for such lesions and to provide adapted treatment in all patients aged less than 50 years presenting a displaced fracture of the wrist.Resume Cette etude prospective a eu pour buts de rechercher d’eventuelles lesions ligamentaires intracarpiennes contemporaines des fractures du poignet et susceptibles d’expliquer des resultats cliniques decevants, de rechercher des facteurs favorisants ces lesions et d’analyser leur impact sur les resultats fonctionnels. Sur une periode de un an, 40 patients presentant une fracture deplacee de l’extremite distale du poignet, necessitant un traitement chirurgical, ont fait l’objet d’un bilan arthrographique a la recherche de lesions ligamentaires intracarpiennes. Une premiere arthrographie de poignet a ete effectuee lors de la synthese de la fracture. Apres obtention d’une consolidation osseuse, l’ablation du materiel d’osteosynthese a ete accompagnee d’une seconde arthrographie. Tous les patients ont ensuite ete revus avec un recul minimum de 1 an afin d’apprecier le resultat fonctionnel. Des images arthrographiques anormales ont ete observees dans 57 % des cas. La survenue de ces lesions n’a ete influencee ni par le type de fracture, ni par l’importance du deplacement. Les resultats fonctionnels precoces n’ont pas ete alteres par ces lesions. Enfin, seules les atteintes du ligament luno-pyramidal semblent avoir un pouvoir de guerison en cas d’immobilisation.