[Six pitfalls around the ankle sprains]. / Entorses de cheville : six pièges à connaître.

Ankle sprains are frequently encountered. They result most of the time in lesions of the lateral ligament complex. Nevertheless, in the context of an ankle sprains, more severe injuries including fracture of the lateral process of the talus, fracture of the base of the 5th metatarsal, tear of the medial ligament complex, lesion of the syndesmosis, sprain of the Chopart joint, and peroneal tendons luxation are potentially overlooked and, if treated inadequately, may be associated with poor functional outcome. The goal of the present paper is to make the emergency practitioner aware of these potential lesions, and to help him making the correct diagnosis in order to initiate the adequate treatment.

Les entorses de cheville sont un motif de consultation très fréquent. Dans la plupart des cas, elles se limitent à des lésions de l'appareil ligamentaire externe. Toutefois, elles peuvent masquer des lésions plus graves incluant les fractures du processus latéral du talus, de la base du 5e métatarsien, les lésions ligamentaires internes, de la syndesmose, les entorses du Chopart et la luxation des tendons fibulaires. Il n'est pas toujours facile de poser le bon diagnostic en urgence et une prise en charge initiale insuffisante de ces lésions peut hypothéquer significativement le pronostic fonctionnel. Le but de cet article est de rendre le praticien de premier recours attentif à ces lésions potentielles et de l'aider à poser le bon diagnostic en vue d'un traitement initial adéquat.

Image-guided percutaneous cryoablation of unresectable sacrococcygeal chordoma: Feasibility and outcome in a selected group of patients with long term follow-up.

BACKGROUND: Chordoma is a rare malignant tumor of the axial skeleton. Percutaneous cryoablation (PCA) is a minimally invasive technique that allows freezing of tumors under imaging control. The purpose of our retrospective study was to investigate the outcome of PCA in a selected cohort of patients with sacrococcygeal chordoma, with a minimum of 5 years follow-up. MATERIALS AND METHODS: Four patients were treated in 10 sessions. The mean follow-up was 57.3 months. We evaluated the feasibility, the procedure-related complications, the impact on pain control and oncological outcomes. RESULTS: Freezing of 100% of the tumor volume was possible in 60%. Pain control was not reliably evaluable. Local recurrence occurred in 90% of the treated lesions; the mean time to progression was 8.1 months (range 1.5-16). At last follow-up, one patient had died of the disease, one of another cause and one was receiving the best supportive care. The only patient alive without the disease had received additional carbon-ion radiotherapy. The 5-year survival rate after index PCA was 50%. CONCLUSION: Complete freezing of the tumor was technically challenging, mainly due to the complex local anatomy. Recurrence occurred in 90% of the lesions treated. PCA should be considered with caution in the curative management of sacrococcygeal chordoma.

[Enhanced recovery after prosthetic surgery]. / Réhabilitation améliorée après chirurgie prothétique.

The enhanced recovery after surgery (ERAS) is a proven concept in many surgical disciplines since the early 2000s. Studies agree benefit in prosthetic surgery and it has been shown to lead to improved practices and results permitting a faster discharge to home with lesser morbidity and mortality. It implies a cohesion in the message delivery and the general practitioner plays a central role. The collection and analysis of the data is fundamental to continuously improve the protocol and thus the care of patients. These protocols are a step towards outpatient management in this kind of surgery.

La réhabilitation améliorée après chirurgie est un concept qui a déjà fait ses preuves dans de nombreuses disciplines chirurgicales depuis le début des années 2000. Les études s'accordent sur son intérêt en chirurgie prothétique et il a été prouvé qu'elle entraîne une amélioration des pratiques et des résultats permettant un retour à domicile plus rapide, avec une diminution de la morbidité et mortalité. Elle implique une cohésion dans la délivrance du message et le médecin généraliste garde une place centrale. Le recueil et l'analyse des résultats sont fondamentaux pour améliorer continuellement le protocole et ainsi la prise en charge des patients. Ces protocoles sont une étape vers la prise en charge ambulatoire de ce type de chirurgie.

Traumatic abdominal wall hernias: disruptions of the abdominal wall muscles associated to pelvic bone fractures illustrated by two case reports.

BACKGROUND: Blunt abdominal traumas are often associated with intra-abdominal injuries and pelvic fractures. Traumatic abdominal wall hernias due to disruption of the abdominal wall muscles may be overlooked. Delayed diagnosis can lead to hernia related complications. CASE PRESENTATION: We present two cases of high kinetic trauma with pelvic fractures and acute traumatic abdominal wall herniation. Both of these cases suffered from a delayed diagnosis and needed surgery to treat the symptomatic herniation. CONCLUSION: Clinical reassessment and appropriate medical imaging are mandatory in patients with high kinetic abdominal blunt traumas and associated pelvic fracture, in order to prevent delayed diagnosis and possible complications.