[Sprained ankle in children]. / L'entorse de cheville de l'enfant.

OBJECTIVE: To review the literature on sprained ankle in children. We can describe our clinical experience but not statistical analysis because of the few cases. MATERIALS AND METHODS: We searched MedLine with sprain, ankle, children, talo-fibular ligament, ligament injury as key words. RESULTS: We found few and no results from a prospective or randomized trial. We analyzed three surgical publications: Vahvanen (1983, 1984), and Chaumien (1986). Vahvanen's studies concerned 50 ankles treated nonoperatively and 40 treated operatively, and Chaumien described 19 patients. Vahvanen's results suggest that sprained ankle is surprisingly common in children and that primary repair of the ligament will resolve symptoms and lead to a stable ankle joint. Chaumien's description revealed severe lesions defined by radiographic criteria. Sixteen of the 18 patients who underwent surgery healed without any complications. The surgical repair of acute ankle sprain in children has generated much controversy. CONCLUSION: Ankle sprain is a common injury in children and probably underestimated. Clinical evaluation and pain on pressure at the anterior talo-fibular ligament are used in diagnosis. Radiographic studies are necessary to eliminate fractures or an avulsion fragment. Ultrasound can be helpful. Most practitioners and orthopedic surgeons prefer to treat ankle sprains in children nonoperatively.

[Clinical evaluation of knee trauma]. / Approche clinique d'un traumatisme du genou.

Clinical evaluation is of preponderant importance in the management of knee trauma. This evaluation is based on a systematic examination that should be well known to any practitioner treating such patients. During recent years, the symptomatology of knee trauma has required a large number of manipulations and clinical tests that can better identify the location and nature of anatomic lesions and specify their severity. The most important of these clinical signs and their pathological significance are presented in this study. Analysis of the symptoms, with grouping and concordance of the different tests, classifies the knee as having suffered "ligament", "patella", "meniscal" or other injury. Despite its limitations and sometimes too schematic nature, this classifications is highly informative and in most cases should be an indispensible step before prescribing radiology.

[Tendinitis and tenosynovitis of the wrist]. / Les tendinites et ténosynovites du poignet.

Tendinitis and tenosynovitis of the wrist are often encountered in daily medical practice. This frequency is due to the long course of the tendons over the wrist, to the role played by these tendons in the mobilization and stabilization of that joint and to overuse of the hand in daily life as well as in professional and sporting activities. In their common form tendinitis and tenosynovitis are benign and episodic diseases which may present under two aspects: straightforward tenosynovitis with exsudation, crepitus, stenosis or adhesion, and tendinitis at the sites of attachment. In certain cases the condition is specific and of infectious or inflammatory origin. The diagnosis is based on questioning and on the demonstration, during examination, of a symptomatic triad characterized by resurgence of pain at palpation, inducement of passive tension of the tendon, and resisted muscular contraction. Treatment is based on local injections of corticosteroids and rest. Surgery is seldom indicated.

[Paralysis of the suprascapular nerve and tennis. Apropos of 3 groups of professional players]. / Paralysie du nerf sus-scapulaire et tennis. A propos de trois groupes de joueurs professionnels.

A recent surge of interest for tennis has given rise to an increased incidence of injuries to the N. suprascapularis. The early symptoms of this pathology are often missed, leading subsequently to a chronic condition, including an irreversible trauma to the nerve. Nevertheless, through the study of three groups of professional tournament players, we were able to show that the neurological injury is reversible if the diagnosis is established early on and if the hurting movement is avoided until full recovery. A backhand stroke done with both arms seems to have a protective effect against this pathology.

[Achilles tendinitis]. / La tendinite d'Achille.

Achilles tendinitis is particularly frequent in athletes. In fact, this entity is made up of various anatomical lesions located in Achilles tendon or at the point where it is attached to the calcaneum. The diagnosis is basically clinical, and it is confirmed by carefully selected paraclinical examinations. Management essentially relies on rest associated with adequate physiotherapy and, when required, with other adjuvant treatments. Management also rests on the prevention of recurrences and on the suppression of the frequently found sport-related causal agent. Surgical treatment is seldom indicated, and only when medical treatment has failed, usually in high-level athletes.

[Osteochondral lesions of the dome of the talus with partial necrosis. Surgical treatment by curettage and filling]. / Les lésions ostéochondrales du dôme astragalien avec nécrose partielle. Leur traitement chirurgical par curetage et comblement.

There are several types of lesions of the talus, including non united fractures and true osteochondritis in adolescents. This article focuses on lesions of the dome of the talus having a large subchondral necrotic zone. The etiology of these lesions is unclear. Even when they result from trauma, this may not be the sole cause. Thirty-three similar cases were studied, allowing analysis of the radiological appearance and the value of arthro scanner data. All the cases were treated by surgery (and were subsequently classified histologically). The necrosis was treated by curettage and filling with cancellous bone grafts taken from the lower tibial epiphysis. Twenty-seven patients were followed up at least one year (average 3 years 3 months). The outcome was functionally good or very good in twenty-two cases. The anatomical reconstruction was scored by radiology as very good in nineteen patients and satisfactory in five, who had irregularities and non-homogenous appearance of the talar dome. These results justify the use of curettage and filling. Arthroscopic techniques, although appropriate for simple ablations of osteochondral fragments, do not appear to be satisfactory for treating lesions including subchondral necrosis. Filling can only be performed surgically.

[Surgical treatment of Achilles tendinitis in athletes]. / Traitement chirurgical des tendinites d'Achille chez le sportif.

A study of 65 cases of Achilles tendinitis treated surgically has allowed us to define the specific symptomatology of the lesion which particularly affects young athletes. Surgical treatment should only be given for high-level athletes who are well-motivated and in whom tendinitis prevents their sporting activity and has proved resistant to prolonged and adequate medical treatment. The details of the suggested operative technique are described. A review of the results shows that, after unsuccessful medical treatment, surgical treatment allowed the athlete to return to his sporting activity in 86 per cent of cases. Post-operative cutaneous or tendinous complications were rare and were directly linked to intra-tendinous injections with steroids.

[Ruptures of the Achilles tendon. Comparison of the results of surgical and nonsurgical treatment]. / Les ruptures du tendon d'Achille. Comparaison des résultats du traitement opératoire et non opératoire.

The authors have compared the results obtained in 76 cases of rupture of the tendo Achillis treated conservatively with a previously published series of cases treated surgically. The same assessment of the results was used. The main complication of surgical treatment was skin necrosis; the main complication of conservative treatment was recurrent rupture. To objective assessment, the loss of strength in the triceps surae was about 20 p. 100 in both series. Subjectively, the conservatively-treated patients seemed more satisfied. These findings support the conclusions of other published comparative studies that conservative treatment is worthwhile since it avoids general anaesthesia and hospital treatment. It is indicated when the conditions are favourable. Surgical treatment should be used in young athletes because healing is quicker in cases of recurrent rupture or old ruptures.