[Ankle and foot sprains: conventional radiography aspects]. / Aspects radiographiques des lésions ostéo-articulaires et ligamentaires des entorses de pied et de cheville.

Emergency departments frequently encounter pathology resulting from injury to the foot and ankle, with approximately 6000 case per day in France. In an ankle sprain, 85% of the lesions involve the lateral collateral ligament. Many other, much rarer, types of lesion with different therapeutic consequences can present, however. Interpretation of the initial conventional radiographs is vital to establishing the type lesion and to proposing adapted and rapid treatment. The objective of this article is to review the various osteoarticular and ligament injuries encountered in the foot and the ankle.

[Ankle instability with involvement of the subtalar joint demonstrated by MRI. Results with the Castaing procedure in 45 cases]. / Instabilité de cheville avec lésion de l'articulation sous-talienne démontrée par l'IRM. Résultats de l'intervention de Castaing dans une série de 46 cas.

The authors report 46 cases of instability of the hindfoot involving the subtalar joint, with or without combined involvement of the tibiotalar ligaments, which were treated using Castaing's technique of ligament plasty between 1988 and 1999. Preoperatively, the patients complained of instability, recurrent sprains and pain. A tarsal sinus syndrome was present in 39%. Forty six patients underwent NMR examination which demonstrated capsuloligamentous lesions in every case. The results were evaluated using Kitaoka's score. With an average follow-up of 5.7 years after operation, instability was no more present in 80% and 63% were painfree. Clinical examination showed a reduction in the range of inversion of the hindfoot in 43%, with values between 50 and 70% of the contralateral foot, but without any significant clinical repercussion. Incipient osteoarthritis was noted on xrays in three patients. The overall results were very good in 82%, fair in 11% and poor in 7%. Eighty seven percent of the patients were satisfied with the result of the operation. The authors found a significant correlation between fair or poor results and a body mass index above 26 kg/m2 or constitutional laxity. Besides, results got worse as the time interval between the first sprain and the operative treatment increased. Comparison of these results with those of other techniques shows that they are essentially similar. Ligament plasty using Castaing's technique is a reliable operation but direct repair of ruptured ligaments at the subtalar joint should be preferred for primary treatment, leaving the possibility for secondary ligament plasty if necessary.

[Complete transverse fractures of the talus: value of magnetic resonance imaging for detection of avascular necrosis]. / Fractures transversales complètes du talus: intérêt de l'IRM pour la détection des nécroses ischémiques.

The authors report a series of 32 complete transverse fractures of the neck or body of the talus. The fractures occurred mostly in young males, as a result of motor vehicle accidents. The fracture line was transverse in the neck or body of the talus in 20 cases, sagittal in four and comminuted in eight cases. Using Hawkins' classification, there were 10 type I, 16 type II, and 6 type III fractures. The treatment was conservative in 8 cases and surgical in 24. The patients were evaluated clinically and radiologically with an average follow-up of 7 years. All patients underwent radiological study at follow-up and 17 underwent NMR evaluation. Eleven underwent NMR evaluation at final follow-up, and the other 6 early in their postoperative evolution. The postoperative results were evaluated based upon clinical and radiological criteria. The clinical result was good or very good in 37.5% of cases. Segmental necrosis of the talar body was noted in 6 cases and complete necrosis in 5, which required arthrodesis in 8 cases. Avascular necrosis is a common complication. Its frequency depends on the type and displacement of the fracture. If it becomes symptomatic, the only treatment is tibiotalar or tibiotalocalcaneal arthrodesis. The contribution of NMR is very important, as it gives the positive diagnosis as well as information regarding evolution. Complete transverse fractures of the talar neck or body are rare; their treatment only gives a little over one third good and very good results in the long term. NMR gives the diagnosis early and shows the extent of necrosis. It can have predictive value for the collapse risk and guide reeducation with or without weight bearing.

[Comparison between scintigraphy, B-mode, and power Doppler sonography in acute pyelonephritis in children]. / Imagerie comparative entre techniques scintigraphique et echographiques en mode B et Doppler energie dans la pyelonéphrite aigüe de l'enfant.

PURPOSE: Comparing Power Doppler imaging versus technetium-dimercapto-succinic-acid (Tc-DMSA) scintigraphy in acute pyelonephritis of childhood. INCLUSION CRITERIA: First episode of urinary tract infection, clinical and biological findings suggesting an upper lesion, absence of urological malformation or obstruction, absence of reflux (or vesico-ureteral reflux inferior to grade 3). Number of patients: 49, length of the study: 26 months (from November 95 to January 98). METHODS: Tc99m-DMSA scintigraphy (after five days), B mode and Power Doppler imaging (on the day of admission or the following day). Systematic cystography (day 5 to day 30). RESULTS: In terms of positive diagnosis, scintigraphy was superior to Power Doppler, and the latter was superior to B mode ultrasonography. Sensitivity (scintigraphy being the gold standard) was equal for both B mode and Power DopplerUS imaging, but combined Power Doppler and B mode US provided improved results. CONCLUSION: Currently, the results with Power Doppler imaging are insufficient to replace DMSA scintigraphy. However, Power Doppler is a good complement to B mode US.

[Aponeurotomy and degenerative lesions of the plantar aponeurosis. Contribution of magnetic imaging]. / Aponévrotomie et lésions dégénératives de l'aponévrose plantaire. Apport de l'imagerie par résonance magnétique.

PURPOSE OF THE STUDY: Talalgia are frequent. Their etiologies are various and diagnosis is sometimes difficult. MATERIAL: From 1980 to 1993, 12 cases of degenerative lesions of plantar aponeurosis were treated surgically. M.R.I. revealed 6 chronic aponeurositis and 6 old tears. The treatment was an aponeurectomy with resection of calcaneal spine after a conservative treatment for several months. The histological examination found inflammation in all cases (aponeurositis or rupture), a calcification of aponeurosis, a cartilaginous metaplasia and fibromatosis. METHODS: Patients were evaluated at a minimum of 2 years follow-up and a maximum of 6 years. The post-operative results were estimated using 3 criteria: pain disappearance, results on the foot static, patients functional activity. RESULTS: Global score was : 9 very good and good results, one fair result and 2 bad results. The M.R.I. realized at the time of revision revealed a good healing of plantar aponeurosis in 5 cases, defect in 1 case, inflammation in 3 cases and defect associated with inflammation in 3 cases. DISCUSSION: Surgical treatment can be suggested in failures of talalgia conservative treatment. Degenerative injuries of plantar aponeurosis, as rupture or aponeurositis may take advantage of an aponeurectomy. Short term results show pain disappearance in 75 per cent of cases without modification of the plantar arch. CONCLUSION: M.R.I. allows to explain exactly the origin of talalgia. After a failure of conservative treatment, some talalgia may take advantage of an aponeurectomy.