[Stress fracture of the distal femoral growth plate in a young belgian table tennis champion]. / Fracture de fatigue du cartilage de croissance fémoral distal chez un jeune champion belge de tennis de table.

We report a rare type of stress fracture in a young athlete, great hope of belgian table tennis. Although this type of fracture is not rare in the broad sense of the term, a stress fracture located at the distal femoral physeal is exceptional. Such a complication must be quickly detected because of growth disorders and impact on sports performances that this may cause. On the basis of an anamnesis and detailed clinical observations, we describe the physiopathology as well as the diagnostic and therapeutic management of this pathology.

Nous présentons un type rare de fracture de fatigue chez un jeune sportif, grand espoir du tennis de table belge. Bien que ce type de fracture ne soit pas rare au sens large du terme, une fracture de fatigue située au niveau du cartilage de croissance fémoral distal est exceptionnelle. Cette complication doit être rapidement détectée vu les troubles de croissance et l'impact sur les performances sportives que cela peut engendrer. A partir d'une anamnèse et d'observations cliniques minutieuses, nous décrivons la physiopathologie ainsi que la prise en charge diagnostique et thérapeutique de cette pathologie.

[Platelet-rich plasma (PRP) and disc lesions: A review of the literature]. / Plasma riche en plaquettes (PRP) et lésions discales : revue de la littérature.

The spine has been the subject of extensive clinical research since it is the source of many painful complaints. However, there is little scientific evidence concerning the therapeutic proposals. During the course of life, the intervertebral disc degenerates, which over time diminishes its damping capacity and facilitates the expulsion of the nucleus pulposus through the annulus fibrosus. The degeneration of the intervertebral disc (DDI) is the origin of some back pain and various specific treatments have been developed. These include the infiltration at the center of the intervertebral disc of plasma rich platelet (PRP), composed of multiple growth factors which act on the disc degeneration. This treatment is recent and less invasive than surgery. Preliminary results seem promising. However, many gray areas and several parameters remained to be clarified. In an attempt to do this, a literature review was conducted based on bibliographic databases Pubmed, Medline and Scopus® using the following Mesh terms : PRP, platelet-rich plasma, intradiscal disc degeneration, disc, intradiscal, discogenic. This analysis reveals that at the present time, no reported study has a sufficient perspective to judge the effectiveness of the infiltration of PRP. Early harvest results will be used to set the limits of this treatment. Accordingly, it is therefore currently recommended to introduce PRP injection as a complementary solution to comprehensive care of the spine. Future research will need to generate randomized controlled studies including comparing the results with conservative treatment and measure the cost-benefit relationship.

Influenza vaccination coverage in elderly people, Campania (Italy), 1999.

A study on the coverage of influenza vaccination among elderly people was carried out. Fity-six per cent of those interviewed had been vaccinated (weighted coverage 50%), compared with the target of 75%, but higher rates were reported in those older than 74 years and those with chronic diseases.

Imaging overuse injury of the elbow in professional team handball players: a bilateral comparison using plain films, stress radiography, ultrasound, and magnetic resonance imaging.

The purpose of this study was to compare the manifestations of elbow stress due to repetitive valgus forces between the dominant and the non-dominant elbow in 40 uninjured elite team handball players using plain films, stress radiographs, ultrasound, and MRI examination. On comparative plain films generalized bony hypertrophy manifested by increased humeral diameter, and cortical hypertrophy of the humeral shaft of the dominant extremity was observed in all players. A significantly greater difference in medial joint space opening between stressed and unstressed elbows was measured in the dominant elbow compared with the non-dominant elbow (0.41 +/- 0.59 mm). The ultrasonographic findings showed statistically significant bilateral differences in the thickness of the flexor-pronator tendon (0.90 +/- 0.56 mm), extensor tendon (0.96 +/- 0.50 mm), triceps tendon (0.69 +/- 0.27 mm), and medial collateral ligament (0.47 +/- 0.24 mm): the values were systematically higher on the dominant side. US examination showed intra-articular effusions in 67% and small loose bodies in 33.3% of the players, exclusively in dominant elbows. MRI showed joint effusion in the same subjects as US, but loose bodies were only detected in half of the cases found by ultrasound. This study demonstrates that repetitive stress on the dominant extremities of handball players is responsible for physiologic and pathologic changes in the dominant elbow.

Modifications of the elbow induced by the practice of handball on radiography, US and MRI.

The objective of this study was to evaluate plain radiographs, US and MRI in detection of occult lesions of the elbow in asymptomatic handball players. Comparative plain films of both elbows were obtained in an anteroposterior and lateral projection. A bilateral comparative ultrasound examination was performed with measurement of the thickness of the flexor and extensor tendons, the triceps tendon, the lateral collateral ligament and the anterior bundle of the medial collateral ligament (MCL). Echogenicity of these structures was evaluated. Articular recesses were scanned for fluid and loose bodies. Axial and coronal MRI of the dominant elbow was performed using a T1W sequence after intravenous injection of gadolinium 30 minutes before the examination and by a FISP 3D T2W echo gradient sequence in coronal plane and reconstruction in a sagittal plane. Twenty-eight male asymptomatic members of the national handball team with 7 to 25 years of experience and undergoing 3 to 4 training sessions per week were studied. Paraphysiological modifications such as hypertrophy of bone and muscles were evidenced. Flexion deformity of the elbow was present even in the youngest players, but valgus deformity occurred preferentially in the more experienced players. US was more efficient in detection of small loose bodies and gave more precise information on the structure of the MCL and the tendons compared with MRI. Plain film and US were sufficient for the detection of chronic lesions of the elbow. MRI did not add significant findings.

Evaluation of patellar cartilage surface lesions: comparison of CT arthrography and fat-suppressed FLASH 3D MR imaging.

The aim of this study was to evaluate the sensitivity and specificity of fat-suppressed fast low-angle shot (FLASH) 3D MR imaging in the detection of patellar cartilage surface lesions in comparison with CT arthrography. Fifty patients, with or without symptoms of chondromalacia, were prospectively examined by CT arthrography and fat-suppressed 3D gradient-echo MR imaging. All MR examinations were evaluated by three observers, two of them reaching a consensus interpretation. The lesions were graded according to their morphology and their extent. The CT arthrography was considered as the reference examination. For both sets of observers, the final diagnosis of chondromalacia was obtained in 92.5 %. The specificity was 60 % on a patient-by-patient basis. Fissures were missed in 83 and 60 %, respectively, but were isolated findings only in 2.5 % of the cases. Considering ulcers involving more than 50 % of the cartilage thickness, 65 and 88 %, respectively, were recognized. Fat-suppressed FLASH 3D is an adequate pulse sequence for the detection of patellar cartilage ulcers. It can be applied on a routine clinical basis, but it does not show as many fissures as CT arthrography and is less precise for grading of lesions.

Ultrasound of the elbow.

Ultrasound examination of the elbow should be performed in a comparative way, exploring joint spaces and fossas. Ultrasound is the method of choice for the detection of joint fluid and loose bodies. Tendinitis and microfissures can be demonstrated in case of tennis and golfer elbow. On the posterior aspect of the elbow, ultrasound shows the different types of bursitis, and allows evaluation of the ulnar nerve in cases of impingement.

Ultrasound examination of the wrist.

Ultrasonography of the wrist requires knowledge of the normal anatomy and dedicated ultrasound equipment. The patient's complaints orientate the examination. Real time dynamic examination provides essential information. In tendon pathology, ultrasound demonstrates better than MRI partial rupture, different types of synovitis and nodular deposits such as tophi, amyloid or pannus. In opposition to ganglion cysts, a joint communication is seen in arthrosynovial cysts. In carpal tunnel syndrome, the surface of the median nerve exceeds 15 sqmm. Ultrasound can demonstrate in specific cases traumatic lesions of bony surfaces or lesions of the triangular fibro-cartilage.