[How I explore... protrusio acetabuli in children]. / Comment j'explore le protrusio acetabuli chez l'enfant.

Protrusio acetabuli is a clinical entity with variable clinical presentation consisting of a medial deviation of the acetabulum in the pelvic direction. Qualified as a silent deformity in view of its asymptomatic nature until the onset of early degenerative changes, the patient will present with progressive joint pain and stiffness until the development of secondary osteoarthritis. In view of the potentially destructive primary causes associated with the development of secondary protrusion acetabuli, the radiological demonstration of this pathology in young patients cannot be neglected and should lead to the investigation of the underlying pathologies associated with this anomaly. This entity must generate regular clinical and radiological monitoring, and potentially multidisciplinary approach in the event of the appearance of diagnostic criteria for Marfan syndrome, which may vary over time and across individuals.

Le protrusio acetabuli (PA) est une entité clinique à présentation clinique variable consistant en une déviation médiale de l'acétabulum en direction pelvienne. Qualifiée de déformation silencieuse au vu de son caractère asymptomatique jusqu'à la survenue de modifications dégénératives précoces, le patient présentera une douleur et raideur articulaire progressivement évolutive jusqu'au développement d'une coxarthrose secondaire. Au vu des causes primaires potentiellement destructrices associées au développement d'un PA secondaire, la mise en évidence radiologique de cette pathologie chez le patient jeune ne peut être négligée et doit faire rechercher les pathologies sous-jacentes associées à cette anomalie. Cette entité doit également engendrer un suivi clinique et radiologique régulier, et potentiellement multidisciplinaire en cas d'apparition de critères de diagnostic du syndrome de Marfan, variables en fonction du temps et des individus.

[Osteoarticular tuberculosis nosology and diagnostic pitfalls]. / Tuberculose ostéoarticulaire : nosologie et pièges diagnostiques.

Osteoarticular or skeletal tuberculosis is a clinical manifestation of extrapulmonary tuberculosis, occurring during the lympho-hematogenous spread of Mycobacterium tuberculosis from a pulmonary primary infection or reactivation of latent infection, years or even decades after the initial infection. Bone and joint tuberculosis is a rare disease with non-specific symptoms and radiological characteristics, often delaying diagnosis for more than a year after clinical onset. First-line hospital departments should develop a clinical suspicion when confronted with a subacute inflammatory bone or joint pathology in patients with underlying comorbidities, especially when coming from tuberculosis-endemic countries. We report a clinical case characterized by lumbar and pelvic abscesses, before addressing in detail the different types of skeletal involvement related to tuberculosis, through a review of the literature.

La tuberculose ostéoarticulaire ou osseuse est une manifestation clinique de la tuberculose extra-pulmonaire, apparaissant lors de la dissémination lympho-hématogène de Mycobacterium tuberculosis à la suite d'une infection pulmonaire primaire ou la réactivation d'une infection latente, des années, voire des décennies après une primo-infection. Il s'agit d'une maladie rare dont les symptômes ainsi que les signes radiologiques sont non spécifiques, ce qui retarde souvent le diagnostic de plus d'un an après les premiers signes cliniques. Les services hospitaliers de première ligne doivent suspecter le diagnostic en cas de pathologie inflammatoire subaiguë des os ou des articulations chez des patients avec comorbidités, surtout s'ils sont originaires de régions endémiques pour la tuberculose. Nous rapporterons un cas clinique caractérisé par des abcès lombaires et pelviens avant d'aborder en détail les différents types d'atteintes squelettiques de la tuberculose au travers d'une revue de la littérature.

[Management of chronic osteomyelitis by long-term antibiotic suppression]. / Prise en charge de l'ostéomyélite chronique par antibiothérapie suppressive au long cours.

Chronic osteomyelitis is a chronic inflammatory disease induced by bone infection. It may be limited to a single portion of bone or involve several areas such as marrow, cortical, periosteum and adjacent soft tissues. Being able to persist for weeks, months or even years, it remains a therapeutic challenge in spite of the important medical and surgical advances, with a prolonged and complex management given the nature of the surgical interventions and the antibiotherapies required. We report a case of chronic osteomyelitis treated by long-term suppressive antibiotic therapy, which may be a reasonable alternative to surgery in inoperable clinical situations, but taking into account the risks associated with it in terms of side effects and selection of resistant organisms, as well as the cost of treatment and the quality of life of the patient.

L'ostéomyélite chronique est une pathologie inflammatoire chronique induite par une infection osseuse. Elle peut être limitée à une seule portion d'os ou impliquer plusieurs zones telles que la moelle, la corticale, le périoste et les tissus mous adjacents. Pouvant persister pendant des semaines, des mois voire des années, elle reste un challenge thérapeutique en dépit des importantes avancées médicales et chirurgicales, avec une prise en charge prolongée et complexe compte tenu de la nature des interventions chirurgicales et des antibiothérapies requises. Nous rapportons un cas d'ostéomyélite chronique pris en charge par antibiothérapie suppressive au long cours, qui peut être une alternative raisonnable à la chirurgie dans des situations cliniques inopérables, mais en prenant en considération les risques qui y sont associés en termes d'effets secondaires et de sélection des germes résistants, ainsi que le coût du traitement et la qualité de vie du patient.

Maternal and perinatal outcomes associated with a trial of labour after previous caesarean section in sub-Saharan countries.

OBJECTIVE: To assess the risks of uterine rupture, maternal and perinatal outcomes associated with a trial of labour (TOL) after one previous caesarean were compared with having an elective repeated caesarean section (ERCS) without labour in low-resource settings. DESIGN: A prospective 4-year observational study. SETTING: Senegal and Mali. SAMPLE: A cohort of 9712 women with one previous caesarean delivery. METHODS: Maternal and perinatal outcomes were compared between 8083 women who underwent a TOL and 1629 women who had an ERCS. Perinatal and maternal outcomes were then stratified according to the presence or absence of risk factors associated with vaginal birth after caesarean section. These outcomes were adjusted on maternal, perinatal and institutional characteristics. MAIN OUTCOME MEASURES: The risks of uterine rupture, maternal complication and perinatal mortality associated with TOL after one previous caesarean as compared with ERCS, RESULTS: The risks of hospital-based maternal complication [adjusted odds ratio (OR) 1.52; 95% CI 1.09-2.13; P = 0.013] and perinatal mortality (adjusted OR 4.53; 95% CI 2.30-9.92; P < 0.001) were significantly higher in women with a TOL compared with women who had an ERCS. However, when restricted to low-risk women, these differences were not significant (adjusted OR 0.90, 95% CI 0.55-1.46, P = 0.68, and adjusted OR 1.13; 95% CI 0.75-1.86; P = 0.53, for each outcome, respectively). Uterine rupture occurred in 25 (0.64%) of 3885 low-risk women compared with 70 (1.66%) of 4198 women with unfavourable risk factors. CONCLUSION: Low-risk women have no increased risk of maternal complications or perinatal mortality compared with women with one or more unfavourable factors. TWEETABLE ABSTRACT: Low-risk women have a lower risk of maternal complications or perinatal mortality compared with high-risk women.