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Resume Les auteurs proposent le transfert retrograde du tendon distal du peroneus longus (PL) sur le tendon tibial anterieur (TA) afin de traiter le pied varus equin spastique de l’adulte. Leurs insertions tendineuses distales en miroir en font des antagonistes. L’objectif est de derouter en avant le tendon distal du PL, inactif, en l’amarrant au TA au tiers moyen de jambe, le transformant en flechisseur dorsal et renforcant son effet everseur. Le niveau de la suture permet d’eviter les conflits cutanes lors du chaussage, ainsi que les complications inherentes aux fixations transosseuses. Une serie preliminaire de 10 patients au recul moyen de 4,7 ans ne montre aucune complication. Le Foot posture index-6 a ete ameliore de 2,4 points en moyenne. Quatre patients ont recupere une flexion dorsale active. Tous ont diminue leur appareillage et le Goal attainment scaling montrait une amelioration chez tous les patients.

We describe a retrograde transfer of the distal tendon of the peroneus longus (PL) onto the tibialis anterior (TA) tendon to treat spastic equinovarus foot (SEVF) in adults. The fact that the distal tendon insertions of the PL and TA are a mirror image makes them antagonists. The aim is to divert the distal tendon in front the inactive distal PL tendon, by fixing to the TA in the middle third of the lower leg. This transforms it into a dorsiflexor and reinforces its eversion ability. The suture level helps to avoid skin impingement when wearing shoes, and the complications inherent to transosseous fixation. In a preliminary case series of 10 patients, we found no complications at a mean follow-up of 4.7 years. The Foot Posture Index-6 improved by an average of 2.4 points. Four patients had regained active dorsiflexion. All patients reduced their use of orthotics. All patients improved according to Goal Attainment Scaling.

Introduction HTLV-I associated tropical spastic paraparesis (TSP) and HTLV-I associated myelopathy (HAM) is an endemic disease in Caribbean Island. Bladder-sphincter dysfunctions are almost present. The objectives of the study are to describe clinic and urodynamic characteristics of voiding disorders in Martiniquan population, evaluate if there is a relationship between motor and urinary handicap, and evaluate prognosis factors of urologic complications. Methods Retrospective study of 60 patients suffering from HAM/TSP. Clinical, urodynamic datas, scale of urinary and motor handicap (Urinary Symptom Profile [USP] questionnaire and Osame Score) were collected. Results Storage symptoms were the most frequent (75%) whatever type of detrusor activity. Detrusor overactivity was the most frequent disorder (68.3%). Bladder compliance was normal in half percent of the cases. Urethral activity was increased in 47% of the cases. Detrusor sphincter dysynergia was found in 78% of the cases, post-void residual in 58% of cases. Sixty five percent of the patients present at least one urologic complication (morphologic and/or infectious) but there was no correlation with motor enablement (P = 0.3097), neither urodynamic study (P = 0.432 for detrusor overactivity, P = 0.107 for detrusor underactivity, P = 0.058 for high urethral activity, P = 0.893 for detrusor sphincter dysynergia, P = 0.850 for post-void residual volume), neither with evolution duration of HAM/TSP (P = 0.348). USP score was not in correlation with Osame score (P = 0.07). Conclusion Urologic symptoms are not always in relationship with urodynamic study: a systematic urodynamic study is necessary to evaluate HAM/TSP neurogenic bladder. No clinic or urodynamic criterias are predictive of urologic complications. These patients need a close follow up. Neurourol. Urodynam. 9999:XX–XX, 2016. © 2016 Wiley Periodicals, Inc.

HTLV-I associated tropical spastic paraparesis (TSP) and HTLV-I associated myelopathy (HAM) is an endemic disease in Caribbean Island. Bladder-sphincter dysfunctions are almost present. The objectives of the study are to describe clinic and urodynamic characteristics of voiding disorders in Martiniquan population, evaluate if there is a relationship between motor and urinary handicap, and evaluate prognosis factors of urologic complications.Retrospective study of 60 patients suffering from HAM/TSP. Clinical, urodynamic datas, scale of urinary and motor handicap (Urinary Symptom Profile [USP] questionnaire and Osame Score) were collected.Storage symptoms were the most frequent (75%) whatever type of detrusor activity. Detrusor overactivity was the most frequent disorder (68.3%). Bladder compliance was normal in half percent of the cases. Urethral activity was increased in 47% of the cases. Detrusor sphincter dysynergia was found in 78% of the cases, post-void residual in 58% of cases. Sixty five percent of the patients present at least one urologic complication (morphologic and/or infectious) but there was no correlation with motor enablement (P = 0.3097), neither urodynamic study (P = 0.432 for detrusor overactivity, P = 0.107 for detrusor underactivity, P = 0.058 for high urethral activity, P = 0.893 for detrusor sphincter dysynergia, P = 0.850 for post-void residual volume), neither with evolution duration of HAM/TSP (P = 0.348). USP score was not in correlation with Osame score (P = 0.07).Urologic symptoms are not always in relationship with urodynamic study: a systematic urodynamic study is necessary to evaluate HAM/TSP neurogenic bladder. No clinic or urodynamic criterias are predictive of urologic complications. These patients need a close follow up. Neurourol. Urodynam. 36:449-452, 2017. © 2016 Wiley Periodicals, Inc.

HTLV-I –associated tropical spastic paraparesis (TSP) and HTLV-I associated myelopathy (HAM) is an endemic disease in Carribean Island. Bladder-sphincter dysfunctions are almost present. Functional disablement is major. Few studies are devoted to urinary disablement, responsible for urologic complications, that gives one of the elements of the severity prognosis of the disease. The objectives of the study are first to describe clinic and urodynamic characteristics of voiding disorders in Martiniquan population, secondly evaluate if there is a relationship between motor and urinary handicap, and thirdly evaluate prognosis factors of urologic complications.

Introduction L’enjeu du traitement du pied varus de l’adulte hemiplegique est de retablir une marche plantigrade stable et sans appareillage. Les techniques de correction du varus par hypertonie du tibial anterieur (TA) sont principalement l’hemitransfert du TA et le transfert du court fibulaire (CF) selon Bardot. Nous decrivons ici une nouvelle technique de transfert du long fibulaire (LF) par amarrage retrograde sur le TA. Materiel et methodes La technique chirurgicale consiste a prelever au tiers inferieur de jambe et transferer le tendon distal du LF et l’amarrer en tension maximale sur le TA. Nous avons mene une etude monocentrique retrospective sur les patients admis en orthopedie pour pied varus reductible avec paralysie des fibulaires entre janvier 2006 et avril 2016. Les gestes associes pouvaient etre une osteotomie de Dwyer, une tenotomie d’Achille ou des flechisseurs des orteils. Les patients ont ete revus par un examinateur independant qui a note les mobilites de cheville, les resultats au test de marche de Tinetti, la satisfaction des patients et les complications. Resultats Dix patients d’âge moyen 56,2 ans ont ete inclus avec un recul moyen de 4,7 ans. Deux patients ont eu une osteotomie de Dwyer associee, six une tenotomie d’Achille et sept une tenotomie des flechisseurs des orteils. Le score de Tinetti moyen etait de 22. Le varus a ete corrige chez tous les patients avec une amelioration moyenne de l’angle tibiocalcaneen de 15° et l’equin a ete ameliore en moyenne de 15° chez sept patients. Il n’y a pas eu de recidive. Tous les patients ont augmente leur perimetre de marche et diminue leur appareillage. Il persistait chez trois patients des griffes d’orteils. Il n’existait aucun conflit entre la cicatrice et le chaussage. Tous les patients etaient tres satisfaits. Discussion L’insertion plantaire du LF a la base du premier metatarsien se fait en miroir par rapport a celle dorsale du TA. D’autre part, le corps musculaire du LF plus court que celui du CF permet un prelevement tendineux plus long et une cicatrice plus proximale que dans la technique de Bardot. Ces deux arguments anatomiques justifient cette technique et expliquent la bonne correction du varus et l’absence de gene au chaussage. Conclusion Le choix du prelevement du LF en alternative au CF decrit dans la technique de Bardot permet de s’affranchir des complications cutanees et semble apporter les memes qualites de correction du varus. Ces resultats sont a confirmer par une serie plus consequente.

Objective Chikungunya is an arbovirus transmitted by Aedes mosquitoes. Significant epidemics have been reported in Reunion in 2005–2006 and the French West Indies whose Martinique in 2013-2014. Mainly, Chikungunya is characterized by polyarthralgia and fever. Patients also related overactive or hypoactive bladder. Those bladder dysfunctions have been described in literature just one time by an Indian team [1] in 2006–2007. The purpose of this study is to identify and describe these disorders. Methods Patients were enrolled using a screening urinary disorders questionnaire through Chikungunya consultation in academic hospital of Fort-de France from January 2015. Results Recruitment of 51 patients: urinary urgency (58%), nocturia (66%), stress urinary incontinence (45%), daytime urinary frequency (15%), enuresis (7%), dysuria (27%). Urodynamic studies show overactive detrusor (57%) with and without detrusor-external sphincter dyssynergia (42%), or intrinsic sphincter deficiency (42%). Dysuria (42%) at flow determination. Discussion Bladder dysfunctions in acute Chikungunya are frequent, and may become chronical. Hypothesis concerning aetiology are myelopathy or neuropathy. Evolution of symptoms is uncertain. A study evaluating the follow up of those patients is still going on.

Opinion/Feedback Arboviruses cause very recurrent epidemics, the oldest Dengue, known especially outside the flu-like syndrome with high fever mainly impacting vulnerable populations, may be responsible for severe hemorrhagic fevers, but also a few cases of Guillain-Barre syndrome. In 2014, the French Antilles occurred an outbreak of Chikungunya, following that of the Reunion's outbreak. During this period have been described, the articular and musculo-squellettic lesions, responsible for loss of autonomy in populations already carriers of chronic inflammatory joint damage or mechanical, but also a heavy impact on the autonomy of elderly and frail people. The Reunion experience has allowed the French Antilles to prepare for managing this epidemic by implementing an algorithm based on precise stripping algic and incapacitating phenomena. The role of the MPR in this dismemberment will allows distinguish true neurogenic damage to types of complex pain syndrome, combining autonomic neuropathy syndromes and tables of small fibers at the crossroads between diagnostic of arthropathy of periarthropaties, synovitis, tenosynovitis and tunnel syndrome on the rise during this epidemic period. And other complications such as bladder and sphincter disorders, and increase of spastic tables in patients suffering from chronic neurological disease. The reach of virus Zika shows an increased incidence of Guillain-Barre syndrome, brings interrogation with the appearance of atypical neurological damage such as myelitis, meningitis, cerebellites showing well this neurotropism. There are also atypical presentation on the neuro-urology plan that raises the question of the pathophysiology of such viruses. As has been the case for the Chikungunya, the overall vision of the MPR will allow better interpretation of pathological phenomena helping the understanding of the pathophysiology of these arboviruses. But it also plays a role in measuring the impact of emerging diseases on the autonomy of individuals.