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L’entorse grave de la cheville est assez frequente dans la pratique quotidienne, mais l’association a une ouverture cutanee est exceptionnelle. Nous rapportons ici l’observation rare d’une entorse grave ouverte de la cheville chez un sportif en detaillant son mecanisme lesionnel avec une revue de la litterature.

Viral respiratory infections are among the most common causes of disease in humans, particularly in young children, and remain a major public health problem worldwide. For many geographic regions, there is limited epidemiological information on the main causative agents of these diseases. In this article, we investigated, in a prospective study, the viral agents leading to acute respiratory disease in children younger than 15 years of age who were admitted to the pediatric emergency unit of a major teaching hospital in Erbil City, capital of the Kurdistan region, Iraq. Nasopharyngeal samples obtained from 269 hospitalized children were analyzed for viral respiratory pathogens using the xTAG Respiratory Virus Panel Fast assay, and the data were correlated with the clinical and demographic information available for these patients. One or more respiratory virus(es) were detected in 203 out of 269 (75.5%) samples. The most frequent viruses were enterovirus/rhinovirus (n = 88; 32.7%), respiratory syncytial virus (n = 55; 20.4%), and human metapneumovirus (n = 36; 13.4%). In 42 samples (15.6%), coinfections with 2 or more respiratory viruses were detected, with enterovirus/rhinovirus, respiratory syncytial virus, human metapneumovirus, and adenovirus being identified as the most common agents in viral coinfections in these patients.

La pathologie traumatique du pied et de la cheville est un motif frequent de consultation aux urgences. Les fractures de la marge posterieure du tibia, anciennement denommees fractures de la malleole posterieure, sont frequentes. Elles sont le plus souvent associees a d’autres lesions ligamentaires ou osseuses touchant les differents elements de la cheville et/ou du pied. Les fractures isolees de la marge posterieure du tibia sont relativement rares. On estime leur frequence a environ 1 % de toutes les fractures de la cheville. Le mecanisme de survenue fait intervenir habituellement une hyperflexion plantaire du pied combinee a une compression axiale de la marge posterieure du tibia par le talus. Nous rapportons le cas clinique d’un patient victime d’une chute d’escalier chez qui le diagnostic a ete pose secondairement grâce a la radiographie de la cheville de profil en rotation externe. L’evolution a ete favorable malgre le retard de prise en charge.

Les osteophytes tibiotaliens anterieurs peuvent etre responsables de douleurs chroniques de la cheville par conflit anterieur osseux. Ces osteophytes sont secondaires a des microtraumatismes repetes ou a des fractures de la cheville. Ces situations sont retrouvees au cours de la pratique de sport. Les patients presentent un tableau mixte associant des douleurs et une raideur de l’articulation tibiotalienne parfois mal toleree. Le but de ce travail etait de presenter la technique operatoire arthroscopique du traitement du conflit anterieur osseux de la cheville avec enraidissement et d’en presenter les premiers resultats a court terme sur la mobilite tibiotalienne et la douleur par l’etude de quatre cas cliniques.

Resume Le kyste synovial intraosseux des os du carpe est une cause rare de douleur du poignet. Peu de cas ont ete rapportes. Nous rapportons un cas tres rare de kyste synovial intraosseux du capitatum, chez une fille âgee de 16 ans qui se plaignait de douleur chronique du poignet droit. Le bilan radiologique a montre une lesion osteolytique avec sclerose marginale. Le diagnostic a ete confirme par l’etude anatomopathologique et le traitement a consiste en un curetage suivi d’autogreffe d’os spongieux. Apres un recul de huit mois, le capitatum etait completement consolide et le resultat fonctionnel satisfaisant.

Resume La prise en charge de patients âges de 30 a 50 ans et presentant une laxite anterieure du genou par rupture du LCA associee a une arthrose femorotibiale interne, est tres difficile. De recentes publications ont montre que l’association d’une osteotomie tibiale a une ligamentoplastie intra-articulaire permettait de freiner l’evolution de l’arthrose tout en corrigeant la laxite du genou. Nous rapportons l’experience de 15 patients du service de traumatologie de l’hopital militaire Moulay Ismail de Meknes presentant une laxite anterieure avec arthrose femorotibiale interne. Ces patients ont beneficie d’une osteotomie de valgisation associee a une ligamentoplastie du LCA.

The combination of elbow dislocation and perilunate dislocation is rare. The prognosis of this condition depends mainly on that of the wrist. While some cases of floating forearm have been reported, no bilateral affection has -of yet- to our knowledge, been published. The authors report a case of a young patient who presented with bilateral floating forearm after a fall from a height. The treatment was surgical at the wrist. The functional result is similar to cases reported in the literature.

Resume Entre 1996 et 2005, 50 patients (54 epaules) ont beneficie d’une intervention de Latarjet pour instabilite anterieure de l’epaule. Nous avons, retrospectivement, evalue les resultats cliniques et radiologiques de cette technique operatoire. L’intervention a ete realisee pour le traitement d’une luxation recidivante dans 51 cas, subluxation recidivante douloureuse dans deux cas et une epaule douloureuse dans un cas. Tous les patients ont eu une evaluation radiographique avant l’intervention et lors du controle le plus recent. Selon le score de Rowe, 51 (94 %) des 54 epaules ont obtenu un resultat bon ou excellent. Au plus grand recul, 51 epaules etaient indemnes d’arthrose glenohumerale.

Nous rapportons deux cas de syndrome fissuraire du tendon du muscle court fibulaire, revele par une tumefaction et douleur retromalleolaire, sans contexte traumatique ou de laxite chronique de la cheville. L’interet de l’imagerie par resonance magnetique est primordial pour le diagnostic positif et le bilan lesionnel associe. Une breve discussion de cette pathologie et une description des differents aspects IRM seront discutees.

Resume Le kyste anevrismal osseux, est une lesion pseudotumorale representant environ 1 % de toutes les tumeurs et pseudotumeurs biopsiees. Nous rapportons le cas d’une localisation tres rare patellaire chez un patient âge de 18 ans, decouverte a l’occasion d’une fracture pathologique. La survenue d’une fracture pathologique complique la conduite therapeutique. Mais lorsque la surface articulaire est epargnee, le kyste anevrismal osseux de la rotule peut etre traite avec succes par curetage et greffe corticospongieuse comme dans notre observation.

Resume Les auteurs rapportent un cas de rupture du tendon distal du biceps brachial opere dans les 48 heures qui ont suivi le traumatisme par voie unique anterieure avec reinsertion anatomique du tendon au niveau de la tuberosite bicipital avec fixation par la technique de l’endobouton. Les resultats obtenus ont ete juges satisfaisants.

La luxation metatarsophalangienne du gros orteil dans sa variete plantaire est une lesion rare. Nous rapportons le troisieme cas de la litterature, en detaillant son anatomie, son mecanisme lesionnel et son diagnostic radiologique. Avec une revue de la litterature.

The scapula is an uncommon site for a chondroma. We report the case of a chondroma in the left acromion, which presented as a painful shoulder in a 19-year-old teenager. The diagnosis was suspected on radiographs and CT scan and confirmed by histological findings.

La tumeur a cellules geantes (TCG) est une tumeur benigne rare de l’os. Elle se voit surtout au niveau des extremites des os longs apres la maturite osseuse. L’atteinte des os du pied est exceptionnelle. Nous rapportons un cas de tumeur osseuse a cellules geantes de l’os cuneiforme median, survenant chez une jeune fille et revele par des douleurs du pied. Nous discutons les differents aspects cliniques, radiologiques et les differentes modalites therapeutiques.

Le pied de Madura, ou mycetome, est une pathologie infectieuse, chronique, deformante des parties molles, de la peau et des structures osseuses. Elle est caracterisee par des nodules indolores, des fistules qui laissent echapper des grains colores. Nous rapportons deux cas de pied de Madura avec une breve discussion.

The authors report a case of fibularis muscle syndrome in a 37-year-old man with no history of trauma to or chronic instability in the ankle. Surgical exploration discovered a split lesion in the fibularis brevis tendon, associated with the supernumerary muscle. Based on clinical history and perioperative observations, the fissure syndrome appears to have resulted from a retromalleolar conflict in the fibularis retinaculum secondary to anatomi- cal abnormality. Tendon repair and accessory muscle excision allowed complete recovery.

Resume La compression du nerf ulnaire au niveau du poignet est rare, en comparaison avec le coude. Elle est le plus souvent secondaire a des traumatismes repetes, des kystes synoviaux, des malformations vasculaires et des bandes fibreuses. La compression du nerf cubital par une fusion entre le pisiforme et l’apophyse unciforme de l’os crochu est rare. Nous rapportons l’observation d’une patiente de 18 ans presentant cette malformation.

Osteoblastoma is a benign but painful bone tumour, which can only be treated surgically. Localization at the elbow is rare and poses diagnostic problems. The tumour in this location causes joint stiffnesses due to pain and the regional inflammatory response. A delay in diagnosis can, despite successful treatment of the tumour, cause loss of the full range of movements of the elbow. We report a case illustrating this aspect.

Resume Les auteurs rapportent un cas de syndrome de Fenton avec luxation perilunaire posterieure, fracture de l’hamatum et du triquetrum. Il s’agit d’une lesion rare dont le diagnostic est difficile, le mecanisme ethiopathogenique et le choix therapeutique sont discutes. L’abord chirurgical est fait par une voie dorsale. Son principe doit etre conservateur vis-a-vis de la tete du capitatum.

Intraosseous cyst of the carpal bones is a rare cause of wrist pain. Few cases have been reported. We report a rare case of intraosseous ganglion cyst of the capitate, in a girl aged 16 who plain of chronic pain of the right wrist. The radiological assessment showed an osteolytic lesion with marginal sclerosis. The diagnosis was confirmed by histopathology and treatment consisted of curettage with autologous cancellous bone graft. At 8 months follow-up, the capitate is fully consolidated and the functional result is satisfactory.

The combination of elbow dislocation and perilunate dislocation is rare. The prognosis of this condition depends mainly on that of the wrist. While some cases of floating forearm have been reported, no bilateral affection has -of yet- to our knowledge, been published. The authors report a case of a young patient who presented with bilateral floating forearm after a fall from a height. The treatment was surgical at the wrist. The functional result is similar to cases reported in the literature.

The scapula is an uncommon site for a chondroma. We report the case of a chondroma in the left acromion, which presented as a painful shoulder in a 19-year-old teenager. The diagnosis was suspected on radiographs and CT scan and confirmed by histological findings.

Aneurysmal bone cyst is a tumor-like lesion which accounts for about 1% of all biopsied tumors and tumor-like lesions of bone. We report an extremely rare case of aneurysmal bone cyst of the patella in an 18-year-old patient revealed by a pathological fracture. The unexpected appearance of a pathological fracture affects the whole therapeutical management. However, in the case of a well-preserved articular surface, curettage and corticocancellous grafting are considered to be successful methods of treatment for aneurysmal bone cyst of the patella, as revealed in our study.

Osteoblastoma is a benign but painful bone tumour, which can only be treated surgically. Localization at the elbow is rare and poses diagnostic problems. The tumour in this location causes joint stiffnesses due to pain and the regional inflammatory response. A delay in diagnosis can, despite successful treatment of the tumour, cause loss of the full range of movements of the elbow. We report a case illustrating this aspect.

Entrapment of the ulnar nerve at the wrist is rare compared with the more commun site at the elbow. This condition was secondary to reccurent blunt trauma, ganglion cyst, vasculitic disorders, and fibrous bands. Compression of the ulnar nerve caused by pisiform-hamate coalition is rare entity. One case of this condition is reported.

Hemangioma is an uncommon bone neoplasm that usually affects the craniofacial bones and spine, accounting for less than 1% of all primary bone tumors. The authors report a case of isolated hemangioma involving the proximal humerus in a 22-year-old man. Radiographically, the lesion was a well-defined osteolytic process with marginal sclerosis. The CT images demonstrated an osteolytic lesion with coarse trabecular pattern and partial cortical breakthrough. Magnetic resonance imaging showed a multilocular and hemorrhagic lesion with fluid-fluid level, that was suggestive of aneurysmal bone cyst.

Bone and joint involvement is observed in 3 to 5 p. 100 of all cases of tuberculosis and in 15 p. 100 of extrapulmonary tuberculosis. Spinal and weight-bearing joints are most frequently involved. We report three cases of bone tuberculosis with rare localizations that raised difficult diagnostic problems. Our patients had tuberculosis of the sternum, the iliac bone and in the third case, the spine but solely in the posterior arch of the fourth cervical vertebra. X-ray evidenced bone lysis and invasion of adjacent tissues. The cold abscesses were evacuated surgically allowing bacteriological and histological diagnosis. The patients were successfully treated with anti-tuberculosis regimens. An infectious etiology should be considered in patients with bone lesions in order to obtain the samples necessary for positive diagnosis.

We report seven cases of traumatic dislocation of the great toe, detailing the anatomy, the mechanism of injury and the radiographic diagnosis. We propose an additional classification based on three hereto unreported cases.Between october 1994 and october 1997, we treated seven patients with traumatic dislocation of the first metatarso-phalangeal joint of the great toe. There were six men and one woman, mean age 35 years (range 24 - 44 years). Dislocation was caused by motor vehicle accidents in four cases and by falls in three. Diagnosis was made on anteroposterior, lateral and medial oblique radiographs. According to Jahss' classification, there was one type I and three type IIB dislocations. There was also one open lateral dislocation and two dorsomedial dislocations. Only these dorsomedial dislocations required open reduction, done via a dorsal approach. Mean follow-up was 17.5 months (range 9 - 24 months) in six cases. One patient was lost to follow-up. The outcome was good in six cases and poor in one (dorsomedial dislocation).Dislocation of the first metatarso-phalangeal joint of the great toe is an uncommon injury. In 1980, Jahss reported two cases and reviewed three others described in the literature. He proposed three types of dislocation based on the feasibility of closed reduction (type I, II and IIB). In 1991, Copeland and Kanat reported a unique case in which there was an association of IIA and IIB lesions. They proposed an addition to the classification (type IIC). In 1994, Garcia Mata et al. reported another case which had not been described by Jahss and proposed another addition. All dislocations reported to date have been sagittal dislocations. Pathological alteration of the collateral ligaments has not been previously reported. In our experience, we have seen one case of open lateral dislocation due, at surgical exploration, to medial ligament rupture and two cases of dorsomedial dislocation due, at surgical exploration, to lateral ligament rupture.We propose another additional classification with pure lateral dislocation (type III) and dorso-lateral dislocation (type IL or IIL+), which are related to the formerly described variants.

The Buschke-Loewenstein tumour (BLT) is a sexually transmissible benign tumour of viral origin. It is characterized by a large tumour volume, the possibility of local recurrence and especially its potential for malignant transformation. We report a case of scrotal BLT in a 49-year-old patient with a history of recurrent scrotal fistula, with negative HIV serology, but in whom the search for Human Papilloma Virus (HPV) was not performed. The tumour arising from the scrotal skin was resected and the testis was found to be normal. Histology confirmed transformation of the tumour into a squamous cell carcinoma. The clinical course was favourable, after a follow-up of 8 months with no local recurrence. In the light of this case of rare tumour, especially in its malignant form and its unusual scrotal site, the authors review the problems related to clinical classification, histology (differential diagnosis with primary squamous cell carcinoma), clinical course and treatment raised by this tumour.

Tuberculosis in an isolated localization in the patella is rarely reported. Five cases were found in the literature. Two new cases together with the radiographic work-up to be performed in case of a "painful" knee are presented. Histology of the curetage specimen is required to reach certain diagnosis and develop an adapted management strategy to protect the functional future of the knee.