Anterior snapping of the hip was first described in 1951 by Nunziata and Blumenfeld. The aim of this study, based upon a personal series and backed up by literature reports, is a current review of this common clinical condition, usually asymptomatic, but sometimes painfull especially in athletes. Material and method 12 cases in 11 patients were treated surgically: 4 men and 7 women, mean age 25 years, 7 of them regularly involved in sport. The onset of the snapping was sudden in 6 cases, related to a precise movement, while in 6 cases pain preceeded the gradual development of snapping. Pain may coincide with snapping, or may be of a "chronic" nature after exercise. The problem had been present for 2 years on average before treatment. Surgery consisted of posterior psoas aponeurotic fascia division and was sufficient in 11 cases. In one patient, disappearance of snapping was obtained only after division of the ilio-femoral ligaments. Mean postoperative follow-up was 6.5 years (1 to 12 years). Pain disappeared in all patients. A slight, intermittent and asymptomatic snapping persisted in 3 cases. All athletes regained their previous performance level. Discussion Clinical Symptoms consist of a dull, deep clicking sensation in the groin during active mobilization of the hip. It never occurs with passive mobilization. The entire problem is that of attributing painful symptomatology to snapping. Anatomical study In almost all cases, snapping is due to a sudden movement of the psoas aponeurotic fascia on the ilio-pectinate eminence. Other causes have been reported: ilio-femoral ligaments on the femoral head, rectus femoris or psoas tendon on bony crests or of psoas on the cotyloid cup of an artificial hip. Investigations These are primarly designed to rule out any other cause of snapping or inguinal pain (foreign body, acetabular labrum lesion, etc). Bursography and dynamic ultrasonography identify the snapping site, but it is sometimes difficult to confirm that this is responsible for painful symptoms. Treatment If such responsibility is confirmed, and if any psychological component can be ruled out, this should first be "medical" by stretching and local injections in the serous bursa. Surgery should consist in division of the psoas aponeurotic fascia, leaving the muscle fibers intact. The procedure should be performed under sensory epidural anesthetic, the only way of ensuring peroperatively that snapping has disappeared. Division of the psoas distal tendon at the lesser trochanter is not appropriate.
Les ressauts anterieurs de hanche ont ete decrits par Nunziata et Blumenfeld en 1951. Le plus souvent asymptomatiques, ils se resument en un claquement sourd et profond au niveau de l'aine. Ce n'est que tres rarement, et surtout dans un contexte sportif, qu'il s'accompagnent de douleurs, soit synchrones du ressaut, soit sous forme chronique, apres effort. Dans la quasi totalite des cas, ils sont dus au deplacement brutal de la lame aponevrotique posterieure du psoas sur l'eminence ilio-pectinee. D'autres causes ont ete rapportees (ligaments ilio-femoraux, droit anterieur, tendon terminal du psoas sur le petit trochanter ou encore cupule cotyloidienne d'une prothese de hanche), mais elles semblent beaucoup plus rares. Les examens complementaires ont surtout pour but d'eliminer toute autre cause de douleurs inguinales ou de ressaut (notamment lesion du bourrelet). La bursographie ou l'echographie dynamique permettent de visualiser et localiser le ressaut, mais n'autorisent pas a lui rapporter la symptomatologie douloureuse. Si la responsabilite du ressaut peut etre affirmee, et apres avoir ecarte toute participation psychologique, le traitement medical, par etirements et infiltrations de corticoides dans la bourse sereuse, peut etre efficace. En cas d'echec, le traitement chirurgical se justifie. Il consiste en la section de la lame aponevrotique posterieure du psoas, en respectant la continuite des fibres musculaires, sous anesthesie peridurale sensitive, seul moyen d'avoir, en per-operatoire, la certitude de la disparition du ressaut. Notre serie comporte 12 interventions chez 11 patients. Dans tous les cas, la douleur a disparu. 3 fois, un discret ressaut intermittent persiste. Le sport a toujours ete repris au niveau anterieur. Ces resultats sont conformes aux series de la litterature.
UNLABELLED:Anterior snapping of the hip was first described in 1951 by Nunziata and Blumenfeld. The aim of this study, based upon a personal series and backed up by literature reports, is a current review of this common clinical condition, usually asymptomatic, but sometimes painful especially in athletes.MATERIAL AND METHOD:12 cases in 11 patients were treated surgically: 4 men and 7 women, mean age 25 years, 7 of them regularly involved in sport. The onset of the snapping was sudden in 6 cases, related to a precise movement, while in 6 cases pain preceded the gradual development of snapping. Pain may coincide with snapping, or may be of a "chronic" nature after exercise. The problem had been present for 2 years on average before treatment. Surgery consisted of posterior psoas aponeurotic fascia division and was sufficient in 11 cases. In one patient, disappearance of snapping was obtained only after division of the ilio-femoral ligaments. Mean postoperative follow-up was 6.5 years (1 to 12 years). Pain disappeared in all patients. A slight, intermittent and asymptomatic snapping persisted in 3 cases. All athletes regained their previous performance level.DISCUSSION:CLINICAL: Symptoms consist of a dull, deep clicking sensation in the groin during active mobilization of the hip. It never occurs with passive mobilization. The entire problem is that of attributing painful symptomatology to snapping. ANATOMICAL STUDY: In almost all cases, snapping is due to a sudden movement of the psoas aponeurotic fascia on the ilio-pectinate eminence. Other causes have been reported: ilio-femoral ligaments on the femoral head, rectus femoris or psoas tendon on bony crests or of psoas on the cotyloid cup of an artificial hip.INVESTIGATIONS:These are primarily designed to rule out any other cause of snapping or inguinal pain (foreign body, acetabular labrum lesion, etc). Bursography and dynamic ultrasonography identify the snapping site, but it is sometimes difficult to confirm that this is responsible for painful symptoms.TREATMENT:If such responsibility is confirmed, and if any psychological component can be ruled out, this should first be "medical" by stretching and local injections in the serous bursa. Surgery should consist in division of the psoas aponeurotic fascia, leaving the muscle fibers intact. The procedure should be performed under sensory epidural anesthetic, the only way of ensuring peroperatively that snapping has disappeared. Division of the psoas distal tendon at the lesser trochanter is not appropriate.
Our purpose has been to describe an original surgical technique without describing all the problems concerning the posterior instability. The original technique has a double effect: active with the muscular flap and passively mechanic, if necessary, by the bone graft.Five patients have been treated with this technique with a follow-up of one year and a half. 4 females and 1 male with an average age of 32 years 1/2. 2 were recurrent posterior instability, one unintentional and 2 intentional subluxations. 2 were epileptics. In all cases, the disparition of the instability was obtained. Full range of movement and sport were resumed at the former level. On X-rays, the humeral head was centered.By its double mechanism, active with the muscular flap and possibly passive with the bone graft, this technic is reliable to treat the majority of posterior instability. It combines the way of action searched in physiotherapy and capsulomyoplasties to center the humeral head and this one by the bone graft in case of posterior glenoid fracture or dysplasia. It doesn't have the insufficiencies of physiotherapy or capsulomyoplasties in posterior traumatic instabilities, nor from the classical bone graft over the glenoid posterior wall, cause of ostearthritis and pain.
Our purpose has been to describe an original surgical technique without describing all the problems concerning the posterior instability. The original technique has a double effect: active with the muscular flap and passively mechanic, if necessary, by the bone graft. Five patients have been treated with this technique with a follow-up of one year and a half. 4 females and 1 male with an average age of 32 years 1/2. 2 were recurrent posterior instability, one unintentional and 2 intentional subluxations. 2 were epileptics. In all cases, the disparition of the instability was obtained. Full range of movement and sport were resumed at the former level. On X-rays, the humeral head was centered. By its double mechanism, active with the muscular flap and possibly passive with the bone graft, this technic is reliable to treat the majority of posterior instability. It combines the way of action searched in physiotherapy and capsulomyoplasties to center the humeral head and this one by the bone graft in case of posterior glenoid fracture or dysplasia. It doesn't have the insufficiencies of physiotherapy or capsulomyoplasties in posterior traumatic instabilities, nor from the classical bone graft over the glenoid posterior wall, cause of osteoarthritis and pain.
The chronic anterior compartment syndrome of the forearm is a rare pathology (3 cases have been already published), and of new knowledge. Three new cases on 2 patients (one on both sides) are described here. The authors describe recent advances about physiopathology, exploration and surgical treatment. It is due to strenuous activity using flexor muscles of the forearm without any release period (here motor cyclist competition). The symptom was pain at the anterior forearm similar to cramp. The most important for diagnosis was to measure the pressure after activity. The threshold level read after activity was up to 30 mm of Hg, with a very slow coming back to normal value. The isotopic scanner with hydroxyl methylene di-phosphonate (HMDP), after activity, showed a delay of arrival of the tracer and a stasis. RMI seems to give abnormal modification of the signal. The only treatment was surgical and an open fasciotomy of superficial and deep fascia must be done, with opening of the muscle's perimysium. The patients became painfree and resumed their sport after surgical treatment.
The chronic anterior compartment syndrome of the forearm is a rare pathology (3 cases have been already published), and of new knowledge. Three new cases on 2 patients (one on both sides) are described here. The authors describe recent advances about physiopathology, exploration and surgical treatment. It is due to strenuous activity using flexor muscles of the forearm without any release period (here motor cyclist competition). The symptom was pain at the anterior forearm similar to cramp. The most important for diagnosis was to measure the pressure after activity. The threshold level read after activity was up to 30 mm of Hg, with a very slow coming back to normal value. The isotopic scanner with hydroxyl methylene di-phosphonate (HMDP), after activity, showed a delay of arrival of the tracer and a stasis. RMI seems to give abnormal modification of the signal. The only treatment was surgical and an open fasciotomy of superficial and deep fascia must be done, with opening of the muscle's perimysium. The patients became painfree and resumed their sport after surgical treatment.
There are several types of lesions of the talus, including non united fractures and true osteochondritis in adolescents. This article focuses on lesions of the dome of the talus having a large subchondral necrotic zone. The etiology of these lesions is unclear. Even when they result from trauma, this may not be the sole cause. Thirty-three similar cases were studied, allowing analysis of the radiological appearance and the value of arthro scanner data. All the cases were treated by surgery (and were subsequently classified histologically). The necrosis was treated by curettage and filling with cancellous bone grafts taken from the lower tibial epiphysis. Twenty-seven patients were followed up at least one year (average 3 years 3 months). The outcome was functionally good or very good in twenty-two cases. The anatomical reconstruction was scored by radiology as very good in nineteen patients and satisfactory in five, who had irregularities and non-homogenous appearance of the talar dome. These results justify the use of curettage and filling. Arthroscopic techniques, although appropriate for simple ablations of osteochondral fragments, do not appear to be satisfactory for treating lesions including subchondral necrosis. Filling can only be performed surgically.
Les etudes anatomiques en ont precise l'etiologie: il est lie a un deplacement brutal du tendon du psoas, au niveau du bord anterieur du bassin, probablement sur l'eminence ilio-pectinee. Il n'existe que lors de l'extension active de la cuisse sur le bassin. Si la gene fonctionnelle le justifie, le seul traitement possible est chirurgical. Il est souhaitable que l'intervention se deroule sous anesthesie peridurale sensitive, seul moyen d'en controler le resultat, par la mobilisation active peroperatoire. Le geste therapeutique necessaire et suffisant semble etre la section de la lame tendineuse situee a la face profonde du muscle, au niveau du bord anterieur du bassin
Since 1978 gamma irradiation has been used for sterilization of bone allografts. The radiation source used was Co 60 (2.5 to 3 megarads). Which was applied at the Atomic Centre of Saclay. The technique of sterilization is absolutely reliable at relatively low cost. It allows pieces of bone from cadavers to be harvested several hours after death, without special aseptic precautions. It appears to diminish antigenicity of the graft very little and incorporation is perhaps slowed down. The grafts did not become radioactive. The graft is carefully packed and frozen as soon as it is taken from the cadaver. Freezing is continued during the irradiation process and the graft may then be stored for several months. This technique was used for reconstruction after tumor resection twice in the knee, once in the pelvis and once in the fibula. There was no postoperative infection. Scintigraphy showed satisfactory incorporation. In one case of replacement of the femoral condyle the cartilage of the graft was replaced by the intact articular cartilage of the patient. Later, this articular cartilage was shown to be necrotic and a total prosthesis was inserted. The fibular graft was secondarily complicated by a fracture. Sterilization using irradiation makes bone harvesting in cadavers easier and allows bone banks to be established. It should lead to more extensive use of allograft bone.
