A pubalgia no jogador de futebol / Pubic pain in the soccer player

A pubalgia tornou-se um problema comum no futebol, preo-cupando atletas, treinadores, ortopedistas e fisioterapeutas. A articulaçäo do púbis é capaz de absorver parte das forças des-cendentes e ascendentes que säo aplicadas ao corpo e seu com-portamento depende diretamente dos movimentos da articu-laçäo sacroilíaca. Esses fatores tornam essa articulaçäo extre-mamente importante, colocando-a algumas vezes em situa-ções estressantes. Por ter como características tratamento di-fícil e de tempo prolongado, torna-se imprescindível o conhe-cimento da fisiopatologia relacionada à pubalgia. Embora näo haja ainda um consenso entre os autores, vários mecanismos têm sido sugeridos na tentativa de explicar o desenvolvimen-to da pubalgia. A proposta deste artigo é discutir esses possí-veis mecanismos, tentando correlacioná-los com a experiên-cia dos autores junto a jogadores profissionais de futebol, mos-trando possíveis caminhos relacionados à prevençäo e reabi-litaçäo. Isso inclui boa flexibilidade dos músculos relaciona-dos com o osso púbico, mobilizaçäo da articulaçäo sacroilía-ca, correçäo de desbalanceamentos de força, calçados e cam-pos de treinamento adequados.

Reflexion a propos de la prevention de l'osteite postfracturaire

The authors report their experiment in treating osteitis and septic non-union. - The problem of fractured osteitis is relatively simple, the fracture being united. Different surgical methods are considered together, all having in common the excision of infected and necrotic tissue. Opinions are divided between supporters of " closed " treatment with " irrigation-drainage ", and " open " treatment with cicatrization by a second intention. The latter being favored by most of the participants. Directed antibiotherapy remains a valuable addition; its utilization locally is discussed. - The treatment of septic " non-union " is more complicated in respect to healing. Different methods are examined with ' osteo-muscular decortication, used alone, led to healing in 17 out of 20 cases of non-union. It constitutes the first and formes treatment for non-union. Isolated, it is reserved for non-union without loss of osseous matter. A PAPINEAU intervention is the method of choice for septic non-union with loss of osseous matter. It was used once or twice in 51 cases and led to union and drving in 75% of the cases. Negative re-results were most often the apanage of diaphysaric resections. Inter-tibio-fibular grafting was only used in 8 cases, usually after the failure of other methods. It allowed union in 6 cases. It retains a non-negligible place after failure of a PAPINEAU intervention, which it can complete in case of insufficient solidity. Of 101 observations of septic non-union, 6 patients underwent amputation. This is most often the result of major traumatologic damage and deficient techniques. Its place should be more and more reduced. The authors conclude by recalling the importance of preventing post-operatory-infection, not by gross means but by rigorous measures in the organization, hygiene and education of hospital staff