Different treatment strategies for acromioclavicular dislocation injuries: a nationwide survey on open/minimally invasive and arthroscopic concepts.

BACKGROUND: Injuries to the acromioclavicular (AC) joint are one of the most common among sporting injuries of the upper extremity. Several studies investigated different treatment options comparing surgical and non-surgical treatment, and type of operative interventions. This study aims to evaluate treatment decisions regarding injuries of the AC joint and to compare different treatment strategies depending on the specific training of the treating physician. METHODS: We performed a nationwide survey by contacting different experienced physicians and sending them questionnaires. The questionnaire included 37 questions that assessed preferred treatment strategies in AC joint injuries. We addressed different surgical and nonsurgical options as well as level of experience and factors that might influence the decision on treatment strategy. The physicians were stratified according to their training into general surgeons (group trauma associated) and orthopedic surgeons (orthopedic associated). The AC joint lesions were categorized according to the widely used Rockwood classification. RESULTS: This study analyses 96 questionnaires. We included 46 (47.9%) colleagues in group trauma and 50 (52.1%) in group orthopedics. Most of the colleagues (98.9%) prefer non-operative treatment of type I and type II AC lesions. Similarly, 96.8% agree on surgical treatment of types IV, V, and VI lesions. The treatment of type III lesions is performed in 41.6% of cases non-operatively and in 58.4% of cases surgically. Trauma-associated colleagues are 3.4 times more likely to treat AC lesions with a hook plate compared to orthopedic-associated colleagues (p = 0.05). In decreasing order, the most commonly used non-surgical technique is sling immobilization (63.7%), and the most commonly performed surgical treatment is the hook plate (41.1%) in treating type III injuries. CONCLUSION: This study shows a distinct difference in treatment of AC joint injuries depending on the training of the physician. Further, the need for high-quality studies arises to define the optimal treatment of type III lesions.

[Diagnostic pitfalls about a specific case of low back pain]. / Pièges diagnostiques à propos d'un cas de lombalgie spécifique.

Diagnostic pitfalls about a specific case of low back pain Low back pain is classified into two principle categories: specific and non specific. This difference is important in terms of screening, medical care and treatment. Specific low back pain has various etiologies that imply specific treatment. This report describes one case of rare specific low back pain. The purpose of this article is to highlight the pitfalls that can represent such a common pathology, to show that obtaining an early diagnosis can be challenging, and finally to prevent care providers from stereotypes related to low back pain management.

[Tuberculous coxitis: diagnostic problems]. / Coxite tuberculeuse: difficultés diagnostiques.

Tuberculosis is still a significant disease in Switzerland, mainly because of the number of immigrants from endemic countries and the AIDS epidemic. The osteoarticular system is affected in a minority (3.1%) of cases; diagnosis is difficult but extremely important since classical treatment by medication started without delay brings about complete recovery, whereas lack of therapy can result in persistent pain and loss of joint function. Therefore, diagnostic procedures must not be limited to x-ray examination alone, but cultures and antibiotic sensitivity tests must be performed in order to select the appropriate antibiotic therapy. Cultures and histological analysis of the synovial membrane and fluid are the most reliable diagnostic tools.

[Chondrocalcinosis and Bartter syndrome]. / Chondrocalcinose et syndrome de Bartter.

A patient presenting with acute left-knee arthritis was diagnosed as having articular chondrocalcinosis. Routine laboratory tests motivated by a history of muscular cramps and weakness revealed hypokalemia and hypomagnesemia. Further investigations showed Bartter's syndrome. The characteristics of Bartter's syndrome and chondrocalcinosis and the relationship between the two diseases are developed.

Primary prevention, education, and low back pain among school children.

After a survey in 1986, a primary educational prevention program for low back pain (LBP) was implemented over a 3 year period in a primary school setting in Switzerland. In 1989 a second survey was carried out to evaluate the effect of the intervention. One thousand seven hundred and fifty-five (1755) children received a questionnaire, 1716 (97.7%) were returned. Recollection of participation in the prevention program was significantly associated with reported increased prevalence of LBP (p 0.000). Simultaneously, there was a significant reduction in the utilization of medical care for LBP (p < 0.05).

Low back pain in schoolchildren. A study of familial and psychological factors.

STUDY DESIGN: The results of a survey organized in the school system of the Swiss canton of Fribourg. An original questionnaire was developed for this study are reported. OBJECTIVES: The goal of this study was to evaluate the possible role of familial or psychological factors in schoolchildren reporting nonspecific low back pain. SUMMARY OF BACKGROUND DATA: Previous surveys have shown a high prevalence of nonspecific low back. pain among schoolchildren, particularly teen-agers. The reported familial incidence raises, among others, the question of a possible role of psychological or behavioral factors. METHODS: This survey was performed with a validated 43-item self-administered questionnaire eliciting information about back pain history, family characteristics, children's activities, and psychological parameters. All schoolchildren (n = 615), ages 12-17 years, in two secondary schools (Fribourg, Switzerland) were surveyed. The response rate was 98%. RESULTS: Reported lifetime prevalence of back pain was 74%. Lumbar pain was the most frequent localization of pain (69% of back pain). The measured psychological factors were significantly associated with reported nonspecific low back pain and its consequences as well as with sibling history of low back pain. CONCLUSIONS: The study suggests that psychological factors play a role in children's reporting of nonspecific low back pain.

[Pseudo-sciatica of neoplastic origin: apropos of an unusual case]. / Pseudosciatique d'origine néoplasique: à propos d'un cas inhabituel.

The authors report a case of 'pseudosciatic' pain due to bone metastasis located in the sacroiliac joint secondary to breast cancer. Complementary investigations are mandatory in any case of sciatic pain starting at 80 years of age, even in the absence of the usual criteria suggesting a neoplastic origin. In this case our investigations revealed sacroiliac bone metastasis from the breast, explaining the clinical picture. Primary and secondary sacral tumors are uncommon. Their clinical manifestations are unspecific, consisting mainly of low back pain and sciatic pain. CT scan and MRI are the best tools to evaluate these lesions. Conservative management, combining radiotherapy and hormonal treatment, has been effective in terms of both pain and function.

Non-specific low-back pain among schoolchildren: a field survey with analysis of some associated factors.

A study population composed of 1,755 children 8-16 years of age were surveyed using a 15-item, self-administered questionnaire. The response rate was 97.7%. The purpose of the survey was to evaluate the possible association between low-back pain and certain social factors and predicaments. Descriptive statistics and logistic regression analysis showed that parental history of treated low-back pain (adjusted odds ratio 2.10; p < 0.001), competitive sports activity (adjusted odds ratio 1.73; p = 0.003), and time spent watching television (adjusted odds ratio 1.23; p = 0.05) significantly increased the risk for low-back pain among children, controlling for the child's age and gender.

Bilateral primary brucellar psoas abscess.

Skeletal involvement is a relatively common complication of human brucellosis. Muscle infection and particularly psoas abcess is rarely reported and always secondary to spondylitis. We report here a case of brucellar abscesses in both psoas and right gluteal and posterior thigh muscles occurring without any skeletal, renal or bowel lesion.

Cross-sectional study of the isokinetic muscle trunk strength among school children.

Our surveys have shown lifetime prevalence of L.BP. over 30% among schoolchildren. The purpose of this study was to evaluate the relationship between back and isokinetic trunk strength, anthropometric parameters, and sports activities. One hundred and seventeen healthy children aged 10-16 years were included. All these volunteers had semi-structured interview, anthropometric and dynamic strength measurements. Lifetime prevalence of back pain was 44.5% and point prevalence was 13%. In this cross-sectional study, anthropometric and strength profiles were significantly related to age and gender. Non specific low back pain was not correlated to trunk muscle strength and/or sports activities.

Uncommon origin for the iliopsoas sign.

The term "iliopsoas sign" has different meanings in the medical literature. Among musculoskeletal disorders, iliopsoas bursitis is probably the most common cause of this clinical sign. Here we report an unexpected vascular pathology in a young man. The only clinical manifestation on examination was an iliopsoas sign.

The frozen shoulder: diagnosis and treatment. Prospective study of 50 cases of adhesive capsulitis.

A prospective study of randomized analysis treatment of 50 cases of frozen shoulder was carried out in 3 Swiss medical centres. Three separate aetiological groups were studied: post-traumatic (40%), neurological (14%) and idiopathic (46%). An increased radioisotope bone scan (99 mTc diphosphonate) was found in 96% of cases, regardless of aetiology. The so-called idiopathic frozen shoulder showed a scapulo-humeral increase in radioisotope uptake in several areas (in 82% of cases) without involvement of the ipsilateral carpus. Clinically, the neurological type was associated with a shoulder-hand syndrome with positive bone scan of the shoulder and the wrist in all cases. The post-traumatic type showed a diffuse (in 50% of the cases) or at several circumscribed areas (also in 50%) increase in radioisotope uptake in the shoulder. In 45% of the post-traumatic type, there was also a shoulder-hand syndrome with uptake in the wrist also. A physical treatment and early mobilization, associated with the administration of subcutaneous salmon calcitonin for 21 days (100 U Calcitonin Sandoz) had a statistically significant increased effect on pain compared to treatment with physiotherapy alone by patients with post-traumatic frozen shoulders (p < 0.02). There was no significant difference, however, in the speed of recovery of function between the two treatment groups. These observations strengthen the hypothesis that adhesive capsulitis behave like an algoneurodystrophic process.

The effect of adding calcitonin to physical treatment on reflex sympathetic dystrophy.

The efficacy of intranasal salmon calcitonin was examined in a double-blind randomized study in reflex sympathetic dystrophy. Sixty-six patients were randomly divided in two groups receiving physiotherapy. In addition group I also received 3 x 100 U/day of salmon calcitonin by intranasal spray whereas group II received 3 sprays of placebo. The pain and the range of motion were improved by calcitonin administration. Similarly the patients' ability to work was also improved. The results confirmed that salmon calcitonin has an effect but that this effect was not equally observed on all parameters analyzed. It was most marked on pain (at rest and on movement) and on the ability to work.

[Still's disease in adults with disseminated intravascular coagulation]. / Maladie de Still de l'adulte avec coagulation intravasculaire disséminée (CIVD).

Coagulation abnormalities are not included in the definition of adult onset Still's disease (AOSD). Nevertheless, eight cases with disseminated intravascular coagulopathy (DIC) sometimes associated with hepatopathy have been reported in the literature. The first patient, a 39-year-old woman, presents an AOSD well stabilized under steroid therapy since 1986. In 1989, she develops a DIC, a pancytopenia and a non-specific hepatopathy with a good response to an intensive steroid therapy and heparin. The second patient, a 30-year-old woman, presents since the age of three years, with juvenile Still's disease in remission since the age of 19. At the age of 28, she presents an AOSD, complicated by DIC which necessitated the introduction of methotrexate given for the poor response to high doses of steroids. The etiology of AOSD and DIC is still unknown. An iatrogenic cause (salicylates, indomethacin, chrysotherapy) has been suggested. An AOSD with DIC (sometime associated with an important hepatopathy and/or pancytopenia) should be treated early with corticosteroids and heparin in order to prevent a possible lethal outcome.