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Diagnosis and management of chronic osteomyelitis of long bones in adultsChronic osteomyelitis is an inflammatory process of the bone caused by an infectious agent. This condition leads to altered bone vascularization and thus to bone destruction and formation of necrotic bone fragments (sequestrum). The treatment of chronic osteomyelitis is primarily based on surgical management, which includes debridement of the sequestrum and sampling of bone tissue for microbiological analysis in order to initiate a targeted antibiotic therapy. A multidisciplinary approach is essential, involving expertise in orthopedic surgery, musculoskeletal imaging and nuclear medicine, infectious diseases, as well as plastic or vascular surgery for complex cases with soft tissue and/or vascular defects.

Gross efficiency (GE) appears to be correlated with strength. The purpose of this study was to investigate GE at 4 different pedaling rates (60, 70, 90, 100 rpm) and its relationship with maximal strength in a population of 8 bike messengers (BMs) and 8 experienced non-bicycle messenger (NBMs) athletes. Methods: Each of the 8 BMs, (mean age, 25.2 years ±3,2), who work in at a delivery company, who ride 218.7 (±65.1) km/week, and participate in an average of 19.6 (±11.1) hours of sport related exercise per week, and the 8 NBMs, (mean age 25.4 years ±2.2), who ride an average of 5 (+ 14.1) km/week and participate in an average of 6.5 (±3.8) hours of sport related exercise per week underwent 2 laboratory sessions. The first laboratory session determined Maximum Aerobic Power (MAP) and maximal oxygen consumption (VO 2 max) with steps of 30W/min. The second session included an efficiency test at 50% of MAP. GE, oxygen consumption (VO 2), heart rate (HR) and Blood Lactate Concentration (BLC) were measured at four randomly selected cadences (60,70,90,100 rpm). The subjects then underwent an isokinetic test, 5 repetitions at 60°/sec and 20 repetitions at 120°/sec, to measure concentric strength for extension and flexion of both knees. Fatigability and peak torque/body weight ratio were then calculated. Results: A difference in GE (at 60, 90 100rpm), BLC (all cadences) and MAP/kg in favor of BMs was found (all P-value<0.05). No difference in VO 2 /VO 2 max (all cadences) was found (p-value>0.05). The most efficient cadence was 60 rpm in both groups. Increased cadence resulted in decreased GE and increased HR and VO 2 in both groups. BLC only increased in the NBMs group. In both groups, a clear relationship between MAP/kg and low BLC was found. NBMs were found to have stronger hamstring muscles than BMs (p-value: 0.038). Few relationships between GE at different cadences, peak-torque/Bw or muscle fatigability were found. Discussion/Conclusion: BMs had a higher GE than NBMs. These results are in line with previously described analyses and are explained by higher aerobic capacity, better training status, different muscle fiber type, and better pedaling technique. At the same power output, anaerobic glycolysis, which is linked to lower economic GE, plays a greater role for NBMs. Stronger hamstring muscles of the NBMs might be explained by the diversity of their practiced sports and therefore their use of a greater diversity of muscle groups. Isokinetic knee maximal strength and fatigability was not linked with GE. Thus, isokinetic strength testing is not a good choice for evaluating GE in cycling.

Les entorses de cheville sont un motif de consultation très fréquent. Dans la plupart des cas, elles se limitent à des lésions de l'appareil ligamentaire externe. Toutefois, elles peuvent masquer des lésions plus graves incluant les fractures du processus latéral du talus, de la base du 5 e métatarsien, les lésions ligamentaires internes, de la syndesmose, les entorses du Chopart et la luxation des tendons fibulaires. Il n'est pas toujours facile de poser le bon diagnostic en urgence et une prise en charge initiale insuffisante de ces lésions peut hypothéquer significativement le pronostic fonctionnel. Le but de cet article est de rendre le praticien de premier recours attentif à ces lésions potentielles et de l'aider à poser le bon diagnostic en vue d'un traitement initial adéquat. Six pitfalls around the ankle sprainsAnkle sprains are frequently encountered. They result most of the time in lesions of the lateral ligament complex. Nevertheless, in the context of an ankle sprains, more severe injuries including fracture of the lateral process of the talus, fracture of the base of the 5 th metatarsal, tear of the medial ligament complex, lesion of the syndesmosis, sprain of the Chopart joint, and peroneal tendons luxation are potentially overlooked and, if treated inadequately, may be associated with poor functional outcome. The goal of the present paper is to make the emergency practitioner aware of these potential lesions, and to help him making the correct diagnosis in order to initiate the adequate treatment.