Lettres à la rédaction
de survie sans récidive de 77 % [10]. Des traitements médicaux
Severe neck lacerations
ont été essayés dans des situations d'échec de la chirurgie. Une
chimiothérapie cytotoxique mais aussi des traitements non during cable skiing in a
cytotoxiques : hormonaux, anti-inflammatoires non stéroïdiens, child
interféron a ont été rapportés [3]. Malgré l'absence de potentiel
métastatique, ces tumeurs peuvent entraîner une morbidité Lacérations sévères du cou chez un enfant lors
significative et entraîner des décès suite à l'invasion locorégio- de la pratique de téléski nautique
nale [11].
Lettres à la rédaction
Les fibromatoses pelviennes sont exceptionnelles, leur diagnos-
tic reste difficile et leur exérèse représente un véritable défi pour A healthy 14-year-old boy suffered from several severe lacer-
le chirurgien tant pour leur voie d'abord que pour le respect des ations of the neck and avoided strangulation when practicing,
marges de sécurité. for the first time, cable skiing in France. During summer 2015, he
went for the first time to practice wakeboarding in a "cable
Déclaration de liens d'intérêts : les auteurs déclarent ne pas avoir de park''. While wakeboarding, he fell in the water. The wake-
liens d'intérêts.
boarder, who was following him, fell as well while performing
jumps and lost grip of the cable. The taut cable rope came to hit
and turn around the neck of the child. Fortunately, he could
Références rapidly free himself from the cable before any strangulation
occurred. He was referred to the local emergency department.
[1] Goldblum JR, Fletcher JA. Desmoid-type fibromatoses. In: Fletcher C,
Unni KK, Mertens F, editors. World Health Organisation classification of He was in good condition but disclosed deep lacerations
tumours. Pathology and genetics of tumours of soft tissue and bone. Lyon: (figure 1). Local wound dressing with sulfadiazine cream was
IARC Press; 2002. p. 83–4.
applied daily and the healing was unremarkable. Only a discrete
[2] Enzinger FM, Weiss SW. Fibromatosis. In: Enzinger FM, Weiss SW, editors.
hyperpigmentation around the neck remains (figure 2).
Soft tissue tumors. 4th ed., 2001. p. 320–9.
[3] Fayçal O, Lamia G, Sonia M, Karima M, Mahmoud S, Samir B, et al. The Discussion
place of medical therapies in children with desmoid tumors. J Pediatr
Wakeboarding is a surface water sport consisting of hydroplan-
Pueric 2005;18:62–8.
[4] Montagliani L, Duverger V. Les tumeurs desmoïdes. J Chir 2008;145 ing on a wakeboard behind a motorboat while being tethered to
–
(1):20 6. a tow cable [1,2]. Briefly, the riders have their foot attached
[5] Mignot L. Les tumeurs desmoïdes. In: Orphanet encyclopédie; 2002.
permanently to the wakeboard and perform various tricks, spin
[6] Cotte E, Glehen O, Monneuse O, Cotton F, Vignal J. Tumeurs desmoïdes
or flip over the wake of the boat, on ramps or on railings [1]. The
associées à la polypose adénomateuse familiale. Gastroenterol Clin Biol
2004;28:574–81. overall incidence of wakeboarding injuries was estimated to 1.3
[7] Bernard J, Le Breton C, Piriou P, Khalil A, Boumenir Z, Cortez A, et al. per 100,000 in 2007 [2] and has been rising yearly since 2000
Apport de l'IRM dans l'étude des fibromatoses desmoïdes extra-abdomi-
[2]. Adolescents and young adults are mainly at risk [2]. Injuries
nales. J Radiol 2002;83:711–6.
[8] Schlemmer M. Desmoid tumors and deep fibromatoses. Hematol Oncol
Clin North Am 2005;19:565–71.
[9] Douira-Khomsi W, Mascard E, Adamsbaum C. Une masse pariétale
lombaire chez un enfant. Arch Pediatr 2009;16:1295–7.
[10] Sherman NE, Romsdahl M, Evans H, Zagars G, Oswald MJ. Desmoid
tumors: a twenty year radiotherapy experience. Int J Radiother Oncol Biol
Phys 1990;19:37–40.
[11] Nakayama T, Tsuboyama T, Toghuchida J, Hosaka T, Nakamura T. Natural
course of desmoid-type fibromatosis. J Orthop Sci 2008;13:51–5.
Hakim Elkaoui, Ahmed Bounaim, Abdelmounaim Ait Ali, Aziz Zentar,
Khalid Sair
Hôpital militaire d'instruction Mohamed V, service de chirurgie viscérale
I, Hay Riad, 10100 Rabat, Maroc
Correspondance : Hakim Elkaoui, hôpital militaire d'instruction
Mohamed V, service de chirurgie viscérale I, Hay Riad, 10100 Rabat, Maroc
Reçu le 19 janvier 2016
Accepté le 22 février 2016
Disponible sur internet le : 7 avril 2016 Figure 1
http://dx.doi.org/10.1016/j.lpm.2016.02.022
© 2016 Elsevier Masson SAS. Tous droits réservés. Severe lacerations of the neck
8 540 tome 45 > n 5 > mai 2016
Lettres à la rédaction
injuries with the use of protective garments (helmets, collars)
and participants' education. Besides, cableways' organizers and
owners should avoid overcrowding. With the speed, any taut
cable can become potentially lethal.
Disclosure of interest: the authors declare that they have no competing interest.
References Lettres à la rédaction
[1] Carson Jr WG. Wakeboarding injuries. Am J Sports Med 2004;32:164–73.
[2] Baker JI, Griffin R, Brauneis PF, Rue LW, 3rd, McGwin Jr G. A comparison of
wakeboard-, water skiing-, and tubing-related injuries in the United
States, 2000–2007. J Sports Sci Med 2010;9:92–7.
[3] Hostetler SG, Hostetler TL, Smith GA, Xiang H. Characteristics of water
Figure 2
skiing-related and wakeboarding-related injuries treated in emergency
Post cicatricial pigmentation several months after departments in the United States, 2001–2003. Am J Sports Med
2005;33:1065–70.
[4] https://en.wikipedia.org/wiki/Cable_skiing, [accessed 30.11.2015].
[5] Tlougan BE, Podjasek JO, Adams BB. Aquatic sports dermatoses: part 3.
are usually related to direct or twisting contact with the water
On the water. Int J Dermatol 2010;49:1111–20.
responsible for a brutal deceleration of the wakeboarder [1].
[6] Navon SE. Facial trauma from a snapped-back water ski towbar. J Trauma
They include mainly lacerations of the head and neck [2,3] but 1998;44:926–7.
also concussions, ligament tears, sprains, dislocations and frac- [7] Knobloch K, Gohritz A, Altintas MA, Spies M, Vogt PM. A wakeboarding
injury presented as acute carpal syndrome and median nerve contusion
tures [1,2]. Lethal cases are exceptional, but fatal subdural
after wrist strangulation: a case report. Cases J 2009;2:100.
hematoma after hitting the water has been reported [1]. Cable
[8] Woodacre T, Marshall M. Traumatic hand amputation while wakeboard-
skiing is an additional way to practice waterskiing/wakeboard- ing. BMJ Case Rep 2011;3:2011 [pii: bcr0320114044].
ing, during which the skier's rope and handle are pulled by an
electrically driven cable and not a motorboat [4]. With a main
1 2
Nicolas Kluger , Marie-Hélène Jegou
cable of 800 meters long, 10 riders can wakeboard at the same
1
University of Helsinki, Helsinki University Central Hospital, Department
time and the speed of the cable is approximately 31 km/h [4].
of Dermatology, Meilahdentie 2, PO Box 160, 00029 Hus, Finland
2
We could not find similar report in the literature. The head and Cabinet de dermatologie, 8, rue Jules-Ferry, 33290 Blanquefort, France
neck is the most commonly injured area during wakeboarding Correspondence: Nicolas Kluger, Helsinki University Central Hospital,
Department of Dermatology, Meilahdentie 2, PO Box 160, 00029 HUS,
(28% to 48% of the injuries) [2,3]. Lacerations are the most
Finland
frequent complication, accounting for a third of all injuries [3]. [email protected]
The head and neck area represents up to 60% of them [2,3].
Received 25 December 2015
Lacerations could be related to the rope, the wakeboard itself or Accepted 25 January 2016
Available online: 25 March 2016
water debris [3]. Rope injuries during water skiing occur when
http://dx.doi.org/10.1016/j.lpm.2016.01.034
inexperienced water-skiers rise from a stationary sitting position
© 2016 Elsevier Masson SAS. All rights reserved.
in the water or when they fail to release the handle when falling
backwards into the water [5]. Eye injuries have been reported by
hitting the tow bar [6]. Rope strangulations have been reported
while wakeboarding. A case of median nerve compression after "Honeycomb'' sign
a wrist strangulation prompted a delayed surgical decompres-
sion and hematoma evacuation [7], while a dramatic case of Image en « rayon de miel »
hand amputation was reported in a 55 year old wakeboard
instructor as the tow cable became wrapped around the
patient's wrist before the towing jet-ski started [8]. A 35 year old woman was referred with a right peripheral facial
Here, we report another unexpected mechanism of laceration as nerve paresis, which progressed to complete paralysis over a
it happened during cable skiing. Hopefully, our patient had the few years. There were no complaints of associated hearing loss,
reflex to pull himself out of the cable in a situation that could headache, dizziness or otalgia.
have become life-threatening with strangulation and/or CT imaging revealed a broadening of the dimple geniculate
drowning. ganglion, bone erosion realizing honeycomb appearance. We
Wakeboard can be associated with unexpected severe compli- also note the presence of micro-calcifications of low density
fi
cations. Prevention is the key to decrease the risk of severe ( gures 1 and 2).
8 tome 45 > n 5 > mai 2016 541