Place of the reposition flap in the treatment of distal amputations of the fingers / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Distal finger amputations pose a therapeutic problem with the distal fragment quality. Reimplantation remains the reference treatment for functional and aesthetic recovery of the hand. The interest of this study is to propose the reposition flap as an alternative to different hedging techniques in the proximal stump, in many situations where revascularization is impossible. It consists in osteosynthesis of the bone fragment and its coverage by a pedicled local flap.</p><p><b>METHODS</b>The technique of reposition flap was evaluated retrospectively between 2003 and 2016 through a study of 13 patients compiled in Nabeul orthopedic department. For each patient, the sensitivity, the pulp trophicity, the interphalangeal mobility, the digital length, the appearance of the nail and radiological consolidation were evaluated.</p><p><b>RESULTS</b>The reposition flap keeps more than 80% of the length of p3. This procedure improves nail aesthetics in comparison with the regularizations. There is no significant difference in sensitivity of the pulp or of the mobility of the distal inter-phalangeal (DIP) joint as a function of the technique studied. However there is a significant difference in average test of the Quick Dash (350 against 500 for regularizations).</p><p><b>CONCLUSION</b>The reposition flap seems to be a good alternative to regularization in the context of trans-p3 fingers amputations, in which the distal fragment is not revascularizable. It allows better aesthetic and functional results.</p>

An exceptional location of tuberculous arthritis: The metatarsal phalangeal joint

Osteoarticular tuberculosis is a rare type of tuberculosis. The spine is the most frequent location, while peripheral locations in the limbs are rare. We report a case of tuberculous osteoarthritis of the metatarsophalangeal joint of the first ray of the foot in a 48-year-old woman

The patient presented with painful swelling of the dorsum of the big toe, insidiously evolving for 6 months. Diagnosis was obtained with histological study after surgical biopsy. Antitubercular chemotherapy for 12 months promoted healing

Through this clinical case the authors describe the epidemiological, diagnostic features, and treatment of osteoarticular tuberculosis and discuss the causes of delayed diagnosis often encountered in these exceptional locations and differential diagnoses, gout in particular, for this particular case

Intraosseous ganglion cyst of the lunate: A case report / 中华创伤杂志(英文版)

Intraosseous ganglion cyst of the carpal bones represents a rare cause of wrist pain. We report a case of a 42 year-old, right-handed female, who presented with pain of the right wrist following a fall on the palm of the hand. Clinical study revealed a moderate swelling over the mid-section of the palmar face and pain through extreme ranges of motion of the wrist. Plain radiographs and CT-scan of the wrist have revealed an intraosseous ganglion cyst of the lunate bone. Curetting-filling by Kuhlman's vascularized radial bone graft allowed a good functional recovery. The clinical, radiological and therapeutic aspects are discussed.

rare localization of tuberculosis of the wrist: the scapholunate joint

The tuberculosis of the hand and the wrist is a rare entity. Affecting the scapholunate joint is exceptional. It is usually diagnosed at an advanced stage of carpal destruction, due to slowly development of the symptoms. We report the case of a 58-year-old female, presenting as wrist pain for 3 months. Clinical study showed a local swelling in the left wrist, the mobility of the wrist was normal but painful at the end of motion. The diagnosis of osteoarticular tuberculosis was suspected after radiological and biological study then confirmed after histological study. Antibacillary chemotherapy during 12 months promoted healing and good outcome

Osteoarticular tuberculosis dactylitis: four cases

Tuberculosis dactylitis is exceptional. We report 4 cases of osteoarticular tuberculous dactylitis in 3 women and 1 man. The diagnosis was suspected on chronic and insidious clinical presentation, and confirmed by histology. Patients were treated by anti-tubercular drugs with good functional and radiological outcome in all cases. Clinical and therapeutic issues are discussed by the authors in the context of an endemic country

Tuberculous flexor tenosynovitis of the hand

Tuberculosis is a major public health problem in developing countries. Flexor tenosynovitis of the fingers constitutes an exceptional tuberculosis localization [Gabl et al., 1997; Senda et al., 2011] [1,2]. Unusual presentations, such as tuberculous tenosynovitis, often go undetected and are associated with a diagnostic and therapeutic delay, especially when bacteriological research proves to be negative. Here, we report a case of tuberculous flexor tenosynovitis of the hand

Fournier's gangrene: what are the prognostic factors? Our experience with 40 patients

Fournier's gangrene [FG] is a serious, extensive fulminant infection of the genitals and perineum. Indeed, despite antibiotics and aggressive debridement, the mortality rate of FG remains high. Through our experience, we intent to identify effective factors in the survival of patients with FG and we try to determine how the Fournier's gangrene severity index score [FGSIS] is accurate. Between 1995 and 2010, 40 patients with Fournier's gangrene were treated in our institution. All of them were treated with broad spectrum triple antimicrobial therapy, broad debridement and exhaustive cleaning. Then they underwent skin grafts or delayed closure as needed. Data were collected on demographics, medical history, predisposing factors of FG, etiological infection agents, admission signs and symptoms, physical examination, admission laboratory studies and bacteriology. Timing and degree of surgical debridement as well as outcomes were also reviewed. The extent of disease was calculated from body surface area nomograms. All the 40 patients included in this study were males; their mean age was 52,75 years [21-75 years]. Twelve patients [30%] had FG secondary to anorectal pathological conditions. No etiologic factors of FG were found in 6 patients [15%]. Diabetes mellitus as predisposing factor was found in 13 patients [32.5%]. The mean hospital stay was 8.72 days [range, 3 to 30]. All the patients underwent surgical debridement. Orchidectomy was done in 7 cases [17.5%]. Skin grafts were applied to 6 patients [15%] and the remaining wounds, once cleaned, were approximated. The overall mortality rate was 17.5% [7 patients] due to severe metabolic acidosis in relation to diabetic decompensation and sepsis. We individualized two groups: those who died [n = 7] and those who survived [n = 33]. We evaluated the admission laboratory parameters that are significantly correlated with outcome included hematocrit [p=0.003] and serum sodium [p=0.05]. The extent of body surface area involved among patients who died was not found significantly different statistically between the two groups [4.07% and 3,14%, p=0,4]. The mean FGSIS [without counting bicarbonate serum level] for survivors was 9.1 compared with 6,8 for non-survivors [p=0.16]. FG is a rapidly progressive, fulminant infection's condition. Hematocrit and serum sodium levels were found to be the only prognostic factors. It doesn't seem that the FGSIS has a prognostic value

Hand enchondroma review of twenty five cases

Enchondroma is the most common benign bone tumor of the hand. It may present as painless swelling or after pathological fracture, and has a typical radiographic appearance. Diagnosis of benignity is proved histologically after complete removal of the tumor, and the resultant cavity is ideally filled with autologous cancellous bone. Other techniques include curettage and filling the cavity with cancellous allograft or bone substitutes, or even curettage alone. All these techniques aim to remove definitively the tumor, with less morbidity and recovery of optimal function to the hand. A series of twenty five adults is reported retrospectively, with a majority of male labourers presenting in almost all cases with painless tumors, or pathological fractures. The average age was 41 years. The middle phalanx was the most common involved site, and the diagnosis was strongly suspected with plain radiographs. Treatment consisted in immobilization, followed by tumor curettage and grafting the lacuna with autologous bone chips. No post-operative complications were recorded. The average follow-up period was 34 months. The majority of patients recovered a full active range of motion. Plain radiographs showed bone healing in all cases, and no degeneration neither recurrence was recorded. As a conclusion, the strategy consisting in tumor curettage followed by cancellous bone grafting achieved excellent clinical and radiological results

Glomus tumours of the hand. about 10 cases

The glomus tumour is a rare benign cutaneous tumour, it is characterized by its clinical and evolutive particular features. The aim of this work is to bring out the various characteristics of the glomus tumours of the hand which remain relatively ignored by practioners. The authors report a series of 10 cases of glomus tumours of the hand, the mean age at the moment of diagnosis was 36 years with a female prevalence of 70% of the cases. The diagnosis delay average was 2 years and half. The tumour was located on the right side in 6 cases and on the left one in 4 cases. The glomus tumour was developed under the nail in 8 cases and was latero pulpar in the both other cases. The diagnosis of glomus tumour was clinical in front of the existence of the three painful symptoms: spontaneous pain, pain on the cold and pain on the pressure. An RMI complement was carried out for two patients having no univocal symptomatology what made possible to confirm the diagnosis and to locate the tumour. A surgical biopsy of the tumour was performed for all patients. The histological study confirmed our clinical and per operational presumptions and showed a glomus tumour. After one year and two months of average retreat, our patients announced a spectacular transformation of their daily activities because of the disappearance of painful symptomatology, two cases of nail dystrophia were noted and there was no recurrence. The glomus tumour are rare benign cutaneous tumours, its diagnostic is essentially clinical and the treatment is exclusively surgical

[ sacrified of sacrifice day]

This prospective study was carried out in the plastic and reconstructive surgery department of Kassab's hospital in Tunis and the hospital of Monastir [Tunisa] during the sacrifice day [Aid el kebir]. The study involved 50 patients. Our purpose was to identify the injuries of the hand occurring during this religions festival. The average age of patients was 39 years with sex ratio of 1.17. All socials and occupational sectors were affected. The lesions concern the dorsal face of non dominant hand [72%] with a peak in the frequency for the thumb [40%] and the index [37%]. Extensor system of the radial finger on the non dominant hand was the main delicate element which is most exposed during such festival. The thumb is being worthy of special mention, for it is the most serious lesions [amputation 10%]. The lesions of flexor tendons are generally associated with nerve and vascular injury. 46% of patients had to undergo surgery

Pathomimie au membre superieur

Pathomimia,or factitious disorders, are characterized by producing symptoms voluntarily with the intention of playing the role of the patient. Inspite of being considered as a psychiatric disorder, pathomimia is often encountered in the daily professional life of doctors without being recognized or diagnosed. There are various clinical aspects of pathomimia. The items that decide the orientation of the diagnosis are essentially the uncommon and odd expression of the reported symptoms. A capricious evolution as well as the multiplicity of the past medical cases. We report a group of five patients who were followed and treated between the years 2000 and 2003. This group was composed of three men and two women with an average age of 30 years. In three cases, we found the notion of skin injury. In one case, we noted a median nerve lesion in the elbow and once in the right upper member. The evolution was performed towards recidives of the initial symptomatology with more or less long periods of improvements

[About a short series of Swanson arthroplasty]

The authors report a series of 12 patients who underwent digital arthroplasty using a Swanson implant. Six patients had the sequellae of an injured hand, and the other six patients had rheumatoid arthritis. The majority of patients were men with an average age of 33 years. The patients were examined again about 4 years later on average. The lateral stability of the operated finger was considered to be satisfactory in 11 cases. The mean movement gain was 40. There was no sign of silicone particle synovitis, because it was fixed arthroplasty