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

Pseudotumoral form of soft-tissue tuberculosis of the wrist

Tuberculosis is a major public health problem in developing countries. Hand and wrist is a rare localization for extra-pulmonary tuberculosis, a pseudotumoral form of soft tissue tuberculosis of the wrist is exceptional. We report the case of a 45-year-old male presenting with a painful swelling of the dorsal aspect of the right wrist evolving for six months. Clinical study was evoking a ganglion cyst of the wrist. Intraoperatively a pseudotumoral mass with rice bodies was found, suggesting tuberculous tenosynovitis. The histopathological study revealed caseating giant cell granulomas with epithelioid cells. Cultures on Lowenstein-Jensen medium detected Mycobacterium tuberculosis. Synovectomy with removal of all the rice bodies followed by anti-tuberculous chemotherapy provided uneventful recovery

Technique and indications of elbowarthroscopy: a twelve-cases report

Describe the technique of the elbow arthroscopy and discuss their indications through a series of 12 cases and a review of the literature. We report a retrospective study of a short series of 12 cases of elbow arthroscopy performed on 4 years. The indications of this technique were loose bodies in 7 cases, parcellar displaced fracture of radial head in 3 cases, fracture of coronoid process in one case and osseous impingement in one case. We have noted no complications and at a mean follow up of 18 months [6 to 40 months] our results were almost satisfactory. Elbow arthroscopy is an effective but delicate technique. Its indications are not frequent. They are dominated by loose bodies

[Diagnosis and treatment of brodie's abcess in adults: about twenty cases]

Background: Brodie's abscess is a bone abscess described as a localized primary purulent collection with sclerotic wall. Since the first report of Sir Benjamin Brodie in 1832, many papers described different clinical and treatment aspects. Pathogeny and therapy still remain not clearly elucidated

Aim: The aim of our study is to describe clinical aspect and to study the result of treatment including surgery and antibiotics

Methods: Our study is retrospective including 20 patients admitted to the author's institution for isolated bone abscess. The mean age of these patients is 30 years old [14 up to 46 years] with male predominance. Symptoms were chronic including localized pain with no systemic illness. The erythrocyte sedimentation rate was elevated in 2/3 of the cases. Roentegenogram was typical in 18 cases showing metaphysic cyst with sclerotic wall. Tibia was the most involved bone, 14 among 20 cases. Bacteriological study of the abscess pus isolated staphylococcus in 12 cases and pseudomonas in two cases. No organism was identified in the six remaining cases. Histopathological study showed chronic osteomyelitis with granulation including lymphocytes and plasma cells in all cases. Surgery and antibiotics were adequate for treatment in all cases. Our approach consisted in curettage without primary skin closure, cast immobilisation and antibiotics

Results: Our patients were followed up over a median period of six years [8 months to 10 years]. Overall, the results of treatment were good and in the long-term the abscess disappeared in all cases without recurrence. The erythrocyte sedimentation rate was normalized in 10 weeks and roentegenologically, the abscess disappeared progressively without oesteomyelitis complication

Conclusion: According to our study, we believe that surgical treatment based on total excision of the bone collection and the sclerotic wall is the best method of therapy. As a matter of fact, healing was obtained without grafting in all cases and in the long-term follow up, abscess disappeared without recurrence and fistulisation

Arthroscopy of the shoulder technics and indications. about 64 cases

Arthroscopic surgery replaced at present more and more conventional articular surgery because its anatomic character, its less morbidity and its more simple post-poerative care. After knee, the shoulder is considere as the articulation witch benefit of the progress of arthroscopic technics. Autors reported their experience in shoulder arthroscopy witch is introduced in the service since 1999. The gol of this study is to describe the technic of the shoulder arthroscopy and to precise its main indications

Results of unicondylar femoral fractures: a review of 28 patients

Unicondylar femoral fractures are rare. They form a particular entity of the femoral lower extremity fractures. The purpose of this work was to evaluate the anatomical and functional results of unicondylar femoral fractures on pain, mobility, walking and stability of the knee. We reviewed, retrospectively, 28 patients presenting unicondylar femoral fracture. There were 19 men and 9 women, with average age of 54 years [22 - 87 years], victims essentially of domestic accident. The fracture was alone in 65% of cases. According to Nordin's classification, the fracture was of type I in 3% of cases, type II in 35% of cases, type III in 20% of cases and type IV in 42% of cases. Twenty five patients had a surgical treatment after a median period of 7 days post-accident, 3 patients were treated orthopedically. After 3 years follow up, results were noted according to MEGY's score which takes into account walking, mobility, pain and the stability. Clinically, we noted 26 good and very good results and 2 moderate results. Anatomically, we obtained 75% of satisfactory reductions. Unicondylar femoral fractures remain rare. It is important to recognize them and to make the exact diagnosis of their type. Surgical treatment exposes old subjects to risk of dismantling anatomical osteosynthesis because of osteoporoses

[Use of Hoffman external fixation for extra-articular upper metaphyseal tibial fractures]

Treatment of extra-articular upper metaphyseal tibial fractures can be difficult. Orthopedic treatment is frequently complicated by second displacement. These fractures are inappropriate for locked intra-medullary nailing because of the shorteness of the proximal extremity. Damages of soft tissues, frequently associated with these factures, expose internal osteosynthesis to many risks. For these reasons, we opted for external fixation. Our study was a retrospective analysis of 46 extra-articular metaphyseal tibial fractures treated by external fixation with Hoffman material. The average follow-up was 24 months. Consolidation was obtained within 4 months in average. Septic complications, inherent to the method were uncommon or minor. Functional results were satisfactory in 84% of cases. So, external fixation with Hoffman material, with particular recommendations, is a promising method for the treatment of extra-articular of proximal metaphyseal tibial fractures

[ results of anterior cruciate ligament reconstrution by bone - patellar tendon - bone technique. a series of 40 cases]

We reviewed retrospectively 40 patients treated surgically for rupture of anterior cruciate ligament. The technique used was arthroscopy bone patellar tendon reconstruction. The mean age of patients was 27 years. The operative delay was 27.2 months in average. Functional and anatomic result was evaluated with a mean follow up of 24 months. 80% of patients were classified IKDC A or B. Sports activity was resumed after 6.6 months in average. Results depented meniscus lesions and operative delay. Reconstruction of anterior cruciate ligament with bone patellar tendon bone is a reliable technique. Operative delay should be as short as possible to prevent meniscus lesion and aggravation of laxity