[Malignant nerve tumors about 8 cases]

Malignant nerve tumors, currently called malignant peripheral nerve sheath tumors, are uncommun, and represent less than 10 percent of adult soft tissues sarcomas. The authors report in this article a series of 8 cases of malignant nerve tumors and propose an epidemiologic, diagnostic, therapeutic study and the outcome of these tumors

[Surgical treatment of the rheumatoid forefoot about 18 cases]

Forefoot deformity in rheumatoid arthritis is a common occurrence leading to significant disability and impingement. Surgical options are frequently used to correct these deformities. The purpose of the present, retrospective study is to report our experience in surgical treatment of the rheumatoid forefoot: forefoot reconstruction with first metatarsophalangeal arthrodesis first metatarsal osteotomy and lesser metatarsal head resection performed on 18 patients. After surgery the results were good 14/17 patients were without pain during weight bearing and were able to wear casual shoes. Three patients were suffering from persistent pain. The average angle of the fused hallux was 19 2°. This surgical procedure is simple and efficient at the same time allowing a good correction of the rheumatoid deformity and respecting the concept of united family forefoot

[ importance of barb wire in surgical treatment of mallet finger a study of 12 cases]

The authors report a series of 12 cases of mallet finger treated surgically by steel wire of barb-wire, all the patients were men with an average age of 32 years and the injury occurs basically in the little finger of the dominant hand. The patients were examined again about 2 years later on average. The results were good in 11 cases with recuperation of complete joint motion, a neuro algodystrophic syndrome with joint stiffness had been noted in one neurotonic patient. No complications such as infection or skin necrosis nor deformity or trophic or dysesthesia trouble had been noted

[ importance of pediculous latissimus dorsi flap in reconstructive surgery about 44 cases]

The authors present a series of 44 cases of pediculous latissimus flaps operated these last ten years at Sahloul Hospital Sousse. They insist on the vascular reliability of this flap and on the importance of its rotation arch for covering the lost of cutaneous substances of the cervico-thoraco-brachial area

[ wrist dorso radial flap about 10 cases]

The wrist dorso-radial flap is another procedure to cover the hand defects. The authors report a series of 10 patients in whom we performed wrist dorsoradial flap. The operative technique, application and results of the use of this flap are described with reference to our clinical series. Various methods of applications to hand reconstruction are described along with a discussion of the various advantages and disadvantages

[Treatment od dorsal fracture dislocation of the proximal interphalangeal joint with arthrodesis technic: about 19 cases]

Trojan fracture is an unstable lesion which associate an anterior marginal fracture of the second phalanx base and a dorsal dislocation of the first interphalangeal joint under the influence of the extensor traction. The instability of this lesion is more important when the anterior marginal fragment is big. Various techniques were described, we report our experience using the arthrorise's technique to treat this lesion. The procedure associate a reduction of the fracture and the dislocation using a dorsal pinning. This procedure is simple and allows an early physiotherapy, important for this joint. We used this procedure in 19 Trojan fractures between 1995 and 2002 awl at 3 years follow-up our results based on functional, clinical and radiological criteria were satisfactory

[Lipoma of the hand a study about 15 cases]

The lipoma are a fat tumors which are rare in the hand they can be lonely or take part of diffuse lipomatose. The physical examination is discerning of the other benign tumors by the "ice cube test" which is reliable and cheap. The treatment consist in surgical excision of all the tumor. Our work is based on retrospective study of 15 cases of hand ilpoma. The analysis shows that lipoma was more frequent in male, the avenge age was 40 years, the dominant hand was morely affected and the anatomopathologic analysis confirmed the diagnostic in all cases. None occurrence was happened after the excision of the tumor

[ traumatic dislocation of the trapezio metacarpal joint about 5 cases]

The high voltage electrical bums cause an exceedingly high rate of morbidity resulting from the massive necrosis of deeper structures often necessitating major limb amputations. The authors report two rare cases of high voltage electrical burns occurring accidentally with a 49 and 19 year old men after an indirect contact with a high voltage line. These high voltage electrical burns caused massive necrosis and extended necrosis m the upper limb requiring the recourse to a disarticulation the shoulder. The indications and the operative techniques used are discussed

[Desmoid tumor of shoulder-Girdle]

Desmoid tumour is an uncommon connective tissue tumour arising from musculoaponevrotic tissue characterized by spindle cell fibroblast and myofibroblast proliferation. Although considered as a benign lesion, it can be very aggressive locally, and has a high rate of local recurrences afer surgical excision. The cause is unknown and it most often encountered in young women. Abdominal localization is the most frequent site. Extra-abdominal desmoid tumors particularly located in the girdles or the most proximal part of the limbs. We report a case of a 31 year old woman with desmoid with tumour of the scapular region which was treated with wide excision, but in the following year the tumour reccured locally of the shoulder-girdle and infiltrated into the brachial plexus. Nevertheless, surgical treatment of recurrent tumors is difficult and often insufficient, compromising functional outcome. Radiotherapy has been advocated for better control tumor growth

main de toupie aspect medico legal

The hand is frequently exposed to professional risks. It is offen the target of accident during non protected work on a topia and many complex and grave lesions can be caused. The authors report a serie of 280 cases of topary hand treated in private and hospital sectors. The purpose of our work is is on the hand to insist on the frequency of topiary work accidents and on the other hand to make people of the importance of applying preventive measures in orde to protect man by reducing professional risks