[Compartmental syndrome in a traumatized patient under VKA a case report]

Oral anticoagurlation inducing bleeding is a worrying problem because of its frequency and potential gravity. The major determinants of haemorrhage are drug interactions and patient characteristics such as heredity, kind of food and age. Authors report the case of a 76 years old diabetic man with a history of atrial fibrillation treated by vitamin K antagonists [VKA] for more than two years. He presented with a compartmental syndrome of the upper right limb consecutive to a trauma that had been treated by nonsteroidal anti-inflammatory [NSAI] drugs. So he was admitted in an intensive care unit, the NSAI drugs were interrupted and the VKA substituted by low-molecular-weight heparin, while the affected limb was elevated and the patient prepared for operation. But a prolonged prothrombin time [Fr], along with the patient's delayed presentation, were reasons to delay surgery. Course was unusually favourable, nerve suffering signs disappeared and resorption of haematoma was noted. Authors remind in this paper the high risks of drug interactions VKA-NSAI, which can lead to a compartmental syndrome. They also remind the indications of surgical decompression depending on the time of presentation

[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

[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

[ sural flap: a study of 16 cases]

The sural flap is a fasciocutaneous flip pediculed on the sural nerve artery. This flap represent a good solution to cover soft tissue defects of the distal lower limb and proximal foot. 16 patients with age ranging from 12 to 45 years and with soft tissue defects of the lower leg due to various causes were treated with sural flap. On this basis we would like to reintroduce the safe and reliable use of the swat flap to treat large soft tissue defects of the distal lower limb and the proximal foot which sometimes is the only solution to cover those regions

[ chinese flap about 26 cases]

The chinese flap, alsow called antebrachial radial flap is a fascio-cutaneous flap based on the radial artery. Since the description, it opened indisputably a new chapter in plastic surgery. Through a series of 26 cases realized in our service of which 24 pediculed and 2 free flaps, we ware able to confirm it's reliability, and we studied its advantages and the inconveniences. It's a quite simple flap who can gives a good quality of skin supple and thick. The principal inconvenient is that it scarify a main artery of the hand, that is why, we have to think about it before potting its indication, although we had no complication inherent to this taking. The zone donor always keeps an unaesthetic scar at the level of the fore arm; and consequently the indication at the woman most be studied well I Finally to hairy subjects this flap must be avoided in certain locations such as the palm of th hand and the face

[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

[Erysipelas at the upper limb about 3 cases]

Erysipelas is an acute bacterial infection of the dermis and hypodermis generally caused by streptococcus. This affection is rare at the upper limb. The authors report the observation of three patients of the 4[th] and the 7[th] decade presenting an erysipelas at the upper limb having evolved favorably under antibiotic treatment and hospitalisation in two cases. The erysipelas is of clinical diagnosis basing on general and local signs. The portal of entry must be always looked for and treated. It represents with the diabetes, the obesity and the lymphedema a factor of gravity of this pathology

[ 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

[Quel est votre diagnostic?: Devant une ulceration du lit de l'ongle de l'index?. [Cell carcinoma of the nail bed]

Squamous Cell Carcinoma of the nail bed is rare, about 150 cases are reported in the literature. We present one case revealed after one year of evolution. It presented as an ulceration associated to an onycholysis. Because of this delayed diagnosis, amputation of the whole finger was needed