The post-traumatic reconstruction of nail bed defects using a homodigital dorsal adipofascial reverse flap.

Nail bed defects (NBDs) of the distal phalanx, are common and remain challenging to reconstruct. This study aimed to evaluate the clinical outcome of these post-traumatic injuries treated using a homodigital dorsal adipofascial reverse flap (HDARF). Sixteen patients, averaging 43-years-old, were retrospectively reviewed, who underwent the aforementioned procedure from February 2018 to December 2019. Range of motion of the distal interphalangeal (DIP) joint, static Weber's 2-point discrimination sensibility of the pulp, the percentage of nail adherence, complications, patient's satisfaction, subsequent nail regrowth, and flap survival were evaluated upon follow-up. At 26 months average follow-up, the percentage of flap survival was 100%. Complete regrowth of the nail was reported in 11 cases (69%), on average 4.7 months after surgery. A total absence of ungual regrowth was noted in 5 cases (31%). The mean static Weber's 2-point discrimination value of injured finger was 4.25 mm, reconstructed fingers' mean range of motion for the DIP joint was 75 degrees. Patient satisfaction was graded as very satisfying in 11 cases (69%), satisfying in 4 cases (25%), and disappointing in 1 case (6%). The HDARF is a good alternative for the management of NBDs of fingers and thumb. It yielded functionally and aesthetically acceptable results with low donor site morbidity. LEVEL OF EVIDENCE: IV.

Treatment of defects in the tip and palmar surface of the fingers.

Defects on the palmar surface of the fingers are an important part of hand emergencies, especially fingertip wounds. Luckily, many coverage methods are available. We will review the anatomy of this area and the thought process for treating these defects. We will also propose an algorithm that can be used to select the best technique based on the type of injury present.

The TASERed finger: A new entity. Case report and review of literature.

The TASER(®) is a self-defense weapon whose use has now become commonplace among law enforcement agencies. Electronic control weapons were first used in the USA in the 1990s and then adopted in Europe and France. We report a case of an 18-year-old male who presented a penetrating lesion of the middle phalanx of the left index finger. To the best of our knowledge, this is the first complex finger injury due to the TASER(®). It highlights the potential major risks to finger vitality and function with use of this electrical weapon.

[Perilunate dislocations and fracture-dislocations of the wrist, a review of 17 cases]. / Luxations et fractures-luxations périlunaires du carpe, étude rétrospective d'une série de 17 cas.

INTRODUCTION: The authors present the results of a retrospective series of 17 cases of dislocations or perilunate fracture-dislocations of the carpus, treated in emergency (period of less than 7 days). The objective aim of our study was to evaluate the radioclinical fate prognosis of these lesions pathologies and their social commitment impact. PATIENTS AND METHODS: It is a retrospective study covering the period from July 2004 to December 2009 (or 54 months). Were included in the study, patients hospitalised for a pure dislocation or a perilunate fracture-dislocation authenticated confirmed by an x-ray postero-anterior and lateral views were included. The series included 15 men and two women, nine manual workers, with an average age of 38.9 years. Based on Herzberg radiological classification, the series included six pure perilunate dislocations (35%) and 11 fracture-dislocations (59%) including seven forms trans-scapho-perilunate and four fractures of the lower end of radius. On the profile x-ray, 16 of the lesions were posterior displacement, including 12 stages I lesions (lunatum in place under the radius), and four stage II (lunatum dislocated in front of the radius). A patient had an anterior dislocation stage II, associated with a radial styloid fracture. All patients were operated using surgical treatment, percutaneous, either open pit, or open approaches combining with broaching scapholunate, scaphocapitate and triquetrolunate pinning. Then, an immobilization for 6 weeks was put in place and was performed using a forearm cast. Rehabilitation began as early as the removal of osteosynthesis was done at pin removal. RESULTS: The average decline follow-up in the series was 26 months. The mean score of Cooney was 63/100. There were two excellent results, two good results, seven middle moderate results, and six bad results. The average Quick-DASH score was 24.6/55 and the PRWE 41/150. The average duration of the work stoppage leave was 8 months, including one retired. The average of flexion-extension arc of the traumatized side was 77% (101°) in comparison to the healthy side. The average strength of the traumatized side was 71% (34kg) in comparison with the healthy side. The average radial-ulnar tilt arc of the traumatized side was 67% (37°) in comparison with the healthy side. DISCUSSION: There is no formal radioclinical prognostic in the radioclinic correlation. However, it seems to emerge that the timing and the type of support treatment bear the most important prognostic guarantors of a better result factors. Perilunate fracture-dislocations have major arthrogeneous arthrogenic potential, yet with a despite functional outcome consistent allowing resumption of recovery of past previous activities. It would seem that perilunate fracture-dislocations have a better functional outcome than those of pure dislocations. Thus, this work is the beginning of a long-term study, including a larger number of patients.

[Immediate weight bearing after treatment of stable epiphysiolysis]. / La mise en charge postopératoire précoce après traitement par vissage des épiphysiolyses stables.

PURPOSE OF THE STUDY: The purpose of this study was to ascertain whether immediate weight bearing after surgery for chronic or stable epiphysiolysis treated with a single percutaneous screw increases the risk of greater displacement. MATERIAL AND METHODS: Epiphysiolysis procedures (n=30) performed in 25 patients were reviewed retrospectively. One percutaneous screw was inserted under fluoroscopic control in all cases. For ten patients (from 2002), weight bearing was allowed immediately after surgery. The Southwick grading system was applied to classify each epiphysiolysis into one of three stages according to the cervicoepiphyseal angle measured on the lateral radiograph. Clinical and radiographic controls were obtained in all children at 1, 3, 6, and 12 months. Outcome was assessed using the Heyman and Herndon criteria. RESULTS: The study population included 17 boys and 8 girls (mean age 12 years 18 months). The left side was involved in 12, the right in 8 and both in 5. Weight bearing was allowed immediately after surgery in 10 patients with a stable epiphysiolysis (4 stage I, 5 stage II, 2 stage III). Time to weight bearing was 3 months on average for the others. Mean follow-up was 4 years (range 1-8 years). Clinically, none of the ten patients presented pain or limping at last follow-up. Abduction was limiting in 9 and internal rotation in 19. There was no increase in the displacement for patients with immediate weight bearing. DISCUSSION: Most teams advise against weight bearing for 6 weeks to 3 months. We were unable to find any pathophysiological reason for this attitude. It would be more logical to wait until complete fusion of the subcapital growth cartilage before authorizing weight bearing. This raises the question of the effect of this practice on postoperative displacement For stable epiphysiolysis, there is no evidence that not allowing weight bearing had an effect on the evolution if the screw is correctly positioned and at least 4 or 5 spires are engaged within the epiphysis.