Dupuytren's disease involving Guyon's canal.

Ectopic localization of Dupuytren's contracture is extremely rare. To the best of our knowledge, there have been only six cases reported in the literature. The authors present a case with Dupuytren's contracture involving Guyon's canal where the patient had limited wrist range of motion and ulnar neuropathy.

[Osteosynthesis of fractures of thr proximal end of the humerus by the screw-pin technique]. / L'ostéosynthèse des fractures de l'extrémité supérieure de l'humérus selon la technique des vis broches.

Both fascicular pinning as described by Appril and palmate pinning are inconvenient in that the pins can perforate the articular cartilage of the humeral head and provoke premature unpinning because of insufficient fixing in an osteoporotic bone. A new osteosynthesis material has been developed to reduce these inconveniences: the screw-pin. This ensures initial stability in the humeral head and allows immediate postoperative re-education of displaced fractures of the upper end of humerus. Results are presented of the use of this new material since 1988 in 26 fractures of upper end of humerus.

[Ballistic hand trauma]. / Traumatismes des mains par agents balistiques.

46 victims of projectile accidents or explosions were treated over a 5 years period between 1984 and 1989. 3 categories were distinguished: injuries due to a single projectile (12 cases), only inducing serious bone damage and, apart from 3 immediate amputations, the final result was satisfactory. Injuries due to multiple scattered projectiles (11 cases), less severe in terms of the initial lesions, not requiring any amputations, with good results in 8 cases. Explosion injuries (23 cases) in which the effect of the explosion induced considerable initial lesions leading to one hand amputation and 33 finger amputations; the association of skeletal and soft tissue lesions raises the problem of excision and primary cover, requiring large flaps. The course is long and 8 out of 26 hands had serious sequelae, while the reconstruction of an elementary pinch can be considered to be an acceptable result in the other cases.

[Comparative study of the effects of a local antibiotic and a local antiseptic in emergency hand surgery]. / Etude comparée des effets d'un antibiotique et d'un antiseptique locaux en chirurgie d'urgence de la main. Etude contrôlée portant sur 223 patients.

An open randomised comparative study was conducted in patients presenting with a hand injury requiring a surgical operation, in order to compare the efficacy of topical application of rifamycin SV with that of iodinated polyvidone dermal solution, in terms of the quality and rate of healing evaluated by the clinician, 268 patients were included in the study and 223 of them participated in the analysis of the results. Analysis of the results demonstrated the following conclusions: signs of infection developed in 8 patients in the rifamycin SV group (7%) and in 20 patients in the iodinated polyvidone group (18.5%). This difference was significant (p = 0.011) in favour of rifamycin SV. The rate of healing was considered to be rapid in 10% of patients in the rifamycin SV group and in 4% of patients in the iodinated polyvidone group. It was considered to be slow in 14% of the subjects in the rifamycin SV group and in 21% of those in the iodinated polyvidone group. This difference was also significant in favour of the rifamycin SV group (p = 0.038). In terms of local tolerance, 32 patients equally distributed between the two treatment groups developed signs of cutaneous intolerance.

[Treatment of thumb arthrosis using Swanson's trapezial silicone implant]. / Traitement des rhizarthroses par implants de trapèze en silicone de Swanson.

Complications related to silicone implants have been widely described since 1985. As trapezial replacement with a silicone implant constitutes our preferred treatment for osteoarthritis of the base of the thumb, we decided to evaluate our results by means of a retrospective critical study. Fifty records of patients operated or between 1975 and 1980 constitute an homogeneous study group as all were operated according to the same technique and by the same surgeon. Seven cases of implant instability have led us to modify our fixation technique. The results in terms of mobility, stability and pain relief are good and comparable to other published series. Only two cases presented bony changes around the implant but they both existed before surgery. Our conclusion is that trapezial resection with replacement by a silicone implant can still be recommended as elective treatment for CMC thumb osteoarthritis because of its simplicity effectiveness and reversibility.

[Complex injuries of the upper end of the 2 forearm bones]. / Traumatismes complexes de l'extrémité supérieure des deux os de l'avant-bras.

Thirty-four cases of severe trauma to the proximal ends of both bones of the forearm have been seen. All were treated surgically. A classification is proposed related to the site of the ulnar fracture. Type I is metaphyseal and the displacement is posterior, the reverse of that of a Monteggia fracture, with a posterior dislocation of the superior radio-ulnar joint. Type II is epiphyseal with anterior displacement. The superior radio-ulnar joint is intact. Type III is metaphysio-epiphyseal with anterior displacement. Type IV is the same with posterior displacement. Fractures of the radial head are present in all cases with posterior displacement and in these types, secondary displacements and non-unions are frequent (six cases). These were related to inadequate fixation of the ulna and to resection of the radial head which led to an increased strain on the ulnar fracture. Severe limitation of movements was infrequent (five cases) and was usually seen in fractures with posterior displacement. It was related to the time of cast immobilization and to the fracture of the radial head. Fractures with anterior displacement and an associated fracture of the radial head were rare but had a better prognosis in spite of the intra-articular site of the fracture. The relevance of repair of the radial column is stressed as being as important as stable fixation of the ulnar fracture.

[Fractures of the trochanter region in elderly patients. A new solution (author's transl)]. / Les fractures de la région trochantérienne chez le vieillard. Une nouvelle approche.

A new solution to the problem of fractures of the trochanter region in elderly patients is based on an original anatomophysiological concept. A specific approach to the cervico-diaphyseal region has been developed which simplifies the introduction of a prosthesis supported by the diaphysis, by employing a sub-trochantirian osteotomy. The trochanter major is conserved, reset, and fixed solidly to the wing of the prosthesis by a large bolt, enabling regular rapid consolidation of the osteotomy and immediate stability, with the possibility of walking after several days and thus avoiding usual complications of prolonged decubitus. Results are comparable in every respect with those obtained using prostheses with cervical supports.

[Post-traumatic disinsertions of the terminal brachial biceps tendon. Surgical technique in five cases (author's transl)]. / Les désinsertions traumatiques du tendon terminal du biceps brachial. Au sujet de cinq observations illustrant une technique chirurgicale.

The many techniques proposed for repair of post-traumatic desinsertions of the terminal brachial biceps tendon well illustrate the therapeutic difficulties encountered when attempting to treat these lesions, none of them being currently unanimously employed. After describing these various operative methods, the authors discuss their technique, as used in five cases, this method allowing restauration of both flexion and supination of the muscle.