ABSTRACT
Some patients present at an advanced stage of their fingertip infection with an extension of the infection in anatomical spaces or into fragile structures. One hundred and twenty-five patients have been operated on for a finger infection. Forty-one patients (33%) have been treated at the "complication" stage, while 84 cases (67%) were considered "non-complicated". The delay between initial injury and the surgical treatment was 12 days in the "non-complicated" group versus 30 in the "complication" group (p < 0.001). Osteitis (39% of the complications), and flexor sheath infection (37%) were the most frequent complications. Prescribing preoperative antibiotics increases the risk of being in the "complicated" group at p = 0.09. One hundred and thirteen patients (90.4%) were cured of their infection after a single operation. Neither the cause of infection, nor the type of germ or associated diabetes increased the risk of complication in our series. A better education of the first interveners (general practitioner or emergency doctor) in hand infection care could reduce the rate of complication allowing a faster access to hand surgeons.
Subject(s)
Fingers , Hand , Anti-Bacterial Agents/therapeutic use , Humans , Iatrogenic Disease/epidemiologyABSTRACT
Although isolated distal radius and scaphoid fractures are common, the combination of both fractures is rare, with a reported frequency between 0.5% and 6%. This rarity is probably due to the fact that both fractures share the same injury mechanism. Published studies are limited, but most patients are males in their 40s and the injuries are typically due to high-energy trauma. In most studies, the distal radius fracture is displaced while the scaphoid fracture is not. Since the functional outcome depends of the severity of the radius fracture, we believe, as do others, that it is logical to fix both fractures with stable devices (i.e., screw fixation for the scaphoid, locking plate for the radius) to allow for early rehabilitation.
Subject(s)
Fracture Fixation, Internal , Fractures, Multiple/surgery , Radius Fractures/surgery , Scaphoid Bone/injuries , Adult , Age Factors , Fractures, Multiple/etiology , Humans , Male , Prognosis , Radius Fractures/etiology , Ulna Fractures/etiology , Wrist Injuries/etiologyABSTRACT
Fourty patients with limited carpal fusion have been retrospectively reviewed. The aim of this study was to compare the results of four bone fusions (30 wrists) versus capitolunate fusion (11 wrists). Follow-up averaged 30 months with a range of 15-96 months. Twelve patients presented SLAC-wrist (scapho-lunate advanced collapse) and fourteen with SNAC-wrist (sapho-non union advanced collapse). There were seven cases of primitive wrist arthritis, one mid-carpal instability, one sequella of Fenton's syndrome, one Preiser's disease and two Kienbock's disease. All 40 patients were evaluated by the same observer. In terms of range of motion, the capito-lunate fusion led to better results than the four bone fusions with a gain of 10 degrees in volar flexion and 12 degrees in radial deviation. Results in term of post operative pain are similar in the two groups of patients with 90% painless wrist in four bone fusion and 81% with capito-lunate fusion. Results for strength were equivalent. Radiological bone fusion was obtained within nine weeks. Absence of fusion was observed in two patients with capito-lunate fusion. Our result in terms of joint motion and strength are similar to those found in the literature. Correction or not of the DISI deformity during the procedure did not affect the results (on 19 patients). The Four bone fusion procedure is still a good treatment in SLAC or SNAC wrist. Capito-lunate fusion remains a good choice, despite the risk of non-fusion.
Subject(s)
Arthrodesis/methods , Carpal Bones/surgery , Osteoarthritis/surgery , Wrist/surgery , Adult , Aged , Carpal Bones/pathology , Female , Humans , Male , Middle Aged , Osteoarthritis/pathology , Pain , Range of Motion, Articular , Retrospective Studies , Treatment Outcome , Wrist/pathologyABSTRACT
Acute form of carpal tunnel syndrome is the less common presentation. Several etiologies are known as rheumatologic, hemopathic, endocrine or pregnant disorders and traumatic. Authors report a non yet described traumatic etiology, consecutive to hamate and triquetral fractures. Patient presented five hours after initial traumatism, a typical presentation of median nerve compression at wrist, with subjective and objective symptoms as pathologic Weber test. A classical median nerve release was performed in emergency. Nerve recuperation was complete two days after surgery, as usual in such pathology. This new etiology must be known; actually, nerve recuperation in acute carpal tunnel syndrome is time dependent.
Subject(s)
Carpal Tunnel Syndrome/etiology , Fractures, Closed/complications , Wrist Injuries/complications , Acute Disease , Adolescent , Carpal Tunnel Syndrome/pathology , Carpal Tunnel Syndrome/surgery , Humans , MaleABSTRACT
About one uncommon case of anterior perilunate fracture-dislocation, the authors show the interest of posterior approach of the wrist to treat all the lesions. The scaphoïd is screwing proximally to distally and a pin is used to stabilise the pyramidolunare articulation. The clinical results are good on motion, on strength; the lunate doesn't present necrosis on radiology at 4 years.
