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1.
Bull Soc Pathol Exot ; 106(1): 9-12, 2013 Feb.
Article in French | MEDLINE | ID: mdl-23385788

ABSTRACT

Mycetoma is a rare disease in Morocco. The purpose of this work is to increase the awareness of this infection that is still not diagnosed in our context by Moroccan practitioners, as well as to show the medical treatment limits in Madura foot disease. This is a retrospective study of 15 patients with an average age of 34 years. All patients presented classic lesions: swelling fistulizing of slow evolution, with elective foot localization. In spite of the identification of pathogenic agents, the delay of diagnosis and the osseous infringement imposed amputations for 14 patients. After a 3-year follow-up, all patients with amputation had a good evolution with the help of adapted orthopedic equipment and psychological support. The delay of diagnosis and the advanced lesions of mycetoma in Morocco make the medical treatment ineffective. The recourse to leg amputation with suitable equipment is a simple alternative treatment that improves better social and professional reintegration. Mycetoma is characterized by an obvious delay of diagnosis. The forecast is worsened by the osseous infringement. Sometimes it can be dramatic and may lead to amputation.


Subject(s)
Mycetoma/epidemiology , Mycetoma/pathology , Adolescent , Adult , Cohort Studies , Delayed Diagnosis/statistics & numerical data , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Morocco/epidemiology , Mycetoma/therapy , Rare Diseases/diagnosis , Rare Diseases/epidemiology , Rare Diseases/pathology , Retrospective Studies , Young Adult
2.
Ann Chir Plast Esthet ; 58(3): 243-7, 2013 Jun.
Article in French | MEDLINE | ID: mdl-20880625

ABSTRACT

The authors reexamined the files of seven patients dealt with for intramuscular hemangioma of forearm. It concerns five women and two men, between 16 and 39 years old. The average time of consultation was 13 months. The clinical signs were dominated by the development of a generally painless soft mass over the anterior compartment of the forearm and/or the elbow. Two patients presented nervous lesions signs of the ulnar or median nerves. The feeder pedicle was the ulnar artery in five cases and radial artery in two cases. The excision was incomplete in two cases because of the invasion of the ulnar nerve by the hemangioma. With four years average follow-up, the five patients having undergone a complete excision do not present a recurrence and the hand function is excellent. The authors insist on the interest of a preoperative diagnosis with the IRM, which permits to envisage surgical difficulties due to the proximity of vascular and nervous pedicles.


Subject(s)
Forearm/surgery , Hemangioma/surgery , Muscle Neoplasms/surgery , Adolescent , Adult , Female , Hemangioma/pathology , Humans , Male , Muscle Neoplasms/pathology , Retrospective Studies , Young Adult
3.
Chir Main ; 27(4): 180-2, 2008 Sep.
Article in French | MEDLINE | ID: mdl-18757228

ABSTRACT

A variety of associated injuries of the upper limb have been described in the literature. The authors report a case of bifocal fracture of the radius and a scaphoid fracture together with elbow dislocation. In our knowledge, this association of lesions has never previously been described.


Subject(s)
Elbow Injuries , Fractures, Bone/surgery , Joint Dislocations/therapy , Radius Fractures/surgery , Scaphoid Bone/surgery , Adolescent , Elbow Joint/diagnostic imaging , Fracture Fixation, Internal , Fractures, Bone/diagnostic imaging , Humans , Joint Dislocations/complications , Joint Dislocations/diagnostic imaging , Male , Radiography , Radius Fractures/complications , Radius Fractures/diagnostic imaging , Scaphoid Bone/diagnostic imaging , Scaphoid Bone/injuries , Soccer/injuries , Traction
4.
Chir Main ; 27(4): 167-70, 2008 Sep.
Article in French | MEDLINE | ID: mdl-18676170

ABSTRACT

The luxatio erecta is a rare form of shoulder dislocation frequently described in young patients. The purpose of our study is to review the mechanism of this affection as well as its clinical, radiographic and therapeutic features. We also report eight cases of luxatio erecta observed between 1995 and 2006. We report six males and two females with an average age of 40 years. The left shoulder was dislocated in seven cases and a direct mechanism was reported by two patients. All of our cases presented with the typical attitude described for this dislocation; an upper limb in fixed abduction with the hand raised and inability to bring the elbow back to the body. No neurovascular injury was reported in this study. Radiographic examination showed inferior dislocation of the humeral head and the axis of the shaft above the horizontal line in all of our cases. The treatment consisted of closed reduction under general anaesthesia followed by a Dujarier's bandage for three weeks. Luxatio erecta is the commonest type of inferior dislocation. Its mechanism is a fall on the upper limb in great abduction or antepulsion. The clinical diagnosis is easy, confirmed by an anteroposterior radiograph. The functional long-term prognosis is excellent.


Subject(s)
Shoulder Dislocation/diagnostic imaging , Shoulder Dislocation/therapy , Adolescent , Adult , Female , Humans , Male , Radiography , Retrospective Studies , Shoulder Dislocation/etiology , Traction
5.
Chir Main ; 26(1): 31-4, 2007 Feb.
Article in French | MEDLINE | ID: mdl-17418767

ABSTRACT

The "kite-flap" is a cutaneous island flap containing a triple pedicle. It is harvested from the dorsum of the index and is intended to cover skin-loss on the thumb. The purpose of our study was to evaluate 12 "kite-flaps" performed over the course of 11 years. The skin defects were on the dorsum of the distal phalanx of the thumb in 3 cases, on the dorsum of both the distal and proximal phalanges in 4 cases and on the volar aspect of the thumb in 5 cases. The associated lesions consisted of combined bone and skin in one case treated by bone graft with external fixation, and one case of septic arthritis of the interphalangeal joint treated by arthrodesis. The results of our series are very good after an average of 2 years follow-up. We have however had 4 cases of cold intolerance, 2 cases of superficial sepsis and one case of shrinkage of the first commissure. It appears that the "kite-flap" is the best solution for cover of simple or complex skin loss of the thumb. Its technical performance is easy, and it gives durable, sensate and stable skin cover.


Subject(s)
Finger Injuries/surgery , Surgical Flaps , Thumb/surgery , Adolescent , Adult , Bone Transplantation , Female , Finger Injuries/etiology , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Thumb/injuries , Time Factors , Transplantation, Autologous , Treatment Outcome
6.
Chir Main ; 23(3): 153-6, 2004 Jun.
Article in French | MEDLINE | ID: mdl-15293922

ABSTRACT

The authors report the case of a multilocular tumour of the soft tissues of the hand and wrist which was removed by excision biopsy and which proved to be a chondroma arising from the soft tissues. Soft tissue chondromas consist of islands of heterotopic cartilaginous tissue and can equally affect the viscera as well as the limbs. The hypothesis that microtrauma is involved in the aetiology of this condition has yet to find any factual support. Simple excision-biopsy should suffice to treat the condition but care should be taken to make the excision complete if recurrences are to be avoided.


Subject(s)
Chondroma/pathology , Chondroma/surgery , Hand/pathology , Hand/surgery , Soft Tissue Neoplasms/pathology , Soft Tissue Neoplasms/surgery , Adult , Humans , Male , Wrist/pathology , Wrist/surgery
7.
Chir Main ; 22(4): 207-10, 2003 Aug.
Article in French | MEDLINE | ID: mdl-14611075

ABSTRACT

INTRODUCTION: Nerve injuries of the upper limb can cause serious damage: primary repair has improved the results but the prognosis for recovery remains uncertain. We present the results of primary repair of 24 median nerve injuries at the level of the wrist. MATERIALS AND METHODS: Between 1990-1998, we repaired 57 median nerve injuries at the wrist. Only 24 patients were included in this retrospective study. The average age of the patients was 25 years (range: 18-60 years). Seventeen patients were men and seven were women. All the patients were operated within 12 h after the accident. In all the cases, epiperineural suture was performed followed by immobilisation in a cast for 3 weeks. No specific rehabilitation programme was employed. RESULTS: At review with a mean follow-up of 3 years, 46% of the patients obtained good or very good results according to Chanson's scoring system. The sensory recovery was between S4-S2 with the Weber test in 75% of patients. Fifty-eight percent of patients recovered a motor function between M3-M2. DISCUSSION: In most papers, very good and good results averaged 60%. The results in our series did not achieve this level. We believe that this is due to two factors: firstly, the age distribution of our patients and secondly the lack of a specific program of sensory rehabilitation.


Subject(s)
Median Nerve/injuries , Median Nerve/surgery , Adolescent , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Wrist
9.
Rev Chir Orthop Reparatrice Appar Mot ; 89(3): 257-60, 2003 May.
Article in French | MEDLINE | ID: mdl-12844050

ABSTRACT

We report the case of a 72-year-old woman who developed osteoarticular tuberculosis after dynamic hip screw osteosynthesis for a pertrocanteric fracture. Necrosis of the head and disassembly of the prosthetic material ensued. This patient had no history of pulmonary or extra-pulmonary tuberculosis. Certain diagnosis was established on the basis of pathology findings and successful antibiotic treatment associated with surgery: ablation of the implant, head-neck resection, total hip arthroplasty. Two hypothetical pathogenic mechanisms can be put forward: hematogenic dissemination from another focus and reactivation of latent local infection.


Subject(s)
Bone Screws , Fracture Fixation, Internal/adverse effects , Hip Fractures/surgery , Surgical Wound Infection , Tuberculosis, Osteoarticular/etiology , Aged , Female , Humans , Necrosis , Prosthesis Failure , Tuberculosis, Osteoarticular/complications , Tuberculosis, Osteoarticular/pathology
10.
Chir Main ; 22(2): 109-11, 2003 Apr.
Article in French | MEDLINE | ID: mdl-12822247

ABSTRACT

Brachial plexus paralysis secondary to anterior dislocation of the shoulder is a rare injury. The authors report a case of traumatic anterior dislocation of the shoulder complicated by brachial plexus palsy. Recovery took a whole year and the patient was left with residual shoulder stiffness.


Subject(s)
Brachial Plexus Neuropathies/etiology , Shoulder Dislocation/complications , Accidental Falls , Electromyography , Humans , Male , Manipulation, Orthopedic , Middle Aged , Orthotic Devices , Radiography , Range of Motion, Articular , Recovery of Function , Shoulder Dislocation/diagnostic imaging , Shoulder Dislocation/therapy , Time Factors , Treatment Outcome
12.
Chir Main ; 21(6): 359-61, 2002 Dec.
Article in French | MEDLINE | ID: mdl-12553197

ABSTRACT

Nerve injuries complicating elbow dislocation reported in literature involve ulnar and median nerve. A case of radial nerve paralysis after lateral dislocation of the elbow is reported.


Subject(s)
Elbow Injuries , Joint Dislocations/complications , Paralysis/etiology , Radial Neuropathy/etiology , Adult , Elbow/innervation , Humans , Male
13.
Chir Main ; 20(3): 236-40, 2001 Jun.
Article in French | MEDLINE | ID: mdl-11496611

ABSTRACT

Giant cell tumor of the tendon sheath (GCTTS), tenosynovial giant cell tumor are a group of rare proliferative disorders which involves synovial joints and tendon sheaths. Considerable confusion exists about the surgical treatment and diagnosis of these disorders. We report an exceptional case of a tenosynovial giant cell tumor of the forearm. It concerns a 23 years old woman presenting multiple tumors of the forearm and wrist. Result of the primary biopsy concluded to an eosinophilic granuloma. Magnetic resonance imaging demonstrated a richly vascularized tissular lesion involving the extensor carpi radialis and extensor pollicis longus. Surgical excision of the tumor was performed. Macroscopic, histologic and immunohistochimic findings confirmed the diagnosis of tenosynovial giant cell tumor. This diffused form is rare compared with the nodular one involving fingers. Optimal treatment is surgical resection. The only risk is recurrence.


Subject(s)
Forearm , Giant Cell Tumors/pathology , Soft Tissue Neoplasms/pathology , Synovial Membrane , Tendons , Adult , Biopsy , Diagnosis, Differential , Female , Giant Cell Tumors/surgery , Humans , Immunohistochemistry , Magnetic Resonance Imaging , Soft Tissue Neoplasms/surgery , Treatment Outcome
14.
Chir Main ; 19(4): 235-42, 2000 Sep.
Article in French | MEDLINE | ID: mdl-11079181

ABSTRACT

Volar perilunar dislocation of the carpus is rare. We report three cases here. The patients were 18, 23 and 31 years of age. The etiology was a traffic accident in all cases and palmar hyperflexion of the wrist was noted in all three. Palmar dislocation was associated with a scaphoid fracture in two cases. In the third case, there was an associated fracture of the radial styloid and capitate. The patients were operated on after a delay of 48 h in two cases and four weeks in one. The dorsal approach was used in two cases and the palmar approach in the other. Reduction, fracture osteosynthesis and intracarpal temporary arthrodesis were the main lines of treatment. The functional result evaluated after a minimum of eight months' follow-up was good in two cases, and acceptable in one (Green and O'Brien score). Volar perilunar dislocation is often associated with fracture of a carpal bone, mainly the scaphoid. It occurs in young men, after a violent injury. Polytrauma is often associated. Closed reduction is attempted first but open reduction is often needed because of instability of the lesion. The functional result is good if the treatment restores carpal bone congruence.


Subject(s)
Joint Dislocations/surgery , Lunate Bone/injuries , Wrist Injuries/surgery , Adolescent , Adult , Arthrodesis , Carpal Bones/diagnostic imaging , Carpal Bones/injuries , Carpal Bones/surgery , Female , Fracture Fixation, Internal , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Humans , Joint Dislocations/diagnostic imaging , Lunate Bone/diagnostic imaging , Lunate Bone/surgery , Male , Postoperative Complications/diagnostic imaging , Radiography , Scaphoid Bone/diagnostic imaging , Scaphoid Bone/injuries , Scaphoid Bone/surgery , Wrist Injuries/diagnostic imaging
15.
Chir Main ; 18(4): 309-12, 1999.
Article in French | MEDLINE | ID: mdl-10855336

ABSTRACT

We present a case of tuberculous tenosynovitis of the extensor tendons of the hand. Our patient was a young doctor working in the respiratory medicine department. He was injured on the dorsal aspect of the hand with a needle used for pleural aspiration. The clinical features consisted of gradually swelling, mild pain and stiffness of the metacarpophalangeal joint. The diagnosis was made after synovectomy. Histological and bacteriological examinations revealed tuberculosis. Treatment consisted of synovectomy and appropriate antibiotics. The clinical course was excellent after one year follow-up. Tuberculous tenosynovitis of the hand is a rare manifestation of extrapulmonary tuberculosis occurring in fewer than 5% of all cases of skeletal tuberculosis. Thickening of the tendon or synovial sheath and local accumulation of fluid are the characteristic manifestations. The diagnosis must be confirmed by surgical biopsy. Antibiotics and synovectomy achieve a good functional result.


Subject(s)
Hand Injuries/complications , Hand/microbiology , Needlestick Injuries/complications , Occupational Diseases/etiology , Tenosynovitis/microbiology , Tuberculosis/etiology , Antibiotics, Antitubercular/therapeutic use , Curettage , Follow-Up Studies , Hand/surgery , Humans , Male , Occupational Diseases/drug therapy , Occupational Diseases/surgery , Paracentesis/instrumentation , Tenosynovitis/drug therapy , Tenosynovitis/surgery , Tuberculosis/drug therapy , Tuberculosis/surgery
16.
Ann Chir Main Memb Super ; 16(4): 339-41, 1997.
Article in French | MEDLINE | ID: mdl-9479443

ABSTRACT

Peripheral nerve haemangiomas are rare and their association with muscular haemangiomas is exceptional. We report a case of haemangioma of antebrachial flexor muscles in a 19-year-old patient. The diagnosis was established during a Scaglietti-Page type of release operation.


Subject(s)
Hemangioma/pathology , Muscle Neoplasms/pathology , Neoplasms, Second Primary/pathology , Peripheral Nervous System Neoplasms/pathology , Ulnar Nerve , Adult , Female , Forearm , Hemangioma/surgery , Humans , Peripheral Nervous System Neoplasms/surgery
17.
Ann Chir Main Memb Super ; 14(4-5): 235-8, 1995.
Article in French | MEDLINE | ID: mdl-8519591

ABSTRACT

The hand is a rare site of fibrosarcoma. We report one case in a fifty two year old female patient, presenting with a two-year history of an ulcerated tumor of the palmar aspect of the right index finger. The X Ray showed severe erosion of the 2nd phalanx. Because of the large volume of the tumor, a proximal amputation of the 2nd finger was performed. Histological examination concluded on a fibrosarcoma which was completely resected. No signs of recurrence or distant metastasis were seen after 8 months. The frequency of fibrosarcoma in the hand is 2.7 to 5.3%. These tumors are rarely located in the soft tissues of the hand. The treatment is essentially surgical based on a carcinological resection, which represents the only way to avoid recurrence, which is evaluated to be 12% after amputation.


Subject(s)
Fibrosarcoma/surgery , Fingers , Amputation, Surgical , Female , Fibrosarcoma/diagnostic imaging , Fibrosarcoma/pathology , Humans , Middle Aged , Radiography
18.
Article in French | MEDLINE | ID: mdl-7569194

ABSTRACT

INTRODUCTION: Anterior open traumatic dislocation of the hip in children is rare. MATERIALS AND METHODS: We report the case of a child aged 9 years, who presented following a motor vehicle accident an anterior open dislocation of the left hip associated with a fracture separation of the trochanter, a fracture of the homolateral humerus and a fracture of the contralateral femur. He was treated by open reduction of the dislocation and pinning of the various fractures. RESULTS: After 15 months functional result of the hip was good. The radiograms showed early signs of necrosis of the femoral head. DISCUSSION: The treatment consisted of emergency reduction of the dislocation. Despite this treatment, a review of the literature showed that necrosis of the femoral head is still frequent. CONCLUSION: Anterior open dislocation of the hip is a severe disease in the child and its prognosis becomes severe with the opening and the association with a fracture.


Subject(s)
Hip Dislocation/etiology , Accidents, Traffic , Child , Emergencies , Femoral Fractures/diagnostic imaging , Femoral Fractures/etiology , Femoral Fractures/surgery , Femur Head Necrosis/etiology , Follow-Up Studies , Fractures, Open/etiology , Fractures, Open/surgery , Hip Dislocation/diagnostic imaging , Hip Dislocation/surgery , Humans , Humeral Fractures/etiology , Humeral Fractures/surgery , Male , Multiple Trauma/complications , Postoperative Complications , Radiography
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