Care pathway of asylum seekers in the health care access points following inclusion in the PREMENTADA project: an observational study.

OBJECTIVES: The health service access point (PASS) allows people in precarious situations to benefit from medical and social care. A mobile PASS service was set up in 2020 in Marseille for people seeking asylum (DA). The objective of our study was to describe the care pathways within the PASS for DA. STUDY DESIGN: We led a retrospective observational study of care pathways of the 418 DA included in the PREMENTADA study (ClinicalTrials number: NCT05423782) in the 3 months following their inclusion. METHODS: We conducted a quantitative study, which ran from March 1, 2021, to August 31, 2021, to collect data from mobile and hospital PASS consultations, referrals following PASS consultations or hospitalizations, emergency room visits, hospitalizations, prescription, and dispensing of treatment following PASS consultations or on discharge from hospital, between D0 and M3. RESULTS: A total of 163 (39.0%) patients were lost to follow-up after an initial assessment of their health status. Overall, 74.4% of the patients were followed only by the mobile PASS for a mental health problem, and 57.4% were followed for a somatic problem until they obtained their rights. The mobile PASS referred 43.5% of patients to the hospital PASS for access to various technical facilities: medical imaging, pharmacy (63% of them benefited from the dispensing of health products), biological tests, and so on. The morbidities of the DAs were severe enough to require technical support that the mobile PASS could not provide, but recourse to the emergency department was fairly low (1.6%), testifying to the efficiency of the primary care provided by the mobile PASS. CONCLUSIONS: Our study provides the first data concerning the DA's healthcare pathway in France. Considering the health status of this population and the fact that early management of health problems allows for rationalization of costs, we can ask the question of the future of these patients in the absence of adapted care systems. The PASS and the hospitals to which they are attached will have to adapt their care offer to take into account the DA's specific problems.

[Fracture-dislocation of the second carpometacarpal joint. Case report and review of the literature]. / Fracture-luxation carpométacarpienne du deuxième rayon à propos d'un cas et revue de la littérature.

A 26-year-old man was involved in a car crash then he presented an isolated trauma of the hand. We found out a dorsal dislocation of the second carpometacarpal joint with trapezoid fracture and a Rolando fracture. In emergency, closed reduction with percutaneous wires to stabilize, was performed. In the same time, the Rolando fracture was treated by internal fixation (plate). In a second time, after computerized tomography of the carpus, the trapezoid was reduced through a dorsal incision and held with two Kirschner-wires. At last follow-up one year after injury, the result was good. All movements of the wrist and fingers were full and pain free. Thumb index pinch and grasp were approximately 80% those of the uninjured hand. The mechanisms of injury, anatomic factors and management of seventy-one cases of similar trauma (included at least a dislocation of the second carpometacarpal joint) were reviewed in the literature.

[An unusual variation of luxation of the wrist: external vertical luxation. Apropos of a case. Review of the literature]. / Une variété rare de luxation du carpe: la luxation verticale externe. A propos d'un cas. Revue de la littérature.

A case of lateral dislocation of the carpal scaphoid associated with a fracture of the triquetral and carpo-metacarpal dislocation of the ring and little finger is described. A thorough search of the literature failed to reveal any previous report of this combination of injuries. The dislocation was reduced by manipulation, but the scapholunate ligament required surgical repair. The results after two year was good.

[Ilizarov method used for the sequela of growth cartilage lesions]. / La méthode d'Ilizarov dans les séquelles de lésions du cartilage de croissance.

Ilizarov distraction osteogenesis is a good way to correct sequelae of growth plate injury after completion of the growth. There is often both limb length discrepancy and angular deformation in varus, valgus, flexum, and recurvatum after surgery or trauma in childhood. Such deformations of the distal femoral growth plate, both proximal and distal tibial and distal radial will be presented, treated by a one-step Ilizarov method.

[Tenosynovial osteochondromatosis of the hand. A case report]. / Ostéochondromatose téno-synoviale à la main. A propos d'une observation.

A 14 year old boy presented with swelling of the middle finger. X-rays showed calcifications of the palmar surface of the head of the third metacarpal and over the first and second phalanges. The natural course was followed over a period of two years with a diagnosis of calcifying peritendonitis. Due to the increased volume of the calcification deforming the proximal phalanx, the masses were resected revealing a diagnosis of chondroma. The discovery of free foreign bodies in the synovial sheath of the flexors and histological examination established the diagnosis of tenosynovial osteochondromatosis, which is rarely located in the hand. No recurrence has been observed after 8 years of follow-up.

[Reduction of traumatic dislocation of the shoulder. For a gentler approach....]. / La réduction des luxations traumatiques de l'épaule. Pour une plus grande douceur....

Early traumatic anterior dislocation of the shoulder may be reduced very easily using a method combining gentle traction along the axis of the arm, slow external rotation and outwards pressure on the humeral head with the patient seated. This gentle method does not require sedation or analgesia.

[Thalamic fractures of the calcaneus. Value of computed x-ray tomography in therapeutic decisions]. / Les fractures thalamiques du calcanéum. Intérêt de la tomodensitométrie dans la décision thérapeutique.

The authors have studied 35 fractures of the calcaneal thalamus and compared the information provided by plain radiology and CT scans of the calcaneal tuberosity, especially those connected with the condition of the posterior subtalar joint. In 8 cases out of 35, the study of the CT sections yielded information that allowed changing the indications for treatment. The authors emphasize the quality of the data obtained, which makes it possible to justify a functional treatment or to establish a preoperative schedule.