[Quality of life after severe hand trauma: A review of 36 cases]. / Qualité de vie apres un traumatisme grave de la main : a propos de 36 cas.

OBJECTIVE: Improve the quality of life of patients with severe hand trauma. MATERIALS AND METHOD: A retrospective study was carried out from August, 1st, 2017, to May 31st, 2020, at the emergency department of a private clinic in Abidjan. Were included in this study all patients with severe hand trauma who had undergone emergency surgery with a quality-of-life assessment time of over six months after surgery. The data were reported on a structured and standardized survey form. RESULTS: We analyzed 36 patients, with average age of 38.6 years (min. 8, max. 71 years). The population study was predominantly male with a sex ratio of 17. 92% of patients were right-handed, and in 53% of cases, the trauma involved the dominant hand. 64.2% of the patients were manual workers. In 83.3% of the cases, the patients had no difficulty in writing. Patients had no difficulty in washing or drying their hair 88.9% of the time. Eighty-nine percent of the patients no longer felt pain. The patients didn't feel any weakness in the hand in 72.2% of the cases and in 63.9% of the cases there was no stiffness in the hand. Only 5.6% of the injured felt their health was poor and 83.3% of patients strongly disagree with feeling less valuable, less confident, or even less capable because of the trauma. 72% of patients were incapacitated for work between 5 and 15 weeks. 80.6% of trauma victims had no loss of income, and 88.9% of patients kept their previous jobs. 83.3% of patients did not experience any social discomfort. CONCLUSION: The patients had a good quality of life despite the severity of hand injuries they had due to early and adequate management combined with good physiotherapy.

Transfer of two motor branches of the anterior obturator nerve to the motor portion of the femoral nerve: an anatomical feasibility study.

Femoral nerve lesions are uncommon, but very distressing at the functional level because of the absence of knee locking mechanism by the quadriceps muscle. We propose here a new neurotization procedure of obturator nerve motor branches to the motor portion of the femoral nerve in the thigh. This study was conducted on five cadavers. The motor portion of the femoral nerve and the motor branches of the obturator nerve, supplying the gracilis and adductor longus muscles, were isolated. The distance between nerve endings and diameter were measured to determine if a direct neurorrhaphy was possible between the femoral nerve and the two united branches of the obturator nerve. The overlap between the two nerve endings was 26 mm on average, and the mean diameter of the two nerve endings was 3.6 mm for the united branches of the obturator nerve and 3.7 mm for the femoral nerve. Thus, a direct suture was possible in all cases. In this anatomical study, access to the femoral nerve and two united branches of the obturator nerve was easy, in contrast to transfer in the pelvis. Moreover, direct suture without tension was possible in all cases. Thus, this transfer is simple and perfectly reproducible and may have a clinical application in proximal femoral nerve injuries.