[Pseudoaneurysm of the radial artery in the hand]. / Faux anévrysme de l'artère radiale à la main.

Over 1,400,000 cases of hand trauma are identified each year in France, with a large proportion with open wounds, accounting for significant activity in orthopedic surgery emergency units. It is customary to focus on nerve or tendon injuries as a priority. However, even partial vascular lesions may be complicated by a false aneurysm. We report the case of a false aneurysm of the palmar branch of the radial artery in 25-year-old man, 6 months after a non-treated puncture wound of the thenar eminence. Surgery was undertaken because of increased volume and discomfort on gripping. The surgical procedure consisted of resection and arterial ligature, after a positive preoperative Allen test. Hand aneurysms require an individualized therapeutic procedure. Origins may be diverse; the palmar digital location requires complex treatment. Compensation via a collateral arterial network is required for the vascular steal following ligation and resection. Careful exploration is needed to ensure appropriate compensation. Otherwise, a revascularization procedure must be considered. Some authors propose new less invasive treatments as an alternative to surgery. Even though surgery is relatively simple, the best means of prevention still remains a systematic exploration of vascular elements in case of a hand wound.

The psychotic mummified hand: an unusual hand injury complication.

The authors report the case of a patient with psychotic symptoms secondary to a posttraumatic stress disorder following a work-related hand injury. The somatic presentation was a "mummified" hand neglected for several years in a splint without any care. The psychiatric analysis concluded that this was part of a delusion of persecution expressing a conflict against the patient's employer and insurance company. Surgical treatment was limited to a hand cleaning with hardware removal. Despite 3 years of antipsychotic medication the patient was still suffering from delusion and the hand remained neglected at the last follow-up.

Novel approach for posttraumatic panarthritis of the wrist using a pyrocarbon interposition arthroplasty (Amandys(®)): Preliminary series of 11 patients.

OBJECTIVES: In case of posttraumatic radiocarpal destruction, failure of first row carpectomy or partial arthrodesis, there are two options, total prosthesis of the wrist or panarthrodesis. Both solutions have limitations. The aim of our study was to evaluate an alternative therapy: interposition arthroplasty with pyrocarbon implant at follow-up of minimum 6months. METHODS: This is a retrospective monocentric study with clinical and radiological evaluation. This study includes 11 patients with a mean age of 55.2years. There were four failures of first row carpectomy, a failure of partial arthrodesis, a case of post-infection osteoarthritis, four cases of stage IV SNAC wrists and one siliconitis after a scaphoid implant. RESULTS: At the average follow-up of 11 months, pain was improved in nine cases. The average flexion was 36.5° and average extension, 35°. The average strength was 8.3kg. Two implant dislocations occurred, only one required second look surgery for implant replacement. However, in this patient, pain remained severe and required panarthrodesis. In another patient, a second panarthrodesis was performed for resistant pain. CONCLUSIONS: The interposition arthroplasty with pyrocarbon seems to give encouraging results as an alternative therapy. It gives satisfactory mobility, pain relief, but moderate strength. It has the advantages of a simple technique and does not preclude manual activities. A long-term validation is, of course, necessary.

[Isolated gonococcal tenosynovitis. Case report and review of literature]. / Ténosynovite isolée à gonocoque, à propos d'un cas et revue de la littérature.

Isolated gonococcal tenosynovitis is rare, and is part of disseminated gonococcal infection. It is due to blood-borne contamination of the flexor tendon sheath. One to 3% of gonococcal mucosal infections develop disseminated infections. Tenosynovitis is present in two-thirds of cases, sometimes in association with arthritis and skin rash. We report a case of a 26-year-old man with isolated gonococcal tenosynovitis of the thumb, with no other medical history, occurring 15 days after unprotected sex. Except local inflammatory signs of the thumb extending to the wrist, and a biological inflammatory syndrome, the patient had no arthritis, skin or mucosa symptoms. Immediate surgical drainage was performed under antibiotic cover with 3rd generation cephalosporin. All bacteriological samples were negative, except for one blood culture positive for Neisseria gonorrhoeae. Thus, in case of an asymptomatic patient with suspected gonococcal infection through a mucus portal, a precise examination, including geographical and sexual history, and a review of screening are recommended. Although the pathophysiology of gonococcal tenosynovitis is still obscure, the best prevention remains that of sexually transmitted diseases.

[Spinal migration of a Kirschner wire after surgery for clavicular nonunion. A case report and review of the literature]. / Migration intrarachidienne d'une broche de Kirschner après une cure de pseudarthrose de la clavicule. Cas clinique et revue de la littérature.

Kirschner wires (K-wires) are often used for osteosynthesis particularly in the upper limb. Postoperative K-wire migration through the tissues is a well-recognised and significant complication of surgery of the clavicle, the wire ending up in the lungs, the oesophagus, the aorta, or the subclavian artery. Localisation of a K-wire migration into the spinal cord is very rare. We report the case of a 34-year-old man with K-wire migration into the spinal cord through the intervertebral foramen of T2, two months after surgery for nonunion of a fracture of the lateral clavicle. Apart from acute respiratory failure related to a pneumothorax, the patient initially had no neurological deficit. It was decided to operate on him immediately. Two therapeutic options are possible: simple K-wire removal via a supraclavicular approach, or the same but with direct visual control in the spinal cord after laminectomy. A postoperative check with an MRI scan is desirable after two days. Even if mechanism of K-wire migration is not known, the means of prevention are, namely strict postoperative immobilization, K-wire removal as soon as bone healing is achieved, and bending the external tip of each implanted wire.