[Reflections on 4 cases of ante-lunar carpal luxations]. / Réflexions à propos de quatre observations de luxations antélunaires du carpe.

Over the past 20 years, 4 cases of ante-lunate carpal dislocation have been treated in the Traumatology and Orthopaedics Department of Besançon. During this same period, 61 cases of retro-lunate dislocation have also been treated. Ante-lunate dislocations are very rare lesions as confirmed by a review of the literature. Our cases do not illustrate the mechanisms of such injuries since 3 cases involved patients with multiple injuries Clinical symptoms may be very minor in children in whom such injuries may easily be overlooked. A thorough interpretation of X-rays is necessary for diagnosis in adults. All 4 cases showed a fracture of the lunate in a frontal plane (factor of instability). Such an instable lesion justifies either internal osteosynthesis or percutaneous trans-articular pinning when rigid internal fixation is impossible. However, in all cases in which the lesion was treated surgically, the capsular plane was not disrupted. Retrospectively, such a finding contraindicates an open surgical approach. Relationships between such dislocations and isolated fractures of the lunate are discussed. The prognosis is mainly determined by early diagnosis and management rather than the type of treatment itself.

Closed traumatic rupture of the ring finger flexor tendon pulley.

We report an unusual case of closed traumatic rupture of the ring finger flexor tendon pulley not previously reported in the literature. This injury occurred in a 21-year-old athlete during rockclimbing. Lack of flexion of the distal interphalangeal joint was accompanied by a palpable subcutaneous cord on the palmar side of the proximal phalanx. A simple repair of the pulley was done. The postoperative functional result was satisfactory.

The treatment of avulsion fractures of the tibial tuberosity in adolescent athletes.

Avulsion fractures of the tibial tuberosity occur mainly during sport activities and are closely related to the strains exerted on the anterior tibial tuberosity by the extension complex of the thigh. A knowledge of the mechanical aspects of these avulsions may improve understanding of the mechanisms of such injuries. In such avulsion fractures, tensile forces due to the contraction of the quadriceps complex overcome the cohesive forces within the apophyseal cartilage. A 1-month cast immobilisation on an extended knee gives good results in the management of nondisplaced fractures. In minor displacements, such immobilisations follow closed external reductions. Open reductions and stable screw fixations precede a 3-week immobilisation for displaced fractures. Long term results are regularly good in well-managed cases.

[Surgical treatment of suppurative axillary hidradenitis: value of a musculocutaneous island flap of the latissimus dorsi. Apropos of 3 cases]. / Le traitement chirurgical de la maladie de Verneuil axillaire: intérêt du lambeau musculo-cutané en ilot du grand dorsal. A propos de 3 observations.

We report our experience of the surgical management of severe, extensive, medically intractable axillary Hidradenitis suppurativa in three male patients. Under general anaesthesia, all patients underwent large, deep and full excision of the disease prone areas, i. e. zones of apocrine sweat gland distribution and not only of the skin involved at the time of surgery, for the best possible prevention of recurrence. The operation was bilateral in two patients and unilateral in one. In all cases closure was achieved using the latissimus dorsi flap technique. In the two patients with bilateral lesions surgery was carried out in two steps at about two months' interval. At present, after a follow-up of about two years, none of the patients have relapsed and their shoulder mobility is perfectly preserved with a normal abduction allowed by the total absence of axillary scar contracture. The latissimus dorsi flap technique consists of transplanting into the recipient's axillary defect the pedicellated lateral margin of the latissimus dorsi muscle with (2 patients) or without (1 patient) a cover of attached skin palette vascularized by the underlying muscle tissue. Mainly used hitherto for reconstructive mammary surgery, this technique perfectly fits axillary diseases, such as Hidradenitis suppurativa, which can only be cured by creating wide surgical skin defects. It is particularly reliable: covering of the defect is easy and the immediate muscle interposition effectively protects the otherwise widely exposed neurovascular pedicle. The need for a skin palette cover associated with the latissimus dorsi flap is discussed.

[Pedal cutaneous island flap. Apropos of 6 case reports]. / Le lambeau cutané pédieux en îlot. A propos de 6 observations.

The authors report their experience using the dorsalis pedis island flap, described by MacCraw, for coverage of soft tissue defects of the heel, and both lateral and medial areas of ankle. The operative technique is recalled and six cases are presented. The authors analyse the several indications of the island flap. Its disadvantages are emphasized.

[Socioeconomic value of early weight-bearing after fracture of the greater trochanter:--the role of osteosynthesis using an angled support plate]. / Intérêt socio-économique de la mise en charge précoce après fracture du massif trochantérien:--place de l'ostéosynthèse utilisant la plaque coudée à étai.

Early full-weight bearing in patients undergoing surgery for femoral trochanteric fractures does not decrease the rate of mortality. However, such full-weight bearing is of great psychological value for the patients as well as the nursing staff to whom immediate care seems thus more ambitious. Moreover, such an attitude reduces post-operative hospitalisation and an eventual convalescence period to a minimum. This full-weight bearing is allowed by different techniques which are here outlined and discussed. The authors propose a 95 degree angular plate which avoids acetabular protrusion during weight bearing before bone healing. Addition of a stay renders this plate more resistant than the 130 degree one which, moreover, migrates toward the hip joint during weight bearing. An experimental study has proved that this material allows early weight bearing without risk of rupture. Clinical applications have confirmed such a view.

[The immediate management of fractures of the femoral trochanter using a plate with a support. Experimental basis, technic, results, indications]. / La mise en charge immédiate des fractures du massif trochantérien grâce à la lame plaque à étai. Bases expérimentales, technique, résultats, indications.

Early full weight bearing in femoral trochanteric fractures is an important problem. It seems to us to be imperative because the very old aged population (about 80 year old average) concerned by that type of fractures. That attitude reduces hospitalisation and rehabilitation time. The authors propose an original 95 degrees angular-plate rendered by a stay. A complete experimental study proved that material able to support the immediate weight bearing. A clinical application on 207 cases confirmed the experimental hypothesis.

[Verneuil's disease. The diffuse inguino-perineo-gluteal and bilateral axillary form]. / Maladie de Verneuil. Forme diffuse inguino-périnéo-fessière et axillaire bilatérale.

The authors report a case of suppurative hidradenitis of unusual severity affecting the axillary, inguinal, perianal, genital and sacral areas. The surgical treatment consisted initially of large excision of the axillary areas. A musculo-cutaneous latissimus dorsi island flap was then used to cover the defect. 45 days later, a complete excision, in only one operative session, of the inguinal, perianal, genital and sacral area was performed, associate durth colostomy. A mesh graft was performed 15 days after the excision. This procedure allowed an early scar.

[Indications for the Greenfield filter at the distal side of renal veins. 15 cases]. / Les indications du filtre de Greenfield en aval des veines rénales. 15 observations.

Analysis of results of short- and medium-term use of 15 Greenfield's filters (GF) introduced distal to renal veins confirmed the good nephrologic tolerance and efficacy of partial interruption of suprarenal inferior vena cava. The surgical technic necessarily involves use of internal jugular vein (with the exclusion of femoral vein) and it is recommended to insert the GF in the retro-hepatic vena cava at a distance from renal veins. Review of 53 cases reported in the world literature indicates cases suitable for this procedure as being patients with severe thromboembolic accidents unable to be treated by direct surgery, fibrinolysis or by effective anticoagulation. Indications for use of a suprarenal GF include suprarenal extension of a caval thrombus or lack of efficacy of an anterior caval block proximal to renal veins. In these cases, that are rare and should remain so, the suprarenal Greenfield filter is the most satisfactory solution at the present time for ensuring the very poor vital prognosis of this very particular group of patients.