Comparison of Modified Kessler and McLarney Techniques in Zone II Flexor Tendon Repair.

Introduction Hand injuries are common in the routine practice of any upper limb surgeon. The laceration of the flexor tendons can engage the functional prognosis of the hand. Hence, there exist a multitude pf suturing techniques whose goal is to have a solid repair, allowing an early rehabilitation. Our study aims at comparing the functional results after flexor tendon repairs in zone II using two different techniques, modified Kessler technique and McLarney technique. Methods Our study included 42 patients, divided into two groups, one having benefited from the modified Kessler technique and the other from the McLarney technique. The modified Strickland classification was used to compare the functional results at six months after surgery of the two techniques. Results Our study showed a better post-operative functional outcome with a lower risk of post-operative rupture in patients operated with the McLarney four-strand technique compared to patients operated with the modified Kessler two-strand technique. Conclusion Hand wounds in zone II remain a therapeutic challenge for any orthopedic surgeon due to the multiplicity of factors involved in the prognosis, in particular the type of suture. The suture with more than two strands has proven its effectiveness and its reproducibility, making it possible to find the balance sought by the surgeon, namely a suture that is not cumbersome, easy and quick to perform, and strong enough to start early rehabilitation.

Modified Technique of Single-Bone Forearm in the Treatment of Deformities.

The single-bone forearm is a salvage technique for massive loss of bone due to serious trauma, malignant tumors, infections or congenital deformity. It is also described to treat the sequelae of hereditary multiple exostoses disease that affects the distal end of the ulna. We present the case of a 29-year-old patient, operated for sequelae of hereditary multiple exostoses disease of the left forearm by a modified single-bone forearm technique. The patient, right-handed, operated on twice in childhood for a hereditary multiple exostoses disease of the left forearm: incomplete excision of the exostosis of the distal end of the ulna and lengthening of this last on external fixator, without improvement. The patient presented for a deformation of the left forearm with shortening compared to the right side|. Significant limitation of prono-supination (pronation 15°, supination 20°). Elbow flexion at 110° and extension with deficit of 15°. Wrist flexion at 50° and extension at 50°, radial inclination at 25° and ulnar at 30°. The pain score was 3 according to the Visual Analogue Scale (VAS), especially on effort. Dash score was 31,82/100. We chose the forearm technique with a single bone. The immediate postoperative result found a realignment of the forearm, without neurological or vascular damages. Consolidation was obtained in four months. At five months, the patient recovered elbow flexion at 110° and full extension, wrist flexion at 45° and extension at 50°. Radial inclination at 20° and ulnar at 25°. The single-bone forearm technique has been described, not only for the treatment of hereditary multiple exostoses disease, but also for serious trauma or tumors with massive loss of bone. The technique generally consists of an osteotomy of the radius as well as the ulna, fixing the radius to the ulna creating a synostosis, with or without resection of part of one or both bones of the forearm. The most described complications of single-bone forearm procedure are pain, complications related to soft tissue secondary to the previous injury, and infections. The one-bone forearm remain a salvage technique for massive loss of bone of the forearm, or large deformities due to congenital malformations. This technique could allow the excision of massive bone and keep only a part of the ulna and the radius, with function maintenance and aesthetic forearm preservation.

[Squamous cell carcinoma in a patient with chronic osteomyelitic lesion: a case report]. / Carcinome épidermoïde survenant sur une lésion d'ostéomyélite chronique: rapport de cas.

Squamous cell carcinoma associated with chronic osteomyelitis is rare. However, it must be suspected in patients with modification of common local symptoms. Delayed diagnosis can be fatal. Repeated biopsies can greatly help physicians who treat patients. We report the case of a 47-year-old patient diagnosed with carcinomatous degeneration associated with chronic osteomyelitis fistulized to the skin. Amputation was performed.

Corrigendum: Schwannome bénin du nerf grand sciatique, à propos de 2 cas.

[This corrects the article DOI: 10.11604/pamj.2014.18.252.4684.].

Corrigendum: Abcès tuberculeux de la face postérieure de la cuisse: à propos d'un cas.

[This corrects the article DOI: 10.11604/pamj.2014.19.50.4683.].

Creation of the bone bank of the Rabat and Casablanca region in Morocco.

For a long time the use of bone grafting has demonstrated its interest in orthopedic surgery and traumatology. The autografts which are still very frequently used present various problems. On the one hand, it is necessary to find a correct mechanical quality and a sufficient quantity of bone. On the other hand, the graft removal lengthens the operative time and generally painful in postoperative. These disadvantages of autografts have led to the development of bone allografts. Indeed, the low immunogenic power of the bone, the good integration of the graft and the ease of bone preservation techniques make it possible to overcome the various problems posed by bone autografts. The increasing use of bone allografts has resulted in the need for a structure allowing the management of graft stocks. The purpose of this work is to demonstrate the mode of operation of a bone bank, whose conservation activity is limited to the femoral heads treated by cryopreservation and without secondary sterilization process. The bank collaborates with all orthopedic surgeons in the Rabat and Casablanca city at first and then with all orthopedic surgeons in Morocco. It provides allografts in quality and safety.