[Not Available]. / Traitement chirurgical initial des brûlures de la main de l'enfant. Revue.

The early management of pediatric hand burns includes surgical treatment, medical follow up and prevention of abnormal scarring by splits and/or pressure garment therapy. The aim of this review was to find the best available evidence in the literature on the surgical part of this management. This review started with a search in the PubMed database for the keywords, hand AND/OR child AND/OR burn. Only the articles published between January 1(st), 2005 and January 1(st), 2011 were selected. The data were compared to French and American textbooks. Contradictory findings were reported on the timing of the excision and graft, with only two comparative studies reported, with a lot of biases. The state of the art on the initial management of hand burns in children is not totally conclusive due to the lack of statistic power in these studies, but many expert opinions help to define options for good therapeutic paradigms. It is important to include these patients in prospective protocols with both early and long-term follow-up in order to increase the amount of evidence at our disposal.

[Rehabilitation protocols after repairs of zone 2 of the flexor tendon of the hand: presentation and indications]. / Protocoles de rééducation après réparation des tendons fléchisseurs de la main en zone 2: présentation et indications.

We report the results of a retrospective study of 47 adult patients corresponding to 54 fingers, operated on in the emergency room at Nancy University Hospital between December 1996 and October 1998. These patients were managed using three different postoperative therapy protocols: passive mobilisation according to the Duran technique, active-passive mobilisation according to the Kleinert technique and immediate active mobilisation as described by Strickland. Patients were evaluated in three different ways; active range of movement obtained according to the Strickland scale, the "400 points" flexor function test and the delay in returning to work. Combining all three evaluations showed a 65% rate of satisfactory results, 22% fair and bad results and 13% ruptures. Analysis according to the re-education technique showed a strong superiority of the Strickland protocol. This now needs to be confirmed by a more extensive prospective study. Delay before return to work is not affected by the type or re-education technique chosen, but side-effects are less frequent with the Strickland method. A result in terms of range of active movement alone did not fully evaluate the result of a flexor tendon repair: functional testing was better at this end and the global "400" points test score gave more useful information than each of its component tests taken individually (Purdue pegboard, Minnesota test, Box and Block). Functional testing seemed more helpful in guiding the medical team in its treatment strategy.

A method for shortening instruments using the Rasch model. Validation on a hand functional measure.

BACKGROUND: Many measurement instruments, particularly measures of hand functional ability, frequently comprise a large number of items. Reduced versions of these instruments can facilitate their use. This work proposes a new method for shortening an instrument. METHODS: The method proposed was based on a scale of item difficulty calculated using the Rasch model. It was applied on a hand functional measure comprising 67 tests. The sample included 194 patients with hand lesions. The shortened instrument obtained was compared with those provided by classic methods used in the literature, with item random choice, and with shortened versions proposed by four independent experts, two rehabilitation physicians and two occupational therapists, who are clinicians familiar with the tool. All the statistical analyses were carried out on a random sub-group of two-thirds of the sample. A cross validation was then carried out on the remaining third. RESULTS: The reduction obtained had score non significantly different from that of the original instrument. In addition, the intra-class correlation coefficient and the Cronbach alpha coefficient were high. Among the different degrees of reduction investigated, the 12-item version seemed to be appropriate. Our method appeared to provide better results in terms of discriminant validity and internal validity than the choices of the four experts. The reductions produced were also better than those obtained by classic methods based on principal component analysis and multiple linear regression, as well as those obtained by random choices of items. CONCLUSION: The method presented is pertinent and useful. The reduction obtained appeared to be better than the choices of experts and the reductions provided by classic methods. The method could be used in other fields.

[Unidimensionality of a functional measure for patient with an injured upper limb]. / Unidimensionnalité d'une mesure fonctionnelle pour des malades ayant une lésion du membre supérieur.

The construction of an instrument including a number of tests requires an analysis of its structure and its unidimensionality (which allows calculation of global score), and the determination of the difficulty level of various tests. This study examined a tool including 67 tests designed to evaluate the functional ability of patients with an injured upper limb. The patients seen in a rehabilitation centre during 12 months (173 subjects) were evaluated by the occupational therapists familiar with the tool. The statistical analyses were made using the principal component analysis method (PCAM), the Cronbach's coefficient and the Rasch model. The PCAM showed 3 principal factors which explained 44%, 10% and 4% of the total variance respectively in the case of patients with injured dominant limb. The predominance of the first axis and the high ratio of first by second eigenvalues suggested the unidimensionality of the tool. The Cronbach's value of 0.97 attested the good congruence of the items. The results obtained with the Rasch model seemed to be consistent with the hypothesis of the unidimensionality of the tool. This analysis also provided the difficulty scale of various tests. Similar results were obtained in patients with injured non dominant limb or with all the sample. The methods used provide complementary results.

Personality self-representations of patients with hand injury, and its relationship with work injury.

This study compared the personality self-representations of 288 hand injured patients with those of 959 young people (15-25 years old) randomly selected from the general population (noted GP), and with those of 336 unemployed people of all ages in professional training (U) in Lorraine (north-eastern France). The relationship between patients' personality self-representations and injury was also investigated. Personality self-representations included 14 questions: in your own opinion are you sociable?, at ease with others?, serious?, careful?, dynamic?, optimistic?, worried?, irritable?, clumsy?, solitary?, organised?, ambitious?, do you have a sense of responsibility?, and many plans? The patients had similar self-representations to GP except for the items non clumsy (odds ratio adjusted on age and sex OR = 2.40, p < 0.05) and optimistic (OR = 1.70, but 0.05 < p < 0.10). The frequencies of non irritable, non clumsy and non solitary people were higher in patients than in the U group (OR about 2.40, p < 0.01). By contrast, the other items were more favourable for the U group except for the items sociable, organised and having many plans. Self-representation items were significantly related to some socio-demographic data. The work injured workmen having one or more previous work injuries during the last five years were more at ease with others than the other subjects. Among the work injured workmen who had had no previous work injury during this time, the people aged 29 or less (the highest risk age class) were more optimistic than the others (71% vs 49%, p < 0.05); a difference was also found for the items at ease with others, careful, dynamic, and non worried, but it was not significant possibly due to the small number of subjects. The sum of these five items differed between the two age groups (3.29 +/- 1.49 vs 2.55 +/- 1.68, p < 0.05). These simple items would provide an interesting approach in terms of personality which could explain in part the excess of work injuries in young people, though the work requirement still seemed to be the highest risk factor.