[Evaluation of the risk of postoperative bleeding complications in hand surgery without interruption of anticoagulant Vitamin K Antagonist (VKA), a retrospective study]. / Évaluation du risque de saignement postopératoire en chirurgie de la main sans interruption des anticoagulants de type AntiVitamines K (AVK), étude rétrospective.

OBJECTIVE: The management of patients on Vitamine K Antagonist (VKA) anticoagulation is a public health issue with surgery being the primary cause of VKA interruption. The aim of this study was to evaluate the bleeding risk in patients operated on hand surgery without interruption of VKA treatment. PATIENTS AND METHODS: This retrospective, monocentric study was conducted between 2013 and 2015. The inclusion criteria were, as follows: patients on VKA over 18 years of age who had emergency or scheduled surgery without interruption of VKA treatment; INR inferior to 3 analyzed less than 24h before surgery. Exclusion criteria were, as follows: INR superior to 3; interruption of VKA treatment with or without switch to heparin treatment. The primary evaluation parameter was any form of bleeding that occurred during the first 7 post-operative days. The secondary criteria were other surgical complications. RESULTS: There were 93 patients and 104 procedures. The mean age was 74.36 years (from 27 to 90) with a sex ratio male-to-female of 2.47. The scheduled surgeries were 61.5% against 36.5% for the emergency cases. The mean INR was 2.29 (from 1.07 to 3). One patient presented a postoperative hematoma on the 4th postoperative day, which did not require any revision surgery. There were no other complications reported. CONCLUSION: The results of this series suggest a small bleeding risk in hand surgery without interruption of VKA treatment provided that IRN is inferior to 3 less than 24hours before the procedure.

[Should we reconstruct the flexor retinaculum in the carpal tunnel?]. / Faut-il reconstruire le rétinaculum des fléchisseurs (retinaculum flexorum) dans le canal carpien?

Conflicting data in the literature justify this review about the flexor retinaculum (FR). Reconstruction of the FR following carpal tunnel open release has been recommended in order to limit the drawbacks of open carpal tunnel release; these drawbacks have been reported in wide series of results published between 1956 and 1988. This paper includes a review of the literature, a survey of the practice of the members of the French society for surgery of the hand (GEM), a self-evaluation of grip strength as well as a summary of indications.

Electra trapezio metacarpal prosthesis: results of the first 100 cases.

The Elektra trapeziometacarpal prosthesis is a cementless, unconstrained prosthesis made by Fixano with titanium and chrome-cobalt steel. This paper examines the results of the first 100 prostheses used by the author for one indication only, viz. painful trapeziometacarpal osteoarthritis. The average follow-up period was 54 (range 36-78) months. Studies of pain, mobility and grip and pinch strength were carried out, the results of which were good in 83 cases. Seven dislocations occurred. Five of these were following severe trauma. The commonest complication was a lack of osteointegration of the trapezial part of the prosthesis, which occurred in 15 cases. Sinking into the metacarpal of the distal stem occurred early in the series in two cases. Some others complications were observed: allergy to the metal (one case), fracture after direct trauma of the thumb (one case) and very painful osteoarthritis of the scaphotrapeziotrapezoid joint (one case).

[The use of digital photographs for surgical and rehabilitation records. Methods and results]. / La photo numérique en chirurgie et en rééducation de la main. Méthode et résultats.

Digital pictures are performed on patients in the pre and postoperative periods, and sometimes during surgery. Seven thousand fourty eight records have been recorded. This method is useful for a multidisciplinary responsibility, particularly for the hand therapist and the splint follow-up. It is also good for patient information, for Workman's compensation doctors and for experts. The pitfall is that one have to manage the records on a strict day by day base.

Mycobacterial tenosynovitis of the flexor tendons of the hand. A report of five cases.

We present five cases of mycobacterial tenosynovitis of the flexor tendons of the fingers. These cases were observed during the last 12 years and treated by the same surgeon. This pathology is uncommon now, but it is becoming more frequent, especially in patients with diminished immunity. The diagnosis was most commonly made after synovectomy in patients presenting with carpal tunnel syndrome associated with slightly painful swelling at the wrist. Histological and bacteriological examinations are very important and revealed tuberculosis in four of our patients and mycobacterium in one, and the treatment consists of synovectomy and appropriate antibiotics. The functional result is usually good, but recurrence is not uncommon. Long-term follow-up is necessary. Local corticosteroid therapy could have a part in the causation of this condition.

[Bundled wiring in fractures of the neck of the fifth metacarpal. 5 cases]. / L'embrochage fasciculé en bouquet dans les fractures du col du cinquième métacarpien. A propos d'une série de cinquante cas.

By reviewing a series of 50 patients operated on using the Foucher technique for a closed isolated fracture of the neck of the fifth metacarpal bone, the authors determine efficiency of this surgical technique which gives satisfactory results when the operation performed is early enough (before 10 days). They explain the modification of the technique, insisting on the importance of a post-operative follow-up which guarantees a good result and they propose other surgical indications whether they concern fractures of the neck of the fifth metacarpal bone with a relatively small displacement, mainly in young subjects and labourers or indications concerning special cases.

[Severe paralysis of the upper limb after axillary brachial plexus block]. / Paralysie grave du membre supérieur après bloc plexique axillaire.

A case is reported of a severe neurological deficit occurring after axillary blockade. The 37-year-old ASA I patient underwent an axillary block for hand surgery using 20 ml of lignocaine 1% with adrenaline and 20 ml of lignocaine 2%. In order to elicit paraesthesia, several attempts were required. Injection of the local anaesthetic was not painful. The tourniquet remained at 250 mmHg for only 35 min. The following day, the patient's arm remained numb. As there was no improvement, epineurotomy was carried out on day 19, to liberate the median nerve which was severely stenosed at the axilla. The patient then started to improve slowly, so that he was able to return to part-time work 6 months later. Prevention of such an accident relies on avoiding intraneural injection and repeated punctures when searching for paraesthesia. When using axillary blockade in day-care surgery, the patient's must be informed upon the possibility of persistent paraesthesia. Should such a rare incident occur, rapid consultation with the anaesthesiologist is essential.

[Local complications after axillary block anesthesia]. / Accidents locaux de l'anesthésie par blocage axillaire.

The authors treated a local complication after axillary block, probably after intraneural injection of lidocaine. At the operation severe epineural fibrosis was found and released. The result was good after some months. After this the authors realized a study with 14 hand surgeons, and only few cases like the first case were found. This technique axillary block, is very reliable technique, but very few local complications can occur, and it's necessary to know them. It's possible to avoid this local problem with a serious technique to realize axillary block. Never intraneural injection and never many punctures to research paresthesia from the nerves of the brachial plexus.

[The saphenous flap called the Acland's flap. Report of 2 cases]. / Le lambeau saphène dit lambeau d'Acland. A propos de deux cas.

The authors present two cases of Acland's flap. This flap described and published in 1981, is a very good flap, but the myocutaneous flaps have limited its use. However, the authors believe that there are indications for this saphenous flap. The vascular supply for this flap is a saphenous artery, the last branch of the femoral artery, before it becomes the popliteal artery. The authors report two cases: one neurovascular island flap for the posterior side of the knee, and the other case is a free flap for forearm. This flap is part of a particularly rich arterial network on the medial side of the thigh and of the knee. Masquelet, in 1986, showed that it is possible to raise a periosteal flap or a vascularized tendon flap.

[Is it necessary to continue to reimplant all or part of the terminal phalanx of the finger? Apropos of a homogenous series of 38 cases (35 patients)]. / Faut-il continuer à replanter tout ou partie de la dernière phalange des doigts? A propos d'une série homogène de 38 cas (35 patients).

The authors present their experience with the very distal reimplantations: an homogenous series of 38 cases is presented. G. Foucher at SOS Mains Strasbourg showed this technique to the authors in 1980. The authors present their technique, which is adapted with the level of distal amputation, then their postoperatively attitude is presented in detail, particularly for "the bleeding maintained" and for the iterative surgery when necessary. Then the failures are precised. Finally functional results are studied: mobility is often good, sensibility is precised with the Weber test, cold pain is frequent, stop of work average is two months. Finally unsatisfactory nail and distal tip are precised.

Extensor tendon injuries. Presentation of a series of ninety-nine cases.

A series of 99 cases of injuries of the extensor system, followed in the 3 Traumatology and Orthopedics Ward (Dijon, France) is presented. Results were analyzed according to Verdan's classification. In most cases, a Jenning "barb-wire" type repair, introduced in France by Y. Allieu, was made. Early mobilization and skin tension problems are emphasized; two cases of degloving on the dorsum of the hand are presented with details. As well, a special place concerning the results of repair in the proximal interphalangeal joint must be reserved, because of the very frequent association of articular destruction and the very difficult problem s of surgical management which arise in these cases.

[Papineau's technique: one possibility to treat osseous infection--a review of 35 cases (author's transl)]. / Une possibilité du traitement de l'infection osseuse: la technique de Papineau. A propos d'une série de 35 cas.

Amongst techniques recently proposed to treat osseous infections, Papineau's technique is one of the most frequently utilized. Success is certain if operating conditions and procedures are strictly respected. The first requirement is to excise as largely as necessary infected and necrotized tissues. Papineau's technique is particularly suitable to treat superficial bones, as tibia, in which the loss of tissue resulting of the excision are easily filled up with pieces cut off from other bones. This technique has a low social cost and may be carried out without an associated antibiotherapy and whatever germ is responsible. For these reasons, Papineau's method has a great value in the treatment of osseous infection in tropical environment.

[Treatment of African vesico-vaginal fistulae in a rural hospital (author's transl)]. / Traitement chirurgical des fistules vésico-vaginales africaines en hôptial rural.

The author reports his own experience of this difficult surgery in a rural african hospital. He describes various types of fistulae and 3 technics which gave him 10 recoveries in 19 patients. Complications, rules of treatment and nursing are considered.