Chirurgie de la main
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Injuries to the nail complex are common in adults and children. These complex injuries often involve the paraungueal tissues, fingertip and bone. ⋯ The current state of knowledge on nail bed lacerations and defects is reviewed and compared to our own experience. Special attention is paid to nail restoration in distal amputation cases and we propose an original technique to restore nail length.
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Chirurgie de la main · Apr 2013
[Cartoons, local anesthesia and nitrous oxide: a solution for the treatment of child's hands wounds].
Wounds and injuries of child's hands are common and create anxiety. The context of stress makes difficult therapeutic cares, anesthesia and surgery, and prevents child's cooperation. We propose a technique combining a local anesthesia performed during inhalation of oxygen and nitrous oxide, and child distraction by watching a cartoon. ⋯ All children could be treated as outpatients. This procedure allows a rapid and adapted treatment for children's hand injuries. It reduces impact of children's anxiety.
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Chirurgie de la main · Apr 2013
Comparative Study[Evaluation of postoperative pain and early functional results in the treatment of carpometacarpal joint arthritis. Comparative prospective study of trapeziectomy vs. MAIA(®) prosthesis in 74 female patients].
Trapeziectomy has been the basis of basal thumb arthritis surgical treatment since the 1950s. This resection arthroplasty has been continuously refined (soft-tissue interposition, ligament reconstruction, spacer implantation, etc.) without leading to a dramatic outcome improvement. Pain decrease is often satisfying in the long-term, but comfort during the early postoperative period may vary. Those disadvantages of trapeziectomy led to the emergence of total trapeziometacarpal prostheses in the 1970s, with a constant improvement of implant design. Few series have compared those two surgical techniques side by side, and prospective ones are even rarer. We compared total trapeziometacarpal prosthesis and trapeziectomy-interposition in the very short term in two similar groups of female patients, to determine whether prosthesis led to faster recovery or not. We compared a total trapeziometacarpal prosthesis (MAIA(®)) and trapeziectomy-interposition in the immediate and short-term (6 months), for objective, subjective, functional criteria, as well as short-term comfort or discomfort. We prospectively followed two comparable cohorts of 47 and 27 female patients above 50 years of age, treated for basal joint arthritis with a constrained trapeziometacarpal joint prosthesis or trapeziectomy-interposition, respectively, between April 2009 and February 2010. The patients were followed postoperatively for 6 months. Mobility, pain reduction, satisfaction, strength and functional scores were better in the prosthesis group. The pinch strength improved by 30%, the length of the thumb column was maintained, and better correction of the subluxation was obtained in this group. There were six cases of De Quervain's tenosynovitis and one case of loosening due to trauma. In the short-term, the MAIA(®) trapeziometacarpal prosthesis gives better outcome than trapeziectomy with interposition. This has to be confirmed in the long-term and after revision surgery that will be likely to occur. ⋯ Therapeuthic 3.
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Chirurgie de la main · Apr 2013
Case Reports[Transscaphoid perilunate dislocation with proximal displacement of the lunate and proximal scaphoid. A case report].
We report the case of a patient who suffered from an unusual anatomic form of trans-scaphoid trans-styloid volar dislocation of the lunate with proximal displacement of both the lunate and the proximal pole of scaphoid, proximal to the radiocarpal joint line. Proximal row carpectomy was performed. A good anatomic and functional result was observed at 3 years of follow-up. Etiopathogeny, therapeutic and outcome modalities are discussed.
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Chirurgie de la main · Feb 2013
Case Reports[Intra-articular distal radial fracture with lunate fossa rotated, about 4 cases: interest of surgical procedure by volar medial approach].
Intra-articular distal radial fractures in young subjects occur in severe trauma. Articular reduction needs to be anatomical. We report four cases with the particularity of having a 90° or 180° rotated lunate fossa. Our goal is to bring out the positive aspects of surgical procedure by volar medial approach and to assess long-term functionnal and radiological results. ⋯ Imaging with simple radiographs is not sufficient and needs to be complemented with CT scan. Our approach allows for direct access to the fragment of the lunate fossa and easier visualization of the distal radioulnar, compared to Henry's approach, thereby avoiding excessive traction of the median nerve. TYPE D'ÉTUDE: Niveau IV.