[What determines the sick leave of repair and rehabilitation of the hand flexor tendons injuries]. / Recherche sur les facteurs influençant la durée de l'arrêt de travail dans les réparations des tendons fléchisseurs de la main.

OBJECTIVES: The purpose of this study is to analyse the relationship between the social and economical consequences, after repair and rehabilitation of the hand flexor tendon injuries, and to prove that it is not related to local factors. METHOD: All the patients who underwent surgery for at least one flexor tendons injury of one or several long fingers, between the years 2003-2004 were included in this study. Information regarding the data was taken from the patient file. Statistical tests were used for analysing these data. RESULTS: Significant first rate factors related to the length of sick leave are the chaotic professional history (P=0.03), the type of occupation (P=0.01) and the age (P=0.0002). A significant second rate factor is represented by the type of mobilization/retraining (P=0.04). Sex, side of injury, finger injured, zone of injury, associated damages, did not significantly influence the results of this study. CONCLUSION: The environmental factors determine the length of sick leave more than the characteristic of injury in hand flexor tendons surgery.

[Boxer's fracture: Cost evaluation orthopaedic or surgical treatment]. / Evaluation du coûit des fractures du col du cinquième métacarpien traitement orthopédique et chirurgical.

UNLABELLED: Many methods of treatment have been proposed for fractures of the neck of the fifth metacarpal ranging from early mobilization to various surgical techniques. The aim of this retrospective study was to evaluate the functional results and the costs of closed as opposed to open treatment (Foucher's K-Wire technique). MATERIALS AND METHODS: We conducted a retrospective study on all fractures without rotational deformity and with a palmar angulation less than 40 degrees C. Details of the patients, the fractures, functional results and the cost of management were analyzed. RESULTS: The functional results were similar between the two groups, but surgical treatment increased the cost of treatment to 1100 euros. CONCLUSIONS: We advocate the use of closed treatment for these fractures. The functional results are the same as with surgical management, but the costs are much reduced.

[Ocular vasospastic syndrome]. / Le syndrome vasospastique oculaire.

Vasospasm can have many different causes and can occur in a variety of diseases as well as in otherwise healthy subjects. We distinguish between primary vasospastic syndrome and secondary vasospasm. The term "vasospastic syndrome" summarizes the symptoms of patients having such a spasm to stimuli like cold or emotional stress. Patients with primary vasospastic syndrome tend to suffer from cold hands, low blood pressure, migraine and silent myocardial ischemia. The ocular vasospastic syndrome is clearly associated, among other manifestations, with glaucomatous optic neuropathy and non arteritic anterior ischemic optic neuropathy. The ocular vasospasm leads to a compromised autoregulation, and therefore sensitizes the eye to intraocular pressure or to a decrease in blood pressure. A variation in ocular perfusion may lead to an increase in free oxygen radicals and in glutamate. This may finally induce apoptosis cascade in retinal ganglion cells. Valuable diagnostic tools are nailfold capillary microscopy and angiography, but probably the best indicator is an increased plasma level of endothelin-1. The role of calcium channel blockers, magnesium, endothelin and glutamate antagonists are discussed.

[Third molar surgery under general anesthesia: a review of 180 patients]. / Extraction des dents de sagesse sous anesthésie générale : à propos de 180 patients.

BACKGROUND: Third molar surgery is an important part of the activity in a maxillofacial surgery department. This common activity is often under-evaluated by patients who forget its surgical aspect. The aim of this study was to evaluate our practice, and especially complications, with special consideration given to medicolegal aspects. MATERIALS AND METHODS: All the patients operated between September 2004 and July 2006 were enrolled in a retrospective study. This population is described, with the indications, follow-up, and complications. RESULTS: One hundred and eighty patients were reviewed (sex-ratio 1, mean age 27 years). The most frequent indications were impaction and pain. The mean duration of hospitalization was 1.7 days and temporary disability, one week. Local infection occurred in 8%; there was neurological complication in 2% for the inferior alveolar nerve, and 1% for the lingual nerve. These were all transient cases. DISCUSSION: Third molar surgery is an important and profitable part of the activity in a maxillofacial surgery department. Standardized information is necessary even if the rate of complications remains low.

[Peri-implantitis or squamous cell carcinoma?]. / Péri-implantite ou carcinome épidermoïde?

INTRODUCTION: Squamous cell carcinoma developed around dental implants has seldom been described. It simulates peri-implantitis. The authors present two cases and a literature review. CASE REPORTS: A 70 year-old woman presented with an exophytic tumor developed around dental implants placed in the anterior part of the mandible. Panoramic X-rays showed major osteolysis, especially around the distal abutment implants. A 72 year-old patient, smoker, presented with chronic lichen planus; he was carrying two implants supporting an overdenture with ball-attachments, placed 15 years before. He presented with an ulcerated symphyseal tumor, bone loss around implant in position 43. The implant had been spontaneously pushed out. In both cases the diagnosis was squamous cell carcinoma. DISCUSSION: Few cases of squamous cell carcinoma developed around dental implants have been reported. They initially mimic peri-implantitis. The carcinogenic role of the implant has never been established. Another hypothesis is the migration of malignant cells, originating from a mucosal tumor, through the sulcus. Risk factors for squamous cell carcinoma (smoking or alcohol consumption, precancerous lesions) are an indication for a permanent follow-up. Biopsies will prove the diagnosis.

[Dynamic distraction and early reeducation in proximal interphalangeal joint fractures: preliminary results of a 15 patients' prospective series]. / Traitement des fractures articulaires interphalangiennes proximales des doigts par distraction dynamique et rééducation précoce: résultats préliminaires d'une série prospective de 15 cas.

INTRODUCTION: The authors present early results of the treatment of interphalangeal fractures with external dynamic distractor and early reeducation. PATIENTS AND METHODS: Fifteen proximal interphalangeal fractures were treated with a "do-it-yourself" external distracter. Distraction was performed with rubber band or steel stitches. Patients sustained immediate self-mobilization and physiotherapy. Total duration of the treatment was 45 days. RESULTS: Thirteen patients had good results with normal mobility after three months and recovered 80% of their controlateral force. Algodystrophia occurred in one case with poor functional results. One late management led to severe interphalangeal rigidity. CONCLUSION: External distraction is a safe and economical treatment providing good early results with few complications. Long-term follow-up is necessary to make this procedure a standard-of-care in the management of proximal interphalangeal fractures.