[Negative pressure therapy in austere environments: extremities]. / Thérapie par pression négative en situation précaire: les membres (2ème partie).

Negative pressure therapy (NPT) is widely used in developed countries where it a technique of choice in the management of wound healing on extremities. Because of the cost, the specific ressources necessary forNPT are scarce in austere environments. This report describes a simple, economical alternative technique using a "breathing bandage" that can be made from from widely used surgical products.

[Management of bluespotted stingray injuries in Djibouti from July 2008 to July 2009]. / Prise en charge des piqûres de raies pastenagues à Djibouti de juillet 2008 à juillet 2009.

Although stingray injuries have always been frequent in the Republic of Djibouti, it was not until July 2008 that the Bouffard Hospital developed a standardised management protocol. The purpose of this report is to describe that protocol and evaluate its impact on the outcome of stingray injuries based on a prospective study for the period between July 2008 and July 2009. During the study period, 12 stingray stings were treated. The treatment protocol that is based on a multidisciplinary approach involving the intensivist, anaesthesiologist, and surgeon achieved wound healing within one month. This outcome contrasts with previous publications that have generally described longer healing times with frequent infectious complications.

[Reverse prosthesis and os acromiale or acromion stress fracture]. / Prothèse d'épaule inversée en présence de mésoacromion ou d'acromion fracturé

PURPOSE OF THE STUDY: We reviewed cases of acromion stress fracture or os acromiale among a consecutive series of 240 reverse prostheses implanted between 1995 and 2003. MATERIAL AND PATIENTS: Ten patients presented os acromiale, ten fracture-fragmentation of the acromion, and one nonunion of the scapular spine. The reverse prosthesis was implanted via a deltopectoral approach with no specific procedure on the acromion. There were 17 women and four men, mean age 72 years. The dominant side was involved for 70%. The prosthesis was indicated for excentered glenoid deterioration (n=14), massive rotator cuff tears without osteoarthritis (n=5), and failure of a hemiarthroplasty (n=2). Seventeen patients were reviewed with more than two years follow-up. RESULTS: 87.5% of the acromial lesions became dislocated postoperatively due to the traction of the deltoid. There was no significant difference between os acromiale and acromion stress fracture. The acromial displacement did not compromise the objective outcome since the Constant score was comparable to that obtained in 179 cases with no acromial lesion reviewed with the same follow-up. Unlike these later shoulders, there were two cases of scapular spine fracture postoperatively, leading to poor function (pain and motion scores less than the global score). CONCLUSION: Acquired or congenital acromial lesions are not a contraindication for reverse prosthesis. Postoperative fracture of the scapular spine is less well tolerated and may required revision for osteosynthesis.

Trapeziometacarpal joint dislocation complicated by a trapezium fracture: A case report and literature review.

The authors report and discuss the management of a 25-year-old male patient with a trapeziometacarpal joint dislocation complicated by a trapezium fracture. This injury combination is rare with only reported 15 cases. After closed reduction resulted in dorsal instability, anatomical reduction of the trapezium fracture and internal screw fixation were performed using an open approach. This fixation stabilized the joint but was fragile due to the small fragment size. For this reason, ligament reconstruction using half of the flexor carpi radialis tendon was added. At the last follow-up, 16 months later, the trapeziometacarpal joint was stable with a normal range of motion, but the patient had slight pain during physical effort and decreased pinch strength.

An automated motion measurement system for clinical gait analysis.

An automated motion measurement system using a television camera interfaced to a computer was constructed and evaluated to determine its applicability to clinical gait analysis. Experimental data indicate that the motion measurement system has a resolution of 1 part in 2000 and a static accuracy of 1 part in 1000 with a worst case dynamic error of 1 part in 300. The study has also shown that this system can reliably track multiple passive markers on a human illuminated with infrared light emitting diodes. This approach minimizes patient distraction, since the illumination is not visible, and reduces patient discomfort since a marker telemetry back pack system, to control active markers, is not needed. Further, the motion measurement system has been successfully demonstrated under conditions similar to those expected in a clinical environment.

Management of neglected open extremity fractures in low-resource settings: Experience of the French Army Medical Service in Chad.

INTRODUCTION: The purpose of this study was to report the experience of the French Army Medical Service in the management of neglected open extremity fractures and related-complications in Chad. HYPOTHESIS: Delayed treatment of open extremity fractures is possible in a low-resource setting. METHODS: An observational prospective study was performed in a French Forward Surgical Team deployed in N'Djamena for six months. RESULTS: Twenty-seven patients, 24 men and three women, mean age 30 years old with an open fracture that was managed more than 24 hours after it occurred were included. The mean treatment delay was 83 days. Fractures were located in the tibia in 20 cases. There were 15 non-infected and twelve infected fractures. The number of cases of debridement, flap coverage, and the overall number of procedures were higher in the group with infection, but the difference was not significant. Treatment of infected fractures was complicated by six early recurrent infections, while there were no complications in the group without infection. The mean follow-up was 4.4 months. Infection was controlled in eleven cases, however evaluation of fracture healing was limited because of the short follow-up in the group with infection. Functional outcome of the lower extremities was often complicated by knee stiffness. DISCUSSION: Delayed management of open fractures depends on the available resources. In low-resource settings, the goals of surgery should be modest. Treatment of non-infected injuries and osteomyelitis is possible. On the other hand, treatment of infected fractures and septic nonunions should be undertaken with caution if all the necessary aspects of treatment, in particular extended antibiotic treatment and sequential procedures are not possible. LEVEL OF EVIDENCE: level IV.

[Management of bilateral hand amputations in low-resources setting: the Krukenberg procedure is still indicated]. / Prise en charge des amputations bilatérales des mains en situation précaire : l'intervention de Krukenberg reste d'actualité.

Double hand amputation leads to complete loss of prehensive function and touch sense. Patients become totally dependent on others for survival. In developing countries, where sophisticated myoelectric prosthesis are not available, the Krukenberg procedure gives to these patients elementary self-sufficiency for daily-life. This procedure can be performed in low-resources setting and requires minimal rehabilitation. However, patient selection and preparation are critical because of an unattractive aesthetic aspect which limits this operation use in occidental countries.

Relaxation of the coherence requirements in holography.

Spatial and temporal coherence limitations in holography can be partially overcome with a simple diffuser box (similar to an integrating sphere). Experimental results show that the scene depth can be extended to at least 10 times the coherence length of the light source. Even holographic intprferometry is possible. An analysis in the time and frequency domain is presented. It shows the important role of the speckling and explains the observed reduction of the SNR.