RESUMEN
A case is reported here of an unusual case of rupture of the flexor tendons of the index finger in the carpal tunnel complicating a subcutaneous displacement of a lunate bone. This was combined with a carpal tunnel syndrome with hypoaesthesia. The treatment, taking account of the age of the patient and the relative tolerance to the dislocation, consisted of a simple resection of the lunate to free the medial nerve together with a partial graft of the flexor digitorum profundus.
Asunto(s)
Traumatismos de los Dedos/complicaciones , Luxaciones Articulares/complicaciones , Hueso Semilunar/lesiones , Traumatismos de los Tendones/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Rotura , Traumatismos de los Tendones/cirugíaRESUMEN
In this study, the authors analyze 197 recent injuries of the flexor tendons of fingers in zones I, II and III of Verdan, without complex cutaneous lesions, associated with an injury of one or both digital nerves, but leaving safe at least one digital artery. Tendon repair is either followed by strict immobilization or by Kleinert's method of immobilization. Results concerning 115 reviewed injuries evaluated according to Kleinert's criteriae, show a net superiority of Kleinert's technique compared to strict immobilization. Global results are analysed according to the age, the finger injured and the presence of a work accident. Lesions treated by Kleinert's technique have been analyzed according to the zone of injury, the tendon injured in zone II and the existence or not of an injured digital nerve. After Kleinert's method, factors affecting the prognosis are lesions in zone II, injury of both tendons, lesions of the fifth finger, the responsibility of a "work accident". The authors conclude as to the correct time for repair, the tendons to be repaired and the type of injuries to be immobilized. They also emphasize the progress brought to the surgery of flexor tendons by Kleinert's method.
Asunto(s)
Traumatismos de los Tendones/cirugía , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios/métodos , Pronóstico , Férulas (Fijadores) , Técnicas de Sutura , Tendones/cirugíaRESUMEN
Classically, the diagnosis of hemoperitoneum is based on clinical symptoms, which are not always relevant. Several complementary procedures can be considered when dealing with polytraumatic patients who may be comatose: scintigraphy, arteriography, CT, sonography and peritoneal lavage. The authors have finally selected sonography and lavage. Since ultrasound is reliable, reproductable and non aggressive, it is being more and more utilized. It readily shows solid-liquid contrast, and is particularly sensitive in displaying fluid in peritoneal recesses; parenchymal lesions are also evaluated. II enables one to explore the abdominal cavity with precision. Lavage is reserved for acute lesion with severe, evolutive hemoperitoneum, requiring immediate surgery. The indications for other imaging modalities are also discussed.
Asunto(s)
Traumatismos Abdominales/complicaciones , Hemoperitoneo/etiología , Ultrasonografía , Hemoperitoneo/diagnóstico , HumanosRESUMEN
In general, fractures of the sternum are of little interest. This is unfair since unstable fractures may be the cause of paradoxical respiration and hence respiratory distress. Fractures often result from automobile accidents and occur in passengers wearing seat belts. In these circumstances, the seat belt in fact replaces the steering wheel as the causative agent. With reference to several cases this variety of injury is studied from the anatomo-pathological, clinical and therapeutic viewpoints. Osteosynthesis using a plate and screws limited to the sternum or including neighbouring rib fractures would appear to be the method of choice. Surgical fixation of the fracture site, the methods of which are discussed, is of value for both isolated lesions of the thoracic cage, and also in the context of single stage surgery in certain patients with multiple trauma.
Asunto(s)
Fijación Interna de Fracturas/métodos , Fracturas Óseas/diagnóstico , Esternón/lesiones , Accidentes de Tránsito , Adulto , Anciano , Placas Óseas , Femenino , Tórax Paradójico/etiología , Tórax Paradójico/cirugía , Fracturas Óseas/etiología , Fracturas Óseas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Cinturones de Seguridad/efectos adversosRESUMEN
Closed isolated fractures of the radial head should be considered and managed in a different way from those associated with other traumatic lesions of the upper extremity. The recommended treatment for the radial head is early motion, with or without internal fixation or arthroplasty. For this to be achieved, surgical fixation of most of the associated fractures, and surgical repair of serious damage to capsular and ligamentous structures, should be performed. Indications are proposed, according to the results of a series of 73 cases which are compared with our series of 168 observations on isolated radial head fractures.
Asunto(s)
Traumatismos del Brazo/complicaciones , Fracturas del Radio/cirugía , Traumatismos del Brazo/terapia , Huesos del Carpo/lesiones , Fracturas Óseas/complicaciones , Fracturas Óseas/cirugía , Humanos , Fracturas del Húmero/complicaciones , Fracturas del Húmero/cirugía , Luxaciones Articulares/complicaciones , Luxaciones Articulares/terapia , Pronóstico , Fracturas del Radio/complicaciones , Fracturas del Cúbito/complicaciones , Fracturas del Cúbito/cirugía , Lesiones de CodoRESUMEN
The review of a series of 168 cases of isolated fractures of the upper end of the radius in adults allows the authors to note the advantage of functional therapy. The early physical therapy contributed to obtain an important rate of good results with the different types of Mason's classification. An osteosynthesis, when performed, must permit the early mobilisation of the elbow in order to avoid stiffness. Such a short experience does not allow the authors to conclude in favor of the necessity for the emergency use of a radial prosthesis instead of an isolated resection.
Asunto(s)
Fracturas del Radio/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We present one case of peritoneal splenosis, which was not confirmed by the splenic scintiscan with 99mTc-sulphur colloid, but whose diagnosis, carried out during a second scintiscan with 99mTc-heat-damaged RBC, was confirmed by laparotomy and histology. This case confirms that, for the diagnosis of splenosis, heat-damaged RBC scintigraphy must be used rather than either sulphur colloid scintigraphy or computed-tomography.