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1.
Acta Orthop Belg ; 88(3): 589-598, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36791714

RESUMO

Congenital syndactylies account for 1 to 2 out of 2000 birth defects. Although several types of syndactylies exist, we only studied embryonic syndactylies. The goal of our study was to compare 2 types of coverage flap for the reconstruction of the finger web spaces: a volar flap described by Blauth and a dorsal flap described by Gilbert. Between 1993 and 2015, children affected by simple and complex syndactylies (partial or complete) were treated in 2 french pediatric hospitals and were selected for our analytic, comparative, retrospective review. The 2 hospitals used different surgical techniques: one used a volar flap described by Blauth and the other a dorsal flap described by Gilbert. The children were followed up to look for signs according to the stages of the Classification of Withey and to evaluate a global result according to the score of Withey. Our secondary criteria of judgement were the aspect of the surgical scar according to the VSS (Vancouver Scar Scale) and the satisfaction of the parents and children. The age of the children, need for a surgical revision and time of last follow- up were also studied. We found statistically significant differences between group I (volar flap) and group II (dorsal flap) in favor of the volar flap: higher scores of Withey (even when the number of commissures was increasing) and better VSS (regardless of the number of web spaces treated). There was no statistically significant difference between the 2 groups in terms of age, follow-up, or rate of surgical revision. All in all, the volar flap presented less sequelae in terms of scar retraction. Regardless of the flap used, the cosmetic results of the full-thickness skin graft used impacted the result both on the receiving site (dyschromia, hairiness) and the donor site.


Assuntos
Procedimentos de Cirurgia Plástica , Sindactilia , Humanos , Criança , Estudos Retrospectivos , Cicatriz/cirurgia , Retalhos Cirúrgicos , Sindactilia/cirurgia , Transplante de Pele , Resultado do Tratamento
2.
Ann Chir Plast Esthet ; 65(3): 204-212, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31178308

RESUMO

OBJECTIVES: The main purpose of our study was to assess the web creep rate of congenital syndactyly treated with a Blauth palmar commissural flap. METHODS: Every child with at least one syndactyly, simple or complex, syndromic or not, were included in this study. The main criterion of this study was the web creep rate according to the Withey scale (0 to 4). Scar assessment according to the Vancouver Scar Scale, hair growth and/or dyschromia on the full-thickness graft, digital spacing, flexion deformity, clinodactyly, range of motion of the finger, sensitivity and satisfaction were also assessed. RESULTS: Separation of the webbed fingers was performed in 65 syndactylies between 1993 and 2015. The median age at the time of surgery was 14 months. We reviewed 31 web flaps with a mean follow-up time of 9 years. Fifty eight percent of the webs were grade 0 on the Withey scale, 36% were grade 1, 6% were grade 2. There was no grade 3 or 4. No correlation was found between the age at the time of surgery, gender, web space involved, complexity of the syndactyly, and the web creep. A decrease in range of motion and a flexion deformity of the fingers involved were more frequently found in complex syndactylies. Eighty seven percent of full-thickness grafts presented dyschromia, and 42% abnormal pilosity. CONCLUSION: Palmar flap as described by Blauth is a safe technique ensuring good functionals outcomes and a low web creep rate for the reconstruction of the web space in congenital syndactyly.


Assuntos
Mãos/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Sindactilia/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
3.
Eur J Orthop Surg Traumatol ; 29(4): 893-898, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30535642

RESUMO

INTRODUCTION: Damage to the common peroneal nerve is the most frequent nerve injury in lower limb traumas. Our objective was to assess the motor and sensory recovery levels and the functional outcomes after remedial surgery for common peroneal nerve trauma, through either neurolysis, direct suture or nerve graft. METHODS: This is a transversal, observational study of a monocentric cohort of 20 patients who underwent surgery between January 2004 and June 2016, which included 16 men and 4 women whose median age was 35 ± 11 years. We assessed the level of sensory and motor nerve recovery and the Kitaoka score. Nine patients benefited from neurolysis, 5 had direct sutures, and 6 received a nerve graft. RESULTS: With 48 months' average follow-up, 7 out of 9 patients underwent neurolysis and 4 out of 5 with direct sutures had good motor recovery (≥ M4), but none for the grafts. Sensory recovery (≥ S3) was satisfactory in 7 out of 9 cases in the neurolysis group, 3 out of 5 in the direct suture group, and 3 out of 6 in the nerve graft group. The average Kitaoka score was 83.7 ± 11.5 for the neurolysis group, 86.8 ± 16 for the direct suture group, and 73 ± 14 for the graft group. CONCLUSION: Surgical treatment by neurolysis and direct suture yields good results with a motor recovery ratio nearing 80%. When a nerve graft becomes necessary, recovery is poor and resorting to palliative techniques in the shorter run is a strategy which should be evaluated.


Assuntos
Procedimentos Neurocirúrgicos , Traumatismos dos Nervos Periféricos/cirurgia , Nervo Sural/transplante , Suturas , Adulto , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Recuperação de Função Fisiológica
4.
Ann Chir Plast Esthet ; 60(3): 247-51, 2015 Jun.
Artigo em Francês | MEDLINE | ID: mdl-25069828

RESUMO

We report a unusual case of "fillet flap" to reconstruct the lower limb with the amputated contralateral leg. This kind of procedure was first described by Foucher et al. in 1980 for traumatic hand surgery as the "bank finger". A 34-year-old man suffered a microlight accident with bilateral open legs fractures. A large skin defect of the left leg exposed the ankle, the calcaneus and a non-vascularized part of the tibial nerve (10 cm). The patient came to the OR for surgical debridement and had massive bone resection of the left calcaneus. The right leg showed limited skin defect at the lower part, exposing the medial side of the ankle and a tibial bone defect, measuring 10 cm. Salvage the left leg was impossible due to complex nerve, bones and skin associated injuries, so this leg was sacrificed and used as a donor limb, to harvest a free fibula flap for contralateral tibial reconstruction. At 18 months of follow-up, the patient was very satisfied, the clinical result was very good on both lower limbs and X-rays showed excellent integration of the free fibula flap. The patient had normal dailies occupations, can run and have bicycle sport practice with a functional left leg fit prosthesis. This case showed an original application of the "fillet flap concept" to resolve complex and rare traumatic situations interesting the both lower limbs. In our opinion, this strategy must be a part of the plastic surgeon skills in uncommon situations.


Assuntos
Amputação Cirúrgica , Fíbula/transplante , Retalhos de Tecido Biológico , Salvamento de Membro/métodos , Fraturas da Tíbia/cirurgia , Adulto , Humanos , Masculino
5.
Ann Chir Plast Esthet ; 58(2): 123-31, 2013 Apr.
Artigo em Francês | MEDLINE | ID: mdl-21236543

RESUMO

UNLABELLED: Necrotizing fasciitis is a hypodermis, muscular fascia then dermis necrotizing infection. OBJECTIVE: The originality of this study is to present a series of necrotizing fasciitis treated and followed these last five years, and to compare the therapeutic results with those of the literature. PATIENTS AND METHODS: We led a retrospective study on the patients treated for necrotizing fasciitis between 2005 and 2009 by bringing together the demographic and clinical data, the bacteriological examinations and the results of management. Follow-up data from these patients during period of study (five years) were notified. RESULTS: Seventeen patients were treated (11 men and six women). The average age of the patients was 52 years (ranging from 28 to 82 years). Risk factors of necrotizing fasciitis for our patients were: nonsteroidal anti-inflammatory drugs (82.2%), cutaneous wound (76.4%), obesity (29.4%), oto-rhino-laryngologic diseases (23.5%), alcoholic and drug addicts (23.5%), and diabetis (11.7%). The most isolated and responsible germ was Streptococcus pyogenes in 75.5% of cases. Culture of specimens collected before antibiotic treatment showed that the bacterium was sensible to the antibiotics being administered (clindamycin in 70.5% of cases). The surgical management was early done with an average delay of 2.7 days (ranging from 1 to 15 days). We observed a low mortality rate (11.7%). One patient died during the period of follow-up after one year (average follow-up of 2.0 years; 1-3 years). CONCLUSION: Contrary to the data from the literature, this study presents a decrease of the mortality in necrotizing fasciitis with an early treatment and an adequate management. The precocity and the quality of surgical procedures as well as the presence of an underlying disease are determining factors for successful management of necrotizing fasciitis.


Assuntos
Antibacterianos/uso terapêutico , Clindamicina/uso terapêutico , Desbridamento , Fasciite Necrosante/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Desbridamento/métodos , Fasciite Necrosante/microbiologia , Fasciite Necrosante/mortalidade , Fasciite Necrosante/patologia , Feminino , Seguimentos , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica , Estudos Retrospectivos , Fatores de Risco , Streptococcus pyogenes/isolamento & purificação , Taxa de Sobrevida , Resultado do Tratamento
6.
Hand Surg Rehabil ; 42(2): 127-133, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36764359

RESUMO

OBJECTIVES: The aim of this study was to compare the clinical and functional outcomes of three surgical techniques (subperiosteal suture, bone anchor and direct repair) for the management of severe acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint with a minimum of 1 year follow-up. MATERIAL AND METHODS: Between 2015 and 2020, 230 collateral ligament injuries required surgical treatment in our department. After the inclusion and exclusion criteria were applied, 100 were included in the study. The Glickel score and functional scores such as QuickDASH and PRWE were assessed. Time to return to work and to sport was quantified. RESULTS: Ulnar collateral ligament injuries affected men who were statistically younger than women (41.8 years old vs 48.3). Subperiosteal suture was the preferred technique (81%), then bone anchor reattachment (12%) and direct repair (7%). All three techniques produced excellent stability (91-100%). Better range of motion was reported in the subperiosteal group, but better strength was found in the bone anchor group. Subperiosteal suture had 89% excellent and good results, while there was 83% in the bone anchor group and 71% in the direct repair group. Mean time to return to work was 2 months in the bone anchor group versus 3 months in the subperiosteal group. Mean QuickDASH was 8.7/100 and mean PRWE was 7.1/100. CONCLUSION: This is the biggest case series to date on surgical treatment of severe ulnar collateral ligament injuries of the thumb metacarpophalangeal joint. The subperiosteal technique is simpler and less expensive. While the results are not often described in the literature, it produces comparable clinical and functional outcomes to bone anchor reattachment with a minimum follow-up of 1 year.


Assuntos
Ligamento Colateral Ulnar , Articulação Metacarpofalângica , Polegar , Adulto , Feminino , Humanos , Masculino , Ligamento Colateral Ulnar/cirurgia , Ligamento Colateral Ulnar/lesões , Articulação Metacarpofalângica/cirurgia , Articulação Metacarpofalângica/lesões , Polegar/cirurgia , Polegar/lesões
7.
Hand Surg Rehabil ; 41S: S11-S15, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34020054

RESUMO

Transferring a muscle's point of force application by modifying its distal insertion will modify its function. This is the basic principle of tendon transfers. Despite being less popular due to superior primary nerve repair results, hand surgeons must be familiar with them. When used according to the Ten Commandments we propose, they provide good and useful functional recovery. Obviously, it depends on the number of muscles available for transfer. Tendon transfer is useful not only in nerve trunk palsy and brachial plexus lesions but also in upper limb tetraplegia rehabilitation. Tendon transfers are active palliative treatments under voluntary command and can be combined with other palliative procedures (arthrodesis, tenodesis) to improve the functional result. Nevertheless, they are far from ideal, as they re-allocate the remaining forces of the limb but do not create new ones.


Assuntos
Plexo Braquial , Tenodese , Plexo Braquial/cirurgia , Humanos , Quadriplegia/cirurgia , Transferência Tendinosa/métodos , Extremidade Superior/cirurgia
8.
Hand Surg Rehabil ; 40(6): 765-770, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34246813

RESUMO

The goal of this study was to describe the long-term functional outcomes of the procedure described by Dubert (stabilized arthroplasty with intermetacarpal arthrodesis) for painful carpometacarpal impingement of the little finger. Between 2005 and 2017, 8 patients (1 woman and 7 men) were operated on who had a mean age of 38 years (24-53 years). Seven cases were post-traumatic (malunion) and one was due to septic arthritis. A total of 5 patients were available for a retrospective clinical, functional, and radiological follow-up at a mean of 73 months (23-108 months). Clinical parameters included pain on VAS, grip strength, Quick Disability of Arm, Shoulder and Hand questionnaire, Patient-Rated Wrist Evaluation, and a subjective hand value (0-100%). Fusion was achieved in all cases. Of the 8 patients, one developed complex regional pain syndrome and one had persistent pain that required secondary proximal metacarpal resection. At the last follow-up, all patients were satisfied and reported a significant reduction in pain and improvement in strength. Mean Quick Disability of Arm, Shoulder, and Hand questionnaire, Patient-Rated Wrist Evaluation and subjective hand value were 19/100 points, 21/100 points and 75%, respectively. Our study suggests that the stabilized arthroplasty of the fifth finger, as describe by Dubert, is an efficient and reliable method to reduce pain and improve hand function in patients suffering from carpometacarpal impingement of the little finger. LEVEL OF EVIDENCE: retrospective series, IV.


Assuntos
Articulações Carpometacarpais , Osteoartrite , Adulto , Artrodese/métodos , Artroplastia/métodos , Articulações Carpometacarpais/cirurgia , Feminino , Humanos , Masculino , Osteoartrite/cirurgia , Estudos Retrospectivos
9.
Hand Surg Rehabil ; 40(1): 97-100, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32781253

RESUMO

The occurrence of compartment syndrome after a viper bite is a rare phenomenon and its treatment remains controversial. We report the case of an 11-year-old boy who developed compartment syndrome of the right upper limb following a viper bite. Decompression by fasciotomy was performed urgently with a good outcome. Surgical decompression for compartment syndrome following a viper bite is not a common treatment according to the literature. Fast access to care and antivenom administration seem to be effective at treating the compartment syndrome without recourse to fasciotomy.


Assuntos
Síndromes Compartimentais , Mordeduras de Serpentes , Antivenenos/uso terapêutico , Criança , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Fasciotomia , Humanos , Masculino , Mordeduras de Serpentes/complicações , Extremidade Superior/cirurgia
10.
Hand Surg Rehabil ; 40(4): 420-426, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33689925

RESUMO

Amandys® pyrocarbon interposition arthroplasty is intended for widespread arthritis of the wrist. The aim of this study was to assess the clinical, functional, and radiological results of this arthroplasty with a minimum follow-up of 12 months. This retrospective single-center study brought together all osteoarthritis indications that can benefit from an Amandys® arthroplasty. Twenty-one implants were used between January 2011 and October 2018. There were seven cases of distal radius malunion, eight SLAC wrists, two SNAC wrists, two cases of Kienböck's disease at Lichtman's stage 4, and two aftermaths of inflammatory arthritis. Twenty-four percent of patients had previously undergone another type of surgery for this wrist arthritis. Six implants were removed, five early for dislocation and one after 6 years for chronic pain. Thirteen patients were reviewed with an average follow-up of 40.7 months (21-90). The average pain level on a visual analog scale was 3.1/10 (0-7). The mean range motion was 36° flexion (10-60) and 33° extension (15-50). The mean grip strength at the last follow-up was 14.8 kg (2-30) (43% of contralateral). The average QuickDASH and PRWE functional scores were 37.9/100 (0-80) and 29.6/100 (0-83.5), respectively. Amandys® interposition arthroplasty is an interesting alternative to total wrist fusion or total wrist prosthesis for widespread arthritis of the wrist. For the implant to be stable, the capsulo-ligamentous systems must be intact.


Assuntos
Prótese Articular , Osteoartrite , Artroplastia , Seguimentos , Humanos , Osteoartrite/diagnóstico por imagem , Osteoartrite/cirurgia , Estudos Retrospectivos , Punho/cirurgia
11.
Hand Surg Rehabil ; 36(5): 355-362, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28756188

RESUMO

The aim of this study was to determine and analyze the functional and radiographic outcomes after proximal row carpectomy (PRC). We hypothesized that this surgery could restore wrist mobility and function in case of radiocarpal osteoarthritis or severe carpal trauma. Sixty-two patients who had undergone PRC were included in this study: 44 patients with wrist osteoarthritis (11 SNAC, 24 SLAC, 3 Kienböck's disease, 6 other) and 18 patients with severe carpal trauma. Each patient underwent clinical (pain, range of motion, grip strength, functional scores) and radiographic evaluations. At the latest evaluation after a mean of 11.8 years, 15 patients (24.2%) required revision total wrist arthrodesis surgery in a median of 22 months (range, 6-179) because of disabling pain and lack of strength. The failure was statistically correlated with being young and a manual laborer. The range of motion and strength of the operated wrist were 61.5% and 70%, respectively, compared to the contralateral side. PRC remains a reliable procedure for treating wrist arthritis and severe carpal trauma. However, manual activity and being under 50years of age can lead to an early salvage procedure such as total arthrodesis of the wrist. In this subset of the population, another alternative must be considered.


Assuntos
Ossos do Carpo/cirurgia , Adulto , Idoso , Artrite/cirurgia , Artrodese/estatística & dados numéricos , Ossos do Carpo/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Ocupações , Dor/etiologia , Dor/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores Sexuais , Resultado do Tratamento , Escala Visual Analógica , Articulação do Punho/cirurgia , Adulto Jovem
12.
Hand Surg Rehabil ; 36(3): 151-172, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28521852

RESUMO

While upper limb nerve transfers were first described and performed several years ago, they have seen expanded use in the past 20 years. Initially indicated for surgical repair of brachial plexus injuries with nerve root avulsion, the indications have been extended to post-ganglionic lesions because of the excellent results of certain intraplexus nerve transfers. The traditional nerve repair techniques - primary suture and nerve grafting - form the basis of nerve surgery. Although nerve transfer does not replace them, they are a useful supplement as they provide a targeted approach to reinnervation and recovery of key functions of the upper limb. The goal of this review is to provide an overview of the various possible transfers by the function being restored and the quality of the outcomes.


Assuntos
Transferência de Nervo , Extremidade Superior/inervação , Anastomose Cirúrgica/métodos , Plexo Braquial/lesões , Plexo Braquial/cirurgia , Humanos , Extremidade Superior/cirurgia
13.
J Hand Surg Eur Vol ; 41(4): 406-12, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26763272

RESUMO

UNLABELLED: This study evaluated recovery of sport performance and correction of bowstringing after surgical reconstruction of closed finger pulley rupture in high-level rock climbers. A total of 38 patients treated with an extensor retinaculum graft were assessed. The mean follow-up time was 85 months, and 30 patients returned to their previous climbing level. The mean total active motion score was 96% of the opposite side. All patients had an excellent Buck-Gramcko score. There was no significant difference in grip strength and tip pinch strength in the crimp position between the injured side and the opposite side. A total of 31 patients were examined with ultrasonography. In 18, flexor bowstringing effects had returned to near-normal values. There was an association between rock climbing level recovery and the flexor bowstringing correction (odds ratio, 6.9; 95% confidence interval, 1.1-42.8). If flexor bowstringing was corrected, patients were more likely to regain their preinjury sport performance. The ultrasonography measurement was a useful tool for predicting functional recovery. LEVEL OF EVIDENCE: 4.


Assuntos
Traumatismos dos Dedos/cirurgia , Volta ao Esporte , Traumatismos dos Tendões/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Força da Mão , Humanos , Masculino , Montanhismo , Adulto Jovem
14.
Chir Main ; 34(2): 59-66, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25769771

RESUMO

The Roseland(®) hydroxyapatite-coated prosthesis is a total trapeziometacarpal joint prosthesis used for the surgical treatment of thumb basal joint arthritis. The aim of this retrospective study was to evaluate its long-term outcomes. Fifty-one patients (64 thumbs) underwent trapeziometacarpal joint replacement with this prosthesis. The mean follow-up was 12.5 years. Survival rate of the prosthesis was 91%. There was either no pain or only occasional pain in 91% of cases. The mean QuickDASH score was 27.6. Abnormal radiographic findings were present in 70% of cases. Since they were often asymptomatic, no further treatment was carried out. Complications were common (25%) and occurred early on but could often be treated without surgery. The long-term results with the Roseland(®) HAC prosthesis are satisfactory in terms of pain relief and function. However, the high complication rate is a major concern.


Assuntos
Articulações Carpometacarpais/cirurgia , Durapatita , Próteses e Implantes , Trapézio/cirurgia , Articulações Carpometacarpais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Falha de Prótese , Radiografia , Estudos Retrospectivos , Fatores de Tempo , Trapézio/diagnóstico por imagem
15.
Rev Inst Med Trop Sao Paulo ; 37(1): 13-8, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-7569635

RESUMO

A parasitological survey was carried out on 222 inhabitants of five farms in Holambra, located 30 km north of Campinas, São Paulo, Brazil, on October 1992. Approximately 70% of the inhabitants were found to be infected with at least one species of intestinal parasite. The positive rates of 6 helminths and 7 protozoan species detected are as follows: 5.4% Ascaris lumbricoides; 8.6% Trichuris trichiura; 19.8% Necator americanus; 10.4% Strongyloides stercoralis; 1.4% Enterobius vermicularis; 0.9% Hymenolepis nana; 3.2% Entamoeba histolytica; 2.7% E. hartmanni; 9.9% E. coli; 14.0% Endolimax nana; 2.3% Iodamoeba butschlii; 10.4% Giardia lamblia; 37.8% Blastocystis hominis. The positive rates of helminth infection were generaly higher in the younger-group under 16 years-old than those in the elder group aged 16 or more, whereas the infection rates of protozoan species were higher in the elder group. The infection rate of Strongyloides was found to be 10.4% by a newly developed sensitive method (an agarplate culture methods).


Assuntos
Helmintíase/epidemiologia , Enteropatias Parasitárias/epidemiologia , Infecções por Protozoários/epidemiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Pré-Escolar , Fezes/parasitologia , Feminino , Humanos , Lactente , Recém-Nascido , Enteropatias Parasitárias/parasitologia , Masculino , Pessoa de Meia-Idade , Prevalência , Saúde da População Rural , Fatores Socioeconômicos
16.
Chir Main ; 23(5): 243-8, 2004 Oct.
Artigo em Francês | MEDLINE | ID: mdl-15573878

RESUMO

INTRODUCTION: Twelve high-level rock climbers were operated on for flexor tendon pulley rupture. Circumstances of pulley rupture and contributing factors are studied; postoperative improvement is evaluated by rock climber level increase, compared to the initial level. METHOD: Average age was 28 years and there were nine males and three females; all of them were high-level rock climbers, succeeding at least in 7a climbing ways before the accident. The surgical procedure was to replace the deficient pulley using an extensor retinaculum graft. RESULTS: The non-dominant hand was the most frequently involved, and especially A2 pulley of the fourth finger. Diagnosis was easy and clinically established. DISCUSSION: Medical or functional treatments never allowed climbers to reach their former level. The only efficient treatment was surgical, whatever the time elapsed between injury and surgery. After this surgical procedure, five of the twelve patients improved their results, five recovered their former level and two decreased. The results are analysed and compared to other surgical procedures. CONCLUSION: Surgical repair of rupture of flexor tendon pulley during sport is the only efficient treatment allowing the rock climber to recover and improve its performance.


Assuntos
Traumatismos dos Dedos/cirurgia , Montanhismo/lesões , Traumatismos dos Tendões/cirurgia , Adulto , Feminino , Humanos , Masculino , Músculo Esquelético/transplante , Ruptura/cirurgia
17.
Chir Main ; 22(4): 197-202, 2003 Aug.
Artigo em Francês | MEDLINE | ID: mdl-14611073

RESUMO

INTRODUCTION: Fifteen patients were treated for arthritis of the base of the thumb by trapieziumectomy and anchovy interposition using Dacron[symbol: see text]. The results are described. METHODS: The 15 patients were between 42- and 68-years-old at the time of operation. The mean postoperative follow-up was 3 years. Pain, pinch strength, opposition, opening of the first web space and height of the space formerly occupied by the trapezium were clinically and radiologically evaluated. RESULTS: Pain had completely disappeared in more than 80% of the patients. The mean post-surgical opposition was 8.9/10 (Kapandji score). The pinch strength and first web-space opening were improved, whereas the height of the trapezium site was always reduced by 25%. The only complication was one case of reflex sympathetic dystrophy: no case of foreign body reaction was reported. Eleven of the 15 patients were satisfied with the operation, and noted better thumb function in everyday life. DISCUSSION: The treatment of arthritis of the base of the thumb by means of trapieziumectomy and anchovy interposition is effective with respect to pain in all the studies previously published, whatever the technique used. Mobility is preserved, contrary to arthrodesis, and grip strength remains compatible with the patient's daily life. The choice of a synthetic anchovy such as Dacron[symbol: see text] allows a quicker operation and better than the ones involving sacrifice of a tendon at the wrist. Anchovy interposition remains the preferred alternative among other procedures in the treatment of basal osteoarthritis of the thumb.


Assuntos
Artroplastia/métodos , Articulações dos Dedos , Osteoartrite/cirurgia , Polietilenotereftalatos , Polegar , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade
18.
Chir Main ; 33 Suppl: S2-12, 2014 Dec.
Artigo em Francês | MEDLINE | ID: mdl-24837978

RESUMO

This short story of flexor tendon repair aims to illustrate hesitations and wanderings of this surgery. Obviously tendon repair was very early considered, but it developed and diffused rather lately. It became a routine practice only in 20th century. This was due on the one hand, in Occident, to the Galen's dogmatic interdiction, on the other hand, to the repair difficulties of this paradoxical structure. Actually tendon is made of fibroblasts and collagen (sticky substances), and then its only goal is to move. According to this necessity, whatever the used techniques are, gliding is the final purpose. Technical evolutions are illustrated by historical contributions to flexor tendon surgery of several "giants" of hand surgery.


Assuntos
Ortopedia/história , Traumatismos dos Tendões/cirurgia , Tendões/anatomia & histologia , Tendões/cirurgia , Traumatismos da Mão/cirurgia , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , História Antiga , História Medieval , Humanos
19.
Chir Main ; 33 Suppl: S13-27, 2014 Dec.
Artigo em Francês | MEDLINE | ID: mdl-24837520

RESUMO

Flexor tendons repair in zone 1 is classically considered providing good results with an overall satisfactory finger function. However, the objective functional results after surgical repair of flexor digitorum profundus are sometimes disappointing. The authors describe the different surgical repair techniques available to the operator from so-called "traditional" sutures to newer methods of internal fixation using miniaturized anchor sutures. The management of postoperative procedures, that of failures and old cases are reported.


Assuntos
Traumatismos da Mão/classificação , Traumatismos da Mão/cirurgia , Traumatismos dos Tendões/classificação , Traumatismos dos Tendões/cirurgia , Humanos , Modalidades de Fisioterapia , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Contenções , Âncoras de Sutura , Técnicas de Sutura , Traumatismos dos Tendões/diagnóstico , Tendões/anatomia & histologia , Tendões/cirurgia , Aderências Teciduais/prevenção & controle
20.
J Mal Vasc ; 39(1): 67-72, 2014 Feb.
Artigo em Francês | MEDLINE | ID: mdl-24210749

RESUMO

UNLABELLED: Secretan's syndrome is a rare condition involving generally trauma-induced hard edema of the dorsal aspect of the hand. The cause is poorly understood but factitious trauma is often suspected. CASE REPORT: A 42-year-old woman presented with a fortuitous edema on the back of the right hand. The minimally depressible edema was associated with moderately intense mechanical pain. Routine laboratory tests were normal. An extensive imaging work-up (bone x-ray of the hand and wrist, bone scintigraphy, computed tomography phlebography, lymphoscintigraphy, magnetic resonance imaging) was equally non-contributive. The diagnosis of self-inflected trauma was suggested by the atypical nature of the edema, the absence of any organic disorder on the tests performed, and the patient's attitude concerning her disease. In this clinical context, the diagnosis of Secretan's syndrome was retained. Outcome was compatible, with secondary development of complex regional pain syndrome. DISCUSSION: Three forms of Secretan's syndrome have been recently described: benign; hyperplastic; and mixed. The cause remains poorly defined. Certain authors report that it is most likely related to pathomimia. Treatment can combine physiotherapy and psychological counseling. CONCLUSION: Secretan's syndrome is a poorly-understood and rarely-described condition that may be underdiagnosed. Physicians specialized in vascular medicine should be aware of this syndrome and its difficult diagnosis by elimination.


Assuntos
Edema/diagnóstico , Deformidades Adquiridas da Mão/diagnóstico , Traumatismos da Mão/complicações , Comportamento Autodestrutivo/diagnóstico , Adulto , Bandagens Compressivas , Feminino , Deformidades Adquiridas da Mão/psicologia , Deformidades Adquiridas da Mão/terapia , Humanos , Linfocintigrafia , Imageamento por Ressonância Magnética , Distrofia Simpática Reflexa/etiologia , Comportamento Autodestrutivo/psicologia , Síndrome
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