[Facial wounds: an epidemiological review of 850 cases]. / Plaies faciales : étude épidémiologique de 850 cas.

BACKGROUND: Facial wound are among the most frequent emergencies. They often affect a young population. We studied the epidemiological profile of facial wounds admitted in our hospital. PATIENTS AND METHODS: This prospective study was carried out in the Emergency Unit from June 2008 to June 2009. It included all patients having presented with at least one facial wound. The analysed parameters were patient, trauma, and wound characteristics. RESULTS: Eight hundred and fifty patients were included, 20% of whom were female patients. The most frequent etiologies were traffic accidents for men, assault for women, and domestic accidents for children. Alcohol abuse was involved in 12.4% of the cases. The most frequent wound localization was frontal (35.4%). A craniofacial organ (eye, brain…) was affected in 6.1% of the cases; the wound was associated to a craniofacial fracture in 9.6% of the cases, and to an extrafacial lesion in 22% of the cases. DISCUSSION: Facial wounds are a frequent emergency. They are predominant in young male patients. The high frequency of traffic accident and alcohol abuse requires an adequate prevention policy.

[Barraquer-Simons syndrome]. / Syndrome de Barraquer-Simons.

The Barraquer-Simons syndrome is a rare acquired acral partial lipodystrophy of unknown etiology. It progressively develops during childhood. It leads to a complete loss of subcutaneous fat in the face, neck, trunk and upper limbs. The disease is more common in female than male patients and causes facial dysmorphy. Free fat transplantation seems to be an appropriate technique to treat facial abnormalities encountered in this syndrome.

[Correction of breast Poland's anomalies. About eight cases and literature review]. / Correction des anomalies mammaires du syndrome de Poland. A propos de huit cas et revue de la littérature.

PURPOSE: The objective of the present study was to analyze current indications and results of different methods for breast anomaly correction of Poland's syndrome. PATIENTS AND METHODS: Eight patients with this deformity were operated between 1997 and 2008: seven females and one male. The mean age was 22. According to Foucras et al. classification, four patients revealed Poland's syndrome grade II, three patients grade I and two patients grade III. Three patients received silicone implants (two with Poland's syndrome grade II, one with grade III). Autologous fat injection was used for a male adolescent who was very embarrassed by his deformity. Controlateral lipo-aspiration was carried out in three cases with moderate Poland's syndrome breast asymmetry. For one patient, correction was achieved by controlateral breast resection. RESULTS: No intraoperative or postoperative complications occurred for the eight patients. Aesthetic results were overall satisfactory. CONCLUSION: The simplest and the fastest breast deformity correction technique in Poland's syndrome patients, the one with the least complications and cosmetic sequella and the most practiced by the surgeon, remains the best method for breast anomaly correction of Poland's syndrome.

[Osteoid osteoma of the lunate: case report]. / Ostéome ostéoïde du lunatum: à propos d'un cas.

The Osteoid Ostéome is a benign tumour which affects the young subjects and is electively located on the level of the long bones. We report a hyperalgic form of the lunatum in a young student with which surgical excision with bone-graft allowed the cure.

[Bipolar dislocation of the forearm]. / Luxation bipolaire de l'avant-bras: luxation du coude et luxation transcapholunaire du carpe. A propos d'un cas.

The authors report the case of a 23 year old patient, who presented the following combination of injuries after a fall, namely a divergent dislocation of the elbow, a fracture of the radial head, a fracture of the ulna and a perilunate dislocation with scaphoid fracture. The entire injury thus represented a bipolar dislocation of the forearm. The emergency management consisted of a closed reduction of the elbow together with osteosynthesis of the ulna, internal fixation of the scaphoid with a compression screw, and scaphocapitate K wiring. After 26 months, the function of the elbow was satisfactory, and the range of motion of the wrist was from 50 degrees of flexion to 40 degrees of extension. Satisfactory healing of the scaphoid was observed. This combination of injuries has only rarely been reported in the literature.

[Aseptic osteonecrosis of the femoral head in thalassemia minor: a case report]. / Ostéonécrose aseptique de la tête du fémur dans la thalassémie mineure: á propos d'un cas.

We report a case of aseptic necrosis of the femoral head in a 14-year-old black adolescent with thalassemia minor disclosed by physical examination and blood tests. No other anomaly could be identified. Despite the very probably secondary nature of the aseptic osteonecrosis of the femoral head and the absence of any other etiology, it is highly difficult to demonstrate the causal effect of thalassemia minor. We reviewed the literature and discuss the pathogenesis of this association.

[Total carpometacarpal dislocation. Case report]. / La luxation carpométacarpienne antérieure complète des doigts. A propos d'un cas.

Anterior carpometacarpal dislocation are rare injuries. The anterior type is exceptional. Mr A.T 18 years old, male, student, right-handed, without pathological medical history. He was admitted in emergency after a fall of a motorbike (unknown mechanism) for a closed left hand injury; examination revealed a total impaired mobility and an important swelling of the hand without vasculonervous disorders. X-ray revealed a pure anterior dislocation of the five carpometacarpal joints. The patient was operated on in emergency using both anterior and posterior approach, which allowed to reduce the dislocation. It was maintained by K-wires. An antebrachiopalmar cast was applied for six weeks. One year later, the result obtained was considered excellent.

[Ewing's sarcoma of the hand: a case report]. / Sarcome d'Ewing de la main: a propos d'un cas.

Ewing's sarcoma of the hand is rare. This tumor was first described in 1921, since then, only a few cases with hand involvement have been reported. We report a case of Ewing's sarcoma of the left hand, presenting as a swelling of the hand gradually enlarging over six months. Plain radiographs showed marked osteolysis of the second, third and fourth metacarpals. Histological confirmation was made following biopsy. Despite amputation and post-operative chemotherapy, death occurred two months later due marrow aplasia.

Which approach is best for subungual glomus tumors? Transungual with microsurgical dissection of the nail bed or periungual?

Glomus tumors are rare, accounting for 1% to 5% of all hand tumors. The treatment of subungual glomus tumors consists of complete surgical excision, either by the periungual or transungual approach. Tumor recurrence and nail dystrophy are the main complications. The purpose of this study was to evaluate the outcome as a function of the surgical approach used - transungual or periungual. Fifty-three patients presenting with a subungual glomus tumor underwent surgical excision through the periungual approach if the tumor was peripheral, or the transungual approach if the tumor was centrally located. These patients were followed for an average of 2years. Pain relief was always obtained the day following surgery. Wound healing was achieved on average after 2weeks with the periungual approach and 5weeks with the transungual approach. Other than some longitudinal striations in 10 patients (18.9%) who had been operated through the transungual approach, there were no complications or tumor recurrence. We recommend a periungual approach for a peripheral tumor and a transungual approach for a central tumor. The latter approach, which carries some risks of nail-related sequelae--always minor in our experience--allows for better exposure if the tumor is centrally located.

Floating thumb metacarpal in a motorcyclist: A case report.

We present a case of simultaneous dislocation of the carpometacarpal and the metacarpophalangeal joints of the thumb (floating thumb metacarpal) in a 47-year-old motorcyclist. The treatment consisted of closed reduction of both joints with cast immobilization. After 24 months, the functional result was excellent. The mechanism of this rare injury and its therapeutic management are discussed.

Evaluation of a new eLearning platform for distance teaching of microsurgery.

Online learning (or eLearning) is in constant evolution in medicine. An analytical survey of the websites of eight academic societies and medical schools was carried out. These sites were evaluated against parameters that define the quality of an eLearning website, as well as the shareable content object reference model (SCORM) technical standards. All studied platforms were maintained by a webmaster and regularly updated. Only two platforms had teleconference opportunities, five had courses in PDF format, and four allowed online testing. Based on SCORM standards, only four platforms allowed direct access without a password. The content of all platforms was adaptable, interoperable and reusable. But their sustainability was difficult to assess. In parallel, we developed the first eLearning platform to be used as part of a university diploma in microsurgery in France. The platform was evaluated by students enrolled this diploma program. A satisfaction survey and platform evaluation showed that students were generally satisfied and had used the platform for microsurgery education, especially the seven students living abroad. ELearning for microsurgery allows the content to be continuously updated, makes for fewer classroom visits, provides easy remote access, and especially better training time management and cost savings in terms of travel and accommodations.

[Primary hydatidosis of the peripheral muscles. 7 case reports]. / L'hydatidose primitive des muscles périphériques. A propos de 7 cas.

The authors reviewed a series of 7 cases of isolated and primitive hydatid cyst in the peripheral muscles. The disease was mainly diagnosed in young (average age 29.3 years) women of rural origin (87.7%), who consulted for a soft tissue tumor, evolving over at least 6 months, without alteration of the general condition. In 5 of the 7 patients, the tumor was located in the thigh and in 3 cases in the adductors compartment. The diagnosis was highly suspect on sonography. The surgical treatment consisted in a complete resection of the hydatic cyst with surrounding muscle tissue in 6 of the 7 cases, and in a subtotal removal of the surrounding tissues in one case which had adhesions of the surrounding tissues with the femoral vessels. With a follow-up of 19 months, neither clinical nor serological examination showed any recurrence or new sites.

[Arthrolysis of the elbow--apropos of 70 cases]. / L'arthrolyse du coude--à propos de 70 cas.

This retrospective review covers 70 cases of elbow stiffness treated by arthrolysis. The average age was 27 years. Eighty percent had a posttraumatic origin; 53.6% were old dislocations. In 67.1% the range of movement was reduced for flexion and extension; 80% were severe to very severe cases. Physiotherapy was passive and active from the third postoperative day, except for the old dislocations, treated for 2 weeks by fixation of the radial condyle, because of instability. For 51.4% the range of movement was -30 degrees extension up to 130 degrees flexion, intra-operatively; for 21.4% it was a long-term result. The results were related to the damage to the joint space, the large number of old dislocations and insufficient rehabilitation.

[Carpal perilunar dislocation. Clinical study (apropos of 39 cases)]. / Luxations péri-lunaires du carpe. Etude clinique (à propos de 39 cas).

Carpal perilunar dislocations are hidden lesions with uncertain outcome and treatment which is not yet standardized. This retrospective study including 39 cases of carpal perilunar dislocations helps clarify these issues. For fresh dislocations, the diagnosis was established in 66%. Surgical treatment was performed in 26 cases. Anatomic results showed nonunion, necrosis and residual instability. Function was always decreased and was worse in open forms or after orthopedic treatment. Scaphoid screwing results were better than those from pinning. Lateral wrist x rays must always be ordered in cases of wrist trauma to avoid delayed diagnosis. Surgical treatment must systematically use a palmar incision; it permits precise repair of bones and ligamentous lesions and reduces the risk of arthritis.

[Solitary osteochondroma of the limbs. Clinical review of 76 cases and pathogenic hypothesis]. / L'exostose ostéogénique solitaire des membres. Revue clinique de 76 cas et hypothèse pathogénique.

The authors report a retrospective study of 76 solitary osteochondromas of the appendicular skeleton treated between 1981 and 1995. The ages of the patients ranged from 13 to 55 years with a mean of 21 years. The male/female-ratio was 1.37. Tumefaction with or without associated pain was the reason for consultation in 68 cases (89%). In 62 cases the osteochondroma was localized in the distal part of the femur or the proximal part of the tibia. All lesions were surgically resected; the resection was complete in all cases. Six patients were lost to follow-up; the other 70 were seen on a regular basis over a time period ranging from 1 to 12 years. The result from surgical treatment was assessed based on pain, joint motion, cosmetic consequences, nerve compression and recurrence of osteochondroma. The results were good in 68 cases and fair in two cases. Based on a review of previous experimental studies, the authors suggest a hypothesis to explain the rotation of a fragment of the growth plate which is needed for the development of osteochondroma. This rotation occurs as a result of the mechanical action from the periosteum under tension.

[Subungual exostoses. A retrospective study of a series of 28 cases]. / Les exostoses sous-unguéales. Etude rétrospective d'une série de 28 cas.

Subungual exostosis represents an uncommon osteocartilaginous benign proliferation with a trend towards recurrence. The authors report on a retrospective series of 28 cases of subungual exostosis of the first toe with histologic confirmation. There were 20 male and 8 female patients, with a mean age of 18 years. A history of trauma or repetitive microtrauma was noted in 21 cases. Surgical treatment was performed using the most direct approach. The tumor was widely excised and the ungual apparatus was reconstructed under optic magnification. All patients were reviewed after 14 to 96 months. Tumor recurrence was observed in 4 cases, treated secondarily with success. No malignant transformation was seen.

[Associated median-ulnar nerve injuries at the level of the wrist. Apropos of 17 cases]. / Les plaies nerveuses médio-cubitales associées au niveau du poignet. A propos de 17 cas.

A study of a homogeneous series of 17 complete associated wounds of the median and ulnar nerves at the level of the wrist, was conducted. They were always associated with tendinous and arterial injuries. Repair in emergency has consisted in an epiperineural suture under optic enlargement, tendinous suture and arterial suture. 29.4 per cent of patients had good results. Elements of bad prognosis were contusion, repaired but non functional arteries, and total and simultaneous character of the two nerves section.

[Idiopathic acro-osteolysis. Apropos of a case with carpal-tarsal onset]. / L'acro-ostéolyse idiopathique. A propos d'un cas à début carpo-tarsien.

This work reports an isolated case of idiopathic acro-osteolysis with a carpo-tarsian onset without associated nephropathy, diagnosed in a 16 year-old patient. It has raised problems of etiologic diagnosis, of classification and therapeutic behaviour in the presence of destructive lesions with an extensive and progressive evolution.

[An osteoid osteoma of the os capitatum]. / L'ostéome ostéoïde du grand os.

We report a hyperalgic form of an osteoid osteoma of the capitatum, wich had evolved since 14 months. The diagnosis was done by roentgenography. Complete surgical excision of the lesion led to the cure.