[Tactic for treatment of African mycetomas (author's transl)]. / Tactique thérapeutique dans les mycétomes africains.

The authors report their own experience from 200 cases and they consider the matter from the point of a surgeon operating in a small medical unit in Africa. The clinical and biological aspects are described; the importance and the difficulties of appreciating the real spreading of infection are emphasized. Conventional radiology is of major value. The biological diagnosis may give way to a medical treatment with DDS and sulfamethoxypyridazine in cases due to actinomycetes with red or yellow granules; but in fungic cases fungicid drugs proved to be inefficient. Surgery is still an important component of the treatment. Its tactics are discussed according to the germ, the localization, the extension and also to the social and psychological status, but it is hoped that more sanitary education will reduce its preponderence in making possible earlier diagnosis and treatment.

[Supracondylar fractures of the elbow in children and osteosynthesis by "open sky" double wiring using J. Séror's method. Apropos of 100 cases]. / Fractures supra-condyliennes du coude de l'enfant et ostéosynthèse par double embrochage "à ciel ouvert" à la façon de J. Séror. A propos de 100 observations.

Emphasis is placed on the value of treating supracondylar fractures of the elbow with displacement (stages III and IV) in children by means of the technique described, in 1959, by J. Séror, J. Rives, J. Frailong, and Cl. Azoulay: "open sky" reduction through a twofold internal and external paratricipital posterior approach; maintenance of reduction by two Kirschner wires entering by the epicondyle and epitrochlear, with fixation into the opposite diaphysial cortex, and sectioned and curved inwards in order to remain subcutaneous. Analysis of the results of 100 cases treated in this manner between 1970 and 1980 (Thesis of Cl. Darmon, Grenoble) demonstrated the value of this technique: long-term follow up in 58 cases showed no poor results and 53 (91.5 p. cent) perfectly normal elbows totally identical to those of the opposite side. More extensive use of this technique, as practised in countries other than France and particularly in German speaking countries, is advocated.

Comparison of the efficacy and tolerance of isoxicam and piroxicam following surgery for skiing accidents.

1 A 10 day double-blind study was carried out comparing isoxicam (300 mg day-1) and piroxicam (40 mg day-1 for the first two days and 20 mg day-1 for the remaining days) following surgery in patients who had sustained skiing accidents. There were 20 patients in each group. The isoxicam-treated group had a slightly greater mean pain score prior to treatment. 2 Both isoxicam and piroxicam reduced pain and nocturnal awakening at days 5 and 10, but isoxicam was significantly superior to piroxicam in producing improvement in pain (at day 5, P less than 0.05) and in nocturnal awakenings (at day 10, P less than 0.05). 3 Both agents facilitated rehabilitation and there was no significant difference between them in this regard. 4 All patients in both groups considered themselves 'better' or 'much better' on day 5 of treatment. 5 Both agents were well tolerated by most patients but one patient in each group left the trial because of abdominal pain. One patient stopped isoxicam when she was found to be pregnant.

Screw or mini-plate fixation in fractures of the first metacarpal. Experience with thirty-nine cases.

Re-establishing normal osteoarticular anatomy, and early mobilization are the principal elements in the successful treatment of fractures of the base of the first metacarpal. To achieve these goals in thirty-nine fractures rigid fixation was obtained by screw alone, or by a mini-plate. Seven Bennett's fractures have been treated by screw fixation when the size of the fragment has made it possible. Extra-articular fractures have been treated, either by screw alone, in oblique fractures (7 cases). Or by mini-plate, T or L shaped, in transverse fractures (23 cases). The use of these techniques have been extended, to comminuted fractures but is not used in Bennett's fractures when the fragment is too small to allow the screw to be anchored in it without its being shattered.

Severe metacarpophalangeal sprain of the thumb in ski accidents. 125 surgical repairs in group of 340 cases of metacarpophalangeal sprains from ski accidents.

In more than 12,000 ski accidents seen during 15 winter seasons (1968-1983), 340 cases of metacarpophalangeal sprains of the thumb were encountered. One hundred fifty-nine were labeled as severe, and 125 of these involving the ulnar slope of the articulation were operated as very urgent or urgent. Three types of anatomic lesions were seen at operation. Capsulo-ligamentous lesions are the most frequent (70%), followed by avulsions of large fragments from the base of teh first phalanx attached to the ulnar ligament as well as to the palmar structures (30%). Finally the true fracture of B. Stener is altogether exceptional (1 in 125). Then follows in detail the operative procedures and long term results, which confirm the excellent prognosis of this group of lesions operated early.

Restoration of the pulp with a homodigital neurovascular flap.

A homodigital neurovascular island flap was used to cover extensive loss of finger tip tissue exposing the distal phalanx in twenty cases (16 adults and 3 children). The anatomic and technical aspects of this flap are detailed. In all cases, the reconstructions were considered to be of excellent quality. The study of functional results substantiates the reliability of this island flap, for which sensibility remained good throughout the follow-up period.

[Traumatic luxation of the peroneal tendons. Report of 36 cases]. / La luxation traumatique des tendons péroniers. A propos de 36 cas.

Between January 1970 and September 1992 we operated on 35 patients with dislocation of the peroneal tendons; in 1 patient both sides were affected. Twelve cases were acute and 24 chronic; 83% were due to injuries at sport, 90% of which were in downhill skiers. In 25 cases the fibroperiosteal detachment and the lax tendon sheath were repaired using either the technique of Meary, or that devised by ourselves. Exner suture of the lesion of the main body of the sheath was carried out in 8 cases, and other procedures in the remainder. Ninety two percent of patients had a satisfactory result. The surgical procedure adopted must depend on the patterns of injury, but the majority of cases require fibroperiosteal release with transosseus reattachment of the sheath.

[The Herbert screw in pseudoarthrosis of the carpal scaphoid]. / Le vissage d'Herbert dans les pseudarthroses du scaphoïde carpien.

For nearly three years, the authors have ensured scaphoid union by fixation with a double thread T.J. Herbert's screw. In these 25 cases a cancellous bone graft was used to fill the defect which would have left shortening of the scaphoid Twenty-two of the 25 cases, obtained rapid union, and 20 had a good or very good clinical result. One doubtful union and two cases of non-union occurred. One of these non-unions required revision. The main advantage of this procedure is to allow early mobilization of the wrist. This early is very appreciated by the patients who were immobilized several months by conservative treatment for their initial fracture.

The operative treatment of intraarticular calcaneal fractures. Indications, technique, and results in 257 cases.

Since 1972, 257 intraarticular fractures of the calcaneus have been treated with operative intervention. A lateral incision and a third tubular plate were used in all cases. The functional results were considered excellent or good in 85%, and there was an infection rate of 2.7%. Although 50% of patients showed a reduced mobility of the subtalar joint, pain and limited ambulation were rare. Only six patients required a late subtalar arthrodesis.

[The value of combining multiple screwed plates in humeral shaft fractures]. / De l'intérêt à synthéser par plaque vissée bon nombre de fractures de la diaphyse humérale. A propos de 246 synthèses.

The authors have reviewed 246 fresh fractures of the shaft of the humerus treated by primary plating over a period of 22 years. It has been customary to treat the majority of fractures of the shaft of the humerus by conservative means, with use of open reduction and fixation by a plate for complicated fractures with associated injuries, or in cases of nonunion. Over the period of review the authors have gradually increasing their use of primary plating as opposed to the traditional methods. They fell that the reliability of union, together with the early mobilisation and return of the arm to normal function, favours the use of this method. Their opinion is based on a careful analysis of their results.