COVID-19: Initial experience of an international group of hand surgeons.

The emergence of the COVID-19 pandemic has severely affected medical treatment protocols throughout the world. While the pandemic does not affect hand surgeons at first glance, they have a role to play. The purpose of this study was to describe the different measures that have been put in place in response to the COVID-19 pandemic by hand surgeons throughout the world. The survey comprised 47 surgeons working in 34 countries who responded to an online questionnaire. We found that the protocols varied in terms of visitors, health professionals in the operating room, patient waiting areas, wards and emergency rooms. Based on these preliminary findings, an international consensus on hand surgery practices for the current viral pandemic, and future ones, needs to be built rapidly.

[Anterior transolecranon fracture-dislocations of the elbow in children: A case report and review of the literature]. / Fracture-luxation trans-olécrânienne antérieure du coude de l'enfant : revue de la littérature à propos d'une observation.

Anterior transolecranon fracture-dislocations of the elbow are rare in children and the literature is poor in recommendations for the management of these lesions. We report a new case with a type of lesion that has not been described previously and discuss this pathology. Based on a literature review, we propose a classification into four types of anterior transolecranon fracture-dislocations of the elbow in children, thereby guiding surgical indications. We recommend reduction and synthesis using a figure-eight tension-band wire in avulsions and transverse type I and II fractures. The bone plate is the best indication in type III oblique fractures in older children.

Posterior approach for surgical treatment of neglected elbow dislocation.

INTRODUCTION: Neglected elbow dislocations often result in contracture and functional impairment. Surgical treatment is challenging because of the accompanying triceps retraction. We wanted to share our experience in treating these neglected dislocations using the posterior approach. PATIENTS AND METHODS: This was a consecutive, prospective study over a 4.5-year period (January 2003 to June 2007) that included all the patients who presented with a neglected elbow dislocation that was older than 21 days. We treated 22 patients (17 men, five women) with an average age of 22.8±8.2 years (range 14 to 46 years). The dislocations were 8.5±4.2 months old on average (range 2 to 17 months). Average elbow flexion was 46.0°±25.9° (10° to 90°) and the extension deficit was 19.5°±18.4° (0° to 60°) before the surgery. A paratricipital approach was used in all patients. In 14 patients, the dislocation was reduced without triceps lengthening. In eight patients, a V-Y plasty of the triceps muscle was required. RESULTS: The average follow-up was 21 months (range 12 to 30 months). The improvement in the overall range of motion was statistically significant. Average elbow flexion was 112.7°±13.3° (60° to 130°) and the extension deficit was 26.6°±17.0° (0° to 60°). The average Mayo Clinic Elbow Performance Index score was 86 (range 50 to 100), with 14 excellent, four good, two average and two poor results. Complications included three cases of ulnar nerve paresis, which subsided within three months, and one case of superficial infection. DISCUSSION: Although surgical treatment is challenging, the functional improvement in neglected elbow dislocations is outstanding. The best functional results can be expected when the triceps splitting approach to the elbow is not used. LEVEL OF EVIDENCE: IV.

Paediatric open tibiofibular fractures following a donkey bite. A report of two cases.

Open tibiofibular fractures resulting from domestic animal bites are exceptional. We report two such cases, in patients of 11 and 13 years of age, and discuss the etiological, pathogenic, anatomic, and clinical aspects of these injuries. These were type III fractures according to the Cauchoix and Duparc classification. The fractures were treated with emergency wound care, wound dressing, and conservative orthopaedic treatment using a long leg cast for immobilization. Preventive parenteral antibiotics were also given. Evolution was favorable in both cases and the patients returned to their normal activities with no substantial disability.

[Entrapment of the median nerve after neglected dislocation of the elbow: a case report]. / Incarcération du nerf médian après luxation négligée du coude : à propos d'un cas.

Entrapment of the median nerve is a rare complication following dislocation of the elbow. The authors report a case of incarceration of the median nerve in a neglected dislocation of the elbow in an 18-year-old right-handed boy. The patient sustained a closed injury of the right elbow during a game. The initial treatment was performed by a traditional bonesetter and consisted of attempts at reduction followed by immobilization in extension. There was persistent pain and limitation of movement in the elbow and paraesthesiae in the long finger. This led the patient to consult us at 45 days postinjury. Radiographs showed a posterolateral dislocation of the elbow. Surgical reduction was carried out 6 months posttrauma. After opening of the capsule, we discovered the median nerve blocking the olecranon fossa, passing at the level of the groove of the trochlea where it was wedged between the latter anteriorly and the olecranon posteriorly before resuming its normal course. Reduction was obtained and the nerve replaced in its normal position. The postoperative course was uneventful with disappearance of the paresthesiae and restoration of a good range of movement of the elbow. The authors discuss the mechanism, the clinical forms and propose a new type according to the classification of Fourrier.