Fingertip injuries managed by a thenar flap: Follow-up and long-term outcomes of 32 cases.

While various techniques are used for the reconstruction of fingertip injuries, the main goals remain the same: preserve finger length, sensation, and function. The thenar flap is a well-described technique and simple procedure in fingertip amputations. This study aimed to evaluate the long-term functional and esthetic outcomes along with patient satisfaction of thenar flaps done for fingertip defects. Thenar flaps used in 32 patients operated between January 2010 and December 2016 were analyzed retrospectively to assess sensory recovery, range of motion, cold intolerance, pain relief, appearance, patient satisfaction, and QuickDASH score. All flaps survived, without adverse events. The flap was detached after 10-14 days (mean 12.5 days). The mean follow-up was 31 months (range, 20-45 months). According to Semmes-Weinstein monofilament test results, protective sensation was achieved in 25 patients (78%). The mean static 2-point discrimination was 6.1 mm. There were no functionally significant finger flexion contractures at the final follow-up. Complications such as pain, donor site morbidity and cold intolerance were not encountered. The thenar flap is an excellent technique for coverage of total or subtotal tissue loss of radial-side fingertips that is not accessible to local flaps. It provides good sensory function and appearance when fundamental technical principles (flap design, timing of division, and early mobilization) are respected.

Necrotizing fasciitis of the upper extremity: a retrospective analysis of 19 cases.

Necrotizing fasciitis (NF) is both a limb-and life-threatening disease that affects skin, hypodermis as well as superficial fascia and deep fascia by rapidly progressive necrosis. Although this serious infection frequently occurs in the extremities, upper limb NF is a rare clinical presentation. The present study attempted to evaluate the clinical profiles, paraclinical findings, treatment modalities, outcomes and predictors of morbidity and mortality in patients with NF of the upper extremity. The validity of the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scoring system was also assessed. Nineteen patients who were treated between January 2010 and December 2019 for NF of the upper extremity were eligible for this study. Data including demographics, clinical signs, paraclinical findings, treatment and outcomes were collected retrospectively from our medical records. Fisher's exact test was used to analyze predictive factors for mortality and morbidity. The mean age was 62 years, with a male predominance. The most common comorbidity was diabetes mellitus (42%). Main clinical manifestations were pain (79%), tense edema (79%) and a large infiltrated swollen erythematous plaque (58%). Severe sepsis and septic shock were identified in 32% and 21% of patients, respectively. Thirteen of our 19 patients (68%) were identified as having a high or intermediate likelihood of NF based of the LRINEC scoring system, while the other 6 (32%) were classified as having low likelihood. All patients received systemic broad spectrum antibiotic therapy in addition to surgical debridement. Two patients (10%) died and one (5%) required amputation. Mortality was associated with septic shock (p = 0.006), delay in surgery >24 h (p = 0.018), creatininemia >141 mmol/l (p = 0.018) and LRINEC score ≥ 8 (p = 0.035). Otherwise, anemia (p = 0.021), hypercreatininemia (p = 0.001) and delayed surgical debridement (p = 0.001) were risk factors for morbidity and mortality. The surviving patients underwent reconstructive surgery (skin grafting after wound preparation by using vacuum therapy) with positive outcome. Early diagnosis coupled with emergent surgical debridement and broad-spectrum empiric antibiotic therapy are the keystones of a successful outcome. The LRINEC score was not strongly correlated to the true diagnosis of NF and was a prognostic tool rather than a diagnostic one.

[Carpal tunnel syndrome and "trigger wrist" revealing a tendinous sheath fibroma]. / Syndrome du canal carpien et poignet à ressaut révélant un fibrome de la gaine des fléchisseurs.

The tendinous sheath fibroma (TSF) is a rare benign tumor, exceptionally responsible for carpal tunnel syndrome and "trigger" wrist: we found this association less than ten times in the English and French literature. We report the case of a 63-year-old right-handed carpenter who featured a triggering phenomenon of the right wrist during the flexion-extension movements and compression of the median nerve at the carpal tunnel, secondary to a TSF of the flexor digitorum superficialis. The diagnosis was suspected at the sonography and MRI, the tumor was excised and proven histologically to be a TSF. One year later, the patient remained free of symptoms.

[Fingers amputation following snakebite: a report of three cases]. / L'amputation des doigts par morsure de serpent : à propos de trois cas.

The amputation of the finger complicating an ophidian bite is rare. It is due to virulence of the venom, its concentration in a small volume of tissue and use of a tourniquet. Support of the victim seeks to save his life and function of his(her) hand. Antivenin immunotherapy is the only specific treatment for ophidian envenimation. It is indicated in case of general signs showing a serious bite, but also if local signs could lead to loss of limb function. The authors report three cases of snakebite complicated by amputation of a finger.

[Diffuse tenosenovial giant cell tumor of the wrist revealed by carpal tunnel syndrome: report of a case]. / Tumeur ténosynoviale à cellules géantes diffuse du poignet révélée par un syndrome du canal carpien: à propos d'un cas.

Giant cell tumour of tendon sheath is a benign proliferative lesion of synovial origin that may affect the joints, bursae and tendon sheaths. It is the second most common soft tissue tumor of the hand after ganglion cyst. The localised (nodular) form is the most common. However, the less-common diffuse-type giant cell tumour is usually located in the peri-articular soft tissue. The authors report the case of a giant cell tumor of the tendon sheath arising from the carpal tunnel of the wrist in a 42-year-old woman. The patient presented a mild carpal tunnel syndrome and a mid-palmar swelling. We present an unusual localization of giant cell tumor of the tendon sheath, causing carpal tunnel syndrome.

[Transtricipital dorsal approach in neglected elbow dislocation]. / La voie d'abord postérieure transtricipitale dans les luxations invétérées du coude.

Neglected elbow dislocation is a rare injury but is still frequent in our country. Authors report 12 cases of neglected elbow dislocation with stiffness in extension. All patients were treated by open reduction using a posterior approach and plasty of tricipital tendon. Authors describe the interest of the posterior approach for treatment of neglected elbow dislocation with stiffness in extension.

[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.

[Results of primary median nerve repair at the wrist: report of 24 cases]. / Résultats de la réparation primaire des plaies du nerf médian au niveau du poignet: à propos de 24 cas.

INTRODUCTION: Nerve injuries of the upper limb can cause serious damage: primary repair has improved the results but the prognosis for recovery remains uncertain. We present the results of primary repair of 24 median nerve injuries at the level of the wrist. MATERIALS AND METHODS: Between 1990-1998, we repaired 57 median nerve injuries at the wrist. Only 24 patients were included in this retrospective study. The average age of the patients was 25 years (range: 18-60 years). Seventeen patients were men and seven were women. All the patients were operated within 12 h after the accident. In all the cases, epiperineural suture was performed followed by immobilisation in a cast for 3 weeks. No specific rehabilitation programme was employed. RESULTS: At review with a mean follow-up of 3 years, 46% of the patients obtained good or very good results according to Chanson's scoring system. The sensory recovery was between S4-S2 with the Weber test in 75% of patients. Fifty-eight percent of patients recovered a motor function between M3-M2. DISCUSSION: In most papers, very good and good results averaged 60%. The results in our series did not achieve this level. We believe that this is due to two factors: firstly, the age distribution of our patients and secondly the lack of a specific program of sensory rehabilitation.

[Femoral neck fracture in osteopoikilosis]. / Fracture du col de fémur sur ostéopoecilie.

Osteopoikilosis was discovered in a 53-year-old patient who suffered a fracture of the right femoral neck. Plain X-rays demonstrated symmetrical bilateral stippling of variable size. No images were seen in the skull and spine. The fracture of the femoral neck was treated by total hip replacement. At surgery, the joint cartilage of the femoral head and the acetabulum had a normal aspect. Pathology examination of the femoral head demonstrated regular thick dense lamellae. Functional outcome at ten months was good (Postel-Merle-d'Aubigné score). Osteopoikilosis is an uncommon clinically latent condensing bone disease which can be revealed by bone fracture.