Management of Volkmann's Ischemic Contracture: Case Series of 32 patients.

INTRODUCTION: Volkmann's contracture condition is of high prevalence in our population and is linked to therapeutic faults. The treatment and its results are determined according to the severity of the lesions. METHODS: This retrospective study was performed in three centers and was conducted over 30 years (1987-2018); it included 32 patients. The disabilities of the arm, shoulder and hand (DASH) score and the Weber test were used to evaluate the functional outcome looking at mid and long-term results. RESULTS: Thirty-two patients were treated for Volkmann's Ischemic Contracture (VIC). The age ranged from 4 to 58 years, with 19 patients aged under 15. Wrist fracture was the predominant cause in 16 cases. Fourteen patients obtained a completely functional hand, seven good functional results, four fair functional results, and seven poor results. DISCUSSION: In comparison with other studies, we noticed significant differences: apart from the dominant male sex and right side, this is one large case series conducted over 30 years (1987-2018) looking at mid-and long-term results. All the patients presented with severe or moderate lesions on the first visit. In our study, the wrist fracture is predominant compared to elbow fractures and soft trauma. X-rays are especially helpful and are a first-line investigation for identifying displaced fractures and other associated lesions. Our study population is not large, and the treatment methods are varied, so it is impossible to provide statistically relevant correlations between the treatment method and outcome. But this work is based on the experience of more than 30 years, which makes it possible to help adequate decision making according to the state of the lesions. This study is a level IV case series.

[Emergency coverage of post-traumatic losses of cutaneous substances of the anterior face of the knee using proximally based sural fasciocutaneous flap: about 4 cases of articular wounds]. / La couverture en urgence des pertes de substances cutanées d'origine traumatique de la face antérieure du genou par lambeau fascio-cutané sural à pédicule proximal: à propos de 4 cas de plaies articulaires.

Our study reports 4 cases of male patients with wounds on the anterior face of the knee loosing cutaneous substance after motorcycle accident. The patients had undergone surgery involving the debridement and the application of four proximally based sural fasciocutaneous flaps since 2012. The average age of patients ranged from 28 to 42 years. The highest loss of cutaneous substance measured 14 x 10 cm. The average pedicle length was 14 cm. The post-operative suites were uneventful with a satisfactory wound healing. From a functional point of view the knee and the ankle were completely mobile. This study shows the effectiveness and reliability of proximally based sural fasciocutaneous flap in the coverage of post-traumatic losses of cutaneous substances of the anterior face of the knee, and allows for limit the indications for heads of the gastrocnemius muscle flaps.

[Infection and detachment of total hip prosthesis due to listeria monocytogenes]. / Infection et descellement d'une prothèse totale de la hanche par listeria monocytogenes.

Joint prostheses are increasingly used in our current practice. Infection is one of the most dreaded complications; it is most often due to germs of the skin flora. Listeria monocytogenes rarely causes this infection. We here report the case of a patient with hip prosthesis infected by this germ. Favorable outcome was obtained by antibiotic therapy and single-stage prosthesis replacement.

[Hip arthroscopy in patients with femoroacetabular impingement: about 2 cases]. / L'arthroscopie de la hanche dans le conflit fémoro-acétabulaire: à propos de 2 observations.

Femoroacetabular impingement (FAI) can causes hip pain in young subjects and in athletes. His diagnosis is based on clinical and radiological examinations. Surgical treatment is based on conventional surgery or on arthroscopy. Arthroscopy proves to be a reliable technique in the treatment of FAI. It is effective on the pain and improves performances of athletes in order to enable them to resume their activities within a very short space of time. We here report our experience within our Department in treating 2 patients with FAI with arthroscopy. Modified Harris score significantly improved at the last follow-up (24 and 18 months).

Significance of neutrophilic CD64 as an early marker for detection of neonatal sepsis and prediction of disease outcome.

BACKGROUND: Neonatal sepsis (NS) is a global health problem owing to its significant contribution to morbidity and mortality. We evaluated the significance of neutrophilic CD64 (nCD64) expression as an early marker for diagnosis of NS compared to CRP and assessed its relation to disease outcome. METHODS: High sensitivity CRP (hs-CRP) and nCD64 were measured in 60 neonates with symptoms and signs of sepsis (40% were culture-proved) and 30 age- and sex-matched controls. RESULTS: Baseline hs-CRP and nCD64% were significantly higher among septic neonates compared with the controls (p < 0.05), while, no significant difference was found between the two septic groups (p > 0.05). nCD64 cutoff value > 34.1% was able to discriminate septic neonates from controls with higher sensitivity and specificity than hs-CRP. The mortality rate was 21.7% among septic neonates. Baseline nCD64% was significantly higher among died patients compared with recovered neonates (p = 0.009) while no significant difference was found between baseline hs-CRP and disease outcome (p = 0.117). CONCLUSION: Flow cytometric assessment of nCD64 was able to discriminate neonates with sepsis from controls with higher accuracy than hs-CRP; however, the combination of both nCD64% and hs-CRP enhances the ability to diagnose NS. Quantitative measurement of nCD64 can predict disease outcome in NS.

Ulnar nerve entrapment complicating radial head excision.

INTRODUCTION: Several mechanisms are involved in ischemia or mechanical compression of ulnar nerve at the elbow. PRESENTATION OF CASE: We hereby present the case of a road accident victim, who received a radial head excision for an isolated fracture of the radial head and complicated by onset of cubital tunnel syndrome. This outcome could be the consequence of an iatrogenic valgus of the elbow due to excision of the radial head. Hitherto the surgical treatment of choice it is gradually been abandoned due to development of radial head implant arthroplasty. However, this management option is still being performed in some rural centers with low resources. DISCUSSION: The radial head plays an important role in the stability of the elbow and his iatrogenic deformity can be complicated by cubital tunnel syndrome. CONCLUSION: An ulnar nerve release was performed with favorable outcome.

[Glomus tumors of the hand: a retrospective study of 11 cases]. / Les tumeurs glomiques de la main: une étude rétrospective de 11 cas.

MASSON described glomus tumour as a benign neuromyoarterial proliferation. It represents approximately 1% -5% of all tumors of the hand. Pain is the main clinical sign. Definitive diagnosis is based on a body of evidence: clinical and radiological but only histology will allow confirmation. We conducted a retrospective study of 11 patient whose average age was of 36, 27 years (range 8-48 years), with a mean follow-up period of 34,40 months. All patients underwent surgical excision. This strategy allowed us to achieve satisfactory results.

Post Discharge Formula Fortification of Maternal Human Milk of Very Low Birth Weight Preterm Infants: An Introduction of a Feeding Protocol in a University Hospital.

The objective of this study is to determine the growth parameters and nutritional biochemical markers and complications of fortification of human milk by post discharge formula of preterm very low birth weight newborns (VLBW). Fifty preterm infants less than 37 weeks with weight less than 1500 g were enrolled in the study. They received parental nutrition and feeding according to our protocol. When enteral feeding reached 100 cc/kg/day, infants were randomized into two groups: group I, Cases, n=25, where post discharge formula (PDF) was used for fortification, group II, Controls, n=25 with no fortification. Infants of both groups were given 50% of required enteral feeding as premature formula. This protocol was used until infants' weight reached 1800 g. Daily weight, weekly length and head circumference were recorded. Hemoglobin, albumin (Alb), electrolytes, blood urea nitrogen (BUN) and clinical complications were documented. Human milk fortification with PDF resulted in better growth with increase in weight 16.8 and 13.78 g/kg/day (P=0.0430), length 0.76 and 0.58 cm/week (P=0.0027), and head circumference of 0.59 and 0.5 cm/week (P=0.0217) in cases and controls respectively. Duration of hospital stay was less in cases (22.76 versus 28.52 days in Controls), P=0.02. No significant changes were found in serum electrolytes, BUN, or Alb between both groups. Hemoglobin was significantly higher in Cases, P=0.04. There were no significant clinical complications. Our feeding protocol of fortification of human milk with PDF in preterm very low birth weight newborns resulted in better growth and decrease in length of hospital stay. The use of PDF could be an alternative option for fortification of mothers' milk for preterm VLBW infants in developing countries with low resources.

[Total hip arthroplasty for the treatment of congenital hip dislocations in adults: about 15 cases]. / L'arthroplastie totale de la hanche dans le traitement des luxations congénitales de la hanche chez l'adulte: à propos de 15 cas.

Total hip arthroplasty for the treatment of congenital dislocation represents a challenge for the orthopedic surgeon. It is now well established that the treatment of congenital hip dislocation in adults is a real "functional miracle". The evolution of surgical techniques and materials has expanded the indications for prosthetic replacement including the most complex cases and thus going against Charnley and Feagin who wrote in 1973 that there was no place for total hip arthroplasty in inveterate dislocations. We conducted a retrospective study of a series of THP 15 for the treatment of congenital hip dislocation in adults;sociodemographic, clinical, paraclinical and therapeutic data were collected from the medical records of 15 patients and also via a written questionnaire which was completed during their last follow-up visit. The average age of our patients was 28 years; female sex ratio was 2F/1H. Severe dysplasia stage VI according to Crowe's classification was present in 4 cases, type III in 9 cases and type II only in 2 cases. All patients underwent cemented total hip arthroplasty, a reinforcement ring was used in 9 cases and a bone graft in 2 cases. At last follow-up visit PMA functional scores were excellent and very good in 74% of cases. Surgical treatment of congenital hip dislocations in adults must meet strict health standards as congenital hip dislocations often occurs in young female population that is more demanding as to the aesthetic and functional outcomes. Several surgical techniques have tried to solve the problems related to this disease, acetabular and femoral hypoplasia, leg length inequality. Total hip arthroplasty for the treatment of congenital dislocations in adults remains a challenge for the orthopaedic surgeon. This is a difficult surgical procedure which requires technical skills and careful pre-design programming to reduce the occurrence of adverse events especially in the particular case of young female population.

Renal functional and structural integrity in infants with iron deficiency anemia: relation to oxidative stress and response to iron therapy.

BACKGROUND: Iron deficiency anemia (IDA) is the most common nutritional deficiency in the world. The aim of our study was to evaluate and compare renal functional and structural integrity in 50 infants with IDA and 50 healthy controls and to assess the relation between IDA and oxidative stress and response to iron therapy. METHODS: This was a prospective study in which peripheral blood samples were collected from all study subjects and the following laboratory investigations performed: serum iron profile, urinary microalbumin, urinary leucine aminopeptidase (LAP), fractional excretion of sodium (FeNa), serum total antioxidant capacity (TAC), serum malondialdehyde (MDA), serum and urinary trace elements (iron, copper, zinc, calcium and magnesium). All patients received oral iron therapy and were followed-up for 3 months. RESULTS: The levels of baseline urinary markers were higher among the patients with IDA than among the controls (p < 0.05). Patients had a lower pre-therapy TAC and lower serum zinc and magnesium levels than controls as well as higher MDA and serum copper levels (p < 0.05). MDA level was positively correlated to microalbumin and LAP level (p < 0.05). Urinary LAP concentration was positively correlated to urinary trace element concentrations (p < 0.05). A significant decrease in microalbumin, LAP, FeNa, and urinary trace elements was observed post-iron therapy while hemoglobin and ferritin levels were increased (p < 0.05). CONCLUSION: Among the study subjects, IDA had an adverse influence on renal functional and structural integrity which could be reversed with iron therapy. Oxidative stress played an important role in the pathogenesis of renal injury in IDA.

Unusual combination of lesions of the traumatic hand: closed central slip laceration of the extensor and interphalangeal thumb joint's dislocation (a case report).

From the functional standpoint, the hand is one of the most important organs of the body. However, its significance depends largely upon the pincer action of the thumb-index. The management of traumatic lesions of the hand is nowadays' subject of numerous scientific discussions. We present here the case of a patient with a recent laceration of the central slip of the extensor tendon with boutonniere deformity linked to a dislocated interphalangeal thumb of the same hand with a loss of force of the clip thumb and index finger. This combination is a rare lesional of the traumatic hand that has not been previously reported in any orthopedic literature. It was observed after adopting the orthopedic treatment that the range of motion of its joint was at the same level as its healthy side without observing any redislocations during the 6-month follow-up period.

Fractures of the neck of the fifth metacarpal bone, treated by percutaneous intramedullary nailing: surgical technique, radiological and clinical results study (28 cases).

This study report the results in 28 patients affected by closed fractures of the neck of the fifth metacarpal bone (boxer's fracture), treated with percutaneous elastic intramedullary nailing using a single wire, to verify the effectiveness of this surgical treatment. We reviewed the results of 28 patients treated with A single Kirschner wire (K-wire) pre-bent in a lazy-S fashion with a mild bend at approximately 5 millimeters, The K-wire is inserted blunt end first in an antegrade manner and the fracture reduced as the wire is passed across the fracture site The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic. The follow-up period averaged of 20,75 months. The parameters evaluated included angulation, rotational alignment, postoperative metacarpophalangeal (MCP) range of motion, and time to union. We opted for this treatment in all cases, regardless volar angulation of the metacarpal head, malrotation of the fifth finger and associated or/no with a severe swelling of the hand. All the patients were reviewed clinically and radiologically at an average of 20,75 months after surgery. At the final follow-up, no patient reported residual pain and All fractures proceeded to bony union but we have one fracture had to be revised for failed fixation and three superficial wound infections needed antibiotic treatment. We recommend that this minimally invasive: percutaneous intramedullary nailing using a single k-wire in all metacarpal neck fracture (boxers' fractures), especially when severe swelling of the hand is present, with good functional results and low morbidity.

The intramedullary nailing using a single knee incision for treatment of extraarticular floating knee (nine cases).

CONTEXT: Floating knee injuries are uncommon and complex injuries. Management of this injury has been variously described in the literature. AIMS: We present the outcome of the intramedullary nailing using a single knee incision for treatment of extraarticular floating knee. MATERIALS AND METHODS: We report a retrospective series of nine patients with extraarticular floating knee. RESULTS: There were seven men and two women with an average age of 35 years. At least one of the fractures was open in three cases. The average Injury Severity Score was 17. According to Fraser's classification, 100% of the cases are type I. All our patients were treated by the intramedullary nailing using a single knee incision. The mean operating time was 146 min. The mean follow-up is 19 months. According to the Karlström criteria, the end results were excellent in two cases, good in four, acceptable in two, and poor in one. Bone union was achieved in eight cases with an average period of 93 days. CONCLUSIONS: The intramedullary nailing using a single knee incision has shown in this series better results.