Ray centralization without bone fixation for amputation of the middle finger.

Twelve patients requiring amputation of the middle finger have undergone resection of the entire ray, including a wedge from the capitate, and soft-tissue approximation of the index to the ring finger to close the gap. All regained full movement and a satisfactory appearance of the hand.

[Fractures of the trochanter region in elderly patients. A new solution (author's transl)]. / Les fractures de la région trochantérienne chez le vieillard. Une nouvelle approche.

A new solution to the problem of fractures of the trochanter region in elderly patients is based on an original anatomophysiological concept. A specific approach to the cervico-diaphyseal region has been developed which simplifies the introduction of a prosthesis supported by the diaphysis, by employing a sub-trochantirian osteotomy. The trochanter major is conserved, reset, and fixed solidly to the wing of the prosthesis by a large bolt, enabling regular rapid consolidation of the osteotomy and immediate stability, with the possibility of walking after several days and thus avoiding usual complications of prolonged decubitus. Results are comparable in every respect with those obtained using prostheses with cervical supports.

[The functional cervico-diaphyseal approach. A new route of approach to the hip for surgery of cervico-trochanteric fractures by diaphyseal prosthesis (author's transl)]. / La voie d'abord cervico-diaphysaire fonctionnelle. Une nouvelle voie d'abord de la hanche pour le traitement des fractures cervico-trochantériennes par prothèse à appui diaphysaire.

The authors report a new route of approach to the hip, specific to cervico-diaphyseal region. Its main application seems to be for the insertion of diaphyseal prostheses in cervico-trochanteric fractures in the eldery. The lack of damage to the capsule, the reconstruction of a solid weight-bearing point on the trochanter, the precise repair of the joint cavity and of muscle continuity make this a simple route of approach with minimal shock, permitting rapid rehabilitation of the patient with immediate weight-bearing.

Use of chemically preserved tendon allografts in hand surgery.

The origin of the use of tendons preserved in Cialit is reviewed and the results of a series of thirty-seven flexor tendon grafts which were performed by this method are discussed.

Cosmetic amputation of the long finger with carpal osteotomy.

Amputations of the third digital ray leave a central gap which can usually be closed by shifting either the second or the fourth digital rays medially. This however calls for an osteotomy with it usual hazards. To avoid metacarpal osteotomy, we have completed the amputation of the long finger in six cases with a central carpal osteotomy through the capitate. This enables the second and fourth rays to be moved intact medially and to close the gap, thus providing a cosmetic three fingered hand.

[Ballistic hand trauma]. / Traumatismes des mains par agents balistiques.

46 victims of projectile accidents or explosions were treated over a 5 years period between 1984 and 1989. 3 categories were distinguished: injuries due to a single projectile (12 cases), only inducing serious bone damage and, apart from 3 immediate amputations, the final result was satisfactory. Injuries due to multiple scattered projectiles (11 cases), less severe in terms of the initial lesions, not requiring any amputations, with good results in 8 cases. Explosion injuries (23 cases) in which the effect of the explosion induced considerable initial lesions leading to one hand amputation and 33 finger amputations; the association of skeletal and soft tissue lesions raises the problem of excision and primary cover, requiring large flaps. The course is long and 8 out of 26 hands had serious sequelae, while the reconstruction of an elementary pinch can be considered to be an acceptable result in the other cases.

[Comparative study of the effects of a local antibiotic and a local antiseptic in emergency hand surgery]. / Etude comparée des effets d'un antibiotique et d'un antiseptique locaux en chirurgie d'urgence de la main. Etude contrôlée portant sur 223 patients.

An open randomised comparative study was conducted in patients presenting with a hand injury requiring a surgical operation, in order to compare the efficacy of topical application of rifamycin SV with that of iodinated polyvidone dermal solution, in terms of the quality and rate of healing evaluated by the clinician, 268 patients were included in the study and 223 of them participated in the analysis of the results. Analysis of the results demonstrated the following conclusions: signs of infection developed in 8 patients in the rifamycin SV group (7%) and in 20 patients in the iodinated polyvidone group (18.5%). This difference was significant (p = 0.011) in favour of rifamycin SV. The rate of healing was considered to be rapid in 10% of patients in the rifamycin SV group and in 4% of patients in the iodinated polyvidone group. It was considered to be slow in 14% of the subjects in the rifamycin SV group and in 21% of those in the iodinated polyvidone group. This difference was also significant in favour of the rifamycin SV group (p = 0.038). In terms of local tolerance, 32 patients equally distributed between the two treatment groups developed signs of cutaneous intolerance.

[Dorsal Dupuytren's disease]. / La maladie de Dupuytren dorsale.

Two different manifestations of the disease are discussed: hyperextension of the distal interphalangeal joint through mechanical fibrous contracture or through pathological involvement of the retinacular ligaments. Surgical correction is performed by transection of the contracted structures but this manifestation tends to be found in severe disease and thus to presage a poor prognosis. Dorsal localisations of the disease itself in the form of (1) knuckle pads when localized on the dorsal aspect of the PIP joint where they do not impair flexion, or (2) distal nodules situated dorsal to the extensor tendon and the IP joints and restricting the range of flexion. Surgical excision in group 2, when requested by patients, has enabled us to determine that the histological aspect is of Dupuytren's disease and that the post-operative course has been uneventful in our 12 operated cases.