S M Souhail | PubMed Health

PubMed2003

[Fenton's syndrome or scapho-capitate fracture (a case report)].

INTRODUCTION: Scapho-capitate fracture is a rare lesion and its mechanism is controversial. Forced extension seems to be the most frequent cause as this movement of the wrist induces scaphoid fracture by compression. Hyperextension of the wrist as a result of the scaphoid lesion, allows contact between the posterior margin of the radius and the neck of the capitate inducing a capitate fracture. MATERIALS AND METHODS: We report a case of Fenton's Syndrome, the patient was operated as an emergency by pining and immobilization of the carpus and thumb until bone consolidation had occurred. RESULTS: Consolidation was noted at 8 weeks with a good mobility of the wrist. DISCUSSION: Fenton's Syndrome is a rare lesion of the wrist. Analysis of our own case and a review of literature demonstrated extension as a causative mechanism, and the frequency of delayed diagnosis. Because of the presence of instability, scaphoid reduction and osteosynthesis is necessary. Immobilization of the carpus and thumb is essential until bony consolidation is obtained.

Adult↗

PubMed2002

[Reposition flap techniques in fingertip amputations: 6 cases].

PURPOSE OF THE STUDY: The purpose of this study was to evaluate an alternative procedure for amputations distal to the distal interphalangeal joint: the reposition flap. MATERIALS AND METHODS: The reposition flap was used for 6 patients who underwent fingertip amputations in an emergency setting. Pulp was excised on the amputated segment and the remaining bone and nail bed were reattached to the proximal stump with a Kirschner wire. The pulp was reconstructed with a local advancement and sensitive flap. The patients were aged 18 to 44 years and had been victims of work accidents. All refused finger shortening. RESULTS: The fingers showed good scarring and good trophicity. Two-point discrimination was 6 mm. Bony fusion was constant but all distal interphalangeal joints remained stiff. Cosmetic results were correct except for two cases of claw nail formation. DISCUSSION: Fingertip amputations have been widely reported. Methods have varied from directed scarring to partial toe transfer. These situations present two types of challenge: insensitivity of the volar aspect or an overly sensitive pulp; cosmetic presentation and function of the dorsal aspect due to the complex role of the nail. Distal reimplantation remains the best technique, but the reposition flap offers an interesting alternative in case of failure or for patients who do not accept finger shortening. The advantage of the reposition flap is that it preserves finger length and the nail. Work stoppage and intolerance to cold can be an inconvenience due to the long time required for wound healing.

Adolescent↗