Biomedical subjects
Publications and source records attributed to Y Tropet.
We report the case of a man with epidermolytic hereditary palmoplantar keratoderma. After failure of topical and systemic therapy, excision and skin grafting of both hands was done in several steps. Attention must be given to the skin-repair procedures (split- or full-thickness grafting), and the exact setting of the suture lines in the fingers is important.
A series of 16 cases of chronic instability of the metacarpo-phalangeal joint of the thumb is presented. The authors begin by summarising the two main surgical procedures used in such cases: ligamentous reconstruction and arthrodesis. In our series, a ligamentous reconstruction with Smith's procedure was performed in 13 patients, a primary arthrodesis in 2 patients and a secondary suture in one patient. The results are analysed in 15 patients (7 women, 8 men) with a minimum followup time of two years. Failure was noted in 4 cases treated by ligamentous reconstruction (3 men and 1 woman). An arthrodesis was subsequently performed in all these patients. There were therefore a total of 6 arthrodesis and 8 ligamentous reconstruction to review. Ligamentous reconstruction gave better functional results than arthrodesis in particular as regards mobility, opposition of the thumb and strength of pinch grip (decreased by 50% with arthrodesis). In manual workers the use of ligamentous reconstruction in these cases was shown in our series to give inconstant results.
The authors report a case of squamous cell carcinoma of the hand unusual because of its very rapid extension: A 64 year old man was referred to us for treatment of a keratoacanthoma located in the thumb web (histological diagnosis on two occasions). In fact, the histological frozen-section examination at the time of surgery revealed a well differentiated squamous cell carcinoma. A wide excision of the tumor was carried out together with amputation of the index finger according to Chase's technique. Axillary lymphadenectomy was performed due to clinical evidence of regional lymphatic spread (large node) twenty one days following surgery. Four months later, a recurrence in the thumb web required radiocarpal disarticulation. Three months later, a new recurrence at the stump, spreading to the forearm, necessitated an above-elbow amputation. In relation to this unusual case, the authors emphasize the importance of initial diagnosis and the difficulties of surgical management of this tumor, especially in palmar and web or deep locations.
The authors report a case of suppurative hidradenitis of unusual severity affecting the axillary, inguinal, perianal, genital and sacral areas. The surgical treatment consisted initially of large excision of the axillary areas. A musculo-cutaneous latissimus dorsi island flap was then used to cover the defect. 45 days later, a complete excision, in only one operative session, of the inguinal, perianal, genital and sacral area was performed, associate durth colostomy. A mesh graft was performed 15 days after the excision. This procedure allowed an early scar.
The authors analyse a series of 50 fresh dislocations of the carpal-lunate. 35 of these patients were reviewed clinically and radiologically: the radial peri-lunar dislocation is more often encountered than described in the literature. Lunate necrosis and collapse is rare and there is no relationship between secondary necrosis of the lunate and primary dislocation. The clinical results, with a mean time follow-up of 5 years and 6 months are good, but radiological abnormalities such as arthrosis and instability are seen without clinical complications. The authors present their management of dislocation of the carpal lunate but it seems that early diagnosis and treatment of these dislocations is essential for good results.
The advantages of immediate wound closure in case of open leg wounds, as opposed to delayed repair or the use of greasy dressings, need no longer be proven. Indeed, modern plastic surgery technics have become quite ingenuous, reliable and applicable to most severe skin, lesions (type III as per Cauchoix-Duparc and so--called potential type III). These facts have been confirmed by a study of 20 cases including both types. Moreover, more and more often, immediate wound repair allows for external fixation replacement, typically by osteosynthesis, which is more advantageous from the viewpoint of fracture consolidation. Complications (namely infection rates) have not increased, which is an encouragement for the continued application of this method, which constitutes a departure from usual indications.
Entrapment of the median nerve as a complication of a dislocation of the elbow has rarely been reported. The prognosis is worse in case of delayed diagnosis. Exploration surgery is indicated when neurological signs remain following reduction of a dislocation of the elbow.
In this study, the authors analyze 197 recent injuries of the flexor tendons of fingers in zones I, II and III of Verdan, without complex cutaneous lesions, associated with an injury of one or both digital nerves, but leaving safe at least one digital artery. Tendon repair is either followed by strict immobilization or by Kleinert's method of immobilization. Results concerning 115 reviewed injuries evaluated according to Kleinert's criteriae, show a net superiority of Kleinert's technique compared to strict immobilization. Global results are analysed according to the age, the finger injured and the presence of a work accident. Lesions treated by Kleinert's technique have been analyzed according to the zone of injury, the tendon injured in zone II and the existence or not of an injured digital nerve. After Kleinert's method, factors affecting the prognosis are lesions in zone II, injury of both tendons, lesions of the fifth finger, the responsibility of a "work accident". The authors conclude as to the correct time for repair, the tendons to be repaired and the type of injuries to be immobilized. They also emphasize the progress brought to the surgery of flexor tendons by Kleinert's method.
Closed isolated fractures of the radial head should be considered and managed in a different way from those associated with other traumatic lesions of the upper extremity. The recommended treatment for the radial head is early motion, with or without internal fixation or arthroplasty. For this to be achieved, surgical fixation of most of the associated fractures, and surgical repair of serious damage to capsular and ligamentous structures, should be performed. Indications are proposed, according to the results of a series of 73 cases which are compared with our series of 168 observations on isolated radial head fractures.
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The authors describe a case of melorheostosis localised in the hand. Melorheostosis is an unusual affection. The first signs appear in some cases at birth, but the disease is often diagnosed during the fourth decade. Clinical symptoms are pain, ankylosis, the deformation provoked by the lesion of soft tissues and especially limitation of motion. Radiographs permit the diagnosis: opacities parallel to the diaphysis with a "monomelic" topography. The natural history of the condition is characterized by the possibility of extension of the disease. Operative treatment is rarely indicated.
The review of a series of 168 cases of isolated fractures of the upper end of the radius in adults allows the authors to note the advantage of functional therapy. The early physical therapy contributed to obtain an important rate of good results with the different types of Mason's classification. An osteosynthesis, when performed, must permit the early mobilisation of the elbow in order to avoid stiffness. Such a short experience does not allow the authors to conclude in favor of the necessity for the emergency use of a radial prosthesis instead of an isolated resection.
A case is reported here of an unusual case of rupture of the flexor tendons of the index finger in the carpal tunnel complicating a subcutaneous displacement of a lunate bone. This was combined with a carpal tunnel syndrome with hypoaesthesia. The treatment, taking account of the age of the patient and the relative tolerance to the dislocation, consisted of a simple resection of the lunate to free the medial nerve together with a partial graft of the flexor digitorum profundus.
The authors report an uncommon' case of carpal tunnel syndrome in a ten year old girl. Symptoms are typical with noctural paresthesias. The nerve conductor studies show a important compression with thenar atrophy. In consideration of the importance of nocturnal pain and amyotrophy an operation was decided. At operation, the median nerve is found constricted under tickened transverse carpal ligament. At the wrist, the volume of nerve is normal, there are not anomalous muscles or inflammatory tenosynovitis. In fact, the appearance of median nerve is identical to the cases of carpal tunnel syndrome in adult. After surgery symptomsare abolished. The mother of the young girl, 37 year old, also present a bilateral carpal tunnel syndrome with onset at the age of 10 years. There is a important thenar atrophy. At operation, the nerve is very constricted with a tickened transverse carpal ligament; no other anomaly is noted. A study of literature complete these observations.
Traumatic rupture of flexor tendons is uncommon. The authors report on twelve cases. The ulnar fingers, especially the ring finger (5 cases), are the most frequently involved. Isolated rupture of the flexor profundus tendon (10 cases), usually at the level of the distal phalanx (9 cases), is the most common lesion. In two cases, both the superficialis and profundus tendons of the little finger were involved. Rupture usually occurs because of severe hyperextension or opposed flexion; more rarely it results from direct trauma. The mean age of patients (male for the most part) was 35 years old. Transosseous reinsertion (5 cases) was performed in acute cases for ruptures of the flexor profundus tendons. When seen secondarily, and according to the functional impairment encountered, the authors performed as follows: one case of arthrodesis, two cases of excision of the profundus with tenolysis of the sublimis, and two cases of tendon grafts. Functional results are good when repair of the rupture is performed within the first few days after injury.
The authors report a case of glomus tumour developing beneath the nail of the ring finger in a 95 year old woman. In contrast with other similar cases, the pain was moderate and had been present for 20 years. The bony phalanx was deformed. Microscopic examination confirmed the diagnosis of a glomus tumour developing in the soft tissues. The phalanx was amputated.