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La chirurgie reconstructive dans les hypoplasies du pouce type III de Blauth
No full textThumb hypoplasia type III according to Blauth remains a rare congenital malformation. Recently Manske has promoted reconstruction versus pollicization in the sub-type IIIA where a first carpometacarpal joint is present. However we felt that pollicization is the solution for sub-type IIB where the basal joint is absent. We have reviewed 14 cases of thumb hypoplasia type III, four of them being type IIIB. After performing a first step with a free vascularized second metatarso-phalangeal joint transfer, the secondary steps were identical in both sub-groups. After a mean follow up of five years, no great difference was found in the two sub-groups and basal stability was even better in type IIIB. However the results were functionally and cosmetically inferior to the ones observed after pollicization. When the relatives refuse pollicization or the patient consults late for functional improvement, reconstruction remains worthwhile.Uhypoplasie du pouce du type lII selon Blauth reste rare et de traitement controvers6. Recemment Manske a defendu la reconstruction dans le soustype Ilia comportant une articulation trapezometacarpienne, proposant la pollicisation dans le sous-groupe IIIB ou l'articulation basale est absente. Nous avons revu 14 reconstructions du type IlI, avec un recul moyen de cinq ans. Lorsqu'un
transfert microchirurgical de la seconde articulation metatarso-phalangienne est pratique, les resultats sont peu differents dans les deux sous-groupes avec merne une meilleure stabilite articulaire. Les resultats restent cependant globalement inferieurs fonctionnellement et surtout esthetiquernent ~ ceux de la pollicisation
What's new in the treatment of Dupuytren's disease?
No full textAmong the recent advances in the field of Dupuytren's contracture, the authors reviewed a series of 171 patients treated by percutaneous needle fasciotomy. Among the 198 hands (241 fingers), 65 were reviewed with a mean follow-up of 2.5 years. Mean age was 62 years and delay between onset and treatment 6.8 years. Rupture of the cords was performed only in the palm in 154 cases, palmo-digital in 82 and purely digital in 5 cases. Complications were rare and benign without tendon or vascular bundle injury. Postoperative gain was essentially observed on the metacarpo-phalangeal joint and recurrence rate was high despite the short follow-up (progression of the disease 54% of cases). The ideal indication for this simple and reliable technique is an elderly patient with a prominent cord and predominant lack of metacarpophalangeal extension
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
The ulnar longitudinal deficiency : proposition of a descriptive classification
No full textUlnar longitudinal deficiency is an extended malformation sometimes involving the whole upper extremity, even including sometimes the opposite side. The clinical and radiological aspects are variable and none of the existing classifications takes into account all the possible deformities. Multiple decisive factors in the surgical indications are missing such as shoulder stability, elbow position (extension or flexion with or without pterygium), orientation of the hand (internal rotation), wrist inclination and number of digits. Based on a review of our 46 clinical cases as well as the published cases in the literature we have developed a simple way to describe each level
Les tumeurs glomiques de la region ungueale : A propos d'une serie de 55 patients
No full textPURPOSE OF THE STUDY:
Glomus tumors are infrequent in the hand. We have review 55 cases, localized in the nail area to discuss their diagnosis and surgical approach.
MATERIAL AND METHODS:
Out of 80 glomus tumors of the hand seen in two hand units, 55 were located around the nail area, 33 in the nail bed area, 8 at the nail root and 14 laterally. The population was predominantly female (42 cases) and the mean age 43 years. The mean delay before presentation was 37 months. Pain was the main symptom (97 per cent) increased by trauma and cold. A blue spot was visible in 15 cases and diagnosis was performed on clinical ground in all cases except two. A notch was present on X-ray in 16 cases. A prospective study with MRI allow a diagnosis in 18 of 21 cases. All tumors were removed through a lateral approach elevating the nail complex and confirmed histologically.
RESULTS:
The diagnosis was per-operatively confirmed in 53 cases and performed in one case. The last case of supposed hemangioma was modified at histological examination. No case of nail dystrophy (not existing pre-operatively) or residual pain was seen at the 81 months of follow up. Seven recurrences were observed, 4 of them having been operated initially in our units.
DISCUSSION:
Clinical diagnosis could be performed on clinical grounds. MRI is to be reserved to recurrences or multi-operated patients. Risk of recurrence has to be mentioned pre-operatively to the patient.
CONCLUSION:
Lateral approach with nail complex elevation is safe, allowing excision of the tumor without nail dystrophy.Cinquante cinq tumeurs glomiques péri-unguéales, confirmées histologiquement ont été revues rétrospectivement avec un recul moyen de 81 mois. Le diagnostic avait été fait cliniquement dans 53 cas, devant une douleur exacerbée au choc et au froid, élicitée avec une pointe de crayon et améliorée par gonflement d'un garrot brachial. Dans 2 cas le diagnostic d'hémangiome a été fait et redressé à l'intervention dans un cas. L'IRM a été étudiée prospectivement et a conduit au diagnostic 18 fois sur 21. Nous la réservons cependant aux cas récidivés ou multi-opérés.
Toutes les tumeurs (sauf les deux pseudo-hémangiomes) ont été abordées par voie latéro-unguéale. Aucune dystrophie unguéale n'est à imputer à cette voie d'abord. Sept récidives ont été observées et doivent conduire à informer les patients en pré-opératoire de cette complication rarement mentionnée
Progressive bone distraction lengthening in the treatment of congenital malformations of the hand
No full text- …
