Acute carpal tunnel syndrome secondary to pyogenic tenosynovitis.
We report a case of acute carpal tunnel syndrome related to a spontaneous pyogenic tenosynovitis and a review of this clinical condition.
Carpal Tunnel Syndrome↗
Biomedical subjects
C Dumontier
Publications and source records attributed to C Dumontier.
Ligamentoplasty of the forearm interosseous membrane using the semitendinosus tendon: anatomical study and surgical procedure.
Total longitudinal disruptions of the interosseous membrane can allow proximal radius migration and are seen in Essex-Lopresti lesions. We propose an original technique of ligamentoplasty using the semitendinosus tendon. The graft corresponds to the forearm rotation axis for an optimized isometry and longitudinal stabilization. Our ligamentoplasty technique was performed on ten fresh frozen right forearms. We successively assessed the innocuousness, efficiency and resistance of the ligamentoplasty. The ligamentoplasty induced neither passive limitation of pronation-supination nor neurovascular lesions. It prevented from radius proximal migration. The mean load to failure was 28 kg at both ulnar and radial sides of the graft. Our technique is original for the type and position of the graft. It seems safe, efficient and resistant enough for in vivo procedures. This technique decreases longitudinal loads on the radius. It should be indicated in patients with Essex-Lopresti syndrome, in association with radial head internal fixation or arthroplasty.
Arthroplasty, Replacement↗
[Arthroscopic treatment of dorsal ganglion cyst at the wrist. About 54 cases].
INTRODUCTION: Ganglion cyst of the wrist can, some time, need surgery. Different arthroscopic technical procedures have been described. We report our experience in all articular resection of dorsal ganglion cyst of the wrist. OBJECTIVES: Evaluation of efficiency of resection of dorsal ganglion cyst of the wrist by of arthroscopic resection of the pedicle. METHODS: Fifty-four cysts of 52 patients have been evaluated retrospectively. Operative data, pain, strength, recurrence and complications have been collected. RESULTS: Average follow up was 28 months (6 to 78). Return to work was 8,8 days, operative time 41 minutes (25 to 90). In 67% cases, the operation was judged easy. Three surgeries had to be performed open. Complications were one hematoma and one neurodystrophy. Pain decrease from 3,37 to 1,76 on analogical pain scale. Flexion was 89% of opposite side, extension 88%. Sixteen recurrences (29.7%) were found. Sixty percent of those recurrences occurred during the first year experience. But independently of experience, the operative performance was foun difficult in 1 time on 3. CONCLUSION: Endoarticular arthroscopic resection of the pedicle of ganglion cyst is not so reproducible. In experimented hands, it remains a difficult procedure after a long learning curve with a recurrence rate 3 times higher from what is reported in literature for open surgery. For our discharge, our long follow-up can contain some cases of de novo cyst explaining this high rate, the learning curve is certainly the main reason for our high recurrence.
Adolescent↗
[Quality of information transfer for informed consent: an experimental study in 21 patients].
PURPOSE OF THE STUDY: Delivering information to the patient, an ethical obligation recognized for years, has recently become a legal obligation. Proof of information delivery has become the legal responsibility of the surgeon. We conducted a prospective study to evaluate the quality of information transfer by assessing patient comprehension of information delivered in an orthopedic surgery unit. MATERIAL AND METHODS: All patients attending consultations before undergoing arthroscopic treatment for rotator cuff tendinopathy were enrolled in this study when the consultation was conducted in the presence of an observer. Two questionnaires, one for the patient and one for the surgeon, were used to collect given information about the pathological condition, the modalities of treatment, and the expected results of the treatment and its complications. RESULTS: All 21 patients included in the study considered they had been well informed and that they had understood their pathological condition as well as the complications of the proposed treatment. However, agreement between their stated comprehension and the information delivered was poor, varying from 15 to 50%. Furthermore, 90% of the patients stated they had understood the potential complications of the surgical procedure, despite the fact that the consulting surgeons had not (generally) provided information on such complications. DISCUSSION: There is a gap between what the surgeon says (or thinks he/she says) and what the patient understands. Potential biases in this study (non-unbiased observer) might explain this discordance which was probably related to the unequal relationship between the patient and the physician for any consultation. Therefore, the basis of informed consent cannot be found in the details concerning complications actually delivered to the patient. Surgeons must become aware that the patients understand very little of their explanations. This does not mean that the information should not be delivered but on the contrary that it must be. The important point is not necessarily the information content but rather the quality of the human relationship enabling information transfer.
Adult↗
Full thickness skin graft for nail unit reconstruction.
A retrospective study of 13 patients assessed the use of a full thickness skin graft for nail unit reconstruction after total nail unit removal for nail bed malignancies. No failures of the graft were observed and no patient had recurrence of the malignant tumour at 4 year follow-up. Full thickness skin grafting is a simple procedure which provides a good cosmetic outcome and does not produce significant donor site morbidity.
Adolescent↗
[Arthroscopic treatment of tennis elbow: preliminary experience with 14 patients].
The purpose of the study was to report our experience in a preliminary series of patients who underwent arthroscopic treatment of tennis elbow in order to appreciate effectiveness of this method. Between September 2000 and February 2004, we treated arthroscopically fourteen patients with epicondylitis which failed to respond to medical treatment given for a mean duration of 15.8 months. We used the technique described by Baker in 1999. Briefly, the external capsule was sectioned followed by section of the extensor carpi radialis brevis and extensor digitorum communis insertions on the epicondyle. Section was continued until muscle fibers were visible. Mean patient age was 45 years (range 36-55). Five patients were victims of occupational accidents and one had an occupational disease. One patient suffered from fibromyalgia. All patients were reviewed at a mean follow-up of 11.5 months. We used the Mayo Clinic score to assess outcome which was excellent or good in nine patients, fair in one and poor in four. Despite these modest preliminary results, arthroscopy appears to be well indicated for this pathological condition. The ideal treatment remains a question of discussion.
Accidents, Occupational↗
[Factual surgery or surgery founded on facts].
In the late 90s, teachers at McMaster's university (Canada) decided to export in clinical practice a teaching concept they had developed which included, among other concepts, a critical analysis of the medical literature. "Evidence-Based Medicine" (EBM) has since been adopted by many medical specialities or physicians as a reference in their practice of medicine. However, evidence-based medicine in its definition had three legs. Critical analysis of medical literature is the most known. The analysis is based on methodological principles that have been developed by statisticians and epidemiologists, principles which are not very familiar to surgeons. The other two legs are less known, but are important. The patient is still in the very middle of the EBM's principles. It is for him, the patient with his demands, that the physician must find a solution that may be not available in the literature. The surgeon, the third leg of the system, must be involved; he must listen to the patient, understand his particular demands, and find, for him the best answers to the question asked by the patient. It is the surgeon's responsibility to be the interface between science and one individual patient. Evidence-based medicine is a new model of the relationship between patients and physicians.
Evidence-Based Medicine↗
[Coronal fractures of scaphoid].
Two cases of frontal fracture of the scaphoid proximal pole after a high energy trauma are reported. Diagnosis was delayed in both cases and was only possible with a CT-scan. One fracture was slightly displaced: the patient was treated conservatively and followed during 11 years with an excellent result. The other patient was operated on because of persistent pain and malunion. Only during surgery was the correct diagnosis made and due to scaphoid malunion, a proximal row carpectomy was performed. At a post operative assessment, in both cases, X-rays showed a double contour of the proximal pole of the scaphoid. We believe than an arthroCT-scan or MRI is necessary to assess the fracture displacement and search for an associated ligamentous injury.
Adult↗
[Antibioprophylaxy in hand surgery: toward a professional consensus].
Antibioprophylaxy in surgery follows, in France, the guidelines published by the French Society of Anesthesia [Société française d'Anesthésie et reanimation (SFAR)]. However these guidelines were mostly made for prosthetic and traumatologic surgery of the lower limb and guidelines for upper limb and hand surgery have been made by extrapolation. The French Society for Surgery of the hand has made multiples studies including: a survey to precise the infection rate for hand surgery which has been estimated to be around 0.1%. A search in the international literature, according to the classification criteria proposed by the "Agence Nationale D'accréditation et d'Evaluation Sanitaire (ANAES)" to better define correct antibioprophylaxy that should be used in hand surgery. Results of those surveys have been presented by national experts at the French Society Meeting of 2003. The attendance was given the opportunity to answer questions from the experts. A jury was present and its conclusion are reported here. Except for total wrist prosthesis and for surgical procedures that last more than 2 hours, there are very few indications for an antibioprophylaxy in hand surgery. In cases where an antibioprophylaxy is needed, the jury recommends that the guidelines proposed by the SFAR, regarding the choice of antibiotics, should be followed.
Antibiotic Prophylaxis↗
[Soft-tissue chondroma of the hand: a case report and analysis of diagnostic procedures for extra-osseous cartilaginous lesions of the hand].
We report a case of a chondroma found in the soft tissues of the hand. Reports in the literature show that this cartilaginous tumor is a rare slowly-evolving benign tumor. Diagnosis is difficult as standard x-rays show variable images depending on the degree of calcification. Magnetic resonance imaging is helpful in orienting the diagnosis and delimiting the tumor but is not always useful in determining its exact origin. Positive diagnosis is provided by the pathology examination, but confirmation may be difficult to establish. We stress the importance of repeated microtrauma in the development of soft-tissue chondroma. Surgical treatment is the only successful solution but recurrence is not exceptional.
Aged↗
[Reasons why musicians consult hand surgeons].
PURPOSE OF THE STUDY: Musicians occasionally consult orthopedic surgeons, particularly upper limb specialists. We wanted to learn more about the reasons why musicians attend orthopedic clinics. MATERIAL AND METHODS: We analyzed retrospectively 227 case files of musicians who consulted our center between 1994 and 2001. We noted patient related factors (age, gender, musical experience, level of performance, daily practice schedule) and their reasons for consulting (pain, discomfort, advice). We studied the medical history of the patients and searched for predisposing or triggering elements. We also recorded therapeutic options proposed. RESULTS: Our series included 119 men (52%) and 108 women, mean age 35 years with 27 years of musical experience on the average. Instruments played were mainly the piano (41%), the violin (19%), and the guitar (15%). Patients playing wind instruments, who consult more often for ENT problems, were exceptional. On the average, the patients played their instrument 4 hours daily. One-third of the patients were high-level amateurs, one-third were professionals, and one-quarter were lower-level amateurs. There was a small proportion of soloists or professors. Two-thirds of the musicians presented disorders of the musculoskeletal system, particularly trauma sequelae. Signs of overuse were present in 18% of the patients, mainly women, signs of misuse due to inappropriate or defective technique in 8.8%, and dystonia in 5.7%. Psychological problems were noted in 4 patients. More than one half of the patients had obtained medical advice prior to consulting an orthopedic surgeon and the very large majority had been referred by specialized physical therapists. A surgical procedure was proposed for only 19% of the patients presenting an orthopedic disorder. DISCUSSION: This study presents a diversified panel of musicians consulting orthopedic surgery clinics. Practicing schedules varied in the study population from one to five hours daily. More than half the patients complained of pain but 18% consulted because they perceived a problem when playing and 17% consulted simply for advice. Our findings recall that musicians comprise a sensitive population requiring careful overall management. Unlike series published to date, we had a majority of men. Problems involving an orthopedic disorder or trauma and trauma sequelae predominated. In the literature, diagnosis has been oriented by the specialty of the consulting physician. We found that our patients who suffered from overuse had often recently changed their habitual practicing methods or conditions. The diagnosis of misuse was facilitated when the patient was examined with his/her instrument. The low rate of dystonic disorders was probably related to the fact that nearly half of our patients were followed regularly by a physical therapist. We did not observe any case of excessive laxity or Linburg Comstock syndrome which exceptionally have functional impact. The very large majority of our patients were referred by physical therapists and when surgery was necessary, the procedure was performed in accordance with accepted rules concerning the therapeutic management of musicians.
Adolescent↗
["Role of the medical expert". GEM Conference, Paris, December 2001].
Explore the source record for details and available documents.
Attitude of Health Personnel↗
[Treatment of post-traumatic nail bed deformities with split-thickness nail bed grafts].
INTRODUCTION: Split-thickness nail bed graft have been proposed for treatment of post-traumatic nail bed dystrophies. Only three papers reported good results in 60 to 90% of cases. We report our experience. MATERIAL AND METHODS: We reviewed 18 cases of split-thickness nail bed grafts from operative and consultation files and photographs. Evaluation was made using criteria as the nail plate shape, its adhesion on the nail bed, patient satisfaction and possible sequelae on the donor finger. RESULTANTS: Thirteen patients have been reviewed with a sufficient follow-up to assess the results. In 13 cases, the graft was taken from the hallux. The nail-bed graft was used for hallux reconstruction two times, the thumb six times, index six times, middle and ring finger one each, and the little finger two times. In every patient the graft was molded using either the patient nail or the nail plate from the donor finger. Clinical results were excellent in five cases, good in three and poor in five cases. Five failures were due to wrong indications in three cases in which matrix problem has been underestimated, and infectious failures in two cases. Fifteen per cent of our patients had some sequelae on the donor finger.
Adolescent↗
[Knowledge of flap complications in finger pulp surgery and patient education--ethical implications].
INTRODUCTION: The two highest French courts have recently decided that not to fully inform a patient constitutes negligence, and that doctors should be able to prove that the information has been given. The medical community is now debating as to how to protect physicians without harming the doctor-patient relationship. Following this study we put forward the hypothesis that although information might not be available to surgeons nevertheless this should not prevent them taking the ethical steps necessary to redress the situation. METHODS: We conducted a telephone interview to discover what surgeons knew about the complications of finger flaps used for the reconstruction of pulp defects. Four flaps were studied: the VY flap described by Atasoy, the island finger flap known as Ventataswami's, the reverse island flap and the thenar flap. Surgeons were asked to give the percentage of necrosis, infection, sensory disturbances, digital stiffness and exclusion, as well as the time off work, the time of healing and the sensory discrimination of the flap. The results obtained were compared to those obtained by a literature review. RESULTS: Twenty one qualified hand surgeons answered the questionnaire. Many answers were absent or only fragmentary when sought in the literature. Where complication rates were available, there was a huge variation among series. A large variety of answers was also found in our study. The direct island flap was the best known flap. Complications of the reverse island flap and the thenar flap were overestimated in the group interviewed. DISCUSSION: There is no true answer, either in the literature or from the study group. There is a gulf between the jurists' demand and the possibilities of knowledge by surgeons. We are still waiting for clinical studies that will answer the questions asked by patients regarding the complications of surgery. However, even if absolute knowledge is not available, it is the ethical duty of surgeons to give the patient information that is as close as possible as the "truth", and that will be helpful to them.
Adult↗
[The DASH questionnaire. French translation of a trans-cultural adaptation].
The DASH (Disability of Arm-Shoulder-Hand) is a self-administered questionnaire developed in 1994 by representatives of the Institute for Work & Health (IWH) and the American Academy of Orthopaedic Surgeons (AAOS). It measures the physical disability and symptoms for all upper limb disorders in a heterogeneous population and for acute as well as chronic disorders. The original american version has been already tested for reliability and validity. Interest in the DASH was raised by several European publications. It appeared that the DASH could provide a common measure for upper extremity physical disability in Northern America and European countries. For this cross-cultural adaptation, we followed the guidelines developed by the Institute for Work & Health and American Academy of Orthopaedic Surgeons. Five translations and two "back-translations" were compared, aiming to semantic, idiomatic, experimental and conceptual equivalence. The final version has been tested in 223 patients presenting a variety of traumatic or non traumatic disorders. 208 questionnaires (93%) were valid because there was less than 4 missing answers. This final version has been proposed to American Academy of Orthopaedic Surgeons in order to be endorsed as an official translation. This could improve assessment for international studies by establishing standard measures.
Arm Injuries↗
The posterior interosseous reverse flap: experience with 113 flaps.
The authors have used a posterior interosseous flap for resurfacing in 113 cases of hand injury during the past 13 years. Its main indications were complex hand trauma or burn injuries with large skin loss, either acute or postprimary. Flaps survived completely in 98 patients. Twelve patients had superficial necrosis of the distal part of the flap, which did not require additional surgical procedures. Three flaps were lost and alternative coverage was used. Six patients demonstrated paralysis of the motor branch to the extensor muscles of the wrist or fingers (generally to the extensor carpi ulnaris, the extensor digiti quinti, or the extensor pollicis longus). All recovered completely within 6 months. The donor area was closed directly in 3 to 4-cm-wide flaps, leaving an inconspicuous scar. Larger flaps required skin grafting. Donor site morbidity was minimal. Major anatomic variations precluding the use of the flap were encountered twice in this series.
Adolescent↗
Radiocarpal dislocations: classification and proposal for treatment. A review of twenty-seven cases.
BACKGROUND: The radiographic characteristics and treatment of radiocarpal dislocation are not well defined. There have been only two reported series of more than eight patients. Thus, there are many questions concerning treatment and functional results. METHODS: Two groups of patients were defined. Group 1 included all patients with pure radiocarpal dislocation and patients with only a fracture of the tip of the radial styloid process. Group 2 included patients with radiocarpal dislocation and an associated fracture of the radial styloid process that involved more than one-third of the width of the scaphoid fossa. A retrospective review and a clinical evaluation were performed. RESULTS: From 1975 to 1998, we observed twenty-seven cases of radiocarpal dislocation. Four were displaced volarly, and twenty-three were displaced dorsally. Fourteen patients presented with associated lesions. Four patients were treated with closed reduction and immobilization in a plaster cast; five, with percutaneous Kirschner wire fixation and cast immobilization; and two, with an external fixator. Eleven patients had open reduction with Kirschner wire fixation and cast immobilization. The seven patients in Group 1 had a highly unstable injury, and four of the seven patients presented with ulnar translation of the carpus. At the time of follow-up, at an average of 26.8 months, pronation averaged 76 degrees; supination, 66 degrees; wrist flexion, 54 degrees; wrist extension, 54 degrees; radial inclination, 15 degrees; and ulnar inclination, 18 degrees. The average grip strength was 27 kg. Group 2 included twenty patients. Only thirteen, with dorsal dislocation, were evaluated at the time of follow-up, which averaged fifty-one months. At that time, six reported no pain; four, slight pain; and two, moderate pain. Pronation averaged 63 degrees; supination, 76 degrees; wrist flexion, 51 degrees; wrist extension, 56 degrees; radial inclination, 21 degrees; and ulnar inclination, 39 degrees. Grip strength averaged 38 kg. Seven patients had complications. CONCLUSIONS: On the basis of our experience and a review of the literature, we believe that patients with pure radiocarpal dislocation or with radiocarpal dislocation with a fracture of the tip of the radial styloid process should be treated with reattachment of the ligaments through a volar approach. In patients with radiocarpal dislocation and a fracture of the radial styloid process that involves more than one-third of the width of the scaphoid fossa, the ligaments are still attached to the radial fragment. We believe that in this group of patients, exact articular reduction should be performed through a dorsal approach. Additional studies are needed to support these hypotheses.
Adolescent↗