Chirurgie de la main
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Chirurgie de la main · Dec 2009
Randomized Controlled Trial Comparative Study[Postoperative analgesia following trapeziectomy with continuous intra-articular infusion of ropivacaïne versus continuous perineural infusion. A prospective randomised study].
A prospective randomised study on 46 patients was performed to evaluate postoperative analgesia after trapezectomy. We compare the efficacy of an in situ catheter 777 (ISC) positioned by the surgeon in the space of the trapezectomy (26 patients) with an axilliary perineural catheter (APC) positioned preoperatively by the anaesthetist (20 patients). The patients were followed-up postoperatively for 48 hours and assessed at 3, 7, 24 and 48 hours, recording pain (VAS), consumption of intravenous rescue analgesia and recovery of sensory and motor function. ⋯ The in situ catheter provided at least as good postoperative analgesia while requiring considerably less time and expertise to site. There was also more rapid recovery of motor and sensory function in patients treated with in situ catheters.
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The vague term of capitellar fractures is still frequently used to designate articular coronal fractures of the distal humeral epiphysis. The use of eponyms for their descriptions may cause confusion. Recent publications describe a wide variety of fracture types and recommend new classifications based on the operative findings. We report our results of surgical treatment of 12 cases of these fractures in comparison to recent series of the literature. ⋯ Articular coronal fractures of the distal humerus are rare. The classification of Dubberley et al. (2006) [7] is comprehensive and allows inclusion of all varieties of these fractures. In addition, it is the only one that indicates the surgical approach according to the fracture type. However, to do so, a preoperative CT-scan is highly recommended. The more the fracture line extends medially to involve the trochlea (types 2 and 3), the less a lateral approach is sufficient and the more a combined lateral and medial or a posterior transolecranon approach is mandatory. An internal fixation using conventional small fragment screws inserted from posterior to anterior is feasible when the articular fragment has a sufficient subchondral bone thickness. A direct anteroposterior fixation is better achieved using headless screws buried beneath the cartilaginous surface; it is particularly helpful when the articular fragment has a thin sub-chondral cancellous bone component. Excision is reserved for comminuted fractures, those not amenable to fixation, very thin or osteoporotic fragments, and for the late diagnosed fracture.
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Chirurgie de la main · Sep 2009
[Pronator quadratus preservation for distal radius fractures with locking palmar plate osteosynthesis. Surgical technique].
A surgical technique is described to preserve the pronator quadratus muscle when fixing distal radius fractures with volar locking palmar plates. ⋯ Preservation of the pronator quadratus muscle is possible for the majority of the fractures of the distal radius treated with locking volar plate osteosynthesis.
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Chirurgie de la main · Jun 2009
Surgical management of elbow dislocation associated with non-reparable fractures of the radial head.
The "terrible triad" of the elbow is the combination of an elbow dislocation, radial head and a coronoid process fracture. Because of a combined sagittal, frontal and transverse instability, these injuries are notoriously difficult to treat. We report our results with a technique for reconstruction of "terrible triad" injuries with either no facture or a type I fracture of the coronoid process in addition to a non-reparable radial head fracture. The hypothesis of this study was that standard surgical treatment of this lesion using a "deep to superficial" stabilisation by a single lateral approach and radial head replacement enables early and reliable functional results. ⋯ Our results suggest that some terrible triad injuries can be successfully managed with deep to superficial stabilisation by lateral approach, consisting in three-dimensional stabilisation done by anterior capsular reinsertion with absorbable anchors, radial head replacement and lateral collateral ligament repair. This standard management provides enough stability to allow early active rehabilitation, preventing post-operative instability and stiffness. This procedure appears to be reliable and reproducible.
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Chirurgie de la main · Apr 2009
[Results of primary repair of injuries to the median and ulnar nerves at the wrist].
Wounds on the palmar side of the wrist affecting the median or ulnar nerves are responsible for motor and sensory sequelae, severe pain and cold intolerance. ⋯ Sensory recovery after an isolated ulnar nerve lesion at the wrist is better than after an isolated median nerve lesion but there is no difference in the motor recovery. Combined median and ulnar lesions have an especially bad prognosis and may require secondary palliative surgery. The existence of nerve contusion and a high number of tendon injuries were factors associated with a poorer prognosis.