Denervation of the wrist with two surgical incisions. Is it effective? A review of 33 patients with an average of 41 months’ follow-up

The goal of wrist denervation is to decrease pain at the wrist, whether caused by an intra- or extra-articular problem or even when the reason for the pain is unknown. It is an alternative to partial or total arthrodesis and proximal row carpectomy. Our hypothesis was that wrist denervation with a two-incision technique was a reliable and efficient way to treat painful degenerative wrists. Thirty-three patients, 48years old on average, were included in this study. Indications were scapholunate advanced collapse (SLAC) in 18 cases, scaphoid nonunion advanced collapse (SNAC) in 10, distal radius fracture sequelae with advanced radiocarpal osteoarthritis in 4, and post-traumatic ulnocarpal impingement in 1 case. At 41 months' follow-up (12-161), there was a 75% reduction in pain levels, decreasing from 7.1 to 1.8 on a visual analog scale (VAS). There were no modifications related to wrist range of motion or grip strength. The QuickDASH averaged 23 points (5 to 70). Radiographic evaluation showed progression of intracarpal degeneration in 6 patients. All but 2 patients returned to their previous work. Persistent dysesthesia was observed in 7 patients; it resolved in 3 cases and persisted in 4. One patient developed complex regional pain syndrome (CRPS). A midcarpal arthrodesis with scaphoidectomy was performed in one patient because of disabling pain 5months after surgery. Wrist denervation with a two-incision technique for post-traumatic osteoarthritis led to satisfactory results in 75% of cases with reduction in pain, preservation of range of motion and grip strength. However, this technique does not stop the progression of osteoarthritis. It can be discussed as a therapeutic alternative to proximal row carpectomy or intracarpal arthrodesis to treat degenerative painful wrists

Les analyses urinaires systématiques avant une arthroplastie totale sont-elles indispensables?

La recherche et l'éradication d'une bactériurie asymptomatique avant la mise en place d'une prothèse de hanche ou de genou est controversée, et, pourtant essentielle pour le chirurgien. L'influence pré-opératoire d'une dose d'antibiotique est inconnue. Notre étude prospective sur 510 arthroplasties a relevé les données d'examens urinaires avant et 3 jours après la chirurgie ainsi que de questionnaires à 3 mois de l'opération envoyé au patient et à son médecin traitant. Après analyse des données, notre conclusion est que la recherche systématique d'une bactériurie asymptomatique en pré-opératoire est coûteuse et ne permet pas de prédire le pathogène en cause. Si une infection symptomatique se produit, une antibiothérapie ciblée permet d'empêcher l'urosepsis et la diffusion hématogène vers le site de l'arthroplastie

Radiologie de la main et du poignet pour le médecin de premier recours

La prise en charge de nombreuses pathologies traumatiques de la main et du poignet peut s’effectuer ou tout du moins être initiée par les médecins de premier recours (MPR), bien souvent premiers acteurs du scénario. Pour ce faire, le MPR doit au préalable avoir effectué une lecture correcte des radiographies standards réalisées avec des incidences spécifiques à la pathologie suspectée. Cet article rappelle comment interpréter une radiographie standard du poignet et de la main. Les pathologies parmi les plus fréquentes en traumatologie de la main et du poignet sont abordées afin d’en faciliter l’interprétation

Aneurysms of the hand: Imaging and surgical technique

Hand aneurysms are a rare entity only described as case reports in the literature. The aim of our study was to describe a series of four cases and the surgical technique using an arterial bypass. We also wanted to define an algorithm for the imaging of this pathology. We have operated on four patients with hand aneurysms in the past decade or so. One patient had an aneurysm in the thumb proper palmar digital artery, one in the superficial palmar arch and the two others in the ulnar artery. All patients had an excision surgery with direct arterial bypass; no patient had a venous graft. All patients were seen a few years after the surgery and underwent an ultrasonography to check the anastomosis permeability. All anastomoses were permeable 2 to 8 years after surgery. Through a review of the literature we discuss the best algorithm for imaging a hand aneurysm. Direct arterial suture by proximal and distal mobilization allows for long-term permeability. If a graft is necessary, a graft of arterial origin should be preferred. The additional first-line examination is ultrasonography, followed by arteriography if acute ischemia is present; otherwise, CT angiography or MR angiography is performed

Do diabetic foot infections with methicillin-resistant Staphylococcus aureus differ from those with other pathogens?

There is controversy as to whether or not diabetic foot infections (DFIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) are associated with worse outcomes than DFIs caused by other pathogens. To address this issue we performed a nonsystematic literature search of published articles in English language journals seeking studies reporting on the outcomes of DFIs related to their microbiology. We retrieved 48 articles published from 1999 to 2013 that described a total of 7771 cases of DFI. The overall proportion of DFIs with an isolate of S aureus was about 30%; just over one third of these (11% of all cases) were MRSA strains. Among the DFI cases caused by MRSA 1543 were episodes of soft tissue infections and 113 of osteomyelitis, while non-MRSA organisms caused 5761 soft tissue infections and 354 cases of osteomyelitis. Only 5 of the included articles attempted a comparison between DFI caused by MRSA and those caused by other pathogens, with no clear differences noted. The median total duration of antibiotic therapy for DFI caused by MRSA was 26 days, of which a median of 10 days was given intravenously. Only a few articles reported the proportion of patients with a recurrence, but they often did not differentiate between MRSA and non-MRSA cases. Four publications reported a worse functional or microbiological outcome in MRSA, compared to non-MRSA, cases, but the findings were variable and differences did not seem to be significant. Many trials failed to adjust for case-mix or to definitively demonstrate a relationship between microbiology and outcomes. Few of the articles specifically commented on whether the MRSA isolates were health care- or community-acquired strains. Notwithstanding the substantial limitations of the available literature, there does not appear to be a need for any special treatment for DFI caused by MRSA. The current guidelines for treating according to established international recommendations seem appropriate

Traumatismes de l'articulation interphalangienne proximale des doigts longs

Les entorses et luxations de l'articulation interphalangienne proximale sont très fréquentes, elles sont néanmoins souvent méconnues. Elles doivent être traitées de manière adaptée afin de limiter le risque de raideur et de déformation. Le bilan commence par une radiographie de face et de profil strict afin d'exclure une fracture qui sera adressée directement au spécialiste. Les luxations sont à réduire en anesthésie locale. L'examen clinique à la recherche d'une laxité est primordial et guidera le traitement. L'indication chirurgicale est rare. L'évolution est lente et des douleurs ainsi qu'un œdème articulaire peuvent persister jusqu'à un an. Des séquelles définitives (raideur, déformation et élargissement de l'articulation) ne sont pas exclues

Staphylococcus aureus soft tissue infection may increase the risk of subsequent staphylococcal soft tissue infections

Staphylococcus aureus is the most common cause of soft tissue infections. It is unknown, however, if a patient who has had such an infection is at greater risk for future soft tissue infections with S. aureus

Morsures animales et humaines : que faire et à quoi penser ?

Animal and human bites are a common cause of admission to the emergency room and the infections are common, although they are often trivialized. Complications can range from simple cellulitis to septic shock especially in asplenic patients with Capnoyctophaga canimorsus infection. Other less common infections are possible such as rat-bite fever, leptospirosis, tularemia, and evaluation of post-exposure prophylaxis (anti-tetanus, anti-rabies, HIV, HBV) is essential. Antibiotic prophylaxis remains controversial but is recommended for certain groups of patients and must cover common bite pathogens