Functional and radiographic evaluation of the treatment of traumatic bone loss of the hand using the Masquelet technique

IF 0.308 (2017)International audienceThis study was a retrospective evaluation of 18 patients with traumatic bone loss affecting the fingers, hand and wrist who were treated using the induced-membrane technique. Sixteen men and two women, mean age 54years (27-74) presented a hand injury including bone loss. Sixteen patients were treated on an emergency basis and two following nonunion of their fractures. There were 13 cases of open fracture of the phalanx and 5 cases of metacarpal fractures. These patients were treated with debridement and the injuries were covered when necessary. To address the bone loss, the first step of the induced-membrane technique involved placing a cement spacer (polymethylmethacrylate [PMMA]) without antibiotics in the defect. During the second step, the cement spacer was removed and replaced by autologous cancellous bone graft. The graft was placed within the biological tube left empty after removal of the cement. For each patient, bone union was assessed with radiographs and/or CT scan. Failure was defined as nonunion at 1year. In 16 patients, the fractures had healed after 4months (1.5-12months) on average. Two failures were noted (one nonunion treated using a PIP prosthesis and one case of delayed union). Mobility of the fingers, evaluated using the Total Active Motion (TAM) was 145° (75°-270°). The Kapandji score reached 8 for the thumb. Grip strength reached 21kg/F and pinch strength was 5kg/F; these values were 50% of those in the healthy hand. The induced-membrane technique is simple and can be used to treat traumatic bone loss in an emergency, thus avoiding amputation and limb shortening, while preserving limb function. It provides immediate stability and allows early mobilization

Crônica de uma praga anunciada epidemias agrícolas e história ambiental do café nas Américas Chronicle of a plague foretold crop epidemics and the environmental history of coffee in the Americas

As epidemias agrícolas fornecem um ponto de vista privilegiado para a história ambiental global e transnacional de commodities. A epidemia da ferrugem, causada pelo fungo Hemileia nastatrix, é uma das mais sérias doenças que têm atingido a indústria global de café. No século XIX, ela devastou as plantações de café no Velho Mundo. Também reduziu agudamente a produção de café do tipo arábica na África, Ásia e no Pacífico. Esse foi um dos fatores que permitiu aos países da Américas dominarem a produção global no século XX. Essa epidemia foi detectada nas Américas pela primeira vez na década de 1970. A sua história nas Américas, e as tentativas de seu controle lançam luzes sobre dois paradigmas maiores que moldaram a história ambiental do café no final do século XX. São eles: o paradigma tecnicista, dominante entre meados do século XX até o início dos anos 1990; e o paradigma da sustentabilidade, cujo domínio emergiu em meados dos anos 1980 e se mantém até o presente.<br>Crop epidemics provide a portal into the global and transnational environmental history of commodities. The coffee rust epidemic, caused by the fungus Hemileia vastatrix, is one of the most serious diseases to have afflicted the global coffee industry. In the nineteenth century, it devastated the coffee plantations in the Old World. It sharply curtailed arabica coffee production in Africa, Asia, and the Pacific. This was one of the factors that allowed the Americas do dominate global coffee production in the twentieth century. The coffee rust epidemic was first detected in the Americas in the 1970s. The history of the rust epidemic in the Americas, and attempts to control it, shed light on two major paradigms that shaped the environmental history of coffee in the late twentieth century. The paradigm of technification, which dominated from the mid-20th century to the early 1990s; and the paradigm of sustainability, which dominated emerged in the mid-1980s and continues to the present