Teeth syndrome: diagnosis, complications and management

Teeth syndrome or fight bite is a specific entity in hand surgery that is little known. It includes infectious complications of the hand following a fist against the teeth. Neglected or misdiagnosed this injury  frequently leads to serious complications that could compromise the function of the hand. A retrospective study was performed on 20 patients treated for teeth syndrome at our department, during a period of 12  years (January 2003 to April 2015). All young adults with a mean age of 28 years and a significant male  predominance. The dominant side was involved in 15 patients. Lesions were divided into 4 cases of simple dorsal wounds facing the MP joint, 8 cases of dorsal hand cellulitis, and 8 cases of arthritis and osteoarthritis of the  metacarpophalangeal (MP) joint of the long fingers. The index was the most affected finger. Treatment  consisted in debridement of necrotic tissues, stabilization with external fixation for arthritis, skin  reconstruction was performed secondarily. Result was assessed as good in 60% of cases. Clenched fist  injuries to the mouth (teeth syndrome or fight bite) are known as being the worst human bites. Usually  treated as minor injuries, without realizing a breach of the joint capsule, a lesion of the extensor tendon, or a contamination by oral flora. Any patient with a wound near the joint of the hand and was involved in a fight, need an appropriate evaluation and a specialized treatment to avoid serious complications.Key words: Human bite, cellulitis, arthritis, finger, Hand surger

Tuberculous flexor tenosynovitis of the hand

AbstractTuberculosis is a major public health problem in developing countries. Flexor tenosynovitis of the fingers constitutes an exceptional tuberculosis localization (Gabl et al., 1997; Senda et al., 2011) [1,2]. Unusual presentations, such as tuberculous tenosynovitis, often go undetected and are associated with a diagnostic and therapeutic delay, especially when bacteriological research proves to be negative. Here, we report a case of tuberculous flexor tenosynovitis of the hand

A pathological fracture of the scaphoid revealing an intraosseous ganglion cyst

Intraosseous ganglion cyst is a benign bone lesion with histological similarities to the soft tissue ganglion cyst. Its location on the short bones, including the carpal bones has rarely been reported. The radiolucent carpal lesions are usually symptom-free found incidentally on radiographs of the wrist performed for other reasons. Detecting a pathological fracture of the scaphoid revealing an intraosseous ganglion cyst is exceptional. We report the case of a 21-year-old, right-handed male, presented with a one year history of progressive right-wrist pain, worsened since a month without a history of previous trauma. Plain radiographs and CT-scan revealed a cystic lesion of the scaphoid with a pathological fracture. He was successfully treated with curettage and packing with a Zaidemberg's vascularized radial graft without recurrence at two years postoperatively.Pan African Medical Journal 2016; 2

Kuhlmann vascularized bone grafting for treatment of Kienböck’s disease: a case report

Treatment of Kienböck's disease has historically been determined by staging, ulnar variance, and presence or absence of arthritic changes. With the advent of newer techniques of vascularized bone grafting, the status of the cartilage shell of the lunate has become another factor that can influence the procedure performed. The purpose of this article is to describe the technique of Kuhlmann vascularized bone graft for Kienböck's disease. In addition, the indications, contraindications, and outcomes are described.Pan African Medical Journal 2016; 2

Carpal tunnel syndrome caused by lipoma: a case report

Lipoma is a relatively frequent, benign soft-tissue tumor rarely located in the hand. A lipoma of the hand causing a carpal tunnel syndrome by compression of the median nerve is exceptional. We report the case of a 70-year-old female presenting with a carpal tunnel syndrome. A compression of the median nerve by a lipoma was discovered during surgery. Transverse carpal ligament release with lipoma excision and neurolysis of the median nerve were performed. Histopathological study of the resected mass was consistent with a lipoma. Two-month postoperatively, the patient recovered full hand function with entire disappearance of  acroparesthesia. Carpal tunnel syndrome caused by space occupying lesions is rare. Diagnosis is difficult, usually based on the clinical study, electrophysiology and magnetic resonance imaging (MRI). Transverse carpal ligament release and excision of lipoma provides excellent functional recovery.Key words: Lipoma, carpal tunnel syndrome, median nerve, nerve compressio

Glomus tumor of the leg: a case report

Glomus tumors are uncommon benign tumors developing from the neuro-myo-arterial glomus body. They are typically located in the fingers. The extra-digital involvement is unusual and makes diagnosis difficult. Only few cases have been reported in literature. We report an exceptional case of a glomus tumor of the lower leg in a 65-year-old male. The diagnosis was clinically suspected and confirmed by a biopsy. Surgical excision gave immediate pain relief. The aim of this report is to make the surgical community more aware of this entity based on the analysis of our own experience and a review of the literature

Humeral Artery Aneurysm Revealing a Rare Association between Tuberculosis and Behçet’s Disease

The association of pulmonary tuberculosis and Behçet’s disease revealed by an aneurysm of the humeral artery is exceptional with a complicated management. We report a case in which the two conditions occurred concomitantly with the vascular complication, apart from any use of immunosuppressive therapy, something that has never been reported in the literature. We report an extremely rare case of a spontaneous rupture of an aneurysm of the humeral artery of a 29-year-old woman, with no history. The patient underwent axillo-humeral bypass. Investigations concluded the diagnosis of Behçet’s disease associated with pulmonary and lymph node tuberculosis. Anti-tuberculous chemotherapy followed by corticosteroids, immunosuppressants and colchicine have been administrated. Based on this observation, we insist on the necessity of searching the symptoms of Behçet’s disease in the presence of arterial involvement when having a young patient. Therapeutic management must include medical treatment to control inflammation and limit the risk of recurrence. Endovascular or surgical treatment is necessary if the arterial involvement is threatening. The association with tuberculosis complicates management and requires close monitoring

Modeling of drift during the application of phytosanitary products on low crops: Literature review

During the spraying of low crops, large quantities of pesticides are transferred from crop-growing areas to the atmosphere, by drift inducing environmental impacts, human health problems and economic loses. To better understand this drift phenomenon, spray emission modeling, in combination with field tests, could be a suitable solution but modeling stills the most used approach. Thus, the scientific community developed mathematical and computational models to describe the complicated interactions between spray droplets and its environment considering the different involved parameters. The final objective is to determine pesticide transport with few field tests. Most of the developed models are Lagrangian models that use the principles of fluid mechanics based on simplifying assumptions regarding the description of the kinetics of particles and the effect of turbulence on the behavior of the droplets.Existing drift models only consider the evaporation of the solvent, which is often water. They assume that there is a loss of pesticide by evaporation only if the drop reaches total evaporation. They also assume that the drops are isolated and that the effect of surface tension is neglected. Thus, evaporation is necessarily overestimated. Several results of those models show that drops smaller than 100 μm are the most sensitive to evaporation. This paper presents a bibliographic review describing some known drift models, particularly their calculation bases of evaporation, considering the diversity of hypothesis and drift principles characterization

Scaphoid Non-Union Treated by Zaidemberg’s Vascularized Bone Graft: About 30 Cases

Introduction: Scaphoid fractures evolves in 10% of cases to nonunion. Untreated, it progresses to arthrosis of the wrist that may compromise the function of the hand. The recently described vascularizedbone grafts have helped to expand the armamentarium of management of scaphoid nonunion. We wantedto verify those data by studying the results of Zaidemberg’s graft made in our orthopedic department. Materials and methods: 30 scaphoid nonunion cases treated by a vascularized bone graft usingZaidemberg’s procedure were studied retrospectively. The clinical criteria studied were: range of motion,the Mayo Wrist Score, the Quick Dash, and PWRE. The radiographs have controlled the consolidation and performed a full radiometry.Results: Our series is made up of young adults (average age 28 years), a male-dominated manual workers. The dominant side is attained in 60% of cas.57% of patients are smokers. The seniority of the nonunion was 4 years on average. Nonunion sat, according to Schernberg’s classifi cation in zone 3 in 30% of cases. We had 50% in stage 2a and 30% in stage 2b according to Alnot’s classifi cation. Fixationwas realized by pins followed by immobilization during 6 weeks on average. We had a consolidation in all cases. The tobacco intoxication had a deleterious effect, a delayed union was observed in smokers’ patients. Our patients had a Mayo Wrist Mean score 72%, a PRWE to 11% and a Quick DASH 10%. Analysis of radiometry showed an improvement of the analyzed parameters.Conclusion: Zaidemberg’s graft is a reliable vascularized bone graft; it requires a learning curve, theseresults are better than inert transplants and Kuhlmann’s graft, it is indicated in the old nonunion, stage 2 Alnot the “proximal pole necrosis and changing of the scaphoid shape”.</p

A rare localization of tuberculosis of the wrist: The scapholunate joint

The tuberculosis of the hand and the wrist is a rare entity. Affecting the scapholunate joint is exceptional. It is usually diagnosed at an advanced stage of carpal destruction, due to slowly development of the symptoms. We report the case of a 58-year-old female, presenting as wrist pain for 3 months. Clinical study showed a local swelling in the left wrist, the mobility of the wrist was normal but painful at the end of motion. The diagnosis of osteoarticular tuberculosis was suspected after radiological and biological study then confirmed after histological study. Antibacillary chemotherapy during 12 months promoted healing and good outcome