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Volume 8, Problème 3 (2019)

Rapport de cas

Reconstruction of the Foot and Lower Leg Defects by Reverse Sural Flap

Sabri EM, Omar L, Mouad B, Boufetal M, Bassir RA, Aitbenali H and Berrada MS

Introduction: The sural fascio-cutaneous flap is a good option in reconstruction of difficult and complex wound in lower leg and foot especially on ankle joint, malleoli, heel, and posterior plantar.

Case report: This study included 17 cases with foot and lower leg defects admitted to Hospitals from January 2017 to April 2019. Their age ranged between 7 and 50 years with a mean of 28.5 years. They were 13 males and 4 females. The patients presented with a variety of leg and foot defects. All patients underwent different surgical procedures specified for each case.

Conclusion: The sural fasciocutaneous flap is a good option in reconstruction of difficult and complex wound in lower leg and foot especially on ankle joint, malleoli, heel, and posterior plantar regions as it showed.

Série de cas

The Caution of Non-Operative Management of High Grade Blunt Hepatic Trauma

Liu SY, Shankara GS, Yang SY and Liu ZJ

Background: Gingival Non-operative management (NOM) has evolved into the treatment of choice for most patients with blunt liver injuries who are hemodynamically stable. However, there are still evidence of patients at higher risk for NOM failure. These patients must be treated more cautiously regarding the NOM approach.

Method: The failure of four high grade blunt hepatic trauma cases treated with NOM was reviewed in recent three years in our hospital.

Results: Four patients with high grade liver trauma (three grade Ⅳ, one grade Ⅴ) were initially hemodynamically stable and treated with NOM. Several hours later, their heart rates increased rapidly, and blood pressure decreased and underwent surgery. One patient died just on opening the abdominal cavity due to massive bleeding while the other three were saved.

Conclusion: Non-operative management should be very cautious for high grade blunt hepatic trauma patients although they are early hemodynamically stable

article de recherche

The Biomechanical Effects of Combining Rigid and Dynamic Fracture Fixation in Simple Fractures

Papineau JL, Bauer S, Hayes AJ, Stoffel K, Day RE and Kuster MS

Introduction: Bridge plating has superseded rigid internal fixation in most situations. In simple fractures increased time to union has been reported. This biomechanical study investigates whether the combination of dynamic and rigid fixation allows for adequate interfragmentary movement.

Methods: Standardised fractures were created in bone surrogates and fixed with either a standard bridging plate construct using a locking compression plate or Non Contact Bridging (NCB®) plates using Far Cortical Locking screws (FCLS, MotionLoc™). The constructs were axially loaded to simulate non, touch and partial-weight bearing and interfragmentary motion measured.

Results: The standard bridge plating and the far cortical locking constructs fixed with a “fracture gap” showed significantly increased fracture motion (p<0.005) relative to other groups. No significant difference in fracture motion was demonstrated between any of the 3 groups, where the osteotomy was anatomically reduced, regardless of the presence of an inter-fragmentary screw.

Conclusion: The combination of a lag screw and dynamic plate osteosynthesis allows sufficient fracture motion for secondary bone healing. In simple fracture patterns the addition of a lag screw did not impair fracture motion.

article de recherche

The Effect of ACL Graft Size on Post-operative Knee Extension

Sheldon M

Introduction: Understanding factors that cause loss of extension post Anterior Cruciate Ligament (ACL) reconstruction may assist surgeons in preventing this problem. The aim of this clinical trial is to determine the effect of reconstructed ACL graft size on postoperative range of motion in ACL reconstruction in human subjects.

Methods: This therapeutic comparative cohort study consisted of a retrospective analysis of prospectively collected data. Participants either received an autologous double bundle ACL graft (Control) or a combined autologous/synthetic graft (Hybrid), which increased graft cross-sectional area. Femoral notch width was measured preoperatively by Magnetic Resonance Imaging. Range of motion was determined using goniometry at two years post reconstruction. Stepwise logistic regression and bivariate correlation was used to analyse data.

Results: 54 participants were included in analysis, 22 Control and 32 Hybrid. Hybrid group had a significantly larger reconstructed graft cross-sectional area (× (Hybrid)=71 ± 9.30 mm2; × (Control)=59 ± 12.26 mm2, t=4.76, p<0.05). Mean notch size was smaller in Control group (1.83 ± 0.18 cm) compared to Hybrid group (1.91 ± 0.27 cm). Hybrid group had significantly fewer cases of postoperative knee extension loss (χ2=3.90, p<0.05), defined as loss of passive range ≥ 3° at 2 years post-surgery. Increased graft cross-sectional area was not a significant predictor of loss of extension. There was also no relationship between notch width and extension range of movement. (r=0.01, p=0.80).

Conclusion: A 20% increase in ACL graft cross-sectional area was not a significant predictor of postoperative extension loss.

Rapport de cas

Recovery of Foix-Chavany-Marie Syndrome with Multi-Modal Rehabilitation Therapy: A Case Report and Review of Literature

Qiu X, Zhang B, Chen C, Gao T, Sun C, Xie B and Bai Y

Foix-Chavany-Marie syndrome (FCMS) is a rare type of pseudobulbar palsy characterized by loss of voluntary control of the facial, glossal, pharyngeal, laryngeal, and masticatory muscles with preserved automatic, involuntary movements, also called “automatic-voluntary dissociation”. These dysfunctions are usually difficult to recover. We would like to report a 50-year-old female presented as FCMS with prominent oral dysphagia and dysarthria. Therapies included speech therapy, transcranial magnetic stimulation and acupuncture. After 3 weeks’ treatment, the patient had improvements in oral facial muscle control and chewing. However, the dysarthria remained prominent. Multi-modal rehabilitation therapy may be helpful in the recovery of FCMS.

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