Fascia lata autograft for chronic Pectoralis Major ruptures - A technical note.

Rupture of the pectoralis major tendon is an uncommon injury but increasing in incidence. Surgical management is often needed, and ruptures treated acutely show more favorable results. However, a significant number of ruptures are missed and diagnosed later in a chronic state.

Preoperative antibiotics reduce early surgical site infections after orthopaedic implant removal: a propensity-matched cohort study.

Background: Implant removal in orthopaedics after fracture consolidation is a very common procedure but is still associated with a high rate of surgical site infection (SSI). Antibiotic prophylaxis is not recommended but advocated by some.

Aim: To assess the efficacy of antibiotic prophylaxis in the prevention of early SSI following orthopaedic implant removal.

Defects of the sciatic nerve and its divisions treated by direct suturing in 90 degrees knee flexion: report on the first clinical series.

Objective: To evaluate functional results after treatment of large defects of the sciatic nerve and its divisions by direct nerve suturing in high knee flexion.

Methods: A retrospective review was conducted in patients treated for lower extremity nerve defects between 2011 and 2019. Inclusion criteria were a defect > 2 cm with a minimal follow-up period of 2 years for the sciatic nerve and 1 year for its divisions.

Open Screw Fixation of Large Anterior Glenoid Rim Fractures Using a Deltopectoral Approach With Subscapularis Splitting.

Anterior glenoid rim fracture is a consequence of the humeral head impacting the glenoid fossa. The management of large glenoid fractures involving more than 20% of the articulating glenoid requires surgical treatment. The 2 main techniques are open reduction internal fixation (ORIF) by screws and arthroscopic treatment using suture anchors or transcutaneous screws.

Ballistic peripheral nerve injuries: basic concepts, controversies, and proposal for a management strategy.

Ballistic injuries to peripheral nerves are devastating injuries frequently encountered in modern conflicts and civilian trauma centers. Such injuries often produce lifelong morbidity, mainly in the form of function loss and chronic pain. However, their surgical management still poses significant challenges concerning indication, timing, and type of repair, particularly when they are part of high-energy multi-tissue injuries.

Wartime upper-extremity injuries in the Sahelian strip: Experience from a French Forward Surgical Team deployed in Mali.

This study aimed to analyze upper-extremity combat-related injuries (CRIs) and non-combat-related injuries (NCRIs) treated in the French Forward Surgical Team currently deployed in Gao, Mali. A retrospective study was conducted using the French Military Health Service OpEX surgical database from February 2013 to March 2020. All patients operated on for upper-extremity injury were included: 224 patients, with a mean age of 28.

The Masquelet Technique: Can Disposable Polypropylene Syringes be an Alternative to Standard PMMA Spacers? A Rat Bone Defect Model.

Background: Usually, the two-stage Masquelet induced-membrane technique for extremity reconstruction begins with a polymethylmethacrylate (PMMA) cement spacer-driven membrane, followed by an autologous cancellous bone graft implanted into the membrane cavity to promote healing of large bone defects. In exceptional cases, spacers made of polypropylene disposable syringes were successfully used instead of the usual PMMA spacers because of a PMMA cement shortage caused by a lack of resources. However, this approach lacks clinical evidence and requires experimental validation before being recommended as an alternative to the conventional technique.

Extremity soft tissue coverage in the combat zone: use of pedicled flap transfers by the deployed orthopedic surgeon.

Background: In theaters of operation, military orthopedic surgeons have to deal with complex open extremity injuries and perform soft-tissue reconstruction on local patients who cannot be evacuated. Our objective was to evaluate the outcomes and discuss practical issues regarding the use of pedicled flap transfers performed in the combat zone on local national patients.

Methods: A retrospective study was conducted on data from patients treated by a single orthopedic surgeon during four tours in Chad, Afghanistan and Mali between 2010 and 2017.

Dermal exposure assessment to trinexapac-ethyl: a case study of workers in golf course in Hawaii, USA.

Trinexapac-ethyl (TE) was more widely used in golf course worldwide. As a plant growth regulator, it inhibited grass development and delayed grass cutting date. Direct contact with TE by workers that handle and apply these agents can lead to harmful effects depending on the exposure dosage and duration.

Registration and local production of essential medicines in Uganda.

Background: Universal access to high quality essential medicines is critical to sustainable development (SDG 3.8). However low- and middle-income countries struggle to ensure access to all medicines on their national essential medicines lists (EML).

Blast injury of the hand related to warfare explosive devices: experience from the French Military Health Service.

Introduction: The objective was to report on the experience of the French Army Health Service in the management of blast injury of the hands related to warfare explosive devices.

Methods: A retrospective study was conducted in the Percy Military Hospital (role 4 medical treatment facility) among French soldiers who presented with a combat-related blast injury of the hand between 2002 and 2018. The functional result was assessed by the disabilities of the arm, shoulder and hand (DASH) and the Orthotics and Prosthetics User Survey (OPUS, upper extremity functional status) scores.

The state of microsurgical practice in French forward surgical facilities from 2003 to 2015.

Microsurgery is an unusual procedure in the theatres of military operations. We sought to analyze the state of microsurgical practices in the French medical treatment facilities (MTFs) deployed around the world in the 21st century. A retrospective study was conducted among all patients who were operated on in French forward surgical facilities between 2003 and 2015.

Masquelet technique for open tibia fractures in a military setting.

Purpose: The induced membrane technique (IMT) is a two-stage procedure dedicated to reconstruction of bone defects of the limbs. The objective of this report was to evaluate employment of the IMT for the treatment of open tibia fractures managed in a military trauma center treating both wartime and peacetime injuries.

Methods: A retrospective study was performed among the patients treated via IMT for tibial bone defects related to open fractures between 2009 and 2018.

Surgical Management of Mycetoma in Chad: Experience from the French Forward Surgical Team Deployed in N'Djamena.

Mycetoma is a disease that occurs in the mycetoma belt, between latitudes 15̊ south and 30̊ north. It affects disadvantaged regions with limited access to medical and health facilities. Its general principles of care have changed little and are poorly known.

Missile Injury of the Sciatic Nerve: Observational Study Supporting Early Exploration and Direct Suture With Flexed Knee.

Missile injuries of the sciatic nerve are frequently encountered in modern violent conflicts. Gunshot and fragment wounds may cause large nerve defects, for which management is challenging. The great size of the sciatic nerve, in both diameter and length, explains the poor results of nerve repair using autografts or allografts.

Risk factors and failures in the management of limb injuries in combat casualties.

Introduction: Treatment of war wounds is based on a sequential surgical strategy, which frequently faces therapeutic failures, which then burden the final functional result. The aim of this study was to identify risk factors of failure of the different treatments to prevent the therapeutic failure.

Methods: A monocentric case-control study was done on French war-wounded soldiers treated for an open fracture caused by an invasive war weapon.

Metacarpal bone reconstruction by a cementless induced membrane technique.

Gunshot wounds to the hand often produce complex injuries and large segmental bone defects. Bone reconstruction remains a challenge in this context. The induced membrane technique is a simple and effective procedure for reconstruction of segmental bone defects.

Graft Choice and the Incidence of Osteoarthritis After Anterior Cruciate Ligament Reconstruction: A Causal Analysis From a Cohort of 541 Patients.

Background: Anterior cruciate ligament (ACL) reconstruction is important to prevent knee osteoarthritis. Neither of the 2 most common graft techniques-the patellar tendon (PT) or hamstring tendon (HS) graft-has demonstrated superiority in terms of the long-term osteoarthritis rate.

Hypothesis: Based on the International Knee Documentation Committee (IKDC) radiographic grading system, PT grafts decrease the incidence of osteoarthritis by providing better knee stability as compared with HS grafts over 12 years of follow-up.

Type III open tibia fractures in low-resources setting. Part 1: strategy and principles of limb salvage.

In developing countries, road traffic accidents result in many cases of open trauma, especially fractures, with the tibia area at particular risk in motorcycle crashes. Despite a high prevalence of severe leg trauma with multi-tissue injuries, few studies have focused on the challenge of their reconstruction in these limited-resource settings. The first part of this review presents the surgical strategy.

Nerve transfer to biceps to restore elbow flexion and supination in children with obstetrical brachial plexus palsy.

Purpose: Nerve transfers to restore elbow flexion have been described for traumatic brachial plexus palsy in adults. Indications are less frequent in infants and the results are less published.

Methods: Ten patients with obstetrical brachial plexus palsy were operated on for lack of flexion against gravity with ulnar or median nerve transfer to biceps motor branch.

Initial management of complex hand injuries in military or austere environments: how to defer and prepare for definitive repair?

Introduction: The damage control orthopedics (DCO) concept is a sequential surgical management strategy indicated when ideal primary treatment is not possible or suitable. DCO principles are routinely applied to hand traumas in wartime practice, but could also be useful in a civilian setting when immediate specialized management cannot be carried out.

Methods: The authors report three typical observations of soldiers treated for a complex hand trauma on the field by orthopedic surgeons from the French Military Health Service (FMHS).

Face to face, person to person: Skills and attributes deployed by rural mental health clinicians when engaging with consumers.

Objective: The purpose of this study was to identify the skills and attributes deployed by rural mental health clinicians when engaging with consumers in the community mental health context.

Design: Reflecting the exploratory nature of this research, a semi-structured focus group was conducted.

Setting: One community mental health service in regional South Australia (catchment area = approximately 60 000 people).