Can Clinical and Surgical Parameters Be Combined to Predict How Long It Will Take a Tibia Fracture to Heal? A Prospective Multicentre Observational Study: The FRACTING Study.

Background: Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time.

Methods: The study included 363 patients.

Intramedullary osteosynthesis after external fixation.

The authors report the results of a retrospective study conducted on 30 cases of fracture of the tibia and femur submitted to external fixation and subsequently to intramedullary osteosynthesis, treated between 1991 and 1999. Intramedullary osteosynthesis was used in 24 cases (5 in the femur and 19 in the tibia) as treatment subsequent to external fixation for nonunion or delays in consolidation. Sequential nailing was used as planned treatment in the remaining 6 cases.

A comparative study of the heterodigital neurovascular island flap in thumb reconstruction, with and without nerve reconnection.

41 heterodigital neurovascular island flaps were used to cover defects of the tactile pad of the thumb in 17 years. With an average follow-up of 75.5 months, 30 patients were reviewed.

Dorsalis pedis flap with vascularized extensor tendons for dorsal hand reconstruction.

We describe three cases of combined loss of skin and tendons on the dorsum of the hand treated with the use of cutaneotendinous dorsalis pedis free flap. The functional and aesthetic results are excellent in the hand and aesthetically acceptable in the foot. This technique is the first choice when the treatment of these injuries requires three or four tendon grafts.

Ancient schwannoma of the motor branch of the median nerve: a clinical case.

The authors present a case of ancient schwannoma of the motor branch of the median nerve. An accurate peroperative diagnosis was not possible despite the use of MRI. Sectioning of the nerve was required as the tumor could not be enucleated.

Replantation and revascularization of large segments of the hand and forearm.

From November 1985 to July 1989, the authors performed replantation or revascularization surgery on 18 patients in whom a large segment of the upper limb between the elbow and the palm of the hand had been either completely severed (9 cases) or incompletely severed with ischemia (9 cases). The operation was successful in 16 cases, and the authors were able to clinically review 14 patients (average follow-up, 23 months). The results were analyzed using a protocol based on the following parameters: range of motion, sensation, muscle strength, cold intolerance, pain, return to work, cosmesis, and the patient's level of satisfaction.

Operative treatment of the post-traumatic boutonnière deformity. A modification of the direct anatomical repair technique.

We report 20 cases of post-traumatic boutonnière deformity treated by a modification of the direct anatomical repair technique, particularly indicated in late cases which have complete passive motion. A swallow-tailed flap is excised from the fibrous tissue between the two ends of the central slip. The proximal one is then advanced up to the coaptation with the distal edge of the scarred capsular tissue at the insertion on the middle phalanx to which it is sutured in correct tension.

Evaluation of ischaemic necrosis of carpal bones by magnetic resonance imaging.

Nine patients with chronic pain in the wrist were examined by M.R.I.

The value of computed tomography in the diagnosis of soft-tissue swellings of the hand.

Twenty patients with palpable swellings of the hand were investigated by computed tomography. The results, when compared with the pathological findings, lead us to consider this a technique of considerable value in the assessment of this kind of disease. The importance of angiography and, occasionally of magnetic resonance imaging, are also stressed.

Neurovascular island flap by the disconnecting-reconnecting technique.

The authors report nine cases of hetero-digital neurovascular island flaps raised by the "disconnecting-reconnecting" technique for defects of the tactile pad of the thumb. At an average follow-up of 25 months, all cases had good restoration of sensibility without any "double sensibility" phenomenon and patients regained good dexterity. No tender neuromata developed and donor site complications were not troublesome.

Simple and complex dislocations of the carpus.

The authors report 33 dislocations of the carpus; 9 simple lunate dislocations and 24 complex fracture dislocations. The number and variety of the lesions and, in particular, the variety of the types of treatment carried out allow us to draw several conclusions regarding the correct management of these rare lesions based on a long-term evaluation of the results.