[Franche Comté hospitals between conquest and revolution. Apogee and architectural refinement].

In the architecture of hospitals, Franche Comté has a particular part: sumptuous 'baroque' structures from the XVIo and XVIIo centuries are specifically captivating by some historical, political, geographical and human reasons.

[The hospital law of December 21, 1941: origins, consequences].

The first law about the organization of the French hospitals dates back to 1796 with the French Revolution which asserts the powerful administrative commission, chaired by the mayor of each town. In 1941, the new law created the job of director whose task was to apply the decisions of the commission. In the same time, the hospital practice was no longer free and the practitioners were chosen by medical boards of examiners.

[Articular reconstructions by a costochondral grafting (or osteochondral costal grafting)].

We describe a novel technique of costochondral autografting for the treatment of trapeziometacarpal arthritis, radioscaphoid osteoarthritis, malunion of the distal end of the radius, and osteoarticular loss of the MP joints of long fingers. The costal graft harvest technique is always the same. A 5-cm horizontal incision is made over the 9th rib, and the rib is exposed at the osteocartilaginous junction.

[Air cleanliness in operating rooms: on-site controls and biological testing].

Air cleanliness control in operating rooms is based on air filtration, and targets the lowest density of particules and bacteria. Legally, the equipment must be periodically verified during periods of inactivity. Most airborne bacteria are of human origin.

[The centralization of medical studies in universities under Napoleon I. History and consequences].

The so called "Loi du 19 ventose au XI" is two centuries old. It is a very important text of the French universitary story. It stands out the end of the Revolution in the medical studies.

[Centromedullary nailing of the femur for bone metastasis: clinical and radiological evaluation using the Tokuhashi score in 24 patients].

Purpose Of The Study: Pluridisciplinary management of patients with metastasis to the femur is well defined, but the choice between palliative surgery or abstention must be decided on the basis of a few evaluated prognostic criteria. We report a series of 24 cases of metastasis to the weakened or fractured femur which was evaluated with the Tokuhashi score and treated by surgery.

Material And Methods: Sixteen women and eight men, mean age 71 years (58-89) underwent centromedullary nailing of the femur.

[Performances of different types of airflow system in operating theatre].

Aim: To compare the performance of various types of airflow system in operating theatre.

Methods: Besançon Hospital has three types of airflow system in operating theatre: laminar (unidirectional) flow, stabilized flow and turbulent flow. We have compared performances of these airflow systems during operations by evaluating several indicators: number of airborne particles, microbial contamination, kinetics of decontamination, rate of mixing and an index of functionality.

[The importance of isolating septic patients in an autonomous unit in orthopedic surgery and traumatology].

Unlabelled: To examine whether Sepsis Containment Units are presently in use by French Orthopedic surgeons in a number of hospitals and the subsequent efficacy of these measures in the prevention of risks linked to methicillin resistant Staphylococcus aureus (MRSA), MRSA was used as an example because it is the bacteria most frequently associated with infection in orthopedics. The transient carriage of MRSA on the hands of hospital personnel is the most common mechanism of patient to patient transmission. Consequently, the incidence of nosocomial MRSA in patients can be used to assess the quality of infection control.

Modelling the usefulness of a dedicated cohort facility to prevent the dissemination of MRSA.

The aim of this retrospective study was to determine whether or not a surgical dedicated cohort facility, mainly dedicated to the care of orthopaedic patients, can control the risk of infection caused by methicillin-resistant Staphylococcus aureus (MRSA). We tested this hypothesis on the orthopaedic surgery ward of a university-affiliated public hospital with 1228 beds by determining whether there was a significant correlation between the colonization pressure exerted by MRSA and the number of cases of acquired MRSA. This was then used as a tool to predict the number of patients contaminated with MRSA in hospitals with and without dedicated cohort facilities.

[Occult fractures of the carpal navicular. Detection by quantitative radioscintigraphy. Social and medico-legal repercussions].

Fractures of the scaphoid of the wrist are not easily diagnosed and when they are eventually recognized due to late complications, the prognosis is much poorer than it would have been at injury. Medical negligence and poorly-performed or interpreted x-rays are frequently cited as reasons for non-diagnosis. Often these fractures are trabecular, so-called occult, and they cannot be seen on a conventional exam, even if well-performed.

[Development of the surgical school of Lorraine, 1872-1919].

Shortly after the 1870-1871 war between France and Prussia, the Faculty of Medicine of Strasbourg was transferred to Nancy. Few works were dedicated to the surgeons of this new school of Medicine, most of them alsatian at its beginning. Yet the surgeons played an important role in the technical success and certainly management of the Faculty as A.

[Osteosynthesis of distal radius fractures by doral plate: advantages and disadvantages].

Distal radius fractures remain a challenge. No one osteosynthesis procedure can solve all the problems. A method of analysis is necessary in order to choose the best tools.

[Evolution of professors recruiting in the medicine area between 1803 to our time].

19 ventose an XI (1803) law reminds the emergence of post Revolution's University. Then, it is interesting to give a sharp look upon the various ways of recruiting as to medical professors for that time. At start, there were only professors without any title, but, since 1823, graduates who had passed the agregation examination came in sight.

[A turning point in the therapeutic history of open leg fractures: osteosynthesis coupled to the immediate dressing in the presence of major damage to the soft tissues].

A brief history of the treatment of open leg fractures (OLF) points out the problems posed by the present therapy with regard to the soft tissues in the most serious cases (type III from cauchoix, Duparc, type III A and B from Gustilo). Which strategy should be foremost, knowing that the debridement, stabilization and cover are the three essential procedures? Rigorous debridement certainly carries unanimous approval but some are opposed to this procedure during the first few days. Also widely recognized is the beneficial aspect of early cover when regarding aseptic evolution, consolidation, low rate of complications, rehabilitation and the patient's helplessness.

[Hand replantation: long-term functional results (apropos of 8 cases)].

Study Aim: The aim of this study was to report the long term functional results after replantation of the hand in eight patients.

Materials And Methods: Between 1977 and 1995, hand replantation was performed in eight cases (six males and two females). Mean age at the time of injury was 31 years (24-47 years).

[Treatment of complex fractures of the ankle and their sequellae using trans-plantar intramedullary nailing].

Unlabelled: Nine patients were treated for complex tibial pilon and talus fractures or non unions from 1990 to 1997 using intramedullary nails introduced through the calcaneus. All patients were followed until healing. The average follow-up was 14 months.

Trauma emergency unit: long-term evaluation of a quality assurance programme.

Objective: Long-term evaluation of a quality assurance programme (after an assessment in 1993).

Design: Review of medical records.

Setting: Emergency area of an orthopaedic, trauma, and plastic surgery unit in a French teaching hospital (Besancon).

[Value of the surgical approach through the patellar tendon for intramedullary nailing of the tibia and the femur].

The goal of this study was to propose a new approach of the upper tibia for intramedullary nailing. Since two years, the authors performed a transversal skin incision superior to the distal end of the patella. The patellar tendon is dissociated and the tibia is perforated through the anterior intercondylar area.

[Reflections on recent ruptures of the diaphragm. Apropos of 45 cases].

Trauma-induced ruptures of the diaphragm are very exceptional but are regularly encountered in trauma surgery units. Closed ruptures occur in 60 to 80% of diaphragm lesions in European series, 9 times out of 10 after traffic accidents. Large American trauma centers however, have had more experience with stab of firearm wounds.

[Complex injuries of the dorsum of the hand. Therapeutic reflections apropos of 2 cases].

Unlabelled: We report 2 similar cases of severe injury of the dorsum of the hand, both treated in emergency.

First Case: A 37-year-old right handed male truck driver was admitted with a complex severe injury of the dorsum of his right hand following a traffic accident. He had a combined large defect involving skin, tendons and bone.

[Functional treatment of isolated fractures of the ulnar diaphysis in adults. A prospective study apropos of 10 cases and review of the literature].

In this prospective study, ten consecutive isolated fractures of the ulna were treated by short-arm plaster cast (an average of 16.8 days) with immediate mobilization in our institution since January 1995. The minimum follow-up was eight months and the longest was two years.