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The importance of anatomical reduction of articular fractures and early mobilisation of these severe forms of trauma which frequently damage the extensor apparatus (58% of cases, led us to propose direct miniaturised osteosynthesis as described by the Nancy-Strasbourg team. Of the 1,000 cases of osteosynthesis performed between 1978 and 1985, we selected 12 fractures of the MP joint, 38 fractures of the PIP joint and 10 fractures of the DIP joint, differentiated into 4 stages according to the condition of the skin and tendons and into 9 categories according to the anatomical type and the site of the fracture. Direct osteosynthesis (screw, bolt, pin) was used in every case. The clinical results were evaluated in terms of the Total Active Range of Movements, the local trophic state, the amount of pain and return to work, for each joint. When well conducted and with effective skin cover, this technique allows almost normal reconstruction in simple fractures and is valuable in more complex fractures by preserving sliding of the tendinous apparatus due to early mobilisation.

Fast Absorption Vicryl was irradiated with gamma rays. The experimental study on 14 mice grafted with human skin showed a constant rupture of the sutures on the 12th day, with the development of a moderate macrophage reaction. Injection of isotonic saline around the suture material did not accelerate the process of resorption. The clinical study with 27 children operated on the limbs showed rupture of the sutures between the 12th and 16th days, without inflammatory reaction, infection or wound dehiscence. Simply wiping the wound with a compress removes the stitches painlessly. This is appreciated by the young subject and his or her family. Since we began to use FAV systematically we have not needed to conduct dressing under anesthesia. The long term results of healing (follow-up: 11.3 months) are similar to those obtained with conventional non-absorbable suture material. The tolerance, the rapid resorption, the comfort of the patient and the cost advantage make FAV the suture material of choice.

Transtriquetral triquetro-lunate arthrodesis is an original technique for partial arthrodesis of the wrist. This operation is indicated in the treatment of certain forms of triquetro-lunate instability and represents a new approach to the treatment of Decoulx's stages I and II of Kienböck's disease. The incision is medial and limited. The use of a special trephine guided by a pine allows the extraction of a triquetro-lunate osteocartilaginous cylinder. A cancellous bone graft is then performed to fill in the loss of substance. This new, simple surgical procedure, but demanding in terms of its technique, should decrease the failure rate and should improve the chances of lunate revascularisation.

Twenty-two protheses of the lunate were implanted in the osteonecrosis stage III described by Decoulx. The authors chose palmar approach to release the median nerve in the carpal tunnel. A dorsal incision is sometimes necessary to fix taut the dorsal capsular ligament. The wrist is immobilised for six weeks. The dislocation (5 cases) is the complication the most to be feared and comes from: a weakness of the capsular ligament system, a badly fithing implant, insufficient immobolisation. This implant decreases the pain and improves the mobility of the wrist but the grasp remains poor (50% operated cases give excellent or good results). The indications of these implants demand serious discussion for manual workers (more than 30% of these operated cases had to change job).

Twelve rabbit femoral arteries were clamped for one hour with a TKS2 clamp in order to confirm the atraumatic nature of the Tamai disposable clamp. After 15 or 30 minutes of revascularisation, the arteries were excised and studied by light microscopy and scanning electron microscopy. Temporary dilatation of the artery was observed after removal of the clamp, as the patency test was always positive. Light microscopy revealed parietal flattening without any cellular disorganisation and scanning electron microscopy revealed flattening of the endothelial cells without any tearing. On the basis of these favourable results, combined with the ease of use, we now use the Tamai clamp daily.

The surgical treatment of "swan-neck" deformities secondary to mallet finger using Littler's technique (Spiral Oblique Retinacular Ligament) in a series of 35 cases, led to a complete correction of the PIP joint hyperextension in 95% of the cases and a correction of the DIP joint flexure in 70% of the cases. This active tenodesis restores the physiology of the extension of the PIP and DIP joints as far as the surgical technique has been strictly respected.

Microsurgical techniques are becoming increasingly important in the emergency treatment of hand trauma and in secondary reconstructive surgery. In the light of the current concern with financial feasibility, we thought it important to determine whether this surgery, sometimes wrongly described as being luxury surgery, is economically feasible. The cost of 40 reimplantations and revascularisations of the thumb treated in the context of work accidents was studied. Although the short-term cost of reimplantation is higher than that of amputation, in the long-term, a successful reimplantation constitutes a definite economy for society and justifies this type of specialist surgery.