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Asthma often remains uncontrolled, despite the fact that the pharmacological treatment has undergone large changes. We studied changes in the treatment of asthma over a 20-year period and identified factors associated with the regular use of inhaled corticosteroid (ICS) treatment. Changes in the use of medication were determined in 4617 randomly selected subjects, while changes in adults with persistent asthma were analysed in 369 participants. The study compares data from three surveys in 24 centres in 11 countries. The use of ICSs increased from 1.7% to 5.9% in the general population and the regular use of ICSs increased from 19% to 34% among persistent asthmatic subjects. The proportion of asthmatic subjects reporting asthma attacks in the last 12 months decreased, while the proportion that had seen a doctor in the last 12 months remained unchanged (42%). Subjects with asthma who had experienced attacks or had seen a doctor were more likely to use ICSs on a regular basis. Although ICS use has increased, only one-third of subjects with persistent asthma take ICSs on a regular basis. Less than half had seen a doctor during the last year. This indicates that underuse of ICSs and lack of regular healthcare contacts remains a problem in the management of asthma., Despite increased ICS use, only 34% of subjects with persistent asthma take ICSs on a regular basis

Negative pressure wound therapy combined with timed, cyclical instillation (NPWTi) of topical wound solutions has been recently presented as a new adjunctive modality for treating wounds with signs of infection. Normal saline, antiseptics and antimicrobials all have been proposed in scientific and clinical studies as potentially effective when used with NPWTi for treating heavily infected wounds. This is a prospective clinical study of 131 patients with 131 wounds treated with NPWTi using saline between January 2012 and December 2012 in two orthopaedic centres and one surgical wound healing centre in France. Saline was exclusively used. Results were favourable: in 98% of the cases, the wounds could be closed after debridement and following the use of NPWTi. Mean duration of NPWTi was 12·19 days. This does not preclude the need for treating the biofilm appropriately with more active antibacterial products when biofilm has been documented.

Hypothesis The aim of the present study was to assess the technical feasibility of minimally invasive volar plate removal following distal radius fracture. Material and methods Three hundred and eighty-eight plates removed from 387 patients (357 females: mean age, 50 years) were assessed retrospectively. The incision used the primary minimally invasive approach and was closed after plate removal by intradermal continuous suture, without drainage or immobilization. Results Mean scar size was 22.2 mm preoperatively, and the incision was 19.8 mm at start and 21.4 mm at end of procedure, these differences being non-significant. The scar was enlarged by accidental skin tear in 13 cases and intentionally by lancet in 11 cases. There were 29 screw-related complications, 1 bone crack without clinical impact, and 1 plate fracture. There were no postoperative complications. Discussion The present results demonstrate the feasibility of removing a volar plate on the distal radius via a 20-mm approach. These findings should be confirmed on a future study comparing minimally invasive plate ablation and conventional approaches.

The current tendency of microsurgery is heading toward supermicrosurgery and microsurgery assisted by robotics. The aim of this work was to study the feasibility of a free hallux hemipulp transfer with a surgical robot in a cadaveric model. We used a human body. The intervention was realized by a Da Vinci SI® robot (Intuitive Surgical™, Sunnyvale, CA) in two stages: first taking off the medial hallux hemipulp, then transferring the hallux hemipulp to the radial thumb hemipulp. The intervention lasted 1 hour 59 minutes, exclusively with the Da Vinci SI® robot, without any interruption or outside intervention. Despite the absence of sensory feedback and an intervention 25% longer than in conventional microsurgery, we have demonstrated the feasibility of free hallux hemipulp transfer with a surgical robot. In the future, it is likely that the added benefits of the robot (physiological tremor suppression, user-friendly ergonomics, ultraprecise control of the instruments) will make the robot an indispensable tool for the surgeon.

Resume La technique d’arthrodese mediocarpienne la plus utilisee dans le traitement des SNAC et SLAC wrists de grade 3 est la plaque circulaire dont la complication principale est la pseudarthrodese. Le but de notre travail etait de mettre au point une technique d’arthrodese mediocarpienne par vis-broches autocassables pour diminuer le risque de pseudarthrodese. Notre serie preliminaire comprenait dix patients. L’arthrodese a ete realisee par deux vis-broches auto-secables a double pas compressif de diametre 2 mm. Aucune greffe osseuse n’a ete utilisee. Au recul de 26,3 mois (11–44), nous avons evalue des criteres subjectifs (douleur, « Quick-DASH », reprise des activites) et objectifs (force, mobilite). Toutes les variables etaient significativement ameliorees apres l’intervention sauf la mobilite. Parmi les complications, on notait un retard de consolidation avec un bon resultat final et une consolidation radiologique. L’arthrodese mediocarpienne par voie dorsale montee par deux vis-broches a compression nous parait une technique interessante, ne necessitant pas de greffe osseuse, avec un cout raisonnable.

Unstable distal phalanx fractures are typically treated by pinning of the distal phalanx or the distal interphalangeal joint (DIP). Complications include unstable fixation, K-wire migration, septic arthritis and osteoarthritis. To limit these complications, we wanted to explore the benefits of using locked extra-articular DIP pinning. The cohort consisted of 12 patients (mean age 36.3 years) who had an extra-articular (6 cases) or intra-articular distal phalanx fracture (6 cases). All patients were treated surgically with a construct consisting of two connected K-wires: one was placed inside the shaft of the distal phalanx and the other was placed perpendicular to the middle phalanx. The K-wires were removed after 1 month. After an average follow-up of 19.9 weeks, pain was 0.4/10 and the QuickDASH score was 7.41/100 on average. The range of motion was, on average, 30.0° less than the contralateral uninjured side for active flexion, 8.8° less for active extension, 32.0° less for passive flexion and 4.1° less for passive extension. The overall hand strength averaged 85.2% of the contralateral one. One secondary displacement occurred but there were no infections. In all, these findings suggest that locked extra-articular DIP pinning is a simple and reproducible surgical treatment for distal phalanx fractures. Level of evidence IV.

Unstable distal phalanx fractures are typically treated by pinning of the distal phalanx or the distal interphalangeal joint (DIP). Complications included unstable fixation, K-wire migration, septic arthritis and osteoarthritis. To limit these complications, we wanted to explore the benefits of using locked extra-articular DIP pinning. The cohort consisted of 12 patients (mean age 36.3 years) who had an extra-articular (7 cases) or intra-articular distal phalanx fracture (5 cases). All patients were treated surgically with a construct consisting of two connected K-wires, one was placed inside the medullary canal of the distal phalanx and the other was placed perpendicular to the middle phalanx. The K-wires were removed after 1 month. After an average follow-up of 19.9 weeks, pain was 0.4/10 and the QuickDASH was 7.41/100 on average. The range of motion was, on average, 30.0° less than the contralateral uninjured side for active flexion, 8.8° less for active extension, 32.0° less for passive flexion and 4.1° less for passive extension. The overall hand strength averaged 85.2% of the contralateral side. One secondary displacement occurred but no infection. In all, these findings suggest that locked extra-articular DIP pinning is a simple and reproducible surgical treatment for distal phalanx fractures.

The treatment of traumatic partial injuries of the flexor tendons of the fingers is seldom published. The only published clinical series states that the therapeutic approach depends on the existence or absence of a preoperative trigger. We hypothesized that the therapeutic attitude mainly depends on the percentage of the injured cross-section. Our retrospective series included 36 partial lesions of 31 fingers in 29 patients. The average age was 42 years, there were 19 men. We noted 8 lesions in zones I, 21 in zone II and 2 in zone III. The average percentage of the injured cross-section was 35% and ranged from 10% to 90%. If the lesion was less than 50% (29 tendons), a tangential resection was performed. If the lesion exceeded 50% (seven tendons), a direct suture was performed, supplemented by a running suture. At a follow-up of 34 months, the average pain on a visual analogue scale was 0.7. The average percentage of strength compared to the contralateral side was 93%. The Quick DASH score was 6.2. The range of motion averaged 214° with extremes ranging from 90° to 260°. We observed no cases of hypertrophic callus, neither through the MRI nor through the ultrasonography. Complications such as trigger finger, pseudoblocage or rupture were not observed. Based on our results, in case of partial injury of a flexor tendon, we propose to perform a tangential resection in cross-section lesions up to 50%, and a suture for those which exceeded 50%.

The gold standard treatment for enchondroma in the hand is curettage and filling of the defect. The goal of this study was to evaluate the results when injectable calcium phosphate cement is used to fill the bone defect. Eight patients having a mean age of 44 years were operated through a minimally invasive skin incision. After a small bone window was made, curettage of the lesion was performed and verified by intraosseous endoscopy. The defect was filled with injectable calcium phosphate cement (AREXyBONE, AREXy, Palaiseau, France). The mean pain score (out of 10) decreased from 4.1 preoperatively to 1.6 postoperatively. The mean QuickDASH (out of 100) improved from 37.66 to 24.14. At the last follow-up (mean of 16 months), the range of motion in the operated hand had reached 89.3% of the contralateral hand. Based on radiographs, a mean of 69.3% calcium phosphate cement remained in the bone. There were two cases of extraosseous cement leakage, one of which required revision and resulted in a poor outcome. Overall, these results show that curettage of a hand enchondroma followed by filling of the defect with injectable calcium phosphate cement is a simple, reliable technique with no donor site morbidity, as long as cement does not leak out.

Background The purpose of this study was to evaluate the technical feasibility of a minimally-invasive surgical technique (MIPO) to perform the removal of anterior osteosynthesis plates for fractures of the distal radius. Methods We reviewed retrospectively 388 cases of removal of plates on 387 patients, of which 357 were women, with an average age of 50 years old. The incision followed the previous surgical scar. After the removal of the plate, the incision was closed using a subcuticular suture without drains or immobilization. Results The scar was in average 22,2 mm long preoperatively, 19,8 mm long in average after the incision, and 21,4 mm in average at the end of the surgery, without significant statistical difference. The scar was enlarged 13 times by involuntary skin tear and 11 times voluntarily with a scalpel. We experienced 29 device-related complications, one osseous slot without consequence and one fractured plate. No postoperative complications were encountered. Conclusion Our results show that it is possible to perform the removal of an anterior osteosynthesis plate of the distal radius by a 20 mm long surgical approach. A subsequent study comparing the MIPO technique to conventional surgical approaches will be needed to validate it.

The fixation of distal radius fractures by pinning or locking plates remains controversial. The aim of this prospective continuous study was to compare the results of 28 anterior locking plates with 23 intrafocal cross-pinning HK2(®) systems. The mean age of group I (SVP(®), SBI™ plate) was 61 years. There were 15 extra-articular and 13 articular fractures. The mean age of group II (HK2(®), Arex™) was 63 years, with 13 extra-articular and 10 articular fractures. Twelve clinical variables were measured: pain, wrist strength, supination strength, pronation strength, quick DASH score, range of wrist motion in flexion, extension, pronation, and supination, ulnar variance, radial slope, and radial volar tilt. At 40 weeks follow-up, there was no difference between the two groups for 10 variables; two variables showed differences between the two groups: mean quick DASH score was 10.7 for group I, 19.7 for group II, and mean ulnar variance was -0.95 mm for group I, and 1.16 mm for group II. Six transient complications were noted for group I: five tenosynovitis, and one carpal tunnel syndrome. We noted 12 complications in group II: four superficial infections, two secondary displacements, one pin migration, two CRPS type II, two tendon ruptures and one nerve irritation. Generally, plates provided a more stable fixation associated with less complications while the HK2(®) system was quicker and less costly. The indications for its use need to be refined with a larger series and longer follow-up.