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The aim of this study was to describe the nature and incidence of hand injuries caused by snowblowers, as well as the accident conditions and accident prevention. We conducted a retrospective evaluation over ten consecutive winters. Nine patients were included. All were men with an average age of 49.7 years (17–71). The accidents occurred at home in seven out of nine patients. The machine was running in 50% of the injury events. In most cases, the injuries occurred when the patient tried to unclog snow from the lateral discharge chute. Only four out of the nine patients had read the instructions or received instructions from the salesperson. The dominant hand was injured in 7 out of 9 patients. An average of 2.7 fingers were injured. The longest fingers were most commonly injured: 8 middle fingers, 7 ring fingers, 4 little fingers, 2 indexes and 1 thumb. All the fractures were open. Three patients were operated on several times. In 7 out of 9 cases, the patients had sequelae such as amputation. The mean time off work was 11.4 weeks (3–24). All the patients were experienced snowblower users (9 years and 57th use on average). Snowblower accidents are very mutilating. Prevention must include protected access to blades and better verbal and written safety warnings. [ABSTRACT FROM AUTHOR]

Abstract: Distal radius fractures remain the most frequent fractures in the adult. Associated osteoporosis increases morbidity risk (secondary displacement is the most frequent) and mortality risk (in women older than 60). Severity of the fracture and functional results are related to the bone mineral density. Anatomy has been recently revisited with better description of palmar and dorsal aspects in order to avoid material-related complications. Standard postero-anterior, lateral and oblique radiographs of the wrist show the fracture and the displacement. CT scan is warranted if conventional X-rays are insufficient to show the articular surface. The involvement of the metaphysis (comminution), the epiphysis (articular fracture) and the ulna is different in each case and each fracture is an association of these three components. The MEU classification describes the fracture with sufficient inter-observer reliability and intra-observer reproducibility to be a useful tool for treatment and prognosis. The PAF system is used to propose the most appropriate treatment for each patient. Anatomical reduction and stable fixation are associated with good functional results but in high demanding patients. [Copyright &y& Elsevier]

Summary: Purpose: Children increasingly participate in horseback riding, especially young girls, with more and more accidents during this activity. The severity of the injuries caused by horses seems to be higher than in other sports. Methods: In a retrospective study, we reviewed 303 accidents of children younger than 15 years of age during the past 13 years. Our study only investigated children who were hospitalized after their accident. Results: Eighty-two percent of the injured children were girls, but there was no difference between girls and boys in terms of severity. In most cases, children were hurt by falling from the horse (87 %). In the other cases, they were kicked or bitten by the animal. The most frequent trauma sustained was fracture (50 %). The upper extremity was injured in 40 % of the traumas followed by the head (32 %). The lower limbs, the abdomen, the spine, or the thorax were injured in less than 10 % of the incidents. The severity of the accidents was studied with the Injury Severity Score and we compared groups of children. Children younger than 11 years old were more severely injured than older children (P =0.0002). Conclusion: The youngest horseback riders should be supervised carefully to avoid severe injuries during this activity. [Copyright &y& Elsevier]

Résumé: Nous avons cherché l’existence d’un lien entre la force de pronation-supination de l’avant-bras dominant et celle du côté non dominant. Quatre-vingt-dix-sept volontaires ont été testés en pronation-supination avec un dynamomètre analogique. Sexe, âge, dominance, poids et taille étaient consignés. La mesure était prise coude à 90°, épaule à 0° d’abduction, poignet en légère extension, en pronation-supination neutre. Nous effectuions quatre mesures par patient : force en pronation et en supination, du côté dominant, puis du côté non dominant. Quinze sujets ont été évalués à deux reprises. Les gauchers (4) ont été retirés de l’analyse statistique. Il y avait 38 hommes (37 ans, 18–66) et 55 femmes (45 ans, 21–71). Les forces étaient plus élevées (p <0,05) chez l’homme que chez la femme, plus élevées en supination qu’en pronation, ainsi que du côté dominant par rapport au côté non dominant (ratio « non dominant/dominant » moyen : 0,85 ; σ =0,16). Il existait une forte corrélation entre la force du côté non dominant et la force du côté dominant (Pearson>0,6). Chez les 15 sujets évalués à deux reprises, la valeur des forces variait dans la journée, mais le ratio « non dominant/dominant » était constant. Les gauchers ont été exclus, leurs valeurs pouvant être différentes de celles des droitiers, comme cela a été montré pour la force de poigne. Il existait une variation des résultats dans la journée, mais le ratio « non dominant/dominant » était constant, rendant plus pertinent une comparaison intra-individuelle (côté non dominant versus côté dominant) plutôt qu’interindividuelle (abaques en fonction du sexe, âge, poids, taille). Chez le droitier, le ratio « non dominant/dominant » est constant, permettant de définir facilement en consultation la valeur attendue de la récupération d’un avant-bras lésé. [ABSTRACT FROM AUTHOR]

Introduction: Cemented stem remains the gold standard for prosthesis in trauma. The purpose of this study was to evaluate the functional and radiological outcomes of a cementless, trauma-specific locked stem (hemi and reverse) for 3- and 4-part proximal humeral fractures. Materials and methods: One hundred and thirty-four 3- and 4-part fractures have been treated by locked stem, 69 with hemiarthroplasty [mean age 68 years (50-90)] and 65 with reversed [mean age 78 years (66-91)]. The length of the stem was 15 cm with a proximal coating of HA automatic locking system (two screws) and four different diameters. Preliminary cadaver study allowed us to validate the system (22 shoulders, no injuries of nerves, locking system efficient). Results: In the group of hemi, Constant score with ponderation reached 72 (11-120) and QDash 31.2 (4.5-77.27) with a mean FU of 25 months (6-96). In the group of reversed, Constant score with ponderation reached 77.6 (28.8-119) and QDash 36.2 (2-84) with a mean FU of 15 months (6-41). Specific complications due to locking system reached 3% but without reoperation. Other complications were capsulitis and infection. Discussion: In this population of elderly patient, new fall with periprosthetic fracture or infection led the surgeon to remove the stem. At shoulder level, the removal of a cemented stem remains a highly demanding procedure with sometimes bad functional results and elevated level of complications. This series is the first one of locked stem without significant complications. Locked stem remains a new but logical tool in trauma. [ABSTRACT FROM AUTHOR]

Abstract: Defects of the median, ulnar or radial nerves in the forearm, can be treated by conventional nerve grafts, or by interposing a synthetic guide such as nerve conduits. Wounds without nerve loss treated with simple suture may be supplemented by sleeving to prevent the nerve irritation symptoms using a nerve conduit or a vein sleeve. We studied the results of nerve conduits in both cases in a single-center retrospective study. Patients and methods: Four patients underwent surgery with placement of a nerve conduit in the forearm, between May 2007 and January 2011. All patients were reviewed by the same examiner. Pain, tenderness, motor (Medical Research Council classification, MRC), time to return to work and self-evaluation by the patient were measured. The averages of these data were calculated and compared with results of other studies in the literature, the nerve grafts for defects and the Socket joints for venous ulcers. Results: The decrease is on average 30 months (2 years). The defect never exceeds 40mm and is 22mm on average. According to the classification MRC, sensitivity found after inserting nerve conduits in the forearm after a defect is excellent (S4) for two of three patients and good (S3) for the third. Motor results were very good (M4 and M3 for one patient) andM2 for the other. As for the insertion of a nerve conduit as a sleeve, the result is good in terms of sensitivity (S3) and excellent in terms of motor (M5) for our case in the study. For our small group of patients with neuroma we obtained, results similar to those published in the literature with conventional techniques. Conclusion: The nerve conduits seem to give results similar to conventional techniques, in situations of defects or neuromasin the forearm, with a diameter greater than 2mm, but defects of less than 30mm. [Copyright &y& Elsevier]