Purpose of the study: Osteosynthesis material adapted to a mini-invasive approach certainly reduces surgical trauma. The purpose of this work was to establish the osteosynthesis equivalence for pertrochanteric fractures using a dynamic hip screw, inserted according to the conventional technique versus a mini-invasive screw system (MISS), in terms of healing without loss of reduction.

Material and methods: This was a prospective pilot study in a single centre. From May 2006 to April 2007, 78 patients (mean age 83 years, 70% women) were included (38 MISS, 40 DHS). There was one exclusion criteria: poor reduction on the orthopaedic table before incision. Radiographic and clinical follow-up for six months. The main outcome was the quality of the reduction and healing at three months.

Results: Eight patients were lost to follow-up and two had died at three months. The two groups were comparable regarding mean age, ASA, fracture type, operator experience, and centring of the head screw. In the MISS group, there was a 20% reduction in blood loss, a shorter incision (9 cm) and shorter operative time (16 min). The differences were not significant. The healing rate without loss of reduction at three months was the same in both groups: 82%. There were three revisions in the MISS group: one infection and two material disassemblies. This problem disappeared with the addition of a locking screw on the nail. There were no revisions for haematoma.

Discussion: There were several biases. The series was not really randomised because the type of material used depended on the availability of the instrument sets. The MISS implant evolved during the course of the study. The operators were more familiar with the DHS. Inclusion criteria were too restrictive. Multiple-injury patients with bleeding had a false impact on blood loss data. None of the differences were statistically significant. Revision for infection was not directly attributable to the material. Nail locking never failed after use of the locking screw.

Conclusion: The main outcome was validated: the healing rate without reduction at three months is equivalent with the two methods (82%). A multicentric study should be conducted to confirm that the mini-incision and the MISS reduces blood loss. It could be expected that this mini-invasive approach will become the rule for osteosynthesis of these fractures with a dynamic hip screw.

Purpose of the study: Available epidemiological data on hand and wrist tumours are scarce and sometimes discordant. In our unit, these tumours are managed conjointly by hand surgeons and tumour specialists. We conducted an epidemiological study of 624 tumours treated from 1980 to 2008.

Material and methods: The recruitment used three methods: diagnostic coding in the database, analysis of discharge letters, study of tumour registries. All hand and wrist tumours treated surgically in our unit were included retrospectively. Exclusion criteria were: patients aged less than 15 years and/or managed in the paediatric surgery unit; poorly identified cases; recurrences.

Results: The study population included 624 tumours (375 female and 249 male). Mean age was 48 years (range 16–94). Eight tumours were malignant: 4 skin, 3 soft tissue, 1 bone metastasis of a primary renal tumour. Soft tissue tumour concerned 525 patients (84.1% of the study population). Respectively, 71 tumours concerned bone and 28 skin. There were 221 synovial cysts. The bone tumours exhibited a harmonious distribution for age and gender with a peak from 35 to 50 years and a sex ratio of 1/1. There were 43 chondromas found at all ages, mainly in long bones.

Discussion: Our series is the third largest reported. A review of the literature identified the eight largest studies available. For 6452 tumours, 81.7% concerned soft tissues, 13% skin, 4.7% bone tissue. These lesions occurred at all ages with female predominance (60%). Malignant tumours were found in 4.4% of the cases. Exclusion of the paediatric cases and the retrospective nature of the data collection were the main biases of this work.

Conclusion: Data on 624 hand and wrist tumours were in agreement with published work. Tumours involved mainly soft tissues. Synovial cysts predominated. Chondromas accounted for 70% of the bone tumours. Malignant tumours were rare (2.9%). For suspect cases, we recommend referral to a specialised centre for the management of malignant tumours of the hand. A pluridisciplinary analysis is indicated to adapt the diagnostic and therapeutic strategy.