Purpose of the study: Infection is a leading cause of morbidity and mortality in sickle cell anemia children. It often triggers an acute episode of anemia with thrombosis. Bone and joint infections are particularly frequent. Diagnosis can be difficult and is sometimes established late.

Material and methods: We analyzed retrospectively the cases of 39 children with sickle cell anemia who presented one or more bone and joint infections during a six-year period (January 1998-December 2003).

Results: Bone and joint infection involved 14% of all sickle cell children hospitalized during the study period. Mean age was nine years, with no gender predominance. Homozygous subjects were more exposed to infection (73%). The infection revealed the disease in 13% of the children. The rate of bone and joint infection was 62% compared with 38% for osteomyelitis; salmonella were isolated in 38% of cases. Medical treatment with adapted antibiotics and plaster cast immobilization were instituted in all cases and associated with surgical treatment in 25% (arthrotomy for evacuation of purulent collections, cleaning, resection of infected tissue). Outcome was favorable in 77% of cases (cured infection, resumed school activities).

Discussion: The frequency of bone and joint infections in sickle cell anemia children in our series was similar to that reported in the literature (10–19%). Compared with children with normal hemoglobin, bone and joint infection in sickle cell anemia children present specific features in terms of localization, blood chemistry findings, causal bacteria, radiographic signs, and therapeutic modalities and sequelae.

Conclusion: Sickle cell anemia is a serious hereditary disease. The risk of complications should lead to the development of preventive measures (screening at risk couples, institution of a prenuptial certificate, allogenic bone marrow graft).

Purpose of the study: Distal amputation of the long fingers with loss of dorsal or volar tissue may leave bone exposed requiring fingertip reconstruction to restore sensorial and tactile function. Several methods have been proposed for fingertip reconstruction. Among the methods the most widely used, thenar flaps predominate because of they are reliable and easy to perform but especially because of the very high-quality tissue function achieved.

Material and methods: We report a series of 86 patients who presented an amputation of a long finger during a 4-year period (January 1998 to December 2002). A tenar flap was constructed within 24 of the operation. Mean patient age was 26 years; 80% of the accidents were occupational accidents; tissue loss was caused by sharp instruments in 72% of the cases; three-quarters of the cases involved the left non-dominant hand; the greatest damage was to the middle finger in 58% of cases. Loss of dorsal tissue was noted for 80% of the amputations. Trunk anesthesia was used for all patients to achieve cover with a thenar flap with a proximal pedicle in 80%. The flap was weaned from its blood supply at 18 days on average.

Results: Outcome was assessed with three criteria at mean follow-up of one year. Subjectively, 80% of patients were satisfied with the operation. Permanent flexion of the distal interphalangeal joint was totally absent in 70% of patients. Using the British Medical Research Council, sensibility was scored S3 in 60% and S2 in 40%.

Discussion: Described as early as 1926, the thenar flap is a novel method for achieving a cutaneous cover very close to the anatomic fingertip. Several drawbacks have nevertheless been formulated, namely permanent flexion of the distal interphalangeal joint, cutaneous sequelae at the donor site, and the «blind» nature of the flap which can be devoid of sensitivity. Analyzing the results obtained in our series showed that harvesting a flap in the middle of the thenar zone avoiding the medial region which raises the risk of a cheloid scar, the risk of distal interphalangeal flexion can be avoided by starting active-passive rehabilitation exercises as early as possible. At two months, the fingertip starts gaining sensitivity via the periphery.

Conclusion: Thenar flaps are reliable, easy to perform flaps which provide an attractive solution to the reconstruction of long fingers.