Effects of proximal row carpectomy on wrist biomechanics: a cadaveric study.

BACKGROUND: Many studies show good clinical results after proximal row carpectomy. Some biomechanical consequences are documented, but to our knowledge muscle moment arm variations have not previously been quantified. METHODS: In five fresh-frozen wrist, kinematics and tendon excursions were measured using a 3D electrogoniometer and Linear Variable Differential Transformers (SOLARTRON Inc., AMETEK Advanced Measurement Technology, Inc, 801 South Illinois Avenue, Oak Ridge, TN 37831-2011, USA), respectively, in three conditions: intact wrist, after posterior capsulotomy and after proximal row carpectomy. Mean pivot point, defined as the point whose sum of the squared distances to the helical axes is minimum, wrist range of motion and mean moment arms were measured during dorso-palmar flexion, radioulnar deviation and circumduction movements. FINDINGS: No alteration of the range of motion was observed. On the other hand, the mean pivot point shifted proximally (6.8-9.1mm) after proximal row carpectomy (p<0.05) for all motions tested and most muscle moment arms decreased significantly after proximal row carpectomy. INTERPRETATION: The results of this study allow a better understanding of the biomechanical effects of this procedure. The important moment arm reduction and pivot point displacement suggest modifications of joint biomechanical parameters which could influence the functional outcome of PRC.

[The Department of Orthopaedics and Traumatology of the University Clinics of Brussels, Erasme Hospital]. / Le Service d'Orthopédie-Traumatologie des Cliniques Universitaires de Bruxelles, hôpital Erasme.

On the occasion of the thirty years since its inauguration, the Department of Orthopaedics and Traumatology of the University Hospital Erasme reviews the milestones of its development. Various original new techniques have been implemented: monitoring of implants using strain gauges, external fixation of the limbs, external minifixation, miniinvasive anterior approach in hip arthroplasty, knee ligamentoplasties, orthopaedic microsurgery and composite tissue allotransplantation. The care of aged patients takes place in close collaboration with the Department of Geriatrics. Two new clinical units have been created, the Unit of Hand and Peripheral Nerve Surgery, and the Centre for Sports. The Department has organized an efficient Bone Bank. The new day care hospital improves the possibilities of ambulatory surgery. The article details as well the activities of teaching and research of the members of the Department.

[Management of the meniscal lesion]. / Prise en charge de la lésion méniscale.

About 1,5 million arthroscopies are each year performed in the world, 50 % for meniscal affections. The menisci participate in the femoro-tibial load transmission and in the joint shock absorption; they contribute to the knee stability and play a role in the joint lubrication. The menisci are therefore important structures, and, in the case of a lesion, surgical abstention or repair should be favoured. When a meniscectomy has to be performed, it should be economical, preserving the meniscal wall. Meniscectomy is contra-indicated in the child and in the case of knee osteoarthrosis. Meniscal healing is compromised if the knee is unstable. If after total meniscectomy a patient presents symptomatic early osteoarthrosis, without marked loss of alignment, meniscal allografting is a therapeutic option, especially at the lateral compartment.

[Reconstruction of the knee anterior cruciate ligament: single or double bundle?]. / Reconstruction du ligament croisé antérieur du genou: simple ou double faisceau?

Anatomical and biomechanical studies have shown that the anterior cruciate ligament (ACL) consists of two distinct bundles, the anteromedial (AM) and posterolateral. Each bundle has its specific role during the motion of the knee. ACL reconstruction techniques have focused on the restauration of the anteroposterior stability by substituting the more isometric AM bundle. Although these ligamentoplasties provide overall good results, in the last ten years double-bundle ACL reconstruction techniques have been developed, to better replicate the ligament anatomy. Despite the growing number of published studies, including randomized controlled trials comparing single bundle and double bundle reconstructions, there is still a lack of evidence of any superiority of the double-bundle technique. Furthermore, many series are criticized for their poor assessement of rotational stability, using most of the time subjective pivot shift clinical testing. Among the methods available to measure tibial rotation, 3-D optoelectronic evaluation is an attractive tool and has been used in some studies reporting rotational mesurements after ACL single-bundle reconstruction. Our Department of Orthopaedics and Traumatology has been using double-bundle techniques for a few years. We conducted a preliminary prospective randomized study, in order to compare single and double-bundle techniques by clinical and optoelectronic evaluations.

Case report: revision of failed Sauvé-Kapandji procedure with an ulnar head prosthesis.

The Sauvé-Kapandji procedure has been developed in order to solve distal radioulnar joint (DRUJ) disorders. Postoperative results are variable. Complications such as painful ulnar stump, ulnar instability and loss of grip strength have often been described. We report the case of a painful ulnar stump instability resulting from a Sauvé-Kapandji procedure. After several attempted salvage procedures, a custom-made Herbert distal ulnar head prosthesis was implanted. Long-term results showed complete pain relief, improvement of the range of motion and satisfactory grip strength recovery. Our findings confirm that the Herbert custom-made ulnar head prosthesis appear to be a reliable salvage solution for failed Sauvé-Kapandji procedures.

[Intracarpal ligament injuries associated with wrist fractures: a prospective radioclinical study of 40 patients]. / Les lésions ligamentaires intracarpiennes associées aux fractures du poignet: étude prospective radio-clinique sur 40 cas.

PURPOSE OF THE STUDY: We performed a prospective study to search for arthrographic signs in favor of intracarpal ligament lesions occurring concomitantly with wrist fractures. We looked for a relationship between type of fracture and displacement and examined their impact on early functional outcome. MATERIAL AND METHODS: The series included 40 patients treated over a 1-year period. All 40 patients had a displaced wrist fracture requiring surgical treatment. A three-phase arthrography was performed during the initial operation in order to search for injuries involving the scapho-lunate, luno-pyramidal or triangular complex ligaments. A second arthrography was performed at the time the osteosynthesis material was removed. All patients were followed one year postperatively. Functional outcome was recorded at one year. RESULTS: Abnormal images were found in 57% of the patients at the first arthrography. Injury to the triangular complex predominated, followed by combined injuries. There was no statistical correlation between type of fracture, degree of displacement, and presence of ligament lesions (p > 0.05). Lesions of the triangular fibrocartilaginous complex (TFCC) were significantly increased (p = 0.04) in the event of intra-articular fracture. Age and gender did not influence ligament injury. At one year, the functional outcome was statistically comparable between patients with and without ligament injury. At the second arthrography, we observed only five cases where cure of the luno-pyramidal ligament had been achieved. DISCUSSION: Intracarpal ligament injuries associated with wrist fractures are frequent. Age had no effect on occurrence of ligament injury in our series, similar to findings reported by others. Likewise, the type of fracture had no effect. Data in the literature show that intra-articular fractures and highly-displaced fractures aggravate ligament injury. Our functional results at one year did not demonstrate any significant difference in patients with and without ligament injury. A 3 or 5-year follow-up might provide further insight. Nevertheless, neglected scapho-lunate lesions still have a bad reputation in the literature, leading us to search for such lesions and to provide adapted treatment in all patients aged less than 50 years presenting a displaced fracture of the wrist.

[Volar distal radio ulnar joint dislocation, case report and literature review]. / Luxation radio-cubitale palmaire, cas clinique et revue de la littérature.

The authors report the case of a volar distal radio ulnar joint dislocation. The rarity of this lesion seems to be linked to the anatomical relationship of the distal portion of the ulna with the tendons of the extensor carpi ulnaris and the tendon of the extensor digiti minimi. Early diagnosis based on physical examination and radiology gives a better prognosis for closed treatment, reserving surgery for failure or irreducible luxations.

[Extraskeletal chondroma of the hand, a rare cause of carpal tunnel syndrome]. / Le chondrome extrasquelettique de la main, une cause rare de canal carpien.

The authors report the case of a 18 years old girl presenting with a carpal tunnel syndrome, with no history of trauma and a progression of the symptoms in 2 months. Surgery was performed and the diagnosis seems to be an extraskeletal chondroma of the hand.

One-stage elbow interposition arthroplasty with a fasciocutaneous distally planned lateral arm flap.

We report a case of severe posttraumatic ankylosis of the elbow with chronic osteomyelitis of the lateral condyle of the humerus. The triple problem of restoring elbow mobility, providing for coverage, and controlling infection was treated in a one-stage procedure. A distally planned fasciocutaneous lateral arm flap was used for elbow interposition arthroplasty. Clinical examination at 27 months showed restoration of a useful range of elbow motion and good pain relief.

[Compound fracture of the ankle treated by locked retrograde transplantar nailing: a case report]. / Fracture complexe de la cheville traitée par clou transplantaire rétrograde verrouillé: un cas clinique.

The authors describe the use of a locked retrograde plantar nailing as primary treatment for a severe trauma of the ankle (trimalleolar fracture associated with posterior dislocation and a compound talus fracture).

Anterior flap for coverage following hip disarticulation for osteomyelitis.

The use of a posterior myocutaneous flap is the most common method of coverage following hip disarticulation. Other options for coverage following hemipelvectomy have been described mainly when the conventional flap is unavailable owing to tumor involvement. We report a case of hip disarticulation for a decubitus ulcer with underlying osteomyelitis of the proximal femur; coverage was obtained using an anterior myocutaneous flap. In this case, two previous unsuccessful attempts at wound coverage prior to the hip disarticulation using a lateral and a posterior flap made the anterior flap the best available option for closure. Complete healing was achieved within two months.

Modifications of arterial blood flow to the hand after carpal tunnel release.

Any surgical procedure is followed by an inflammatory reaction, associated with arteriolar dilatation and increased capillary permeability. The normal evolution is in most cases a progressive decrease of the inflammatory signs. Some patients however, particularly after orthopedic trauma affecting the extremities, develop algodystrophy, initially characterized by arterial vasodilatation and low capillary flow. In an effort to better understand the normal phenomena seen after uncomplicated hand surgery, the authors have evaluated the postoperative arterial blood flow using the Duplex flowmetry ultrasound technique in 13 patients operated for carpal tunnel syndrome, who did not subsequently develop algodystrophy. After measurement of the transverse section of the ulnar and radial arteries, and longitudinal measurement of the mean velocimetry, the arterial blood flow was calculated. The measurements were done 1, 2 and 4 weeks after the operative procedure. The study demonstrated a moderate (15%-30%) but significant increase in the arterial blood flow to the hand, related to arterial dilatation of the vessels and to an increase in blood velocimetry.