[Osteosynthesis by intramedullary headless screw in digital fractures: A retrospective scannographic and anatomical study]. / Ostéosynthèse par vis centromédullaire sans tête dans les fractures digitales : une étude rétrospective scanographique et anatomique.

INTRODUCTION: Long finger skeletal fractures are common injuries. In displaced forms, surgical treatment is required. With the advent of headless cannulated screws, the technique has been simplified and allows reduction in both planes. The objective of our study was to evaluate the functional recovery of patients operated on by this technique. MATERIAL AND METHOD: We conducted a retrospective single-center study between 2019 and 2022. Eleven patients were followed and 12 fractures analyzed. A radio-clinical follow-up was carried out at 1 month then at the last follow-up with an evaluation of the articular amplitudes and a quality of life score (QuickDash, QD). The time to return to professional and sporting activities, pain (EVA) was collected. An anatomical/scannographic evaluation was performed to assess tendon and cartilage damage. RESULTS: At the last follow-up, the average global flexion was 266° and the extension was total. An average QD score of 15.9 and a Jamar force of 106% compared to the healthy side were observed. The return to physical and professional activities was earlier and the pain quickly tolerable. No secondary displacement was objectified and all were consolidated at the last follow-up, without malunion. No patient had been operated on secondarily. CONCLUSION: This technique seems to be a safe and non-traumatic. It allows a faster return to sports and professional activities with fewer complications and no need to remove the material.

ISIS trapeziometacarpal arthroplasty: What are the outcomes in male patients?

Trapeziometacarpal arthroplasty is a well-known treatment of thumb basal joint arthritis. However, only a few studies have been done on its use specifically in men, with one of the most recent showing a high implant failure rate. Our study was a retrospective analysis of the ISIS prosthesis exclusively in men. Our hypothesis was that it is a viable therapeutic solution. Between 2010 and 2020, 23 ISIS prostheses were implanted in 19 patients. A radiological and functional analysis was done, combined with a self-evaluation by multiple validated outcome scores (visual analog scale for pain, QuickDASH, PRWE, SF36, and Kapandji scores). The median follow-up was 76 months (13-134) with a median age of 69 years. The mean pain level was 1/10, the QuickDASH was 22.7, the PRWE was 14.2, the SF-36 was 61.1 and the Kapandji score was 8.9. One dislocation occurred in one patient; two patients had to be reoperated for periprosthetic ossifications. Radiolucency was found around the cup in one patient and around the metacarpal shaft in one patient. There was no implant failure and only one case of asymptomatic loosening, with a survival rate of 94% at 111 months. In the medium-term, clinical, and functional outcomes were satisfactory with pain relief similar to that of published studies, with a low rate of complications. ISIS arthroplasty appears to be a suitable treatment for thumb basal joint arthritis in men, although a non-negligible rate of periprosthetic ossifications required revision surgery in half of the cases.

Influence of the level of arterial resection on the replanting and revascularization results in hand surgery: prospective study over 22 months.

The objective of this work was to assess whether the injury mechanisms are responsible for histological arterial lesions. This prospective single-center study included adults with wrist or hand arterial injury. Arterial resection of at least 2 mm from the proximal and distal stumps was performed before the arterial anastomosis. Histological analysis of the arterial stumps was performed. An ultrasound was performed 1 month postoperatively to check arterial patency. A clinical and functional evaluation was done at 1 month postoperative, then every 3 months. From 2018 to 2020, 46 patients were included with a maximum follow-up of 13 months. There were 35 cuts, 2 crush injuries, 8 amputation and 1 blast injury. Macroscopically, 37% of the margins were considered damaged. Histological analysis showed significant damage in 59% of the sections (27 out of 46 patients) with 50% for crush injury, 55% for cuts by mechanical tool, 62% for cuts by power tool, 62% for amputations and 100% for blasts. The failure rate was 9%: 2 replantations and 2 asymptomatic thromboses diagnosed by ultrasound. Postoperative pain on VAS was 1.75/10, range of motion was 87%, Quick DASH was 8%, SF36 PCS was 69% and SF36 MCS was 70%. Factors influencing the success or failure of anastomosis were the mechanism of injury (p = 0.02), associated nerve damage (p = 0.014) and length of proximal arterial cut (p = 0.046). Histological arterial lesions seem to correlate with the injury mechanism. Cuts caused by glass or crush injuries do not seem to require arterial resections of more than 2 mm. A continuation of the study with a larger number of subjects may generate statistically significant results.

Scaphotrapeziotrapezoid osteoarthritis: From the joint to the patient.

Scaphotrapeziotrapezoid osteoarthritis (STT OA) is common and often associated with thumb basal joint arthritis. Pain at the base of the thumb on the volar aspect and during resisted extension is characteristic of symptomatic STT OA. If conservative treatment fails, surgical treatment may be offered. In case of STT OA, treatment may range from arthrodesis to trapeziectomy (isolated or associated with ligament reconstruction and/or interposition). Any preoperative intracarpal instability (DISI) can be exacerbated by resecting more than 3 or 4 mm of the distal pole of scaphoid. For peritrapezial osteoarthritis, trapeziectomy is the logical solution, but it exposes the patient to known complications: loss of strength, long recovery, trapeziometacarpal impingement. Initial treatment of thumb basal joint arthritis by arthroplasty is also an option. Treatment of both sites is also possible by interposition of pyrocarbon implants. In all cases (isolated or associated STT OA) and no matter the technique chosen, maintaining the scaphoid height (arthrodesis, resection < 3 mm and/or associated interposition) and performing oblique trapezoidal osteotomy (to prevent scaphoid-metacarpal impingement) are the two crucial elements of surgical treatment.

Cartilage graft from rib to treat trapeziometacarpal arthritis.

Trapeziectomy has been considered as the gold standard for treating trapeziometacarpal arthritis. But trapezial space collapse is responsible for thumb strength decrease and intracarpal deformities (with or without tendon interposition). Partial trapeziectomy with interposition of a chondrocostal autograft combines the advantages of trapeziectomy and a biological spacer without the disadvantages of arthroplasty. Partial trapeziectomy is performed by a dorsal approach, under regional anaesthesia. The graft is harvested by a direct approach of the 9th rib during a short bout of general anaesthesia and inserted in the trapeziectomy space. A thumb spica cast is used for 3-6 weeks. In our experience, long-term outcomes and radiological evolution of the graft are good, similar to that of other procedures reported in the literature, except for strength, which is better in this scenario. With more than 5 years of follow-up, the graft is viable, the length of the thumb is maintained, and any areas of graft metaplasia are localized. The result is stable over time and any donor site morbidity is anecdotal. The interposition of a biological material is feasible and produces a stable and strong thumb.

Functionalized nerve conduits for peripheral nerve regeneration: A literature review.

Functionalized neurotube are a third-generation of conduits with chemical or architectural bioactivity developed for axonal proliferation. The goal of this review is to provide a synopsis of the functionalized nerve conduits described in the literature according to their chemical and architectural properties and answer two questions: what are their mechanisms of action? Has their efficacy been proven compared to the autologous nerve graft? Our literature review relates all kind of conduits corresponding to functionalized neurotubes in peripheral nerve regeneration found in Medline and PubMed Central. Studies developing nerve gaps, chemotactic or structural features promoting each conduit, results, efficiency were selected. Fifty-five studies were selected and classified in: (a) intraluminal neurotrophic factors; (b) cell-based therapy (combined-in-vein muscles, amniotic membrane, Schwann cells, stem cells); (c) extracellular matrix proteins; (d) tissue engineering; (e) bioimplants. Functionalized neurotubes showed significantly better functional results than after end-to-end nerve suture. No studies can be able to show that neurotube results were better than autologous nerve graft results. We included all studies regardless of effectives to evaluate quality of reinnervation with modern tubulization. Functionalized neurotubes promote basic conduits for peripheral nerve regeneration. Thanks to bioengineering and microsurgery improvement, further neurotubes could promote best level of regeneration and functional recovery to successfully bridge a critical nerve gap.

Long-term functional results of digital replantation: A survey of 28 patients.

We sought to evaluate the long-term quality of life and functional outcome of patients who underwent digital replantation after amputation. A retrospective single-center study was conducted of patients treated between January 2010 to May 2016. Twenty-eight patients who underwent successful replantation after single or multiple digital amputation were reviewed in person after at least 2years' follow-up (mean 4.6years). Total active range of motion, grip and pinch strength were assessed. Functional outcomes were evaluated using the SF-36 and DASH questionnaires. The patients' occupational status and daily activities were reported. Mean total active range of motion was 42% of the contralateral healthy side. Better active mobility and higher grip strength were found when the amputation was distal to the insertion of the common flexor tendon. Mean grip and pinch strength were 80% and 65%, respectively. Fusion did not significantly influence active mobility. The mean DASH score was 22.3. In our study, 77% of the patients returned to the same job and 75% experienced cold intolerance. The majority of patients who underwent digital replantation maintain a quality of life that allows them to return to work. Fusion, especially in the thumb, can be performed with few functional consequences. Even many years after the replantation procedure, sensory recovery remains poor.

Two-team management of vascular injuries concomitant with osteo-articular injuries in 36 patients over six years.

BACKGROUND: Patients with both vascular and osteoarticular injuries require multidisciplinary management. Vascular injuries may be function- and/or life-threatening. The lower limbs are predominantly affected. Traffic, domestic, and work-related accidents contribute most of the cases. The primary objective of this study was to describe the management of patients with concomitant vascular and osteo-articular injuries, with special attention to the rates of amputation and fasciotomy. The secondary objective was to suggest a management sequence to optimise our surgical practice. HYPOTHESIS: The management sequence is a crucial consideration in patients with both vascular and osteo-articular injuries. MATERIAL AND METHODS: A 6-year, retrospective, observational study was conducted in patients with concomitant vascular and osteo-articular injuries. RESULTS: The study included 36 patients with a mean age of 40.6±22.1 years. The main sources of injury were traffic accidents (n=19, 52.8%), crush injury (n=8, 22.2%), and falls (n=5, 13.9%). A compound fracture was present in 20 (55.6%) patients. Evidence of ischaemia in 25 (69.4%) patients, and bleeding in 11 (30.6%) patients. Pre-operative imaging, by ultrasonography or computed tomography, was performed in 27 (75.0%) patients. The lower limb was involved in 30 (83.3%) patients, who had osteoarticular injuries to the femur and leg combined with injury to the popliteal artery. Fasciotomy was performed in 11 (30.6%) patients and secondary amputation in 7 (19.4%) patients. The limb salvage rate was 80.6%. Median patient survival was 9.3 [0-74.8] months. DISCUSSION: Coordinated work by two surgical teams is crucial to manage concomitant vascular and osteo-articular injuries. The management sequence must be defined clearly. Computed tomography angiography is the investigation of choice and should be performed at the slightest suspicion of vascular injury. LEVEL OF EVIDENCE: IV, retrospective observational study.

Learning of supermicrosurgical vascular anastomosis: MicroChirSim® procedural simulator versus Anastomosis Training Kit® procedural simulator.

Many biological and non-biological simulators have been developed to reduce the length of the learning curve for supermicrosurgery. All of them have disadvantages. The goal of this study was to evaluate the feasibility of the new MicrochirSim® (0.5mm) non-biological procedural simulator by comparing it to the Anastomosis Training Kit® (2mm). After viewing a video of end-to-end anastomosis of a rat-tail artery, 10 residents in surgery reproduced the same technique on a procedural simulator: 5 on the MicroChirSim® (group 1) and 5 on the Anastomosis Training Kit® (group 2). The 10 residents then each performed five end-to-end anastomoses of the rat-tail artery on which they were evaluated. The average length of the procedure was 33minutes in group 1 and 45minutes in group 2. The average number of suture points was 3.7 in group 1 and 5.4 in group 2, which suggests training with a 0.5mm simulator improves suturing. The anastomosis was patent in 25 cases in group 1 and in 22 cases in group 2. The anastomosis was free of leaks in 25 cases in group 1 and in 19 cases in group 2. In conclusion, the MicroChirSim® procedural simulator accelerates the learning curve for vascular supermicrosurgery.

Posterior interosseous nerve to the superficial branch of the ulnar nerve transfer at the distal third of the forearm through a single anterior approach: Anatomical feasibility study.

The purpose of this study was to determine in a cadaver model, whether transfer of the posterior interosseous nerve (PIN) to the superficial branch of the ulnar nerve (SBUN) by a single approach was feasible. The experiment was carried out on five fresh cadavers. The ulnar nerve was split into its motor branches and the SBUN. The PIN was collected behind the interosseous membrane and sutured to the SBUN on its anterior surface. All sutures were tensionless and technically possible with the PIN's diameter being at least 50% of the SBUN's diameter in all cases. Our results demonstrate that PIN to SBUN transfer through a single anterior approach is feasible in a cadaver model.

Radiation exposure and the orthopedic surgeon's hand: Measurement of the equivalent dose over 13 months.

Exposure to ionizing radiation in the operating room is governed by practical prevention and protection measures on the international, national and local levels. We evaluated the equivalent dose to the hand of an orthopedic surgeon over 13 months. An orthopedic surgeon wore a ring dosimeter on the ring finger of his right hand for all surgical procedures requiring intraoperative fluoroscopy between March 2014 and April 2015. Monthly doses were evaluated by the IRSN over the study period. The number and type of procedures were compiled as well as the type of fluoroscopy unit used. Four hundred procedures were performed during this period, including 182 with fluoroscopy. The equivalent cumulative dose at the hand was 4,75 mSv. No correlation was found with the type of procedure or type of fluoroscopy unit (conventional or mini C-arm). Equivalent doses were below the annual regulatory limit in France of 500 mSv. These results are consistent with those reported in the literature. However, recent studies have noted that both younger surgeons in training and more experienced surgeons must remember to use radiation protection measures.

Cementless and locked prosthesis for the treatment of 3-part and 4-part proximal humerus fractures: prospective clinical evaluation of hemi- and reverse arthroplasty.

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.

[Nucleolar organizers: NOR. New prognostic factors in prostatic cancer. Preliminary results in 20 cases]. / Les organisateurs nucléolaires: NOR. Nouveaux facteurs pronostiques dans le cancer de la prostate. Résultats préliminaires á propos de vingt observations.

The authors present a preliminary series if two groups of ten patients with advanced prostatic cancer with sufficient follow-up in whom the study of nucleolar organizers (NOR) was performed according to a new light microscopy argentaffin technique. This original technique was developed by D. Ploton at the CHU de Reims. The principles of the technique are presented. The interpretation of the results, very dispersed at the present time, leads the authors two us two new clinical and histological indicators estimating the degree of severity of the prostatic cancer: the index of clinical severity based on the quality of survival and its duration from time T0 and the multifactorial index of histological severity based on the WHO classification, Gleason grade and NOR.