[Arthroscopic treatment of lateral epicondylitis: a prospective study on 14 cases]. / Traitement arthroscopique de l'épicondylite latérale : étude prospective à propos de 14 cas.

Lateral epicondylitis of the elbow is a relatively common pathology and would involve 1-3% of the overall population. Lack of consensus on surgical techniques reflects the difficulty of understanding and treating this disease. Our prospective study reports the results of its arthroscopic treatment on 14 patients operated on between 2009 and 2012. The mean follow-up was 7.15 months. All patients underwent a well conducted medical treatment for an average of 32.5 months. The operation was carried out under regional anesthesia in an outpatient. The technique included a time of joint exploration, joint capsulotomy and a transverse division of the pathological tendon of extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC). The value on the visual analogic scale (VAS) at rest and during exercise increased from 2.85 to 0.43 and from 7.71 to 2.43, respectively, then remained stable over time. Professional activity was resumed on average at 9.1 weeks. Neither intraoperative nor postoperative complications were found. No laxity was observed. The Mayo Clinic and DASH scores were significantly improved from 52.14 to 92.5 and from 54.11 to 9.7, respectively. Overall, we observed 11 very good and three good results. Although our prospective series has a few patients and limited follow-up, our results are better or similar than those reported in the literature on pain relief and functional recovery. In contrast, the average recovery of professional activity was longer. Elbow arthroscopy, less invasive than open procedures, and allowing further joint exploration, seems an excellent alternative technique in this indication.

[Pathology of wrist ligaments. 32 lesions of the carpal triangular fibrocartilage complex (TFCC). Prognostic significance of associated luno-triquetral lesions]. / La pathologie ligamentaire du poignet. À propos de 32 lésions du complexe fibro-cartilagineux triangulaire du carpe (TFCC). Intérêt pronostique des lésions luno-triquetrales associées.

Trauma of the wrist is often responsible for multiple ligament injuries. We wanted to know if the association of a luno-triquetral ligament lesion and a triangular fibrocartilage disc lesion has a poor prognosis. We reviewed 32 patients with a traumatic injury of the triangular ligament, with a mean age of 35 years, and 32 months of follow up. The functional scores used were the Modified Mayo Wrist score, the Quick DASH score, and the Herzberg score. Patients were classified according to the severity of luno-triquetral lesions, in conformity with the Geissler's classification. Ten patients had a healthy ligament, 11 a stable lesion stage 1 and 11 an unstable lesion stage 2, 3 or 4. The joint mobility averages were 59.5° in flexion, 64.2° in extension, a pronation of 71.3°, a supination of 74.1°, an ulnar inclination of 33.8° and a radial inclination of 16.8°. The Modified Mayo Wrist score average was 75/100, the Herzberg score average was 81.5/100 and the average of the Quick DASH 8/100. The patients were all very satisfied or satisfied with their intervention. There was no statistically significant difference between the three groups studied regarding mobility and functional scores. In this study, an associated luno-triquetral ligament injury does not seem to worsen the functional outcome after surgery, provided appropriate treatment had been performed. However, a larger patient sample is needed to verify these findings.

[Central-medullary nailing of proximal humerus fractures using T2 nails. A retrospective study of 38 cases]. / Enclouage centromédullaire des fractures de l'extrémité proximale de l'humérus par clou T2. Etude rétrospective de 38 cas.

The intramedullary nailing of humerus has emerged as one of the treatments of reference for proximal fractures. We have reviewed 38 patients aged 64.2 on average with a mean follow of 18 months. The functional scores used were the Constant and Murley's score as well as the DASH self-administered quality of life questionnaire. Radiological criteria have been analyzed, namely the cephalic angle noted alphaF and the presence of any osteolysis of the major tuberosity. Patients were grouped by type of fracture, according to Neer's classification, with nine cases in Neer 2 group, 19 in Neer 3 group, and ten in Neer 4 group. The unrefined Constant score was 53.4 points on average, balanced to 71.6%. The joint mobilities were an average forward elevation of 108 degrees, an average abduction of 100 degrees and an external rotation of 27 degrees. These scores were even worse than the fracture was comminuted. It was not found a radioclinical correlation between value of the angle alphaF and clinical outcome, but the presence of osteolysis of the major tuberosity was significantly associated with poor late functional results. Five cases of osteonecrosis have been counted, divided with 10.5% in the Neer stage 3, and 30% in the Neer stage 4. The average unrefined Constant score from these patients was 38.5 points on average, balanced to 57.7%. Intramedullary nailing allows fixation of comminuted fractures with three or four fragments, but control of fixing and strength of assembly were not always practiced. In young patients, where tuberosities consolidation is essential, screwed plates seem to be a favorable alternative. Moreover, total reverse prosthesis seems to have more and more arguments to impose itself like the preferred treatment towards fractures in four fragments in people aged over 75 years.