[Treatment of non-unions of the carpal scaphoid using a nonvascularised corticocancellous bone graft: a retrospective series of 47 cases]. / Traitement des pseudarthroses du scaphoïde carpien par greffe corticospongieuse non vascularisée: étude rétrospective de 47 cas.

OBJECTIVES: The authors report their results on the treatment of scaphoid non-unions without osteoarthritis or necrosis, by anterior nonvascularized bone graft. PATIENTS AND METHODS: Forty-seven patients treated between 1988 and 2003 were analysed with a mean follow-up of 74 months. There were 19 non-unions without carpal instability (IIA) and 28 with carpal instability (IIB). All patients were treated by an anterior approach with corticocancellous bone graft and osteosynthesis using two pins. Clinical results were analysed on pain, strength and mobility. Radiographic analysis was of union, correction of instability and occurrence of osteoarthritis. RESULTS: These were divided into stages IIA and IIB: 1) stage IIA: all cases proceeded to bony union; ten results were excellent and nine good and no instability; there was one case of osteoarthritis; 2) stage IIB: 78% of patients proceeded to bony union; one result was excellent, 17 good, four moderate and six cases remained un-united. There were 12 cases of osteoarthritis. Most of them occurred in patients with residual instability after the initial surgical procedure. CONCLUSION: Corticocancellous nonvascularized bone graft by a palmar approach is an excellent technique for treatment of scaphoid non-unions without osteoarthritis and necrosis. The presence of instability is a poor prognostic factor; its correction during the operation allows the surgeon to decrease the risk of osteoarthritis.

[Acromelic arthritis: a new entity]. / L'acropolyarthrite rhumatoïde.

PURPOSE OF THE STUDY: Few patients with rheumatoid arthritis present isolated acromelic bone and joint destructions. Concerned joints are wrist, MP, PIP, DIP and forefoot. The aim of the current study is to describe and evaluate the long-term results of wrist, hand and forefoot surgery in an acromelic arthritis group. MATERIAL AND METHODS: 93 patients with acromelic arthritis were included in the study. 202 surgical procedures were performed between 1981 and 2001 in addition to medical treatment. 93 procedures concerned dorsal wrist surgery. The mean follow-up of this group was 7 years (24 months-20 years). 78 synovectomies of radio-carpal and medio-carpal joints with a Sauvé-Kapandji procedure were performed and 10 with a radio-lunate arthrodesis and 5 with other surgeries. The main indication for surgery was severe pain. RESULTS: Functional results and radiographic evolution (Larsen X-ray classification) were studied. All patients were satisfied or very satisfied and pain was significantly reduced. Radiographic lesions progressed but Larsen's stage remained unchanged in 73% of patients. All patients with forefoot surgery recovered total walk autonomy. DISCUSSION: Acromelic arthritis is a particular form of rheumatoid arthritis that progresses very slowly. Surgery should be indicated earlier, for a better joint function stabilisation.

[Syringomyelia and associated bone and joint diseases]. / Syringomyélie et pathologies ostéo-articulaires associées.

Syringomyelia can occur in patients presenting bone and joint diseases of various origins. When joint destruction of the shoulder or elbow produces little pain, a neurological cause might be involved. In this case, the disease history can be of utmost importance because an initial diagnosis of rheumatoid polyarthritis, polyosteoarthritis, or destructive joint disease can be misleading before the syringomyelic origin of the bone and joint disease becomes patent. We report two cases illustrating this association and the diagnostic pitfalls which can delay recognition of the syringomyelia. Better awareness of the prevalence of this condition should be helpful in establishing the diagnosis and in selecting patients who can benefit from neurosurgical treatment. The two cases presented here suggest that syringomyelia could be underdiagnosed in certain patients with an initially atypical presentation. A review of the current knowledge of syringomyelia suggests that arthroplasty is generally not advisable for destroyed dislocated syringomyelic joints.

[Bipolar shoulder prosthesis for rheumatoid arthritis with irreparable rotator cuff tear: results after 5 years' follow-up]. / La prothèse humérale bipolaire dans l'épaule rhumatoïde avec rupture de coiffe irréparable. Résultats à plus 5 ans de recul.

PURPOSE OF THE STUDY: The goal of this study was to assess the clinical and radiological outcome of bipolar shoulder prosthesis in twelve shoulders with rheumatoid arthritis (RA) and irreparable rotator cuff tears. MATERIAL AND METHODS: The follow-up was more than five years (range 2-9 years). In addition, in order to investigate the effect of rheumatoid arthritis on outcome, results were compared with ten bipolar shoulder prostheses implanted for osteoarthritis with massive rotator cuff tears. RESULTS: The mean preoperative Constant score was 16.9 points with 2.6 points for pain, 4.2 points for activity, 9.5 points for motion and 0.6 points for force. The preoperative active motion was 63.8 degrees for forward flexion, 45 degrees for abduction and 12 degrees for active external rotation. At last follow-up, the average Constant score was 39.4 points with 10.7 points for pain, 10.8 points for activity, 13.8 points for motion and 4.1 points for force. Regarding the active motion, mean forward flexion was 83.7 degrees, 70.4 degrees for abduction and 29.1 degrees for external rotation. The complication rate was low, mainly superior migration due to infraspinatus tear and glenoid wear. Satisfactory deltoid arm level was achieved in all patients and no loosening was observed. Preoperative and postoperative scores of the rheumatoid group were not significantly different from the arthritis group (p<0.001). DISCUSSION: Our findings suggest that bipolar shoulder prosthesis provides a viable replacement alternative in RA combined with massive rotator cuff tear with a low rate of complication. Bipolar shoulder prosthesis demonstrates no clear superiority over conventional hemiarthroplasty regarding improved motion and glenoid wear. In addition, no significant difference with arthritis was observed (p<0.05), assuming that outcome depends principally on the preoperative condition of the rotator cuff. CONCLUSION: Some massive tears involving the subscapularis tendon can lead to anterior recurrence after bipolar shoulder prosthesis. They might be a limit to the procedure and require a reversed shoulder prosthesis or a glenohumeral arthrodesis.

[Scapho-trapezio-trapezoidal arthrodesis for scapho-trapezio-trapezoidal osteoarthritis]. / Traitement de l'arthrose scaphotrapézotrapézoidienne isolée par arthrodèse scaphotrapézotrapézoidienne: une série de 13 cas.

Scapho-trapezio-trapezoid arthrodesis was originally performed for the treatment of scapho-lunate instability. However, only a few publications have described this technique for treatment of osteoarthritis of the scapho-trapezio-trapezoid (STT) joint. The purpose of this paper is to analyze the results of triscaphoid arthrodesis for STT osteoarthritis with a long-term follow-up. Thirteen cases of osteoarthritis of the STT joint in twelve patients, all treated by STT arthrodesis, were reviewed with an average follow-up of 60 months. Pain was classified according to Alnot's classification: eight patients were classified as grade III, two as grade IV and two as grade II. The average preoperative range of motion of the wrist was 51 degrees for flexion, 39 degrees for extension, 9 degrees for radial deviation and 28 degrees for ulnar deviation. Grip strength was compared to the contralateral side. Radiographic changes were classified according to Crosby's classification, including sublevels for carpal instability. Four wrists were classified 2a and nine wrists were classified 2b. The average radio-lunate and scapho-lunate angles were 14 and 45 degrees respectively. Pain was improved in all patients (P = 0.05) all of whom were subjectively satisfied. Strength and range-of-motion did not statistically decrease after STT arthrodesis except for wrist extension (P = 0.03). Radio-lunate and scapho-lunate angles were unchanged in five patients and improved in five patients. There were four non-unions of whom two patients without pain were not re-operated. The other two were re-operated with the same technique leading to fusion. Scapho-trapezio-trapezoid arthrodesis is an efficient procedure for STT osteoarthritis with regard to pain reduction. Strength and global range-of-motion are not modified by this procedure. Moreover, as it limits carpal instability, this procedure is preferable in active patients.

[Merkel cell carcinoma of the skin: two case reports located at the hand, with a review of litterature]. / Le carcinome cutané de Merkel: revue de la littérature à propos de deux localisations à la main.

The Merkel cell carcinoma of the skin are rare neuroendocrine tumours, with a dermal location. Their severity and metastatic potential are higher than cutaneous melanomas'. Two cases are reported at the hand. A review of literature displays the pejorative prognosis of these tumours. Hand surgeons must be aware of them, in order to fasten the diagnosis and include the patient among a multidisciplinary medical team.

Intraneural mucoid pseudocysts. A report of ten cases.

A mucoid pseudocyst of a peripheral nerve is a rare and benign tumour of controversial origin. We have reviewed ten patients with a mean follow-up of 3.2 years. The tumour affected the common peroneal nerve in eight and the ulnar nerve in two. The mean time between the onset of symptoms and diagnosis was 7.4 months (1.2 months to 2 years). On examination, there was pain in eight patients and swelling in seven. Motor deficit in the corresponding nerve territory was found in all. The diagnosis was usually confirmed by MRI. Treatment was always surgical. All the patients recovered, with a mean time to neurological recovery of 10.75 months. Recurrence was seen in only one patient and was treated successfully by further surgery. Our results are similar to those reported by other authors. A successful surgical outcome depends on early diagnosis before neurological damage has occurred.

Partial replantation after traumatic proximal lower limb amputation: a one-stage reconstruction with free osteocutaneous transfer from the amputated limb.

A case of immediate stump reconstruction following proximal leg amputation below the knee is reported. Additional length and sensation are conferred to the stump by free autotransplantation of a composite flap taken from the unsalvageable amputated leg. This flap provided 13 cm of vascularized tibia invested in the skin of the foot. This operative procedure facilitated the fitting of a prosthesis and preserved knee function despite an initial very proximal amputation.

Brachial plexus injuries in scapulothoracic dissociation.

The rare condition of scapulothoracic dissociation (STD) is characterized by a lateral displacement of the scapula from the thoracic cage following severe trauma to the scapular girdle. This study presents an analysis of five STDs. There were three supraclavicular brachial plexus palsies and two retro- and infraclavicular palsies. Recovery of elbow flexion was obtained in only two cases. Nerve damage dominates the prognosis and nerve recovery only rarely occurs. Nerve surgery should attempt to reestablish elbow flexion.

Anatomical and biomechanical studies of the pathogenesis of trapeziometacarpal degenerative arthritis.

An anatomical and biomechanical study of the stabilizing ligaments of the thumb trapeziometacarpal joint was conducted on 32 hand specimens. Five main ligamentous structures could be identified. The mechanical properties (in particular, strength) of the five ligaments using a strain-rate failure test were determined and evaluated quantitatively. The maximum tensile strength of each ligament was correlated with the condition of the trapeziometacarpal articular cartilage. In studying the anterior oblique ligament, maximum strength decreased from Grade 0 to Grade 1 by 51%. With the first intermetacarpal ligament, the drop from Grade 1 to Grade 2 was 53%. With the posterior oblique ligament, the decrease was closely related to the grade of the deterioration of the trapeziometacarpal articular surface. These three ligaments also significantly decreased in strength with age. Our results may suggest that the anterior oblique ligament, intermetacarpal ligament and posterior oblique ligament play a large role in stabilizing the trapeziometacarpal joint and that the decrease in their strength is related to the pathogenesis of trapeziometacarpal osteoarthritis.

Traumatic brachial plexus lesions in the adult. Indications and results.

Several types of lesions in adults can be differentiated. The author discusses his experience with 810 operated cases from 1975 to 1994.

Elbow flexion palsy after traumatic lesions of the brachial plexus in adults.

The development of direct repair of traumatic injuries of the brachial plexus has completely transformed the treatment of these severe lesions. Treatment must be an integrated procedure combining direct nerve surgery and muscle transfers, if needed. This article presents the results of a study of 315 surgically treated supraclavicular lesions.

[Paralytic shoulder secondary to post-traumatic peripheral nerve lesions in the adult]. / L'épaule paralytique de l'adulte par lésions nerveuses périphériques post-traumatiques.

A critical review is presented of the indications for nerve repair or transfer and for palliative operations in the management of paralytic shoulder following traumatic neurological injuries in the adult. Different situations are considered: paralytic shoulder following supraclavicular lesions of the brachial plexus, following retro- and infraclavicular lesions and following lesions to the terminal branches of the plexus (axillary, suprascapular and musculocutaneous nerves) and finally problems related to lesions of the accessory nerve and the long thoracic nerve. I. Supraclavicular lesions of the brachial plexus. In complete (C5 to T1) lesions, the possibilities for nerve repair or transfer are at best limited, and the aim is to restore active flexion of the elbow. Palliative operations may be associated in order to stabilize the shoulder. In case of a complete C5 to T1 root avulsion, amputation at the distal humerus may be considered but is rarely performed combined with shoulder arthrodesis if the trapezius and serratus anterior muscles are functioning. The shoulder may also be stabilized by a ligament plasty using the coracoacromial ligament. In cases where the supraspinatus and long head of the biceps have recovered, but where active external rotation is absent, function may be improved by derotation osteotomy of the humerus. In partial C5,6 or C5,6,7 lesions, the indications for nerve repair and transfer are wider, as well as the indications for muscle transfers. In C5,6 lesions, a neurotization from the accessory nerve to the suprascapular nerve gives 60% satisfactory results; this is also true following treatment of C5,6,7 lesions, whereas restoration of active elbow flexion is obtained in 100% of cases in C5,6 lesions but only in 86% in C5,6,7 lesions. In cases where shoulder function has not been restored, palliative operations may be considered: arthrodesis or, more often, derotation osteotomy of the humerus which can be combined with transfer of the teres major and latissimus dorsi. II. Retro- and infraclavicular lesions of the brachial plexus. Twenty-five percent of the lesions of the brachial plexus occur in the retro- or infraclavicular region and involve the secondary trunks, most commonly the posterior trunk. Nerve repair should be performed early. The shoulder may be affected owing to involvement of the axillary nerve in cases of lesions of the posterior trunk, often associated with a lesion of the suprascapular nerve. Regarding the terminal branches (axillary, suprascapular and musculocutaneous nerves), spontaneous recovery may be expected in a significant proportion of cases but is often delayed (6-9 months), and the problem is to avoid unnecessary operations while not unduly delaying surgical repair in cases where it is indicated. MRI may be useful to delineate those cases where surgery is indicated: repair is usually performed around 6 months following trauma. Isolated lesions of the axillary nerve may be repaired with good results using a nerve graft. The lesion may occur in combination with a lesion of the suprascapular nerve; the latter may be interrupted at several levels. Proximal repair may be performed using a nerve graft; distal lesions are more difficult to repair and may require intramuscular neurotization. Lesions of the musculocutaneous nerve may be repaired with good results using a nerve graft. Lesions of the axillary nerve may be seen associated with lesions of the rotator cuff. The treatment varies according to the age and condition of the patient and according to the condition of the cuff muscles and tendons: in a young patient with avulsion of the tendons from bone, cuff reinsertion is indicated; in an older patient, the cuff must be evaluated by MRI or arthroscan, and repair is indicated unless the cuff tear is not amenable to surgery or there is fatty degeneration of the muscles. Palliative surgery may be indicated in cases seen late or after failed attempts at nerve repair. (ABSTRACT

[Rheumatoid arthritis of the wrist with adult onset]. / Le poignet rhumatoïde des polyarthrites débutant à l'âge adulte.

The author reviews the consequences of rheumatoid synovitis of tendons and joints at the wrist, consequences which are different on the volar and dorsal aspects of the wrist. He refers to a modified Larsen classification to describe the consequences of instability in the radiocarpal (RC), midcarpal (MC) and radioulnar (RU) joints, both in the coronal and sagittal planes. A. On the volar aspect, tenosynovitis of the flexor tendons is frequent but may be difficult to diagnose. Synovitis in the carpal tunnel, although frequent, rarely results in compression of the median nerve; persistence of synovitis despite medical treatment is an indication to synovectomy. The latter may have to be extended into the palm and over the proximal phalanges, using the appropriate approach in the individual cases. Flexor tendon ruptures may occur, mostly of the flexor pollicis longus (FPL) and the flexor tendons to the index finger. Rupture of the FPL may be treated by a tendon graft or by arthrodesis of the i.p. joint. Rupture of the deep flexor tendon to the index may be treated by anastomosis to that of the medius; rupture of the superficial flexor tendon to the index may be treated similarly; rupture of both flexor tendons requires a tendon graft. B. On the dorsal aspect, the indications vary according to the stage of the disease. In Larsen's stage IV or V (destruction of one or more of the radiocarpal and intracarpal joints with navicular dislocation), arthrodesis or arthroplasty is indicated; the latter is ruled out however if extensor tendons are ruptured or the bone stock is insufficient. An original or modified Mannerfelt technique is used for arthrodesis, with the wrist in neutral or slightly extended position. Several wrist prostheses are available. Swanson's silastic implant has been discontinued; the Meuli, CFV, Biax, Trispherical, ATW, and GUEPAR prostheses have all been used with varying degrees of success. The choice between arthrodesis and arthroplasty is based on the severity of articular and tendon pathology, on uni- or bilateral involvement and on the condition of other joints, particularly in the upper limb. In less advanced stages, the author advocates using a combined operation with synovectomy of the extensor tendons and of the RC, MC and RU joints, relaxation by tendon transfers and Sauvé-Kapandji's technique; he stresses important technical points. The specific indications for radiolunate arthrodesis are discussed.

[Proximal median and ulnar resections. Results of primary and secondary repairs]. / Les sections proximales des nerfs médian et ulnaire. Résultats des réparations primitives et secondaires.

PURPOSE OF THE STUDY: Recovery after median and ulnar nerve proximal repair is widely appreciated. The place and time for secondary functional reconstruction remains controversial. MATERIAL AND METHOD: From January 1983 to January 1990, 66 patients suffering from proximal injury of the median or ulnar nerves underwent nerve repair. Forty-five patients had a postoperative follow-up of more than 24 months: 24 isolated ulnar nerve lesions, 12 isolated median nerve lesions, and 9 combined median and ulnar nerve lesions. Ten patients were given a primary microsurgical nerve suture in our department. Thirty-eight patients underwent a delayed or secondary nerve repair of one or both nerves: 8 secondary nerve sutures, and 35 nerve grafts in 31 patients. RESULTS: Muscular strength, sensitivity, motion, and pain were better after primary nerve sutures (when technically possible) or after shortly delayed secondary sutures, although 40 per cent of patients treated with nerve grafts get final "good" or "very good" results. The time between the injury and nerve repair was the most significant prognosis factor. Results of ulnar nerve repairs at the elbow were statistically better with anterior transposition as compared to in situ repairs (p < 0.005). Fourteen patients required secondary functional reconstruction. Tendon transfers were performed at least 24 months after nerve repair. DISCUSSION: Nerve repair of proximal lesion to the median or ulnar nerves depends on the type of injury, but is advised even when delayed. Residual deficit following nerve repair should require functional transfers depending on hand sensitivity and extrinsic function.

[Non-traumatic osteoarthritis of the distal radio-ulnar joint: a consecutive series of 11 wrists with 42 months follow-up]. / Arthrose non traumatique radio-ulnaire distale: à propos d'une série continue de 11 poignets revus avec un recul moyen de 42 mois.

PURPOSE OF THE STUDY: Non-traumatic osteoarthritis of the distal radio-ulnar joint is generally observed in a context of chondrocalcinosis and can lead to rupture of the extensor tendons. We reviewed patients operated on in our unit between 1986 and 1988 for this condition in order to examine modalities of surgical care. MATERIAL AND METHODS: Eleven patients who underwent surgery for non-traumatic osteoarthritis of the distal radio-ulnar joint were included in the study. Demographic data, clinical signs, joint amplitudes, radiologically identified lesions, peroperative macroscopic features, and results of the microscopic examinations of the synovectomy specimen were recorded. Injury to the extensor tendons and surgical procedures used for repair were noted. Outcome was assessed clinically (pain, stability of the ulnar stump, active extension of the fingers, pronation-supination, flexion-extension) and radiologically. RESULTS: The series included 11 wrists in 8 women, mean age 73.2 years. The underlying cause was chondrocalcinosis in 9 cases and primary osteoarthritis in 2. All patients had painful pronation-supination and 9 of them had ruptured extensor tendons. There was a dorsal displacement of the ulnar head in all cases. Synovectomy-realignment-stabilization was performed using the Sauvé-Kapandji procedure in 10 wrists and resection of the ulnar head using the Darrach procedure in one. Extensor tendons were repaired by side-to-side anastomosis with neighboring tendons in 6 wrists and with grafts in 3. At a mean 42 months follow-up, 7 wrists were pain free and 4 continued to have climatic pain. The ulnar stump was stable in all cases. All the patients achieved active extension of the fingers and preserved wrist mobility. DISCUSSION: According to the literature, non-traumatic osteoarthritis of the distal radio-ulnar joint is uncommon and occurs principally in the elderly patient. The most common complication being rupture of the extensor tendons. Different treatments can be discussed, but we prefer synovectomy-realignment-stabilization using the Sauvé-Kapandji method which, in light of the results obtained in this series, can regularly provide good pain relief and good functional results when associated with tendon repair as needed and as early as possible.

[Lesions of the circumflex nerve. Apropos of 19 cases]. / Les lésions du nerf circonflexe. A propos de 19 cas.

The authors studied a series of 19 lesions of the circumflex nerve either isolated (14 cases) or in association with a lesion of the suprascapular or musculocutaneous nerves. All were treated surgically. One was caused by a gunshot wound, the others were due to traction on the axillary region, and associated with anterior dislocation of the shoulder in five cases, a fracture of the humerus in two cases and a fracture of the clavicle in one case. Despite complete paralysis of the deltoid, active abduction was often possible. The operation took place 4 to 6 months after injury. In the 14 cases of isolated lesions of the circumflex nerve, the nerve was approached both anteriorly and posteriorly. It was always found to be divided and could be repaired by grafting in 10 cases, and secondary suture in one case. On three occasions the lesion was too distal and could not be repaired. When repair was possible, two excellent and eight good results were obtained, one case being too recent for follow up. In cases of associated lesions of the circumflex and suprascapular nerves, the repair of the latter was not possible and results were poor. In contrast, in cases of associated lesions of the circumflex and musculocutaneous nerves, repair was possible with satisfactory results at the level of the deltoid and biceps. These results indicate that an earlier diagnosis would allow a repair and a more satisfactory condition of lesions which are close to the motor end plates and of relatively good prognosis.

[Traumatic lesions of the radial nerve of the arm]. / Les lésions traumatiques du tronc du nerf radial au bras.

The authors analyse their experience with 63 lesions of the radial nerve in the upper arm. 39 cases were associated with fractures of the humeral shaft, 20 cases with open wounds or nerve contusions, and 4 cases with grade 3 complicated humeral fractures with neurovascular lesions. In contusions and open wounds the indication for nerve reconstruction is obvious and results are good or very good after graft-reconstruction or suture. In closed humeral fractures, the results of nerve reconstructions and the improvement of microsurgical techniques, together with precise indications are in favor of treatment of radial nerve lesions by suture or graft-reconstruction. Muscular transfers are only secondary procedures to the nerve reconstruction itself. The indications for treatment in emergency of fractures of the humeral shaft associated with radial nerve palsy, depend on the type of fracture, the associated lesions and the cutaneous status. An osteosynthesis is desirable in specific situations, like in poly-traumatised patients or multiple-level fractures of the upper limb, and an exploration of the radial nerve will be done during exposure. We believe also that an osteosynthesis with exploration of the radial nerve is indicated in severely displaced fractures, in particular in oblique or spiral midshaft fractures, and in fractures of the distal third of the humerus, because in this type of fracture a majority of radial nerve lesions, accessible to direct suture are found. In all the other cases, conservative treatment remains indicated with clinical and electromyographical follow-up and exploration two months after fracture union, in the rare cases of absence of recovery.

[Restoration of elbow flexion by tendon transfer in traumatic paralysis of the brachial plexus in adults. Apropos of 44 injured patients]. / Réanimation de la flexion du coude par transferts tendineux dans les paralysies traumatiques du plexus brachial de l'adulte. A propos de 44 blessés.

Forty-four post traumatic paralyses of the brachial plexus were operated on to restore elbow flexion using tendon transfers. On 19 occasions, the plexus had been explored surgically with 10 neurolyses and 9 nerve repairs. Eight patients had a second tendon transfer, the first one having failed. Twenty-two Steindler flexor plasties were performed, the medial epicondyle being transferred upwards by an average of 4.5 cms. Details of treatment are described by which secondary displacement of the transplanted medial epicondyle can be avoided. On 5 occasions the results were poor. Pectoralis minor was transferred 8 times with 5 failures due to the difficulty of appreciating the preoperative strength of the muscle and because of technical problems. The technique should only be used in C5-C6 lesions. On 14 occasions the triceps was transferred with 14 successes. The simultaneous contraction of biceps and triceps was advantageous. The results of all kinds of transfers were much better after C5-C6 paralysis than after C5-C6-C7 lesions. For correction of medial rotation deformity, osteotomy appeared to be safer than tendon transfer.

[Traumatic lesions of the trunk of the femoral nerve and its terminal branches. Apropos of 52 cases]. / Les lésions traumatiques du tronc du nerf sciatique et de ses branches terminales. A propos de 52 cas.

Fifty-two cases of nerves injuries involving the sciatic nerve or one of its two main branches (tibialis or peroneal nerve), between the sciatic notch and the knee, were treated by nerve grafts or nerve sutures. 26 cases were injured in the thigh. They were treated by 11 nerve sutures followed by good results in isolated lesions, and 15 nerve grafts. In 9 cases nerve loss was short and fascicular graft was possible. Clear cut injuries had satisfactory results. In 6 cases, nerve loss was extensive (> 10 cm), especially after sciatic nerve disruption following femoral bone fracture. There was not enough nerve graft available to repair the entire sciatic nerve. Tibialis nerve repair was chosen to restore plantar sensitivity. A vascular nerve graft of peroneal nerve could restore plantar sensitivity in all cases. 26 cases were injured around the knee and involved the peroneal nerve. In 12 cases the lesion was clear cut, treated in 10 cases with a short fascicular nerve graft, and in 2 cases by a suture. In most of the cases, results were good, better than that those obtained after tibialis posterior transfer. 14 cases had peroneal nerve disruption after a severe lateral sprain of the knee. Nerve damages were extensive and results were poor. Tendon transfer had to be done quite often.