Benefits of a collagen membrane for recurrent ulnar nerve entrapment at the elbow: A series of 40 cases.

The rate of failure or recurrence after ulnar nerve release at the elbow is up to 25%. Various biomaterials have been developed to protect nerves from postoperative adhesions. The aim of this study was to review a case series of 40 surgical revision procedures of the ulnar nerve at the elbow, protected by a collagen membrane (Cova™ ORTHO). Forty patients who had this revision surgery between January 2013 and December 2017 were reviewed: 34 were evaluated in person, 6 were evaluated over the phone. The operation consisted in release of the ulnar nerve, anterior subcutaneous transposition and nerve protection using a collagen membrane. We assessed the following parameters with an average follow-up of 4 years and 3 months: paresthesia, night awakening, quality of life (QuickDASH score) and neuropathic pain (DN4 questionnaire). The outcome was determined with the Gabel & Amadio score. The patients' satisfaction was evaluated. A significant decrease in paresthesia and night awakening was found (p < 0.05). The average Gabel & Amadio score improved from 4.4 to 6.7 with 5 excellent, 19 good, 9 fair, and 1 poor result. The average DN4 was 5/10 and the QuickDASH score was 40.1. Eighty percent of patients were satisfied or very satisfied with the outcome. Surgical revision of the ulnar nerve at the elbow remains a delicate operation without a gold standard. This case series found good or excellent results in 70% of patients. Surgical revision of the ulnar nerve with a collagen membrane is a reliable alternative among other possibilities for ulnar nerve release at the elbow.

Middle phalangectomy with shortening fusion of the fifth finger in Dupuytren's digital hooks.

Severe contracture of the little finger due to Dupuytren's disease continues to be a therapeutic problem. Fifth finger amputation, which is sometimes the only solution, has a major negative impact on function and appearance, and exposes the patient to adjacent digital hook aggravation. Middle phalangectomy with finger shortening fusion is an alternative surgical solution. The aim of this study was to report on a continuous series of 36 cases treated with this approach. This was a retrospective series of 33 patients (26 males and 7 females) operated from 1994 to 2015. All patients had severe contracture of their little finger and 30 had prior surgery. The combined extension lag was 143° (75-270), with considerable functional deficit and poor appearance. The surgical technique consisted of a dorsal approach, a more or less extensive excision of the middle phalanx, and arthrodesis with alignment of the remaining bone segments, while preserving the fingertip/nail complex. The following outcomes were determined when the patients were reviewed: functional discomfort and use, appearance, residual pain, pulp sensitivity, recurrence of contracture and overall satisfaction. Six patients were dead and two were lost to follow-up. Twenty-five patients (27 cases) were reviewed at a mean follow-up of 64 months (12-280). There were no post-operative complications. Twenty-two patients (24 cases) were satisfied or very satisfied. The resulting appearance was graded at 7.13/10 (1-10). Pain on a 10-point Visual Analog Scale was 0.46 (0-5). Cold intolerance was found in 9 cases (33.3%) and decreased fingertip sensitivity in 3 cases (11.1%). The hand could be flattened in 21 cases; in the other cases, it could not be flattened due to contracture in another finger. Wearing gloves was again possible in 26 cases. Fusion was achieved in 18 of the 21 cases evaluated with X-rays at the last follow-up (85.7%). All the other cases had a non-union with no clinical repercussions. There were 5 local recurrences at the level of the little finger. Finger shortening through a dorsal approach seems to provide satisfactory outcomes in patients with Dupuytren's disease who have severe contracture of the little finger. This technique results in an acceptable looking functional finger, which has sensation and no significant morbidity.

Interest of the "compress test" in diagnosis of nerve injury in hand wounds.

INTRODUCTION: Hand wounds are a common cause of emergency department admission. Digital nerve lesions are found in 5% of palm wounds. Early diagnosis reduces the risk of morbidity, sequelae and litigation. Screening for digital nerve injury by the usual tests is difficult in an emergency context. We assessed the diagnostic value of the simple "compress test" to screen for pulp sensibility disorder and the factors that may influence the value of this examination, with a view to validating routine use. MATERIAL AND METHOD: A retrospective study included 821 palm wounds treated between January 2014 and May 2016. There were 605 male and 216 patients; mean age, 42.8 years (range: 18-90 years). The dominant hand was involved in 307 cases (37.4%). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of the compress test were calculated. Diagnostic value was also calculated according to age, gender, affected digit, dominant side and examiner's experience. RESULTS: Clinical deficit was found in 412 cases (50.2%). A digital nerve lesion was found intraoperatively in 277 cases (33.6%). Test sensitivity was 87.3%, specificity 68.6%, positive predictive value 58.5%, negative predictive value 91.4%, positive likelihood ratio 2.78 and negative likelihood ratio 0.18. The test was more effective for thumb wounds and for examination by a junior surgeon. There were no differences according to injured side, innervation territory or gender. CONCLUSION: This clinical test is reliable, with very good negative predictive value and good sensitivity, allowing its use in routine clinical practice. Nevertheless, surgical exploration of deep palm injuries should remain the rule.

Acute finger-tip infection: Management and treatment. A 103-case series.

INTRODUCTION: Acute fingertip infections (AFTI) are common. Surgical treatment is the norm in case of effusion. There is, however, no consensus on treatment modalities, or on adjuvant antibiotic therapy (AT). We present the results of a consecutive cohort of 103 AFTIs treated in emergency consultation. MATERIALS AND METHOD: One hundred and one patients were treated by excision and extensive lavage under digital anesthesia, with systematic bacteriological sampling. Patient history, treatment history, location, type of bacteria, complications or recurrences and AT prescription were recorded and analyzed. All patients were reviewed at first dressing (5-7 days) and recontacted at 1 month, to record any pain, stiffness or recurrence. Three groups were distinguished: A: without preoperative AT (n=71); B: under AT before surgery (n=14); C: with postoperative AT (for severe comorbidity) (n=16). RESULTS: Mean age was 39.7 years (range: 14-84 years). The three main types of bacteria were: Staphylococcus aureus (58.3%), polymicrobial flora (16.5%), and Streptococcus (12.6%). Mean time to first dressing was 5.7 days. There were no recurrences, whatever the bacterial type or patient group. In 5 patients in group A (8.2%), AT was later prescribed at day 5 (3 for hypercicatrization and 2 for maceration). In groups B and C, progression was unproblematic. At 1 month, all patients considered themselves cured; finger-tip sensitivity was conserved in 10, and 16 were awaiting complete nail regrowth. DISCUSSION: Hospital admission, operative treatment under general anesthesia, and AT are factors exacerbating cost and increase the management burden of AFTI. Treatment in emergency consultation seems perfectly feasible. AT does not seem useful in the absence of severe comorbidities if resection is complete. Analysis of bacterial susceptibility and renewal of the initial dressing at 1 week enable progression to be monitored and treatment changed as necessary.

Intermediate term evaluation of the Eclypse distal radio-ulnar prosthesis for rheumatoid arthritis. A report of five cases.

HYPOTHESIS: Early medical management of rheumatoid arthritis with biotherapy has changed the traditional musculoskeletal damage from this disease. When the distal radio-ulnar joint (DRUJ) is involved, classic procedures may be inappropriate. We chose a hemi-arthroplasty of the DRUJ joint (Eclypse™) in patients with persistent synovitis and chondrolysis with a stable joint. The aim of this study was to assess the intermediate term results of this approach in these specific cases. MATERIALS AND METHODS: We report a retrospective study of 5 Eclypse arthropasties implanted between March 2005 and March 2011. There were 4 women and 1 man, mean age: 58.4years old (54-62) with RA that had been present for 21.6years (15-33). This hemi-arthroplasty replaced the ulnar head with a pyrocarbon component. Patients were evaluated by an independent observer for pain by VAS, range of motion, grip strength in the neutral position by Jamar dynamometer, pronation and supination strengths with a pronosupinator, DASH score and wrist X-rays. RESULTS: One patient was lost to follow-up and the 4 others underwent a follow-up evaluation at 64 months (43-90). There were no intra-operative or postoperative complications. The pain score at the final follow-up was 1.5/10 (0-4), pronation was 70° (60-80) and supination was 80° (80-80). Grip strength was 148% compared to the contralateral side (73-200%). Pronation and supination strengths were 1.7kg (1.5-2) and 2.1kg (2-2.5) respectively. The DASH score was 55.9 points (42.6 to 79.3). X-rays did not show any changes in the ulnar notch. CONCLUSION: This distal radio-ulnar arthroplasty is less invasive and preserves the bone and ligaments. Clinical results are rapid, remain stable over time and are well tolerated. This arthroplasty, which was initially developed for osteoarthritis and traumatic lesions of the DRUJ, is promising for specific cases of rheumatoid arthritis.

Cross-finger flap for reconstruction of fingertip amputations: Long-term results.

UNLABELLED: Fingertip amputations are severe hand injuries. Their treatment must restore the sensation and metabolic activity needed for pain-free finger function. The cross-finger flap (CFF) can be used for this purpose. The goal of this study was to assess the long-term clinical outcome following use of this flap. METHODS: This was a retrospective analysis of 28 patients operated because of fingertip amputation: 16 type 3, 8 type 2 and 4 type 4. The CFF was harvested from an adjacent finger on the dorsal side of the middle phalanx down to the epitenon. A dorsopalmar hinge was preserved to ensure vascularisation. The CFF was divided an average of 18.7 days later. The following parameters were evaluated: pulp volume (injured compared to contralateral finger), presence of neuroma, occurrence of complications (necrosis, infection, and donor site morbidity), cold discomfort, static and tactile discrimination, and patient satisfaction (0 to 10 on VAS). RESULTS: The average follow-up was 19.7 years; 22 patients (78.6%) were re-examined in person or contacted by telephone. The average healthy pulp to reconstructed pulp ratio was 1.03. No postoperative complications such as neuroma were found. Cold sensitivity was present in 7 patients. The flap was re-sensitised in all the patients. There was no donor site morbidity. The average patient satisfaction score was 9 (range 8-10). CONCLUSIONS: Over the long-term, use of the CFF results in nearly normal fingertip metabolism, no complications and good distal sensitivity without pain or neuromas. This is a simple, reliable, long-lasting reconstruction technique. LEVEL OF EVIDENCE: IV.

"Butterfly flap": The retinaculum to the rescue of the extensors.

Extensor digitorum tendon (EDT) tear in the wrist is frequently associated with inflammation (rheumatoid arthritis, chondrocalcinosis) or distal radio-ulnar osteoarthritis. EDT protection and repair is often hampered by poor tissue trophicity and associated procedures. We describe an extensor retinaculum (ER) plasty, protecting and recentering the EDTs. The procedure consists in raising the ER on either side of Lister's tubercle so as to create a strap protecting and recentering the 4th, 5th and 6th compartment EDTs; the 2nd and 3rd compartment EDTs are left free on the lateral side of Lister's tubercle. This "butterfly plasty" provides solid and effective protection of the EDTs in an often fragile pathologic context. It creates a glide space, stabilizing EDTs and wrist. LEVEL IV: Retrospective series.

[Perineal gangrene: new bacteriologic approach. Results of medico-surgical treatment (81 cases)]. / Gangrènes périnéales: nouvelle approche bactériologique. Résultats du traitement médicochirurgical (81 cas).

STUDY OBJECTIVE: The objective of this retrospective study was to report the results of a series of 81 cases of perineal gangrene treated in the same center. PATIENTS AND METHODS: From 1988 to 1998, 81 patients (64 males, 17 females, mean age: 58 years) with perineal gangrene were treated by a medico-surgical team, by means of a protocol combining appropriate intensive care measures based on a new bacteriologic concept of infectious agents, extensive excisions and drainage of the infraperitoneal region and hyperbaric oxygen therapy. RESULTS: The mortality rate was 24.7%. Mean duration of intensive care stay was 19 days, mean duration of hospital stay was 31 +/- 4 days (range: 6 to 60 days). Risk factors were: age > 68 years (p = 0.001), shock (p = 0.83), subcutaneous crepitation (p = 0.25) and severity index > 10 (p = 0.003). Sequelae were anal incontinence (n = 3) and permanent colostomy (n = 5). Secondary plastic reconstruction was necessary in four patients. There were no urologic or genital sequelae. CONCLUSION: Perineal gangrene is still a very serious disease. The time to treatment, the simplified severity index and consideration of bacteriologic combinations are the main prognostic factors.

[Fractures of the anterior rim of the distal part of the tibia. Apropos of a series of 38 cases]. / Les fractures marginales antérieures du pilon tibial. A propos d'une série de 38 cas.

PURPOSE OF THE STUDY: Fracture of the anterior rim of the distal tibia is a rare injury. This fracture seems less serious than other pilon fractures but its treatment is often difficult and didn't give better results. The aim of this study was to describe problem we dealed with and to suggest solutions in order to improve long term results. MATERIAL: The study included 38 cases, treated in 5 Paris district trauma centers, with a minimal follow-up of 6 months. All patients were asked for clinical and radiological review between september 92 and march 93 ; otherwise, latest review datas were used. METHODS: Authors suggest a radiological classification based upon type, width and talus anterior displacement. Different surgical procedures were performed for 33 cases (screw, plate, external fixation) ; conservative treatment was used 5 times (non weight bearing plaster cast). Anatomical reconstruction was analysed. Functional results scoring system included pain, global abilities and ankle range of motion. Ankle arthritis was rated according to 1992 SOFCOT scoring system at 1 and 3 year follow-up. RESULTS: Follow-up ranges from 6 months to 11 years (average 28 months). 55 per cent of cases were lost for review with 1 year mean follow-up. 45 per cent of patients were recently tested with 4 year mean follow-up. Three ankles had joint fusion 6 to 18 months after trauma. Functional result was poor. For 35 ankles analysed 1 out of 4 remained totally painless (9 cases), 1 out of 2 had a good function (20 cases) and 1 out of 3 normal X-rays (12 cases). Arthritis was found for 2 ankles out of 3 after one year follow-up (16 cases out of 23). Loss of reduction or incomplete reconstruction seemed the most important point (13 cases out 38, 13 cases after 35 surgical procedures). DISCUSSION: Many patients didn't get a long term evaluation, and this study has no statistical value. Anyway, function loss was always early on a weight bearing joint. A perfect and stable reconstruction gives a higher rate of good result (11 out of 14). Analysis of cases with anatomic imperfection leads to recommendations: fixation of separation fracture, even undisplaced, bone grafting to correct impaction, appropriate use of external fixation for neutralization. CONCLUSION: Better results should come from a better analysis of the bone lesions : separation, impaction or mix fracture. This analysis leads to appropriate surgical procedure which give back a stable and anatomic distal tibia. External fixation can be usefull for immobilization ; this can't avoid open reduction and internal fixation of the fracture. Bone grafting can be useful for impaction fracture.

[Value of pelvic osteotomy in the management of the hip in children with cerebral palsy]. / Intérêt de l'ostéotomie pelvienne dans la prise en charge de la hanche de l'enfant IMC.

PURPOSE OF THE STUDY: The authors analyzed the effectiveness of pelvic osteotomy for the treatment of hip dislocation or subluxation in CP children. MATERIAL: Fifteen pelvic osteotomies were performed on 11 children aged 30 months to 12 years (mean age 6 years). Seven children suffered from Little's disease. Follow-up averaged 10 years (from 2 to 16). Six children were reviewed at the end of growth (9 cases). METHODS: A Salter or triple osteotomy with adductor release was performed. Four cases had also a proximal femoral osteotomy. RESULTS: Following surgery, the mean Reimers' percentage decreased from 55 to 0 per cent. Correction was perfect in 11 cases, incomplete in 4 but excentration remained under 20 per cent. At the end of growth, 6 out of 9 hips remained stable without any further surgery, 2 hips developed slight excentration (less than 20 per cent) and one recurrent subluxation was treated by proximal femoral osteotomy. Six hips remained stable but their growth was not ended at last review. DISCUSSION: This surgical procedure is compared to others described in literature. Pelvic osteotomy with tenotomy improves acetabular cover and corrects muscle imbalance. Its risks seem overestimated in the literature. Both pelvic and femoral osteotomies are useful in specific cases. CONCLUSION: Triple or Salter osteotomy with adducter release seems to be a useful procedure to restore good hip morphology at the end of growth. No posterior dislocations following this osteotomy were seen in spite of the important correction. Proximal femoral osteotomy is not always necessary.

[Gouty arthritis of the wrist. Five case reports]. / Arthropathie goutteuse du poignet à propos de cinq cas.

Gout is rarely localized to the wrist. Based on five new cases of this condition and literature review, the authors outline the clinical and radiographic signs which differentiate gout from other causes of isolated unilateral chronic synovitis of the wrist. On the clinical basis, this localization was the first appearance of the disease in three of the five cases. On the X-rays, large defects and joint destructions were present. A scapholunate dissociation was evident in 4/5 cases with sometimes bone condensation. Other diagnoses should be eliminated as chondrocalcinosis, rheumatoid arthritis or wrist infections in subacute forms. Final diagnosis is provided by histological examination, demonstrating specific microcrystals.

[Treatment for a chronic proximal interphalangeal fracture-dislocation with hemi-hamate arthroplasty]. / Traitement d'une fracture-luxation chronique de l'interphalangienne proximale par un greffon d'hémi-hamatum.

Fracture-dislocations of the proximal interphalangeal (PIP) joint are complex and challenging to manage once they become chronic. We report a case of PIP joint fracture-dislocation treated by hemi-hamate arthroplasty. An 18-year-old male polytrauma patient presented with a neglected PIP joint fracture-dislocation in the third finger of the left hand. After four months of follow-up, he remained disabled due to clinodactyly and stiffness. After performing a cadaver study to evaluate the feasibility of grafting, we resurfaced the bone-cartilage defect with a hemi-hamate arthroplasty. The range of motion at the last follow-up was 65° without pain; the DASH score was 2.27. The patient was able to return to heavy manual labour work at 5 months postoperative.

Neuroma-in-continuity of the median nerve managed by nerve expansion and direct suture with vein conduit.

Autologous nerve grafting is the current standard for bridging large gaps in major sensory and motor nerves. It allows both function and pain improvement with predictable results. Clinical observations of nerve elongation caused by tumours have prompted experimental animal studies of induced gradual elongation of the nerve stump proximal to the gap. This technique allows direct suturing of the two nerve ends to bridge the gap. Here, we describe a case of neuroma-in-continuity of the median nerve managed by resection and direct suture after nerve elongation with a tissue expander. We are not aware of similar reported cases. Secondary repair 3 years after the initial injury improved the pain and hypersensitivity and restored a modest degree of protective sensory function (grade S1).

Focal periosteal chondroma of the hand: a review of 24 cases.

INTRODUCTION: Periosteal chondroma is a benign cartilaginous tumour that is less common than enchondroma and rarely arises at the hand. PATIENTS AND METHOD: We report a retrospective review of 24 patients with focal periosteal chondroma of the hand and a mean follow-up of seven years and four months. The 13 females and 11 males had a mean age of 41 years and three months. RESULTS: Radiographs performed to investigate a hard lump on a finger established the diagnosis in 23 (95.8%) patients, and histological documentation was obtained consistently. The proximal and distal phalanges were the most common sites of involvement. The tumour recurred in a single patient, a 10-year-old child, 10 months after surgery. CONCLUSION: No other complications were recorded. Tumour excision and curettage of the lesion are the suggested treatments for periosteal chondroma. Most recurrences occur early after initial surgery. LEVEL OF EVIDENCE: Level IV.

[Cartoons, local anesthesia and nitrous oxide: a solution for the treatment of child's hands wounds]. / Dessin animé, anesthésie locale et mélange de protoxyde d'azote : une solution pour le traitement des plaies de la main de l'enfant.

Wounds and injuries of child's hands are common and create anxiety. The context of stress makes difficult therapeutic cares, anesthesia and surgery, and prevents child's cooperation. We propose a technique combining a local anesthesia performed during inhalation of oxygen and nitrous oxide, and child distraction by watching a cartoon. In a prospective series of 39 children, we evaluated the feasibility of such care and its impact on the child's anxiety by a visual analog scale (VAS) at three moments of care sequence: arrival of the child (EVA1), at the end of the cartoon (EVA2), and at the postoperative visit (EVA3). Thirty-seven children were included (94.9%). Mean anxiety decreased throughout the therapeutic course: EVA1 (5.6), EVA2 (2.97), EVA3 (1.4). Children were less and less anxious along the procedure (100%, 46%, 10.8%, respectively). All children could be treated as outpatients. This procedure allows a rapid and adapted treatment for children's hand injuries. It reduces impact of children's anxiety.

Reverse wedge osteotomy of the distal radius in Madelung's deformity.

Madelung's deformity results from a growth defect in the palmar and ulnar region of the distal radius. It presents as an excessively inclined radial joint surface, inducing "spontaneous progressive palmar subluxation of the wrist". The principle of reverse wedge osteotomy (RWO) consists in the reorientation of the radial joint surface by taking a circumferential bone wedge, the base of which is harvested from the excess of the radial and dorsal cortical bone of the distal radius, then turning it over and putting back this reverse wedge into the osteotomy so as to obtain closure on the excess and opening on the deficient cortical bone. RWO corrects the palmar subluxation of the carpus and improves distal radio-ulnar alignment. All five bilaterally operated patients were satisfied, esthetically and functionally. Its corrective power gives RWO a place apart among the surgical techniques currently available in Madelung's deformity.

Giant cell tumors of the tendon sheaths in the hand: review of 96 patients with an average follow-up of 12 years.

INTRODUCTION: Giant cell tumors (GCT) of the hand are relatively common and have a good prognosis, but the risk of recurrence is high. The goal of this study was to evaluate the long-term clinical results of a consecutive series of patients and to determine the risk factors for recurrence. MATERIAL AND METHODS: This was a retrospective study of 96 patients (57 women, 39 men) operated between February 1982 and October 2005 for GCT of the tendon sheaths in the hand. The average age at the time of the procedure was 47.7±14.5 years (range 13-75). All the patients were reviewed by an independent surgeon. The following were recorded: clinical result (QuickDASH, satisfaction), recurrence, histological appearance of tumor, location of tumor, excision margins and extension into the neighboring anatomical structures (tendon, joint). The tumor was located in the index finger in 29 cases, middle finger in 23 cases, thumb in 21 cases, ring finger in 11 cases, little finger in 11 cases, hypothenar area in two cases and thenar area in one case. In all cases, the lesion was isolated. The swelling was palmar in 27 cases, dorsal in 20 cases and medial or lateral in 59 cases. The most common joint location was the DIP joint (35% of cases). The swollen area was sensitive in 12 cases. The time from the appearance of the tumor to physician consultation ranged between 1 month and 7 years. Before the surgery, standard X-rays were taken in all patients; ultrasonography was also performed in eight patients and MRI in one patient. The tumor had an average diameter of 15.8±2.6mm (range 5-30). Histological analysis revealed a multilobed lesion with multinucleated giant cells, with or without encapsulation. RESULTS: The average follow-up at the time of review was 12.1±3.8 years (range 5-29). There were eight recurrences in seven patients (8.3%). The average time to recurrence was 2.75±2 years (range 1-6.5). In every case of recurrence, there had been intra-articular tumor development and/or tendon destruction (P<0.01). There was one functional complication: one DIP joint fusion secondary to one of the recurrences. The average QuickDASH was 2.3/100 (range 0-31). CONCLUSION: Giant cell tumors of the synovial sheaths in the hand are benign lesions where recurrence is the primary risk. The recurrence typically occurred within 36 months of the excision. Intra-articular tumor development, marginal resection and tendon involvement seem to contribute to recurrence. There was no correlation found between the histological type of tumor (encapsulated or not) and recurrence. LEVEL OF PROOF: IV.

Simplified scaphoid reconstruction technique with Zaidemberg's vascularized radial graft.

For more than 10 years, we have been using a simplified reconstruction technique for scaphoid non-unions that involves the use of a graft first described by Zaidemberg et al. [1]. This approach requires that an island bone graft harvested from the radial styloid and pedicled on the 1,2-intercompartmental supraretinacular artery be embedded into the site of the non-union. The objective of our technical modifications was to simplify the harvesting and handling of the graft and the internal fixation. This technique is only used for cases of scaphoid non-union with avascular changes in the proximal fragment, repeated non-union after bone grafting and internal fixation, chronic non-union with osteophyte formation in the dorso-radial aspect and fracture secondary to Preiser disease.

Lateral epicondylitis treatment by extensor carpi radialis fasciotomy and radial nerve decompression: is outcome influenced by the occupational disease compensation aspect?

INTRODUCTION: The etiology, treatment, and patient management in cases of chronic epicondylitis, within the legislation on occupational disease, remain highly controversial. HYPOTHESIS: Recognition as an occupational disease has a negative influence on the functional result of epicondylitis treated with aponeurotomy and neurolysis of the motor branch of the radial nerve. PATIENTS AND METHODS: Twenty-eight patients (30 cases of epicondylitis) were operated between January 2007 and January 2008. There were nine men and 19 women whose mean age was 46.1 years. A preoperative EMG found anomalies in the deep posterior interosseous nerve in all cases. Patients were divided into two groups: one group of patients recognized as having an occupational disease and a group of patients whose disease was not considered occupation-related. RESULTS: The patients were seen at follow-up at a mean 21.8 months. In the group of patients with occupational disease, there were six excellent, nine good, and five acceptable results; in the second group, there were six excellent, two good, and two acceptable results. CONCLUSION: Recognition of epicondylitis as an occupational disease has a significant influence only on the time to pain relief and the result on strength. LEVEL OF EVIDENCE: Level IV. Retrospective study.

Vein conduit associated with microsurgical suture for complete collateral digital nerve severance.

The aim of this study is to present the long term results of a series of 53 vein conduit grafts as first line therapy to repair complete severance of one or more collateral digital nerves. The surgical technique included an epi-perineural suture of the nerve under minimal tension, associated with a vein graft harvested from the back of the hand to cover the nerve. None of the patients presented with a neuroma, spontaneous pain or had stopped using the injured finger. Sensibility results were good or very good in 67% of cases. The scar at the donor site was very light or invisible. A total of 96% of patients were satisfied or very satisfied. This simple technique, by protecting the injured nerve, results in a rate of sensory nerve recovery that is comparable or better than that of other series in the literature, without neuroma and with minimal scarring at the donor site.