[Focus on tizanidine in primary care medecine]. / Le point sur la tizanidine en médecine de premier recours.

Tizanidine is an alpha2 agonist with central action whose myorelaxant effects are often used off-label against primary backpain in clinical practice. It is mainly metabolized by the liver. The concomitant use of CYP1A2 inhibitor drugs increases the plasmatic concentration and thus can cause serious adverse effects. Severe hypotension is the most memorable example. Its narrow therapeutic range and the interindividual different sensitivity to the molecule justify using it wisely. A clinical case is reported as illustration.

La tizanidine est un agoniste alpha-2-adrénergique d'action centrale dont l'effet myorelaxant est utilisé « hors indication ¼ en pratique médicale pour les lombalgies primaires. Elle est principalement métabolisée au niveau hépatique. Lorsqu'elle est administrée de manière concomitante à un inhibiteur du CYP1A2, sa concentration plasmatique augmente, entraînant potentiellement plusieurs effets indésirables. L'hypotension sévère en est l'exemple le plus probant. Sa marge thérapeutique étroite et la sensibilité variable des sujets à la molécule justifient son utilisation judicieuse. Un cas clinique illustratif est rapporté.

Perioperative Morbidities in Distal Radius Fractures Treated Using Locking Plates in the Super-Elderly Population: A Retrospective Study.

Purpose: Currently, there is no consensus on the treatment of distal radius fractures in the super-elderly population. The aim of this study was to evaluate the perioperative morbidities and the need for rehabilitation care after a distal radius fracture treated with locking plates among patients aged 85 years or older. Methods: A retrospective study was conducted in all patients aged 85 years or older who underwent open surgical treatment using a locking plate for an isolated distal radius fracture from January 2013 to December 2018 at a level 1 trauma center. The occurrence of minor complications (tendinopathy, neuropathy, carpal tunnel syndrome, and infection), major complications (complex regional pain syndrome, nonunion, loss of reduction, intra-articular screw, and hardware failure), and the need for revision surgery were recorded. The need and timing of rehabilitation were also documented. A nested case-control study was performed to evaluate predictive factors associated with the need for inpatient rehabilitation. Results: The majority of fractures were AO type A, numbering 88 (55.7%), followed by 64 type C (40.5%), and then 6 type B (3.8%). The overall complication rate among the 158 included patients was 17% (n = 26), with 12 (7.6%) having minor complications and 14 (8.9%) having major complications. Inpatient rehabilitation was required for one-third of the patients (n = 59), and 11 (7%) were definitively discharged to a nursing home. The place of residence before the fracture, American Society of Anesthesiologist score, and the type of anesthesia were associated with a need for inpatient rehabilitation. Conclusions: Overall, this study suggests that perioperative morbidity of distal radius fractures treated using a locking plate is acceptable even in the super-elderly population. Nevertheless, given the frequent requirement for rehabilitation, the impact of age cannot be ignored. Type of Study/level of evidence: Therapeutic IV.

Percutaneous ultrasound-guided ulnar nerve release technique compared to open technique: A cadaveric study.

OBJECTIVES: To evaluate the outcomes of a novel percutaneous ultrasound-guided technique for release of ulnar nerve entrapment at the elbow when compared to standard open release Methods: One single surgeon performed an ultrasound-guided percutaneous release of the cubital tunnel on a group of five cadaveric elbows and open release on five others. All procedures were timed, and incision lengths were recorded. Meticulous anatomic dissection was then performed to assess the complete release of the carpal tunnel and iatrogenic injuries. RESULTS: No significant difference was found between the two groups in terms of complete release and iatrogenic injury, whereas Operative time was significantly shorter for the US-guided technique. Incomplete releases of the nerve were found only during the first two trials in each group, while the third, fourth, and fifth trials showed a complete ulnar nerve release in both series, highlighting a fast learning curve for both techniques. All of this through a significantly smaller incision in the US-guided technique. CONCLUSIONS: This study highlights the similar effects of these two techniques in terms of complete release of the ulnar nerve, with no clear superiority of one over the other in terms of morbidity rate. Both have a fast learning curve for an ultrasound-trained surgeon, with the US-guided technique being a less traumatic and quicker alternative procedure.

Determining diagnosis of scaphoid healing: Comparison of cone beam CT and X-ray after six weeks of immobilization.

PURPOSE: To assess the accuracy and reliability of using cone beam computed tomography (CBCT) compared to X-ray six weeks after injury for predicting scaphoid union. MATERIALS AND METHODS: Overall; 52 patients with scaphoid fractures between April 2018 and March 2019 were prospectively included in this study. The mean age was 34.52 (13-88) years, and the gender ratio male/female 43/9. Of the fractures, 26 had occurred on the right side, and 26 on the left side. In total, 28 % of patients were manual workers. All patients underwent X-ray and CBCT six weeks after injury. Four readers, two radiologists, and two hand surgeons analyzed the findings using double-blinded X-ray and CBCT and categorized fractures as consolidated based on a 50 % visibility threshold concerning trabecular bridges. Proximal pole sclerosis, communition, cyst formation, and humpback deformity were similarly analyzed for all cases. Agreement between readers was calculated using Kappa, and sensitivity, specificity, and accuracy using RStudio software. The gold standard was the radiologic and clinical follow-up for all patients at two months. RESULTS: Inter-reader agreement between the four readers was moderate concerning X-ray (0.543) but substantial concerning CBCT (0.641). It was almost perfect between seniors regarding CBCT (Kappa = 0.862). Sensitivity, specificity, and accuracy were 0.75-0.78, 0.4, and 0.61-0.64, respectively, for two readers regarding CBCT. The X-ray values were 0.65-0.71, 0.35-0.4, and 0.53-0.59, respectively. CONCLUSION: CBCT proves more accurate and reliable than X-ray for diagnosing scaphoid union at an early follow-up and prevents longer immobilization and interruption of activity or work.