Long-term outcome of fibula flaps in complex limb reconstruction compared to alternative procedures, a median follow up of 41 months.

INTRODUCTION: Complex open long bone fractures present a multidisciplinary surgical challenge. Various treatment options are discussed with no consensus. Fibula flaps (FF) are frequently used in maxillofacial surgery, however their use in limb injuries is less common. With the tremendous improvement in microsurgery, orthoplastic surgery gained importance. Our retrospective study aims to assess the long-term results and the quality of life of the patients operated by FF for complex traumatic limb reconstruction. PATIENTS AND METHODS: We conducted an observational mono centric retrospective study from the year 2011 to the year 2021. Patients operated for complicated traumatic limb fractures using FF were included in the study. Not only long-term clinical results were evaluated, but also Patient-reported outcome measures (PROM). These included the Lower Extremity Functional Scale (LEFS), Quick Disabilities of the Arm, shoulder and hand (Qdash), and the Visual Analogue Scale (VAS). The statistical analysis was done using the R Software. RESULTS: Twenty patients were included in our study. 80% achieved complete union with no re fracture rate at a median follow-up of 41 months. All of the patients (n = 4) who underwent amputation were smokers (p = .09), were operated for lower limb fractures (p = .54), and were males (p = 1). The length of hospital stay was associated with an increased duration to complete bony union (p = .01, coefficient = 2.88). At the end of follow-up, the LEFS median score was 67 for the total population and 63.5 for the lower limb reconstructed sub group. CONCLUSION: VFF is an important tool in the armamentarium of orthoplastic surgeons. Encouraging long term functional and clinical outcomes were obtained in patients with complex traumatic limb fractures.

Ligamentoplasty in scapholunate instability: short-term results of the "all dorsal scapholunate repair" technique.

Injury to the scapholunate complex is the cause of scapholunate instability which can lead to radiocarpal and medio-carpal osteoarthritis. Several ligamentoplasty techniques have been reported for the treatment of chronic scapholunate instability before the osteoarthritis stage. The objective of this study was to assess the short-term results of an "all dorsal scapholunate repair" ligamentoplasty. We report the clinical, radiological and functional results of a retrospective study including 21 patients, operated between June 2019 and December 2020 for a stage 3 or 4 scapholunate instability according to the Garcia Elias classification. With a follow-up of 14.2 months, the pain was 0.1/10 according to the VAS at rest and 4/10 during exercise. Wrist strength was measured at 65% of the opposite side. The flexion-extension range of motion was 105°. Radiologically, there was a reduction of the diastasis and scapholunate angle. Osteolysis areas around the anchors were described in 47% of patients. The mean QuickDASH was 29.2/100, PRWE 24/100 and Mayo wrist score 67.8/100. Eighty-one percent of patients were satisfied. Seventeen patients had returned to work 5.2 months postoperatively. In the case of work-related injury, the functional scores were poorer, with a delayed return to work. This technique provides encouraging results in the short term. Most patients were improved compared to preoperative state. The work-related injury appears to be a poor prognostic factor. A longer-term study is imperative to confirm the maintenance over time of the correction of carpal malalignment and the evolution of the osteolysis areas.Level of evidence: Level IV Retrospective study.

Comparison of proximal row carpectomy with RCPI® versus proximal row carpectomy with Eaton's capsular interposition in the management of advanced wrist osteoarthritis.

INTRODUCTION: Proximal row carpectomy (PRC) is one of the recommended techniques for managing wrist osteoarthritis, it implies the integrity of the lunate fossa of the radius and the proximal pole of the capitate. If PRC is not possible, it is suggested to consider combining it with a capsule interposition (such as Eaton's flap) or opting for intra- or radiocarpal arthrodesis. Another alternative is to combine capitate resurfacing with a pyrocarbon implant (RCPi®). The aims of this study was to assessed the results between proximal PRC+Eaton and those associated PRC+RCPi® for advanced wrist osteoarthritis. HYPOTHESIS: We hypothesized that there would be no differences in clinical or functional outcome between proximal row carpectomy associated with RCPI® and those associated with Eaton capsular flap. MATERIAL AND METHODS: It is a monocentric, retrospective, multi-operator study involving 83 wrists with osteoarthritis, included between January 2000 and December 2020 with a minimum follow-up period of 12 months. Thirty-nine patients underwent PRC+Eaton and 44 patients underwent RCPI® resurfacing. Data such as pain, flexion, extension and strength as well as functional scores (PRWE, Mayo and quick DASH) were collected from the patient files at the last check-up. RESULTS: Results were comparable between the two groups in terms pain (VAS), mobility (flexion and extension), strength (GRASP) and functional scores (PRWE, Mayo and quick DASH). Carpal height was better preserved in the PRC+RCPI® group, with a Youm and McMurtry index evaluated at 0.3 in the PRC+Eaton group compared to 0.4 in the PRC+RCPI® group (p-value<0.001). Radiocarpal arthrodesis was required in 16% of the PRC+Eaton group and 6.8% of the PRC+RCPI® group, with a statistically significant difference (p-value=0.023). DISCUSSION: This study reports clinical and functional results that suggest RCPI® is an interesting alternative and can be associated with proximal row carpectomy in advanced wrist osteoarthritis. LEVEL OF EVIDENCE: IV; retrospective study.

Outcomes of Arthrodesis of the Metacarpophalangeal Joint of the Thumb for Sequelae of Collateral Ligament Injuries: A Series of 18 Cases with 6-Year Follow-Up.

Background: Untreated or insufficiently treated collateral ligament injuries of the thumb metacarpophalangeal (MP) joint can lead to instability or even osteoarthritis. Arthrodesis is one of the treatment options available for the treatment of the sequelae of collateral ligament injuries. The objective of our study was to evaluate the radiological, clinical and functional outcomes of MP joint arthrodesis performed for sequelae of collateral ligament injuries. Methods: We conducted a retrospective, single-centre study and reviewed the files of patients who had a thumb MP joint arthrodesis following a collateral ligament injury between 2011 and 2019. We collected patient's demographic data and the results of the radiological and clinical examinations. Results: Eighteen patients were included in the study. The average age was of 53.6 years and the time between injury to arthrodesis averaged 7 years. Four patients (22%) had nonunion. In the remaining 14 patients with solid union at an average of 72 months follow-up, the visual analogue pain score at rest was 0.14, the thumb opposition was 82%, grip strength 85%, tip pinch 92% and key pinch 79% of the contralateral side. Conclusions: The clinical and functional results of patients with a successful arthrodesis are satisfactory with restoration of good grip and pinch strength. Despite a lack of thumb MP joint flexion, stability allowed force transmission and may be preferred for manual workers. Level of Evidence: Level IV (Therapeutic).

Surgical treatment of terrible triad of the elbow: Retrospective continuous 50-patient series at 2 years' follow-up.

INTRODUCTION: Terrible triad (TT) of the elbow is an association at high risk of instability. Treatment aims to restore joint stability. Lateral collateral ligament (LCL) repair is systematic, whereas medial collateral ligament (MCL) repair is only exceptionally necessary. The main aim of the present study was to assess clinical results in TT surgery. The secondary objective was to compare clinical progression with versus without MCL repair. MATERIAL AND METHODS: A retrospective study included 50 TTs operated on via an isolated lateral or combined medial-lateral approach. Clinical assessment comprised MEPS, QuickDASH, VAS, flexion-extension and pronation-supination, and return to work and sport. Subgroup analysis was made according to associated MCL repair. RESULTS: Fifty patients (19 female, 31 male) were operated on between January 2006 and January 2017. Mean follow-up was 24 months. At last follow-up, mean MEPS was 89.1, VAS 0.7, QuickDASH 16, flexion-extension 114°, and pronation-supination 137°. Only MEPS was significantly improved by MCL repair (p=0.02), with no significant difference in complications. DISCUSSION: TT surgery with immediate mobilization gave good long-term functional results, not significantly improved by MCL repair. The lateral approach should be adopted in first line, with the medial approach in second line in case of persistent instability after lateral osteo-ligamentous repair. LEVEL OF EVIDENCE: IV; retrospective study.

Recent and chronic sprains of the First Metacarpo-Phalangeal Joint.

Sprains of the first metacarpo-phalangeal joint (MCPJ) are a common form of hand injury that mainly affects the ulnar collateral ligament. Although the diagnosis is made on the physical findings, radiographs must be obtained and ultrasonography or magnetic resonance imaging (MRI) is necessary in some cases. If the joint is unstable or a bony fragment is displaced, surgery must be performed within 4 weeks after the injury. Beyond this interval, ligament reconstruction is the preferred treatment. The objective of this article is to provide evidence, from both older and recent studies, that guides the choice of the best treatment in clinical practice. To this end, we will address the following questions: (1) What is a Stener lesion? (history and pathophysiology); (2) In addition to the physical examination, what other investigations are appropriate in doubtful cases? (with special attention to the indications of ultrasonography and MRI); (3) What are the clinical and radiological criteria for performing surgery in patients with acute first MCPJ sprains? (4) What reconstruction procedures are appropriate in patients with acute or chronic MCPJ sprains?

Perilunate dislocations and transscaphoid perilunate fracture-dislocations: a retrospective study with minimum ten-year follow-up.

PURPOSE: Perilunate dislocations and transscaphoid perilunate fracture dislocations are associated with a high incidence of posttraumatic arthritis. According to the current literature, at medium-term follow-up, radiological signs of arthritis do not correlate with functional scores. The aim of this study was to evaluate patient hand function and the development of posttraumatic arthritis after perilunate dislocations (11 cases) and transscaphoid perilunate fracture dislocations (7 cases) at a minimum 10 years of follow-up. METHODS: A retrospective review was performed including 18 patients with a minimum 10-year (average, 13 y) follow-up. The clinical results were evaluated using the Mayo wrist score and the patient-rated wrist evaluation. Radiological abnormalities were stratified using the Herzberg classification. RESULTS: According to the Mayo wrist score, the authors found 5 excellent, 3 good, 7 fair, and 3 poor results. The mean Mayo wrist score was 76 (range, 60-90). There were 6 type A, 5 type A1, 6 type B1, and 1 type C, according to the Herzberg classification. Posttraumatic degenerative changes were observed in 12 cases. CONCLUSIONS: The presence of radiological arthritis and static carpal instability did not cause reduced function at our minimum follow-up of 10 years. Based on our findings and previously reported series, we conclude that signs of posttraumatic arthritis after perilunate dislocations and transscaphoid perilunate fracture dislocations increase progressively but are well tolerated at an average follow-up of 13 years. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Sentinel lymph node biopsy in cutaneous melanoma: outcome after 5-years follow-up.

Sentinel lymph node procedure for cutaneous melanoma is largely used and sentinel lymph node status is an important prognostic factor. Few French centers have reported their experience and data. We analysed technique feasibility, recurrence-free and overall-survival rates at 36 and 60 months for the first 62 patients submitted to this technique. The positivity of sentinel lymph nodes was 17.7%. Recurrence-free survival at 36 and 60 months was of 85% and 78% respectively for patients with negative sentinel lymph nodes, whereas the rates were of 45% and 36% respectively for patients with positive sentinel lymph nodes (p = 0.0046). The overall survival rate was of 94% at 36 months and 85% at 60 months for negative patients as opposed to 82% at 36 months and 47% at 60 months for positive patients (p = 0.0019). In our experience, sentinel lymph node technique is a safe procedure with few complications and good pronostic value. This technique allows the identification of patients with a high risk of recurrence who could benefit from early adjuvant therapeutic management. However, these results show that the survival rate of patients with positive sentinel lymph nodes remains significantly lower, even when elective lymph node dissection is performed.