Modeling and concepts of the Malingue plasty compared to Z-plasty.

Malingue's diamond-shaped skin plasty is a random skin plasty derived from the Z-plasty. Not widely known, this technique is an alternative to fasciectomy in Dupuytren's disease. The main objective of the present study was to analyze the topographical and anatomical differences between Z-plasty and Malingue plasty in cadaveric and experimental models and the geometrical and mathematical differences in modeling, in order to determine the respective gains in length. The study was carried out in two steps. An anatomical step on a cadaveric model studied vascularization. The second step was based on inert models (latex gloves) and cadaveric models, to study the mechanical behavior of the flaps. Differences in gains in length were analyzed by Euclidean and non-Euclidean geometry. The Malingue plasty flaps showed greater vascular richness than in Z-plasty. The experimental cadaver and inert material models showed 50% length gain with a single Malingue plasty, versus 33.3% with Z-plasty. The gain decreased in multiple plasties: respectively, 25% and 17.5% with double plasty and 20% and 16.7% with triple plasty. The analysis of Euclidean plane geometry did not explain these results, whereas 3D analysis on non-Euclidean geometry can explain a superior elongation effect in the Malingue plasty. The Malingue plasty could be an interesting option when significant lengthening is required, especially when Z-plasty would be insufficient.

Preiser's disease or avascular osteonecrosis of the scaphoid: An updated literature review.

Avascular necrosis of the scaphoid, often referred to as Preiser's disease, is little known despite the scaphoid being the second most frequently involved location in avascular pathology of the carpal bones after the lunate (Kienböck's disease). Nonetheless, very few cases have been reported in the medical literature over the last century. Its pathophysiology is not completely elucidated although the unique vascularization of the scaphoid and several risk factors seem to be recurrently incriminated. Two new classifications based on modern imaging have appeared in the last decade and are now considered essential supplements to Herbert and Lanzetta's original radiographic classification. Because of the lack of formal treatment guidelines, a wide range of different treatments have been explored over time, contributing to the confusion around this pathology. Adding to this confusion, are the numerous terms used to designate the condition and lack of knowledge concerning its pathophysiology, risk factors, clinical and radiographic presentation. The aim of this review is therefore to explore and clarify Preiser's disease in terms of history, terminology, pathophysiology, clinical considerations and imaging and to propose a simple updated treatment algorithm based on the results provided by a thorough review of literature (53 publications, 170 patients) since Georg Preiser's original and controversial description in 1910.

Revision of Arpe® trapeziometacarpal prosthesis by isolated head and linear exchange in five patients.

With the increase in the number of trapeziometacarpal arthroplasties being done, the indications for revision due to implant wear will also increase significantly in the coming years. Isolated linear exchange in the context of polyethylene wear without osteolysis or loosening of the implants is already well known in the case of hip arthroplasty. This revision option offers the advantages of less morbidity, faster recovery, and bone preservation. We retrospectively reviewed five patients who underwent trapeziometacarpal revision with isolated polyethylene liner exchange. Revision surgery was performed an average of 17.6 years (10.7-21.3 years) after the primary arthroplasty procedure. The indication for revision was dislocation in four cases and prophylactic revision for wear and limited osteolysis of the cavity in the other case. Mean follow-up was 48.7 months (36-60). One patient had a recurrent dislocation 4 years after revision and required another revision where only the cup was changed. The other patients had no instability, and no complications were reported. The mean QuickDASH score was 11.9 (4.5-15.9). Pinch strength was 102% (90-120) and grip strength was 92% (70-110) relative to the opposite side. Radiological evaluation showed no abnormalities at the last follow-up. Trapeziectomy is often the solution of choice in the surgical revision of arthroplasties. Unipolar revision of the cup has the risk of trapezium fracture, especially when the cup is well integrated. The technique we report here preserves bone and simplifies the surgical procedure with outcomes corresponding to those of primary arthroplasty. Isolated exchange of the polyethylene liner is a relevant option in the revision of trapeziometacarpal arthroplasty with good short-term results.

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.

Vein conduit with microsurgical suture repair of superficial branch of the radial nerve injuries at the wrist.

The superficial branch of the radial nerve (SBRN) at the wrist is susceptible to trauma and lacerations. These lesions can develop into painful neuromas with debilitating consequences. The aim of our study was to demonstrate the effectiveness of systematic use of vein conduits associated with microsurgical suture repair in SBRN injuries to prevent the occurrence of these neuromas. Our study was retrospective and performed at a single site. An independent examiner performed the clinical assessment. The study included 33 patients and the mean follow-up was 63 months. We looked for a so-called "trigger point". None of the patients developed a painful neuroma or experienced any pain. All the patients were either satisfied or very satisfied with their treatment. Systematic use of vein conduit in SBRN injuries at the wrist helps prevent the occurrence of painful neuroma and the disorder's inherent consequences, which can be severe not only clinically, but also socially and professionally.

Peritrapezial osteoarthritis: Inter- and intraobserver reliability of the Allieu classification.

The Allieu classification takes into consideration the distal and proximal joints of the trapezium. Trapeziometacarpal (TMC) joint arthritis, TMC joint instability (TMI) and scapho-trapezio-trapezoid (STT) joint arthritis are considered independently, which better corresponds to the anatomical examinations. The aim of the study was to evaluate the inter- and intraobserver reliability of the Allieu classification of the peritrapezial arthritis. This was a prospective, single-center study performed from May to September 2016 with 30 cases of primary thumb osteoarthritis. Five raters scored the X-rays twice. In the Allieu classification, TMC arthritis is scored as "0" when the TMC joint is normal, "1" when the TMC joint space is <50% narrowed, "2" when the TMC joint space is >50% narrowed, "3" when the joint space is loose with advanced degenerative changes. TMI is scored as "0" for reducible subluxation, painful and unstable joint, "1" for advanced reducible subluxation, "2" for chronic subluxation <1/3 of the surface, "3" for chronic subluxation >1/3 of the surface. STT joint arthritis is scored as "0" for normal joint space, "1" for joint space narrowing <50%, "2" for important joint space narrowing and "3" for advanced degenerative changes with sclerotic subchondral bone changes. Inter- and intraobserver reliability was assessed using the weighted Cohen's kappa coefficient. Additional analyses were undertaken to determine the intraclass correlation coefficient (ICC) for the overall raters. The interobserver reliability was "moderate" to "substantial" for the TMC arthritis; "fair" to "substantial" for STT arthritis and "fair" to "substantial" for TMI. The intraobserver reliability was "moderate" to "excellent" for TMC arthritis (2 "excellent", 2 "substantial", 1 "moderate"); "fair" to "excellent" for the STT (1 "excellent", 2 "substantial", 1 "moderate", 1 "fair") and "fair" to "excellent" for the TMI (1 "excellent", 2 "substantial", 1 "moderate", 1 "fair"). The worst reliability, either for intra- or interobserver, was for TMI. The ICC for TMC arthritis was 0.67 (95%CI, 0.28-0.83); for STT it was 0.47 (95%CI, 0.15-0.66) and for TMI it was 0.30 (95%CI, 0.23-0.70), which is "fair". This study confirms a large variation in X-ray staging for peritrapezial arthritis. It shows that the Allieu classification is moderately reliable. However, the interobserver reliability was better for evaluating the TMC than the STT and worse for TMI. The classification for TMC and STT is simple to apply, based principally on the joint narrowing. The intraobserver is better than the interobserver reliability.

Occupational prognosis factors for ulnar nerve entrapment at the elbow: A systematic review.

Although ulnar nerve entrapment is the second most common entrapment neuropathy, there is a dearth of studies identifying occupational prognosis factors. We carried out a systematic review of the occupational prognosis factors for ulnar nerve entrapment in order to identify professions at risks and allow better follow-up for their workers. Using the key words, "ulnar OR cubital", "neuropathy OR tunnel", and "work OR occupational" without limitations, original prospective studies were selected from four databases (PubMed, Embase, Web of Science, Cochrane Library) after two rounds (valid design, valid prognosis outcome reported, valid work exposure). Associations between prognosis for ulnar neuropathy and occupational factors were extracted and analyzed qualitatively. Dating from 1981 to 2013, three prospective studies were included; 1420 cases of ulnar nerve entrapment were followed for an average of 4 years and occupational exposure was retrieved. The only high-quality study (related to this question) found a significant relationship between occupational exposure and prognosis with an odds ratio for ulnar nerve entrapment of 1.78 (1.10-2.88). The two other studies were less focused on the occupational prognosis factors; one found that work activity requiring effort had worse prognosis after surgery, while the other found no significant relationship between occupational hand exposure and prognosis. Occupations requiring high effort may be associated with more severe ulnar neuropathies, but further studies (exposure as well as associated disorders) are mandatory for clinicians to provide work task information to their patients.

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.

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.

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.

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.

Dellon's anterior submuscular transposition of the ulnar nerve: Retrospective study of 82 operated patients with 11.5 years' follow-up.

Anterior submuscular transposition of the ulnar nerve described by Dellon can solve the dynamic component of cubital tunnel syndrome at the elbow. We carried out a retrospective, single-surgeon study. The McGowan scale as modified by Goldberg (MG) was used preoperatively and at the final assessment; the QuickDASH was completed at the final assessment. The cohort comprised of 82 patients (38 females, 44 males) with a mean age of 61.2 years (37-92). The preoperative MG grade was: stage I (52%), IIA (28%), IIB (16%), III (4%). Three postoperative complications (3.5%) were recorded: two hematomas that did not require surgical revision and one case of elbow stiffness that resolved with physical therapy. Mean follow-up was 11.1 years (11-12). We identified 5 cases of confirmed recurrences (5.9%), 7 of secondary deterioration (8.5%) and 3 of initially poor result (3.5%). Sixty-six patients (86%) considered themselves cured at the final assessment. The MG scale at the last follow-up was: stage 0 (85.5%), I (9%), IIA (5%), III (0%). The QuickDASH was 11.88 (11-16). Mean time to recurrence was 6.3 years (1.5-10). Dellon's anterior submuscular transposition can be considered a reliable procedure. Eighty-six percent of patients were cured and 6% recurrence rate was noted. However, this is a demanding procedure.

"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.

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.

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).

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.

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.

[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.

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.