Does the DISI matter after distal scaphoidectomy with tendon interposition for STT osteoarthritis?

Progression to dorsal extension of the lunate after distal scaphoidectomy was described more than a decade ago. Still, this technique remains a popular choice for surgical treatment of isolated scaphotrapeziotrapezoid osteoarthritis (STT OA). This study aimed to investigate short-term postoperative function, patient satisfaction and radiographic outcomes of distal scaphoidectomy with tendon interposition for isolated STT OA in the wrist. Scaphoid resection width, amount of DISI and postoperative complications were also assessed. We evaluated all distal scaphoidectomies done at our hospital from 2012 to 2018. Postoperative clinical analysis consisted of grip and key pinch strength, joint amplitude, pain on visual analog scale (VAS), hand usability (VAS) and functional scores (QuickDASH and PRWHE scores). On follow-up radiographs, we measured the amount of DISI, resection height and scaphoid working length and compared them to functional scores. Eighteen patients with 21 operated wrists were eligible. Average time to postoperative evaluation was 36 (5-78) months. We observed DISI in 95% of the cases (n=19). A mean increase of 13° (±6) in radiolunate angle was noted when comparing pre- and postoperative radiographs. Neither the amount of DISI nor the resection height was significantly correlated with the functional scores. No revision surgery for advanced wrist collapse was reported. Four concomitant surgeries were needed. Distal scaphoid excision with tendon interposition yields good short-term results in isolated STT OA. While 95% of cases developed a DISI deformity, there were no cases of functional impairment. Longitudinal studies with long-term follow-up are required to further evaluate lunate extension and possible clinical implications.

Ultrasound of wrist and hand masses.

Ultrasound is a useful tool to investigate soft tissue masses in the wrist and hand. In most situations ultrasound helps distinguish between a cyst and a tissue mass. This article provides a simple clinical approach to the use of ultrasound imaging for the diagnosis and preoperative assessment of wrist and hand masses.

Surgical reconstruction of an unstable rheumatoid thumb deformity. A case report.

The thumb is frequently impaired in rheumatoid arthritis. This leads to major disability in affected patients. Through a clinical case, we describe a reconstructive strategy for a three-joint adduction thumb deformity that caused instability of the interphalangeal and metacarpophalangeal joints, without cartilaginous lesion. Ulnar collateral ligament destruction was treated by a bone-ligament-bone graft at the interphalangeal joint and by a Littler ligamentoplasty at the metacarpophalangeal joint. The trapeziometacarpal lesion was treated by trapeziectomy in combination with suspension ligamentoplasty. Clinical and radiological assessments at 22 months of follow-up revealed good outcomes. This technique is a new option to include in the reconstructive treatment for thumb instability, particularly when caused by rheumatoid arthritis.

Volar perforators of common digital arteries: an anatomical study.

The palmar triangle is an area vascularized by perforator arteries arising from the common digital palmar arteries. The aim of this article was to perform an anatomical study of common digital palmar arteries perforators. Twelve injected specimens were included in this study. The purpose was to quantify the number of perforator arteries of each common digital palmar arteries in the 2nd, 3rd, and 4th intermetacarpal space, measure distances between them, between the distal perforator and corresponding commissure, and the distance between the proximal perforator and the superficial palmar arch. Four to eight perforators were arising from common digital palmar arteries of the 2nd, 3rd, and 4th intermetacarpal space. The average distance between perforator arteries was 6.5 mm, between superficial palmar arch and proximal perforator artery - 8.2 mm, between the distal perforator artery and corresponding commissure - 6.3 mm.

[Dislocation of the thumb extensor tendons: an anatomical, clinical study and new classification]. / Luxation des tendons extenseurs du pouce : étude anatomique, clinique et nouvelle classification.

The authors report on 11 cases of ulnar dislocation of the extensor pollicis longus (EPL) due to rupture of the dorsal aponeurosis at the thumb metacarpophalangeal (MCP) joint. This condition is rare. By performing a descriptive study of this injury, we were able to establish a classification system for thumb extensor tendon dislocation. The series included 11 patients with a mean age of 27years. All patients presented with either varus or rotational thumb injury. This resulted in an active extension deficit in the thumb MCP joint with EPL dislocation behind the MCP. Surgery was required in all cases. We defined three different injury presentations: 1) dissociated form with isolated EPL dislocation, but the EPB still in place; 2) complete form with dislocation of both tendons on the ulnar side of the MCP; 3) dissociated or complete form associated with a severe sprain of the lateral collateral ligament of the thumb MCP joint. The surgical treatment was adapted to each case. A classification into three types of dislocation of the extensor tendons at the MCP joint of the thumb was established. This rare condition must be identified at the time of thumb MCP joint injury and also when harvesting the EPB. This new classification system has a diagnostic and therapeutic role as it precisely describes the dislocation type and the resulting damage. Only a surgical treatment can produce good repairs.

[Fracture of a pyrolytic carbon proximal interphalangeal prosthesis: clinical case]. / Fracture d'une prothèse en pyrocarbone de l'articulation interphalangienne proximale : cas clinique.

Pyrolytic carbon prostheses are one of the options for the treatment of arthritis of the proximal interphalangeal (PIP) joint. Deficiency of the extensor mechanism, instability, dislocation and infection are the most frequent causes described for revision. We report the case of a female patient who underwent a PIP arthroplasty with a pyrolytic carbon implant of her right long finger; she suffered from an implant fracture only 11 months after surgery, a rare complication of this kind of implant; it makes think to fragility of this kind of implant.

[Imaging of wrist injuries in athletes]. / Imagerie du poignet du sportif.

Wrist imaging is currently used for diagnosis of sport injuries as part of a global strategy of rapid recovery. Standard x-rays are the first step in this procedure. Although arthrography is still the reference for the diagnosis of intrinsic ligament and cartilaginous lesions, MRI can sometimes be sufficient. Ultrasonography is a dynamic process and is accurate in detecting tendon injuries. Wrist sport injuries are frequent and often asymptomatic. Here we review the usual aspects of bone, ligament, and tendon lesions encountered in each sport, while providing advice on the most appropriate imaging for each clinical symptom.

[Failure of initial surgical treatment of a giant cell tumor of the capitate and its salvage: a case report]. / Echec du traitement chirurgical d'une tumeur a cellules géantes du capitatum et sa reprise: propos d'un cas.

Giant Cell Tumors are rare tumors in the young adult and localisation in the hand is even more exceptional. In the absence of adjuvant treatment, the literature reports a strong potential for local recurrence of between 75 and 86%. These tumours also have a risk of sarcomatosis degeneration and pulmonary metastasis. The case report concerns a 24-year-old patient, with a Giant Cell Tumour of the capitate initially diagnosed on simple curettage, and we describe her treatment together with the treatment of a subsequent reccurrence. A literature review will also highlight the current knowledge of this disease.

[Pathological fragmentation of the sesamoid bone of the index due to repetitive micro trauma: a case report and review of the literature]. / Pathologie par fragmentation du sésamoïde de l'index dans le cadre de microtraumatismes répétés: à propos d'un cas et revue de la littérature.

Pathology of the sesamoid bones have been rarely described in the literature especially those of the index. We present the case of a 45 years old amateur tennis player who presented with pain on the radial border of the index finger at the level of the metacarpophalangeal joint. The clinical examination and the operative findings allow us to conclude that the symptoms were due to tendinitis of the flexors of the index associated with fracture of the sesamoid and cartilaginous degenerative changes. We also present a review of the literature.

Closed rupture of the thumb flexor tendon pulleys.

Closed flexor tendon pulley ruptures are relatively rare injuries. All previously reported cases have been in the long finger pulleys. To our knowledge, there has not been a case of closed thumb flexor tendon pulley rupture reported in the literature. This paper presents two cases of this pathology and discusses appropriate treatment of it.

Extensor carpi ulnaris problems at the wrist--classification, surgical treatment and results.

Twenty-eight extensor carpi ulnaris lesions at the wrist were treated surgically between 1990 and 2002. Fifteen patients had an isolated extensor carpi ulnaris tenosynovitis or tendinopathy, five had extensor carpi ulnaris dislocation, four had an extensor carpi ulnaris subluxation and four had an extensor carpi ulnaris rupture. Seventeen patients first developed their symptoms while playing sports. At a mean follow-up of 23 months, twenty-two patients had returned to their previous activities. Seven of the 27 patients had lost more than 30% of their grip strength and five had restricted wrist motion. Two needed an extensor carpi ulnaris tenolysis. Pure isolated extensor carpi ulnaris lesions are rare and associated ulnar sided lesions (eleven triangular fibrocartilage complex tears and four lunotriquetral ligament tears), as well as possible predisposing factors (seven anomalous tendon slips, four ulnar styloid non-unions and one flat extensor carpi ulnaris tendon groove), were frequent. A classification of extensor carpi ulnaris tendon and subsheath lesions was developed to allow the surgeon to adequately evaluate the different components of these lesions.

Trigger finger treatment by ulnar superficialis slip resection (U.S.S.R.).

Surgical release of the A1 pulley for treatment of trigger finger normally produces excellent results. However, in patients with long-standing disease, there may be a persistent fixed flexion deformity of the proximal interphalangeal joint. This is sometimes due to a degenerative thickening of the flexor tendons and may be treated by resection of the ulnar slip of flexor digitorum superficialis tendon. One hundred seventy-two patients (228 fingers) who had undergone this procedure were reviewed at a mean follow-up of 66 months. Mean pre-operative fixed flexion deformity of the proximal interphalangeal joint was 33 degrees. All but eight fingers were improved by surgery and there was an average gain of 26 degrees in passive extension (7 degrees residual fixed flexion deformity) of the proximal interphalangeal joint. Full extension was attained in 141 of the 228 fingers, and in all 101 fingers with a pre-operative loss of passive extension of 30 degrees or less. This technique is indicated for patients with loss passive extension in the proximal interphalangeal joint and a long history of triggering.

Responsiveness of the Cochin rheumatoid hand disability scale after surgery.

OBJECTIVE: To assess the responsiveness of the Cochin functional disability scale for the rheumatoid hand after surgery. METHOD: In a prospective study, patients with rheumatoid arthritis (RA) scheduled for surgery of the wrist and/or fingers were evaluated within 48 h before surgery and at least 6 months after surgery. Clinical outcome measures included duration of morning stiffness, total score for tenderness, total score for swelling, visual analogue scale score for pain in the hands and wrists, a score for overall mobility of the wrist and the fingers, grip and pinch strength, the Hand Functional Index (HFI), the Kapandji index and the Cochin scale. Responsiveness was assessed with the paired t-test, the effect size (ES), the standardized response mean (SRM) and the non-parametric Spearman rank correlation coefficient (r(S)). RESULTS: Fifty patients (42 women) were evaluated twice at an interval of 7.16 +/- 2.10 months (mean +/- s.d.) (range 6-15 months). Thirty-six patients (72%) were very satisfied or satisfied with the results of surgery, seven (14%) were not satisfied or dissatisfied and seven (14%) were dissatisfied or very dissatisfied. The Cochin scale score improved at the second visit (P < 0.0001), with SRM and ES values of 0.66 and 0.58 respectively. The correlation of the change in Cochin score with patient overall satisfaction was r(S) = 0.40. Among the impairment measures, grip strength showed the best responsiveness (SRM = - 0.43, ES = - 0.36, correlation with patient overall satisfaction r(S) = 0.46). The change in Kapandji index had the best correlation (r(S) = 0.51) with patient overall satisfaction but its SRM and ES values were low (- 0.19 and - 0.10 respectively). CONCLUSION: The Cochin scale is responsive and appropriate for the assessment of the effects of surgical treatments on disability in RA hands.

[Osteogenic exostosis of the capitate bone. Case report and review of the literature]. / L'exostose ostéogénique du capitatum. Présentation d'un cas et revue de la littérature.

The occurrence of an osteochondroma in the carpus is very rare and its excision is indicated in the case of significant symptoms or change in its appearance. The diagnosis is often made in adulthood due to the onset of a functional problem even though development of the tumour occurs during skeletal growth. We report the case of a 38 year old patient, with no antecedent trauma, who presents with simultaneous exostoses on the dorsal and palmar surfaces of the capitate, which has not been previously described in the literature. The existence of a bipolar lesion extending anteriorly and posteriorly in the carpus is a possibility which may not be apparent and renders plain radiograph insufficient in the investigation of such a lesion. CT scan and MRI scan are indispensable in the investigation of this kind of carpal lesions, allowing better visualization of the base of the tumour, the expansion of the tumour and relation to the neighbouring soft tissues and the presence of malignant degeneration.

Subcutaneous herniation of tendon interposition after trapeziectomy in three cases: explanation and implications.

We report a complication following trapeziectomy and tendon interposition. Subcutaneous herniation of the tendon interposition occurred in 3 of 412 cases in which trapeziectomy, ligament reconstruction, and tendon interposition were performed. This herniation occurred posterolaterally in the early postoperative period and resulted in dorsal swelling and superficial pain. Magnetic resonance imaging was helpful in confirming the diagnosis and excision of the herniated interposition material resulted in satisfactory pain relief and functional outcome as long as metacarpal stability was present.

Hemangiomas of the fingers: MR imaging evaluation.

PURPOSE: To report the magnetic resonance (MR) imaging features of finger hemangiomas. MATERIALS AND METHODS: Sixteen patients clinically suspected of having hemangioma of the finger underwent 1.5-T MR imaging with a customized local gradient coil. The location, size, margins, signal intensity, and enhancement patterns of the lesions were noted. In accordance with the literature on MR imaging of deep hemangiomas, the authors' findings could be divided into those with typical features-that is, high signal intensity at T1- and T2-weighted imaging, lobulated appearance, strong enhancement, and heterogeneous pattern with flow void artifacts-and those with atypical features. The reference standard was surgery (n = 12) or clinical outcome (n = 4). RESULTS: One posttraumatic hematoma was excluded. Most lesions were in the fingertip (n = 10), with involvement of the nail bed and/or the pulp (n = 5). Hemangiomas were classified as typical in ten cases and atypical in five. The mean size of typical lesions was larger than that of atypical lesions. The unique imaging features of atypical hemangiomas included a masslike appearance, which was either homogeneous with diffuse enhancement-suggestive of hypervascularity (n = 2)-or heterogeneous with poor enhancement (n = 3). CONCLUSION: MR imaging characteristics of finger hemangiomas can be classified as typical or atypical. Knowledge of both patterns can be helpful in the distinction of soft-tissue abnormalities at this location.

Surgical treatment of compression of the lateral antebrachial cutaneous nerve.

We describe an operation to relieve compression of the lateral antebrachial cutaneous nerve at the elbow. Between 1987 and 1997 we operated on seven patients, one with bilateral compression. In two the compression was associated with injury to biceps. A longitudinal or a transverse incision was carried out and the nerve was released from the deep fascia. Partial excision of the biceps aponeurosis was undertaken in the patients who did not have injury to biceps; some additional procedures were required for those patients with injuries. All patients had symptomatic relief.

[Glomus tumor of the nail area. Apropos of a series of 55 patients]. / Les tumeurs glomiques de la région unguéale. A propos d'une série de 55 patients.

PURPOSE OF THE STUDY: Glomus tumors are infrequent in the hand. We have review 55 cases, localized in the nail area to discuss their diagnosis and surgical approach. MATERIAL AND METHODS: Out of 80 glomus tumors of the hand seen in two hand units, 55 were located around the nail area, 33 in the nail bed area, 8 at the nail root and 14 laterally. The population was predominantly female (42 cases) and the mean age 43 years. The mean delay before presentation was 37 months. Pain was the main symptom (97 per cent) increased by trauma and cold. A blue spot was visible in 15 cases and diagnosis was performed on clinical ground in all cases except two. A notch was present on X-ray in 16 cases. A prospective study with MRI allow a diagnosis in 18 of 21 cases. All tumors were removed through a lateral approach elevating the nail complex and confirmed histologically. RESULTS: The diagnosis was per-operatively confirmed in 53 cases and performed in one case. The last case of supposed hemangioma was modified at histological examination. No case of nail dystrophy (not existing pre-operatively) or residual pain was seen at the 81 months of follow up. Seven recurrences were observed, 4 of them having been operated initially in our units. DISCUSSION: Clinical diagnosis could be performed on clinical grounds. MRI is to be reserved to recurrences or multi-operated patients. Risk of recurrence has to be mentioned pre-operatively to the patient. CONCLUSION: Lateral approach with nail complex elevation is safe, allowing excision of the tumor without nail dystrophy.

Primary synovial osteochondromatosis of the hand and wrist. Report of a series of 21 cases and literature review.

OBJECTIVES: To define the characteristics of synovial osteochondromatosis of the hand and wrist. PATIENTS AND METHODS: Retrospective study of 21 patients, including 11 with intraarticular and 10 with tenosynovial disease. Cases secondary to degenerative joint disease were excluded. Surgery consisted in removal of the osteocartilaginous bodies and of the adjacent synovial membrane. Mean follow-up was seven years (range, three to 18 years). The relevant literature was reviewed in part. RESULTS: Recurrence was seen in four patients and was multiple in two of these four. Most recurrences occurred within five to ten years after surgery. All four patients with recurrences had intraarticular disease. No cases of malignant transformation were seen. The characteristics of synovial osteochondromatosis at the hand and wrist are reviewed. CONCLUSION: Detailed preoperative investigations including computed arthrotomography and magnetic resonance imaging should be performed to increase the likelihood of complete excision.