Fractures of the fifth metacarpal neck treated by syndactyly: functional and quality of life outcomes of a series of 39 patients.

The management of the fractures of the fifth metacarpal neck is still debated between surgical, orthopedic, and functional treatments. The main objective of our study was to report the functional results at two, six, and twelve weeks of patients treated with syndactyly for fifteen days for a fracture of the neck of the fifth metacarpal and to determine if these results were compatible with a short-term medical follow-up and if they allowed for a quick return to work. Thirty-nine patients were retrospectively included. Functional results and their variations were analyzed at two, six, and twelve weeks using self-questionnaires filled out during consultation (VAS scores, QuickDASH, EuroQol-5D-5L, and EuroQol- 5D-VAS). The duration of work leave was extracted from medical records. Two weeks after the trauma, patients mostly had a very moderate impact of their fracture on their daily life with an average VAS of 4.2±1, QuickDASH of 42.2±20.9, and EuroQol-5D-VAS of 78±11. QuickDASH and EuroQol-5D-VAS scores showed significant improvement between two and twelve weeks of follow-up, decreasing from 42.2±20.9 to 2.1±6 and from 78±11 to 96±6, respectively (p<0.0001). The dimensions of common activities, pain, and autonomy had the most patients in the "moderate impairment" subgroup at two weeks. Only the dimension of common activities still had 21% of patients moderately impacted. Twenty-five patients returned to work at an average of 21.8±1.5 days. Syndactyly treatment offers good functional results at two weeks that are confirmed during follow-up, compatible with reduced medical follow-up and early return to work.

Could intraoperative ultrasound improve clinical and radiological outcomes during arthroscopic calcification evacuation of rotator cuff?

Background: Martinel et al described an intraoperative ultrasound technique to easier identify calcification (CA) under arthroscopy. Our hypothesis was that intraoperative ultrasound monitoring allowed better evacuation of calcific tendinopathy. Our aim was to determine whether ultrasound monitoring improved the short-term clinical and radiological outcomes of calcific tendinopathy. Methods: A prospective, single-center, single-operator, consecutive study conducted between February 2020 and June 2023. The inclusion criterion was surgical treatment for evacuation of symptomatic macro-centimetric CA type A or B. The first 20 patients were operated on using the standard surgical technique and the next 20 under ultrasound control. The mean age at surgery was 49.8 years (minimum: 28 years; maximum: 64 years). Patients were reviewed at 6 weeks and 3 months. The evacuation of the CA was checked at 6 weeks by X-ray. Results: In the standard technique group, the mean preoperative Constant score was 41.4/100 (±15.07). Postoperatively, the Constant score was 58.88/100 (±15.28) at 6 weeks and 69.16/100 (±13.86) at 3 months. The mean preoperative Subjective Shoulder Value (SSV) was 39.0% (±18.61). Postoperatively, the SSV was 64.0% (±17.21) at 6 weeks and 79.47% (±16.06) at 3 months. In the ultrasound control group, the preoperative Constant score was 44.48/100 (±14.28) and 58.18/100 (±15.64) at 6 weeks and 66.87/100 (±18.45) at 3 months postoperatively. The mean preoperative SSV was 40.0% (±16.54) and 61.75% (±18.59) at 6 weeks and 76.05% (±19.62) at 3 months postoperatively. There was no significant postoperative difference in Constant score (P = .732) or SSV (P = .566) between the 2 groups. There was a significant difference (P = .004) between the 2 groups in terms of complete evacuation of the CA with the standard technique in 65% of cases (13 patients out of 20) and with intraoperative ultrasound monitoring in 95% of cases (19 patients out of 20). Conclusion: There was no significant postoperative difference in Constant score and SSV between the 2 groups in the short term. Evacuation of calcification was significantly better with ultrasound monitoring.

Denosumab in the management of Aneurysmal bone cyst.

BACKGROUND: Aneurysmal bone cyst (ABC) is a benign, locally aggressive tumour that arises predominantly in long bones and spine. Following the encouraging results of denosumab use in Giant Cell Tumors (GCT) and the histological similarities between ABC and GCT, the interest on the role of denosumab in the therapeutic arsenal of the most advanced ABC is growing. The purpose of this literature review is to investigate the current state of knowledge about the use of denosumab in ABCs. METHODS: A literature research was conducted through PUBMED, COCHRANE and GOOGLE SCHOLAR using the keywords "aneurysmal bone cyst" AND "denosumab". Seventeen articles were included. RESULTS: A total of 43 cases were reported in the literature. There were 23 males, 20 females. The mean age was 15,9±8,1 year. Pain relief and neurological improvement were rapid and sustained. Radiological assessment showed ossification and/or volume reduction in 36/39 patients. Eight patients (18,6%) presented a recurrence after or during denosumab therapy of whom 7 were adults. Adverse events occurred in 11 patients, 5 of them were admitted to the intensive care unit due to hypercalcemia. CONCLUSION: Denosumab use in non-surgical ABCs has shown a positive impact in pain and neurological symptoms. The oncological outcome remains unclear with a recurrence rate of 18,6% during/after denosumab therapy, mostly in adults. However, regarding the potential clinical benefits, its use might be discussed in the most advanced cases. Further research and clinical trials are mandatory to precise its belonging in the therapeutic arsenal.