Fifth carpometacarpal fracture dislocations fixed with Meta-HUS®: a series of 31 cases.

Fracture dislocations of the fifth carpometacarpal are usually treated by percutaneous K-wires despite occasional complications: displacement, stiffness, malunions, and arthritis. Our aims were to evaluate the use of locked K-wire fixation for these fracture dislocations. Our series includes 31 fracture dislocations, five extra-articular and 26 articular, 21 of which were at the base of the metacarpal, four at the hamate, and one involving both the hamate and the metacarpal. Mean tourniquet time was 22 min and irradiation 2 mGy. After reduction, an M4 M5 K-wire and a carpometacarpal wire were connected using an MetaHUS® connector. Immediate immobilization was allowed. Return to normal activity was resumed at 6.5 weeks. At around 15 months follow-up, mean pain score was 8.5, Quick DASH was 6.36, and overall grip strength was 92%, TAM of the fifth ray was 96% of the contralateral side. There were two displacements that were re-operated with good result, three superficial infections, and one case of stiffness. All fractures healed without arthritis. Overall, percutaneous K-wire and splinting of fracture dislocations of the fifth carpometacarpal joint is unstable, and internal fixation can cause adhesions and stiffness. Our results show that the percutaneous locked K-wire technique is a good alternative as it associates closed reduction with K-wire fixation and a solid fixation using an external connector. This technique allows immediate mobilization of the hand and removal of hardware in clinic.

Scapholunate injuries: challenging existing dogmas in anatomy and surgical techniques.

The management of scapholunate injuries and dissociation remains debatable. Traditional methods of fixation had centred around open procedures, but advances in wrist arthroscopic techniques has redefined both major anatomical findings and operative approaches. This article challenges two main existing dogmas: first, the anatomy of the scapholunate ligament and second, the management of these injuries. For the first, we propose that scapholunate stability is in fact maintained by a whole anatomic complex, consisting of well-defined capsuloligamentous structures and extrinsic ligaments, and that the scapholunate ligament itself probably has a limited role. For the second, we challenge the notion that scapholunate injuries often require open procedures and propose that mini-invasive arthroscopic dorsal repair of the scapholunate complex is an efficient technique and sufficient for achieving long-term stability.

Limb replantation with two robots: a feasibility study in a pig model.

The aim of this study is to assess the feasibility of limb replantations and transplantations by telesurgery. The material consisted in a large white pig and two surgical robots (DaVinciS telemanipulators). The procedure consisted in a trans-humeral cross-section of the left thoracic limb, which was secondarily replanted. Results showed good vascular permeability, while the operator's physiological tremor was suppressed. Our results seem to demonstrate that telesurgery could improve limb replantation and transplantation management, especially regarding operating gesture precision.

Minimally Invasive Plate Osteosynthesis for a Distal Radius Fracture with Forearm Skin Problem.

In this study, we performed osteosynthesis for a distal radius fracture using a minimally invasive approach for a patient with skin disorder of the forearm and obtained favorable results. This case report may provide new findings confirming the usefulness of this surgical approach for distal radius fractures. Blister formation on the right forearm was observed in a 53-year-old female who was diagnosed with a distal fracture of the right radius and underwent splinting in a local hospital, and she was referred to our hospital 2 days after the injury. Minimally invasive locking plate osteosynthesis was performed, and there was no skin lesion at this incision site. Postoperatively, there were no complications in soft tissues and the operative scar was almost unrecognizable. We reported volar locking plate osteosynthesis using the minimally invasive approach in a patient with skin disorder of the forearm. Such patients are rarely encountered. However, this minimally invasive approach is extremely useful for utilizing the advantages of volar locking plate fixation without being affected by the soft tissue environment.

Vascularized nail transfer from non-replantable digit: a case report.

We report the case of a traumatic amputation by circular saw of the ring and small fingers, associated with middle finger nail matrix loss and tendon, bone and joint exposure. The replantation was not attempted with patient's consent. Since the nail unit from the ring finger was intact, we decided to harvest the ring finger nail unit for major finger reconstruction. Although the principle of vascularized transfer from a severely damaged finger is widely recognized and the vascularized nail transfer from toe is a relatively common procedure, there is no description of a vascularized nail transfer from a non-replantable digit in the literature.

Arthroscopic assisted percutaneous screw fixation of Bennett's fracture.

Several techniques are used for fixation of Bennett's fractures. The aim of this study was to assess a technique of arthroscopic-assisted reduction and percutaneous cannulated screw fixation of Bennett's fractures. Seven patients (mean age 29 years) with three fractures Type I and four fractures Type II according to Gedda were operated under arthroscopic lavage, fluoroscopic screw fixation, and arthroscopic control of the joint reduction. Arthroscopy, showed satisfactory joint reduction in all cases. At 4.5 months, the mean pain score was 1 (0-4), QuickDASH 15 (0-61), and Kapandji score 9 (5-10). Compared to the contralateral side, first web opening was 86% (58-100), key pinch 73% (45-89), grip strength, and 85% (40-100). Four secondary displacements were noted, two of which had a step of more than 1 mm. Our results showed that the use of arthroscopy for percutaneous screw fixation of Bennett's fractures facilitates joint reduction but does not guarantee stability of fixation.

The utility of the fluoroscopic skyline view during volar locking plate fixation of distal radius fractures.

Background Open reduction and internal fixation (ORIF) using a volar locking plate is a common method for treating displaced distal radius fractures. There is, however, the risk of extensor tendon rupture due to protrusion of the screw tips past the dorsal cortex, which cannot always be adequately seen on a lateral fluoroscopic view. We therefore wished to compare the sensitivity of an intraoperative fluoroscopic skyline view to a lateral fluorosocopic view in detecting past pointing of these screws. Material and Methods Our series included 75 patients with an average age of 59 years who underwent volar locked plate fixation of a displaced distal radius fracture. Intraoperative anteroposterior (AP), lateral, and skyline fluoroscopic views were performed in each case. The number of screws that were seen to protrude past the dorsal cortex of the distal fracture fragment were recorded for both the lateral and skyline views. The number of screws that required exchange was also documented. Results No screws were seen to protrude past the dorsal cortical bone on the lateral fluroscopic views. 15 of 300 screws (5%) were seen to protrude past the dorsal cortex by an average of 0.8 mm (range, 0.5 to 2 mm) and were exchanged for shorter screws in 11/75 patients. Conclusion Our results demonstrate that the skyline is more sensitive than a lateral fluoroscopic view at demonstrating protrusion of the screws in the distal fracture fragment following volar locked plate fixation. Level of Evidence IV.

Percutaneous fixation of first metacarpal base fractures using locked K-wires: a series of 14 cases.

The treatment of choice for first metacarpal base fractures is surgical. Open fixation is stable but causes tendinous adhesions. Percutaneous fixation is minimally invasive but is often followed by secondary displacement. Herein, we describe an alternative approach that combines advantages of both techniques through increasing stability of the Iselin technique by externally connecting the K-wires. Our series included 13 men of mean age 28 years. There were 13 fractures, 6 of which were extra-articular; there were 7 Bennett fractures, 5 of which had a large fracture fragment. After reduction, two 18 mm K-wires were driven medially crossing the 3 cortices of the first and second metacarpals. After bending them at 90-degree angles, the K-wires were connected externally in a construction allowing adaptation of the gap between the K-wires. Gentle immediate mobilization was allowed and the K-wires were removed 6 weeks later in clinic. At 16-month follow-up, mean pain score was 0.2/10 and Quick DASH was 2.9/100. Pinch grip was 81.8% of the contralateral side and grip strength 91.2%. The first web space opening was 79.1%. There was 1 secondary displacement with a good final result and 2 malunions. No arthritis was noted, but the follow-up was short. Our results show that the Iselin technique using locked K-wires is minimally invasive, stable, allows immediate mobilization, and K-wire removal in the office. Its indications may be extended to all fractures of the base of the first metacarpal whether articular or extra-articular.

Hamate hook nonunion treated with a hook plate: case report and surgical technique.

Despite of its rarity, hamate hook nonunion can cause several complications like tendon rupture or loss of grip strength. Admitted treatments in the literature are excision of the bone fragment or its open reduction and internal fixation. We report a clinical case of a high-level baseball player with hamate hook nonunion treated with an original technique of fixation using a hook plate.

Nerve repair in telemicrosurgery: an experimental study.

Since the development of microsurgery in the 1960s, the prognosis of peripheral nerve lesions has greatly improved. However this new technique's evolution has remained limited by human factors, in particular by physiological tremor. Telesurgery, a technique used in other surgical fields, was developed in the 1990s. This study assesses the feasibility of peripheral nerve repair using telemicrosurgery. Anatomical material from three subjects of different species (rat, pig, and human) was used. The telesurgical step of the procedure was performed with a Da Vinci S robot (Intuitive Surgical, Inc., Sunnyvale, CA). Four anatomical epiperineural repairs were performed. Another neurotrophic repair was performed with a nerve regrowth guide. Regardless of the type of repair performed, the telemanipulator removed the physiological tremor factor. The suture needle was distorted when held by two clamps at a time. Repairs were all performed without any damaging twisting movements of both nerve ends. Our results demonstrated that telesurgery allows very safe and precise peripheral nerve repairs by counteracting physiological tremor and by improving the overview of the surgical field, either with an anatomical or a neurotrophic technique.