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.

Four-corner arthrodesis using the 4Fusion® quadripodal shape memory staple: a long-term review.

We investigated the reliability of the 4Fusion® quadripodal memory staple in a consecutive series of 59 four-corner arthrodeses in a single centre. Forty-one patients (46 wrists) had a radiological and clinical assessment at a mean follow-up of 7.4 years. Thirteen patients (13 wrists) were lost to follow-up. Bone union was achieved in all but one patient. Seven patients were reoperated, six for device removal and one for nonunion. Most patients were satisfied, had a functional range of wrist mobility, good strength and were free of pain, comparable with the best previously reported series.Level of evidence: IV.

Retrospective, multicenter, observational study of 112 surgically treated cases of humerus metastasis.

INTRODUCTION: The humerus is the second most common site for metastasis in the peripheral skeleton. These humeral metastases (HM) occur in the midshaft in 42% to 61% of cases and theproximal humerus in 32% to 45% of cases. They are often secondary to primary breast (17-31%), kidney (13-15%) or lung (11-24%) cancer. The optimal surgical treatment between intramedullary (IM) procedures, fixation or arthroplasty is still being debated. HYPOTHESIS: We hypothesized that fixation and/or arthroplasty are safe and effective options for controlling pain and improving the patients' function. MATERIALS AND METHODS: Between 2004 and 2016, 11 French hospitals included 112 continuous cases of HM in 54 men (49%) and 57 women (51%). The average age was 63.7±13.4 years (30-94). The HM occurred in the context of primary breast (30%), lung (23%) or kidney (21%) cancers. The HM was proximal in 35% of cases, midshaft in 59% and distal in 7% of cases. Surgery was required in 69% of patients because of a pathological fracture. The surgical procedure consisted of bundle pinning, plate fixation, arthroplasty or locked IM nailing in 6%, 11%, 14% and 69% of patients, respectively. RESULTS: Seven patients (6%) had to be reoperated due to surgical site complications including two infections and four fractures (periprosthetic or away from implant). Twelve patients (11%) experienced a general complication. The overall survival was 16.7 months, which was negatively and significantly impacted by the occurrence of a fracture, a diaphyseal location and the type of primary cancer. At the final assessment, 75% had normal or subnormal function and more than 90% were pain-free or had less pain. The final function was not related to the occurrence of a fracture or etiology of the metastasis. In epiphyseal and metaphyseal HM, there was a trend to better function after shoulder arthroplasty than after plate fixation or IM nailing. CONCLUSIONS: Our initial hypothesis was confirmed. Our findings were consistent with those of other published studies. Based on our findings, we recommend using static locked IM nailing with cementoplasty for mid-shaft lesions and modular arthroplasty for destructive epiphyseal or metaphyso-epiphyseal lesions. The criteria for assessing humeral fracture risk should be updated to allow the introduction of a preventative procedure, which contributes to better survival. LEVEL OF EVIDENCE: IV, retrospective study.

Extensive Necrotic Skin Lesions Due to Post-varicella Protein S Deficiency.

Postvaricella protein S deficiency is a rare and severe disease. We report a case of extensive necrotic skin lesions of acute onset 7 days after varicella in a 4-year-old girl. Protein S antigen and activity were <10%, and antiprotein S antibodies were detected. She was treated with anticoagulation, plasmapheresis and fresh frozen plasma. She survived but required leg amputation.