Risk of suprascapular nerve injury in open Trillat procedure: an anatomical study.

PURPOSE: The open Trillat Procedure described to treat recurrent shoulder instability, has a renewed interest with the advent of arthroscopy. The suprascapular nerve (SSN) is theoretically at risk during the drilling of the scapula near the spinoglenoid notch. The purpose of this study was to assess the relationship between the screw securing the coracoid transfer and the SSN during open Trillat Procedure and define a safe zone for the SSN. METHODS: In this anatomical study, an open Trillat Procedure was performed on ten shoulders specimens. The coracoid was fixed by a screw after partial osteotomy and antero-posterior drilling of the scapular neck. The SSN was dissected with identification of the screw. We measured the distances SSN-screw (distance 1) and SSN-glenoid rim (distance 2). In axial plane, we measured the angles between the glenoid plane and the screw (α angle) and between the glenoid plane and the SSN (ß angle). RESULTS: The mean distance SSN-screw was 8.8 mm +/-5.4 (0-15). Mean α angle was 11°+/-2.4 (8-15). Mean ß angle was 22°+/-6.7 (12-30). No macroscopic lesion of the SSN was recorded but in 20% (2 cases), the screw was in contact with the nerve. In both cases, the ß angle was measured at 12°. CONCLUSION: During the open Trillat Procedure, the SSN can be injured due to its anatomical location. Placement of the screw should be within 10° of the glenoid plane to minimize the risk of SSN injury and could require the use of a specific guide or arthroscopic-assisted surgery.

A New Arthroscopic Classification of Triangular Fibrocartilage Complex Disorders.

Introduction The use of wrist arthroscopy has become a prerequisite for diagnosis and treatment of triangular fibrocartilage complex (TFCC) disorders. Since Palmer's landmark paper, many new arthroscopic descriptions of TFCC tears have been published but there is no currently available updated comprehensive arthroscopic classification of TFCC lesions. Purpose We recently described the arthroscopic anatomy of the TFCC as viewed from a 3-4 portal. Our purpose was to propose a new TFCC disorders classification based on this new arthroscopic TFCC description. Methods We included all currently described TFCC disorders to the best of our knowledge into our arthroscopic, functional, and vascular anatomical concept. We also included patient's specific ulnar variance and distal radial ulnar joint coronal inclination as baseline treatment-oriented parameters. The fresh or chronic, reparable or nonreparable nature of some types of TFCC tears were considered as separate parameters. Results The proposed classification includes disc "D" (degenerative or traumatic), reins "R" (traumatic), and wall "W" (traumatic) lesions. Combined lesions of those three parts of the TFCC may be easily identified. This new classification should facilitate future analysis of isolated or combined TFCC disorders whether they are degenerative and/or traumatic. Discussion The authors present a new three-dimensional-three-part arthroscopic updated description of TFCC disorders with relevance to etiology and treatment principles.

Role for Wrist Hemiarthroplasty in Acute Irreparable Distal Radius Fracture in the Elderly.

Volar locking plates for distal radius fracture (DRF) in the elderly may show complications in the most comminuted osteoporotic cases. The authors provide criteria for DRF in elderly that may not be amenable to volar plating ("irreparable DRF") and review the current results of a preliminary series of wrist hemiarthroplasty for these injuries. Between 2011 and 2019, 28 wrists with acute irreparable intra-articular DRF were treated with wrist hemiarthroplasty (96% female, mean age 79 years). A total of 17 wrists with a mean follow-up of 32 months were reviewed. At follow-up, mean visual analog scale (VAS) pain was 1/10, mean forearm rotation arc was 148°.

New Computerized Elbow and Forearm Clinical Scores.

Background Current elbow clinical scores are scarce with limited comparability between them. None of them are computerized yet. There is no forearm clinical score assessing all anatomical components of forearm disorders such as the Essex-Lopresti injuries. The aims of this paper were to present new computerized elbow and forearm clinical scores. Methods These new computerized elbow and forearm clinical scores include four clinical criteria: pain, function, active range of motion and muscle strength. To each criterion is given a numerical value among 5 grades. The weight of each criterion is equivalent so that patient's and physician's related scores are equally balanced. Results Clinical scores components are automatically included into diamond-shape graphs and tables that can be directly exported into PowerPoint presentations for demonstration and comparison purposes. Discussion These user-friendly updatable clinical elbow and forearm scores are based on four classic clinical criteria, pain, function, motion, and strength that are expressed into grades. They were designed to evaluate any osteoarticular elbow or forearm disorder regardless of the etiology. These scores are open since they may be modified in future versions.

Arthroscopically Assisted Treatment of Volar Rim Fractures.

Background Arthroscopically-assisted reduction and internal fixation (AARIF) for distal radius fractures (DRF) has been extensively described. Little information is available about AARIF in AO "B3" and "C" DRF with displaced lunate facet volar rim fragment (VRF) and volar carpal subluxation. However, lunate volar rim fragment (LVRF) may be very difficult to reduce and fix under arthroscopic control using the flexor carpi radialis (FCR) or FCR extended approaches while traction is applied. Purposes The aims were to describe our surgical technique of AARIF of partial or complete DRF with VRF and provide information about how often this technique may be necessary, based on a large DRF database. Methods The dual-window volar approach for complete articular AO C DRF with volar medial fragment was described in 2012 for performing open reduction internal fixation (ORIF). Since 2015, we have used the dual-window approach for AARIF of "B3" or "C" DRF with volar carpal subluxation. We analyzed our PAF database, searching for patients treated with AARIF in "B3" and "C" fractures. Results The dual-window volar approach is very useful when using AARIF for AO "B3" and "C" DRF with displaced VRF and volar carpal subluxation. The anteromedial part of the exposure allows a direct access to reduction and fixation of the LVRF under traction and arthroscopic control. Overall, 1% of all articular DRF in this series showed a displaced LVRF amenable to the dual-window volar approach. Conclusion It is almost impossible to access and properly fix a VRF using traction and arthroscopic control through the FCR or FCR extended FCR approach because of the stretched flexor tendon mass. The use of the dual-window approach during AARIF of AO "B3" or "C" DRF has not previously been reported. Displaced VRF are rare whether they were part of "B3" or "C" fractures. If AARIF is chosen, we strongly recommend the use of the dual-window volar approach for AO "B3" and "C" fractures with VRF. A single anteromedial approach can also be used for isolated "B3" anteromedial DRF.

Satisfactory Outcomes of All-Poly Fixed Bearing Unicompartmental Knee Arthroplasty for Avascular Osteonecrosis Versus Osteoarthritis: A Comparative Study With 10 to 22 Years of Follow-up.

BACKGROUND: While good mid-term results for treating spontaneous knee osteonecrosis (SPONK) with unicompartmental knee arthroplasty (UKA) have been reported, concerns remain about implant survival at long-term. This study aimed to compare outcomes and survivorship of UKA for SPONK vs osteoarthritis at a minimum of 10 years. METHODS: This case-control study included medial UKA for femoral SPONK operated between 1996 and 2010 with a minimum 10-year follow-up (n = 47). Each case was matched with a medial UKA for osteoarthritis based on body mass index (BMI), gender, and age. Knee Society Score (KSS), complications and radiological (loosening) data were collected at the last follow-up. Kaplan-Meier survivorship analysis was performed using revision implant removal as endpoint. RESULTS: The mean follow-up was 13.2 years (range 10 to 21 years). Mean age and BMI were 72.9 ± 8.4 years and 25.5 ± 3.6 Kg/m2 in SPONK group. At last follow-up, knee and function KSS were 89.5 ± 12 and 79 ± 18 in SPONK group vs 90 ± 15 (P = .85) and 81.7 ± 17 (P = .47) in control group. Complications and radiological results showed no significant differences. The survival rate free from any revision was 85.1% at last follow-up in SPONK group and 93.6% in control group (P = .23). The leading cause for revision was aseptic tibial loosening (57.1%) in SPONK group. The 15-year survival estimate was 83% in SPONK group. CONCLUSION: Satisfactory clinical outcomes at long-term after UKA for femoral SPONK were observed, similar to those after UKA for osteoarthritis, despite a higher risk of tibial loosening in the SPONK group. No symptomatic femoral loosening leading to a revision was observed. LEVEL OF EVIDENCE: IV.