Acute Essex-Lopresti Syndrome: About a Case of Brachioradialis Tendon Transfer.

Background The classic treatment for acute Essex-Lopresti syndrome is closed reduction percutaneous pinning (CRPP) of the distal radioulnar joint (DRUJ). This work aimed to verify whether it was possible to add a transfer of the brachioradialis tendon to the pinning. Case Description The patient was a 39-year-old right-handed man, climbing instructor, who sustained the Mason II fracture and disjunction of the DRUJ. A transfer of the brachioradialis tendon severed from its muscle attach that was made through a bone tunnel passing through the radius and the neck of the ulna. The clinical and radiological result at the 6-month follow-up was satisfactory. Literature Review and Clinical Relevance Our results in a single case showed that the brachioradialis tendon transfer was useful in acute Essex-Lopresti syndrome.

Homogenization of the management of acute paronychia with abscess formation within the context of an evaluation of professional practices.

INTRODUCTION: There is no consensus in the literature, or even within the same team, on the most appropriate treatment option for acute paronychia with abscess formation. The performance of an evaluation of professional practices (EPP) using a clinical audit measures the quality of our practices with the aim of standardizing them. Therefore, the primary objective of this study was to develop a clinical pathway for the management of acute paronychia with abscess formation. The secondary objectives were to evaluate our professional practices using a clinical audit before and after the dissemination of the clinical pathway and then recommend strategies for improving our management of acute paronychia with abscess formation. MATERIALS AND METHODS: A working group was established that designed an audit grid comprised of 15 items. Thirty patients (Group 1) who had an acute paronychia with abscess formation were included and their health records were analyzed using this audit grid. The working group then developed a clinical pathway for the management of acute paronychia with abscess formation. Thirty new patients (Group 2) were included after the dissemination of this clinical pathway and their records were analyzed using the same audit grid. RESULTS: Our clinical pathway for the management of acute paronychia was validated by the local infectious disease committee of our university hospital center. The difference between groups 1 and 2 was significant (p<0.05) for eight items. There was no significant difference in the rate of surgical revision between the two groups. DISCUSSION: This EPP enabled us to develop a clinical pathway that detailed the processes for managing acute paronychia with abscess formation, and in particular it provided indications for antibiotic therapy and its limitations. LEVEL OF EVIDENCE: IV, retrospective study.

Arthroscopic intramedullary nailing of humeral fractures through the rotator interval.

INTRODUCTION: Antegrade nailing of humeral fractures is a proven technique with well-documented results. The standard surgical approach requires incision of the supraspinatus tendon to insert a nail, which comes with the risk of damaging the rotator cuff. The aims of this study were to describe a new surgical technique for arthroscopic humeral nailing that does not require opening the rotator cuff and to report the clinical and radiological outcomes of this technique. MATERIALS AND METHODS: This was a single center, retrospective study of patients who had a humeral shaft or surgical neck fracture at our hospital in 2017 and underwent antegrade intramedullary nailing by arthroscopy. The nail was introduced through the rotator interval without opening the rotator cuff. All were reviewed at 1-year postoperative: clinical examination (joint range of motion and Constant score) plus AP and lateral radiographs of the shoulder. RESULTS: Eighteen patients (12 women, 6 men) with a mean age of 65.4 years (37-84) were included retrospectively. One patient died during the follow-up period thus 17 patients were available for analysis. At the 1-year follow-up, the mean forward flexion was 152.1° (90-180), the mean external rotation was 56.1° (30-80), the mean absolute Constant score was 73.9 (54-88) points and the mean adjusted Constant score was 93.5 (67-100) points. Bone union was achieved in 16/17 patients (94%) with 1 patient experiencing a nonunion. There were no complications. CONCLUSION: Arthroscopic antegrade nailing of humeral shaft and surgical neck fractures through the rotator interval yields good clinical and radiological results in our hands. This new, rotator cuff-sparing technique is a viable option for treating humeral fractures by arthroscopy. LEVEL OF EVIDENCE: IV; retrospective study without control group.

Isoelastic resurfacing prosthesis for distal radius fractures: Outcomes in 24 cases with at least 2 years' follow-up.

BACKGROUND: Unicompartmental resurfacing prostheses have been reported to be useful for treating comminuted fractures involving the distal radial joint surface in elderly patients with osteoporosis. However, the data on this method remain scarce and further evaluations are needed. The objective of this study was to evaluate the clinical and radiological outcomes after unicompartmental resurfacing prosthesis implantation in patients with distal radius fractures and at least 2 years' follow-up. HYPOTHESIS: Outcomes with Prosthelast® are as good in the mid-term as in the short term. MATERIALS AND METHODS: We studied 24 patients with type C fractures in the AO classification. The Prosthelast® prosthesis was implanted in each. Mean age was 78 years (60 to 91). There were 22 females. Three of the fractures were open. The patients were evaluated clinically using a visual analogue scale (VAS) for pain, ranges of motion at the wrist, and grip strength. In addition, functional scores were determined, and radiographs obtained. RESULTS: Mean follow-up was 55.2 months (24-97). Mean tourniquet time was 61.9minutes (37-126). Mean motion ranges were 39° in flexion, 49° in extension, 74° in pronation, and 68° in supination. The mean VAS pain score was 2.1 (0-7). The mean Quick DASH was 39.8 (9.09-77), the mean PRWE was 42.7 (5-95), and mean grip strength was 38 (25-150). Painful motion limitation of the elbow was noted in a patient treated with total elbow prosthesis. Complex regional pain syndrome developed in 6 patients, and 5 patients required revision surgery. Asymptomatic perforation of the radial head occurred in 8 patients. No cases of peri-prosthetic osteolysis or osteoarthritis were noted. The prosthesis impinged on the lunate bone in 2 patients and on the scaphoid bone in one patient. Mean ulnar variance was +0.17mm (-1 to 7.5). Bone remodelling about the prosthesis was noted in all the patients, but 2. DISCUSSION: Our data obtained after a mean follow-up of 55 months indicate that resurfacing prostheses have a role to play in the treatment of comminuted articular fractures in patients with osteoporosis. A long-term study is needed to further evaluate these results. LEVEL OF EVIDENCE: IV; therapeutic.

Transverse and oblique fractures of the diaphysis of the fifth metacarpal: surgical outcomes for antegrade intramedullary pinning versus combined antegrade and retrograde intramedullary pinning.

The purpose of this study was to develop a technique allowing a faster return to previous activities after surgical treatment of short transverse and oblique fractures of the diaphysis of the fifth metacarpal. It consisted of an anterograde and retrograde centromedullary double pinning connected. Our series included 40 patients of average age 25 years including 2 women. In 20 cases (group I), an anterograde centromedullary pinning with a 1.6- or 2-mm pin was performed followed by a 6-week orthosis and then 2-week self-education. In 20 cases (group II), an anterograde and retrograde centromedullary double pinning was performed using 2 1.5-mm pins connected by a connector (MétaHUS®, Arex™). A first pin was introduced into the canal antegrade, then the second retrograde. The 2 externalized pins were connected, and self-rehabilitation was encouraged. Mean tourniquet time was 14.75 min (group I) and 15.8 min (group II), respectively. At the last follow-up, the average pain was 0.35/10 and 0.2/10, the Quick DASH 0.68/100 and 0.57/100, the strength of the hand 94.65% and 94.35%, the active flexion MCP 98.5% and 99%, respectively. MCP active extension was 98.5% and 98.75%; the sick leave was 8.4 and 6.3 weeks. All fractures healed without recovery with 3 complications: 2 infections on pins, in each group, 1 CRPS1 (group I). Our results seem to show that the technique of anterograde and retrograde centromedullary double pinning connected in the treatment of short transverse and oblique fractures of the diaphysis of the fifth metacarpal gives results at least as good as the reference technique with a non-negligible socioeconomic advantage, a less time off work.