The role of the musculocutaneous and radial nerves in elbow flexion and forearm supination: a biomechanical study.

The intention of this prospective study was to evaluate the role of the musculocutaneous and radial nerves in elbow flexion and forearm supination. The study included 29 patients having loco-regional anaesthesia for minor hand surgery. Elbow flexion and forearm supination forces were evaluated before and after an isolated musculocutaneous nerve block in one group and an isolated radial nerve block in another group. The results showed that the biceps tendon is responsible for 47% of the forearm supination force and the combination of brachioradialis and the supinator for 64% of this force. It showed also that the musculocutaneous and radial nerves contribute by 42% and 27.5%, respectively, to the flexion force of the elbow. These results are intended to help surgeons in decision making when treating chronic biceps tendon rupture, in repair of traumatic brachial plexus neuropathy and in using tendon transfers, such as the Steindler transfer, around the elbow.

[Predictive factors of long-term functional rehabilitation in thoracic outlet syndromes: 85 patients]. / Facteurs prédictifs des résultats à long terme de la rééducation fonctionnelle des syndromes de la traversée thoracobrachiale: à propos de 85 patients.

INTRODUCTION: Thoracic outlet syndromes are expressed by various clinical manifestations. Treatment is mainly rehabilitation. We aimed to identify factors predicting long-term functional rehabilitation in patients with this treatment and recurrence of symptoms. PATIENTS AND METHODS: We performed a descriptive retrospective analysis of 84 patients who underwent rehabilitation for thoracic outlet syndrome as defined by Revel and colleagues. Data collection involved a questionnaire exploring personal information, risk factors for developing thoracic outlet syndrome, clinical signs, and x-ray results. Long-term results of treatment were evaluated by telephone questionnaire. Data analysis involved use of Stata 6 software. RESULTS: Univariate analysis: predictive factors of negative results with treatment were ligament hypermobility, sensitive disturbances at the time of diagnosis, and a positive Adson's test result. Predictive factors of positive results were absence of paresthesia at the end of the treatment, and a negative "bell sign" at the end of the treatment. Predictive factors of nonrecurring symptoms were age younger than 34, bilateral positive Adson test result, and need for a supplementary number of sessions. MULTIVARIATE ANALYSIS: predictive factors of positive results with treatment were absence of sensitive impairment at the time of diagnosis, compliance with home exercises, initial negative Adson's test result, absence of hypermobility, and absence of paresthesia at the end of treatment. Predictive factors of recurring symptoms were age younger than 34, the need for a supplementary number of sessions and bilateral positive Adson's test result. CONCLUSION: A larger number of subjects are needed to further explore the predictive factors of rehabilitation and recurring symptoms in thoracic outlet syndrome for better validity and significance.

Pedicled hypothenar fat flap for median nerve coverage in recalcitrant carpal tunnel syndrome.

We report the use of a hypothenar pedicled fat flap to cover the median nerve in recalcitrant carpal tunnel syndrome. Forty-five patients with recurrent symptoms after previous carpal tunnel surgery were included in this study. Patients with incomplete release of the transverse carpal ligament were not included. We performed an anatomical study on 30 cadavers. The original technique with the section of the deep branch of ulnar artery was modified. The flap could be transferred onto the median nerve without stretching. The median follow-up was 45 months (range, 12-80 months). Pain completely disappeared in 41 patients with normal nerve conduction. Based on clinical and electromyographic signs, the global results showed excellent results (49%), 19 good results (45%), two average results (4.5%) and two failures (2%). The use of a hypothenar pedicled fat flap to cover the median nerve in recalcitrant carpal tunnel syndrome is a simple and efficient technique which improves the trophic environment of the median nerve and relieves pain.

[Recurrent multifocal chronic osteomyelitis: scintigraphy or MRI. Apropos of 2 cases]. / Ostéomyélite chronique multifocale récurrente: scintigraphie ou IRM. A propos de deux cas.

We report two cases of chronic recurrent multifocal osteomyelitis. In both cases, MRI demonstrated the presence of asymptomatic lesions that the technetium bone scan failed to show. The asymptomatic lesions were located in the acetabelum and the distal femur. Despite the actual literature, MRI was more specific than bone scan in these two cases.

[A new location of osteochondritis: the os trapezium. Apropos of a case]. / Une nouvelle localisation de l'ostéochondrite: l'os trapezium. A propos d'un cas.

The authors report a case of osteochondritis dissecans of the trapezium in a 10 year old boy. The main symptom was pain. X-Rays showed osteosclerosis and diminished volume of the trapezium. Magnetic resonance imaging confirmed the diagnosis. At six months, the patient was almost asymptomatic and at one year, X-Rays and the MRI were judged normal. This localisation has never been reported before. The treatment was conservative. Remission was complete.

Compound tibial fractures with bone loss treated by the Ilizarov technique.

We report our experience of the use of the Ilizarov technique to treat nine patients with severe compound tibial fractures. The mean defect in bone was 6.3 cm, and four cases were infected. All nine patients had satisfactory union and function without the use of bone grafts or antibiotics. The Ilizarov technique was very satisfactory; there were no major complications.

[Lunar-triquetral instability]. / Les instabilités luno-triquétrales.

Luno-triquetral instability dogs not appear to be as rare as one is lead to believe. The clinical features are essentially of progressive discomfort on the medial aspect of the wrist. Plain radiographs are generally of little help, with the diagnosis being made by arthrography with cine-radiography. The authors are reporting a retrospective series of 24 patients which fall into two separate groups: 14 isolated luno-triquetral lesions, 10 associated with a generalized involvement of the proximal carpal row, either as a result of peri lunate dislocation or combined scapho-lunate and luno-triquetral instability without anterior subluxation. The authors have performed 13 luno-triquetral arthrodeses, 6 by pin, 6 by compression screws and one by key graft. For the mixed instabilities the treatment was less specific. The results with a mean follow up of is months have highlighted the problem of non union of the arthrodesis and residual pain various technical aspects of achieving a sound luno-triquetral arthrodesis are discussed.

[Critical study of 200 surgically treated lumbar disk hernias]. / Etude critique de 200 hernies discales lombaires opérées.

The authors reviewed 200 cases of operated lumbar disk hernias. Hernias of the L4-L5 disk were twice as frequent as those of the L5-S1 disk. When clinical examination revealed simultaneous involvement of the L5 and S1 nerve roots, the L4-L5 disk was more frequently responsible (75%). Clinical examination alone was not sufficient to localize the level of the disk hernia and CT scan used for this purpose had a sensitivity of 93.2%. In 20% of cases, the CT scan demonstrated a second asymptomatic lesion. The results of surgical treatment were assessed as 83% good and very good results and 50% complete cures. The authors propose the following recommendations: Look for involvement of the L5 and S1 nerve roots which is suggestive of an L4-L5 hernia; only operate after radiological demonstration of the level of the herniated disk; do not operate on asymptomatic lesions detected by CT scan.