Orientation of the Scapula in the Standing Position.

OBJECTIVES: A new ultrasound-based device is proposed to non-invasively measure the orientation of the scapula in the standing position to consider this parameter for Total Shoulder Arthroplasty. The aim of this study was to assess the accuracy and reliability of this device. METHODS: Accuracy was assessed by comparing measurements made with the ultrasound device to those acquired with a three-dimensional (3D) optical localization system (Northern Digital, Canada) on a dedicated mechanical phantom. Three users performed 10 measurements on three healthy volunteers with different body mass (BMI) indices to analyze the reliability of the device by measuring the intra and interobserver variabilities. RESULTS: The mean accuracy of the device was 0.9°± 0.7 (0.01-3.03), 1.3°± 0.8 (0.03-4.55), 1.9°± 1.5 (0.05-5.76), respectively, in the axial, coronal, and sagittal planes. The interobserver and intraobserver variabilities were excellent whatever the BMI and the users experience. CONCLUSIONS: The device is accurate and reliable enough for the measurement of the scapula orientation in the standing position.

Study of the position of six volar locking plates for distal radius fracture relative to the watershed line.

INTRODUCTION: Volar plate malpositioning in the treatment of distal radial fracture can lead to tendinitis or even tendon tear, especially when the plate position is very distal. We studied the impact of design on plate position in the distal radius. The primary aim was to compare the position of six volar wrist plates relative to the watershed line using the Soong classification. The secondary objectives were to assess the epidemiology of volar locking plate fixation within the administrative Département of Finistère (northwestern France) and to study whether the type of fracture played a role in plate position. HYPOTHESIS: The plate design itself influences positioning relative to the watershed line on the Soong classification. MATERIALS AND METHODS: A total of 2723 volar locking plate fixation cases were analyzed and categorized according to the Soong classification. Plates used were divided into six groups based on design: Zimmer Biomet®, Newclip Technics®, Stryker®, Synthes®, Medartis® and Medartis® Footprint. The number of Soong 0 + 1 plates (i.e., plates graded 0 and 1 taken together) was determined for each design, then compared using the Marascuilo procedure with a significance level of α = 0.05. RESULTS: On the Marascuilo procedure, we found significant differences in the number of Soong grade 0 + 1 plates. The Zimmer Biomet and Newclip Technics® plates were significantly more often proximal to the watershed line than the Synthes and Medartis Footprint plates. Plate position with the Medartis® design was significantly more proximal to the watershed line than for its companion design, the Medartis® Footprint plate. The rate of volar locking plate fixation of distal radial fractures over the past 10 years increased in Finistère. Also, the type of fracture affected the choice of plate when different designs were available within a hospital center (Medartis® Footprint plate used in 2R3A fractures). CONCLUSION: Our study highlights a significant difference in volar locking plate position relative to the watershed line between the various models available. Plate design is a deciding factor when treating distal radial fracture, to avoid impingement when implant removal is not routinely planned.

ACTIfit™: 38% full resorption at 8 years in a cohort of 18 cases.

BACKGROUND: Preserving meniscal tissue is a major priority in young, physically active patients. Extensive meniscal defects may result in exercise pain and premature osteoarthritis. ACTIfit™ is a synthetic meniscal substitute that may improve short-term functional scores via biological integration with meniscal tissue regeneration. However, long-term data on the lifespan and chondroprotective effect of this newly formed tissue are lacking. The primary objective of this study was to assess the biological integration of ACTIfit™ based on magnetic resonance imaging (MRI) findings. The secondary objective was to evaluate long-term clinical outcomes. HYPOTHESIS: The ACTIfit™ meniscal substitute undergoes biological integration over time, suggesting chondroprotective potential. MATERIALS AND METHODS: A 2014 report by Baynat et al. described the 2-year clinical and radiological outcomes of 18 patients after ACTIfit™ implantation at the Clermont-Tonnerre military teaching hospital (Brest, France). The patients had chronic knee pain of at least 6 months' duration after failure of primary meniscal surgery with segmental meniscal defects. Mean age was 34.0±7.9 years. A concomitant procedure was performed in 13 (60%) patients, including osteotomy in 8 and ligament reconstruction in 5. For the current study, the clinical and radiological follow-up was at least 8 years. Assessments were with the Genovese grading scale for substitute morphology on MRI scans, International Cartilage Research Society (ICRS) score for osteoarthritis progression, and Lysholm score for clinical outcome. Failure was defined as total substitute resorption (Genovese morphology grade 1) or revision surgery with implant removal, conversion to meniscus allografting, or arthroplasty. RESULTS: MRI scans were available for 12 (66%) patients. The reason for not having long-term MRI scans was surgery for substitute removal or arthroplasty in 3 of the remaining 6 patients. Complete implant resorption (Genovese grade 1) was noted in 7/12 (58%) patients and osteoarthritis progression to ICRS grade 3 in 4/12 (33%) patients. At last follow-up, the mean Lysholm score was significantly improved vs. baseline (79±15 vs. 55±13, P=0.005). CONCLUSION: The frequency of complete ACTIfit™ resorption 8 years after implantation was high. This finding argues against ability of this substitute to induce the regeneration of durable meniscal tissue with a chondroprotective effect. The clinical outcome score was significantly improved at last follow-up. However, no conclusions can be drawn regarding the effectiveness of ACTIfit™ given the high frequency of concomitant surgical procedures. LEVEL OF EVIDENCE: IV, retrospective observational cohort.

Post-traumatic total wrist arthrodesis: Satisfaction study of 42 cases at a mean 97months' follow-up.

INTRODUCTION: Total wrist arthrodesis is effective in reducing pain in osteoarthritic wrist, but at the cost of range of motion. The aim of the present study was to assess patient satisfaction after post-traumatic total wrist arthrodesis, complications and risk factors. HYPOTHESIS: Post-traumatic total wrist arthrodesis provides a high rate of satisfaction. PATIENTS AND METHODS: A single-center retrospective observational satisfaction survey was carried out for the period 2005-2020 by telephone interview. RESULTS: Forty-two post-traumatic dorsal plate total wrist arthrodeses were included. Mean follow-up was 97 months. Total arthrodesis achieved a mean 75% reduction in pain, with good functional results (QuickDASH: 23±9.1 [11-42]) and satisfaction (83% of patients very satisfied or satisfied). Seventy-two percent of patients continued in their previous work. The complications rate was 48%. Twenty patients had complications, including 14 (33%) requiring surgical revision. Thirteen patients (31%) had hardware removed due to plaque discomfort and 1 due to bone and joint infection. Seven patients showed CRPS. CONCLUSION: Total wrist arthrodesis provided good results in terms of pain relief and satisfaction, at the cost of loss of motion. It is a reliable surgical technique, with an essential place in the therapeutic algorithm for post-traumatic osteoarthritic wrist, particularly in manual workers. LEVEL OF EVIDENCE: IV, single-center retrospective observational study.

WALANT for hand wound exploration in isolated conditions: Feasibility study.

INTRODUCTION: Military doctors usually deal with hand wound management. Their practice sometimes takes them far from any specialized surgical center. The WALANT could be a powerful tool for doctors operating in nuclear submarines or as part of special forces. This is a comparative, prospective and multicenter study. The hypothesis was that the management of hand wounds by military doctors specifically trained in WALANT and in the surgical exploration of hand wounds allowed a diagnosis as effective as in the FESUM center. PATIENTS AND METHODS: Military doctors, usually operating in isolated conditions, were trained at WALANT. Then, this method was used for the exploration of hand wounds in the emergency room, in a center outside FESUM. At the end, two different questionnaires were completed respectively by the patient and the operator. They aimed to assess various criteria such as the overall satisfaction of the patient and the operator, the level of pain felt or the ability of the operator to establish a precise lesion assessment. The results were compared with those obtained under the same conditions by hand surgeons in the FESUM centre. RESULTS: No significant difference was found between the two centers in terms of diagnostic capacity, satisfaction, comfort and perceived pain intensity. DISCUSSION: Under cover of prior training, the WALANT is effective for the exploration of hand wounds by submariner doctors and members of the special forces. Its use makes it possible to establish a precise injury report and this in material and human conditions approaching as closely as possible those of the armed forces on mission. The comfort of the patient remains preserved. CONCLUSION: The WALANT represents an effective tool for the exploration and lesion assessment of hand wounds outside the FESUM centre. Since emergency conditions are similar to those encountered in operational conditions, its use is also possible in situations specific to military doctors: nuclear submarines, special forces on mission. LEVEL OF EVIDENCE: III; comparative study, retrospective, multicentre.

The hamstrings are more impacted than the quadriceps after severe ankle sprain.

Ankle sprains (AS) are common in the military population, with a prevalence 5 to 8 times higher than that for civilians. The aim of this study was to evaluate in patients with severe AS the impact of disuse on thigh muscle induced by unloading and immobilization due to care. This study focused on muscle trophicity and dynamometric strength. In this observational prospective study, assessments were repeated at 3 visits: close to injury, 15 and 30 days following the sprain. The injured limb was compared to the contralateral limb. A dynamometer assessment was used to monitor changes in strength and fatigue of the thigh muscles of both limbs. Isometric and isokinetic concentric evaluation of peak torque (PTiso and PTdyn), total work (Wt), and peak torque time integral (IPT) of thigh muscles. Full follow-up was obtained in 30 subjects. The injured limbs showed significant deficits in the mean (SD). The quadriceps PTiso and IPT deficits were -12.6% ± 1.9% (P < .0001) and -13.27% ± 1.8% (P < .0001), respectively. The quadriceps PTdyn showed a significant deficit since V2 (-12.2.5% ± 2.0). The quadriceps Wt presented a significant deficit of -4.2% ± 2.4 (P < .0007) at 1 month. The hamstring PTdyn deficit presented a mean loss of -16.5% ± 2.4% (P < .0001). The hamstring Wt deficit was -13.7% ± 2.3% (P < .001). The analysis of variance showed that the grade of the sprain had a significant effect on the quadriceps PTq deficit (P < .016) but not the type of discharge. Our study showed that disuse leads to a significant deficit in the strength of knee muscles within 1 month. It is noteworthy that the hamstrings are more affected than the quadriceps. The rehabilitation protocol to prevent the risk of iterative ankle injuries and secondary knee injuries should incorporate early training of both quadriceps and hamstrings.

Intestinal prolapse through a persistent omphalomesenteric duct causing small-bowel obstruction.

Persistent omphalomesenteric duct as a cause of small-bowel obstruction is an exceptional finding. A neonate presented with occlusion due to intestinal prolapse through a persistent omphalomesenteric duct. Remnants of the duct were successfully resected, and the postoperative course was uneventful. We discuss the presentation of omphalomesenteric duct and its management.