The distal dorsal intermetacarpal ligament: characterization of an overlooked structure-an anatomical study of 25 hands.

PURPOSE: Exhaustive literature is available on the metacarpophalangeal joints of the long fingers, but the dorsal ligamentous structure overlaying the interosseous muscles and joining the metacarpal heads of the long fingers remains to be fully characterized. Previously, our surgical hand team observed a non-classically reported structure connecting the metacarpal heads of the long fingers, in the dorsal part of the intermetacarpal spaces. Therefore, the aim of this anatomical study was to characterize this ligamentous structure in terms of size, insertions, and anatomical position. METHODS: Twenty-five hands were dissected for a total of 75 long finger intermetacarpal spaces. A ligamentous structure was exposed after cellular tissue excision and dorsal superficial fascia opening. The length and thickness were measured and anatomical position and insertions were studied. Histological analysis was performed on five specimens and ultrasound analysis in one healthy subject. RESULTS: All 25 dissections revealed a dorsal ligamentous structure, hereafter named distal dorsal intermetacarpal ligament, which was inserted in the lateral tubercle of each adjacent long finger metacarpal head. This distal dorsal intermetacarpal ligament surrounded interosseous tendons. It was more proximal compared to oblique and transversal interosseous muscle fibers. Histological analysis confirmed the ligamentous nature of the structure. Ultrasound analysis showed that this structure was well identified under the dorsal aspect of the hand. CONCLUSION: All dissections revealed a tense ligamentous structure between each metacarpal head of the long fingers. This was a constant structure meeting the definition of a ligament. The distal dorsal intermetacarpal ligament seems to stabilize the metacarpal heads at the second and fourth spaces by limiting hyperabduction.

Ambulatory hand emergency: 2 years-experience in an public university hospital center.

Hand emergencies represent the most frequent traumatic injuries and outpatient surgery is still improving. It will achieve 70% of total surgeries by 2022. Our hand trauma center has been able to set up an emergency day surgery department in a university hospital center. With this article, we would like to report the ambula- tory care management and practice for hand emer- gencies in our university hospital center over 2 years. 892 patients suffering from hand traumas and managed in our day surgery department, were retro-spectively reviewed between January 2016 and December 2017. Patients' demographic data, anesthe- tic data, trauma's circumstances, medical care and surgical outcomes have been disclosed. A descriptive analysis and a statistical assessment was realized. Cut injury was the most recorded case, followed by impactions. Tendon injuries were the most frequent (32%), followed by fractures (26%), and exposed joints (18%). 13% of injuries were nil findings. Average patient care delay was 1.16 days. Mean of hospitalization was 7.5 hours. 16/892 patients needing intravenous antibiotics required hospitalization. 41 complications including 27 secondary surgeries were reported. Hospital facilities are forced to reassess their entire procedures to achieve efficiency and improvement for healthcare. Progress in outpatient surgery permits emergency management in hand surgery, improving patient cares both medically and economically.

Dorsal Dupuytren's disease: a systematic review of published cases and treatment options.

Dorsal lesions in Dupuytren's disease are rare and data concerning their epidemiology and management are sparse. We conducted a systematic review to summarize reported cases of dorsal Dupuytren's disease. Pubmed, Cochrane, and Embase databases were searched from 1893 to 2018, and 17 articles were selected (525 patients). The male to female ratio was 3.8:1. The dorsal disease was bilateral in 225 patients (50%). The index was the most commonly affected finger (48 patients). The proximal interphalangeal joint was the most commonly affected (484 cases). The most frequently reported lesions were knuckle pads (503 patients), dorsal nodules between interphalangeal joints (14 patients), boutonnière deformities (12 patients), and swan-neck deformities (2 patients). Nearly half of the included patients were treated surgically. Postoperative functional result depended on the treated lesion. Most of the included studies had a low level of evidence. Higher-quality studies are necessary to confirm our findings.