Unusual entrapment symptomatology treated in 115 cases by neurolysis of the common fibular nerve at the fibular head combined with neurolysis of the posterior tibial nerve at the tarsal tunnel.

INTRODUCTION: Entrapment of the common fibular nerve (CFN) at the head of the fibula and entrapment of the posterior tibial nerve (PTN) at the tarsal tunnel are the most common nerve entrapment syndromes in the lower limb. Our aim was to study the results of combined neurolysis of the CFN and PTN for chronic lower limb pain. We hypothesized that combined neurolysis allowed a reduction of this chronic pain. MATERIAL AND METHOD: This bi-centric retrospective study took place from January 2015 to November 2018, with a single senior surgeon. The inclusion criteria were all patients operated on for an idiopathic entrapment syndrome with neurolysis of the PTN at the tarsal tunnel, combined with neurolysis of the CFN at the head of the fibula. The primary endpoint was the pain evolution assessed on a numerical analogue scale (NAS) preoperatively and postoperatively on D+21, and at the last follow-up. The secondary endpoint was to determine the prognostic factors on the clinical outcome of neurolysis. RESULTS: One hundred and fifteen neurolysis were included, comprising 64 women and 38 men with a mean age of 57±17.6 years. The preoperative pain (NAS0) was evaluated at 6±2.4 points. At D+21 postoperatively, there was a significant reduction in pain (NASD+21: 3±2.6 points, p<0.01). Similarly, at the last follow-up (with a mean follow-up of 37±8.4 months), there was a significant reduction in pain (NASLFU: 2±2.5, p<0.01). A history of systemic inflammatory disease was the only factor associated with a less significant decrease in pain at D+21, according to a multivariate analysis (p<0.01). There were 14 complications (12%) not requiring revision surgery. CONCLUSION: This study is the first to demonstrate the efficacy of combined neurolysis of the CFN at the head of the fibula and the PTN at the tarsal tunnel, in the treatment of idiopathic nerve entrapment syndrome of the lower limb. LEVEL OF EVIDENCE: IV; Retrospective comparative study.

Digastric olecranon osteotomy a new approach to the elbow: retrospective study of 24 Coonrad-Morrey® total elbow arthroplasty at 30-month follow-up.

BACKGROUND: Digastric olecranon osteotomy approach allows an excellent articular exposure and preserves principal vascular supply and the continuity of the extensor apparatus. The aim of this study was to assess the early clinical and radiological outcome after total elbow arthroplasty implanted from a digastric olecranon osteotomy approach. METHODS: We retrospectively enrolled 22 patients (two men and twenty women) treated with 24 Coonrad-Morrey® total elbow arthroplasty implanted from a digastric olecranon osteotomy approach in Island of France (Paris, Argenteuil and Saint-Denis). The mean age was 80 years (50-96). We treated 20 fractures; according to AO classification, seven patients suffered from a C1 fracture, seven from a C3 and C2, two from malunions, and four from rheumatoid arthritis. The mean time of follow-up was 30 months (6-132). Clinical outcomes were assessed with the Mayo elbow performance score. We evaluated triceps strength and radiographic healing. RESULTS: At the latest follow-up, the average flexion arc was 23° (5°-50°) to 112° (95°-130°). The Mayo elbow performance score averaged 92 points (75-100). The mean strength of the triceps in extension and flexion was, respectively, 1.9 and 4.7 kgs. All elbows were stable. A single immediate post-operative wound infection was reported and did not require any surgical revision. Radiological consolidation of the olecranon osteotomy was assessed in sixteen patients between 8 and 16 weeks. Heterotopic ossifications were noted in one elbow. One patient had an elbow dislocation by fracture of the axe's component. CONCLUSION: The early clinical and radiological outcomes are promising and support the use of digastric olecranon osteotomy for the implantation of total elbow arthroplasty. LEVEL OF EVIDENCE: Treatment study, level IV.

Immune status and apoptosis activation during brain death.

The present study evaluates the role of the inflammatory status and apoptosis activation in the development of organ dysfunction after brain death using plasma assays and macroarray analysis on skeletal muscle biopsies to look for evidence of remote tissue damage in two intensive care units in France and one in Belgium. As controls, we used patients undergoing hip surgery and healthy volunteers. Causes of brain death in the 85 consecutive patients included in the study were cardiac arrest (n = 29; 34%), stroke (n = 42; 49%, with 38 patients having hemorrhagic stroke), and head injury (n = 14; 17%). Of the 85 patients, 45 donated 117 organs. Plasma endotoxin and cytokine levels indicated a marked systemic inflammatory response in brain-dead patients, which was strongest in the cardiac arrest group. Leukocyte dysfunction, as assessed by cytokines production in response to various stimuli, was noted in a subgroup of patients with brain death after stroke. Interestingly, skeletal muscle biopsies showed no increase in mRNAs for genes related to inflammation, whereas mRNAs for both antiapoptotic and proapoptotic genes were increased, the balance being in favor of apoptosis induction. The increased activation of the proapoptotic caspase 9 was further confirmed by Western blot. In conclusion, the presence of inflammation and apoptosis induction may explain the rapid organ dysfunction seen after brain death. Both abnormalities may play a role in organ dysfunction associated with brain death. However, the level of systemic inflammation or the presence of circulating endotoxin was not associated with lower graft survival.

Digastric olecranon osteotomy: feasibility study of a new approach to the elbow.

PURPOSE: None of the multiple posterior approaches to the elbow simultaneously satisfies the following three properties: good articular surface exposure, attention to the extensor apparatus continuity and olecranon vascularization. This study aims to describe a new approach to the elbow: digastric olecranon osteotomy. METHODS: Nine anatomical subjects were prepared. One-third underwent intra-articular digastric osteotomy, one-third extra-articular osteotomy and one-third a vascularization study using arteriography. RESULTS: Digastric olecranon osteotomy, notably intra-articular, offered excellent articular exposure. After restoration, digastric stability was excellent. Olecranon vascularization was preserved using the two variations of digastric olecranon osteotomy. CONCLUSION: Digastric olecranon osteotomy preserves the principal vascular supply of the olecranon and the continuity of the extensor apparatus. Articular surface exposure is excellent, and the natural coaptation of the digastric enables immediate mobilization without any theoretical risk of deconstruction.