Clinical and radiological outcomes of 40 cases of SLAC and SNAC wrist treated by four-corner arthrodesis with locking plate.

The treatment of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist varies. No clear consensus exists on surgical indications. Scaphoid excision and four-corner arthrodesis with locking plate is one of preferred treatments for these lesions. The purpose of this study was to assess the clinical and radiological outcomes of locking plates for treating SNAC and SLAC wrist after a mean follow-up of 5 years and to compare these outcomes with the results reported in the literature. A retrospective study was conducted in two hospitals, involving 40 patients who underwent scaphoid excision and four-corner arthrodesis with locking plate between January 2006 and September 2016. All patients were reviewed as outpatients with clinical and radiographic measurements. At the last follow-up, the mean pain level on visual analog scale (VAS) was 2.5/10 [0-7] (SD: 1.7). Patients had a mean flexion of 46% and a mean extension of 46% compared to the contralateral side. An 18% gain was observed in grip strength. The mean postoperative QuickDASH score was 30 [0-57] (SD: 15.3). Seventy percent of patients were satisfied with the operation. Complete (all four joint interfaces) joint space fusion was achieved in 55% of patients. Only one patient (2.5%) had no joint fusion. The joint between the lunate and the capitate was fused in 38 patients (95%). Nine patients suffered complications; eight of them required surgical revision (20%). Four-corner arthrodesis with locking plate is a valuable surgical technique for treating SLAC and SNAC wrist because it preserve satisfactory range of motion and grip strength (64% compared to the non-operated side), maintains the height of the carpus and prevents the premature appearance of radiocarpal osteoarthritis, as long as the technical challenges of this procedure are mastered.

Arthroscopy-assisted treatment of scaphoid and lunate cysts: Clinical evaluation of 7 cases.

Intraosseous cysts of the carpus are relatively common benign tumors. They are often discovered by chance and can cause wrist pain thereby requiring appropriate management. While conventional open surgical treatment leads to good results, it has certain disadvantages, the main one being postoperative stiffness. Arthroscopic treatment has been proposed as an alternative for lunate cysts. The present study consisted in evaluating the feasibility and outcomes of arthroscopic treatment for lunate and scaphoid cysts. The main objective was to evaluate the postoperative clinical outcomes at 3 and 18 months. The secondary objective was to evaluate the integration of a cancellous bone graft. We conducted a retrospective study of eight patients who underwent surgery between April 2010 and October 2016. Of these, four had a lunate cyst and four had a scaphoid cyst; all cysts had a dorsal operculum. Patients had disabling wrist pain that did not respond to conservative treatment. The diagnosis was confirmed by radiography and either a CT scan or an MRI. Curettage and cancellous grafts were performed under arthroscopic control. The technique was carried out successfully in all cases. One patient was lost to follow-up. At 18 months, postoperative pain was rated at 1.28 on a visual analog scale. The grip strength (measured with a Jamar dynanometer) was 77% when compared to the contralateral side. There was an improvement in joint range of motion, with an average wrist flexion of 67.5° compared to 48.3° preoperatively and an average wrist extension of 71.5° compared to 47.6° preoperatively. The Patient-Rated Wrist Evaluation (PRWE) score decreased from 69.7 to 12.7, which was a significant decrease. A good integration of the cancellous graft was confirmed at 6 months in all cases by CT scan or MRI. Curettage with a cancellous graft of lunate and scaphoid cysts under arthroscopic control is a technique that allows surgeons to obtain satisfactory clinical results with good integration of the graft.

Results of 115 Rubis II reverse thumb carpometacarpal joint prostheses with a mean follow-up of 10 years.

The aim of this study was to assess the clinical and radiological results of the Rubis II thumb carpometacarpal joint reverse prosthesis, at a mean follow-up of 10 years. Between 1997 and 2008, 253 prostheses were implanted in 199 patients; 115 were reviewed. The survival after a mean of 10 years was 89%. At the last follow-up, 70% of prostheses were painless; the others reported moderate or intermittent pain. The satisfaction rate was 98%. The mean opposition was 9 on the Kapandji scale; the mean QuickDASH score was 30. Wrist, key and tip pinch strengths were comparable with the non-operated side. Of the 115 implants, one was radiologically loose (1%) and 15 had suffered dislocations (13%), 12 of which were caused by an injury. Eleven thumbs had revision surgery. This study confirms that the good clinical results of the Rubis II prosthesis are maintained in the medium and long term, and represents a useful alternative to trapeziectomy for selected patients. LEVEL OF EVIDENCE: IV.

[Results of the treatment of basal thumb osteoarthritis by Rubis II prosthesis after more than 5 years. A retrospective study of 118 cases]. / Résultats à plus de cinq ans du traitement de la rhizarthrose par la prothèse Rubis II. À propos de 118 implantations.

OBJECTIVES: The goal of the work was to evaluate the mid-term results of the Rubis II® trapeziometacarpal prosthesis for the treatment of basal thumb osteoarthritis. METHODS: From 1997 to 2003, 118 trapeziometacarpal prostheses Rubis II® were implanted at Saint-Quentin's Hospital. Seventy-seven have been clinically and radiologically reviewed. The average follow-up was of 88 months. Sixteen patients were reviewed by phone. Fourteen patients were lost to contact and two died (13.5% of cases). Nine prostheses were removed (7.6% of cases). RESULTS: Among the reviewed prostheses, 76.6% of patients had no pain, the others had moderate pain. Postoperatively, the average opposition according to Kapandji's scale was 9.52. The average key-pinch force was similar on both sides. All reviewed patients were satisfied or very satisfied. No radiological loosening was noted. Nine removals were necessary; for post-traumatic dislocation in six cases, post-traumatic fracture of the trapezium in two cases, and inflammatory reaction with no infection in one case. The survival rate of the prosthesis was 93% at five years. CONCLUSIONS: The Rubis II® prosthesis presents a satisfactory survival rate after five years and good clinical results. The design of the implant could explain the absence of loosening. The main risk of the Rubis II prosthesis seems to be the post-traumatic dislocation occurring mostly during the first two years after surgery.

[Rubis 2 trapezometacarpal prosthesis: concept, operative technique]. / Prothèse trapézométacarpienne Rubis 2: concept, technique opératoire.

INTRODUCTION: We have implanted 49 uncemented reversed trapeziometacarpal prostheses since 1997. OPERATIVE TECHNIQUE: We used a classical dorsal approach. A good preparation of the base of the first metacarpal will give excellent exposure of the trapezium, the most important stage of the operation. Instrumentation allows easy insertion of the two components and also their adjustment. RESULTS: A follow-up of three years is too short and we intend to give our full results at five years. At the present time the patients are well and seem satisfied. DISCUSSION: The reversed design of this prosthesis is useful because it spares the scarce bone stock of the trapezium. The shape of the trapezial implant prevents not only its sinkage but also any lateral movement.

[Treatment of fresh humeral diaphysis fractures by Seidel intramedullary locked nailing. A study of 23 initial cases after 2.5 years with rotator cuff evaluation]. / Traitemet des fractures récentes de la diaphyse humérale par enclouage centro-médullaire verrouillé selon Seidel. Révision des 23 premiers cas à 2.5 ans avec étude de la coiffe des rotateurs.

PURPOSE OF THE STUDY: The Seidel intramedullary locking nail is one of the alternative methods for operative treatment of humeral shaft fractures. Short follow-up demonstrated persistent pain and stiffness at the shoulder joint. The aims of this retrospective study were first to evaluate results with attention to operative technique, consolidation rate and postoperative complications. Second we studied rotator cuff healing in our first patients. MATERIAL AND METHODS: Twenty-five acute diaphyseal fractures were treated between May 91 and Dec 94. We reviewed personally 23 patients with a mean follow-up of 33 months (range 22-66). The dominant fracture type according to AO was type A. Clinical shoulder assessment was carried out using the Constant score. Isometric strength was recorded in both shoulders with a hand-held dynamometer in abduction, external and internal rotation. Sonographic evaluation of the rotator cuff was performed using a 7.5 MHz linear array transducer in all 23 patients. RESULTS: All but one fracture healed at an average of two months. Impingement was observed in three patients but pain relief and normal shoulder motion have been reached after nail removal. Infection occurred in one patient but final result was good. Constant score averaged 78.7 (range 51-94.2) classifying the result in all but two patients as excellent or good. Compared with the external and internal rotations, strength was significantly reduced in abduction but reached 83.5 per cent of the opposite shoulder. No statistical differences were found in relation with age, gender and side. Compared with the contralateral shoulder, rotator cuff evaluation with sonography was considered as normal in 18 patients. Calcium deposits of the cuff were noticed in the infected patient. In three cases sonography detected hyperechoic line considered as scar in the supraspinatus tendon without any partial or full-thickness tear. DISCUSSION AND CONCLUSION: A median starting point avoids the avascular area and gives a straight access to the medullary canal. This study demonstrates that using this entry portal and a reliable technique antegrade nailing of the humerus does not compromise rotator cuff healing and shoulder function. Technical errors lead to poor or fair results but despite this learning curve, Seidel nail when operative treatment is indicated, is a good choice. Attention must be paid to patients with clinical history of impingement or rotator cuff tendinopathy.

[Articular fractures of the base of the first metacarpal. Comparative study of direct osteosynthesis and closed pinning]. / Les fractures articulaires de la base du premier métacarpien. Etude comparative de l'ostéosynthèse directe et de l'embrochage extra-focal.

The authors retrospectively studied 35 articular fractures of the base of the first metacarpal, with an average follow-up of 3 years. Treatment consisted of closed reduction and pinning in 19 cases, open reduction and rigid fixation in 16 cases. Results were estimated in terms of pain, range of movement (flexion-adduction arc and abduction-extension arc), strength and X-rays. There was no significant difference between the two groups, for age, sex, occupation, side and postoperative care. Only one significant difference between both procedures was found: flexion-adduction was better after osteosynthesis than after closed pinning (p = 0.03). The authors observed a better range of flexion-adduction and pinch strength after treatment of Bennett's fracture. Radiographic features were not different at follow-up between open and closed osteosynthesis.

[Carpometacarpal dislocations of the long fingers. Apropos of 26 cases with review of 20 cases]. / Les luxations carpo-métacarpiennes des doigts longs. A propos de 26 cas dont 20 cas revus.

PURPOSE OF THE STUDY: A retrospective study reports the evolution of patients treated for dislocation of one or several of the four medial carpometacarpal joints. MATERIALS AND METHODS: In five of twenty-six patients, the dislocations were undiagnosed in emergency. Twenty-five dislocations were dorsal. A patient presented a divergent dislocation of the four medial metacarpals proximal ends. The mean age was 25-30 years. Twenty-six patients were treated: ten by closed reduction and sixteen by open reduction. Stabilization by oblique K-wire pining was used in twenty-four cases. Twenty patients were followed for an average of fourty-one months. Six patients were lost for follow-up. Two patients had an an ulnar nerve injury. In eighteen cases, dislocation was associated with avulsion fracture of the involved bone. Eleven fractures of the distal carpal row was reported. RESULTS: The results were assessed by the range of wrist and fingers motion, grip strength, pain and deformity. Three patients had a limited range of wrist motion, five patients had a limited range of fingers motion. Six patients had a loss of fourth and fifth carpometacarpal joint motion. Eight patients had an excellent grip strength. Four patients were pain free and fourteen had climatic pain, or after strenuous use of the hand. Eleven had no deformity or limited prominence and three a disabling deformity. Results were rated good in thirteen cases, fair in three and poor in four. DISCUSSION: Dislocation or fracture-dislocation of the carpometacarpal joints are uncommon injuries. The diagnosis can be easily missed. The authors recommend closed or open reduction but constant fixation by pins and immobilization in a plaster cast. In this study, the majority of results was good when no serious injuries were associated and when reductions were stabilized with k-wires. One out of four poor results had been treated by closed reduction without k-wires, the three others were due to associated injuries.

[Supraepitrochlear process and median nerve compression]. / Apophyse sus-épitrochléenne et compression du nerf médian.

The supra-condylar process exists in a small percentage of the population. Infrequently this process may cause compression of the median nerve. The authors such a case associated with compression of the ulnar nerve. Excision of the bony process led to immediate resolution of the symptoms. In the presence of compressive symptoms with neurologic deficit, it is important to always to look for a supracondylar process by palpation.