Arthroscopic treatment of basal joint arthritis by partial trapeziectomy with ligament reconstruction: Short-term results from a prospective study of 20 patients.

Partial trapeziectomy for basal joint arthritis is an alternative to total trapeziectomy that preserves the height of the thumb column. Using arthroscopy reduces the incidence of periarticular lesions and the risks of complications. The purpose of this prospective single-center study was to evaluate the results of arthroscopic partial trapeziectomy combined with suspension and interposition ligament reconstruction using half of the abductor pollicis longus tendon. Twenty patients (18 women, 2 men) with a mean age of 55 years (43-65 years) were operated using this technique between November 2013 to February 2015. Patients were evaluated clinically and radiologically at 1 month, 3 months, 6 months and 12 months after surgery. The 20 patients were reviewed after 12 months. The subjective QuickDASH score improved from the 3rd post-operative month (P = 0.0029) from 50.6 preoperatively to 30.3 after 3 months, 17.6 after 6 months and 9.6 after 12 months. Pain was reduced in the 1st month post-operative (P < 0.0001). The Kapandji Score and pinch strength improved from the 3rd month (P = 0.034). Return to work was possible for 19% of employed patients after 1 month, 44% after 3 months and 87.5% after 6 and 12 months. Eighty-eight percent of the patients were satisfied or very satisfied after 3 months and 95% after 6 and 12 months. Pain levels, range of motion and QuickDASH Score are similar to those of open partial trapeziectomy described in the literature. However, recovery seems to be faster with this arthroscopic technique. Arthroscopic treatment of basal joint arthritis, which limits capsule and ligament lesions, leads to good short- and medium-term results in terms of pain relief and thumb motion while preserving strength. LEVEL OF EVIDENCE: 4 (Prospective, non-randomized).

Upper limb and hand patterns in cerebral palsy: Reliability of two new classifications.

AIM: To evaluate the inter- and intra-rater reliability of two previously developed classifications of upper limb and hand patterns. METHOD: Two hundred and twelve films of patients with CP (118 of UL postures and 94 of hand tasks; median age 14, 3-46 years) were viewed by 18 examiners from 2 different rehabilitation centers, and one expert who had participated in the design of the classifications. They classed upper limb (3 patterns with sub-types) and hand patterns (2 patterns with subtypes) twice, at 2 months' interval. Inter- and intra-rater reliability were analysed. RESULTS: Intra-rater and inter-rater reliability were very high for upper limb and hand patterns (0.87 < k < 0.92), and high for the subtypes (0.58 < k < 0.68). Examiners stated that both classifications were useful and feasible in clinical practice. INTERPRETATION: Despite the single, short training session on use of the classifications, agreement between the examiners and the expert examiner was good to high, confirming that these classifications are easy to use and reliable. The classifications proposed here provide homogenous terminology for use in both clinical practice and research, to describe, evaluate and follow-up changes in upper limb and hand patterns in patients with cerebral palsy, particularly those with dyskinesia.

[Study of the veno-arteriolar reflex in young and elderly subjects by recording of TcPO2]. / Exploration du réflexe veino-artériolaire chez le sujet jeune et âgé par l'enregistrement de la TcPO2.

The variations' measurement of transcutaneous oxygen tension (TcPO2) looks as an interesting local vasomotor reflex (L.V.R.) exploration, particularly on lower limbs arterial occlusive disease. However the possible impacts of physiological ageing upon this reflex have not clearly been evaluated. But they can be better analysed with a dynamic measure of TcPO2 on the first intermetatarsal space of the patient, successively recumbent, sitting standing and walking on a moving walkway. TcPO2 is measured with a Radiometer TCM3 oxygen monitor. Two groups of patients, without any arterial occlusive lesion, have been tested like that: 20 young (mean age: 23.3 +/- 1.8 years) and 16 older subjects (mean age: 68.3 +/- 6 years). In recumbent position, TcPO2 is about 74.05 +/- 5.6 mmHg in young and 62.2 +/- 4.7 mmHg in older subjects (P less than 0.01). From recumbent to sitting position, after 15 seconds TcPO2 is elevating to a maximal value at 1 min 30 sec. (85 +/- 6 mmHg in young--71.5 +/- 5 mmHg in older subjects--P less than 0.01). Whilst in young TcPO2 decreases slowly to a stable value, at 5 minutes, higher than in recumbent (+ 6.3 +/- 0.5 mmHg), in the older TcPO2 increases ever to a stable value higher than in recumbent (+ 12 +/- 0.7 mmHg). For the last ones there is no TcPO2 adaptation from recumbent to sitting position because of the vascular ageing, while the LVR increased from recumbent to standing position. During the walk, the LVR disappears for both of them. These measurements confirm the decrease of vascular reactivity with ageing and oblige to compare the results on same age people, during the arterial occlusive disease exploration, by evaluating the graph kinetics.

Extensor tendon injuries. Presentation of a series of ninety-nine cases.

A series of 99 cases of injuries of the extensor system, followed in the 3 Traumatology and Orthopedics Ward (Dijon, France) is presented. Results were analyzed according to Verdan's classification. In most cases, a Jenning "barb-wire" type repair, introduced in France by Y. Allieu, was made. Early mobilization and skin tension problems are emphasized; two cases of degloving on the dorsum of the hand are presented with details. As well, a special place concerning the results of repair in the proximal interphalangeal joint must be reserved, because of the very frequent association of articular destruction and the very difficult problem s of surgical management which arise in these cases.