Subungual Glomus Tumor.

Subungual glomus tumors arise from the glomus body of the digits. They are rare and benign and often in a single location. Their diagnosis relies on the typical clinical triad of symptoms and on imaging findings, mainly magnetic resonance imaging with gadolinium injection. Subungual tumors treatment is complete resection, essential for cure. The different surgical techniques aim to: a painless digit with normal range of motion and sensitivity, without nail deformity after tumour resection, and to recurrence prevention. They vary according to tumor location. Classic surgical approaches are: the nail unit sparing ones (para-ungual, lateral subperiosteal, periungual), and the nail unit non-sparing ones (all transungual approaches with nail bed splitting). In this paper, we review the literature for the different approaches describing the advantages and drawbacks of each of them. We also describe the author's preferred subperiosteal "shark mouth" flap containing the nail plate and the nail bed as a single unit. It can be performed whether the tumor is located centrally, peripherally, or under the germinal matrix with very satisfactory outcomes.

Ulnar Superficial Slip Resection for Resistant Trigger Finger: A Minimally Invasive Technique.

Primary trigger finger is a common hand disorder for which nonoperative treatment or release of A1 pulley is usually effective. For resistant or recurrent cases, there are different surgical techniques including partial or complete opening of A2 pulley, reduction tenoplasty, and resection of the ulnar slip of the flexor digitorum superficialis tendon. Here, we present our minimally invasive technique for ulnar superficial slip resection surgery. Our indications are the patients with persistent residual proximal interphalangeal joint contracture after A1 pulley release and also the recurrent cases. Then, we report the clinical outcomes of our patients operated using this technique.

Modified Pull-Out Technique for Zone One Flexor Digitorum Profundus Repair.

Pull-out suture fixation is widely used to fix zone one flexor tendon injuries. The original technique of Bunnell generally has good results. However, in some cases, it may result in complications, including nail deformity and infection. The all-inside techniques for fixation of the tendon at this zone cannot totally replace the Pull-out technique. In this article, we propose a modification of the pull-out technique, which can reduce the complications and report the results of our patients' series.

[Glomus tumors of the fingers]. / Tumeurs glomiques des doigts.

"Glomus tumors of the fingers. Glomus tumors of the fingers are benign lesions. The main symptom is a paroxysmal pain with particular hypersensiti¬vity to temperature changes. They are rare in their census, but there is very probably a very high rate of misdiagnosis, due to the very ignorance of their existence by the medical corpus. Their diagnosis is based on a typical clinical exami¬nation and characteristic imaging. The only treatment is their complete surgical resection, which is essential for recovery. Different surgical techniques have been described in the medical literature to achieve a painless finger without nail deformity after tumor resection, while limiting recurrences."

"Tumeurs glomiques des doigts. Les tumeurs glomiques des doigts sont des lésions bénignes. Le symptôme principal est une douleur paroxystique à leur contact et au changement de température. Elles sont rares dans leur recensement, mais il existe très probablement un taux de défaut diagnostique très élevé, dû à la méconnaissance de leur existence par le corps médical. Leur diagnostic repose sur un examen clinique et une imagerie caractéristiques. Le seul traitement est la résection chirurgicale complète, essentielle à la guérison. Différentes techniques chirurgicales ont été décrites dans la littérature médicale pour aboutir à un doigt indolore sans déformation unguéale après résection tumorale, tout en limitant les récidives."

Volar rerouting of the 1,2 intercompartmental supraretinacular artery vascularized bone graft for middle and distal scaphoid nonunions.

BACKGROUND: The bone graft vascularized by the 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) placed on the scaphoid by a dorsal approach is a technique used to treat scaphoid nonunions with avascular necrosis of the proximal pole and without significant bone loss or carpus collapse. We present the results of patients treated with a volar rerouting of the 1,2 ICSRA graft under the tendons of the first extensor compartment to treat more distal scaphoid nonunions than the proximal pole. The aim of this study was to assess the clinical and radiological outcomes of patients operated with this technique with the hypothesis that it would allow to treat more distal nonunions than those of the proximal pole. PATIENTS AND METHODS: This retrospective study involved patients treated by a volar rerouting of the 1,2 ICSRA graft for nonunions of the middle and distal thirds of the scaphoid. Assessments included clinical outcomes and radiological bone consolidation. QuickDASH and Mayo Wrist scores were computed. Range of motion and grip strength were evaluated for both the operated and the contralateral sides. RESULTS: Nineteen patients were followed-up for 33 months (range: 6-75). Mean postoperative QuickDASH score was 10 (range: 0-45), and mean Mayo wrist score was 85 (range: 50-100). Flexion and extension, ulnar and radial deviations were statistically different between the affected and healthy sides (p<0,05). Consolidation was achieved in 17 patients (89%). DISCUSSION: This technical modification allowed good functional outcomes and scaphoid consolidation. It expands the classic indications of the vascularized 1,2 ICSRA bone graft to more distal nonunions than the proximal pole. LEVEL OF EVIDENCE: IV.

Surgical comfort and clinical outcomes of MIPO with an extra-short plate designed for distal radius fractures.

OBJECTIVES: Volar locking plates (VLPs) are increasingly used for distal radius fractures (DRFs) with minimally invasive plate osteosynthesis (MIPO), but surgery learning curves could be long. The purpose of this study was to assess a new extra-short plate with two locking diaphyseal divergent screws, specifically designed for MIPO, preserving the pronator quadratus muscle. MATERIALS AND METHODS: This retrospective study consisted of three phases: (i) the evaluation of surgical comfort with the incision size and the duration of 59 consecutive surgeries using the extra-short plate in DRFs; (ii) the verification of the implant ability to maintain radiographic indices compared immediately postoperatively and at consolidation. They included radial inclination (RI), volar tilt (VT) and ulnar variance (UV); (iii) the assessment of clinical outcomes at last follow-up through: pain measured on the visual analogue scale (VAS), QuickDASH score, patient-rated wrist evaluation (PRWE) score, grip strength, range of motion and complications. RESULTS: In the first phase: mean incision size was 32 mm, and mean operative time was 28.5 min. In the second phase, there was no statistical difference between the two measures of the indices studied. In the third phase, mean follow-up time was 14.2 months, VAS score was 1.1, QuickDASH score was 11.4/100, and PRWE score was 9.5/100. Flexion was 91%, extension was 94%, and grip strength was 86% compared to the contralateral side. CONCLUSION: The surgical comfort may be related to short operative time and incision. The implant allowed maintaining the radiographic indices without secondary displacement. Functional clinical outcomes were satisfactory. This extra-short plate design belongs to a novel generation of VLPs.

Improving the detection of subscapularis tears using a specific transverse CT arthrography image.

BACKGROUND: The prevalence of subscapularis (SSC) tendon tears is often underestimated. This negatively impacts the shoulder function because the SSC muscle is a powerful internal rotator. The primary aim of this study was to compare a blended clinical and radiological preoperative index of suspicion for SSC tears to the arthroscopic findings. The secondary aim was to compare the surgeon's and radiologist's index of suspicion to determine which is more accurate. HYPOTHESIS: Analyzing a transverse image passing under the tip of the coracoid process, in combination with clinical examination, will be the standard for detecting SSC tears. METHODS: This prospective study enrolled 50 consecutive patients who underwent shoulder arthroscopy. Preoperatively, four clinical tests were doneto detect SSC tears: lift-off, internal rotation lag sign, bear-hug, belly-press. A CT arthrography slice passing under the coracoid process tip was analyzed by the surgeon. The surgeon deduced a radiological index of suspicion for SSC tears then a blended clinical and radiological index of suspicion based on the clinical examination. Lastly, the surgeon looked at the radiologist's findings and index of suspicion for a lesion. The three indexes of suspicion were compared with the actual arthroscopy findings. RESULTS: The surgeon's blended clinical and radiological index of suspicion was similar to his radiological index. Both of the surgeon's indexes of suspicion were higher than the radiologist's. The prevalence of SSC tears was 58 %. DISCUSSION: We recommend doing multiple clinical tests as they complement each other in detecting SSC tears, since each one activates a different portion of the muscle. We advise surgeons to supplement their clinical examination by analyzing a specific image of the tendon below the coracoid, as the reference view for the starting point of SSC tears. LEVEL OF EVIDENCE: IV, prospective diagnostic study on consecutive patients.

The 'shark mouth' flap approach for digital glomus tumours in 24 patients: technique and clinical outcomes.

This retrospective, single-centre study was carried out on patients with digital subungual glomus tumours. We describe a subperiosteal approach with a 'shark mouth' flap containing the nail plate and nail bed as a single unit, providing ideal exposure and easy access to the tumour. It combines the advantages of the transungual and lateral approaches, whether the subungual tumours are located centrally, peripherally or under the germinal matrix. The 'shark mouth' flap approach was used by the same surgeon in 24 patients with solitary glomus tumours of the fingers. Clinical outcomes at the early postoperative phase and at the last follow-up were satisfactory. Pain relief and wound healing were quickly achieved. No complications, such as fingertip numbness or nail deformities, were observed, and there was only one recurrence. This approach is reliable, nail-sparing and less time-consuming than other techniques. Level of evidence: IV.