Ultrasound-guided fasciotomy for chronic exertional forearm compartment syndrome: a cadaveric feasibility study.

OBJECTIVES: Chronic exertional forearm compartment syndrome is observed in patients who engage in physical activity requiring repetitive isometric muscular effort of the wrist during prolonged grasping. Open fasciotomy was considered as the gold-standard treatment, for its ability to release all compartments. However, its invasiveness means that high-level athletes have to abstain from competition for a long period of time. For this reason, minimally invasive techniques have been developed, to allow faster recovery. The objective of this cadaveric study was to evaluate the feasibility and reproducibility of ultrasound-guided palmar fasciotomy in the treatment of chronic exertional forearm compartment syndrome. METHODS: Surgery consisted in ultrasound-guided palmar fasciotomy of the superficial anterior compartment, using a single minimally invasive approach. Twenty forearms were then dissected by an independent operator, (1) to check complete fasciotomy and (2) to screen for iatrogenic lesions on the tendons, veins and superficial sensory branches. RESULTS: Sixteen fasciotomies were total and 4 partial: i.e., a release rate of 80%. The superficial sensory branches were intact, and notably the branches of the medial cutaneous nerve of the forearm. Mean surgery time was 9 min, progressively decreasing with the repetition of the ultrasound-guided procedure. CONCLUSIONS: Ultrasound-guided fasciotomy in the management of chronic exertional forearm compartment syndrome appears to be a simple, effective, safe and reproducible technique.

Ligamentoplasty with interposition of the proximal interphalangeal joint in the treatment of unicondylar osteochondral defects: a cadaveric feasibility study.

BACKGROUND: Injuries to the proximal interphalangeal (PIP) joint are common and complex. However, the treatment of osteochondral defects of the head of the proximal phalanx has rarely been described. Herein, we propose a new technique for the management of unicondylar defects of the proximal phalanx that can restore joint amplitudes and provide PIP stability. METHODS: In this cadaveric feasibility study, unicondylar defects were generated using striking wedges and chisels. First, a transverse tunnel measuring 2 mm in diameter passing through the head of the proximal phalanx was made. A second tunnel at the base of the middle phalanx with the same diameter was then created. The hemitendon of the flexor carpi radialis graft was passed through each of these tunnels. The proximal end of the graft was interposed in the area with a loss of bone substance. The ligamentoplasty was then tensed and fixed by two anchors on the proximal phalanx. Joint amplitudes and frontal stability were measured preoperatively and postoperatively. RESULTS: There was no significant change in the joint's range of motion: preoperatively, the mean mobility arcs were -2° to 113.80°, and they were -2° to 110° after the procedure (P=0.999). There was no significant difference in joint stability (P>0.05). CONCLUSIONS: Ligamentoplasty with PIP interposition appears to be a possible solution for the management of unicondylar defects of the proximal phalanx. An evaluation of clinical results is planned in order to definitively confirm the validity of this procedure.