Surgical Support for Severe COVID-19 Patients: A Retrospective Cohort Study in a French High-Density COVID-19 Cluster.

Background. The COVID-19 epidemic has resulted in a massive surge in the need for intensive care unit (ICU) care. To avoid being overwhelmed, hospitals had to adapt and support the ICU teams in structured ICU care including involving surgical teams. This work aims at describing the collaborative efforts between the ICU care team and the Surgical Task Force (STF) during a surge of ICU activity in a University Hospital in a French high-density COVID-19 cluster. Study Design. This retrospective single center study analyzed the STF workflow and the ICU population. The study included 55 patients hospitalized in our ICU, ICU-converted step-down units, and post-anesthesia care units. The primary measure was the global daily STF activity. The secondary measure was the daily activity for each of the 5 tasks accomplished by the STF. Results. The STF attempted 415 phone calls for 55 patients' families, 237 mobilizations of patients requiring prone positions, follow-up of 20 patients requiring medevac, and contribution to ethical discussion for 2 patients. The mean (SD) daily number of successful phones calls, ethical discussions, mobilizations of patients requiring prone positions and medevac follow-up were 18 (7), .1 (.4), 10 (7), and 2 (3), respectively. No actions for discharge summaries writing were required. The maximum number of daily mobilizations for patients requiring prone positions was 25. The maximum number of daily attempted phone calls and successful phone calls were 37 and 26, respectively. Conclusion. Surgeons' technical and nontechnical skills represented an effective support for ICU teams during the COVID-19 pandemic.

Survival Rate on a 10-Year Follow-Up of Total Wrist Replacement Implants: A 23-Patient Case Series.

Background According to current literature, the estimated average survival rate for Remotion, the total wrist implants, is above 90% on an 8-year follow-up. We examined our series of Remotion to calculate its survival rate on a 10-year follow-up. Case Description A total of 23 cases of total wrist implants were reviewed. The case series included 22 patients, 18 females and 4 males, of an average age of 55 years. The case series included 19 inflammatory rheumatic diseases, 3 Kienböck disease, and 1 posttraumatic arthrosis. Conclusion The average survival rate of our case series was 95.7% on a 4-year follow-up, 91.3% on a 6-year follow-up, and 69% on a 10-year follow-up. On our review, the QuickDASH score, pain, wrist extension range of motion, and grip strength were improved postoperatively. No difference was shown between preoperative and postoperative values for wrist flexion, pronation, and supination. The case series included a septic case, treated by arthrodesis, and three total wrist implants displacements, two of which were treated by carpal implant, and the remaining one was treated by arthrodesis. Clinical Relevance The survival rate of the total wrist replacement implant Remotion was estimated to be 69%.

Surgical technique: about a new total and isoelastic wrist implant (Prosthelast®).

This study describes a new total wrist implant (Prosthelast®) designed to reduce the risk of distal migration of the carpal component. The Prosthelast® implant consists in a one-block radial implant replacing the metaphysis and the articular surface fixed to a radial elastic centromedullar wire and a carpal component in titanium with an articular condylar surface in polyethylene. We operated on five patients (three male patients and two female patients) and followed them up for 12 months on average. Two of the patients presented with rheumatoid arthritis of the wrist, and an ulnar osteotomy (Darrach procedure) was carried out at the same time of the arthroplasty. All clinical variables improved postoperatively (Quick DASH score, pain score, range of motion) except from wrist flexion which was reduced. No patients underwent revision surgery. Two patients presented with a periprosthetic radiolucent loosening around the radial component, but no implant migration was observed. Overall, the preliminary results of our case series show that the new Prosthelast® implant presents comparable short-term results to those described in the literature. We will follow up the patients to verify that long-term results are as satisfactory as the short-term results.

Correction to: The minimally invasive flexor carpi radialis approach: a new perspective for distal radius fractures.

With regards to Juan José Hidalgo Diaz, fifth author. The author's name is incorrectly listed on Pub-Med. The first and last name has been mixed up.Correct first name is: JJ (on PubMed: JJH.).Correct last name is: Hidalgo Diaz (on PubMed: Diaz).On SpringerLink the name is listed correctly, but on PubMed he is listed as Diaz JJH.

The minimally invasive flexor carpi radialis approach: a new perspective for distal radius fractures.

The minimally invasive flexor carpi radialis approach can be used for volar locking plate fixation of distal radius fractures. After 15-mm incision on the lateral aspect of the FCR tendon and all structures but the radial artery are reclined ulnarly, a plate is inserted under the pronator quadratus just proximal to the "watershed line." The distal epiphyseal screws are put in place, and the proximal part of the plate is exposed by flexion of the wrist to put in place the proximal screws. No drainage or postoperative immobilization is used. It offers the advantage of preserving ligamentotaxis which facilitates the reduction, and the small size of the scar improves the esthetic result of the procedure. It is indicated for extra-articular fractures of the distal radius. In the case of an intraarticular fracture, an arthroscopy may be associated. In the case of a proximal diaphyseal extension of the fracture, a second proximal approach can be added in order to use a longer plate. Relative contraindications are comminuted articular fractures in elderly osteoporotic patients. Functional and radiological results are comparable to those obtained with the extented flexor carpi radialis approach. A conversion of the procedure for a larger incision is always possible in the case of a difficult reduction.

The minimally invasive approach for distal radius fractures and malunions.

This article reviews the author's currently used minimal invasive approach for volar plating of distal radius fractures. A single longitudinal incision of 1.5 cm is drawn on the lateral aspect of the flexor carpi radialis tendon in order to insert a plate under the pronator quadratus. With the wrist flexed, the plate is applied on the anterior cortex of the radius to reduce the fracture. This approach offers the advantage of preserving ligamentotaxis, which facilitates the reduction, and the small scar improves the cosmetics. It is mainly indicated for extra-articular and simple intra-articular fractures of the distal radius. Relative contraindications are comminuted articular fractures in elderly osteoporotic patients. Functional and radiological results are comparable with those obtained with an extended flexor carpi radialis approach. My colleagues and I have used it for more than 2000 cases since 2012. This technique requires practise. Attempted conversion to a larger incision is possible in case of difficulty, but this is seldom necessary.

Long Volar Plating for Metadiaphyseal Fractures of Distal Radius: Study Comparing Minimally Invasive Plate Osteosynthesis versus Conventional Approach.

Background Minimally invasive plate osteosynthesis (MIPO) has been used in wrist surgery for several years. The purpose of this retrospective study was to compare clinical and radiologic outcomes of MIPO technique with those of a conventional approach in the treatment of metadiaphyseal distal radius fracture by long volar plating. Materials and Methods Our series consisted of 32 fractures in 31 patients, mean age 63.9 years, including 16 men and 15 women. MIPO technique was used in 15 wrists (group 1) and conventional approach (> 60 mm of skin incision) in 17 wrists (group 2). In group 1, a long volar plate was inserted under pronator quadratus through a 15- to 30-mm distal incision then fixed to the epiphysis of the distal radius. Then, through a 15- to 30-mm proximal incision, the plate was fixed to the diaphysis of the radius, thus reducing the fracture. Results In group 1, mean distal incision size was 23.5 and 16.9 mm for proximal one. Mean total scar size (sum of both distal and proximal incisions) was 40.0 mm in group 1 and 84.1 mm in group 2. Mean tourniquet time was 58.4 minutes in group 1 and 68.9 minutes in group 2. At latest follow-up, no significant difference was noted in both the groups concerning pain, quick-DASH score, grip strength, ROM, and radiologic data. One extensor pollicis longus rupture treated by tendon transfer was done in group 1. Conclusion The MIPO technique for metadiaphyseal fractures of the distal radius by long volar plating has cosmetic and economic advantages compared with the conventional approach. Conversion to conventional approach is possible at any time in case of technical difficulties. Level of Evidence III.

Conservative treatment in Jersey finger: a case report.

UNLABELLED: We report a case of a Type Vb flexor digitorum profundus tendon avulsion in a patient for whom surgery was contraindicated because of a high risk of stroke if anticoagulant treatment was to be stopped. After a 6-week conservative treatment and a 3-week self-physiotherapy programme, the patient achieved a nearly full active range of motion and an excellent functional result. A radiograph demonstrated a good fracture healing. LEVEL OF EVIDENCE: V.

Augmented reality-based navigation system for wrist arthroscopy: feasibility.

PURPOSE: In video surgery, and more specifically in arthroscopy, one of the major problems is positioning the camera and instruments within the anatomic environment. The concept of computer-guided video surgery has already been used in ear, nose, and throat (ENT), gynecology, and even in hip arthroscopy. These systems, however, rely on optical or mechanical sensors, which turn out to be restricting and cumbersome. The aim of our study was to develop and evaluate the accuracy of a navigation system based on electromagnetic sensors in video surgery. METHODS: We used an electromagnetic localization device (Aurora, Northern Digital Inc., Ontario, Canada) to track the movements in space of both the camera and the instruments. We have developed a dedicated application in the Python language, using the VTK library for the graphic display and the OpenCV library for camera calibration. RESULTS: A prototype has been designed and evaluated for wrist arthroscopy. It allows display of the theoretical position of instruments onto the arthroscopic view with useful accuracy. DISCUSSION: The augmented reality view represents valuable assistance when surgeons want to position the arthroscope or locate their instruments. It makes the maneuver more intuitive, increases comfort, saves time, and enhances concentration.

Can total wrist arthroplasty be an option in the treatment of the severely destroyed posttraumatic wrist?

Background Severely destroyed posttraumatic wrists are usually treated by partial or total wrist fusion or proximal row carpectomy. The indications for and longevity of total wrist arthroplasty (TWA) are still unclear. Case Description The aim of this study was to analyze a series in which one last-generation total wrist arthroplasty was used as a salvage procedure for wrists with severe arthritis due to traumatic causes. The data were prospectively recorded in a web-based registry. Seven centers participated. Thirty-five cases had a minimum follow-up time of 2 years. Average follow-up was 39 (24-96) months. Pain had improved significantly at follow-up, mobility remained unchanged. The total revision rate was 3.7%, and the implant survival was 92% at 4-8 years. Literature Review Very few studies have described specific results after TWA in posttraumatic cases and almost none using classical "third-generation" implants. The number of cases and the follow-up in the published series are small. Clinical Relevance Although painful posttraumatic wrists with severe joint destruction can be salvaged by partial or total fusion, we found that, evaluated at short- to midterm, total wrist arthroplasty can be an alternative procedure and gives results that are comparable to those obtained in rheumatoid cases. Level IV Case series.

Feasibility of computer-assisted surgery for trapeziometacarpal prosthesis: a preliminary experimental study.

BACKGROUNDS: The main complication of trapeziometacarpal replacement is trapezial cup loosening due to an imperfect positioning of the trapezial component. This problem is quite similar to those related to other arthroplasties. Hip surgery was progressed toward computer-assisted surgery (CAS) for the improvement of acetabular cup positioning. In this study, we propose an analysis of the feasibility of CAS in trapeziometacarpal replacement. METHODS: We implanted the hand of a cadaver with a trapeziometacarpal prosthesis (Elektra, by SBI). The surgical procedure and the analysis of motion with CAS were carried out in 6 steps: incision, bone morphing preparation and initialisation, trapezial and metacarpal recordings, first kinematic analysis, prosthesis insertion, and second kinematic analysis. The evaluation of the results was carried out as the comparison of the 2 curves sequences before and after prosthesis insertion. RESULTS: We did not notice any dislocation of the prosthesis. The comparison of 2 curves showed differences regarding motion. For instance, as for abduction-adduction movements, before prosthesis insertion, an opposed-phase automatic rotation was clearly observed whereas after prosthesis insertion, no rotation was observed. CONCLUSION: CAS makes it possible to analyze the trapeziometacarpal joint motion in terms of biomechanics rather than in terms of anatomy. Such progress should result in measurement standardization that in turn should improve the positioning of prostheses and perhaps the lengthening of their life expectancy by decreasing the rates of prosthesis loosening.

Contribution of computer-assisted surgery in total wrist prosthesis: a comparative preliminary study of eight cases.

BACKGROUND: The outcome of total wrist prostheses is disappointing due to complications, mainly loosening or absence of osseointegration. The main reason is poor placement. The aim of this study was to examine whether computer-assisted surgery (CAS) was advantageous in wrist prosthesis implantation. METHODS: Our study group comprised eight patients. Group I was operated on with CAS and Group II without. In both groups, we used the RE-MOTION PGT prosthesis. In Group I, we used a navigation system to navigate the guide pin and K-wire of the radial component. The evaluation consisted of measuring the operating time, intra-operative stability and mobility and orientation of the prosthetic components on X-rays. RESULTS: The operating time was increased by 34 min with CAS. Intra-operative mobility in the two groups was comparable. There was no difference between the two groups with regard to the position of prosthetic components, except for the lateral view of the radial component. CONCLUSIONS: Our results show that CAS could improve placement of total wrist prostheses. All that is left to be done is to convince industrialists to invest in navigation systems dedicated to small joints.

Kirschner wire placement in scaphoid bones using fluoroscopic navigation: a cadaver study comparing conventional techniques with navigation.

BACKGROUND: During scaphoid fixation, a pin guide is first inserted along the axis of the scaphoid, and then a cannulated screw is inserted around the pin guide. At least, the pinguide is removed. To verify the position of the pin guide, fluoroscopy is typically used, with the disadvantage of irradiation. Thus, it is impossible to visualize the pin guide in more than one view simultaneously. The goal of this study was to compare two pin guide placement techniques in scaphoid fixation: conventional (CF) vs. fluoroscopic navigation (FN). METHODS: Eleven upper limbs of cadavers were divided into two groups. The CF group included four scaphoids which were to be fixed with pin guide. The FN group included seven scaphoids which were to be fixed with the same technique under FN. RESULTS: The accuracy of screw insertion in both groups does not differ. In the CF group, the X-ray exposure time is four times higher. The total duration of the surgical procedure is slightly higher in the FN group. CONCLUSIONS: We are of the opinion that FN could be applied in clinical practice and could offer significant benefits in the treatment of fixation of the scaphoid.