Hand Surgery & Rehabilitation最新文献

{"title":"Aspects échographies postopératoires à court et long termes des ruptures du biceps distal réinsérées par endoboutton","authors":"Florent Weppe,&nbsp;Lyliane Ly,&nbsp;Justin Ruyer,&nbsp;Maximilien Arnal,&nbsp;Thomas Jalaguier","doi":"10.1016/j.hansur.2024.101844","DOIUrl":"10.1016/j.hansur.2024.101844","url":null,"abstract":"<div><div>Distal biceps rupture is a rare but well-known lesion in young active men. Surgical treatment has improved with the use endobutton. The use of sonograph has changed the diagnosis and management of several pathologies of the upper limb, especially since the advent of wire less portable devices. This is a simple tool that can also help in the postoperative follow-up.</div><div>We retrospectively reviewed the characteristic features of reinserted distal biceps tendon with endobutton at short and very long term in 10 patients in different position of the forearm with a portable sonograph. We assessed the distance between the radial head and the position of the tunnel on the radial tuberosity and the diameter of the tendon; and compared it to the contralateral side.</div><div>The mean distance between the radial head and the reinserted tendon was 43.05<!--> <!-->mm with no statistical difference with the contralateral side. The mean ratio between the diameter of the reinserted tendon and the contralateral tendon at short and long-term was 1.3. No failure of the device has been reported.</div><div>Portable sonograph is a good tool to assess the healing of distal biceps reinsertion and the right positioning of the endobutton.</div><div>Portable sonograph is a costless and non-invasive imagine that can help in the follow-up distal biceps tendon rupture. Several views can be done to assess the tendon. However the normal and postoperative characteristic features of a distal biceps tendon has to be known.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101844"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fractures du radius distal après 75 ans : quelles fractures et quels patients opérer ? Évaluation prospective continue pendant les 6 premiers mois","authors":"Safire Ballet ,&nbsp;Inès Guerzider Régas ,&nbsp;Zouhair Aouzal ,&nbsp;Alexandre Quemener-Tanguy ,&nbsp;Axel Koehly ,&nbsp;Laurent Obert ,&nbsp;François Loisel","doi":"10.1016/j.hansur.2024.101796","DOIUrl":"10.1016/j.hansur.2024.101796","url":null,"abstract":"<div><div>Le traitement chirurgical (TC) et le traitement orthopédique (TO) des fractures du radius distal après 65 ans ont des résultats fonctionnels similaires à 1 an postopératoire. Peu d’études évaluent ces résultats après 75 ans.</div><div>Nous supposons que le TC apporte de meilleurs résultats cliniques et radiologiques que le TO. L’objectif principal de l’étude était de comparer à court terme, les résultats des deux traitements pour toutes fractures confondues et pour les fractures déplacées et très déplacées (bascule<!--> <!-->&gt;<!--> <!-->20°) du radius distal après 75 ans.</div><div>Cette étude prospective a inclus en deux ans 74 patients suivis 6 mois minimum. Le traitement dépendait du déplacement de la fracture, des comorbidités (Charlson) et de l’autonomie du patient. Le TC était une ostéosynthèse par plaque antérieure verrouillée à ciel ouvert (<em>n</em> <!-->=<!--> <!-->24). Le TO était une manchette plâtrée 6 semaines sans réduction (<em>n</em> <!-->=<!--> <!-->50). Les critères de jugement principaux étaient cliniques (amplitudes articulaires, force, scores EVA (échelle visuelle analogique), QuickDASH (Disabilities of the Arm, Shoulder and Hand), PRWE (Patient Rated Wrist Evaluation) et SF-36 (36-Item Short Form Health Survey). Les critères de jugement secondaires étaient les résultats radiologiques et les complications.</div><div>Le TC améliorait significativement de 7° : la flexion, l’inclinaison ulnaire, la supination, l’angle dorsal et la variance ulnaire dès 1,5 mois et la pronation et l”index radio-ulnaire distal dès le 6^e mois (<em>p</em> <!-->&lt;<!--> <!-->0,05). Le TC améliorait significativement de 10° : la flexion, l’inclinaison ulnaire, la supination chez les fractures déplacées et très déplacées dès 1,5 mois (<em>p</em> <!-->&lt;<!--> <!-->0,05).</div><div>Le TC améliore significativement les résultats cliniques et radiologiques après 75 ans dans les 6 mois post-fracture du radius distal. Le TC est conseillé pour les fractures du radius distal déplacées et très déplacées pour une récupération plus précoce des amplitudes articulaires. Au-delà des 6 mois, les résultats sont équivalents.</div><div>Cette étude nous encourage à proposer le traitement chirurgical en fonction du déplacement de la fracture et des exigences fonctionnelles du patient.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101796"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Taux de consolidation de l’ostéotomie accourcissante de l’ulna par plaque APTUS Wrist","authors":"Thomas Daoulas ,&nbsp;Hoel Letissier ,&nbsp;Mathilde Bernard ,&nbsp;Arthur Dellestable ,&nbsp;Guillaume Bacle ,&nbsp;Clara Sos","doi":"10.1016/j.hansur.2024.101829","DOIUrl":"10.1016/j.hansur.2024.101829","url":null,"abstract":"<div><div>Ulnar carpal impingement syndrome causes pain on the ulnar side of the wrist. Various surgical techniques have been described. Ulnar shortening osteotomy is now a standard treatment for carpal ulnar impingement syndrome. However, it is associated with complications such as non-union of the osteotomy site.</div><div>The main objective was to report the rate of radiographic consolidation after ulnar shortening osteotomy with cutting guide.</div><div>This is a multicenter retrospective series of 30 cases reporting clinical and radiographic criteria with a minimum 6-month follow-up.</div><div>The non-union rate was 3.4%. One case presented a non-union of the osteotomy site. 87% of patients were satisfied or very satisfied with the procedure. Mean VAS pain was 2.7 (standard deviation 2.4). The QuickDash and PRWE averages were 24.7 (standard deviation 19.2) and 28.6 (standard deviation 25.3). Mean Jamar dynamometer strength was 27.4<!--> <!-->kg (standard deviation 8.9). One patient developed complex regional pain syndrome. Five patients required plate removal for hardware-related discomfort.</div><div>The Aptus wrist plate ulna shortening osteotomy provides a standardized approach to the surgical treatment of ulnar impingement syndromes of the carpus. Compared with other series in the literature, this procedure provides a satisfactory consolidation rate and clinical results.</div><div>The Aptus wrist plate ulna shortening osteotomy provides good outcomes for the treatment of ulnar carpal impingement syndrome.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101829"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Résultats fonctionnels du transfert de Huber-Littler chez l’enfant dans les anomalies congénitales du pouce","authors":"Alexia Milaire,&nbsp;Élie Saghbini,&nbsp;Louis-Charles Castel,&nbsp;Raphael Vialle,&nbsp;Manon Bachy-Razzouk,&nbsp;Franck Fitoussi","doi":"10.1016/j.hansur.2024.101870","DOIUrl":"10.1016/j.hansur.2024.101870","url":null,"abstract":"<div><div>Dans les hypoplasies ou agénésies du pouce après pollicisation, il existe très souvent un défaut d’opposition par absence ou faiblesse des muscles thénariens externes. Afin de renforcer l’opposition, un transfert musculo-tendineux peut être effectué comme celui de l’Abductor Digiti Quinti (ADQ) décrit par Huber. L’objectif de cette étude est d’évaluer les résultats fonctionnels à moyen et long termes du transfert de Huber chez l’enfant.</div><div>Tous les patients ayant eu un transfert de Huber pour anomalie congénitale du pouce avec un recul postopératoire minimal de 6 mois ont été inclus de façon rétrospective et monocentrique. Une évaluation fonctionnelle (Quick Dash, cotation de la force musculaire, évaluation cosmétique, et mesure des forces de préhension), ainsi qu’un bilan d’ergothérapie (Block and Boxes Test (BBT) et Melbourne Assessment 2 Test (MA2)) ont été réalisés au dernier recul.</div><div>11 transferts sur 10 patients ont été inclus avec une moyenne d’âge lors de la chirurgie de 6,9 ans (DS<!--> <!-->=<!--> <!-->4,08) et un recul moyen de 3,73 ans (DS<!--> <!-->=<!--> <!-->2,75). Dans 8 cas, il existait une hypoplasie sévère du pouce (Blauth? IIIA) ; une association syndromique dans 4 cas, et une main bote radiale ipsilatérale dans 5 cas, dont 3 syndromiques.</div><div>La moyenne du Quick Dash était de 77,73 (DS<!--> <!-->=<!--> <!-->7,32). Le score de Kapandji moyen était de 7,86 (DS<!--> <!-->=<!--> <!-->1,34) et la force musculaire, en moyenne de 3,91 (DS<!--> <!-->=<!--> <!-->0,70) sur 5. L’aspect esthétique était en moyenne de 3,09 (DS<!--> <!-->=<!--> <!-->0,83), la visibilité cicatricielle de 3,36 (DS<!--> <!-->=<!--> <!-->0,81) et la satisfaction esthétique de 3,82 sur 5 (DS<!--> <!-->=<!--> <!-->1,25). 9 patients sur 10 recommanderaient l’intervention à un autre patient du même âge et les résultats des tests BBT ET MA2 étaient très satisfaisants.</div><div>Une retente du plan collatéral ulnaire a été nécessaire dans 3 cas, et 3 patients ont conservé une instabilité de l’articulation métacarpo-phalangienne. Aucun transfert n’a nécessité de reprise chirurgicale.</div><div>Dans cette série de patients atteints d’une hypoplasie sévère du pouce avec plus de 3 ans recul, les résultats cliniques subjectifs rapportés sont bons esthétiquement, fonctionnellement et sans morbidité associée. Cela est confirmé par la réalisation de tests ergothérapeutiques objectifs, validés et reproductibles.</div><div>Le transfert de Huber donne de bons résultats fonctionnels et esthétiques dans les hypoplasies sévères du pouce. Malgré l’existence de plusieurs tests cliniques et ergothérapeutiques, l’évaluation fonctionnelle de la main pédiatrique reste un défi.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101870"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allergie aux métaux : qu’en est-il de la prothèse trapézo-métacarpienne ?","authors":"Marie Witters,&nbsp;Jean Baptiste De Villeneuve Bargemon,&nbsp;Alice Mayoly,&nbsp;Najib Kachouh,&nbsp;Regis Legré,&nbsp;Charlotte Jaloux","doi":"10.1016/j.hansur.2024.101850","DOIUrl":"10.1016/j.hansur.2024.101850","url":null,"abstract":"<div><div>Allergy to implants is an emerging topic in orthopedic literature, yet its prevalence in non-weight-bearing prostheses is poorly documented, with only 3 cases described in the literature for trapeziometacarpal arthroplasty. The objective of this study was to evaluate the clinical outcomes following the removal of trapeziometacarpal prosthesis in suspected cases of metal allergy.</div><div>This retrospective cohort study spans from 2004 to 2024. We included all cases of trapeziometacarpal implant failure suspected to be due to metal allergy. Criteria analyzed included type of prosthesis, clinical signs of allergy (pain, itching, local dermatitis), radiological signs (bone lysis or aseptic loosening), skin patch tests (positive for prosthesis components), intraoperative findings, histological status, treatment, and outcomes after implant removal or replacement. Exclusion criteria included signs of infection, implant malposition, or a history of trauma.</div><div>Nineteen women and two men were included, with a follow-up period of 23 months. There were 9 Electra®, 7 Rubis II®, 5 Camargue®, and 2 Moovis® implants. All cases exhibited persistent, non-mechanical pain. Swelling was observed in 5 cases and dermatitis in 3 patients. All trapeziometacarpal joints remained flexible, unlike in cases of algoneurodystrophy. Radiologically, 12 cases of bone lysis were observed, with significant aseptic loosening in 4 cases, while no pathological findings were noted in 10 patients. Skin patch tests were conducted on 18 patients, with positive results for at least one component of the prosthesis in each patient (14 cobalt, 2 chrome-cobalt, 3 nickel, and 1 titanium). Intraoperatively, synovitis was observed in all patients, with macroscopic metallosis particularly evident in metal-on-metal prostheses, and bone lysis and loosening in half of the patients but no histological signs of metallosis were found. In all cases, symptoms either diminished or disappeared following prosthesis removal or replacement.</div><div>Although rare, implant allergy should be considered in cases of persistent, unexplained symptoms. Management should include full disclosure about the uncertain nature of this condition. The only way to confirm a diagnosis of metal allergy may be the resolution of symptoms after implant removal. In our experience, revision or replacement surgeries are prone to complications and are often more complex than the initial surgery. Therefore, in cases with a history of dermal metal allergy or allergy to other orthopedic materials, we recommend the use of hypoallergenic prostheses as a first option.</div><div>Metal implant allergy remains a diagnosis of exclusion, with no guidelines for either diagnosis or treatment. It is essential to investigate this condition thoroughly.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101850"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Réanimation du triceps par transfert nerveux des branches axillaires par voie postérieure, étude anatomique de faisabilité","authors":"Cerise Gosselin ,&nbsp;Elvire Guerre ,&nbsp;Anne Perruisseau-Carrier ,&nbsp;Nadine Sturbois-Nachef","doi":"10.1016/j.hansur.2024.101794","DOIUrl":"10.1016/j.hansur.2024.101794","url":null,"abstract":"<div><div>La voie postérieure est utilisée pour la réanimation du muscle deltoïde par les branches du nerf radial dans le cadre de lésions du plexus brachial. Cependant, celle-ci n’est pas utilisée pour la réanimation du muscle triceps brachial par les branches du nerf axillaire chez le patient tétraplégique où la voie antérieure est privilégiée.</div><div>Le but de notre étude était de décrire la faisabilité du transfert par voie postérieure des branches motrices du nerf axillaire pour réanimer une branche motrice du triceps brachial.</div><div>20 dissections ont été réalisées sur 10 pièces anatomiques de façon bilatérale (5 femmes, 5 hommes). La faisabilité du transfert des branches motrices du nerf axillaire sur les branches motrices du triceps était évaluée et la longueur nerveuse des nerfs donneurs par rapport à l’espace quadrilatère, la longueur des branches motrices du triceps jusqu’au point d’entrée dans le muscle ainsi que les diamètres de chaque nerf et de leurs branches étaient mesurées.</div><div>Le transfert des branches motrices du nerf axillaire sur les branches motrices destinées au triceps était faisable dans tous les cas. La longueur moyenne du nerf du petit rond était de 23,5<!--> <!-->mm, celle de la branche postérieure du deltoïde de 70,5<!--> <!-->mm, et de la branche du triceps de 87,1<!--> <!-->mm. Les calibres moyens étaient respectivement de 4,1<!--> <!-->mm, 2,6<!--> <!-->mm et 3,6<!--> <!-->mm.</div><div>Le transfert des branches motrices du nerf axillaire sur les branches motrices du triceps par voie postérieure présente l’avantage d’une meilleure exposition des branches et sa simplicité. La longueur de dissection des nerf donneurs peut laisser prévoir des temps de repousse plus court que la voie axillaire. La voie antérieure axillaire reste indiquée lorsque plusieurs transferts par voie antérieure sont planifiés dans le même temps opératoire.</div><div>En comparaison avec l’abord axillaire antérieur, la voie postérieure permet une meilleure exposition des branches motrices du nerf axillaire et du triceps et permet une suture au plus proche des effecteurs du muscle receveur. Par cet abord la réanimation de plusieurs chefs du triceps en fonction du calibre des branches et des variantes anatomiques peut être réalisée à la demande pour optimiser le résultat fonctionnel final.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101794"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Walant technique in wrist fractures","authors":"Jefferson Kalume","doi":"10.1016/j.hansur.2024.101801","DOIUrl":"10.1016/j.hansur.2024.101801","url":null,"abstract":"<div><h3>Introduction</h3><div>Fractures of the distal radius are one of the most common types of injuries encountered in hand surgery. Plate osteosynthesis is recommended for unstable fractures.</div><div>Distal radius fractures are treated using open reduction and internal fixation and using general anesthesia (GA) or regional blocks. Wide-awake local anesthesia with no tourniquet (WALANT), allows this operation to be conducted in non-sedated patients without the use of tourniquets.</div></div><div><h3>Material and methods</h3><div>We use a combination of 1% lidocaine, 1:100,000 epinephrine, and 10:1 8.4% sodium bicarbonate. However, we use only 40<!--> <!-->mL of the prepared solution because we strictly adhere to the safe limit of 7<!--> <!-->mg/kg for lidocaine with epinephrine. First, a total of 10<!--> <!-->mL of subcutaneous local anesthesia is infiltrated using a 27-gauge needle along the modified Henry skin incision. We inject the solution using a 23-gauge needle at the radial border of the radius where it is easily palpable. A total of 30<!--> <!-->mL of local anesthesia is used starting proximally with 10<!--> <!-->mL in each injection site. It is ideal to allow the local anesthesia a duration of at least 30<!--> <!-->minutes to take effect. It takes an average of 25<!--> <!-->minutes for maximal cutaneous vasoconstriction to occur with 1:100,000 epinephrine.</div></div><div><h3>Discussion</h3><div>This technique was first introduced and popularized in the 1980's by Dr. D. Lalonde, a plastic surgeon from Canada working in hand surgery for the past 10 years. This technique relies on the injection of buffered diluted lidocaine with epinephrine at the surgical site. The tourniquet at the base of the limb, which is a source of discomfort, becomes unnecessary as the epinephrine acts as a chemical tourniquet. This technique can also help prevent the potential complications associated with regional or general anesthesia and can be used in patients who are not eligible for general anesthesia <span><span>[1]</span></span>, <span><span>[2]</span></span>, <span><span>[3]</span></span>, <span><span>[4]</span></span>, <span><span>[5]</span></span>, <span><span>[6]</span></span>, <span><span>[7]</span></span>, <span><span>[8]</span></span>, <span><span>[9]</span></span>.</div></div><div><h3>Conclusion</h3><div>The WALANT technique is an easily applied, safe, and efficient anesthetic technique for open reduction and internal fixation of distal radius fractures. It does not require tourniquet so it keeps the patient free from tourniquet pain and complications. It is economical because it doesn’t require for any more expensive preoperative investigations. It does not require sedation, which allows the patients to communicate with the doctors during the procedure and perform active movement of the operated limb to examine if there is an impingement of implants.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101801"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apport de l’échographie peropératoire pour l’évaluation du débord dorsal des vis épiphysaires dans l’ostéosynthèse de l’extrémité inférieure du radius : étude anatomique comparative versus radiographie","authors":"Yoan Kim De Almeida ,&nbsp;Théo François ,&nbsp;Sylvie Collon","doi":"10.1016/j.hansur.2024.101798","DOIUrl":"10.1016/j.hansur.2024.101798","url":null,"abstract":"<div><div>Les fractures de l’extrémité inférieure du radius (FEIR) représentent le motif de consultation le plus fréquent en traumatologie. Nous avons voulu étudier l’apport de l’échographie en cours d’intervention pour mettre en évidence une ou plusieurs vis épiphysaires débordantes grâce à une étude anatomique.</div><div>Cette étude anatomique a porté sur 4 poignets, provenant de 2 cadavres adultes non formolés. Une plaque d’ostéosynthèse anatomique était positionnée par un premier opérateur puis stabilisées par deux vis en proximal. En distalité, un forage bicorticale était réalisé dans chaque trou des rangées proximale et distale de la plaque. Le nombre de vis introduites était ensuite laissé à la discrétion de l’opérateur avec un minimum de 3 vis par procédures. Cette dernière procédure a été réalisée à 14 reprises pour chaque spécimen (7 par poignets) soit un total de 28 répétitions.</div><div>L’évaluation du débord dorsal des vis épiphysaires était jugée par un second opérateur, en aveugle, en utilisant trois techniques d’imagerie : radiographies en incidence « Skyline view » (SLV) et de profil et oblique ainsi qu’en échographie.</div><div>Les valeurs prédictives négatives et positives ainsi que la spécificité et la sensibilité étaient respectivement de 94 %, 92,5 %, 96,3 % et 88,1 % pour l’analyse échographique ; 92,8 %, 92,5 %, 96,3 % et 86 % pour l’analyse radiographique en incidence SLV ; 78,6 %, 97,5 %, 98,5 % et 58,2 % pour l’analyse radiographique de profil et oblique.</div><div>L’échographie est un outil diagnostique validé pour l’étude des tendons après ostéosynthèse par plaque antérieure des FEIR. L’intérêt de l’échographie peropératoire par rapport l’échographie postopératoire est de pouvoir changer une vis proéminente en cours d’intervention, afin de prévenir un possible conflit ultérieur.</div><div>L’objectif de cette étude était d’évaluer l’intérêt de l’échographie en cours d’intervention par un chirurgien orthopédiste qui ne peut avoir l’expérience d’un radiologue ni la performance d’un échographe d’un centre de radiologie.</div><div>Cette étude n’a pas permis de montrer de supériorité de l’analyse échographique comparativement à une analyse radiographique en incidence SLV pour la détection de vis proéminentes.</div><div>L’échographie est un examen non irradiant mais nécessite une courbe d’apprentissage et un matériel technique adapté pour obtenir des images de qualité suffisante pour la recherche de vis débordantes.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101798"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence de l’anatomie de la surface articulaire proximal du trapèze (PAST) et de la surface articulaire trapézoïdienne du trapèze (TRAST) sur le placement de la cupule durant l’arthroplastie trapézo-métacarpienne","authors":"Thibault Druel ,&nbsp;Gaetan Vanpoulle ,&nbsp;Stéphane Barbary ,&nbsp;Aram Gazarian ,&nbsp;Arnaud Walch ,&nbsp;Alain Tchurukdichian","doi":"10.1016/j.hansur.2024.101816","DOIUrl":"10.1016/j.hansur.2024.101816","url":null,"abstract":"<div><div>Trapeziometacarpal prosthesis is one of the surgical options to address trapeziometacarpal osteoarthritis. Several authors reported the importance of the position of the cup and of bone stock to minimize the risk of loosening. Recenlty, Athlani et al. argued that the cup should be placed in the middle of the width of the trapezium. The senior author of the present study observed that placing the cup in the middle of trapezial width is not always possible, due to impingement (early contact) between the cup and the trapezoidal articular surface of the trapezium (TRAST), especially when trapezial height is low. The objective of the present study was to analyze the influence of the proximal articular surface of the trapezium (PAST) and TRAST anatomy on cup placement, in order to improve preoperative planning for trapeziometacarpal arthroplasty.</div><div>The influence of the anatomy of the PAST and the TRAST on cup placement during trapeziometacarpal arthroplasty was retrospectively evaluated on 56 preoperative anteroposterior radiographs of patients who underwent surgery for trapeziometacarpal osteoarthritis. The percentage coverage of the prosthetic cup by the PAST and the available height of the trapezium were calculated. The available height of the trapezium corresponds to the trapezium height after the bone cut at the ulnar edge of the proximal end of the prosthetic cup; it is the smallest available height of the trapezium witch was calculated considering the anatomy of the PAST and TRAST, with the cup placed in the middle of the width of the trapezium.</div><div>In 39% of cases, there was a significant difference (up to a mean 4.5<!--> <!-->mm, <em>P</em> <!-->&lt;<!--> <!-->0.001) between the radial height of the trapezium (which is usually considered) and the available height of the trapezium.</div><div>The anatomy of the PAST and the TRAST has an impact on the placement of the prosthetic cup when trapezium height is low. The results of the present study suggest that these considerations must be known by all operators performing trapeziometacarpal arthroplasty; that lateralization, implant suspension, or surgical alternatives should be considered to prevent several intra- and postoperative surgical complications.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101816"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morbidity of surgical techniques for radioscapholunate fusion in radiocarpal osteoarthritis","authors":"Pablo Rodriguez ,&nbsp;Nicolas Simon ,&nbsp;Jean-Yves Beaulieu ,&nbsp;Alissa Gübeli","doi":"10.1016/j.hansur.2024.101831","DOIUrl":"10.1016/j.hansur.2024.101831","url":null,"abstract":"<div><div>Radioscapholunate (RSL) arthrodesis is a treatment option for radiocarpal osteoarthritis in conditions such as post traumatic osteoarthritis after intra-articular distal radius fracture, stage 2 SLAC wrist, Kienbock's disease, and rheumatoid arthritis. Fusion can be achieved by various techniques such as fixation by K-wires, staples, plates and screws, with or without bone grafting, with no standard fixation technique currently established. We performed a retrospective analysis of patients treated with radioscapholunate fusion in our institution to analyze the morbidity of the different surgical techniques.</div><div>We performed a retrospective data analysis of patients treated with RSL fusion for radiocarpal osteoarthritis in our institution between 2013 and 2023.</div><div>20 patients underwent RSL fusion; 3 with rheumatoid arthritis and 17 with post-traumatic radiocarpal osteoarthritis. Fixation was performed with screws in 11 cases (55%), with plates and screws in 6 cases (30%) and with plates in 3 cases (15%). In 17 cases (85%), bone graft was inserted in the fusion zone, mostly from distal radius (25%) or iliac crest (20%). The mean range of motion (ROM) of the affected wrist decreased from 81° preoperatively to 53° postoperatively, grip strength decreased from 25<!--> <!-->kg preoperatively to 21<!--> <!-->kg postoperatively. 8 cases (40%) showed a total of 11 complications during follow up, all of them were revised surgically. The most common complications were conflict of hardware with soft tissue or joint surface (36%, 4 cases), followed by non-union and pancarpal arthritis (each 18%, 2 cases), one seroma of the iliac crest, one lunohamatal conflict and one tendon irritation. 2.4<!--> <!-->mm plates were used for fusion in 3 of the 4 cases suffering from conflict with the hardware. Both cases of non-union occurred in heavy smokers with over 30 pack years.</div><div>We observed a slightly higher fusion rate of 90% compared to the literature, with only two cases of non-union heavy smokers. There was no significant difference in complication rate or severity between the surgical techniques, however the majority of the complications were observed in patients treated with dorsal plates as fusion material. This can be explained by the hardware prominence, which causes conflict and irritation of the surrounding tissue.</div><div>Hardware-related complications, non-union and pancarpal osteoarthritis remain the main problems in RSL fusion. The hardware prominence can increase the risk of conflict with the surrounding soft tissue. We therefore recommend the use of screws or anatomically adapted low-profile plates for fusion.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101831"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}