Ahmed Zemirline

Prospective continuous study comparing intrafocal cross-pinning HK2® with a locking plate in distal radius fracture fixation

The fixation of distal radius fractures by pinning or locking plates remains controversial. The aim of this prospective continuous study was to compare the results of 28 anterior locking plates with 23 intrafocal cross-pinning HK2(®) systems. The mean age of group I (SVP(®), SBI™ plate) was 61 years. There were 15 extra-articular and 13 articular fractures. The mean age of group II (HK2(®), Arex™) was 63 years, with 13 extra-articular and 10 articular fractures. Twelve clinical variables were measured: pain, wrist strength, supination strength, pronation strength, quick DASH score, range of wrist motion in flexion, extension, pronation, and supination, ulnar variance, radial slope, and radial volar tilt. At 40 weeks follow-up, there was no difference between the two groups for 10 variables; two variables showed differences between the two groups: mean quick DASH score was 10.7 for group I, 19.7 for group II, and mean ulnar variance was -0.95 mm for group I, and 1.16 mm for group II. Six transient complications were noted for group I: five tenosynovitis, and one carpal tunnel syndrome. We noted 12 complications in group II: four superficial infections, two secondary displacements, one pin migration, two CRPS type II, two tendon ruptures and one nerve irritation. Generally, plates provided a more stable fixation associated with less complications while the HK2(®) system was quicker and less costly. The indications for its use need to be refined with a larger series and longer follow-up.

ARTHROSCOPIC ASSISTED PERCUTANEOUS SCREW FIXATION OF BENNETT'S FRACTURE

Several techniques are used for fixation of Bennetts fractures. The aim of this study was to assess a technique of arthroscopic-assisted reduction and percutaneous cannulated screw fixation of Bennetts fractures. Seven patients (mean age 29 years) with three fractures Type I and four fractures Type II according to Gedda were operated under arthroscopic lavage, fluoroscopic screw fixation, and arthroscopic control of the joint reduction. Arthroscopy, showed satisfactory joint reduction in all cases. At 4.5 months, the mean pain score was 1 (0-4), QuickDASH 15 (0-61), and Kapandji score 9 (5-10). Compared to the contralateral side, first web opening was 86% (58-100), key pinch 73% (45-89), grip strength, and 85% (40-100). Four secondary displacements were noted, two of which had a step of more than 1 mm. Our results showed that the use of arthroscopy for percutaneous screw fixation of Bennetts fractures facilitates joint reduction but does not guarantee stability of fixation.

The MetaHUS(®) fixation system versus pinning and plating in 5th metacarpal neck fractures.

The treatment of fifth metacarpal neck fractures is controversial. The aim of this work was to modify the intermetacarpal pinning technique with an external connector, and to compare the results of this modified technique to those of intramedullary pinning and locking plate techniques. Our series included 56 extra-articular fractures of the neck of the fifth metacarpal treated by intramedullary pinning (group A), locking plate Aptus(®) MEDARTIS™ (group B) and MetaHUS(®) Arex™ (group C); the last one consisted in intermetacarpal percutaneous pinning and connecting the pins externally. There were no statistically significant differences for all criteria except active mobility, which was less important for group B. In groups A and B, 6 complications were noted, in group C, one. Our results showed that blocked intermetacarpal K-wires is a technique of choice for the treatment of displaced fifth metacarpal neck fractures, not only because it is easy to assemble and to remove, but also because it allows immediate active mobilization.

Possibility of Fixation of a Distal Radius Fracture With a Volar Locking Plate Through a 10 mm Approach.

The management of distal radius fractures has dramatically improved due to the development of a locking plate system. In addition, mini-invasive surgery has been performed in a lot of surgical fields in recent years. The aim of the present study is to investigate the possibility of fixation of a distal radius fracture with a volar locking plate through a 10 mm approach. Eighteen patients with distal radius fracture (mean age: 66 y; range, 28 to 88 y; 8 males and 10 females) were operated on using a volar locking plate. The incision for plating was always 10 mm long. The clinical, cosmetic, and radiologic outcomes were investigated. At 3 months’ follow-up, the range of motion of the wrist joint was 67.5 degrees in flexion, 65.6 degrees in extension, 88.3 degrees in pronation, and 88.3 degrees in supination. The % grip strength compared to the healthy side ranged from 35% to 100%. The VAS, Q-DASH, and modified Mayo scores were 0.7, 8.5, and 93.3, respectively (excellent in all 18 patients). Bone union was achieved on plain x-ray radiography and cosmetic problems were satisfied in all patients. Our results suggest that it is possible to achieve fixation of a distal radius fracture with a volar locking plate through a 10 mm approach. However, its applicability to surgery must be carefully examined. If any difficulties in plate installation or approach occur during this intervention, it will be necessary to consider switching to a conventional approach. We believe that surgeons must not adhere to a mini-invasive approach.

Percutaneous fixation of first metacarpal base fractures using locked K-wires: a series of 14 cases.

The treatment of choice for first metacarpal base fractures is surgical. Open fixation is stable but causes tendinous adhesions. Percutaneous fixation is minimally invasive but is often followed by secondary displacement. Herein, we describe an alternative approach that combines advantages of both techniques through increasing stability of the Iselin technique by externally connecting the K-wires. Our series included 13 men of mean age 28 years. There were 13 fractures, 6 of which were extra-articular; there were 7 Bennett fractures, 5 of which had a large fracture fragment. After reduction, two 18 mm K-wires were driven medially crossing the 3 cortices of the first and second metacarpals. After bending them at 90-degree angles, the K-wires were connected externally in a construction allowing adaptation of the gap between the K-wires. Gentle immediate mobilization was allowed and the K-wires were removed 6 weeks later in clinic. At 16-month follow-up, mean pain score was 0.2/10 and Quick DASH was 2.9/100. Pinch grip was 81.8% of the contralateral side and grip strength 91.2%. The first web space opening was 79.1%. There was 1 secondary displacement with a good final result and 2 malunions. No arthritis was noted, but the follow-up was short. Our results show that the Iselin technique using locked K-wires is minimally invasive, stable, allows immediate mobilization, and K-wire removal in the office. Its indications may be extended to all fractures of the base of the first metacarpal whether articular or extra-articular.

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.

Lumbo-sacral malformations and spina bifida occulta in medieval skeletons from Brittany

IntroductionCompared with the other French regions, the incidence of neural tube defects is raised in Brittany. It can be explained by the Celtic origin of the Britton people, who migrated from Great Britain in the High Middle Ages. Notwithstanding, there are no historical or archeological evidences of the occurrence of these pathological conditions in medieval Brittany.Materials and methodsWe investigated the incidence of lumbo-sacral malformations on the skeletal remains of 30 individuals excavated from the necropolis of Saint-Urnel (southwest Brittany).ResultsWe found out several anatomical variations among five specimens, three of which had spinal dysraphism involving the sacrum.ConclusionOur results enrich the very few paleopathological data about spinal dysraphism, from the Hippocratic Corpus to the first description of Spina Bifida in sixteenth century. But, their interpretation remains delicate until the same genetic factors are shown in the etiology of both open and closed spinal dysraphism.

Contribution of arthroscopy in case of septic appearance arthritis of the wrist: a nine cases series.

Septic arthritis of the wrist is a diagnostic and therapeutic emergency. Synovectomy and lavage by arthrotomy is often followed by stiffness. The purpose of this study was to evaluate the diagnostic and therapeutic contribution of emergency arthroscopic synovectomy with intraarticular lavage. Nine patients were operated on for wrist pathology with septic appearance. All had signs of local inflammation, three showed locoregional inflammation, three were febrile. In one patient several joints were involved. Seven patients presented with inflammatory or degenerative arthritis. All patients underwent emergency surgery using radiocarpal joint puncture, arthroscopic exploration, intraarticular lavage and synovectomy at both the radiocarpal and midcarpal joints. The results were evaluated by pain, Quick DASH, grip strength, and wrist range of motion. In three cases, joint fluid appeared clear, in three it was turbid, and in three purulent. Gram stain and culture revealed bacteria in four cases. Synovitis was radiocarpal four times, radiocarpal and midcarpal once. In one case, there was radiocarpal and midcarpal chondritis. Average pain was 5.3/10 preoperatively and 2/10 at the last clinical follow-up visit. Mean grip strength was 23.3 kg on the involved side vs. 33.5 kg on the opposite one. Mean flexion was 55° for the involved wrist vs. 68°; mean extension was 52° for the affected wrist vs. 59°. No patient was reoperated on. In all cases, there was no sign of local inflammation, regional lymphadenopathy or systemic infection at the last follow-up. One patient died of colon metastatic cancer. Another patient developed a severe Complex Regional Pain Syndrome type I (CRPS1). Our results suggest three principles of management of wrist arthritis with septic appearance: extended surgical indication, emergency operation and arthroscopic procedure.

Meniscoligamentous band between the posterior horn of the lateral meniscus and the anterior cruciate ligament: arthroscopic, anatomical and histological observations.

BackgroundFollowing the example of the anterior cruciate ligament reconstruction, the success of meniscus allograft transplantation relies on good position of the graft and firm anchorage. The anatomy of the intercondylar region and the connections between the cruciate ligament and the meniscal horns have been the subject of many surveys. However, as far as we know, there is only one description of meniscoligamentous band between the posterior horn of the lateral meniscus (PHLM) and the anterior cruciate ligament (ACL) (Lahlaïdi in Rev Chir Orthop Reparatrice Appar Mot 57(8):593–600, 1971).MethodsFourteen cadaveric knees have been dissected to study the presence and variations of the band between the PHLM and the ACL. In addition, we undertook a histological study to ensure its ligamentous nature.ResultsThis meniscoligamentous band was found 13 times amongst the 14 investigated knees, and its ligamentous intra-articular extra-synovial nature was proved.ConclusionsThis study helps us to better understand the biomechanics of the menisci that are both stable and mobile structures.

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.