D. Corcella

Perilunate Dislocations and Transscaphoid Perilunate Fracture–Dislocations: A Retrospective Study With Minimum Ten-Year Follow-Up

PURPOSE Perilunate dislocations and transscaphoid perilunate fracture dislocations are associated with a high incidence of posttraumatic arthritis. According to the current literature, at medium-term follow-up, radiological signs of arthritis do not correlate with functional scores. The aim of this study was to evaluate patient hand function and the development of posttraumatic arthritis after perilunate dislocations (11 cases) and transscaphoid perilunate fracture dislocations (7 cases) at a minimum 10 years of follow-up. METHODS A retrospective review was performed including 18 patients with a minimum 10-year (average, 13 y) follow-up. The clinical results were evaluated using the Mayo wrist score and the patient-rated wrist evaluation. Radiological abnormalities were stratified using the Herzberg classification. RESULTS According to the Mayo wrist score, the authors found 5 excellent, 3 good, 7 fair, and 3 poor results. The mean Mayo wrist score was 76 (range, 60-90). There were 6 type A, 5 type A1, 6 type B1, and 1 type C, according to the Herzberg classification. Posttraumatic degenerative changes were observed in 12 cases. CONCLUSIONS The presence of radiological arthritis and static carpal instability did not cause reduced function at our minimum follow-up of 10 years. Based on our findings and previously reported series, we conclude that signs of posttraumatic arthritis after perilunate dislocations and transscaphoid perilunate fracture dislocations increase progressively but are well tolerated at an average follow-up of 13 years. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

Results with the Roseland(®) HAC trapeziometacarpal prosthesis after more than 10 years.

The Roseland(®) hydroxyapatite-coated prosthesis is a total trapeziometacarpal joint prosthesis used for the surgical treatment of thumb basal joint arthritis. The aim of this retrospective study was to evaluate its long-term outcomes. Fifty-one patients (64 thumbs) underwent trapeziometacarpal joint replacement with this prosthesis. The mean follow-up was 12.5 years. Survival rate of the prosthesis was 91%. There was either no pain or only occasional pain in 91% of cases. The mean QuickDASH score was 27.6. Abnormal radiographic findings were present in 70% of cases. Since they were often asymptomatic, no further treatment was carried out. Complications were common (25%) and occurred early on but could often be treated without surgery. The long-term results with the Roseland(®) HAC prosthesis are satisfactory in terms of pain relief and function. However, the high complication rate is a major concern.

Place actuelle du lambeau d’extensor digitorum brevis dans la reconstruction des pertes de substance de la cheville et du pied. À propos de 15 cas

The authors report their experience about a 15 cases series of ankle and foot soft tissues defects reconstruction with the extensor digitorum brevis flap which demonstrates its advantages. The flap was elevated in 9 cases on the tibial artery while the 6 others were raised on the distal dorsalis pedis artery with a retrograde flow. Healing was obtained for all cases with a complete resolution of septic problems for the 8 concerned cases. The outcome was uneventful for all but one which presented with a partial skin donor site secondary necrosis. No functional or trophic problems were noticed in other cases. Elevation of the extensor digitorum brevis flap is simple without note-worthy sequelaes. It is a reliable technique either for skin coverage or osteitis cure at level of the ankle. When raised with a retrograde arterial flow, it also appears as a useful alternative for the fore-foot reconstruction, location recognized difficult to treat by local means.

Appareil fléchisseur : rupture sous-cutanée récente des poulies

La premiere description averee des poulies des tendons flechisseurs des doigts semble revenir a Leonard De Vinci (1452–1529). Vesale, en 1543, en souligne l’importance biomecanique montrant qu’elles permettent de produire une mobilite articulaire par la traction sur les tendons sans creation d’une corde d’arc. En 1751, dans l’Encyclopedie de Diderot et d’Alembert, les poulies sont designees de facon imagee et fonctionnaliste, comme « les ligaments qui retiennent les flechisseurs des doigts ». Les anatomistes du debut du XIXe siecle apportent des descriptions plus fines qui precisent le role de ces poulies et s’accordent avec l’anatomie que nous reconnaissons aujourd’hui (1).

53 Reconstruction digitale par transfert partiel d’orteil

Introduction Cette etude avait pour but d’evaluer les resultats des reconstructions digitales par transfert partiel d’orteil chez l’adulte. Pour tous les patients, la reconstruction microchirurgicale etait secondaire a une amputation de la pulpe ou a une destruction articulaire traumatique de l’IPP. Materiel et methode Dix-huit transferts partiels d’orteil ont ete realises depuis decembre 1997. La serie incluait 9 transferts pulpaires, 4 transferts articulaires de l’IPP et 4 transferts composites osteo-onychopulpaires tailles sur mesure. L’âge moyen de la population etait de 27 ans (9 a 41 ans). A huit reprises il s’agissait d’une reconstruction du pouce ; dans 10 cas la reconstruction interessait un doigt long, dont tous les transferts articulaires. Le delai moyen entre le traumatisme et la reconstruction microchirurgicale etait de 1,3 mois. Douze fois il s’agissait d’un transfert a pedicule court, la dissection s’arretant a la face dorsale de la premiere commissure du pied. Elle a comme principal avantage de limiter la rancon cicatricielle sur le site donneur. Resultats Trois patients ont du etre repris en urgence pour une revision des sutures arterielles. Malgre cela, un transfert a evolue vers la necrose. La sensibilite des pulpes transferees a ete evaluee par le test de Weber. Les resultats montraient une discrimination comprise entre 7 et 11 mm avec un recul moyen de 14,3 mois. L’aspect esthetique etait juge bon malgre une dystrophie ungueale moderee chez les patients ayant beneficie d’un transfert composite distal. Tous les patients, a l’exception d’un, ayant beneficie d’une reconstruction pulpaire du pouce ont juge le resultat tres bon. Dans chaque cas, la marche a pu etre reprise au 5e jour postoperatoire et le port de chaussures fermees a ete possible environ 1 mois apres l’intervention. Le resultat des transferts articulaires a ete juge bon avec un enroulement digital satisfaisant, malgre un deficit d’extension de l’IPP de 30° en moyenne. Discussion et conclusion Au terme de cette serie encore relativement courte, il apparait que le transfert partiel d’orteil repond au mieux aux objectifs fonctionnels et esthetiques de la prise en charge des pertes de substances etendues et/ou composites des doigts. Les proprietes de resensibilisation et la possibilite de transferer tout ou partie du complexe ungueal en fait notre choix privilegie pour la reconstruction digitale distale. Le transfert articulaire nous semble egalement tout a fait justifie notamment chez l’adulte jeune malgre des resultats imparfaits.