François Moutet

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.

Middle and ring fingers are more exposed to pulley rupture than index and little during sport-climbing: a biomechanical explanation.

BACKGROUND Finger pulley injury is a common incident observed during sport-climbing. The total rupture of one or several pulleys is highly debilitating and requires surgical reconstruction and/or rehabilitation programs. Literature reports show that fingers are not equally exposed to this injury. The ring and middle fingers are usually injured while the index and little fingers are less exposed. The objective of this study was to determine the biomechanical factors leading to the enhanced exposure of ring and middle finger pulleys. METHOD Eight subjects were required to exert maximal four-finger force in a specific sport-climbing finger posture. External fingertip forces and finger joint postures were used as input data of a specifically developed biomechanical model of the four fingers (i.e., index, middle, ring and little). This model was based on classical Newton static laws and used an optimization process to quantify the flexor tendon tensions and the pulley forces in each finger. Passive participation of ligaments was also considered into mechanical equations. FINDINGS Results showed that two main factors could explain the enhanced exposure of ring and middle fingers. Firstly, the fingertip force intensities applied by these two fingers were higher than those observed for the index and little fingers. Secondly, results show that the pulley forces of the ring and middle fingers were close to their rupture thresholds, while it was not the case for the two other fingers. This could be explained by a specific localisation of the finger pulleys of the ring and middle fingers leading to enhanced pulley forces. INTERPRETATION These results are relevant and could help clinicians to understand finger pulley pathologies and adapt the surgical interventions to reconstruct the fingers pulleys.

Pins and Rubber Traction System for intra-articular proximal interphalangeal joint fractures revisited

The Pins and Rubber Traction System (PRTS) can be used to treat proximal interphalangeal intra-articular fractures. Our experience is that outcomes are not always excellent and that many patients have reduced joint function or residual deformities. The aim of this study was to evaluate the reasons behind the poorer outcomes of some of the patients treated with this system. A retrospective clinical and radiological evaluation was performed on 15 patients after a minimum of 2 years’ follow-up. The mean interphalangeal joint flexion range was 66° (range 0—100) in our series. The review of the literature shows an average active interphalangeal joint flexion of 78° (range 64—95). Reasons for this difference include preoperative delay, technical deficiencies, the learning curve, a lack in postoperative physiotherapy and degenerative changes due to the longer follow-up. Although the Pins and Rubber Traction System seems a simple procedure, a learning curve is necessary to avoid pitfalls.

Postoperative Management of Extensor Tendon Repairs in Zones V, VI, and VII

This paper describes the postoperative management plan for extensor tendon repair in zones V, VI, and VII as conceived by the Grenoble team. This plan includes immediate, postoperative systematic mobilization for all patients with surgical repairs in zones II through VIII. Postoperative mobilization in zones V and VI is performed under the protection of a Levame-type, dorsal steel leaf-blade spring. Depending on lesion location, proximal or distal to juncturae tendinum, Frères three-finger rule applies. In zone VII, differential tendon gliding between the wrist and finger extensors and surrounding tissue is accomplished with a Tom splint, which gives individual extension assistance to each digit and the wrist while limiting flexion.

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.

Force sharing and neutral line during finger extension tasks

There is general consensus that the minimization of the secondary torque of the hand provides a universal model for explaining the force sharing patterns among the fingers. Since biomechanical secondary axes of the hand are unchanged in extension, it appears relevant to validate this model for finger extension forces. Fifteen subjects performed flexion and extension forces in a four-finger task. Each fingertip force was expressed in percentage of the force produced by an individual finger force over the resultant four-finger force (force sharing), and the point of force application of the resultant force was calculated (neutral line). The force-sharing pattern was different for flexion and extension. The index and ring fingers were equally involved, regardless of the task. The neutral line was located differently in flexion and extension, and for proximal and distal force application in extension. The mode of control of the finger redundancy was specific to the force production in flexion and extension. In flexion, the principle of minimization of secondary torque was confirmed. This was not observed in extension. We concluded that the minimization of the secondary torque is not a universal mode of control of the finger redundancy.

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).

Training and Back to Training

The position of a finger can be either straight, arched, or hooked. The hand morphology, the various grips available outdoors or indoors (CG), the climber’s level, and his personal abilities are factors which determine the possibilities of seizing a hold.

Assessment and Safety

More and more young people practice climbing at a higher and higher level. Trying to reach excellence implies a rise in the number of training sessions and in the duration of these sessions, which consequently leads to an increase in injuries. Most of the common pathologies are found with high-level climbing. Indeed, finger structures are extremely strained at that level. In a way, just like highly skilled climbers, the common climber also wants to be a good performer, but contrary to the former one, the latter does not follow strict rules, which could nonetheless help him to reduce risks as regards possible lesions.