Lior Amsallem

Arthroscopic Screw Removal After Arthroscopic Latarjet Procedure

Arthroscopic Latarjet procedure is an efficient and reliable approach for the treatment of shoulder instability. Nevertheless, the screws fixing the bone block may sometimes be responsible for pain and uncomfortable snapping in the shoulder that is triggered during active external rotation. We propose an all-arthroscopic technique for screw removal in cases of complications involving the screws from a Latarjet procedure. The all-arthroscopic screw removal is reliable and efficient. This procedure is indicated in more cases than thought because of the bone block resorption. It permits a revision of the glenohumeral joint in case of persisting pain.

Distal sensory disorders in Dupuytren's disease

PURPOSE Dupuytrens disease is a common and disabling condition. Its pathophysiology is not well understood. Some patients complain of postoperative loss of fingertip sensitivity that could be due either to the surgery or to the disease itself. Our hypothesis is that distal sensory disorders are a component of Dupuytrens disease. METHODS We performed a prospective, single-center study to compare two populations: controls and patients with Dupuytrens disease. Subjects were excluded if they were under 18 years of age or had any disease or treatment that could alter finger sensitivity or test comprehension. Sensitivity was determined using Webers static two-point discrimination test. Each ray of the tested hand in the Dupuytrens patients was classified as healthy or diseased; the diseased rays were graded using the Tubiana stages and the type of involvement (pure digital, pure palmar, palmar-digital). RESULTS The study enrolled 56 patients in two comparable groups of 28 patients and 28 controls. A statistically significant difference was found between the affected hands of Dupuytrens patients and the hands of the controls. There was also a significant difference in the mean sensitivity of affected and normal rays in the Dupuytrens patients. CONCLUSION Preoperative distal sensory disorders are a component of Dupuytrens disease that could be related to neuropathy and/or mechanical nerve compression. LEVEL OF EVIDENCE IV, case-control study, diagnostic study.

Hand injury without any deficit: Is systematic surgical exploration justified?

Out of 100,000 inhabitants, 700 to 4000 suffer a hand wound each year. Numerous hand wounds that may not have a clinically evaluated deficit, actually have damage to a major structure after surgical exploration in the operating room (OR). The aim of our study was to evaluate the incidence of major structure damage within a population of patients presenting a hand wound with no deficit on the clinical examination. Every patient older than 12 years, consulting for a wound deeper than the dermis with no clinical signs of major structure damage underwent surgical treatment and exploration of the wound under regional anesthesia in the OR. After each surgery, the surgeon filled out an anonymous study form describing the wound characteristics and the potential findings of major structure damage. Of the 145 wounds with normal clinical examination, we found that 58.6% had a major structure damaged. Given that damage to any major structure in the hand can lead to functional sequela, and the fact that a well-conducted clinical examination by a qualified hand surgeon is not sufficient to eliminate major structure damage, we recommend systematic surgical exploration of hand wounds, even when no clinical deficit is evident. LEVEL OF EVIDENCE III.: Type of sudy: diagnostic study.

Arthroscopy-Assisted Reduction and Fixation of a Transversal Glenoid Fracture: About a Case

An articular glenoid fracture is an uncommon injury. Usually significantly displaced intra-articular glenoid fractures are treated with open reduction surgery. Conventional open surgery techniques involve high morbidity. Here we describe an arthroscopy-assisted reduction and fixation method of an Ideberg type III glenoid fracture. This method provides good articular reduction without extensive exposure or soft tissue dissection and without nerve and/or vascular lesion.

Idiopathic bilateral lunate and triquetrum avascular necrosis: A case report

We report on the case of bilateral avascular osteonecrosis (AVN) of the lunate and triquetrum in a 45-year-old woman without any relevant medical history for which the cause could not be established. She was treated conservatively with splinting and analgesics. The patient was able to pursue her work and hobbies with subnormal range of motion at 1-year follow-up. AVN of the triquetrum is very rare, as it is a richly vascularized bone. The presence of AVN in multiple carpal bones has only been described in patients receiving high doses of corticosteroids. To our knowledge, there are no other cases of idiopathic AVN of multiple carpal bones in the literature.