Patrick Lorea

Camptodactyly as a spectrum of congenital deficiencies: a treatment algorithm based on clinical examination.

Background: Camptodactyly is a frequent congenital hand disorder, but its cause and treatment remain a matter of controversy. Although it is difficult to establish the primary cause of camptodactyly, careful clinical examination allows the assessment of all the structures involved (e.g., skin, subcutaneous fascia, flexor tendons, extensor tendon, intrinsic muscles, and joints). The purpose of the study was to assess the validity of an algorithm based on the clinical examination in planning the operation. Methods: An algorithm based on clinical examination and the authors’ 27-year experience was designed to determine and customize the surgery for each case according to the function of the anatomical structures involved. The authors compared the results of surgical treatment in two groups of patients with camptodactyly of the fifth finger operated on before (group 1, 33 patients) or after use of the algorithm (group 2, 35 patients). All patients had more than 1 year of follow-up (range, 21 to 47 months). Results: There were significantly fewer failures in group 2 (14 percent versus 45.5 percent, p < 0.01). The improvement, after an extensive liberation in stiff early cases (type Ia), gave better results than previous attempts but did not reach significance (84 percent versus 66 percent). Similarly, for types Ib (early and correctable) and IIb (late and correctable) camptodactyly, the surgical results were improved, with 91 percent and 90 percent improvement, respectively, in group 2 versus 50 percent and 44 percent in group 1 (not significant). Conclusion: A selective surgical indication, based on careful clinical examination, improves the results of camptodactyly treatment by correcting the involved anatomical components.

Principalization of pollicization of the index finger in congenital absence of the thumb.

After reviewing our experience with pollicization in congenital cases of thumb hypoplasia or aplasia, we found that classic techniques have several weak points concerning function and appearance. Abduction is frequently inadequate, and adduction is quite weak. Esthetically the thumb has a slender aspect, the web fold is absent, and the commissure looks more like a cleft. We tried to prioritize the issues to propose some technical modifications for improvement of function and appearance.

Dénervation trapézométacarpienne. Description de la technique chirurgicale et résultats préliminaires dans une série prospective de 14 cas

INTRODUCTION The main goal of first carpometacarpal arthritis surgical treatment is to relieve pain. The main disadvantages of the usual techniques (trapeziectomy, implant arthroplasty) are loss of strength or presence of a prosthetic device. It is difficult to propose such extensive surgery at an early stage of the disease. Selective denervation of the first carpometacarpal joint seems to be an interesting choice. We propose a new technique of denervation based on our previous anatomical investigations. TECHNIQUE Two incisions are needed to cut all the articular branches derive from the superficial branch of the radial nerve, the palmar cutaneous branch of the median nerve, the thenar branch of the median nerve and the lateral ante brachial cutaneous nerve. MATERIAL Fourteen patients were prospectively included in our study with a mean follow-up of 5 months. RESULTS Pain relief was very satisfying in 12 cases (mean decrease 84%). An increase in grip and key pinch strength was noted. Complications were uncommon, excepted temporary paresthésia in the radial nerve area. DISCUSSION This technique seems to be promising and a good indication for patients with no disabling deformity, but only long-term results will confirm the place of denervation in the treatment of first carpometacarpal arthritis.

The Preliminary Results of Treatment of Symptomatic Carpal Boss by Wedge Joint Resection, Radial Bone Grafting and Arthrodesis with a Shape Memory Staple:

There is no consensus regarding the aetiology or treatment of carpal boss. Recurrences or carpometacarpal instability is reported after simple resection. Carpometacarpal arthrodesis has been proposed as a primary treatment and after failure of simple resection. This paper reports the results at a mean follow-up of 17 (range 13–28) months of treatment by wedge-shaped joint resection, corticocancellous radial bone graft and arthrodesis with a shape memory staple of seven of 32 patients who presented with a painful carpal boss. The study group included five women and two men of mean age at operation 29 (range 18–40) years. Fusion was achieved in all cases and all patients were pain free at follow-up. No complications occurred and all the patients were pleased with the aesthetic aspect of the treatment.

Evolution of surgical techniques for skin releases in the treatment of simple congenital syndactyly: a review

Since the first publications in the early nineteenth century on surgical techniques for releasing congenital syndactyly, this pathology has received constant interest in the medical literature. Current techniques for separating syndactylized digits include three major steps that are discussed separately: commissure reconstruction, digital incision and ways to overcome the lack of skin. The use of the recently described commissural flaps – usually larger and more proximally-raised than conventional flaps – that allow for closure without a skin graft is discussed, based on the personal experience of the authors.

Correction of Clinodactyly by Early Physiolysis: 6-Year Results

PURPOSE To review results at least 6 years after physiolysis for treatment of the delta phalanx associated with clinodactyly. METHODS We present 22 cases of clinodactyly treated with physiolysis in which we removed the central part of the epiphysis, which is the portion restricting longitudinal growth unilaterally and inducing progressive finger deviation, and placed a fat graft in the resultant defect. RESULTS This retrospective study reports the results of early physiolysis in 27 fingers with radial clinodactyly, including 17 fingers from 17 patients previously reported and 10 little fingers from 5 additional patients. All patients had a minimum follow-up of 6 years. Mean preoperative angle was 38° (range, 25° to 47°). At final follow-up, mean angle was 8° (range, 0° to 24°), a mean correction of 79%. Twelve fingers in 9 patients had more than 10° of deformity at final follow-up, whereas 15 fingers in 13 patients had a residual deformity of less than 10°, which is effectively full correction of a clinodactyly. No patient required a closing wedge osteotomy later for insufficient correction. CONCLUSIONS These accumulative findings confirm our previous preliminary report. Early physiolysis is a quick and simple procedure that allows for growth and partial but often adequate correction of the clinodactyly. The correction occurs slowly over a period of years, which can be seen as a disadvantage, and requires careful counseling of the parents. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

Évaluation fonctionnelle du lambeau homodactyle en îlot unipédiculé de Venkataswami-Subramanian : étude rétrospective sur 29 patients au recul moyen de 35 mois

CP018 Evaluation a long terme de la reconstruction digitale apres amputation distale. Revue d’une serie de 181 cas M.-L. Abi-Chahla a, H. Choughri a, A. Gay b, P. Pelissier a, E. Sawaya c, B. Sommier a,∗ a Chirurgie plastique et chirurgie de la main, CFXM, CHU de Bordeaux, Bordeaux, France b Chirurgie plastique et chirurgie de la main, CHU de la Conception, AP–HM, Marseille, France c Institut aquitain de la main, clinique Saint-Martin, Pessac, France ∗Auteur correspondant. Adresse e-mail : sommierbenjamin@yahoo.fr (B. Sommier)

26 Récidive des tumeurs à cellules géantes des gaines tendineuses après la voie d’abord dite des « dents de la mer »

Introduction Les tumeurs a cellules geantes des gaines tendineuses sont redoutees pour leur haute propension a recidiver. Ces recidives locales sont generalement imputees a une exerese incomplete. Nous avons revu a long terme un groupe de tumeurs circonferentielles excisees par une voie d’abord large. Materiel et methodes Vingt-six tumeurs circonferentielles ont ete excisees entre 1980 et 1998 par une voie d’abord originale decrite par l’auteur senior. Cette voie d’abord consiste en quatre lambeaux triangulaires, un dorsal, un palmaire (tous deux a base proximale) et deux lambeaux lateraux (a base distale). Six cas avaient deja subi une ou plusieurs exereses anterieures (en moyenne 2,5 operations). Plusieurs structures anatomiques avoisinantes etaient envahies dans tous les cas sauf un. Cette approche a permis dans tous les cas une exerese macroscopiquement satisfaisante. Resultats Vingt-cinq patients ont ete revus par un observateur independant apres un suivi moyen de 6 ans. Six patients (24 %) ont presente une recidive apres un delai moyen de 17 mois. Parmi ceux-ci, 5 avaient deja ete operes (83 %) et 5 presentaient de multiples tumeurs. Discussion Une excision macroscopiquement complete ne suffit pas pour prevenir les recidives. Le taux de recidive semble plus etre correle a l’existence d’une sous-population tumorale ayant un potentiel invasif different qu’a une exerese incomplete. Des travaux immuno-histochimiques recents confirment cette hypothese et un tel examen est recommande en routine clinique. Si une excision macroscopiquement complete ne previent pas les recidives dans un sous-groupe de patients, la voie d’abord circulaire reste cependant un outil technique precieux dans l’excision de ces tumeurs.