Thierry Dreano

Anatomical and Radiological Assessment of Trapezial Osteotomy for Trapezial Dysplasia in Early Trapeziometacarpal Joint Arthritis

Opening wedge osteotomy of the trapezial saddle was reported first by Kapandji and Heim (2002) as a possible surgical treatment for early trapeziometacarpal joint arthritis. This study evaluates the feasibility and anatomical risks of the procedure. Ten upper limbs from fresh cadavers were used for this anatomical and radiological study. A dorsolateral opening wedge osteotomy with a 10° correction was performed on each specimen. CT scans and AP radiographs of all the wrists were performed before and after osteotomy to assess the correction of the slope angle, defined as the angle between the longitudinal axis of the second metacarpal and the axis of the trapeziometacarpal articulation. On standard radiographs, mean trapezial slope was 126° preoperatively and 117° postoperatively. On sagittal and coronal CT reconstructions, one case of trapezial translation and two impingements between trapezoid and trapezium bones were identified. Trapezial osteotomy is technically demanding with several possible complications, but merits further study for young patients with Eaton stage 1 or 2 osteoarthritis and an abnormal trapezial slope.

A review of main anatomical and sonographic features of subcutaneous nerve injuries related to orthopedic surgery

Lesion to subcutaneous nerves is a well-known risk of orthopedic surgery and a significant cause of postoperative pain and dissatisfaction in patients. High-resolution ultrasound can be used to visualize the vast majority of small subcutaneous nerves of the upper and lower limbs. Ultrasound detects nerve abnormalities such as focal hypoechoic thickening, stump neuroma, and scar encasement, and provides information not only about the peripheral nerve itself but also about its relationship to adjacent anatomical structures. The purpose of this review is to provide an overview of the anatomy of the main subcutaneous nerves damaged during orthopedic surgery, recall at-risk procedures, and offer useful anatomic landmarks to help the sonographer identify and follow the nerves when an iatrogenic lesion is suspected.

Recurrent primary giant cell tumour of the proximal radius with pulmonary metastases.

Pulmonary metastases secondary to primary bone giant cell tumour (GCT) is extremely rare. Although occurrence has been reported in large case series of recurrent distal radius lesions following surgical treatment, this has not been previously reported following a proximal radius lesion. Treatment of a proximal radius GCT is reported and the risk of pulmonary metastases is highlighted for recurrent surgery. Favourable outcome was achieved at 3 years following three resections despite pulmonary metastases.