Wissam El Kazzi

Radiocapitellar joint contacts after bipolar radial head arthroplasty.

PURPOSE The purpose of this study was to determine radiocapitellar contacts before and after radial head replacement, using the bipolar design of Judet. METHODS Joint contacts were measured by moulding the joint surfaces of 6 fresh-frozen cadaveric specimens, in various positions of elbow flexion and forearm rotation. RESULTS Expressed as function of the radial cup, contact areas averaged 44% in the normal elbow, decreasing with flexion and increasing with supination (P < .05). After prosthetic implantation, contact areas averaged 33% and remained quite similar, irrespective of elbow position. Subluxation of the prosthetic head over the lateral margin of the trochlea was seen systematically with supination. CONCLUSIONS Because of intraprosthetic mobility, contact areas were not dependant on elbow position. This adaptability, however, also led to abnormal positioning of the prosthetic radial head with supination, subluxing over the trochlea lateral margin.

Hand Trauma, Dislocations and Fractures, Infections

The goal in the treatment of a hand trauma or a hand infection is full and rapid restoration of hand function. The main complication is stiffness, which may be of articular origin, or result from ligament shortening, from adhesions within the gliding planes or along the tendons or the consequence of intrinsic tightness or algodystrophy. Understanding the precise cause of stiffness in a particular case allows the instauration of an efficient prevention. Most ligament injuries result from sporting accidents, and the proximal interphalangeal joints of the long fingers and the metacarpophalangeal joint of the thumb are particularly at risk. The principles of treatment of hand fractures are anatomical reduction, followed, when possible, by immediate mobilization and, if necessary, by immobilization of the injured finger in the “protective” position, minimizing that support period as much as possible, and remobilization when the fracture is clinically stable. The indications of replantation include amputation of the thumb, amputation of multiple digits, single-digit amputation distal to the insertion of the flexor digitorum superficialis, amputation in a child, and amputation through the palm, the wrist, or the forearm. Most hand infections result from direct contamination from a penetrating injury or a laceration.