Hand Surgery & Rehabilitation最新文献

{"title":"Arthroscopie du coude et conflit postérieur","authors":"Luiz Guilherme Rezende","doi":"10.1016/j.hansur.2024.101849","DOIUrl":"10.1016/j.hansur.2024.101849","url":null,"abstract":"<div><h3>Introduction</h3><div>L’arthroscopie du coude est un outil essentiel pour le diagnostic et la prise en charge des maladies du coude. La plupart des maladies qui ne s’améliorent pas avec une prise en charge non chirurgicale utilisant des méthodes invasives et non invasives conviennent à une option chirurgicale mini-invasive. L’avancement des compétences en IRM et en arthroscopie permet une meilleure compréhension de l’articulation du coude et de la façon de gérer certaines affections qualifiées de mythes par certains collègues, comme le conflit postérieur (impact). Il était autrefois associé aux activités sportives et aux travaux lourds.</div></div><div><h3>Matériel et méthodes</h3><div>Cette étude rétrospective a évalué les patients présentant un conflit postérieur réfractaire du coude géré par arthroscopie du coude. Les critères d’exclusion étaient les maladies post-traumatiques du coude ou l’instabilité du coude. Ainsi, 11 patients ont été inclus.</div></div><div><h3>Résultats</h3><div>Il y avait une association avec une tendinopathie latérale du coude et une dégénérescence du biceps ou du triceps. Les corps libres étaient utilisés pour être vus dans les maladies avancées. La récupération et le retour à la fonction se sont produits entre 5 et 34<!--> <!-->jours. Aucune infection n’a été observée et aucune progression de la dégénérescence du coude n’est survenue au cours des deux années de suivi.</div></div><div><h3>Discussion</h3><div>L’arthroscopie du coude reste controversée et très difficile à discuter entre collègues et toutes les procédures arthroscopiques. Cette procédure mini-invasive a permis de soulager les symptômes et la douleur du conflit postérieur du coude, permettant un mouvement immédiat et un retour rapide au travail et à la fonction. Les procédures ouvertes utilisées par sa prise en charge comportent plus de restrictions et un retour tardif aux activités quotidiennes. Sinon, l’arthroscopie du coude permet une amplitude de mouvement et un retour précoce à la fonction. Les patients sont revenus à leur fonction d’origine et aucune complication n’a été observée. Des recherches plus approfondies et des techniques comparatives sont nécessaires, mais le coude est une articulation réalisable pour le travail arthroscopique.</div></div><div><h3>Conclusion</h3><div>Un retour précoce à la fonction, les avantages mini-invasifs de la prise en charge arthroscopique du conflit postérieur du coude et un soulagement complet de la douleur ont été obtenus dans cette série de cas.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101849"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic management of thumb carpometacarpal arthritis : Experience with established techniques and low-cost adaptations","authors":"Felipe Roth","doi":"10.1016/j.hansur.2024.101818","DOIUrl":"10.1016/j.hansur.2024.101818","url":null,"abstract":"<div><div>Thumb carpometacarpal (CMC) arthritis is a degenerative condition that significantly impacts hand function, causing pain and functional limitations. Arthroscopic treatment has gained prominence for being minimally invasive and offering faster functional recovery. This study reports the experience of a surgeon in managing CMC arthritis arthroscopically, utilizing both established techniques and low-cost adaptations, applied in over 150 patients between 2016 and 2024.</div><div>A total of 150 cases of CMC arthritis treated arthroscopically were analyzed, with patients classified according to the severity of osteoarthritis. The techniques employed included synovectomy and arthroscopic ligament and joint capsule shrinkage for early-stage cases. For more advanced joint degeneration, procedures such as hemitrapezectomy with k-wire arthrodiastasis, hemitrapezectomy with ligament reconstruction (P. Desmoineaux et al., 2012), or suture-button suspensionplasty, as well as low-cost adaptations, were performed. After 2020, the arthrodiastasis technique was discontinued. Outcomes were assessed using QuickDASH and VAS functional scores, along with surgical time, costs, and morbidity.</div><div>Although the low-cost techniques required greater technical skill from the surgeon, they resulted in up to 40% savings in operational costs. Surgical time was, on average, 15% longer compared to conventional techniques, but without an increase in postoperative morbidity. The QuickDASH and VAS functional scores showed significant improvement in functional recovery, with similar results between the established techniques and the low-cost modifications. The arthrodiastasis technique was abandoned after 2020 due to the prolonged recovery time.</div><div>Low-cost adaptations for the arthroscopic management of CMC arthritis proved to be both viable and effective, particularly in financially constrained settings. Although surgical time was slightly longer, the reduction in costs without compromising functional outcomes justifies the use of these techniques. The discontinuation of arthrodiastasis reflects the pursuit of more effective procedures.</div><div>Arthroscopic management of thumb CMC arthritis, utilizing both established techniques and low-cost adaptations, offers an effective approach with favorable functional outcomes and reduced costs. Proper patient selection and the surgeon's technical expertise are critical to the success of the treatment.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101818"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Couverture du coude par le lambeau de l’artère radiale superficielle descendante : à propos d’une série clinique et revue de la littérature","authors":"Robin Fauconnet ,&nbsp;Arthémon Heitz ,&nbsp;Thibault Druel ,&nbsp;Arnaud Walch ,&nbsp;Adeline Cambon-Binder ,&nbsp;Laurent Mathieu","doi":"10.1016/j.hansur.2024.101815","DOIUrl":"10.1016/j.hansur.2024.101815","url":null,"abstract":"<div><div>Soft tissue coverage of the posterior aspect of the elbow requires thin and flexible flaps to adapt to movements without constraining them. The authors report a clinical series of reconstruction by the descending superficial radial artery (DSRA) flap, a proximal forearm perforator flap which use is rarely reported in the literature.</div><div>Seven patients with a mean age of 50 years (range: 24–88 years) were treated for a posterior elbow defect using the DSRA flap with an adipofascial pedicle. The flap was tunneled to the defect in the subcutaneous tissue or raised using the racket-like technique to avoid any pedicle compression.</div><div>The mean follow-up was 3.3 months (range: 1–12 months). A partial necrosis of the skin paddle occurred in an 88-year old patient. In the other cases, the flap evolution was straightforward. At the last follow-up, the appearance of the flaps was satisfactory in terms of color, texture, and thickness. No complications were observed at the donor site.</div><div>This study has several limitations, such as its retrospective nature, the low number of patients included and the diversity of the trauma mechanisms. However, to our knowledge this study constitutes the largest clinical series of DSRA flaps published. The indications for the DSRA flap are limited, which explains the low number of cases published in the literature. It is aimed at small or medium-sized PDS in the peri-olecranon region, rather on its lateral side.</div><div>The DSRA flap with an adipofascial pedicle is a simple, reliable, and reproducible method for reconstruction of small to moderate-sized defect on the posterior aspect of the elbow. Its use is easier for defects on the posterolateral side, but it can reach the medial olecranon.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101815"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Résultats à long terme des greffes de peau plantaire versus greffes de peau des zones velues pour la couverture des pertes de substances cutanées de la face palmaire des doigts, de la paume de main et de la plante du pied chez les patients à peau noire","authors":"Anatole Kibadi Kapay","doi":"10.1016/j.hansur.2024.101812","DOIUrl":"10.1016/j.hansur.2024.101812","url":null,"abstract":"<div><div>En dépit de l’utilisation de la greffe de peau totale dans le traitement des pertes de substances cutanées de la face palmaire des doigts, de la paume de main et de la plante du pied, les données publiées dans la littérature des résultats à long terme chez les patients à peau noire sont inexistantes. L’objectif de cette étude est d’évaluer les résultats à long terme des greffes de peau plantaire versus greffes de peau des zones velues pour la couverture des pertes de substances cutanées palmaires et plantaires chez les patients à peau noire.</div><div>Il s’agissait d’une étude de cohorte prospective ayant inclus 123 greffes de peau totale pratiquées chez 93 patients, tous sont des noirs africains. Des greffes de peau plantaire versus greffes de peau des zones velues ont été réalisées pour couvrir des pertes de substances cutanées des faces palmaire et plantaire. Cette étude couvre une période de 163 mois du 1^er janvier 2011 au 1^er août 2023. Les paramètres d’études ont été : sociodémographiques, médicocliniques, suivi postopératoire à long terme de résultats esthétique et fonctionnel partant d’un recul d’au moins 12 mois. Les patients ont été revus dans un but d’évaluer le gain fonctionnel, le regain de la sensibilité du greffon et le résultat esthétique. L’évaluation était clinique avec prise de photos.</div><div>Soixante-quatre greffes des zones velues ont été réalisées auprès de 52 patients dont 29 du sexe masculin et 23 du sexe féminin, soit un sex-ratio H/F de 1,3 ; et 59 greffes de peau plantaire chez 41 patients dont 21 du sexe masculin et 20 du sexe féminin, sex-ratio H/F de 1. La face palmaire digitale a été la plus receveuse de la greffe plantaire, soit 35,5 % de cas. Après un recul postopératoire d’au moins 12 mois, tous les patients ou leur entourage ont déploré l’aspect inesthétique de la greffe de peau velue et parmi lesquels 71 % (46 sur 64) ont sollicité le remplacement de cette peau greffée.</div><div>La texture et la couleur sont d’autant meilleures que la greffe de peau totale est prise dans une zone histologique identique. Au vu de ces résultats, nous conseillons pour les patients à peau noire une greffe de peau plantaire pour couvrir des pertes de substances cutanées de la face palmaire des doigts, de la paume de main et de la plante du pied, si elle est indiquée.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101812"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Dupuytren's disease: Staged and alternative procedures","authors":"Luiz Guilherme de Saboya Lenzi,&nbsp;João Baptista Gomes dos Santos,&nbsp;Vinicius Ynoe de Moraes,&nbsp;Jorge Raduan Neto,&nbsp;Carlos Henrique Fernandes,&nbsp;Flávio Faloppa","doi":"10.1016/j.hansur.2024.101826","DOIUrl":"10.1016/j.hansur.2024.101826","url":null,"abstract":"<div><div>Dupuytren's Disease (DD) causes contracture of the palm and fingers. Surgical procedures are indicated, however, some complications such as bruising, infections, vascular lesions, skin necrosis, and recurrence may occur. Thus, the type of incision to which the patient is submitted is decisive for the efficiency of healing. In this sense, the present study aimed to compare the healing quality in patients with DD treated by the Bruner and McCash incision, in patients with different stages of Dupuytren's disease.</div><div>Randomized clinical trial, carried out, between May 2017 and November 2018, comprising 12 women and 60 men, diagnosed with DD, who had not had previous surgery on the affected hand. Patients were classified according to the Tubiana classification and divided into two groups: Bruner and McCash. Scar evaluation was performed in the sixth postoperative month using 4 methods: Visual Analogic Scale (VAS), Vancouver Scar Scale (VSS) and Patient and Observe Scar Assessment Scale (POSAS).</div><div>Thirty-eight patients were allocated to the Bruner group and 34 to the McCash group. The mean age of the patients was 61 years, approximately 72.2 % were Caucasian. The time of onset of the disease was on average 6 years. By the Tubiana, 19 patients were classified as stage I, 27 as stage II, 10 as stage III and 16 as stage IV. Greater postoperative complications (<em>P</em> <!-->&lt;<!--> <!-->0.05) were determined for the Bruner group compared to the McCash group. With superiority of pain in the McCash group. There was a significant difference (<em>P</em> <!-->&lt;<!--> <!-->0.05) for the 4 evaluation scales, when considering the division between the Tubiana Mild (stages I and II) and Severe stages (stagse III and IV).</div><div>Our study describes highly satisfactory results with the McCash incision and demonstrated better outcomes in terms of healing quality and complications, which was confirmed with very low cases of postoperative complications compared to the Bruner incision. In this way, our study indicates that the McCash incision technique has advantages compared to the Bruner incision regarding postoperative complications, quality of healing, and patient satisfaction with DD.</div><div>For patients with DD classified as mild stages, either the Bruner or McCash incision achieves a good result and a high level of satisfaction. Firstly, in severe stages the McCash incision presents more satisfactory results.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101826"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Évaluation d’une technique chirurgicale hybride dans la maladie de Dupuytren","authors":"Marie Plomion ,&nbsp;Philippe Bellemère ,&nbsp;Ludovic Ardouin","doi":"10.1016/j.hansur.2024.101824","DOIUrl":"10.1016/j.hansur.2024.101824","url":null,"abstract":"<div><div>Nowadays, the therapeutic arsenal for Dupuytren's disease (DD) consists of treatments of varying degrees of invasiveness. The debate continues, particularly between percutaneous needle fasciotomy (PNF) and segmental fasciectomy (SF). It revolves around recovery times, recurrence rates and complications. Although PNF is often acclaimed for its safety, it appears to be less effective than SF in terms of recurrence. The aim of our study is to evaluate a mixed surgical technique, which consists of PNF supplemented by limited fasciectomy (PNF<!--> <!-->+<!--> <!-->LF) performed by the frequently occurring skin tear. We compared it with the conventional SF technique. Our hypothesis is that it could be a compromise between the two historical techniques, preserving the safety of PNF while reaching the efficacy to SF.</div><div>We conducted a retrospective, single-center, comparative study evaluating 69 patients treated between 2018 and 2019 by PNF<!--> <!-->+<!--> <!-->LF (31 patients) or SF (38 patients). Both groups were comparable in terms of age, sex, severity of DD and diathesis scores. Clinical evaluation was based on measurement of digital extension gain, recovery time, need for physiotherapy, satisfaction, Quick DASH and URAM functional scores, recurrence rate and complications.</div><div>At a mean follow-up of 49.8 months (about 4 years), there were no significant difference between the 2 groups regarding the total digital extension gain, satisfaction rate, and functional scores. However, the SF group had significantly longer recovery time and bigger need for physiotherapy. The recurrence rate was 50% in SF group and 19.4% in PNF<!--> <!-->+<!--> <!-->LF group. Complications occurred 8 times in the SF group (4 nervous, 4 cutaneous) and 3 times in PNF<!--> <!-->+<!--> <!-->LF (3 cases of hypoesthesia).</div><div>The technical points specific to this method were as follows: PNF was performed with a pink needle every 5<!--> <!-->mm. There was no skin incision. The fasciectomy was performed minimally through the skin tear, without deep sectioning or dissection. There were no skin sutures. Self-education was started immediately. Results of PNF<!--> <!-->+<!--> <!-->LF look similar to those of other surgical techniques of DD reported in the literature in terms of gain of digital extension, including disappointing results for PIP joint. However, recurrence rate of this technique appears to be lower than series evaluating PNF alone in the medium term and its safety is similar.</div><div>This technique of PNF<!--> <!-->+<!--> <!-->LF may represent a compromise between PNF alone and SF techniques. Its results encourage us to continue our investigations in the long term, with a larger number of patients, and on a prospective basis.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101824"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amyloidosis and carpal tunnel syndrome: can we predict occurrence?","authors":"François Saade ,&nbsp;Camille Barani ,&nbsp;Matthieu Guyard ,&nbsp;Matthieu Malatray ,&nbsp;Élisabeth Hugon-Vallet ,&nbsp;Philippe Schiele","doi":"10.1016/j.hansur.2024.101789","DOIUrl":"10.1016/j.hansur.2024.101789","url":null,"abstract":"<div><h3>Introduction</h3><div>Carpal tunnel syndrome, especially when bilateral, may be associated with amyloid deposits, a precursor of systemic amyloidosis. Systemic amyloidosis affects various organs, cardiac involvement having the poorest prognosis. Diagnosis is often delayed. Current treatments are only effective in the early stages of the disease. The primary objective of our study was to evaluate the incidence of amyloidosis in patients with bilateral carpal tunnel syndrome; the secondary aim was to screen for cardiac forms.</div></div><div><h3>Material and methods</h3><div>Between 2019 and 2023, we conducted a single-center prospective observational and diagnostic study to investigate the anatomical pathology of amyloid deposits in tenosynovial samples taken during open nerve release surgery on the median nerve. The tenosynovial biopsy was sent to a specific laboratory for analysis, and typing if positive. If amyloidosis was detected, the patient was referred to a specialist for a specific work-up.</div></div><div><h3>Results</h3><div>We included 54 patients, with a mean age of 67 years (range, 51–89 years): 16 men and 38 women. Sixteen analyses were positive, 12 of which were transthyretin and 4 non-typed.</div></div><div><h3>Discussion/conclusion</h3><div>Bilateral carpal tunnel syndrome was predictive of amyloidosis. As synovial biopsy during surgery is simple and rapid, it should be implemented to identify amyloidosis at an early stage. This could change prognosis, by improving survival through screening and initiation of early specific treatment.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101789"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors that interfere with immediate return to activity after volar locking plate fixation for distal radius fractures","authors":"Kenjiro Kawamura ,&nbsp;Kiyohito Naito ,&nbsp;Takamaru Suzuki ,&nbsp;Yasuhiro Yamamoto ,&nbsp;So Kawakita ,&nbsp;Norizumi Imazu ,&nbsp;Muneaki Ishijima","doi":"10.1016/j.hansur.2024.101803","DOIUrl":"10.1016/j.hansur.2024.101803","url":null,"abstract":"<div><div>Volar locking plate (VLP) fixation contributes to immediate return to activity in patients with distal radius fractures, but poor results have been seen in some cases. In this study, we report on clinical findings affecting the Q-DASH score at 1 month postoperatively, which was used as a measure of immediate return to activity after VLP fixation.</div><div>Ninety-five patients who underwent VLP fixation for distal radius fracture at our hospital between July 2014 and January 2022 were divided into a good group (<em>n</em> <!-->=<!--> <!-->86; 22 males, 64 females; age 61.9) and a poor group (<em>n</em> <!-->=<!--> <!-->8; eight females; age 63.6) according to the quartiles of Q-DASH score at 1 month after VLP fixation. Duration from injury to surgery, direction of fracture dislocation, and radiographic parameters (radial inclination: RI, volar tilt: VT, ulnar variance: UV) at the time of injury were examined. Radiographic parameters (RI, VT, and UV), range of motion of the wrist joint, grip strength ratio, and visual analog scale (VAS) at 1 month after VLP fixation were also examined. These parameters were compared among both groups. Moreover, logistic regression analysis was performed to determine whether these factors were independently associated with poor Q-DASH score at 1 after VLP fixation.</div><div>At the time of injury, fracture displacement was significantly higher in the poor group (VT<!--> <!-->=<!--> <!-->−23.8°, UV<!--> <!-->=<!--> <!-->4.2<!--> <!-->mm) than the good group (VT<!--> <!-->=<!--> <!-->−6.5°, <em>P</em> <!-->=<!--> <!-->0.02; UV<!--> <!-->=<!--> <!-->1.3<!--> <!-->mm; <em>P</em> <!-->=<!--> <!-->0.01). No differences in other parameters were observed between the groups. At 1 month after VLP fixation, grip strength ratio (17.2%) in the poor group was significantly lower than the good group (43.8%, <em>P</em> <!-->&lt;<!--> <!-->0.001), while VAS (5.6) in the poor group was significantly higher than the good group (2.4, <em>P</em> <!-->&lt;<!--> <!-->0.001). Logistic regression analysis revealed that VT and UV at injury (<em>P</em> <!-->&lt;<!--> <!-->0.05), grip strength ratio (<em>P</em> <!-->&lt;<!--> <!-->0.001), and pain VAS (<em>P</em> <!-->&lt;<!--> <!-->0.001) were all independently associated with poor Q-DASH score.</div><div>Fractures with large displacement at the time of injury have been found to hinder immediate return to activity, and intervention to treat osteoporosis, which is associated with the amount of fracture displacement, should be considered. The results also suggest that physical therapy to improve grip strength and postoperative pain management are important to promote immediate return to activity.</div><div>This study suggested that large amounts of fracture displacement, weakness of grip strength and postoperative pain can be interference factors to return to activity immediately after VLP fixation.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101803"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Les lambeaux adipeux freestyle pour le resurfaçage des lésions post-traumatiques des nerfs périphériques","authors":"Marie Witters,&nbsp;Jean Baptiste De Villeneuve Bargemon,&nbsp;Alice Mayoly,&nbsp;Najib Kachouh,&nbsp;Charlotte Jaloux","doi":"10.1016/j.hansur.2024.101793","DOIUrl":"10.1016/j.hansur.2024.101793","url":null,"abstract":"<div><div>The outcomes and prognosis after a traumatic nerve lesion remain uncertain and heavily dependent on the local environment, which can predispose perineural fibrosis. Studies have shown that interposing adipose flaps can create a well-vascularized barrier against scar tissue, thereby promoting peripheral nerve regeneration. We report the use of freestyle adipose flaps for wrapping peripheral nerves after a trauma, regardless of the nerve injury location.</div><div>We retrospectively reviewed patients who underwent a nerve wrapping with a local freestyle adipose flap. Data collected included age, nerve involved, cause and location of irritation, flap vascularization, follow-up duration, pain, patient satisfaction, and complications.</div><div>We included 6 patients, aged 11 to 60 years, with a minimum follow-up of 12 months (range: 12–24 months). Cases involved contusion of 2 radial nerves after humerus fractures, 1 ulnar nerve elongation at the elbow after arthrolysis and 1 median nerve neuroma-in-continuity in the forearm, 1 femoral cutaneous nerve neuroma-in-continuity, 1 sural nerve neuroma-in-continuity at the ankle after lacerations. All patients experienced pain, 4 had dysesthesia, and the 2 patients with radial nerve involvement also had motor paralysis. A local freestyle adipose flap was used for each patient, with excellent clinical perfusion noted intraoperatively. No complications were observed. All patients reported significant pain relief and were satisfied at the last follow-up.</div><div>In animal studies, vascularized adipose flaps have been shown to accelerate revascularization, enhance nerve regeneration and decrease fibroblast infiltration, by providing adipose stem cells and an optimal nutritional environment. Multiple adipose flaps have been described in human for compression neuropathies with good results (i.e.: the vascularized hypothenar fat pad transposition after a carpal tunnel release). There are 3 small cases series on post-traumatic nerve lesion wrapping with pedicle adipose flaps but those are only applicable in specific locations. Yamamot et al. even described the use of a free temporoparietal flap for resurfacing a radial nerve neuroma with good results. The main advantage of using freestyle adipose flaps is that they are available regardless of injury location, as limbs have numerous available perforators. This non-comparative retrospective study highlights the feasibility of those freestyle adipose flaps both in upper and lower limbs. This technique is straightforward with minimal risk of complications.</div><div>Freestyle adipose flaps provide a flexible and well-vascularized envelope that promotes nerve recovery and cushioning. Our report underscores the effectiveness of a simple surgical technique that is applicable regardless of the nerve lesion location.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101793"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"L’échographie peropératoire a-t-elle un intérêt en pratique courante dans le cadre de l’ostéosynthèse par plaque antérieure des fractures du radius distal ?","authors":"Yoann Dalmas,&nbsp;Stéphanie Delclaux,&nbsp;Hugo Barret,&nbsp;Pierre Mansat","doi":"10.1016/j.hansur.2024.101799","DOIUrl":"10.1016/j.hansur.2024.101799","url":null,"abstract":"<div><div>L’ostéosynthèse par plaque antérieure est devenue le <em>gold</em> standard dans la fixation des fractures du radius distal. Les ruptures tendineuses que ce soit du long extenseur du pouce par un rebord de vis en postérieur ou du long fléchisseur du pouce à cause d’une plaque débordante sont des complications redoutées.</div><div>La fluoroscopie est utilisée pour évaluer l’absence de débord dorsal des vis. Néanmoins, l’effet de superposition sur une vue 2D est à risque de méconnaître un débord. La classification de Soong sur un cliché de profil permet de prévoir un conflit entre le long fléchisseur du pouce et la plaque. L’échographie pourrait être une technique supérieure à la radio pour évaluer ces 2 risques en peropératoire. Les objectifs de cette étude étaient de déterminer la concordance entre les radiographies et l’échographie.</div><div>Nous avons mené une étude observationnelle monocentrique. Les patients opérés par un seul opérateur de plaques antérieures du radius distal étaient inclus. Des fluoroscopies de face, profil, tangentielle palmaire ainsi qu’une échographie étaient réalisées en peropératoire pour évaluer le débord dorsal des vis et un conflit entre la plaque et le tendon du long fléchisseur du pouce.</div><div>Dix patients ont été inclus. Deux vis débordantes ont été observées sur les clichés tangentiels palmaires. L’échographie peropératoire a retrouvé 2 protrusions de vis dorsale. Les clichés de profil ne retrouvaient pas de vis débordante. Un accord parfait été trouvé entre le cliché tangentiel palmaire et l’échographie (ICC<!--> <!-->=<!--> <!-->1) alors que celui du cliché de profil était de 0,42. Le temps opératoire moyen a été de 48<!--> <!-->min alors que l’ajout de l’échographie supposait en moyenne 5,1<!--> <!-->min de plus. L’échographie a permis de détecter un cas de conflit avec le long fléchisseur du pouce qui était supposé avec le cliché radiographique de profil. L’échographie permettait une épargne moyenne de 2,6 Clichés radioscopiques soit 7,8<!--> <!-->mGy.cm².</div><div>L’échographie permet de détecter avec une très bonne fiabilité les vis débordantes en dorsal et un conflit entre la plaque le long fléchisseur du Pouce. Néanmoins elle ne permet pas d’amélioration significative. L’épargne en termes de dose de rayon est faible, et le temps nécessaire à réaliser l’échographie étant significatif et nécessité du matériel supplémentaire. Nous pensons que l’échographie a un intérêt en pratique courante en cas de doute sur les clichés scopiques concernant le débord postérieur d’une vis et chez les patients Soong 1.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101799"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}