Hand Surgery & Rehabilitation最新文献

{"title":"Walant technique in wrist fractures","authors":"Jefferson Kalume","doi":"10.1016/j.hansur.2024.101801","DOIUrl":"10.1016/j.hansur.2024.101801","url":null,"abstract":"<div><h3>Introduction</h3><div>Fractures of the distal radius are one of the most common types of injuries encountered in hand surgery. Plate osteosynthesis is recommended for unstable fractures.</div><div>Distal radius fractures are treated using open reduction and internal fixation and using general anesthesia (GA) or regional blocks. Wide-awake local anesthesia with no tourniquet (WALANT), allows this operation to be conducted in non-sedated patients without the use of tourniquets.</div></div><div><h3>Material and methods</h3><div>We use a combination of 1% lidocaine, 1:100,000 epinephrine, and 10:1 8.4% sodium bicarbonate. However, we use only 40<!--> <!-->mL of the prepared solution because we strictly adhere to the safe limit of 7<!--> <!-->mg/kg for lidocaine with epinephrine. First, a total of 10<!--> <!-->mL of subcutaneous local anesthesia is infiltrated using a 27-gauge needle along the modified Henry skin incision. We inject the solution using a 23-gauge needle at the radial border of the radius where it is easily palpable. A total of 30<!--> <!-->mL of local anesthesia is used starting proximally with 10<!--> <!-->mL in each injection site. It is ideal to allow the local anesthesia a duration of at least 30<!--> <!-->minutes to take effect. It takes an average of 25<!--> <!-->minutes for maximal cutaneous vasoconstriction to occur with 1:100,000 epinephrine.</div></div><div><h3>Discussion</h3><div>This technique was first introduced and popularized in the 1980's by Dr. D. Lalonde, a plastic surgeon from Canada working in hand surgery for the past 10 years. This technique relies on the injection of buffered diluted lidocaine with epinephrine at the surgical site. The tourniquet at the base of the limb, which is a source of discomfort, becomes unnecessary as the epinephrine acts as a chemical tourniquet. This technique can also help prevent the potential complications associated with regional or general anesthesia and can be used in patients who are not eligible for general anesthesia <span><span>[1]</span></span>, <span><span>[2]</span></span>, <span><span>[3]</span></span>, <span><span>[4]</span></span>, <span><span>[5]</span></span>, <span><span>[6]</span></span>, <span><span>[7]</span></span>, <span><span>[8]</span></span>, <span><span>[9]</span></span>.</div></div><div><h3>Conclusion</h3><div>The WALANT technique is an easily applied, safe, and efficient anesthetic technique for open reduction and internal fixation of distal radius fractures. It does not require tourniquet so it keeps the patient free from tourniquet pain and complications. It is economical because it doesn’t require for any more expensive preoperative investigations. It does not require sedation, which allows the patients to communicate with the doctors during the procedure and perform active movement of the operated limb to examine if there is an impingement of implants.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101801"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152350","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":"Apport de l’échographie peropératoire pour l’évaluation du débord dorsal des vis épiphysaires dans l’ostéosynthèse de l’extrémité inférieure du radius : étude anatomique comparative versus radiographie","authors":"Yoan Kim De Almeida ,&nbsp;Théo François ,&nbsp;Sylvie Collon","doi":"10.1016/j.hansur.2024.101798","DOIUrl":"10.1016/j.hansur.2024.101798","url":null,"abstract":"<div><div>Les fractures de l’extrémité inférieure du radius (FEIR) représentent le motif de consultation le plus fréquent en traumatologie. Nous avons voulu étudier l’apport de l’échographie en cours d’intervention pour mettre en évidence une ou plusieurs vis épiphysaires débordantes grâce à une étude anatomique.</div><div>Cette étude anatomique a porté sur 4 poignets, provenant de 2 cadavres adultes non formolés. Une plaque d’ostéosynthèse anatomique était positionnée par un premier opérateur puis stabilisées par deux vis en proximal. En distalité, un forage bicorticale était réalisé dans chaque trou des rangées proximale et distale de la plaque. Le nombre de vis introduites était ensuite laissé à la discrétion de l’opérateur avec un minimum de 3 vis par procédures. Cette dernière procédure a été réalisée à 14 reprises pour chaque spécimen (7 par poignets) soit un total de 28 répétitions.</div><div>L’évaluation du débord dorsal des vis épiphysaires était jugée par un second opérateur, en aveugle, en utilisant trois techniques d’imagerie : radiographies en incidence « Skyline view » (SLV) et de profil et oblique ainsi qu’en échographie.</div><div>Les valeurs prédictives négatives et positives ainsi que la spécificité et la sensibilité étaient respectivement de 94 %, 92,5 %, 96,3 % et 88,1 % pour l’analyse échographique ; 92,8 %, 92,5 %, 96,3 % et 86 % pour l’analyse radiographique en incidence SLV ; 78,6 %, 97,5 %, 98,5 % et 58,2 % pour l’analyse radiographique de profil et oblique.</div><div>L’échographie est un outil diagnostique validé pour l’étude des tendons après ostéosynthèse par plaque antérieure des FEIR. L’intérêt de l’échographie peropératoire par rapport l’échographie postopératoire est de pouvoir changer une vis proéminente en cours d’intervention, afin de prévenir un possible conflit ultérieur.</div><div>L’objectif de cette étude était d’évaluer l’intérêt de l’échographie en cours d’intervention par un chirurgien orthopédiste qui ne peut avoir l’expérience d’un radiologue ni la performance d’un échographe d’un centre de radiologie.</div><div>Cette étude n’a pas permis de montrer de supériorité de l’analyse échographique comparativement à une analyse radiographique en incidence SLV pour la détection de vis proéminentes.</div><div>L’échographie est un examen non irradiant mais nécessite une courbe d’apprentissage et un matériel technique adapté pour obtenir des images de qualité suffisante pour la recherche de vis débordantes.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101798"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152353","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":"Influence de l’anatomie de la surface articulaire proximal du trapèze (PAST) et de la surface articulaire trapézoïdienne du trapèze (TRAST) sur le placement de la cupule durant l’arthroplastie trapézo-métacarpienne","authors":"Thibault Druel ,&nbsp;Gaetan Vanpoulle ,&nbsp;Stéphane Barbary ,&nbsp;Aram Gazarian ,&nbsp;Arnaud Walch ,&nbsp;Alain Tchurukdichian","doi":"10.1016/j.hansur.2024.101816","DOIUrl":"10.1016/j.hansur.2024.101816","url":null,"abstract":"<div><div>Trapeziometacarpal prosthesis is one of the surgical options to address trapeziometacarpal osteoarthritis. Several authors reported the importance of the position of the cup and of bone stock to minimize the risk of loosening. Recenlty, Athlani et al. argued that the cup should be placed in the middle of the width of the trapezium. The senior author of the present study observed that placing the cup in the middle of trapezial width is not always possible, due to impingement (early contact) between the cup and the trapezoidal articular surface of the trapezium (TRAST), especially when trapezial height is low. The objective of the present study was to analyze the influence of the proximal articular surface of the trapezium (PAST) and TRAST anatomy on cup placement, in order to improve preoperative planning for trapeziometacarpal arthroplasty.</div><div>The influence of the anatomy of the PAST and the TRAST on cup placement during trapeziometacarpal arthroplasty was retrospectively evaluated on 56 preoperative anteroposterior radiographs of patients who underwent surgery for trapeziometacarpal osteoarthritis. The percentage coverage of the prosthetic cup by the PAST and the available height of the trapezium were calculated. The available height of the trapezium corresponds to the trapezium height after the bone cut at the ulnar edge of the proximal end of the prosthetic cup; it is the smallest available height of the trapezium witch was calculated considering the anatomy of the PAST and TRAST, with the cup placed in the middle of the width of the trapezium.</div><div>In 39% of cases, there was a significant difference (up to a mean 4.5<!--> <!-->mm, <em>P</em> <!-->&lt;<!--> <!-->0.001) between the radial height of the trapezium (which is usually considered) and the available height of the trapezium.</div><div>The anatomy of the PAST and the TRAST has an impact on the placement of the prosthetic cup when trapezium height is low. The results of the present study suggest that these considerations must be known by all operators performing trapeziometacarpal arthroplasty; that lateralization, implant suspension, or surgical alternatives should be considered to prevent several intra- and postoperative surgical complications.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101816"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152356","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":"Scapholunate reconstruction by arthroscopy: An innovative approach in treating complex joint injuries","authors":"Giuseppe De Luca","doi":"10.1016/j.hansur.2024.101834","DOIUrl":"10.1016/j.hansur.2024.101834","url":null,"abstract":"<div><h3>Background</h3><div>Scapholunate ligament injuries can lead to chronic wrist pain and instability if not properly addressed. Arthroscopic techniques have evolved to provide minimally invasive solutions, offering excellent visualization and preservation of surrounding tissues. The 360-degree arthroscopic reconstruction technique provides a comprehensive approach, avoiding the use of synthetic implants, which may reduce complications and improve outcomes.</div></div><div><h3>Objective</h3><div>To describe step by step a 360-degree arthroscopic technique for scapholunate ligament reconstruction and outline all the steps necessary to make this technique practical and easily applicable for hand surgeons worldwide, even without access to specialized materials.</div></div><div><h3>Methods</h3><div>This technique utilizes autologous (palmaris longus tendon) grafts to reconstruct the scapholunate ligament under arthroscopic guidance, enabling precise and comprehensive repair through a 2.4<!--> <!-->mm arthroscope via mediocarpal portals and two mini-incisions—one volar and one ulnar. The procedure completely preserves the integrity of the wrist joint capsule, allowing for early range of motion with minimal restrictions, resulting in high patient satisfaction and minimal morbidity. No synthetic materials or anchors are employed. The technique ensures full circumferential reconstruction around the scapholunate joint, maintaining joint stability while promoting natural healing. Post-operatively, a structured hand rehabilitation protocol is initiated early to promote mobility and function, focusing on reducing stiffness while protecting the repair.</div></div><div><h3>Results</h3><div>From 2019 to 2024, 17 patients with chronic scapholunate ligament injuries, without radiocarpal or midcarpal arthritis, underwent this technique. There was an improvement in the DASH score in the pre- and postoperative comparison of these patients. The overall average range of motion was 78 degrees of flexion, 66 degrees of extension, 10 degrees of radial deviation, 32 degrees of ulnar deviation, 90 degrees of supination, and 80 degrees of pronation. Radiographic control at 3 months showed no widening of the scapholunate space, and the scapholunate angle was 38 degrees. All patients returned to sports and work without restrictions. The early hand rehabilitation protocol has demonstrated improved recovery times and range of motion when compared to traditional immobilization protocols.</div></div><div><h3>Conclusion</h3><div>Arthroscopic 360-degree reconstruction without synthetic materials offers a promising alternative for treating scapholunate ligament injuries. When combined with an early rehabilitation protocol, it enhances functional recovery while minimizing complications, making it a valuable technique in wrist surgery worldwide with low cost.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101834"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152514","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":"Morbidity of surgical techniques for radioscapholunate fusion in radiocarpal osteoarthritis","authors":"Pablo Rodriguez ,&nbsp;Nicolas Simon ,&nbsp;Jean-Yves Beaulieu ,&nbsp;Alissa Gübeli","doi":"10.1016/j.hansur.2024.101831","DOIUrl":"10.1016/j.hansur.2024.101831","url":null,"abstract":"<div><div>Radioscapholunate (RSL) arthrodesis is a treatment option for radiocarpal osteoarthritis in conditions such as post traumatic osteoarthritis after intra-articular distal radius fracture, stage 2 SLAC wrist, Kienbock's disease, and rheumatoid arthritis. Fusion can be achieved by various techniques such as fixation by K-wires, staples, plates and screws, with or without bone grafting, with no standard fixation technique currently established. We performed a retrospective analysis of patients treated with radioscapholunate fusion in our institution to analyze the morbidity of the different surgical techniques.</div><div>We performed a retrospective data analysis of patients treated with RSL fusion for radiocarpal osteoarthritis in our institution between 2013 and 2023.</div><div>20 patients underwent RSL fusion; 3 with rheumatoid arthritis and 17 with post-traumatic radiocarpal osteoarthritis. Fixation was performed with screws in 11 cases (55%), with plates and screws in 6 cases (30%) and with plates in 3 cases (15%). In 17 cases (85%), bone graft was inserted in the fusion zone, mostly from distal radius (25%) or iliac crest (20%). The mean range of motion (ROM) of the affected wrist decreased from 81° preoperatively to 53° postoperatively, grip strength decreased from 25<!--> <!-->kg preoperatively to 21<!--> <!-->kg postoperatively. 8 cases (40%) showed a total of 11 complications during follow up, all of them were revised surgically. The most common complications were conflict of hardware with soft tissue or joint surface (36%, 4 cases), followed by non-union and pancarpal arthritis (each 18%, 2 cases), one seroma of the iliac crest, one lunohamatal conflict and one tendon irritation. 2.4<!--> <!-->mm plates were used for fusion in 3 of the 4 cases suffering from conflict with the hardware. Both cases of non-union occurred in heavy smokers with over 30 pack years.</div><div>We observed a slightly higher fusion rate of 90% compared to the literature, with only two cases of non-union heavy smokers. There was no significant difference in complication rate or severity between the surgical techniques, however the majority of the complications were observed in patients treated with dorsal plates as fusion material. This can be explained by the hardware prominence, which causes conflict and irritation of the surrounding tissue.</div><div>Hardware-related complications, non-union and pancarpal osteoarthritis remain the main problems in RSL fusion. The hardware prominence can increase the risk of conflict with the surrounding soft tissue. We therefore recommend the use of screws or anatomically adapted low-profile plates for fusion.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101831"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152509","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":"Surgical treatment of proximal interphalangeal joint stress fracture in a climber","authors":"Yuji Saeki,&nbsp;Mitsunori Shigetomi,&nbsp;Koji Yoshida,&nbsp;Yosuke Yamashita","doi":"10.1016/j.hansur.2024.101790","DOIUrl":"10.1016/j.hansur.2024.101790","url":null,"abstract":"<div><div>Proximal interphalangeal joint stress fractures commonly occur as epiphyseal line injuries in teenage climbers; however, fractures with closed epiphyseal lines are rare. Poor outcomes are more common if treatment is delayed. We report the case of a 16-year-old climber who underwent delayed surgical treatment for a fracture with a closed epiphyseal line, with a favorable outcome. There was 20 ° extension lag at the proximal interphalangeal joint and a fracture on the dorsal aspect of the base of the metaphyseal bone, with osteosclerosis at the fracture site. The fracture site was refreshed and internal fixation was performed using the tension-band wiring technique. At 3 months postoperatively, there was no pain, extension had improved, and bone union was achieved. This case illustrates the effectiveness of surgery in achieving favorable outcomes for delayed proximal interphalangeal joint stress fractures in climbers with epiphyseal line closure.</div></div><div><h3>Level of evidence</h3><div>V.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101790"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484117","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":"Est-ce que la WALANT est indispensable dans la « petite chirurgie » de la main ambulatoire ?","authors":"Silvia Pietramala,&nbsp;Camillo Fulchignoni,&nbsp;Lorenzo Rocchi","doi":"10.1016/j.hansur.2024.101859","DOIUrl":"10.1016/j.hansur.2024.101859","url":null,"abstract":"<div><div>Wide Awake Local Anesthesia (WALANT) is an alternative to general or regional anesthesia that became popular among hand surgeons for being ideal for tendon repair in which the cooperation of the patients is crucial, avoiding the use of the tourniquet, also giving more comfort to the patients. On the other hand, the learning curve is long for the surgeon and the injection must take place at least 30<!--> <!-->minutes before starting the procedure, increasing the time needed to perform each surgery. Among the complications related to WALANT are digital ischemia and epinephrine-related-cardiac ischemia. Considering people undergoing CTR are mostly elderly and admitted to an outpatient service without the presence of an anesthesiologist, we cannot properly estimate the risk of adverse events.</div><div>From February 2023 to November 2023, we selected 300 patients who underwent outpatients hand surgery (carpal tunnel release and trigger finger). Each patient was administered local anesthesia with lidocaine and a tourniquet at the arm was applied for the whole length of the surgery. Demographic data were collected as long as the time of the surgery, the type of the surgery and the pain and discomfort felt by the patients during the tourniquet on period (evaluated with VAS).</div><div>Average length of the surgery was 12<!--> <!-->minutes. The most common surgery performed was carpal tunnel release. The mean value, according to VAS, was of 3.2. Furthermore, we noted that the VAS was higher in older patients and longer surgeries. In only 3 cases, the tourniquet had to be released before end of surgery because of patient discomfort.</div><div>Despite WALANT being helpful and crucial to perform some hand surgeries, such as post-traumatic tenolysis or tendon repairs, the risk-benefit ratio doesn’t justify its use in short outpatient hand surgery. A limitation of our study is the lack of a control group to validate the effective disadvantage in terms of time and underestimated complications, considering the mean age of patients and the possible comorbidity that could interfere with the use of WALANT.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101859"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152185","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":"Fracture de tête radiale Mason III isolée : prothèse de tête radiale ou ostéosynthèse — Résultats cliniques et radiologiques entre 5 et 14 ans de recul","authors":"Lyliane Ly,&nbsp;Thibault Druel,&nbsp;Arnaud Walch","doi":"10.1016/j.hansur.2024.101843","DOIUrl":"10.1016/j.hansur.2024.101843","url":null,"abstract":"<div><div>Le traitement des fractures comminutives de la tête radiale Mason III est controversé. L’objectif de ce travail était de comparer les résultats cliniques, fonctionnels et radiologiques à 5 ans de recul minimum des prothèses de tête radiale (PTR) et de l’ostéosynthèse dans les fractures isolées de la tête radiale Mason III.</div><div>Nous avons mené une étude rétrospective monocentrique entre janvier 2008 à décembre 2017 portant sur les fractures fermées de tête radiale opérées dans le service. Dix-neuf patients étaient inclus dans le groupe PTR et 35 patients dans le groupe ostéosynthèse. La moyenne d’âge des patients était de 51 ans dans le groupe PTR contre 41 ans dans le groupe ostéosynthèse (<em>p</em> <!-->=<!--> <!-->0,02). Une évaluation clinique (douleurs, mobilités, force, stabilité, complications), fonctionnelle (Mayo Elbow Performance Score, Subjective Elbow Value, Lyon Elbow Score, QuickDASH et Oxford Elbow Score) et radiologique était réalisée dans les 2 groupes.</div><div>Le délai de suivi moyen était de 8 ans (5–14, <em>p</em> <!-->&gt;<!--> <!-->0,005). Cliniquement, aucune différence significative n’a été retrouvée entre les deux groupes, excepté une pronation meilleure dans le groupe PTR (76,7° contre 71,3° ; <em>p</em> <!-->=<!--> <!-->0,04). Il existait un pourcentage plus élevé mais non significatif d’algoneurodystrophie dans le groupe PTR (26,3 % contre 8,6 % ; <em>p</em> <!-->=<!--> <!-->0,15). Il y a eu deux résections secondaires de tête radiale ou d’implants dans chacun des groupes (<em>p</em> <!-->=<!--> <!-->0,56). Sur le plan radiologique, nous avons noté un surdimensionnement des implants dans 21 % des cas et un allongement trop important dans 42 % des cas. Il y avait significativement moins d’ossification hétérotopique dans le groupe PTR (15,8 % contre 42,8 % ; <em>p</em> <!-->=<!--> <!-->0,03). L’ostéolyse péri-prothétique était retrouvée dans 63 % des cas, prédominant sous la cupule radiale. L’érosion du capitulum était retrouvée dans 63 % dans le groupe PTR contre 25,7 % dans le groupe ostéosynthèse (<em>p</em> <!-->&lt;<!--> <!-->0,05).</div><div>Les résultats cliniques et fonctionnels à 8 ans de recul moyen de l’arthroplastie de la tête radiale étaient comparables à ceux de l’ostéosynthèse dans les fractures de tête radiale Mason III isolées. Le descellement aseptique était la principale raison d’échec de l’arthroplastie, et le cal vicieux dans le groupe ostéosynthèse. Les résultats fonctionnels des échecs d’ostéosynthèse étaient relativement pauvres (SEV 40, arc F/E 97°, arc P/S 120°, récupération force 20 %).</div><div>Nous recommandons la mise en place d’une PTR si la réduction articulaire ou la stabilité du montage de l’ostéosynthèse ne sont pas satisfaisants, ou devant l’impossibilité de réaliser une ostéosynthèse dans la zone de sécurité, si celle-ci est réalisée par plaque.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101843"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151435","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":"Étude macroscopique et histopathologique du muscle grand pectoral chez les patients atteints de paralysie brachiale obstétricale tardive","authors":"Samuel Ribak,&nbsp;Mayque Rodrigues De Oliveira Alves","doi":"10.1016/j.hansur.2024.101839","DOIUrl":"10.1016/j.hansur.2024.101839","url":null,"abstract":"<div><div>During our casuistry of treatment to gain external rotation (ER) of the shoulder in patients with late obstetric paralysis (OP), we observed ectoscopy morphological changes in the lower portion of the pectoralis major (PM).</div><div>To accurately analyze the PM muscle in its lower region and its alterations both macroscopically and histopathologically in late cases of patients with obstetric brachial palsy.</div><div>Evaluation of samples from 5 patients with late OP with retraction of anterior shoulder structures who underwent orthopedic procedures to gain ER. Samples for histological study were collected when there was an indication of PM muscle release.</div><div>Surgical Technique: After identifying the PM and visualizing its portions macroscopically, we found a lower portion with a different color that we considered to be a retraction zone. We then release this retracted portion of the muscle and this segment is removed in the proximal-distal axis for anatomopathological evaluation.</div><div>Histopathological Evaluation: Equidistant cross-sections were performed with a regular thickness of approximately 2.0<!--> <!-->mm. The evaluation was simplified and quantified in degrees of intensity of the sampled tissue (mild, moderate or severe), or variable foci of inflammatory component/fibrosis were noted along the muscular cross-sections.</div><div>In all cases, the area of muscle retraction was found along the lower PM region. After the excision of this segment and consequent release of the PM, the maneuver of passive movements of ABD and RE was repeated and a visible improvement of the ROM was observed in all cases. In the microscopic analysis, all the samples taken showed fibrotic or inflammatory tissue of varying degrees and it was verified that the latter was more intense in the proximal-distal direction.</div><div>The literature does not cite the pectoralis major muscle as one of the main structures to be released, and in many cases, its release is not included in the surgical technique.</div><div>With the knowledge of such anatomical changes, we can infer that in a patient with OBPP who requires the release of retracted muscular structures to gain ER and ABD, the release of the pectoralis major muscle should be performed by excising its inferior segment, which is altered and in retraction.</div><div>In cases of OP, the inferior portion of the PM muscle can be the determining cause of its retraction. Histopathological, the lower portion of the PM shows varying degrees of fibrosis.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101839"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151439","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":"Réapparition des brides-rétractions aux doigts après une ancienne réparation de mêmes séquelles de brûlure dans une population des enfants africains à peau noire au cours de croissance","authors":"Anatole Kibadi Kapay","doi":"10.1016/j.hansur.2024.101873","DOIUrl":"10.1016/j.hansur.2024.101873","url":null,"abstract":"<div><div>Les séquelles de brûlures de doigts sont fréquentes auprès des enfants africains de peau noire, cela à cause de l’incidence élevée de brûlures et d’un accès limité au traitement standard. Les cicatrices pathologiques (hypertrophiques, chéloïdes) sont endémiques dans certaines régions d’Afrique. À notre connaissance, il n’existe pas de travaux publiés consacrées uniquement aux réapparitions des brides-rétractions après une ancienne réparation de mêmes séquelles de brûlure chez les enfants à peau noire au cours de croissance.</div><div>Il s’agit d’une étude rétrospective observationnelle, allant de janvier 20018 à décembre 2022. Les paramètres étudiés ont été : le sexe, l’âge de l’enfant à la première chirurgie, le type de traitement initial, le délai et l’âge de réapparition des nouvelles lésions (brides, rétractions), les antécédents individuels ou familiaux des cicatrices pathologiques, les types de lésions observées, les types de traitement proposés.</div><div>Un total de 34 doigts a été observé chez 14 enfants, soit 11 mains. Huit patients étaient du sexe masculin et 6 du sexe féminin. L’âge au moment de la première réparation des brides-rétractions était compris ente 1 à 4 ans. Le délai moyen de réapparition des lésions était de 2 ans avec des extrêmes allant de 5 à 31 mois. Vingt-et-un doigts ont bénéficié initialement des plasties en Z (61,7 %) et 14 doigts de greffe de peau totale (41,1 %).</div><div>Ces résultats préliminaires de la présente étude, la première à son genre, semblent prometteurs malgré le faible nombre de la population étudiée et du faible recul. Des études approfondies sur la nature histopathologique des tissus excisés, les antécédents individuels et familiaux de cicatrisation, le meilleur moment d’une réparation des séquelles de brûlure de la main chez les enfants en cours de croissance, s’avèrent plus qu’importantes pour cette population vivant en zone endémique des cicatrices pathologiques</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 6","pages":"Article 101873"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151443","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}