Venous system mapping of the digits and the hand: An anatomical study and potential surgical applications.

Background: Venous anatomy of the digits and the hand is poorly reported in the literature compared to arterial anatomy. While knowledge of the venous anatomy is crucial to ensure safe skin incisions, skin flap design, or blood return restoration for digital replantations, data in anatomical and clinical textbooks are rather limited. The purpose of this anatomical study was to describe the venous anatomy of the digits and the hand. Method: Our series reports descriptive results from 10 non-embalmed hand dissections from 5 different corpses. Hands were previously co-injected by arteries followed by veins with a different colored latex before being dissected under optical magnification (x4). Each anatomical specimen was photographed before being analyzed. Results: Each injection revealed both arterial and venous vascular systems. Latex injections were a useful technique to show the dorsal, volar superficial, and deep venous system. There was a constant and reliable topographic vascular anatomy of the superficial venous system of the digits and hand. However, we could not observe a high density of dorsal superficial venous valves as previously reported. Conclusion: The knowledge of the arrangement of the venous system of the digits and the hand should help the surgeon when performing surgical procedures in the hand. The surgeon should take into consideration this venous anatomy when performing skin incisions, skin flaps, or replantation procedures which would preserve the normal venous physiology as much as possible.

Stenosing tenosynovitis of the extensor digitorum tendons of the hand: clinical and sonographic features.

OBJECTIVE: To describe the ultrasound (US) features of 18 patients with extensor digitorum communis stenosing tenosynovitis (EDCST). MATERIALS AND METHODS: A retrospective search in the radiologic information systems of two separate Institutions was performed to identify all patients presenting EDCST between January 2010 and September 2019. A total of 18 patients (ten males and eight females; mean age, 57.4 years) were identified and included. Sonographic examinations were retrospectively reviewed by two senior radiologists to assess morphologic changes and power Doppler activity of the extensor retinaculum (ER) and of the extensor digitorum communis (EDC) tendons and sheath. The presence of dynamic impingement between the EDC and the ER was evaluated using video clip records. RESULTS: At the ultrasound, all patients (18/18; 100%) presented thickening of both the ER and EDC tendons associated with EDC tendon sheath effusion. Power Doppler hyperemia of the ER was inconstant and observed in 11 cases (11/18; 61.1%) as tendon sheath effusion observed in 16 cases (16/18; 88.9%). A cyst located inside the EDC of the index finger was observed in three of these patients (3/18; 17%). Dynamic examination showed impingement of the EDC against the ER during active tendon extension in all patients (18/18; 100%). Four of these patients (4/18; 22%) underwent surgery allowing diagnosis confirmation and release of EDCST, while the remaining fourteen patients (14/18; 78%) were either treated conservatively or using US-guided steroid injection. CONCLUSION: US findings of EDCST include thickening of the ER and EDC tendons, EDC tendon sheath effusion, and in some cases presence of an EDC intratendinous cyst. Impingement of the EDC tendons against the ER is well demonstrated using dynamic US.

Carpal height and postoperative strength after proximal row carpectomy or four-corner arthrodesis: Clinical, anatomical and biomechanical study.

Proximal row carpectomy (PRC) and four-corner arthrodesis (4CA) are the two most commonly performed surgical procedures to treat wrist arthritis. Postoperative strength is one of the criteria for choosing between the two techniques. Some authors believe that strength is correlated with residual carpal height. The goal of this study was to determine if postoperative carpal height was predictive of postoperative strength. This study consisted of two parts: a clinical evaluation of grip strength after 4CA or PRC; anatomical and radiological measurements of carpal height before and after 4CA or PRC. Grip strength was better preserved after PRC (87.5%) than after 4CA (76.1%), when expressed relative to the opposite hand (P=0.053). There was a significant decrease in carpal height for the PRC group with a Youm's index of 0.37 versus 0.50 for the 4CA group (P<0.0001). Our clinical results and analysis of the literature indicate that 4CA is not superior to PRC when it comes to grip strength, whereas carpal height is significantly decreased after PRC. The decreased tendon excursion after PRC is balanced by an increase in joint stresses after 4CA.

Comparative morphometry of the antebrachial and crural interosseous membranes: preliminary study for the use of the crural interosseous membrane in the surgical repair of the antebrachial interosseous membrane tears.

INTRODUCTION: Traumatic tears of the antebrachial interosseous membrane (AIOM) on its whole length are difficult to treat, particularly in the Essex-Lopresti syndrome. The number of ligamentoplasty techniques described in the literature witnesses the difficulty of its reconstruction and the absence of reliable and satisfying procedure. The aim of this study was to explore a new way of treatment, which consists in replacing the AIOM by the crural interosseous membrane (CIOM), harvested from the same patient. MATERIALS AND METHODS: A morphometric study of the AIOM and CIOM has been conducted on both sides of 15 formalin preserved corpses (i.e. 30 AIOM and 30 CIOM). Studied data were: length of forearms and legs, length and width (at different locations) of the membranes, in situ and after harvesting, and orientation of their fibers. The thickness of membrane was also measured but only after harvesting. RESULTS: Concerning the AIOM, the mean length was 13.3 cm in situ and 12.8 cm after harvesting. Its width was maximal at the union of middle and distal thirds with an average value of 1.7 cm in situ and 1.45 cm after harvesting. Mean thickness was 1 mm. Anterior fibers were oblique distally and medially (20.5° ± 0.95°), and posterior fibers were oblique distally and laterally (40° ± 3.4°). Concerning the CIOM, the mean length was 24.75 cm in situ and 23.9 cm after harvesting. Its width was maximal at the union of proximal and middle thirds with an average value of 2.3 cm in situ and 1.85 cm after harvesting. Mean thickness was 0.5 mm. Obliquity of its fibers was reverse of that of the AIOM: the anterior fibers were quite oblique distally and laterally (13° ± 2.6°), and the posterior fibers oblique were oblique distally and medially (24.2° ± 2.48°). DISCUSSION: From these results, one may conclude that the largest length and width of the CIOM allow its use as substitute for the injured AIOM. The orientation of its fibers should necessitate either its reversal while using the same side or the use of the CIOM of the opposite side; its relative sharpness could signify that its biomechanical properties could be worse. A biomechanical study is necessary to evaluate how this new way of replacing the AIOM could resist to the strains imposed on the forearm.