Outcomes at 7 and 21 years after surgical treatment of Dupuytren's disease by fasciectomy and open-palm technique.

The goal of this study was to assess the recurrence of Dupuytren's disease and the stability of the functional result after fasciectomy combined with the McCash open-palm technique. From 1989 to 1999, 56 consecutive patients were surgically treated for Dupuytren's disease. In 2003, 40 of these operated patients were reviewed by an independent evaluator; 12 patients were Tubiana stage 1, 16 stage 2, 9 stage 3 and 3 stage 4. Twenty-one of them were reviewed again in 2016 by a second evaluator who was unaware of the clinical results in 2003. The mean follow-up was 7.32 years (range, 4.26 to 12.5 years) at the first review. Recurrence occurred in 7 patients (17.5%) and extension of the disease in 15 (37.5%). Three patients had developed complex regional pain syndrome (CRPS). Mean residual contracture was 19.3°. Average improvement in finger extension was 53°. At the second review, 21 patients were assessed with a mean follow-up of 21.5 years (range, 18.7 to 26.3 years). None of them were re-operated and no extension of the disease was observed. There was no recurrence in patients who had no recurrence in 2003. However, the contracture had worsened in five patients (23.8%), three of whom had a recurrence of the disease in 2003. Mean residual contracture was 31.8°. Recurrence occurs most often in the first few years after surgery. The functional result is stable over time. CRPS and the number of rays operated are the main factors negatively affecting overall improvement of mobility.

Radiocarpal dislocations and fracture-dislocations: Injury types and long-term outcomes.

INTRODUCTION: Radiocarpal dislocation (RCD) and fracture-dislocations (RCFD) are severe but rare injuries for which the treatment and outcomes are not well defined. The aim of this retrospective study was to describe the prevalence of the various injury types and their long-term outcomes. PATIENTS AND METHODS: Between 1992 and 2014, 41 patients with RCFD were seen at our institution. According to the Dumontier classification, there were 4 cases of type 1 and 37 cases of type 2. Thirteen patients were reviewed again after a mean follow-up of 168 months (20-260). RESULTS: Among these 41 patients, 6 required secondary wrist fusion. At the latest follow-up evaluation, flexion-extension amplitude was 100° (25°-152°), grip strength was 86% of the contralateral side (10kgf-112kgf), the mean VAS for pain was 1.3 (0-5), the mean QuickDASH was 23 (0-59) and the mean PWRE was 27 (0-75). Six patients developed osteoarthritis in the radiocarpal and midcarpal joints. DISCUSSION: For cases of RCD, when reduction and stabilization have been confirmed by a dorsal approach, there is no reason to perform volar capsule and ligament suturing. For cases of RCFD, after anatomical reduction, radiostyloid pinning can be performed and an open surgical approach is not always required. Radiolunate fusion is a good solution for treating secondary instability. CONCLUSION: The good functional outcomes and absence of osteoarthritis can be attributed to the effective reduction and radiocarpal stabilization, along with the absence of radial and intracarpal marginal fractures. LEVEL OF EVIDENCE: IV, retrospective.

Chronic instability of the thumb metacarpo-phalangeal joint: Seven-year outcomes of three surgical techniques.

BACKGROUND: Severe sprain of the thumb metacarpo-phalangeal joint (TMCPJ) is a common injury whose functional outcome is good when repair is performed at the acute stage. The diagnosis is often missed, however, leading to chronic instability. The optimal treatment of chronic TMCPJ instability is controversial. The objective of this study was to compare the clinical outcomes of the three main surgical techniques used to treat chronic TMCPJ instability. HYPOTHESIS: Arthrodesis is the best surgical option when ligament repair is not feasible. MATERIAL AND METHODS: This single-centre retrospective study included all patients managed surgically between 2000 and 2012 for chronic post-traumatic TMCPJ instability using any of the three following techniques: primary repair, ligament reconstruction, and arthrodesis. Subjective and objective outcomes and complication rates at last follow-up were compared across these three techniques. RESULTS: Of 67 included patients, 55 were re-evaluated, after a mean follow-up of 84 months (range: 24-164 months). Among them, 48 (87.3%) were satisfied or very satisfied with the outcome. Pain relief was significantly better in the arthrodesis group. Mean Quick-DASH scores were 17.4 (range: 0.0-89.5) with primary repair, 25.7 (range: 0.0-58.3) with ligament reconstruction, and 17.8 (range: 0.0-50.0) with arthrodesis. Mean pinch-test strength compared to the normal side was 89% with primary repair, 84% with ligament reconstruction, and 94% with arthrodesis. In the ligament reconstruction group, 6 of the 10 patients had instability at last follow-up and the proportion of patients describing themselves as fully recovered was significantly smaller than in the other groups. Four failures were recorded at last follow-up. CONCLUSION: Surgery to treat chronic TMCPJ instability produces good outcomes. Primary repair deserves preference whenever possible. In contrast to previous reports, outcomes after ligament reconstruction were not better compared to arthrodesis. LEVEL OF EVIDENCE: IV, retrospective study.

Volar fracture-dislocation of the proximal interphalangeal joint: Four cases at an average follow-up of 3 years.

Volar dislocation of the proximal interphalangeal joint associated with dorsal fracture of the base of the middle phalanx is a rare injury, with only 38 cases published. We report here four such cases: three treated surgically and one conservatively. Patients had a mean age of 19.5 years. At an average follow-up of 3 years, pulp-to-palm contact was obtained and no pain was reported with regular daily activities. All patients considered themselves cured and were very satisfied with the result. Incomplete reduction of the dorsal fragment or the presence of localized articular impaction warrant surgical treatment.

Lateral band translocation for swan-neck deformity: Outcomes of 41 digits after a mean follow-up of eight years.

BACKGROUND: Swan-neck deformity (SND) of the fingers can cause major functional impairment. The Zancolli-Tonkin procedure is a crossed dynamic tenodesis that prevents overextension of the proximal interphalangeal (PIP) joint and promotes extension of the distal interphalangeal (DIP) joint. We assessed the outcomes of this procedure in patients with SND due to various causes. HYPOTHESIS: The Zancolli-Tonkin procedure provides effective and stable correction of SND due not only to RA, but also to other conditions. PATIENTS AND METHODS: Consecutive patients managed at two centres between 2000 and 2013 were included. The causes of SND were inflammatory joint disease, trauma, iatrogenic events, and neurological disorders. The same operative technique was used in all patients. RESULTS: Forty-one fingers in 14 patients were evaluated. After a mean follow-up of 8 years, all patients could harmoniously flex the operated fingers and none had recurrence of the deformity. At the PIP joints, mean active flexion was 86° (range: 40°-90°) and mean loss of extension was 15° (range: 0°-40°). At the DIP joints, mean active flexion was 65° (range: 0°-70°) and mean extension lag was 4° (range: 0°-30°). The mean visual analogue scale pain score was 1/10 (range: 0/10-8/10) and the mean patient satisfaction score was 7.5/10 (range: 4/10-10/10). DISCUSSION: The SND was corrected and the results were stable after 8 years in all cases. Advantages of the Zancolli-Tonkin procedure include limited invasiveness, with no need to harvest a distant tendon, and rapid active postoperative rehabilitation. The moderate excessive PIP joint flexion has no adverse impact on the overall functional outcome. The high level of patient satisfaction reflects the improvements in function. CONCLUSION: The Zancolli-Tonkin procedure is a simple and reliable technique that provides lasting correction of an incapacitating deformity associated with impaired overall hand function. LEVEL OF EVIDENCE: IV.