[Non-traumatic osteoarthritis of the distal radio-ulnar joint: a consecutive series of 11 wrists with 42 months follow-up]. / Arthrose non traumatique radio-ulnaire distale: à propos d'une série continue de 11 poignets revus avec un recul moyen de 42 mois.

PURPOSE OF THE STUDY: Non-traumatic osteoarthritis of the distal radio-ulnar joint is generally observed in a context of chondrocalcinosis and can lead to rupture of the extensor tendons. We reviewed patients operated on in our unit between 1986 and 1988 for this condition in order to examine modalities of surgical care. MATERIAL AND METHODS: Eleven patients who underwent surgery for non-traumatic osteoarthritis of the distal radio-ulnar joint were included in the study. Demographic data, clinical signs, joint amplitudes, radiologically identified lesions, peroperative macroscopic features, and results of the microscopic examinations of the synovectomy specimen were recorded. Injury to the extensor tendons and surgical procedures used for repair were noted. Outcome was assessed clinically (pain, stability of the ulnar stump, active extension of the fingers, pronation-supination, flexion-extension) and radiologically. RESULTS: The series included 11 wrists in 8 women, mean age 73.2 years. The underlying cause was chondrocalcinosis in 9 cases and primary osteoarthritis in 2. All patients had painful pronation-supination and 9 of them had ruptured extensor tendons. There was a dorsal displacement of the ulnar head in all cases. Synovectomy-realignment-stabilization was performed using the Sauvé-Kapandji procedure in 10 wrists and resection of the ulnar head using the Darrach procedure in one. Extensor tendons were repaired by side-to-side anastomosis with neighboring tendons in 6 wrists and with grafts in 3. At a mean 42 months follow-up, 7 wrists were pain free and 4 continued to have climatic pain. The ulnar stump was stable in all cases. All the patients achieved active extension of the fingers and preserved wrist mobility. DISCUSSION: According to the literature, non-traumatic osteoarthritis of the distal radio-ulnar joint is uncommon and occurs principally in the elderly patient. The most common complication being rupture of the extensor tendons. Different treatments can be discussed, but we prefer synovectomy-realignment-stabilization using the Sauvé-Kapandji method which, in light of the results obtained in this series, can regularly provide good pain relief and good functional results when associated with tendon repair as needed and as early as possible.

Nerve repair using a composite graft of vein and denatured skeletal muscle: morphologic analysis.

Five groups of six rats each underwent sciatic resection, bridged with a 20-mm-long graft. Five different types of graft were used: (1). vein; (2). fresh muscle; (3). denatured muscle; (4). vein and fresh muscle; and (5). vein and denatured muscle. Denaturation was obtained by dry thermal shock in a microwave oven. Morphologic analysis took place at 6 months. The macroscopic appearance of the graft was continuous in all type 4 and 5 animals. Morphometric analysis within the graft revealed a significantly greater number of fibers in type 3 animals. Average fiber diameter and g ratio were higher, although not significantly, in type 5 animals. Distal to the graft, average fiber diameter and g ratio were significantly higher in type 5 rats. Denaturation by exposure to thermal shock significantly improves axonal regeneration, both quantitatively and qualitatively. The regeneration rate seems to be more rapid within denatured muscle. Denaturing muscle by exposure to thermal shock provides an excellent guide for axonal regrowth, but axonal leaks may occur. This problem is solved by a muscle-in-vein graft technique.