Traumatic avulsion of the flexor digitorum profundus tendon. Jersey finger, a 29 cases report.

Traumatic avulsion of flexor digitorum profundus (jersey finger) is an uncommon injury. Our study aimed to describe functional outcomes of jersey fingers after surgical treatment. From January 2004 to 2014, we performed surgery on 32 patients who had jersey finger. Twenty-six of these patients were male and 6 were female with a mean age of 37.2years (range 16-68). Of the 32 cases, 11 were sports injuries, 16 presented on the ring finger and 13 on the little finger. Using the Leddy and Packer and Smith classifications, 16 of the injuries were type I, 4 were type II, 5 were type III, 7 were type IV. The mean time between injury and surgery was 6.8days (range: 0-32). The surgical techniques used were anchor, pull-out, or an association of both these techniques. Prior to the patient discharge, functional outcomes were evaluated. Twenty-nine patients were evaluated in total and three patients were lost. Of the 29, the average time between surgery and discharge was 36.6months ranging from 4.5 to 118months. According to the Buck-Gramcko classification, six patients had an excellent result, six had a good result, seven had a satisfactory result and ten a poor result. The mean Quick DASH score immediately to prior discharge was 5.66 (range: 0-56.82). Twelve complications were reported on nine patients. No infections were reported. Rapid diagnosis and rapid surgical treatment led to restoration of full range motion.

Balloon humeroplasty reconstruction for acute Hill-Sachs injury: A technical note.

Posterior Hill-Sachs humeral defects are present in 80% to 100% of cases of anterior shoulder dislocation and are a factor in recurrent instability. Several techniques have been described to fill the defect and avoid recurrence. We developed a percutaneous technique to fill the newly created defect in which a percutaneous balloon, analogous to the one used in vertebral kyphoplasty, is used to reduce the defect, which is then filled with calcium phosphate cement. One patient with an acute anterior dislocation of the shoulder with no previous history was treated using this method. Early imaging results showed adequate reduction of the defect and no cement resorption. The patient was followed for 12 months; he had normal function of the shoulder and no recurrent dislocation. Shoulder computed tomography (CT) arthrography with contrast after 3 months showed an intact capsule and no recurrence of the defect. While this technique is certainly in its infancy, we have demonstrated that emergency reduction of the defect in acute first occurrence anterior shoulder dislocation is feasible, helps to restore normal anatomy of the humeral head and leads to good clinical results. Whether it can improve clinical results and prevent recurrent shoulder dislocation remains to be evaluated.

Free tendon grafts in elder patients, a case report of repair of flexor pollicis longus tendon with a free palmaris longus graft in an 89-year-old woman.

Flexor tendon rupture is a potential complication after volar plating of distal radius fracture. Palliative procedures such as tenodesis and arthrodesis are usually employed in elder patients with imperfect results. We report a case of delayed flexor pollicis longus rupture seven years after volar plating of a distal radius fracture occurring in an 89-year-old woman. The repair with a free tendon graft of palmaris longus was successful in terms of strength and range of motion. Free tendon grafts should not be limited to younger patients and could be used in elder patients after careful selection.

Avulsion fracture of the extensor carpi radialis longus carpal insertion due to a basketball injury: case report and literature review.

Articular fractures of the base of the 2nd metacarpal involving the extensor carpi radialis longus insertion are unusual and poorly understood. There is no consensus as to how these fractures should be treated. We report the case of a 2nd metacarpal base fracture in a professional basketball player that was treated surgically with open reduction and internal fixation using cannulated screws. The management of this case is compared to similar cases in the literature.

Optimization of bone-block positioning in the Bristow-Latarjet procedure: a biomechanical study.

BACKGROUND: In the Bristow-Latarjet procedure, optimal positioning of the coracoid bone-block on the anterior aspect of the glenoid (standing or lying on the glenoid rim) remains debated. A biomechanical study assessed the effect of the position of the bone-block with its attached conjoint tendon on anterior and inferior stabilization of the humeral head. MATERIALS AND METHODS: The Bristow-Latarjet procedure was performed on 8 fresh cadaveric shoulders. The bone-block size was systematically at 2.5×1×1 cm. Anterior translation of the humeral head was stress induced under 30-N traction, in maximum external rotation at 0° and at 90° abduction: respectively, adduction and external rotation (ADER), and abduction and external rotation (ABER). Under radiological control, displacement of the center of the humeral head was compared with the glenoid surface at the 3, 4 and 5 o'clock (medial, antero-inferior and inferior) positions for the 2 bone-block positionings. RESULTS: The lying position at 4 o'clock substantially decreased anterior and inferior displacement of the humeral head respectively in ADER and ABER; and in ABER it also tended to decrease anterior translation, but not significantly. The standing bone-block position did not affect translation. CONCLUSIONS: Positioning the bone-block so that it lies on the anterior aspect of the glenoid in the middle of the antero-inferior quarter of the rim at 4 o'clock can decrease anterior displacement of the humeral head and inferior glenohumeral translation, especially in ADER for anterior displacement and in ABER for inferior displacement. STUDY DESIGN: Laboratory study.

PIP joint volar rotatory dislocation: An anatomical study to explore extensor system lesions and the Stener effect.

Volar rotatory dislocation of the proximal interphalangeal joint results from volar rotation of the condyle around an intact opposite collateral ligament. A cadaveric study was preformed to better understand the mechanisms of this injury. Thirty-two long fingers (II to V) were studied. After partial section of the triangular ligament, the radial collateral ligament was cut (partly or completely, at proximal or distal insertion) and volar rotatory dislocation was induced. We studied the incidence of a fixed dislocation, the distal extension of the triangular ligament lesion, and the Stener lesion of the radial collateral ligament. A buttonhole lesion was produced by a dislocated lateral band in all cases with complete section of the collateral ligament. When the lesion of the triangular ligament extended distally, dislocation became irreducible. A Stener effect (interposition of the lateral band between the condyle and the collateral ligament) was observed after reduction in 21% of cases with proximal lesions of the radial collateral ligament.

Chronic coccydynia in adolescents. A series of 53 patients.

BACKGROUND: Little is known about coccydynia in adolescents. AIM: The aim of this study was to explore causes, clinical and imaging features and response to treatment of chronic coccydynia in adolescents. DESIGN: This was a cohort study. SETTING: The study included patients followed up at a specialized consultation in a university hospital. METHODS: A series of 53 adolescent patients with chronic coccydynia were followed for 1-4 years. Investigations included dynamic X-ray films, with a magnetic resonance imaging scan of the coccyx in 26/53. Treatment was by coccygeal steroid injection or non-steroidal anti-inflammatory drugs (NSAIDs). Amitriptyline or coccygectomy were used as second-line treatment. Outcomes were assessed at a consultation two months after the treatment, then between one to four years later, by telephone interview, questionnaires and by a visual analogue scale (VAS). Fifty-one adult patients with coccydynia formed the control group. RESULTS: In 20 cases (37.7%) the coccydynia was subsequent to trauma. Obesity was not a risk factor. Abnormal mobility was rarer and spicules more frequent compared to adult patients (P<0.001); 11/27 MRI scans showed a hypersignal within the disc or adjacent bone and 6/27 a hypersignal surrounding the tip of the coccyx (bursitis). Initial treatment was a coccygeal steroid injection for 41 patients and NSAIDs for 12. Ten were given amitriptyline and 3 a coccygectomy. At final assessment, there was no pain or almost no pain in 32/53 (60.4%), moderate pain and functional impairment in 12/53 (22.6%) and severe pain and functional impairment in 9/53 (17%). CONCLUSION: Coccydynia in adolescents differs from coccydynia in adults. A MRI scan is helpful and should be obligatory for diagnosis. Prognosis is relatively good. CLINICAL REHABILITATION IMPACT: Our results should help clinicians manage this rare and debilitating condition.

Complex proximal humeral fractures: a prospective study of 22 cases treated using the "Bilboquet" device.

INTRODUCTION: Despite recent improvements in surgical devices, complex proximal humerus fractures internal fixation still encounters frequent mechanical failures. HYPOTHESIS: The aim of this study was to confirm that the Bilboquet device (a design mimicking the cup-and-ball game) helps solving mechanical difficulties associated with these fractures internal fixation and to present a simplified version of the original surgical procedure. PATIENTS AND METHOD: This non-randomised prospective study included 22 fractures in 22 patients, mean age: 70 years. According to the Neer classification there were three-part fractures in seven cases and four-part fractures in 15 cases. Fractures were all reduced and treated by internal fixation in a simplified surgical procedure using the Bilboquet device. RESULTS: Mean postoperative follow-up was 34 months. The mean Constant score was 66 and the weighted Constant score was 86. Mean active forward elevation was 108° and mean active external rotation was 28°. No per- or postoperative complications occurred. Initial reduction of the tuberosity was incomplete in four cases. Union was obtained in all fractures. There was no secondary tilting of the head, and no migration or pseudarthrosis of the tuberosities. Five patients developed postoperative avascular necrosis of the humeral head. DISCUSSION: The Bilboquet staple component provides a supporting platform for the entire humeral head area. This peripheral stabilization associated with tension band wiring explains the lack of secondary displacement in these cases. Although the Bilboquet device provides a solution to the mechanical problems of complex fractures of the proximal humerus, it does not solve the problem of secondary avascular necrosis of the humeral head, which occurred in 23% of the patients in this series and in 33% of patients in the four-part fractures subgroup. LEVEL OF EVIDENCE: IV (non-randomised prospective study).

[Isolated gonococcal tenosynovitis. Case report and review of literature]. / Ténosynovite isolée à gonocoque, à propos d'un cas et revue de la littérature.

Isolated gonococcal tenosynovitis is rare, and is part of disseminated gonococcal infection. It is due to blood-borne contamination of the flexor tendon sheath. One to 3% of gonococcal mucosal infections develop disseminated infections. Tenosynovitis is present in two-thirds of cases, sometimes in association with arthritis and skin rash. We report a case of a 26-year-old man with isolated gonococcal tenosynovitis of the thumb, with no other medical history, occurring 15 days after unprotected sex. Except local inflammatory signs of the thumb extending to the wrist, and a biological inflammatory syndrome, the patient had no arthritis, skin or mucosa symptoms. Immediate surgical drainage was performed under antibiotic cover with 3rd generation cephalosporin. All bacteriological samples were negative, except for one blood culture positive for Neisseria gonorrhoeae. Thus, in case of an asymptomatic patient with suspected gonococcal infection through a mucus portal, a precise examination, including geographical and sexual history, and a review of screening are recommended. Although the pathophysiology of gonococcal tenosynovitis is still obscure, the best prevention remains that of sexually transmitted diseases.

Arthroscopic treatment of a fresh lunate bone fracture detaching the scapholunate ligament.

Fractures of the lunate bone are rare and usually treated by prolonged immobilization. We report a fracture of the dorsal pole of the lunate bone detaching the scapholunate ligament. The clinical presentation was equivalent to an acute disruption of this ligament. Percutaneous screw repair of the bone fragment was performed under wrist arthroscopy. The patient kept an analgesic splint for five days and early mobilization was provided. After 6 weeks, the patient had returned to his previous level of activity with normal wrist motion and full strength. Screw fixation under arthroscopy is minimally invasive and provides accurate restoration of the lunar anatomy, yielding good functional results after a short recovery period. This treatment offers a satisfactory alternative to prolonged immobilization and ensures good reduction and compression of the fracture. We present a detailed description of the surgical technique and its results.

Percutaneous retrograde screw fixation of non-displaced fractures of the scaphoid waist: an antirotation wire may not be necessary.

Some authors recommend using an antirotation wire when performing percutaneous screw fixation of acute non-displaced scaphoid waist fractures. The aim of this study of 21 cadaveric wrists was to assess the usefulness of such a wire in Herbert's B2-type fractures. A B2-type fracture was created experimentally on each scaphoid. An antirotation wire was inserted in eight wrists. Retrograde percutaneous fixation using a double-threaded headless cannulated screw was performed on all wrists. Computed tomography was used to measure interfragmentary rotation. No interfragmentary rotation was noted in either group. Our study suggests that using an antirotation wire may be unnecessary when performing retrograde percutaneous screw fixation of isolated B2-type scaphoid fractures.

Pulmonary embolism following thrombosis of the brachial vein after shoulder arthroscopy. A case report.

Thromboembolic complications are very rare after arthroscopic surgery of the shoulder. We report the case of a 25-year-old who presented thrombophlebitis of the brachial vein complicated by pulmonary embolism following arthroscopic surgery for posterior instability of the shoulder. No hemostasis impairment was found in this patient. The factors arguing in favor of thrombosis that had been retained from the literature were the lateral decubitus position with traction of the limb in its axis, prolonged surgical time, use of interscalene brachial plexus block, and a general condition susceptible to thrombosis (personal or family history of thromboembolism, genetic risk factor for thrombosis, smoking, obesity, neoplasia). There are currently no guidelines on the need for thromboembolism prevention during shoulder arthroscopy.

[Rupture of axillary artery and brachial plexus paralysis as complications of recurrent anterior glenohumeral dislocation: a case report]. / Rupture de l'artère axillaire et paralysie du plexus brachial compliquant une luxation glénohumérale antérieure récidivante : à propos d'un cas.

The authors report a case of transection of the axillary artery and brachial plexus paralysis following recurrent anterior glenohumeral dislocation. Subsequent vascular reconstruction was performed using a venous interposition graft. The brachial plexus was explored at the same time and found to be in continuity. Neurological recovery was complete within a few months.

Bristow-Latarjet procedure with specific instrumentation: study of 34 cases.

A Bristow-Latarjet procedure with specific instrumentation was performed for recurrent dislocation or subluxation of the glenohumeral joint in 34 patients. The procedure was performed through a subscapularis splitting approach with three specific instruments and a special screw. The clinical outcome was assessed by the Duplay and the Constant scores. Radiographic study was conducted on 23 patients and CT scan in 11 patients. Of the 27 patients interviewed 92% were satisfied. Of the 23 patients examined, 15 had an excellent Duplay score, four a good score, three a medium score, and only one had a bad score. One patient had subluxation episodes, and one patient was revised after a redislocation following violent trauma. On the standard radiographs, all bone blocks were in the correct position. A pseudarthrosis was diagnosed in the patient with subluxation episodes. This device simplifies the surgical technique and provides reproducibility to the procedure.

Acute carpal tunnel syndrome secondary to pyogenic tenosynovitis.

We report a case of acute carpal tunnel syndrome related to a spontaneous pyogenic tenosynovitis and a review of this clinical condition.

Thumb reconstruction for aesthetic reasons using an exteriorised microvascular pedicle.

Thumb reconstruction following amputation is usually performed in order to restore function. Nevertheless, the reconstruction should be cosmetically acceptable in order to be fully functional, and, in some cases, reconstructive surgery may be justified for purely aesthetic reasons. The most satisfying aesthetic results in adults are obtained with microsurgical partial great-toe transfer. The technique that we use for thumb reconstruction is illustrated by two case reports: that of a 26-year-old female patient and that of a 35-year-old male patient. Both patients had a distal thumb amputation with destroyed nail apparatus, and both sought thumb reconstruction for cosmetic reasons. Aesthetic reconstruction was performed in both cases with a partial ipsilateral great-toe transfer, composed of nail apparatus, underlying bone and custom-made pulp tissue. The vascular anastomosis was done at the snuff-box, through a small incision, with an exteriorised pedicle. The result was satisfactory in both cases, with minimal donor-site sequelae. Partial toe transfer has proven to be a reliable technique for thumb reconstruction. It is an evolving technique. Many modifications have been introduced to optimise the aesthetic result and to reduce donor-site morbidity. Our technique allows us to restore thumb length, replace the missing nail and reconstruct the pulp, with acceptable sequelae at the donor toe. The exteriorised-pedicle technique prevents pedicle compression and twisting and reduces scarring and stiffness. It does, however, require delicate postoperative care and a second procedure for pedicle division.

[Biomechanical evaluation of osteosynthesis with cannulated screws for Ponteau-Colles fractures in a bird model]. / Evaluation biomécanique de l'ostéosynthèse par vis canulées enfouies des fractures de Ponteau-Colles sur un modèle aviaire.

INTRODUCTION: The use of cannulated screw without protrusive head in Colles fractures could avoid some of the drawbacks of conventional pinning. In order to compare the mechanical resistance of Kirshner wires versus cannulated screws we designed a animal model of Colles fractures and tested three types of osteosynthesis: A: K-wires, B: Herbert cannulated screw, C: specific cannulated screws. METHOD: After creating a 10 mm defect in three sets of 10 fresh turkey tibia, 3 types of osteosynthesis were done and tested in compression with an Adamel Lhomargy machine: set A: K-wire fixation, set B: Herbert screws fixation and set C: specifics screws fixation. RESULTS: The compression strength needed for failure of the fixations were: for the K-wires (set A): 52 N +/- 17; for the Herbert screws (set B): 93 N +/- 39; for the specifics screws (set C): 160 N +/- 48; (p < 0.0001). DISCUSSION: The use of an animal model makes the experimentation easier and the sampling more homogeneous. In this model, resistance to compression of the cannulated screw was better than K-wires and the specific cannulated screw better than Herbert screw. Therefore clinical trial of osteosynthesis with cannulated screw in Colles fracture could be considered.

Use of the extensor retinaculum as a donor site for bone-ligament-bone grafts.

The recent introduction of bone-ligament-bone grafts for ligament reconstruction in hand surgery has led to a search for suitable graft donor sites. The extensor retinaculum had been suggested, but harvesting details were still lacking. We therefore studied the anatomy of the extensor retinaculum, with radiography and morphometric measurements. Ten cadaver wrists were dissected; the thick portion of the retinaculum and its insertions on the radius in the different extensor compartments were studied. The compartments were wire-marked, and AP radiographs taken of each specimen. The retinaculum spanning the first three compartments was removed with the bony ridges it inserted on, and the inter-ridge retinaculum length was measured. A comparison of our dissections with the radiographs showed that only the radial compartments 1, 2 and 3 had constant bony insertions on both ridges, making them suitable for bone-ligament-bone grafting. The mean compartment length was 11.7 mm (compartment 1), 17 mm (compartment 2) and 7.3 mm (compartment 3) respectively. Thus, the extensor retinaculum can be relied upon to provide bone-ligament-bone grafts from the first three compartments, for possible use in ligament reconstructions in the hand and wrist.