Altered hand proprioception following regional anesthesia as a cause of traumatic jersey finger: Report of two cases.

The sense of body ownership is being increasingly studied by manipulating incoming signals from the periphery with local anesthetics. We sought to understand how altered proprioception induced by anesthesia triggered a traumatic jersey finger, immediately postoperatively, in two patients who underwent surgical carpal tunnel release. Multiple mechanisms contributed to these postoperative injuries associated with a fall. Hand anesthesia deprives the brain of important afferent sensory information and modifies hand size perception in the brain. Moreover, it blocks efferent motor signals that contribute to the perception of hand position with sensory afferent signals. When the patients fell, their movement control was inadequate, generating a strong contraction of the hand extrinsic flexor muscles, against forceful distal phalanx extension. Lastly, both patients had removed their numb operated hand from their arm sling. Disrupted sensory and motor paths modify self-attribution of the hand, and thus halt adequate efferent commands. Protecting the operated hand until full sensory and motor control is regained could have prevented such rare accidents from happening. Level of evidence: V.

[Complex fracture-dislocation of the proximal interphalangeal joint. A case report and focus on palmar proximal interphalangeal fractures-dislocations]. / Fracture-luxation complexe de l'articulation interphalangienne proximale. À propos d'un cas et mise au point sur les fractures-luxations palmaires interphalangiennes proximales.

The palmar fracture-dislocation of the proximal interphalangeal (PIP) joint of fingers is an uncommon injury. We report a complex form in a 16-year old teenager, associating a palmar fracture-dislocation and a fracture of the base of the middle phalanx with the dorsal fragment dislocated between the neck of the proximal phalange and the palmar plate. The management was surgical with open reduction and fixation of the fragments by K-wires and temporary PIP arthrorisis. The result at 6months of follow- up after removal of the wires and physiotherapy was satisfactory. The patient was painless with a range of motion of 115°. Clinically, the sagittal and frontal stability of the joint both in flexion and extension was maintained. Osseous healing was obtained on X-ray control. The patient went back to his usual activities. A focus on palmar fracture-dislocations of PIP joint is presented through incidence, mechanism and treatment.

Lesions of the scapholunate ligament associated with minimally displaced or non-displaced fractures of the scaphoid waist. Which incidence?

INTRODUCTION: It was commonly considered that a non-displaced or minimally displaced isolated scaphoid fracture was mechanically incompatible with a lesion of the scapholunate ligament (SL). However, some authors who described such an association have recently challenged this statement. The aim of this prospective study was to determine, after screw fixation and using arthroscopy, the existence and incidence of lesions of the SL as associated with acute non-displaced or minimally displaced isolated fractures of the scaphoid. METHODS: Between December 2009 and January 2011, the study included all patients presenting with an acute non-displaced or minimally displaced isolated fracture of the scaphoid waist, eligible for percutaneous screw fixation and accepting the procedure after informed consent. The surgical protocol included a first retrograde arthroscopically controlled percutaneous screwing of the scaphoid, followed by a second arthroscopy seeking only lesions of the SL. Geissler's classification was used for the classification of SL lesions. RESULTS: Eighteen patients were included in the study. The mean was 29 years. In 17 cases, the scaphoid fracture was due to a low-energy fall, and in 1 case, to a road accident. No SL lesion was evidenced by the diagnostic arthroscopy. CONCLUSION: Unlike some published reports, we did not observe any SL lesion associated with non-displaced or minimally displaced isolated fractures of the scaphoid. Nevertheless, despite such results and based on the literature, we recommend arthroscopy with percutaneous scaphoid screw fixation, with the triple advantage of providing reduction control, adequate screw fixation verification, and diagnosis of potential associated ligament lesions.

Free vascularised fibular graft in multi-operated patients for an aseptic non-union of the humerus with segmental defect: Surgical technique and results.

In cases of non-union of the humerus with segmental bone defect, if a conventional treatment has failed, free fibular transfer should be considered as a reliable option to allow satisfactory bone union. We reported five cases of aseptic and multi-operated non-union of the humerus from trauma. In each case, a free fibular flap was performed after failure of a conventional treatment and bony union was demonstrable radiologically within six months. Some technical points such as harvesting of the fibula, humerus approach, fibula placement and fixation are highlighted in order to simplify the transfer and to standardise the technique.

[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.

[Fusion and function after eight scapulothoracic arthrodesis]. / Consolidation et fonction après huit arthrodèses scapulothoraciques.

PURPOSE OF THE STUDY: Scapula alata resulting from a deficient musculus serratus anterior leads to shoulder instability, pain and loss of elevation. Etiologies include fascioscapulohumeral dystrophy and lesion of the thoracicus longus nerve. Dynamic (muscle transfer) or static (scapulopexia or scapulothoracic arthrodesis) stabilization methods can be proposed. The purpose of this study was to assess fusion and function after eight scapulothoracic arthrodeses performed in five patients. We used cerclage with compression after intercostal avivement to increase the contact surface. MATERIAL AND METHODS: This retrospective study included four men and one woman. Three patients had fascioscapulohumeral dystrophy who underwent bilateral arthrodeses and two patients with post-traumatic injury to one thoracicus longus nerve. All scapulothoracic joints were unstable; six were painful. There was a cosmetic prejudice in all cases. Preoperative function was 71+/-6 degrees antepulsion (range: 60-80 degrees ) and 71+/-7 degrees abduction (range: 60-80 degrees ). Postoperative assessment included: reduction of the scapula alata, gain in motion, Constant score (raw and weighed), subjective assessment of daily activity, complications, respiratory function in patients with double arthrodesis and bone fusion on the CT scan. RESULTS: Patient follow-up was 21.5 months on average. The scapula alata was reduced in all cases. Mean gain in motion was 39+/-21 degrees antepulsion and 41+/-26 degrees abduction. The raw Constant score was 77.75+/-11.4/100 and the weighted score was 81.5+/-9.1/100. Daily activity was scored 100% in four of five patients. Complications were transient intercostal dysesthesia, mild exercise-induced pain, one pneumothorax which did not require drainage. There was no evidence of an impact on respiratory function. The control scans revealed fusion in five shoulders and nonunion in three. DISCUSSION: Scapulothoracic arthrodesis enabled reduction of the scapula alata and improved shoulder function for elevation and daily activities. The gain in motion and Constant score were satisfactory and similar to other results in the literature. The main drawback was deficient external rotation. Pain was mild and resulted from the deafferentation. It resolved six months postoperatively. Secondary exercise-related pain was mild with little impact. Technically, authors have proposed using different ribs for the fusion, depending on the patient's morphology and searching for a good position for the scapula for external rotation. There have been few postoperative complications: we had one pneumothorax and no neurological, vascular or pulmonary complications. Our results are the first reporting CT fusion findings. Indirect signs of nonunion on plain x-rays reported in earlier studies are not fully reliable, since our CT scans demonstrated nonunion in three shoulders. The lack of fusion does not mean poor function, as was also noted by others, since function was improved (mean gain 27 degrees flexion and 25 degrees abduction).

[Adventitial mucoid cyst of the radial artery associated with volar wrist ganglion. A case report]. / Kyste mucoïde adventitiel de l'artère radiale associé à un kyste arthrosynovial radiocarpien de la gouttière du pouls. A propos d'un cas.

The authors report a rare case of a 51-years old woman presenting with cystic mucoid adventitial disease of the radial artery associated with a volar wrist ganglion. Imaging namely doppler sonography, magnetic resonance scanning and angio-MR was performed preoperatively because of a history of radial artery aneurysm in the opposite wrist. The radial artery was resected and the defect bridged by a venous autograft; the volar wrist ganglia was removed. Postoperative histological analysis confirmed mucoid adventitial cyst without communication with the volar wrist ganglion. Surgeons ought to be aware of this rare differential diagnosis (less than ten cases in the literature) in cases of preoperative or peroperative diagnostic doubt.

[Bifocal fracture of sternal end of clavicle-pseudodislocation of sternoclavicular joint. Report of a case]. / Fracture bifocale du quart proximal de la clavicule-pseudoluxation sternoclaviculaire. A propos d'un cas.

We report an unusual case of bifocal fracture of the sternal part of clavicle, combining a metaphysodiaphysal fracture of the sternal end of the clavicle, a proximal physeal fracture, and a ligament avulsion of sternoclavicular joint, without neurovascular damage. Its surgical repair used an osteosynthesis with K-wires and tension band wiring and synthetic ligamentoplasty of the anterior and posterior sternoclavicular ligaments, without any reconstruction of the costoclavicular ligament. The clinical and radiographic results at six months are presented and the operative technique used in this case of pseudodislocation of sternoclavicular joint is discussed and compared to those previously published.