Ten-year radiological and clinical outcomes of capitolunate arthrodesis with scaphoid and triquetrum excision for advanced degenerative arthritis in the wrist: Single-center, retrospective case series with 10patients.

The aim of this study was to evaluate the long-term outcomes of capitolunate arthrodesis for treating advanced wrist osteoarthritis. The arthrodesis procedures were performed in three women and seven men having a mean age of 59years (range, 20-70). Eight of the patients were manual laborers. The dominant hand was operated on in seven patients. The osteoarthritis was attributed to scapholunate dissociation (SLAC) in six patients and scaphoid nonunion (SNAC) in four patients. The arthrodesis site was stabilized with two vertical compression screws. Patients were reviewed after an average follow-up of 122months (80-172). The clinical and radiological outcomes consisted of measuring pain on a visual analog scale (VAS), determining the QuickDASH and PRWE scores, the patients' satisfaction, the radiolunate and capitolunate angles, carpal height, radiolunate joint condition, and fusion of the arthrodesis site. The mean pain level was reduced from 5 to 1 (P<0.05). The range of motion improved by 20° in flexion-extension and 10° in radioulnar deviation, while strength improved by 8kg relative to the preoperative measurements (P<0.05). The QuickDASH was 15points (±12) and the PRWE was 20 (±32). Relative to the preoperative values, the radiolunate angle was reduced by 4.5° and the capitolunate angle by 6.5°. Carpal height was 6.5mm less on average (P<0.05). None of the patients had a nonunion or deterioration of the radiolunate joint. One patient developed Type II complex regional pain syndrome. The nine other patients were able to return to work. Capitolunate arthrodesis provided pain relief and good function in 9 of the 10patients in our case series. The results was maintained over time, both in terms of mobility and pain relief, which were clearly improved after the surgical treatment. We found no signs of deterioration of the radiolunate joint over 10years. There are very few published studies describing the long-term outcomes of this procedure. Our findings are consistent with those in the literature, which makes capitolunate arthrodesis with scaphoid and triquetrum excision a highly satisfactory and reliable technique in the long term for the treatment of advanced osteoarthritis in the wrist. LEVEL OF EVIDENCE: IV.

[Should we reconstruct the flexor retinaculum in the carpal tunnel?]. / Faut-il reconstruire le rétinaculum des fléchisseurs (retinaculum flexorum) dans le canal carpien?

Conflicting data in the literature justify this review about the flexor retinaculum (FR). Reconstruction of the FR following carpal tunnel open release has been recommended in order to limit the drawbacks of open carpal tunnel release; these drawbacks have been reported in wide series of results published between 1956 and 1988. This paper includes a review of the literature, a survey of the practice of the members of the French society for surgery of the hand (GEM), a self-evaluation of grip strength as well as a summary of indications.

Effects of the selective alpha 1a-adrenoceptor antagonist silodosin on ECGs of healthy men in a randomized, double-blind, placebo- and moxifloxacin-controlled study.

In order to determine the effects of therapeutic and supratherapeutic doses of silodosin on QT interval, healthy men (N = 186; aged 18-45 years) were randomized to receive silodosin (8 or 24 mg) or placebo for 5 days or moxifloxacin 400 mg (positive control, known to prolong QT) once on day 5. At baseline and on day 5, five ECGs were recorded 0.25 h before dosing and 1, 1.5, 2, 3, 4, 6, 8, 10, and 23.5 h after dosing. Adjusted mean differences (analysis of covariance) between silodosin and placebo in the change in individual heart rate-corrected QTc (QTcI) from baseline to day 5 were <5 ms at all times (all 90% confidence interval (CI) upper limits <10 ms). The QTcI difference for moxifloxacin compared with placebo often exceeded 5 ms, establishing assay sensitivity. For silodosin, no statistically or clinically significant correlation was seen between plasma concentration and QTcI, and no clinically important effects on heart rate, PR segment, QRS complex, or morphologic ECG data were observed.

[Osteosynthesis using intra-focal pins of anteriorly dislocated fractures of the inferior radial epiphysis]. / Ostéosynthèse par broches intra-focales des fractures à déplacement antérieur de l'épiphyse radiale inférieure.

The authors describe two anterior approaches to intra-focal pinning of distal radius fractures, with anterior tilt, Smith type and anterior margin type. They demonstrate that this fixation mode is as reliable as anterior plate osteosynthesis, with less anatomic cost. It allows immediate mobilization and affords good functional results. Performed with regular K. Wire or better with "Arum" Pins, this procedure was used in ten Smith's fractures, six anterior margin fractures, one two-margins fractures, and twelve multi-fragment fractures. Anterior pins are also used when excessive anterior reduction is feared in Colle's fractures. Secondary displacements are rare, except radius shortening which is possible with all types of fracture and treatment. As cast is prohibited, early rehabilitation provides good and excellent functional results. Complications are exceptional, occurring at the beginning of the authors' experience. Thanks to some precaution, such as the "open approach" and protecting the pin ends, this technique is simple, reliable, economic and effective.

Immunologic localization and kinetic characterization of a Na+/Ca2+ exchanger in neuronal and non-neuronal cells.

The plasma membrane Na+/Ca2+ exchanger is believed to play a role in the regulation of Ca2+ fluxes in neurons, though the lack of specific inhibitors has limited the delineation of its precise contribution. We recently reported the development of antibodies against a 36-kDa brain synaptic membrane protein which immunoprecipitated exchanger activity from solubilized membranes. In the present study we examined the kinetics of the Na+/Ca2+ exchanger in primary neurons in culture, in a neuronal hybrid cell line (NCB-20), and in a fibroblast-like cell line (CV-1) to see whether the level of exchanger activity correlated with the degree of immunostaining produced by our antibodies. The Vmax was determined for each cell type and found to be highest in primary neurons. Exchanger activity increased in primary neurons between days 1 and 6 in culture, but no such time-dependent change occurred in either of the cell lines. Immunoblot analysis of the three cell types probed with the anti-36-kDa protein antibodies revealed significantly greater immunostaining in the primary neurons compared with the other two cell types. Intensity of staining of neurons also increased significantly between days 1 and 6 in culture. Immunocytochemistry showed significant labelling of the primary neurons on the neuritic processes and points of contact between cells. The NCB-20 and CV-1 cells showed considerably lower levels of immunoreactivity. The antibodies immunoextracted approximately 90% of the exchanger activity in the primary neurons and approximately 70 and 50% of the activity in NCB-20 and CV-1 cells respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Characterization of Na(+)-Ca2+ exchange activity in plasma membrane vesicles from postmortem human brain.

Procedures were developed for measurement of Na+/Ca2+ exchange in resealed plasma membrane vesicles from postmortem human brain. The vesicle preparation method permits use of stored frozen tissue with minimal processing required prior to freezing. Vesicles prepared in this manner transport Ca2+ in the presence of a Na+ gradient. The kinetic characteristics of the Na+/Ca2+ exchange process were determined in membrane vesicles isolated from hippocampus and cortex. The Kact for Ca2+ was estimated to be 32 microM for hippocampal and 17 microM for cortical tissue. The maximal rate of Ca2+ uptake (Vmax) was 3.5 nmol/mg protein/15 sec and 3.3 nmol/mg protein/15 sec for hippocampal and cortical tissue, respectively. Exchange activity was dependent on the Na+ gradient, and was optimal in the high pH range. Therefore, membranes in which Na(+)-dependent Ca2+ transport activity is preserved can be isolated from postmortem human brain and could be used to determine the influence of pathological conditions on this transport system.

[Shearing splints]. / Orthèse en cisaillement.

The splint proposed here is designed for patients undergoing extensive tenolysis of the long fingers in zone 5. Based on the anatomy, the principle of this splint is to place the flexor tendons of one finger in a short position and its neighbour in a long position and vice versa. This promotes the formation of "long" adhesions allowing independent movement of each finger.

Fractures of the fifth metacarpal neck.

The authors reviewed 129 cases of fractures of the neck of the fifth metacarpal. The radiological work-up of this fractures should include an anterio-posterior film with the hand supinated, and an oblique ulnar view with the hand pronated. This fractures can be separated into 4 categories: true cervical fractures; cervico-cephalic fractures; cervico-diaphysary fractures; and epiphyseal separations. In 78 patients an immediate mobilisation was performed. 51 fractures have been treated by multiple medullary pinning because of an unacceptable volar angulation associated with mal-rotation. Good and excellent results were obtained in 86% of cases.