Traumatic Dorsal Hand Reconstruction through A free Anterolateral Thigh Flap, Induced Membrane Technique, Toe Joint Transfer, and Joint Prosthesis.

Introduction: This study presents a case of post-traumatic dorsal hand reconstruction by describing the surgical technique in several stages and the outcome. Case report: It involves a patient with loss of cutaneous tissue, loss of bone, and tendon in the dorsal hand and fingers following a car accident. He was treated on a four-stage hand salvage and reconstruction. Stage one fulfilled in emergency involved K-wire and osseous filling through acrylic cement, hunter tendon rods, and a free anterolateral thigh flap. The second stage at 2 months involved osseous grafts and finger joint prostheses. The third stage time at 7 months involved a toe joint transfer. The last stage at 11 months involved extensor tendons graft reconstruction. The functional outcome at 2 years is acceptable. Conclusion: The post-traumatic dorsal hand reconstruction requires several techniques to reconstruct the losses of substances observed and this in several stages. It allowed to have an acceptable hand function.

The advantages of computer assistance in total knee arthroplasty.

OBJECTIVES: The aim of this study was to compare the results of computer-assisted total knee arthroplasty (CA-TKA) and non-computer-assisted total knee arthroplasty (C-TKA). METHODS: We reviewed 175 cases of TKA and assigned them into two groups according to the use of computer assistance. Group A consisted of 50 cases (35 women, 15 men; mean age: 61.3 years), who had C-TKA and Group B consisted of 125 cases (94 women, 31 men; mean age: 70.9 years), CA-TKA. The results of the groups were compared based on the length of the incision, the duration of the surgery, the length of hospitalization and the final alignment of the prosthesis. RESULTS: The achievement rate of optimal alignment in the coronal plane was significantly higher in the CA-TKA group (95.2%) than the C-TKA group (74%) (p<0.0001). The average surgical time was 69.32 minutes in the C-TKA group (range: 45-94 minutes) and 70.21 minutes in the CA-TKA group (range: 46-98 minutes). The average surgical incision length was 15.78 (range: 11-18.4) cm in the C-TKA group and 12.6 (range: 9.2-16.6) cm in the CA-TKA group. The average hospital stay was 7.3 (range: 5-16) days for the CA-TKA group and 8.5 (range: 5-17) days for the C-TKA group. CONCLUSION: Our results suggested that computer assistance provides a more accurate alignment in TKA. The reduced incision length and hospitalization time appear as two other advantages of this technique.

Vascularized osteochondral graft from the medial femoral trochlea: anatomical study and clinical perspectives.

PURPOSE: Few donor sites for vascularized reconstruction of convex joint surfaces have been described. We studied the feasibility of a convex vascularized osteochondral graft harvested from the medial femoral condyle and trochlea, on an anatomical and practical point of view. METHODS: An injection-corrosion technique was used on 16 fresh cadaver specimens, and completed by a modified Spalteholz clearing. The extra- and intraosseous vascularization of the medial femoral condyle was systematized and the luminal diameter of the arteries was microscopically measured. Radii of curvature of the medial trochlea and of the carpal bones were measured on arthro-CT-scanner reconstructed images. RESULTS: The periosteal vessels of the medial condyle are responsible for the whole peripheral intraosseous vascularization, without any watershed region. They are fed by the articular branch of the descending genicular artery and/or the superomedial genicular artery. Several constant vascular axes can be found, and may serve as a pedicle for a vascularized osteochondral graft from the medial femoral trochlea. The radii of curvature of this graft do fit those of the proximal carpal row. A simple surgical approach is suggested. CONCLUSIONS: A vascularized graft harvested on the medial femoral trochlea is a technically feasible procedure that could represent a new reconstructive tool for convex joint surfaces. Osteonecrosis of the proximal pole of the scaphoid or Kienböck's disease are among several situations where such a graft could be beneficial.

Kienböck's disease in a 6-year-old boy.

A case of avascular necrosis of the lunate bone in a 6-year-old boy is reported. This is the youngest child reported in literature with Kienböck's disease. Clinical and radiological healing was obtained with conservative treatment. Non-operative management is recommended in children with avascular necrosis of the lunate bone.

Radial nerve entrapment in a humeral fracture callus.

A patient with a radial nerve palsy which persisted nine months after a diaphyseal fracture of the humerus was referred to our department. Radiographs and ultrasound examination showed that the radial nerve was transected and partially entrapped in the fracture callus. This double injury was confirmed and was repaired during subsequent surgical treatment. We report this rare case of combined primary and secondary nerve lesion.

Prospective functional analysis of trapeziectomy combined with intermetacarpal tendon stabilisation in trapeziometacarpal arthritis.

We conducted a prospective study to evaluate the functional status of patients surgically treated by trapeziectomy with intermetacarpal tendon stabilisation. Pain relief, the height of the trapezial cavity, hand impairment, and manual ability were measured in a group of 18 patients at a mean of 2.3 years after surgery. Complete relief of pain was achieved in 89% of our patients. The height of the trapezial cavity was significantly reduced. Hand strength and digital dexterity were not impaired after the operation. Manual ability was significantly improved by the trapeziectomy as demonstrated by the median VAS values of 53.5 before and 95.5 after surgery. The ABILHAND questionnaire revealed that most of the patients were satisfied with the functional results of the trapeziectomy. Based on our findings in this prospective study, it appears that trapeziectomy with intermetacarpal tendon stabilisation relieved pain in almost 90% of patients suffering from trapeziometacarpal osteoarthritis, at no functional cost.