[Hands and feet of prosimians primates. Attempts of morphologic characterization]. / Mains et pieds des primates prosimiens. Essai de caractérisation morphologique.

The length of the carpus and tarsus, the metacarpus and metatarsus, the fingers and toes of 142 prosimian apes was measured. The relationship expressed as a percentage was drawn up for each individual between the length of each osseous part and that of its third metacarpal in order to eliminate the differences related to the size of the rest of the body. This ratio was compared with that of man. The characteristic variations appeared at the level of the subfamilies. CONCERNING THE HAND: The carpus presented the same values as that of man except for that of the indris, which was shorter. The thumb had proportionally the same length as that of man, sometimes longer and sometimes smaller as in the Eulemurs, Hapalidea, Megalapidea, Indrises, Daubentonia and Perodictus. The different metacarpals, including the fourth, were a little shorter than the third. In these subfamilies, the second ray was also often shorter and even much shorter in the Megalapidea and the Perodictus. The other rays were a little longer, in particular the fourth which could exceed the third in rather many subfamilies. CONCERNING THE FOOT: The length of the tarsus was extremely variable. It was twice larger in the Galagoidae, definitely larger in the tarsius and discreetly in the Hapalidae, a little smaller in the other Lemurs and much smaller in the other Prosimian apes, joining in that the near totality of the simians. The hallux was proportionally as long as that of man and sometimes even longer. The metatarsals were sometimes a little longer, sometimes less long, but always appreciably of the same length between them. The other toes were short at the aye aye (daubentonia), of which the foot appeared even smaller than that of man. The toes of the other prosimious resembled much to the fingers and in the propithecus and the perodictus, the fourth took gigantic proportions. There has been establishment of an anatomical relation and functional calculus between the length of the last three rays of the hands and the feet of prosimian apes and the biomechanics of their trapezometacarpal and their first cuneometacarpal joints.

[The first ray of the hand and the foot in the primates (II). Functional anatomy]. / Le premier rayon de la main et du pied chez les primates (II). Anatomie fonctionnelle.

To study the articular amplitude of the first ray of both hands and feet using passive mobilisation, either on fresh human cadavers or on living primates after anesthesia (namely eight pongidae, 15 cercopithecidae, two platirrhinii, eight lemuroidae, three daubentonidae, two loridae and two galagonidae). Plans slightly parasagittal and parafrontal have been chosen to obtain the maximum dorsal and palmar or plantar inclinations and the maximum lateral and medial inclinations. The pronosupination of the first ray has been evaluated in relation of these plans and alike for the hand of the simian primates on the plan of the concavity and the convexity of trapezial surface. The results have been compared with these obtained in the man. The pronosupination of the first ray, so denominated by analogy with the pronosupination of the fore-arm is the movement which allows the pulp of the thumb or of the hallux to look now forward or now backward in order to be opposed at the other fingers during the pollici- or the hallucidigital pinch. It can be considered like "effective" unless if there is rotation around the longitudinal axis of its metacarpus (or metatarsus). The prosimian primates had great and sensibly similar circular amplitude of their first metacarpus and first metatarsus, which reached more than 90 degrees in all the directions. It allowed a pronosupination of 90 degrees, but this was only "apparent" because it has been obtained by the alone combined action of the two orthogonal axes at the basis of the ray by simple effect of cardan joint. The anthropoids had only limited circular amplitude, not exceeding 45 degrees. It was associated with an "effective" pronosupination according to a longitudinal axis. The rotation reached 90 degrees. It was produced around the point of anchorage made up by the medial ligaments for the trapezometacarpal articulation and the lateral ligaments for the cuneometatarsal. This movement was possible because of the peculiar relief of the articular surfaces: modified cardan for the trapezometacarpal and spiraled trochoid for the cuneometacarpal joint. The man was the sole primate, which had practically no mobility at the level of the first ray of his foot. However, the morphology of his cuneometatarsal articulation was similar to that of the other anthropomorphous primates. The muscles which was inserted on the first metacarpus (or metatarsus) played an active role in the circular amplitude and in the apparent circular amplitude, but very discreet in the effective circumduction. The transversal fascicle of the short abductor of the thumb and of the hallux had a little pronator effect. At the level of the foot, the tendon of the fibular longus had an action of pronation and the abductor longus muscle an action of supination. The metacarpophalangeal and the metatarsophalangeal articulations of all the primates were condylar with laterality movements, which were able to reach 40 degrees and which were then unsteady. The metacarpophalangeal articulation of the man was the single exception. He was the sole one with a really steady thumb.

[Hands and feet of Simian primates: an attempt at morphological characterization]. / Mains et pieds des primates simiens: Une tentative de caractérisation morphologique.

The carpal height, the length of the metacarpus, the metatarsus, and of all the phalanges of 269 simians were measured, then for each specimen, converted to percentage taking the 3rd metacarpus as the reference unit. They were then compared despite differences between specimens. The average values were determined for the different species, subspecies or families. Mathematical ratios were established: height of the carpus divided by the 3rd metacarpus, carpus divided by the 1st metacarpus, 1st ray of the hand divided by the 2nd, 1st ray of the hand divided by the 1st ray of the foot. CONCERNING THE HAND: For little monkeys, the length of the carpus and the medial metacarpus were similar to those observed in humans. Colobinae exhibited a relatively short thumb column. The length of the thumb was slightly shorter for the platyrrhinii and cercopithecinae, especially macacus. Some hapalidae had a relatively longer thumb than humans. All of their medial fingers were longer than those observed in humans. The big monkeys had a smaller carpus and thumb column, sometimes much smaller than in humans, with a similar length for the metacarpi and the medial fingers, except for gibbons, whose medial fingers were longer. CONCERNING THE FOOT: The 1st ray in humans is nearly as long as the 2nd toe, the other toes being very short. The 1st ray of the hallux of all monkeys was always longer than the ray of the thumb, but shorter than the hallux of humans. The other metatarsi of little monkeys were similar to those in humans, except for the platyrrhinii which had a shorter 2nd metatarsus. The lateral toes, which were much longer than in humans, were very similar to fingers though slightly longer, except for platyrrhinii with much longer toes. The big monkeys had very short metatarsi and slightly smaller lateral toes than humans.

[Tumeral calcinosis: case report of an erosive form affecting the long finger]. / Calcinose circonscrite erosive d'un doigt long: a propos d'une observation.

Tumoral calcinosis is characterised by deposits of hydroxyapatite in the soft tissues. The authors report an observation of localization at the level the P.I.P. joint of a ring finger. The lesion appeared to be a subcutaneous tumour but had completely eroded the distal epiphysis of the middle phalanx. The diagnosis was made radiographically and was confirmed by histology. Calcinosis presents in two very different forms; either disseminated or localised. The localised form can invade the juxta-articular gliding spaces. It may exhibit one of two clinical courses: one is acute and diffuse. The other is chronic, localised and insidious and gives rise to tumoral masses arising near joints, but without invading them. An erosive tumoral calcinosis is exceptional. It is characterized by bony right up to the articular surfaces. At the level of the wrist and the hand, tumoral forms are rare and we could only find one other case in the literature and it was localized in the middle finger.

[Ganglions of the wrist: proposals for topographical systematization and natural history]. / Kystes dits "synoviaux" du poignet: systématisation topographique et pathogénie.

PURPOSE OF THE STUDY: We looked for the anatomic origin and mechanism of constitution of the so-called "ganglions" of the wrist. MATERIAL AND METHODS: Fifty-nine formations considered to be synovial ganglions were dissected and removed according to the same protocol by the same surgeon. Eleven were re-examined by a pathologist. All ganglions were extra-articular but had intra- and extra-capsular components. The extra-capsular part was the clinically palpable main cyst. The intra-capsular part was composed of the cystic stalk and its base of implantation. An intra-capsular stalk was present in 58 cases. The stalk was situated between the joint synovium and the capsula which it perforated at a weak point between two ligaments, forming a collar before expanding outwardly. Based on our findings, we propose a topographical systematization and natural history of ganglions of the wrist. RESULTS: The stalk's implantation base was always located on bone and found in the intermediate area of Colomniati and Soubbotine, which lies outside the articular cartilage between the synovium and the ligamentous capsula. This area is exposed to mechanical stress initiating histological degenerative lesions, particularly mucoid degeneration. At the radiocarpal joint, the stalk's base of implantation was located at the distal end of the lateral dorsal or volar edge of the lunate bone or at the corresponding part of the scaphoid. The collar of the proximal ganglions was situated between the dorsal radiocarpal and transverse scaphotriquetral ligament. The collar of distal dorsal ganglions was situated between the transverse scaphotriquetral and the trapezotriquetral ligament. The collar of the lateral ganglions was situated between the lateral collateral and the transverse ligament. The collar of the volar ganglions was situated between the stylocarpal ligament and the radiolunotriquetral ligament, or between the different stylocarpal ligaments. At the level of the scaphotrapezal joint, the stalk's base of implantation was located near the collateral edge of the distal surface of the joint with the collar between the distal scaphoidal ligaments. The palmar cysts exhibited a collar between the stylocarpal ligaments and the radiolunotriquetral ligament or between the different stylocarpal ligaments. DISCUSSION: At pathology examination, the lesions were not found to be different from those observed in other connective tissues exposed to overuse or repeated microtrauma (sports, occupational exposure). Anatomic conditions inside the joint capsula excluded extension of the mucoid degeneration transversally. The only issue was through the capsula, allowing the mucus enclosed in the connective tissue fibers to form the main cyst. CONCLUSION: Knowledge of these different processes enabled a topographical systematization useful for complete surgical or arthroscopic removal of the ganglion. Complete resection would prevent recurrence.

[Importance of the posteromedial trapezometacarpal ligamentous complex]. / Importance du complexe ligamentaire postéromédial trapézométacarpien.

Pronation and supination of the human thumb has both a practical and a symbolic importance. In supination the thumb caresses but in pronation it grasps. The articular surfaces of the trapezium and first metacarpal are not congruent enough in themselves to assure pronation and supination, but their reciprocal saddle shape causes them to have two distinct orthogonal "fundamental" axes of rotation, and hence two "privileged" planes of rotation. The one corresponds to the movements of the lateral pinch grip and the other to opposition and counter-opposition of the thumb. The important ligaments are situated on both sides of the trapeziometacarpal joint. The posteromedial ligamentous complex is composed of the posterior oblique ligament, the anterior oblique ligament, the intermetacarpal ligament, and a fourth or more anteromedial ligament which we have called the retinaculometacarpal ligament by reason of its proximal insertion. It plays an essential role in suspending and anchoring the base of the first metacarpal. By its action it induces two types of motion: 1) a discrete translation of the metacarpal along the articular concavity of the trapezium in lateral pinch grip; 2) a more important motion characterised by a prosupination of 90 degrees during its rotation in the plane of opposition. The anterolateral ligament's action is restricted to strengthening the action of the posteromedial ligaments in the extreme positions of closing of lateral pinch and thumb opposition. In cases of trapeziometacarpal subluxation it prevents a complete dislocation. These various observations have significant clinical and therapeutic implications.

[A minimal trapezometacarpal ligamentoplasty]. / Ligamentoplasties trapézométacarpiennes a minima.

To correct chronic instability of the trapeziometacarpal joint, the authors reconstructs the posteromedial ligamentous complex using flaps of extensor retinaculum. Two small dorsal incisions allow harvesting free segments of extensor retinaculum detached from the proximal portion of extensor retinaculum to repair dorsal injuries when these prove to be superficial. When necessary, a clip passed via a small palmar cunter incision allows a complementary palmar reconstruction. For repair of anterior ligaments, the palmar incision can be extended and a pedicled flap derived from the retinaculum is used. There is a detailed description of technique and results.

[Luno-triquetral angle and dislocation of the wrist]. / Pente luno-triquétrale et dissociation du carpe.

The mediocarpal force, determined by the distal articular surface of both, lunate and triquetral bones, abuts against the double bolt, composed of the scaphoid and the radial styloid process. An important wrist trauma can rupture this bolt and cause a proximal and lateral translation of the distal carpal row. This situation may present under 3 forms: fracture of the scaphoid bone and midcarpal dissociation; fracture of the radial styloid process with scapholunate dissociation; scapholunate dissociation, associated with a dorsal radiotriquetral ligament rupture and medial translation of the lunotriquetral block. Experimental and clinical illustration of this process, discussion and treatment.

[Complications related to the existence of a lunotriquetral synostosis]. / Complications liées á l'existence d'une synostose luno-triquétrale.

The authors report the observation of a patient, in whom coexisted a hypersolicitation of the wrists, a congenital lunatotriquetral fusion, a stress fracture of the hook of the hamate and a VISI, giving evidence of a medial carpal instability. They analyse the factors, which allow to understand the relations between these different elements. They caution against arthrodesis, advocated in the treatment of VISI.

[Painful extensor digitorum brevis]. / Douleurs en rapport avec un court extenseur des doigts.

A boxer suffered from a painful extensor digitorum brevis muscle. The pathology involved the proximal insertion on the lunate and caused a specific form of carpal instability. On excision of the muscle the pain disappeared.

[Reconstruction of the medial collateral ligament of the knee in rats using a free autogeneic transplant of fascia lata, ligament or tendon]. / Reconstruction du ligament collatéral latéral du genou du rat par un transplant libre autogène constitué de fascia lata, de ligament ou de tendon.

After resecting the lateral collateral ligament of the knee in 56 male mature rats, the authors replaced it by an autogenous transplant of the same size, made of fascia lata, ligament or patellar tendon. The authors then studied this transplant after an evolution of 2 days to 5 1/2 months. This lapse of time can be divided into three stages: an initial stage (first week), marked by transplant necrosis and acute inflammation--an early stage (from the second to the fourth week), which shows the migration of the cells from the host to the transplant and the rebuilding of collagen fibers. Tissues with a loose, extensible, but weak texture, such as the fascia lata, are totally colonized by the fibroblasts. Tissues with a dense, strong, but less extensible texture, as the patellar tendon, are soon destroyed and recolonized at the periphery, whereas their center is destroyed and recolonized by fibroblasts later and more irregularly--a late phase of consolidation (from the second to the fifth month), which shows the rebuilding of a dense collagen network and its reorientation. In fascia lata transplants, this new collagen is homogeneous and is made of parallel bundles. In tendon transplants, the network is not homogeneous. It has a persistent nodular aspect at the periphery and well-oriented bundles, separated by calcified or granulomatous foci at the center. In the case of ligament transplants, the new collagen network shows an intermediate aspect between the two described above. The weakest regular connective tissues are the best for ligamentoplasties, and tendons are the worst.

[The frondiformis ligament and stabilization of the posterior tarsus]. / Ligament frondiforme et stabilisation du tarse postérieur.

The frondiformis ligament is a part of the retinaculum extensorum of the instep. Actuated by the tendons of the extensor digitorum longus, it takes a direct effect on the talus and the calcaneum, induces the valgus of the tarsus and contributes to the stability of the ankle and the foot.

[Aponeuroses and superficial fascia. Mechanical and structural properties]. / Aponévroses et fascia superficiels. Propriétés mécaniques et architecturales.

Eleven superficial aponeuroses have been examined in order to study their biomechanical and structural properties. Specimens were taken from 5 fresh cadavers, 3 males, 2 females with a mean age between 40 and 60 years. The study was done by two methods: biomechanical and histological. Aponeuroses can be classified in 2 biomechanical and histological groups that match perfectly. The first group has biomechanical and histological properties similar to those of tendons, and the second group similar to those of tendons, and the second group similar to those of ligaments. Ignoring the biomechanical and histological properties of tendons, ligaments and aponeuroses can be the cause of failure of a number of ligament and tendon plasties. The surgeon has an important role in choosing the transplants according to the histological properties (thickness, length of structures, bundle orientation) and biomechanical properties (solidity and extensibility).

The distal ligamentous complex of the scaphoid and the scapho-lunate ligament. An anatomic, histological and biomechanical study.

22 fresh cadaver specimens have been examined to study the anatomy, histology and biomechanical features of the ligaments of the proximal and distal poles of the scaphoid. The biomechanical study was carried out by two methods: an analytical one on an Instron machine, and a global one in situ. The different experiments show the predominant rôle of the distal ligamentous complex of the scaphoid over the scapho-lunate ligament. This contrasts with the generally accepted concept and modifies the management of lateral carpal instability.

[Severe and chronic lateral sprains of the wrist with axial deviation, and their treatment]. / Entorses graves et invétérées externes avec désaxation du carpe et leur traitement.

Firmly established lateral carpal instability may be practically corrected by a ligamentoplasty of the distal scaphoidal ligamentous complex. It may be entirely and definitively cured by a double ligamentoplasty of the distal scaphoidal complex and of the scapholunate ligament. Four cases with a postoperative follow-up of more than 2 years are presented.

[Dorsal trapezoid-scaphoid luxation. A case report]. / La luxation columnaire trapézo-scaphoïdienne dorsale. A propos d'une observation.

Dorsal trapezoscaphoid dislocations are characterised by posterolateral translation of the trapezium and the distal part of the first finger in relation to the rest of the wrist and hand. The authors found only 7 cases in the literature and they analyse the principal features in the light of a new personal case caused by violent trauma. It was easily reduced orthopaedically, but because of the instability, double pinning was performed to the adjacent bones and plaster immobilisation was maintained for six weeks. An excellent functional and radiological result was obtained and remained stable after two years.

[Trans-scaphoid-triquetrum-retrolunar fracture luxation. A case report]. / Fracture luxation transscapho-triquétro-rétrolunaire. A propos d'un cas.

The authors report an exceptional case of retrolunate dislocation of the carpus associated with a Schernberg type III scaphoid fracture and a transverse fracture of the triquetrum at the level of its median crest, avulsing all of the upper third of this bone. That describe the emergency treatment and the radiological and operative findings.

[The posterior interosseous artery. Descriptive anatomy. Possibilities of clinical and orthopedic applications]. / L'artère interosseuse postérieure. Anatomie descriptive. Possibilités d'application clinique en orthopédie.

Study of 25 forearms of fresh cadavers, whose the arteries have been injected with colored latex. The posterior interosseous artery is known for its superficial branches, which allow to autonomise cutaneous dorsal flaps. Its way, along the ulna allows to imagine other possibilities by use of the constant branches of this artery, which supplies the proximal and the distal extremities of the bone. The proximal branch is the posterior recurrent radial artery, which supplies the posterolateral face of the proximal pars of the diaphysis, in touch of the insertions of the supinator muscle, and the lateral edge of the olecranon. The distal arteries shape 2 or 3 fascicles, which disperse on the extremity of the diaphysis and the cervical pars of the ulna. To realize a vascular pedicle with the posterior interosseous artery, two cases can be envisaged: use of the distal ulnar epiphysis and creating of a direct pedicle. use of the proximal ulnar epiphysis and creating of a recurrent pedicle.

[The intermetatarsal transverse ligaments and their connections with the tarsometatarsal articulations]. / Les ligaments transverses intermétatarsiens et leurs relations avec les articulations tarsométatarsiennes.

The authors have performed 20 systematical dissections of the distal part of the foot, conserved in the Toulon's liquor and 3 dissections of fresh cadavers. The last ones have been submitted at different puttings in charge before and after the resection of the intermetatarsal transverse ligament. The intermetatarsal transverse ligament is supple, extensible, but very strong. It constitutes the area of convergence of all the neighbouring fibrous structures and of several tendons of the foot. It connects together the heads of the metatarsus. It renders them jointly liable and its action is reflected above. By its modulating of the convergence of the metatarsus and their necessary associated palmar inclination, by its limitation of their divergence in relation with their dorsal inclination, it modulates and it limits the amplitude of the tarsometatarsal joints. It is helped for that by the little intermetatarsal transverse ligaments, whose the presence has been always confirmed. The metatarsus varus, very frequently associated with the hall valgus, means the escape of the first ray from the effect of the transverse intermetatarsal ligament.