Extensor indicis proprius tendon transfer using shear wave elastography.

The means for judging optimal tension during tendon transfers are approximate and not very quantifiable. The purpose of this study was to demonstrate the feasibility of quantitatively assessing muscular mechanical properties intraoperatively using ultrasound elastography (shear wave elastography [SWE]) during extensor indicis proprius (EIP) transfer. We report two cases of EIP transfer for post-traumatic rupture of the extensor pollicis longus muscle. Ultrasound acquisitions measured the elasticity modulus of the EIP muscle at different stages: rest, active extension, active extension against resistance, EIP section, distal passive traction of the tendon, after tendon transfer at rest and then during active extension. A preliminary analysis was conducted of the distribution of values for this modulus at the various transfer steps. Different shear wave velocity and elasticity modulus values were observed at the various transfer steps. The tension applied during the transfer seemed close to the resting tension if a traditional protocol were followed. The elasticity modulus varied by a factor of 37 between the active extension against resistance step (565.1 kPa) and after the tendon section (15.3 kPa). The elasticity modulus values were distributed in the same way for each patient. The therapeutic benefit of SWE elastography was studied for the first time in tendon transfers. Quantitative data on the elasticity modulus during this test may make it an effective means of improving intraoperative adjustments.

Dorsal approach and internal fixation of impacted intra-articular distal radius fractures with 2.4 mm locking plates.

The treatment of impacted distal radius fractures is complex. Internal fixation by a dorsal approach with arthrotomy should be considered, particularly when the fractures are dorsally comminuted. This was a retrospective, observational study of 26 patients operated between 2008 and 2012 who were reviewed in September 2013. In the surgical procedure, a single dorsal incision was made over the distal radius and arthrotomy performed; the fracture site was stabilized with two 2.4mm locking plates. The average follow-up was 39months. All fractures were type 23C in the AO classification. All patients were assessed with the QuickDASH and Mayo Wrist scores. Total range of motion was 82% of the contralateral side. Grip strength was 30kg in average. The mean radial sagittal tilt was +6° postoperatively. No plate movement or intra-articular screws were present. Four patients developed symptomatic early osteoarthritis. Thirteen patients had the plate removed due to discomfort. No tendon ruptures were observed. The dorsal approach remains a treatment option for specific intra-articular fractures. It offers direct intra-articular congruency control, along with a stable buttress and locking fixation for early mobilization. Our results are comparable to those using other surgical techniques for this type of high-energy fracture.