Proximal interphalangeal joint prosthetic arthroplasty.

Surgical treatment of the painful proximal interphalangeal (PIP) joint has evolved considerably over the past century. If arthrodesis has long been the gold standard and remains so for some, prosthesis would meet patient demand: mobility and indolence. Faced with a demanding patient, the surgeon must decide the indication, the type of prosthesis, the approach, the post-operative follow-up, etc. The history of the development of PIP prostheses demonstrates the complexity of the treatment of the destroyed PIP: appearance of prostheses, evolution and sometimes disappearance from the market for commercial reasons or related to complications. The main objective of this conference is to identify the main indications for prosthetic arthroplasties and to describe the various prostheses available on the market.

The position of the upper limb during shoulder arthroscopy does not affect the distance between axillary nerve and glenoid.

PURPOSE: The segment of the axillary nerve (AxN) near the glenoid rim is at risk of iatrogenic lesion during arthroscopic procedures. We hypothesize that the distance between the AxN and the glenoid rim is not modified by the patient's positioning. The primary objective was to compare the position of the AxN with the inferior glenoid rim in lateral decubitus or in beach chair and positions of the upper limb. METHODS: Sixteen shoulders were dissected in beach chair position with the shoulder in neutral rotation. Needle one was placed in the axillary nerve where it was the closest with the inferior glenoid rim. In lateral decubitus with traction and 70° of abduction needle two was placed in the AxN at the closest with the inferior glenoid rim. The glenoid rim was marked with a needle at 6 o'clock. In beach chair position, the distance between needle one and the glenoid needle was measured for six positions. In lateral decubitus, measures were done for two positions of abduction. In lateral decubitus with 70° of abduction, the distance between needle two and the glenoid needle was also measured. RESULTS: The mean distance between AxN and the inferior glenoid rim was 14.4 mm in reference position in beach chair. The results showed the absence of difference between the positions during surgery except for lateral decubitus with 70° of abduction. CONCLUSION: Our study showed that the position of the shoulder during arthroscopic procedures cannot take away the AxN from the inferior glenoid rim. LEVEL OF EVIDENCE: Level IV-basic science study.

3D printing in hand surgery.

While 3D printing in hand surgery is still in its infancy, it offers new avenues in research, teaching, and personalized medicine. For these reasons, some surgeons may want to jump on the bandwagon of this trendy technology. But we cannot forget that its superiority over conventional techniques has not been demonstrated. Surgeons who want to work with 3D printed objects must master their use and the entire manufacturing process, otherwise they risk becoming dependent on engineers and/or medical device companies.

Fixation of the nail plate by tension band suture versus 2-octyl-cyanoacrylate gluing for traumatic nail bed injuries reduced without suture: A retrospective study of 27 cases.

Repair of the nail bed and plate after distal phalanx trauma remains controversial. The aim of this study was to determine whether simple approximation of the nail bed flaps maintained by tension band suture of the nail plate is sufficient to prevent nail dystrophies. Our series gathered 27 fingers in 25 patients with a mean age of 36 years. In 15 cases (Group I), the nail plate was fixed in a single layer by a point in a frame, and in 12 cases (Group II), the bed and the plate were fixed layer-by-layer using the wound adhesive, 2-octylcyanoacrylate. At the last follow-up, the Zook score was excellent and very good in 100% of Group I patients, and in 83.3% of Group II patients. Within 8 days, the average pain was 1/10 in Group I, and 2.5/10 in Group II. There was one infection in Group I and four hematomas in Group II. The Quick DASH score was 1.13/100 in Group I and 0 in Group II. Our results show that in the case of a traumatic nail bed injury, suturing the nail bed and applying 2-octylcyanoacrylate adhesive is less effective than simple approximation of the nail bed flaps by tension band suture of the nail plate.

Agreement between pre-operative and intra-operative bacteriological samples in 85 chronic peri-prosthetic infections.

BACKGROUND: Whether pre-operative microbiological sampling contributes to the management of chronic peri-prosthetic infection remains controversial. We assessed agreement between the results of pre-operative and intra-operative samples in patients undergoing single-stage prosthesis exchange to treat chronic peri-prosthetic infection. HYPOTHESIS: Agreement between pre-operative and intra-operative samples exceeds 75% in patients undergoing single-stage exchange of a hip or knee prosthesis to treat chronic peri-prosthetic infection. MATERIAL AND METHODS: This single-centre retrospective study included 85 single-stage prosthesis exchange procedures in 82 patients with chronic peri-prosthetic infection at the hip or knee. Agreement between pre-operative and intra-operative sample results was evaluated. Changes to the initial antibiotic regimen made based on the intra-operative sample results were recorded. RESULTS: Of 149 pre-operative samples, 109 yielded positive cultures, in 75/85 cases. Of 452 intra-operative samples, 354 yielded positive cultures, in 85/85 cases. Agreement was complete in 54 (63%) cases and partial in 9 (11%) cases; there was no agreement in the remaining 22 (26%) cases. The complete agreement rate was significantly lower than 75% (P=0.01). The initial antibiotic regimen was inadequate in a single case. DISCUSSION: Pre-operative sampling may contribute to the diagnosis of peri-prosthetic infection but is neither necessary nor sufficient to confirm the diagnosis and identify the causative agent. The spectrum of the initial antibiotic regimen cannot be safely narrowed based on the pre-operative sample results. We suggest the routine prescription of a probabilistic broad-spectrum antibiotic regimen immediately after the prosthesis exchange, even when a pathogen was identified before surgery. LEVEL OF EVIDENCE: IV, retrospective study.

Active extensor indicis proprius extension strength after its use as a tendon transfer: 19 cases.

Complications following extensor indicis proprius (EIP) tendon transfer are loss of strength, independence and mobility in the index finger in extension. The main goal of this study was to measure the index finger's independent and dependent extension strength after a tendon transfer. Secondary goals were to determine if the index finger retained the ability to extend independently after the transfer and to evaluate second metacarpophalangeal (MCP) joint mobility. Our study consisted of 19 patients in whom the EIP tendon had been divided proximally to the extensor hood. The EIP tendon was retrieved through a proximal approach at the distal radius level and rerouted towards a recipient tendon. At an average follow-up of 41 months, the average independent extension strength was 5.6N versus 11N on the contralateral side and the dependent strength was 10.9N versus 20N. No patient complained of a loss of extension strength and all had retained independent active extension on the operated index finger. The second MCP joint on the operated side had an independent extension lag of 15.3° compared to the contralateral healthy side and a dependent extension lag of 0.2°. Two patients were impaired in their daily activities when moving the operated index finger. Our results show that EIP harvesting for tendon transfer leads to decreased independent and dependent strength as well as decreased active extension of the second MCP joint. However, the functional impact was negligible and should not compromise the use of the EIP as a tendon transfer. LEVEL OF EVIDENCE: III.

Establishing a reproducible protocol for measuring index active extension strength.

The goal of this study was to establish a reproducible protocol to measure active extension strength in the index finger. The secondary objectives consisted in correlating the independent or associated index extension strength to the other fingers force of contraction of the extensor indicis propius with hand dominance. The population studied consisted of 24 healthy volunteers, including 19 women and 20 right-handed individuals. The independent and dependent index extension strength in each hand was measured three times with a dynamometer by three examiners at Day 0 and again at Day 7. Intra and inter-examiner reproducibility were, respectively, >0.90 and >0.75 in all cases. The independent extension strength was lower than the dependent one. There was no difference between the independent index extension strength on the dominant and non-dominant sides. The same was true for the dependent strength. Our results show that our protocol is reproducible in measuring independent and dependent index extension strength. Dominance did not come into account. LEVEL OF EVIDENCE: II.

Resistance of primary microsurgical repair of palmar digital nerves to finger mobilization: A cadaver study.

The aim of this study was to assess the resistance of microsurgically repaired proper palmar digital nerves (PPDN) to mobilization. Thirty-nine PPDN from fresh forearms cadavers were transected and then sutured using 10/0 nylon. After skin closure, each finger was forcefully flexed and extended 10 times. Out of the 39 repaired nerves, two were elongated and four were ruptured; this amounts to a 15.38% complication rate. We recommend immobilization of nerve repairs, although this contradicts most recent studies.

[Consequences of prosthesis on quality of the radiation therapy]. / Implications de la pose de matériel « inerte ¼ dans l'organisme humain sur la qualité de la radiothérapie.

Dose prescription, delineation and dose calculation are clearly complicated when a patient have been operated on with insertion of prosthesis. Knowledge of the physical and material characteristics is needed to decrease incertitude of calculations. Recommendations for each step of treatments are proposed in this article allowing to optimization of the treatment safety.