Recovery of rock climbing performance after surgical reconstruction of finger pulleys.

UNLABELLED: This study evaluated recovery of sport performance and correction of bowstringing after surgical reconstruction of closed finger pulley rupture in high-level rock climbers. A total of 38 patients treated with an extensor retinaculum graft were assessed. The mean follow-up time was 85 months, and 30 patients returned to their previous climbing level. The mean total active motion score was 96% of the opposite side. All patients had an excellent Buck-Gramcko score. There was no significant difference in grip strength and tip pinch strength in the crimp position between the injured side and the opposite side. A total of 31 patients were examined with ultrasonography. In 18, flexor bowstringing effects had returned to near-normal values. There was an association between rock climbing level recovery and the flexor bowstringing correction (odds ratio, 6.9; 95% confidence interval, 1.1-42.8). If flexor bowstringing was corrected, patients were more likely to regain their preinjury sport performance. The ultrasonography measurement was a useful tool for predicting functional recovery. LEVEL OF EVIDENCE: 4.

Results with the Roseland(®) HAC trapeziometacarpal prosthesis after more than 10 years.

The Roseland(®) hydroxyapatite-coated prosthesis is a total trapeziometacarpal joint prosthesis used for the surgical treatment of thumb basal joint arthritis. The aim of this retrospective study was to evaluate its long-term outcomes. Fifty-one patients (64 thumbs) underwent trapeziometacarpal joint replacement with this prosthesis. The mean follow-up was 12.5 years. Survival rate of the prosthesis was 91%. There was either no pain or only occasional pain in 91% of cases. The mean QuickDASH score was 27.6. Abnormal radiographic findings were present in 70% of cases. Since they were often asymptomatic, no further treatment was carried out. Complications were common (25%) and occurred early on but could often be treated without surgery. The long-term results with the Roseland(®) HAC prosthesis are satisfactory in terms of pain relief and function. However, the high complication rate is a major concern.

[Lower limb salvage with a free fillet fibula flap harvested from the contralateral amputated leg]. / Un cas de "jambe-banque" pour le sauvetage d'un membre inférieur.

We report a unusual case of "fillet flap" to reconstruct the lower limb with the amputated contralateral leg. This kind of procedure was first described by Foucher et al. in 1980 for traumatic hand surgery as the "bank finger". A 34-year-old man suffered a microlight accident with bilateral open legs fractures. A large skin defect of the left leg exposed the ankle, the calcaneus and a non-vascularized part of the tibial nerve (10 cm). The patient came to the OR for surgical debridement and had massive bone resection of the left calcaneus. The right leg showed limited skin defect at the lower part, exposing the medial side of the ankle and a tibial bone defect, measuring 10 cm. Salvage the left leg was impossible due to complex nerve, bones and skin associated injuries, so this leg was sacrificed and used as a donor limb, to harvest a free fibula flap for contralateral tibial reconstruction. At 18 months of follow-up, the patient was very satisfied, the clinical result was very good on both lower limbs and X-rays showed excellent integration of the free fibula flap. The patient had normal dailies occupations, can run and have bicycle sport practice with a functional left leg fit prosthesis. This case showed an original application of the "fillet flap concept" to resolve complex and rare traumatic situations interesting the both lower limbs. In our opinion, this strategy must be a part of the plastic surgeon skills in uncommon situations.

[Management of zone 1 flexor digitorum profundus tendon injuries]. / Prise en charge des lésions du tendon fléchisseur profond des doigts en zone 1.

Flexor tendons repair in zone 1 is classically considered providing good results with an overall satisfactory finger function. However, the objective functional results after surgical repair of flexor digitorum profundus are sometimes disappointing. The authors describe the different surgical repair techniques available to the operator from so-called "traditional" sutures to newer methods of internal fixation using miniaturized anchor sutures. The management of postoperative procedures, that of failures and old cases are reported.

[Repair of a facial nerve substance loss by interposition of a collagen neurotube]. / Réparation d'une perte de substance du nerf facial par neurotube en collagène.

We are exposing the case of a 22 year-old patient presenting a wound of the right cheek, with a palsy of the right corner of the mouth. He has been sent to us 6 days after the trauma for secondary exploration. A section of the buccal branch of the right facial nerve with a 1cm gap has been brought out. We have bypassed the loss of substance with a collagen absorbable biological conduit. The 6-months clinical and electromyographic follow-up has shown a clear improvement of the function of the orbicularis oris, as well as its reinnervation by the buccal branch of the right facial nerve.

[Foreign body reaction in osteoarthritis of the trapeziometacarpal joint treated by trapezectomy and interposition of a L-polylactic acid "anchovy" (Arex®615R). A series of eight cases]. / Réaction à corps étranger dans les rhizarthroses traitées par trapézectomie et interposition d'un « anchois ¼ en acide L-polylactique (Arex®615R). À propos de huit cas.

Osteoarthritis of the trapeziometacarpal joint is a common pathology. When the trapezium is not large enough to allow using a total joint arthroplasty or in case of peritrapezial osteoarthrosis, the authors used a trapeziectomy with interposition of an absorbable L-polylactic acid anchovy (Arex(®)615R). This technique is simple and fast. From 2006 to 2010, out of 68 implants, nine displayed a prolonged inflammatory reaction, both clinically and radiologically abnormal, leading the patients to undergo revision surgery for removal of the implant before the end of the third postoperative year. Histological analysis highlighted in all the cases a resorptive gigantocellular immune foreign body reaction.