[Floating first metacarpal with recurrent trapeziometacarpal dislocation in a subject with hyperlaxity]. / Premier métacarpien flottant avec luxation trapézo-métacarpienne récidivante chez un sujet hyperlaxe.

A case of trapezometacarpal dislocation associated with metacarpophalangeal dislocation (floating first metacarpal) is described. The trapezometacarpal dislocation re-occurred twice despite well conducted orthopedic treatment. Ligamentoplasty of the carpal radial flexor tendon using the Eaton and Littler method then provided an excellent result. Failure of orthopedic treatment was probably related to the congenital hyperlaxity presented by this patient. Considering this hypothesis, the presence of hyperlaxity would affect management practices used for trapezometacarpal dislocation. In the presence of hyperlaxity, it would be preferable to propose first-intention surgery with suture and pinning or ligamentoplasty. Conversely, for patients without hyperlaxity, orthopedic treatment remains the first-intention treatment of choice.

Electron transport through rectifying self-assembled monolayer diodes on silicon: Fermi-level pinning at the molecule-metal interface.

We report the synthesis and characterization of molecular rectifying diodes on silicon using sequential grafting of self-assembled monolayers of alkyl chains bearing a pi group at their outer end (Si/sigma-pi/metal junctions). We investigate the structure-performance relationships of these molecular devices, and we examine the extent to which the nature of the pi end group (change in the energy position of their molecular orbitals) drives the properties of these molecular diodes. Self-assembled monolayers of alkyl chains (different chain lengths from 6 to 15 methylene groups) functionalized by phenyl, anthracene, pyrene, ethylene dioxythiophene, ethylene dioxyphenyl, thiophene, terthiophene, and quaterthiophene were synthesized and characterized by contact angle measurements, ellipsometry, Fourier transform infrared spectroscopy, and atomic force microscopy. We demonstrate that reasonably well-packed monolayers are obtained in all cases. Their electrical properties were assessed by dc current-voltage characteristics and high-frequency (1-MHz) capacitance measurements. For all of the pi groups investigated here, we observed rectification behavior. These results extend our preliminary work using phenyl and thiophene groups (Lenfant et al., Nano Lett. 2003, 3, 741). The experimental current-voltage curves were analyzed with a simple analytical model, from which we extracted the energy position of the molecular orbital of the pi group in resonance with the Fermi energy of the electrodes. We report experimental studies of the band lineup in these silicon/alkyl pi-conjugated molecule/metal junctions. We conclude that Fermi-level pinning at the pi group/metal interface is mainly responsible for the observed absence of a dependence of the rectification effect on the nature of the pi groups, even though the groups examined were selected to have significant variations in their electronic molecular orbitals.

[Peri-lunate wrist dislocation: long-term outcome]. / Luxation péri-lunaire du carpe: résultats à long terme.

PURPOSE OF THE STUDY: We report our experience with 25 peri-lunate posterior wrist dislocations and compare outcome with data in the literature searching for prognostic factors. MATERIAL AND METHODS: Our series included 24 men and one woman, mean age 36 years. Twenty-three patient were less than 50 years old at the time of the accident. Diagnosis was established late in five patients. All patients were reviewed clinically and radiologically with a mean follow-up of 57 months. We differentiated pure dislocations (n=16) from trans-scapho-lunate dislocations (n=9). The pure dislocations included six type 1 and ten type 2 in the Witvoët and Allieu classification. We also distinguished groups by open or closed treatment, with or without pinning, and with or without suture of the scapho-lunate ligament. Screw fixation was used in case of scaphoid fracture. Post-operative cast immobilization was 45 days on the average, followed by three months of rehabilitation exercises. RESULTS: Residual pain of variable intensity was reported by 22 patients but subjectively, 21 patients considered outcome to be good or very good. Wrist movement was greatly impaired in eight patient with a 60 degrees flexion-extension arc. All patients had a 20% reduction in force compared with the healthy side. According to the Green and O'Brian functional score, outcome was poor in four wrists. The scapholunate space and the sapholunate angles were abnormal in seven wrists. Reduction was insufficient in only one case with the scapholunate space measuring 5 mm after trans-scapho-lunate dislocation. In most of the cases, these poor functional and/or radiographic results coincided with carpal instability which developed early or late after trauma. The most bothersome element in other cases was wrist stiffness. The trans-scapho-lunate dislocations appeared to evolve more favorably than the pure dislocations, but could also cause carpal instability. DISCUSSION: There is a real functional impairment after posterior peri-lunate dislocation. The differences in outcome we observed were not statistically correlated with type of treatment, probably because of the small number of patients, but did reveal certain tendencies. Closed reduction did not always avoid the development of carpal instability and gave only average results. Percutaneous pinning or open reduction did not improve outcome in pure dislocations. It might be good to use scapho-lunate suture more often to obtain better healing and reduce the risk of carpal instability, as has been suggested by certain teams.

[Surgical treatment of chronic Achilles tendiopathies. Report of 52 cases]. / Traitement chirurgical des tendinopathies corporéales chroniques d'Achille. A propos de 52 cas.

PURPOSE OF THE STUDY: We reviewed a series of 52 cases of chronic Achilles tendinopathy treated surgically by release of the fascia cruris, resection of peritendon, longitudinal incision of the tendon and occasional excision of intratendinous lesions. MATERIALS AND METHODS: The mean course prior to surgery was about 18 months. Twenty-six patients practiced sports. Complaints were bilateral in 12 cases. Pain was always present. Ultrasound exploration evidenced paratendinitis (n=21), tendinosis (n=22) and paratendinitis with tendinosis (n=9) (Puddu classification). Patients were reviewed after a minimal 2-year follow-up. Results were assessed on the basis of clinical findings. RESULTS: Mean follow-up was 5 years 6 months. Twenty-nine patients were free of pain. The range of motion was normal in 48 cases and 29 patients resumed sports activities at the same level as prior to surgery. Outcome was very good in 29 patients, good in 14 average in 6 and poor in 3. DISCUSSION: Stiffness of the tibio-tarsal joint can be avoided by proper mobilization. Outcome appears to be better in middle-aged patients. Poor outcome is closely related to amyotrophy. The presence of a foot deformity does not appear to have an unfavorable influence on outcome. The Achilles tendon must not be infiltrated. Ultrasound is highly contributive, but MRI provides a more accurate analysis. CONCLUSION: Surgical treatment of chronic Achilles tendinopathies can be proposed when conservative treatment has been unsuccessful. Outcome is better in young active patients and in cases where paratendinitis predominates.

[Gauthier's subcapital osteotomy in the treatment of metatarsophalangeal luxation of the 2nd ray. Apropos of 44 cases with 5 year followup]. / L'ostéotomie sous-capitale selon Gauthier dans le traitement de la luxation métatarsophalangienne du deuxième rayon. A propos de 44 cas avec un recul de 5 ans.

The authors report on a series of 44 metatarsophalangeal dislocations of the second ray which were treated surgically using Gauthier's technique. The patients were 44 middle-aged women. The surgical indication was a dislocation of the 2nd metatarsophalangeal joint with hallux valgus. There was excess length of the second metatarsal ray or acquired shortness of the first metatarsal. The treatment always included an osteotomy of the neck maintained by a transosseous pin. The average follow-up was 8 years and 3 months (minimum 5 years). Postoperative results were evaluated using clinical and radiological criteria. Surgical treatment gave 68.2% very good and good results and 4 recurrences of dislocation. The results in this series are identical with those in other series reported, but the backward displacement of the head of second metatarsal was found to be limited. Weil's osteotomy seems to provide better results because it better restores the relative lengths of the metatarsals and often makes interphalangeal arthroplasty unnecessary. Gauthier's metatarsal osteotomy is an easy procedure which effectively improves static metatarsalgia, but it provides limited metatarsal shortening. Weil's osteotomy is preferable in cases with long lateral metatarsals.

[Haglund disease treated by simple resection of calcaneus tuberosity. An angular and therapeutic study. Apropos of 74 cases with 2 years follow-up]. / Maladie de Haglund traitée par résection tubérositaire simple. Etude angulaire et thérapeutique. A propos de 74 cas avec deux ans de recul.

PURPOSE OF THE STUDY: The authors report the treatment of Haglund's disease, using a simple os calcis tuberosity resection. They reviewed long term results and the value of radiological criteria for pre-operative evaluation. MATERIAL: The series included 54 patients (74 feet) mostly female and young. The simple resection of os calcis tuberosity was performed without further operation or post-operative splint. METHODS: Post-operative results were appreciated according to 3 criteria: pain, functional activity and shoe wearing. Radiological criteria used Fowler and Philip angle, angle of calcaneal inclinaison, total angle, CL angle, Denis and Huber-Levernieux test and Heneghan and Pavlov parallel lines. Correlation tests with simple regression were used for statistical analysis. RESULTS: Results were graded as excellent and good in 73 per cent fair in 16.2 per cent and poor in 10.8 per cent cases. DISCUSSION: Results were compared to other series. Neither radiological criteria, angular or not, can rule out simple tuberosity resection, because results showed no relation between test and angle measurements. There is no correlation between post-operative radiographs and final result. The only efficient criteria of resection is the difference between Fowler and Philip, and CL angles. This technique may be recommended after few months of medical treatment, without using calcaneal osteotomies of Zadek type. CONCLUSION: The simple resection of os calcis tuberosity showed good results in 73 per cent cases at an average follow up of 6 years 9 months.

[Subtalar dislocations. Apropos of 35 cases]. / Les luxations sous-astragaliennes. A propos de 35 cas.

PURPOSE OF THE STUDY: The subtalar dislocation is a rare injury. The authors appreciate the difference of frequency between medial and lateral displacement, the factors likely to increase a classical favorable prognosis and the therapeutic attitude to suggest. MATERIAL AND METHODS: 35 observations were included of which two bilateral, 26 had a medial displacement, 9 a lateral displacement. Treatment was conservative in 21 cases and surgical in 14 cases. The results were analysed using Gay and Evrard's clinical scoring system at which we added radiological results. RESULTS: The average follow-up was 7 years and 7 months. The global results are 11 excellent, 13 good, 9 fair, 2 poor. DISCUSSION: The high frequency of medial displacement is explained by the fact that the subtalar joint is only really unstable in inversion. The lateral displacement is rare. The prognosis is good in pure dislocation. It is only good enough every time a fragmentary talar fracture is associated as a factor of stiffness. The 11 arthrosis cases are secondary to a dislocation associated with a talar dislocation, a scaphoid dislocation or a vascular injury. In the series, there is no syndrome of tarsal sinus, and no post traumatic instability. Talar necrosis are rare: 3 cases in this series. They occur following large dislocations at the limit of enucleation. The reduction is urgent. The treatment is more often conservative. It must be surgical in case of associated injury requiring a surgical procedure or in front of widely open dislocation. CONCLUSION: Subtalar dislocation is a rare injury. In the majority of cases, the displacement is medial. The prognosis is good in pure cases. It's only good enough every time a fragmentary talar fracture is associated as a factor of joint stiffness.

[The Sixtine metatarsophalangeal prosthesis at first glance. Preliminary results in 74 cases]. / La prothèse métatarso-phalangienne Sixtine du premier rayon. Résultats préliminaires, à propos de 74 cas.

The Sixtine prosthesis is a metallic, hemiconical, flat concave, metatarsophalangeal interposition prosthesis, with a rim on the phalangeal end, with a lateral capsular fixation or a temporary fixation by axial pinning. Seventy-four cases using a Sixtine prosthesis were reviewed with a minimum follow-up of 2 years. The range of motion was improved (+12.4 degrees), as was the phalangeal valgus (18.2 degrees for 30.2 degrees), but weight bearing on the ventral side of the first toe was very often lost in spite of the complete preservation of the flexor hallucis brevis. The complication rate was 9.5% with 8% subluxations, which do not influence the final result. The comparison of patients who kept the prosthesis, and of patients in whom the prosthesis was systematically retrieved after one year, shows that the prosthesis may be left in place and that retrieval is only indicated in cases of complications or subluxation.

[Rehabilitation of the rheumatoid dorsal wrist by the Sauve-Kapandji operation combined with a realignment-stabilization synovectomy]. / Réhabilitation du poignet dorsal rhumatoïde par l'intervention de Sauvé-Kapandji associée à une synovectomie-réaxation-stabilisation.

The authors present a series of 25 cases of rheumatoid wrists, operated by tendon and intra-carpal synovectomy, accompanied by an arthrodesis of the lower ulnar articulation following a metaphyseal resection of the lower extremity of the ulnar according to Sauve and Kapandji. This series is "young", as the mean follow-up is 2 years. It involves 25 patients, including 4 operated on both wrists. This series has the advantage of being coherent as all the operations were performed by the same surgeon. The results concerning pain are good; 87% of the wrists were painless or only periodically painful, and 88% of the patients say they are well or very much better. This operation offers the satisfying aspect of prevention; an absence of pain in the wrist when inflamed and the absence of complications such as ruptured tendons. The study of the range of motion shows a global loss of 9% in the sagittal plane and a significant reduction in the score for motion in palmar flexion. The radiological signs of deterioration of carpitis are not stopped despite the operation but it does seem to be slowed down after intra-carpal synovectomy. Ulnar sliding has been carefully studied. We observe that a further sliding is more obvious in the Larsen 2 phase than in the Larsen 3 phase. This sliding is very slight. The comparison between the different series shows that operation protects the wrist from ulnar sliding more than ulnar head resections.