Effect of four-corner fusion with locking plate without bone graft on functional recovery of the wrist: New treatment guidelines.

We assessed the effect of four-corner intercarpal fusion with locking plate without bone graft on daily activities and pain in patients with stage II and III scapholunate advanced collapse and scaphoid nonunion. Twenty-one patients who underwent four-corner fusion with scaphoidectomy without bone graft were evaluated with the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Visual Analog Scale (VAS) pain scores before and 16 months after surgery. We also compared postoperative grip strength between the operated and the healthy side. A principal component analysis was used to establish the relationship between functional benefit, immobilization period and number of physiotherapy sessions. We compared our results with published data. VAS and QuickDASH scores improved significantly. Loss of strength was observed postoperatively. QuickDASH score improved the most with a short immobilization period. No significant difference was found relative to the literature for follow-up time, range of motion, grip strength and QuickDASH score. All patients had bone fusion after 1 year. Four-corner fusion with locking plate is a procedure that reduces pain and improves functional scores. Our results are equal to those reported in the literature with bone graft. The union rate seemed high despite the absence of bone graft but was only assessed by x rays. This study allowed us to establish a treatment guideline: a shorter immobilization leads to better recovery.

[Clinical retrospective evaluation of the arthroscopic treatments of the triangular fibrocartilage complex of the wrist]. / Évaluation clinique rétrospective des traitements arthroscopiques des lésions du complexe triangulaire du poignet.

OBJECTIVES: The aim of this study is the retrospective clinical evaluation of the arthroscopic treatments for triangular fibrocartilage complex tears. METHODS: Between 2003 and 2010, 76 patients with a traumatic lesion (Palmer type 1) and 25 patients with a degenerative lesion (Palmer type 2) of the triangular fibrocartilage complex underwent wrist arthroscopy. Clinical evaluations were based on the Mayo Modified Wrist Score (MMWS), on a compared measurement of the grip force and on a measurement of the different ranges of motion. We also made a subjective evaluation of the benefit brought by arthroscopy and a retrospective evaluation of the pre and postoperative pain. RESULTS: Mean MMWS was 86.3 for traumatic lesions and 83 for degenerative lesions. Mean grip force was 84.8 (Palmer type 1) and 84.2 (Palmer type 2) compared to the controlateral side. Mean ranges of flexion-extension, prosupination and radioulnar motions were 135°, 164° and 56° respectively for traumatic lesions and 130°, 156° and 54° respectively for degenerative lesions. Ninety-four percent of the operated patients reported an improvement of the symptomatology with better results for type 1 (98.7%) compared to type 2 (80%). We noted a clear diminution of the postoperative pain compared to the preoperative's one with frequently some mild persistent pain however. CONCLUSIONS: Arthroscopic treatments of the triangular fibrocartilage complex seem to be effective with an improvement of the symptomatology.

Prognostic factors in the treatment of carpal scaphoid nonunions.

The aim of this multicenter study of 138 patients with scaphoid nonunions was to assess the prognostic factors of bone healing or failure after curative surgical treatment options: isolated bone grafting (30%), internal fixation (23%), or combined bone grafting and internal fixation (47%). Bone healing occurred in 75% of cases. Persistent nonunion was evident in 20% of cases; it was possible in 6%. The clinical and radiologic results were worse in the group of failures. Stepwise multiple logistic regression analysis was conducted to identify the factors of prognosis toward bone healing or failure. In univariate analysis, professional heavy work, age of the nonunion of over 5 years, associated radial styloidectomy, and duration of postoperative immobilization were associated with a significantly decreased likelihood of healing of the scaphoid nonunion. In multivariate analysis, the only remaining predictor was the delay between the initial trauma and the treatment of the nonunion. Among the cases of internal fixation (with or without bone grafting), the only predictor in multivariate analysis was the importance of bone resorption. The dorsal approach resulted in a more pronounced loss of wrist flexion and extension amplitudes. If the time elapsed between the initial fracture and the treatment of the nonunion exceeds 5 years, the chances of healing of the nonunion are decreased.

[Fractures of the proximal end of the humerus treated by the Kapandji centro-medullary nailing technic. A review of 21 cases]. / Fractures de l'extrémité proximale de l'humérus traitées par embrochage centro-médullaire selon Kapandji. Revue de 21 cas.

Over a 7 years period (from September 1989 to April 1996), 25 patients have been treated for proximal humeral fractures using Kapandji's method of internal fixation. Twenty-one were available for evaluation. The mean follow-up was 3 years 9 months. Various indications were found, with a majority of 2 and 3-part fractures. Complications were frequent, the most common being pin migration, but the functional results following Constant scores are very good. The technique is easy, quick, non- invasive and inexpensive. The approach is direct and avoids opening the elbow joint.

[Long-term results of 9 cases of elongation of the ulna in treatment of Kienböck's disease]. / Résultats à long terme de neuf cas d'allongement du cubitus dans le traitement de la maladie de Kienböck.

The treatment of Kienböck's disease is currently controversial. Ulnar shortness is usually considered to be the main etiological factor. This observation is the basis for distal radio-ulnar joint levelling procedures, which means the radial shortening osteotomy and ulnar lengthening osteotomy. Several authors have reported their experience on the topic, but there are very few studies with sufficient follow-up to evaluate the value of the operative procedure on the carpus. We report a 9 patient review series following an ulnar lengthening procedure for Kienböck's disease. The average follow-up was 24 years (range: 12 to 21 years). There were 7 men and 2 women and the average age was 30 years at the time of the operation. The dominant side was affected 6 times out of 9.6 heavy workers and 3 light workers are reported. Four out of 9 patients had a history of trauma. The surgical procedure was a stair-step distal diaphyseal ulnar lengthening with distraction and osteosynthesis with a plate, without bone graft. The selected patients underwent a clinical examination of wrist pain, mobility and strength in comparison with the non-operated side. All patients under went a standard radiographical examination in neutral position. The analysis of the series shows that ulnar lengthening was successful for all patients especially on the strength and pain level, whereas mobility deteriorated. Without being able to reconstitute the normal morphology of the lunate bone, the procedure was able to stop the long-term natural course of the disease leading to carpus collapse and arthrosis without radio-carpal disturbance. Excessively long consolidation times and a very high pseudarthrosis rate are reported. Ulnar shortness does not seem to be an etiological factor. The natural history of the disease is perhaps not as bad as previously thought. The impact of the procedure on the distal radio-ulnar joint and the ulnar impaction syndrome in excessive lengthening are serious issues which need to be resolved. The procedure is preferably indicated in young patients, at the beginning of the disease, with a negative distal radio-ulnar variance. The Linscheid operative technique is recommended.

[Tibiotarsal and subtalar instability of the ankle. Importance of an original dynamic test in the treatment choice. Experimental study and clinical application]. / Instabilité tibio-tarsienne et sous-astragalienne de la cheville. Apport d'un testing dynamique original dans le choix thérapeutique. Etude expérimentale et applications cliniques.

Various ligamentoplasties are available allowing formation of new proprioceptive chains in cases of failure of physiotherapy. Most of these plasties sacrifice half or all of the fibulolateral tendon, causing stiffness of the subtalar joint. This is a too serious complication to accept for simple tibiotarsal instability: hence the importance of preoperative assessment to determine the type of plasty most appropriate for each type of instability. We have designed an adjustable boot, linked to a dynamometer by means of a metal rod, with a radiological marker attached to the boot, to measure subtalar mobility preoperatively. We studied this boot with the ankles of 15 cadavers, on which we sectioned the ligaments of the tibiotarsal and subtalar joints to measure the degree of laxity. Accurate assessment is possible if the mobility of the tibiotarsal and subtalar joints is measured in cases of acute sprain, in particular in isolated lesions of the anterior talofibular ligament and lesions of the calcaneofibular ligament; or in chronic instability, including: purely tibiotarsal, purely subtalar, and mixed types. This method allows optimal therapeutic choice.

[Reflections on a small series of cementless total hip prostheses]. / Réflexions à propos d'une courte série de prothèses totales de hanche sans ciment.

We report on our series of 48 patients with uncemented hip prostheses, with an average follow-up of 3 years. The clinical results, according to the Merle d'Aubigné's classification, are comparable to those obtained with cemented prostheses except for transitory pain, very often localized to the lateral aspect of the thigh, which seems to be correlated with the bone adaptation to the implant. Radiological findings are valuable in the assessment of long-term results with uncemented prostheses. During the operation, it is of utmost importance that the surgeon obtain a very tight fit of the prosthesis into the bone, which must be confirmed on postoperative X-ray. Under such conditions, the radiological appearance remains the same, showing a condensation line outlining the cup and absence of radiolucent lines along the stem. On the other hand, cortical thickening, bony condensation around the tip of the stem and sclerotic lines are the radiological evidence of bone adaptation to the prosthesis. They are not indicative of a less good result. Finally, radiolucent lines wider than 1 millimeter, extending along the stem, or a progressive sinking of the femoral component are the radiological signs of implant instability. In these rare cases, the prognosis may be compromised.

[Dupuytren's disease. Review of 326 surgically treated patients]. / Maladie de Dupuytren. Revue de 326 patients opérés.

The COC (Orthopedic Society of Charleroi) has presented an analysis of operated cases. We have taken 326 files into account. The pre-operative evaluation is based upon the classification by Tubiana, Michon and Thomine. The analysis pays special attention to the post-operative results in terms of several factors: the age, the stage of illness, the extent of illness and the improvement. For this final summing up, we put forward criteria which for us are better in the evaluation of the final result.

[Primary osteochondritis of the carpal scaphoid]. / Ostéochondrite primitive du scaphoïde carpien.

One case of bilateral osteochondritis dissecans of the carpal scaphoid is reported. The patient was a 15 year old student without any significant history of injury. Pain and loss of mobility of the right wrist were the presenting symptoms. X-rays showed an area of osteochondritis dissecans in the proximal pole on the right scaphoid. Surgical removal of the sequestrum was performed via a dorsal approach. The cartilage was removed for excision of sequestrum and further fixed by a "mini" screw AO 0 1.5 mm. Three years later the patient described no pain; X-rays showed a reconstitution of the scaphoid.

[Trapeziectomy in rhizarthrosis]. / La trapézectomie dans la rhizarthrose.

The purpose of this study is to determine the place of trapeziectomy among the various surgical treatments of osteoarthritis of the trapezio-metacarpal joint. We have had 25 cases with seemingly satisfactory results. Loss of strength, which is given as a frequent objection to this method, has not generally been found in our series. Careful repair of the capsule and prolonged postoperative immobilization appear all-important to us and are a guaranty for good postoperative stability.

[Semilunar disease]. / La maladie du semi-lunaire.

In a multicenter study involving the five Orthopaedic Services of the COC, 57 patients with Kienböck's disease were reviewed 90% were treated surgically. The most common operations were ulna lengthening (30 cases) and lunate resection (11 cases). The most frequent indications or surgery were pain and stiffness of the wrist. Radiological changes are classified according to Decoulx. For evaluating post-operative radiological changes, however, the authors use different criteria ulna lengthening and lunate resection improved pain and mobility in 75% of cases. This study shows that lunate resection is a valid operation in the treatment of Kienböck's disease.