General principles of tendon transfers: The ten commandments.

Transferring a muscle's point of force application by modifying its distal insertion will modify its function. This is the basic principle of tendon transfers. Despite being less popular due to superior primary nerve repair results, hand surgeons must be familiar with them. When used according to the Ten Commandments we propose, they provide good and useful functional recovery. Obviously, it depends on the number of muscles available for transfer. Tendon transfer is useful not only in nerve trunk palsy and brachial plexus lesions but also in upper limb tetraplegia rehabilitation. Tendon transfers are active palliative treatments under voluntary command and can be combined with other palliative procedures (arthrodesis, tenodesis) to improve the functional result. Nevertheless, they are far from ideal, as they re-allocate the remaining forces of the limb but do not create new ones.

Clinical, functional, and radiological results of the Amandys® interposition arthroplasty in 13 cases of wrist osteoarthritis.

Amandys® pyrocarbon interposition arthroplasty is intended for widespread arthritis of the wrist. The aim of this study was to assess the clinical, functional, and radiological results of this arthroplasty with a minimum follow-up of 12 months. This retrospective single-center study brought together all osteoarthritis indications that can benefit from an Amandys® arthroplasty. Twenty-one implants were used between January 2011 and October 2018. There were seven cases of distal radius malunion, eight SLAC wrists, two SNAC wrists, two cases of Kienböck's disease at Lichtman's stage 4, and two aftermaths of inflammatory arthritis. Twenty-four percent of patients had previously undergone another type of surgery for this wrist arthritis. Six implants were removed, five early for dislocation and one after 6 years for chronic pain. Thirteen patients were reviewed with an average follow-up of 40.7 months (21-90). The average pain level on a visual analog scale was 3.1/10 (0-7). The mean range motion was 36° flexion (10-60) and 33° extension (15-50). The mean grip strength at the last follow-up was 14.8 kg (2-30) (43% of contralateral). The average QuickDASH and PRWE functional scores were 37.9/100 (0-80) and 29.6/100 (0-83.5), respectively. Amandys® interposition arthroplasty is an interesting alternative to total wrist fusion or total wrist prosthesis for widespread arthritis of the wrist. For the implant to be stable, the capsulo-ligamentous systems must be intact.

[Results of Blauth Palmar Flap in congenital syndactyly: Long-term outcome in a 31 webs study]. / Évaluation du lambeau palmaire de Blauth lors de la prise en charge des syndactylies congénitales : à propos de 31 commissures.

OBJECTIVES: The main purpose of our study was to assess the web creep rate of congenital syndactyly treated with a Blauth palmar commissural flap. METHODS: Every child with at least one syndactyly, simple or complex, syndromic or not, were included in this study. The main criterion of this study was the web creep rate according to the Withey scale (0 to 4). Scar assessment according to the Vancouver Scar Scale, hair growth and/or dyschromia on the full-thickness graft, digital spacing, flexion deformity, clinodactyly, range of motion of the finger, sensitivity and satisfaction were also assessed. RESULTS: Separation of the webbed fingers was performed in 65 syndactylies between 1993 and 2015. The median age at the time of surgery was 14 months. We reviewed 31 web flaps with a mean follow-up time of 9 years. Fifty eight percent of the webs were grade 0 on the Withey scale, 36% were grade 1, 6% were grade 2. There was no grade 3 or 4. No correlation was found between the age at the time of surgery, gender, web space involved, complexity of the syndactyly, and the web creep. A decrease in range of motion and a flexion deformity of the fingers involved were more frequently found in complex syndactylies. Eighty seven percent of full-thickness grafts presented dyschromia, and 42% abnormal pilosity. CONCLUSION: Palmar flap as described by Blauth is a safe technique ensuring good functionals outcomes and a low web creep rate for the reconstruction of the web space in congenital syndactyly.

Free composite medial femoral trochlea osteochondral cutaneous flap for wrist scaphoid and lunate cartilage lesions: Advantages of a skin paddle.

The medial femoral trochlea flap is a chondrocorticoperiosteal flap. It has recently been described in the context of cartilage lesions. It is mainly used for reconstruction in non-union of the scaphoid's proximal pole and Kienböck disease. The medial femoral trochlea flap may be harvested with a skin island flap to monitor its vascularization. The surgical technique has been extensively described for its primary osteochondral form. However, the corticoperiosteal form has not been thoroughly studied and described. Here, we describe and report the early results of three cases of the composite medial femoral trochlea flap, with a skin paddle for postoperative monitoring, being used to reconstruct the injured proximal scaphoid and lunate.

Adaptive Proximal Scaphoid Implant (APSI): 10-year outcomes in patients with SNAC wrists.

Radioscaphoid arthroplasty with the Adaptive Proximal Scaphoid Implant (APSI®) is an attractive treatment alternative in the short and medium term for patients with early scaphoid non-union advanced collapse (SNAC) wrist. The purpose of our study was to determine the long-term outcomes of this implant in SNAC wrists. All patients who received the implant from October 2002 to October 2010 were included. A clinical and radiographic study was performed. Our case series included 39 patients, of which 33 were contacted, with a mean follow-up of 10 years (5.8-13.4). Most of the patients had stage-1 SNAC wrist (95%). There were nine complications (27%), seven of which required reoperation: implant dislocation (44%) or progression of the carpal degeneration (33%). Ninety-six percent of patients contacted were satisfied or very satisfied with their surgery (although 21% needed a second surgery) with a Mayo Wrist Score of 80/100 and a Patient-Rated Wrist Evaluation of 17.5/100. Wrist strength was 86% of the contralateral side. Flexion-extension range was 101° and pain assessed using a visual analog scale was at 1.2 (0-6). We report satisfactory and lasting results with the APSI®, similar to those of scaphoid excision with four-corner fusion and proximal row carpectomy. Hence, the APSI® is a reliable alternative for treating osteoarthritis in SNAC wrists.

Upper limb nerve transfers: A review.

While upper limb nerve transfers were first described and performed several years ago, they have seen expanded use in the past 20 years. Initially indicated for surgical repair of brachial plexus injuries with nerve root avulsion, the indications have been extended to post-ganglionic lesions because of the excellent results of certain intraplexus nerve transfers. The traditional nerve repair techniques - primary suture and nerve grafting - form the basis of nerve surgery. Although nerve transfer does not replace them, they are a useful supplement as they provide a targeted approach to reinnervation and recovery of key functions of the upper limb. The goal of this review is to provide an overview of the various possible transfers by the function being restored and the quality of the outcomes.

Estudio de niveles séricos de cobre y zinc y su posible rol como indicadores de dismenorrea primaria / Study of serum levels of copper and zinc and its possible roll like indicators of primary dysmenorrheal

En este trabajo se ha determinado el contenido de cobre y zinc en suero sanguíneo de 39 mujeres con edades comprendidas entre 17 y 21 años de edad, n = 25 con dismenorrea primaria diagnosticada clínicamente y n = 14 grupo control con diagnóstico negativo para la patología estudia-da. Las muestras de suero sanguíneo se obtuvieron antes (a) y durante (d) la menstruación. Fueron analizadas por Espectroscopia de Absorción Atómica con inyección en flujo continuo (EAA-IFC). Las concentraciones obtenidas fueron de 1,56 ± 0,43 mgL-1 de cobre y 1,28 ± 0,34 mgL-1 de zinc antes de la menstruación y 1,06 ± 0,23 mgL-1 de co bre y 1,21 ±0,4 mgL-1 de zinc durante la menstruación, para el grupo control y 1,64 ± 0,52 mgL-1 de cobre y 1,88 ± 0,61 mgL-1 de zinc antes de la menstruación y 1,21 ± 0,34 mgL-1 de cobre y 0,94 ± 0,27 mgL-1 de zinc durante la mens ruaciónt en el grupo estudio. Los elementos determinados en ambos grupos antes del periodo menstrual, no observaron diferencias significativas con p= 0,63 y 0,16 para cobre y zinc, respectivamente. Sin embargo, durante la menstruación, fue evidente una diferencia con p < 0,005. Este resultado nos hace presumir, que el aumento brusco de los niveles séricos de cobre se deba probablemente por la alteración de las prostaglandinas, siendo este bioelemento uno de los responsables de las molestias que se presentan en esta patología y otros efectos secundarios motivados por el descenso brusco del zinc. La relación cobre/zinc se calculo en ambos grupos, con valores de 1,47 y 1,06 antes y durante, respectivamente para el grupo control y para el grupo bajo estudio 1,36 y 1,97 antes y durante, respectivamente.

In this work has determined the copper content and zinc in sanguineous serum of women with primary dysmenorrheal diagnosed clinically and a group of women control with I diagnose negative for the studied pathology. The samples of sanguineous serum taken before (a) and during (d) the second day of the menstruation come from 39 women in ages between 17 and 21 years of age, n = 14 controls and n = 25 women with primary dysmenorrheal. They were processed by Spectroscopy of Atomic Absorption with injection in con-tinuous flow (EAA-IFC). The concentrations obtained of 1.56± 0.43 mgL-1 of copper and 1.28± 0.34 mgL-1 of zinc before menstruation and 1.06 ±0.23 mgL-1 of copper and 1.21 ±0.4 mgL-1 of zinc during the menstruation (second day), for the group control and 1.64 ±0.52 mgL-1 of copper and 1.88 ±0.61 mgL-1 of zinc before menstruation and 1.21± 0.34 mgL-1 of copper and 0.94± 0.27 mgL-1 of zinc during the menstruation in the group study. In relation to the serum levels it initiates to them in both groups were not significant differences (p = 0.63). The zinc, observe he himself behavior, between both groups before the menstruation was not observed significant differences with p = 0.16, nevertheless, during the menstruation I throw p = 0.0033. This result evi-dence that indeed the copper is affected by the alteration of the prostaglandins, being probably one of the people in charge of the annoyances that appear in this pa hologyt and other indirect effect motivated by the abrupt reduction of the zinc, such as alteration in the synthesis and excretion of the hormone stimulating follicle (FSH), of the luteinizante hormone (LH), abnormal development of the ovary, alterations of the menstrual cycle. The copper/zinc re ationl I calculate both groups, with values of 1.47 and 1,06 before and during res pectively for the group control and the group under study 1,36 and 1.97 before and during respectively.