Result of A1 pulley reconstruction after closed rupture of the thumb pulleys during childbirth.

Closed rupture of the thumb flexor tendon pulleys is rare. Although anatomical and biomechanical studies have exposed the roles played by the pulleys in flexor pollicis longus (FPL) function, no standardized surgical management has yet been defined, in contrast to situations where pulley reconstruction is required in the fingers. We describe a case of rupture of the three pulleys in the thumb that probably occurred after violent thumb grasp during childbirth in the absence of any other trauma. We reconstructed the A1 pulley only using an extensor retinaculum graft because no remnants of the native pulleys were present.

Surgery for trapeziometacarpal osteoarthritis.

Trapeziometacarpal (TMC) osteoarthritis is a common, disabling condition that mostly affects women. The demand for surgical treatment is growing and the patients are becoming younger, adding to the challenge. Surgery can only be proposed after failure of well-conducted conservative treatment and requires a complete X-ray assessment. In the early stages, conservative surgery measures can be used to stabilize the joint or realign it in cases of dysplasia, but in most cases, patients are seen with more advanced arthritis and joint replacement must be considered. The ideal arthroplasty technique has yet to be defined but nevertheless, the chosen technique must be well-suited to the patient's condition. Although many studies have been published on this topic, they do not help us define the treatment indications. Prospective studies focusing on the patient rather than evaluating a certain surgical technique are needed. Trapeziectomy with or without ligament reconstruction is still considered the gold standard, but the challenges associated with treating its complications limit its indications. Arthrodesis, interposition or arthroplasty are also viable therapeutic options. The patient must be sufficiently informed to be able to contribute to choosing the indication.

Can we achieve bone healing using the diamond concept without bone grafting for recalcitrant tibial nonunions?

The purpose of this study was to evaluate the efficacy and safety of a combination of recombinant human bone morphogenetic protein 7 (rhBMP-7) and resorbable calcium phosphate bone substitute (rCPBS) as a salvage solution for recalcitrant tibial fracture nonunions. Twenty consecutive patients, 16 male and four female, with a mean age of 46.8±15.7 years (21-78) and a mean body mass index (BMI) of 24.2±5.3kgm(-2) (21.5-28.5), suffering from 20 recalcitrant tibial fracture nonunions were included. The mean number of operations performed prior to the procedure was 3.3, with homolateral iliac crest bone grafts being used for all of the patients. All patients were treated with a procedure including debridement and decortications of the bone ends, nonunion fixation with a locking plate, and filling of the bony defect with a combined graft of rhBMP-7 (as osteoinductor) with an rCPBS (as scaffold). The mean follow-up was 14±2.7 months. Both clinical and radiological union occurred in 18 cases, within a mean time of 4.7±3.2 months. A recurrence of deep infection was diagnosed for one of the non-consolidated patients. No specific complication of rCPBS or rhBMP-7 was encountered. This study supports the view that the application of rCPBS combined with rhBMP-7, without any bone grafting, is safe and efficient in the treatment of recalcitrant bone union.