Treatment of chronic scapholunate instability according to the functional demand of the wrist.

Scapholunate instability is the most common form of carpal instability. Complete scapholunate ligamentous complex failure can lead to pain, reduced functional performance, and scapholunate advanced collapse if untreated. The goal of surgery for chronic scapholunate instability (diagnosed later than 6 weeks) before onset of osteoarthritis is to correct the scapholunate instability in order to reduce pain while limiting loss of motion and protecting against osteoarthritis-related collapse in the long-term. Because many ligament reconstruction techniques have been described and not every patient is a candidate for a demanding procedure, we addressed the question of what is the best adapted treatment for each stage of chronic scapholunate instability? This article reviews the anatomy and biomechanical properties of the scapholunate complex and the current diagnostic tools in scapholunate instability. A treatment algorithm based on instability stage and the patient's functional demand is proposed. LEVEL OF EVIDENCE: III.

Dorsal intercarpal ligament capsulodesis: a retrospective study of 120 patients according to types of chronic scapholunate instability.

The purpose of this study was to assess the results of dorsal intercarpal ligament capsulodesis (Mayo technique) for cases of chronic scapholunate instability and to specify the indications according to the severity of instability. A retrospective analysis was conducted and examined dorsal intercarpal ligament capsulodesis procedures performed for chronic scapholunate instability without intercarpal or radiocarpal arthritis. One-hundred and twenty patients were examined by an independent observer (48 predynamic, 48 dynamic and 24 static scapholunate instabilities). The follow-up period averaged 54 months (range 24-127). Mean final Mayo wrist score was 70, mean final Patient-Rated Wrist Evaluation was 27 and mean final QuickDASH score was 26. Functional, clinical and radiological data were improved for the operated patients. We concluded that dorsal intercarpal ligament capsulodesis is a good option for treating early stages of scapholunate instability.Level of evidence: IV.

Adaptive Proximal Scaphoid Implant: Indications and Long-Term Results.

Objective This study aims to define the indications of APSI and to evaluate the long-term results. Patients and Methods This is a monocentric study including patients that underwent an arthroplasty of the scaphoid proximal pole using an APSI between 1994 and 2010. Patients were assessed using autoquestionnaires and measuring ranges of motion, key pinch, and grip strength. X-ray views of the wrist were done to control the mobility of the implant and the evolution of the carpal collapse, if present. Results There were 19 patients included with a mean follow-up of 11 years. The mean range of motion was 106 degrees (65% of contralateral side) in flexion-extension and 33 degrees (78% of contralateral side) in radialulnar deviation. The mean grip strength was 72% of the contralateral side. The mean Mayo wrist score was 69/100, the mean QuickDASH 26/100, and the mean patient-rated wrist evaluation (PRWE) 25/100. After 10 years, evolution to osteoarthritis was noted in 32% of the patients. This was associated with a decrease of the carpal height. More specifically, capito-lunate osteoarthritis was noted after 10 years and two out of three patients were concerned after 20 years of follow-up. No osteoarthritis was diagnosed at the radiolunate articulation. Conclusion APSI is a treatment option that enables patients with scaphoid nonunion advanced collapse (SNAC), scapholunate advanced collapse (SLAC) I or II to preserve the strength and mobility with good functional results. But this arthroplasty does not prevent natural evolution to a carpal collapse after a follow-up of 20 years which is clinically well tolerated.

Total Thumb Carpometacarpal Joint Arthroplasty: A Retrospective Functional Study of 28 MOOVIS Prostheses.

BACKGROUND: Trapeziometacarpal prostheses have been used for more than 50 years in the treatment of first carpometacarpal joint arthritis. Even though this technique is more expensive than trapeziectomy, it has many advantages such as faster convalescence with better patient comfort and improved strength and range of motion. The aim of this study was to report the early functional results of a patient cohort treated with a dual mobility thumb carpometacarpal joint prosthesis. METHODS: A retrospective study was performed to assess the functional results of 25 patients treated for trapeziometacarpal advanced osteoarthritis (Eaton and Littler stage III) with 28 MOOVIS prostheses. Preoperative and postoperative assessments included pain, range of motion, and pinch and grip strength. The average follow-up time was 27.5 months. RESULTS: The mean pain score measured by a visual analog scale was 8 preoperatively and 1 postoperatively. The mean preoperative Kapandji opposition score was 7 and counter-opposition score was 1; postoperative scores were 10 and 4, respectively. The grip strength improved after the surgery and the results were compared separately between dominant and nondominant sides. Final functional results were good: the mean Quick Disabilities of the Arm, Shoulder and Hand Questionnaire score was 12, and the mean Michigan Hand Outcomes score was 87%. CONCLUSIONS: Total joint arthroplasty with a dual mobility prosthesis appears to be a satisfactory solution in our series. The absence of prosthesis instability encourages us to recommend this technique for the treatment of advanced trapeziometacarpal osteoarthritis for people having an activity without too many manual constraints.

[Extraordinary case of malignant phylloid tumor of the breast: surgical reconstruction treatment]. / Eccezionale tumore mammario filloide maligno: trattamento chirurgico ricostruttivo.

Phyllode tumors of the breast are fibroepithelial tumors similar to fibroadenomas but with a predominant conjunctive tissue component. They are rare with an incidence of less than 1% of all breast neoplasms. They can be divided in three categories: benign, borderline, malignant. The Authors report the case of a 53 years old woman who presented an exceptional 6.5 kg phylloid tumor of the left mamma. The diagnostic strategies, the surgical total mastectomy procedure with anterior thoracic parietectomy and the surgical reconstructive treatment are described.