[Retinaculum flexors: clinical and experimental anatomic bases in favor of reconstruction in carpal tunnel surgery]. / Le rétinaculum des fléchisseurs--bases anatomiques cliniques et expérimentales en faveur de sa reconstruction dans la chirurgie du canal carpien.

The goal of this anatomical study is to prove that reconstruction of the flexor retinaculum in carpal tunnel syndrome surgery is a reliable procedure and can improve the results of this procedure. In the first static study, we noted that when left to heal spontaneously, after 3 months the gap between the two edges of the cut retinaculum remained equal to or even larger than the gap created at the time of the surgery. A special Canaletto implant was created to achieve this reconstruction. It is technically possible to do this reconstruction by a 2 to 3 cm surgical approach in the palm. In another, dynamic study, we used a transducer to analyse the forces borne by the retinaculum during flexor tendon contraction. We compared these forces in a normal retinaculum, a reconstructed retinaculum with the Canaletto implant and a retinaculum opened endoscopically. This reconstruction conserves the anterior continuity of the retinaculum, allows excellent carpal tunnel decompression and immediately permits near-physiological forces. We discuss the advantages and the limits of this reconstruction. We think that this new surgical technique in the Carpal Tunnel Syndrome (CTS) will be able to improve the results, particularly in recurrences, in wrist malunion with CTS, in cases with severe electromyographic change with a sensory conduction speed of under 15 m.s-1 and in metabolic CTS. As always, his implant needs to be evaluated through a mid and long term clinical follow-up. By recovering better grip strength and reducing postoperative pain, this surgical technique can decrease the time needed to return to work and hence the economic costs of CTS surgery.

[Orthopedic treatment of fifth metacarpal neck fractures: prospective study]. / Traitement orthopédique des fractures du col du cinquième métacarpien: étude prospective.

Many methods of treatment have been proposed for the metacarpal neck fractures of the little finger, from early mobilisation to open or closed surgical techniques. A prospective studies of 20 cases treated by a non surgical technique is presented. The reduction was performed by manipulation under local anesthesia according to the Jahss technique and a modified Thomine brace was applied for four weeks. All patients were reviewed for follow-up at 30, 60, and 180 days. The fracture displacement was initially 34 degrees. It was reduced by manipulation to 12 degrees. All fractures healed with an average final displacement of 20 degrees. At 6 months for final examination, average T.A.M. was 245 degrees, T.P.M. was 276 degrees, grip strength reached 96% of the other hand. There were 19 excellent and one bad results. In conclusion, ambulatory non surgical treatment by reduction and local immobilisation of the fractures of the fifth metacarpal provide a good final result with a low cost.

[Evaluation of the Scarf osteotomy in hallux valgus related to distal metatarsal articular angle: a prospective study of 79 operated cases]. / Evaluation de l'ostéotomie Scarf pour hallux valgus en fonction de l'angle articulaire distal métatarsien: etude prospective sur 79 cas opérés.

PURPOSE OF THE STUDY: The hallux valgus surgery concerns many operative techniques. The purpose of this report was to evaluate the radiographic results of the Scarf osteotomy related to Distal Metatarsal Articular Angle (DMAA). MATERIAL AND METHODS: The Scarf osteotomy was performed on 79 feet with an hallux valgus deformity (75 females and 4 males from 16 to 82 years). Pre and postoperative weight-bearing X-rays were performed; We measured the Distal Metatarsal Articular Angle (DMAA), the intermetatarsal angle (M1-M2, M1-M5), the metatarsophalangeal angle, the obliquity of the metatarsocuneiform joint and the length of the first and second metatarsal. RESULTS: All parameters were statistically significantly improved by the surgery. However correction on the DMAA was not sufficient (from 14.6 degrees to 12.6 degrees although normal value is 6 degrees). We found a correlation between the metatarsophalangeal angle and the DMAA. DISCUSSION: The preoperative measures showed that the DMAA value increases with the value of the metatarsophalangeal angle; it is insufficiently decreased in comparison to the normal value. It has to be strongly taken in consideration in the preoperative evaluation. CONCLUSION: The preoperative DMAA value is the most important factor in the hallux valgus evaluation. It determines if Scarf or other operative technique are indicated. Its normalisation may provide less recurrences.