Tremor Induced by Focal Peripheral Nerve Entrapment: A Case Series.

Little is known about tremors caused by peripheral nerve entrapment. We report two cases of tremors caused by peripheral nerve compressions. Two patients presented with intentional tremors combined with peripheral nerve compression symptoms on their affected hand. Based on the clinical findings and evaluations, the first patient was diagnosed with double-crush compression of the ulnar nerve at the cubital tunnel and Guyon canal, and the second patient was diagnosed with lacertus syndrome. The first patient underwent surgical release of the cubital tunnel and Guyon canal in two stages. The second patient underwent release of the lacertus fibrosus. At the 1-month follow-up after surgery, the tremors had completely resolved, and neurological symptoms improved. Peripheral nerve entrapment should be considered a potential cause of tremors in patients with tremors combined with symptoms of peripheral neuropathy. Surgical release can be curative.

Changes in professional practices. Contribution of conformity scoring in assessing and improving operative reports: The SCHOCRO.

INTRODUCTION: In orthopedics, as in all surgical specialties, procedures are described in an operative report. This is an essential and mandatory part of the medical file (Article R.1112-2 of the French Public Health Code) and a fully codified medicolegal document comprising precise items determined by the Health Authority (HAS) and the ORTHORISQ risk management and accreditation organization. HYPOTHESIS: Information on the rules for filling out operative reports could improve their level of conformity, especially if provided early in surgical training. MATERIAL AND METHODS: A prospective comparative study was conducted with 6 groups of junior or senior surgeons, in the public or private sector, who had or had not been given specific information on the criteria for filling out the operative report. A conformity score was designed, based on the HAS-ORTHORISQ criteria (SCHOCRO, out of 100 points) for comparison between groups. RESULTS: Scores did not differ between junior and senior surgeons, whether informed or not. Private-sector surgeons had better scores than university hospital surgeons when not informed (p=0.016). The information improved conformity. The earlier residents were informed, the better their conformity. DISCUSSION: Harmonization of operative reporting improves report quality and should be standard practice for all, and especially for residents as soon as they enter the foundation phase. The SCHOCRO score seemed well suited for assessing operative report quality, being simple and reproducible. LEVEL OF EVIDENCE: II; prospective study.

Modified Lateral Approach of the Elbow for Surgical Release and Synovectomy.

Elbow stiffness is a common reason for consultation. In recent years, arthroscopic techniques in elbow surgery have progressed, but there are still some contraindications to performance of arthroscopic synovectomy and release in this joint (elbows with anatomic deformity after multiple procedures, malunion, presence of osteosynthesis material, severe stiffness of >80 degrees, instability, or previous transposition of the ulnar nerve). Therefore, knowledge of a safe and reliable open approach to achieve elbow release and/or synovectomy is essential. We report the technical details of the modified lateral approach between extensor carpi radialis brevis and longus muscles, as well as the clinical results of 43 elbow release and/or synovectomy procedures, illustrating its feasibility. The modified lateral approach, providing visual control of the radial nerve and good anterior exposure of the elbow joint, is detailed. From 1994 to 2016, this approach was used in 43 release and/or synovectomy procedures of the elbow in 41 patients, 30 men and 11 women, with a mean age of 40.56 years (range, 17 to 84 y). Using this procedure, 38 elbows (93%) recovered full extension and 5 subtotal extension with an average deficit of 11 degrees (range, 5 to 20 degrees). All elbows were stable. No neurological complications were reported. The modified lateral approach preserves the insertion of the lateral epicondyle muscles that are major dynamic stabilizers and reduces the risk of instability. Initially described for the treatment of radial tunnel syndrome, it should also be recommended for elbow release and synovectomy.

Fixed-hinge cemented modular implants: An effective reconstruction technique following primary distal femoral bone tumor resection. A 136-case multicenter series.

BACKGROUND: Reconstruction by endoprosthesis is widespread after bone tumor resection. The design and type of fixation and of hinge remain a matter of debate. The aim of the present study was to assess survival, complications and functional results in a homogeneous series of adult patients undergoing bone defect reconstruction following distal femoral tumor resection, using a single model of fixed-hinge cemented endoprosthesis, at a minimum 5 years' follow-up. HYPOTHESIS: The study hypotheses were that loosening and infection are the main causes of failure, and that this type of reconstruction is reliable following distal femoral resection. PATIENTS AND METHODS: All patients aged over 17 years undergoing reconstruction using the Stanmore Mets® fixed-hinge cemented modular endoprosthesis following distal femoral resection for primary bone tumor in 4 French reference centers between 2004 and 2013 were included. Epidemiological data, MSTS functional score, clinical and radiological examination results, complications and survival with types of failure according to the Henderson classification were assessed. RESULTS: One hundred and thirty-six patients (68 male, 68 female; mean age, 41.2 years [range, 17-77 years]) were included. Mean follow-up was 81 months [range, 61-134 months]. Thirty-two patients (38%) experienced a total 67 complications requiring surgical revision: mainly infection (n=28) or mechanical failure (n=26). Overall implant survival was 78% at 5 years. There were 30 implant failures on the Henderson classification. Mean MSTS score was 82%. DISCUSSION: The present results are comparable to those of the literature and for other types of reconstruction. Recent meta-analyses suggest that type of hinge and of stem fixation have little effect on implant survival. International comparative studies are needed to determine the exact role of each type of reconstruction according to the patient profile. LEVEL OF EVIDENCE: IV, multicenter retrospective series.