Colour duplex sonographic and multislice spiral CT angiographic diagnosis of ulnar artery aneurysm in hypothenar hammer syndrome.

We report a case of hypothenar hammer syndrome secondary to a thrombosed aneurysm of the ulnar artery in a 36-year-old patient presenting with pain due to compression of the ulnar nerve in the Guyon's canal. The initial diagnosis was made by colour Duplex sonography but complete assessment of the thrombosed aneurysm was performed by multislice spiral CT angiography (msCTa). This case illustrates the potential of msCT as an alternative to conventional arteriography.

[Camptodactyly: classification and therapeutic results. Apropos of a series of 50 cases]. / Camptodactylie: classification et résultats thérapeutiques. A propos d'une série de 50 cas.

Fifty patients with camptodactyly of one or several fingers were seen in the Strasbourg SOS Main unit between 1980 and 1988. Classification of these lesions was based on the mobile or fixed nature of the deformity in flexion of the interphalangeal joint. This classification is useful for the therapeutic management. Treatment by dynamic splint for a mean duration of 20 months gives good results in fixed or mobile camptodactylies of small children, provided that this treatment is commenced as soon possible. This splint treatment also obtains favorable results in patients reaching the end of the growth period, whether their camptodactyly is mobile or even, in some cases, fixed. In every case, treatment by dynamic splint constitutes a therapeutic test (safety of the apparatus, patient's cooperation) and only forms of camptodactyly resistant to conservative treatments benefit from Malek's type of surgical correction. It must be remembered that a certain number of cases of camptodactyly have a potential for severity with time, progressing towards irreducible forms which can only be corrected by surgical treatment. Camptodactyly in adults must be analysed meticulously and only major deformities causing functional discomfort or major aesthetic prejudice should be operated.

Study of anatomical bases of a latero-dorsal flap of the forearm preserving the radial artery.

The authors studied the dorso-lateral cutaneous branches of the radial artery in 26 forearms of fresh cadavers following injection of latex. Three to eight branches were identified, with frequent anastomoses. Extensive venous drainage was also observed. One to three cutaneous branches arose within a 3-cm region close to the radial styloid precess. This provides a basis for an island flap supplied by these branches and thus, it is possible to maintain the radial artery intact.

A new flap based on the distal branches of the radial artery.

A flap based on the distal branches of the radial artery is raised on the dorso-lateral aspect of the distal third of the forearm. Thirty fresh cadaver dissections have established the anatomical rationale of the flap. The potential territory is supplied by a subaponeurotic plexus of vessels fed by lateral branches of the radial artery in the distal third of the forearm. This new knowledge of the anatomy has been applied to the performance of this flap in seven clinical cases. Various methods of application to hand and wrist reconstruction are described along with a discussion of the various advantages and disadvantages.

[Treatment of severe callus of the metacarpus and phalanges. Indications and results apropos of a series of 38 patients]. / Traitement des cals vicieux du métacarpe et des phalanges. Indications et résultats à propos d'une série de 38 patients.

Severe deformities of metacarpals and phalanges, whether isolated or associated with soft tissues lesions impair the hand function and are to be corrected. The authors initial proposal was the fixation after corrective osteotomy by wiring which have been proved to be suitable in the treatment of recent fractures. This technique was used in 25 cases out of 38 treated malunions with 21 satisfactory results. 4 poor results were related to associated lesions of the soft tissues more than to the osteotomy itself. The other 13 malunions were treated by several techniques arthrodeses, callus resections, dynamic splintage, osteotomies with satisfactory results.

[Escalator flap in the treatment of claw nail]. / Le lambeau "escalator" dans le traitement de l'ongle en griffe.

Nail horn deformity can be corrected by a proximal withdrawal of the nail complex on the distal remaining skeleton. The main problem is the flap coverage and we have combined an "in bloc" O'Brien island flap with the withdrawal of the nail. This "escalator" technique allowed a good correction with a satisfactory palmar skin cover and a decreased "wave" of the dorsal skin.

Thumb duplication: surgical treatment and analysis of sequels.

Between 1978 and 1988, 50 thumb duplications were operated upon at either the orthopedic department of Hôpital Trousseau (Paris) or at l'Institut Français de la Main (Paris). Following Wassel's classification, we observed a large incidence of types IV, II and VII (in that order). There was a 30% incidence of associated anomalies. The average age at operation was 15 months. We were able to review 30 patients (31 thumbs) with a mean follow-up of 30.9 months. We divided our series into two groups depending on the operative protocol. Group A: 19 patients (20 thumbs), operated on between 1978 and 1982 and reviewed at 33 months on average. Group B: 11 patients (11 hands) operated on between 1983 and 1988 and reviewed with a mean follow-up of 28.5 months. All of the children were evaluated following Wassel's and Tuch's criteria. In groupe A, only five thumbs could be considered normal, or near normal upon this reexamination. All the others were affected by various sequels, which were essentially esthetic. Only two thumbs had a functional deficit, due to instability of the MP joint in one case, and stiffness of the two joints of the thumb in the other. These poor objective results were, however, not shared by the children and their parents, since 16 of them declared themselves satisfied with the appearance and the function of the thumb. 6 patients required further surgery with an average of 2.5 operations per patient. These secondary operations gave imperfect results: out of 6 such patients, we obtained 3 fair results, and three remained poor. This relatively high proportion of sequels in our patients in group A led us to change our treatment protocol in 1983. Our revised attitude was to treat all deformities at once, and especially axial deviation with a corrective osteotomy if soft tissue surgery alone did not afford perfect realignment of the thumb. Thus, among the 11 reviewed patients of group B, 6 results could be considered to be good, 4 suffered from slight sequels, and one patient required a secondary surgery (tenolysis of the extensor apparatus) to correct an inadequate active extension of the IP joint. This result was functionally good on review. The optimal age for operation is between 12 and 18 months. Il seems to us that bad results are apparent early, after 6 to 12 months, because they are mainly due to inadequate treatment. Conversely, good short-term results seem to persist with growth, but there is an overall paucity of studies in this field.

A radiological technique for measurement of the height of the trapezial cavity. Applications in pre- and post-operative assessment in osteoarthritis of the base of the thumb.

The authors present an original radiological technique which allows a precise measurement of the height of the trapezial cavity. The measurement is performed on an antero-posterior radiological projection of the trapezio-metacarpal joint in a neutral position, as described by Kapandji. The first point of reference is fixed and consists of a line projected through the radial articular surface of the second metacarpal with the trapezium. Two perpendicular lines to this first point of reference, are then projected respectively from the distal extremity of the scaphoid and the base of the first metacarpal, so defining a space which corresponds to the height of the trapezial cavity. We have used this measurement for assessment of the column of the thumb, in a series of 33 patients operated on for trapezio-metacarpal osteoarthritis (18 patients were treated by trapezectomy, ligamentous stabilisation and tendon interposition following Burton's or Jones technique and 15 patients underwent insertion of a Swanson trapezium implant. Radiologic measurement pre- and post-operatively provided information relative to the change of the height of the trapezial cavity after the two different surgical techniques, and to assess the kinetics of collapse of the trapezial gap following trapezectomy.