[Treatment of non-unions of the carpal scaphoid using a nonvascularised corticocancellous bone graft: a retrospective series of 47 cases]. / Traitement des pseudarthroses du scaphoïde carpien par greffe corticospongieuse non vascularisée: étude rétrospective de 47 cas.

OBJECTIVES: The authors report their results on the treatment of scaphoid non-unions without osteoarthritis or necrosis, by anterior nonvascularized bone graft. PATIENTS AND METHODS: Forty-seven patients treated between 1988 and 2003 were analysed with a mean follow-up of 74 months. There were 19 non-unions without carpal instability (IIA) and 28 with carpal instability (IIB). All patients were treated by an anterior approach with corticocancellous bone graft and osteosynthesis using two pins. Clinical results were analysed on pain, strength and mobility. Radiographic analysis was of union, correction of instability and occurrence of osteoarthritis. RESULTS: These were divided into stages IIA and IIB: 1) stage IIA: all cases proceeded to bony union; ten results were excellent and nine good and no instability; there was one case of osteoarthritis; 2) stage IIB: 78% of patients proceeded to bony union; one result was excellent, 17 good, four moderate and six cases remained un-united. There were 12 cases of osteoarthritis. Most of them occurred in patients with residual instability after the initial surgical procedure. CONCLUSION: Corticocancellous nonvascularized bone graft by a palmar approach is an excellent technique for treatment of scaphoid non-unions without osteoarthritis and necrosis. The presence of instability is a poor prognostic factor; its correction during the operation allows the surgeon to decrease the risk of osteoarthritis.

[Bizarre parosteal osteochondromatous proliferation (Nora's lesion). Two case reports]. / Prolifération ostéocartilagineuse parostéale bizarre ou tumeur de Nora. A propos de deux cas.

Bizarre parosteal osteochondromatous proliferation, or Nora's tumor, is an uncommon lesion, involving mostly tubular bones of hands and feet, arising from the cortical surface. It must be distinguishable from chondrosarcoma, parosteal osteosarcoma and florid reactive periostitis. It is a benign lesion, characterized by a proliferation of chondroid, bony and fibrous tissues. The authors report two cases involving the hand. The diagnosis can be made thanks to imaging techniques and confirmed by histological examination. The treatment is surgical, namely complete excision but there is a high rate of local relapse.

[Glomus tumor of forearm: a case report]. / Tumeur glomique de l'avant-bras: a propos d'un cas.

The authors report a case of a glomus tumor of the soft-tissues of the forearm in a 23 year old woman. The diagnosis was suspected on MRI, and confirmed by a biopsy. The result after surgical resection was excellent, just like other cases in the literature.

[Internal fixation of proximal humerus fracture by "palm tree" pinning]. / Ostéosynthèse des fractures de l'humérus proximal par brochage en palmier.

PURPOSE OF THE STUDY: Fractures of the proximal humerus are increasingly frequent. Conservative treatment is most often proposed, but surgery must be performed when the displacement is significant and/or when the fracture is unstable. Osteoporosois and comminution are two essential elements for deciding on the surgical technique. MATERIAL AND METHODS: This retrospective study included 31 patients who underwent pinning from the deltoid V according to the Kapandji procedure. There were 19 females and 12 males. Mean age was 61 years. There was a fracture of one of the tuberosities in 12 cases and significant metaphyseal comminution in 8. RESULTS: Mean follow-up was 26 months. Outcome was excellent or good in 22 cases (70.9%), fair in 4 (12.9%), and poor in 5 (16.2%). Fifteen complications were noted (48.4%): material displacement 8 cases, reflex sympathic dystrophy 3 cases, radial nerve palsy 2 cases, head osteonecrosis 1 case, and humeral fracture at the site of insertion of the K wires 1 case. DISCUSSION: At the present time, there is no consensus for the surgical management of fractures of the proximal humerus, including proximal metaphyseal fracture with or without fracture of one of the tuberosities. Closed reduction and pinning is not really an invasive procedure, and does not injure the rotator cuff. Surgical approach at the level of the deltoid V according to the Kapandji technique avoids elbow pain and stiffness. The procedure requires a fluoroscan and experience to obtain satisfactory divergence of the K wires in the humeral head, an essential technical point. This procedure cannot be recommended for elderly patients whose bone quality is too poor to obtain good fixation of the K wires.

[Surgical treatment for boutonniere deformity of the fingers. Retrospective study of 47 patients]. / Traitement chirurgical de la déformation en boutonnière des doigts longs. Etude d'une série rétrospective de 47 patients.

Disruption or laceration of the central slip of the extensor tendon at the proximal interphalangeal (PIP) joint with volar displacement of the lateral bands can result in the so-called boutonniere deformity which includes loss of extension at the PIP joint and compensatory hyperextension of the distal interphalangeal (DIP) joint. Many procedures has been described in the literature and no standard treatment can be recommended. The authors reports a series of 47 cases of posttraumatic boutonniere deformity. The mean follow-up was five years. Majority of patients were males (38 males). The mean age was 41 years-old (17-82 y.o.). The etiology was in 23 cases a missed subcutaneous disruption of the central slip of the extensor tendon and in 24 cases an inappropriate treatment of laceration of the extensor apparatus at the dorsal aspect of the PIP joint. The involved digit was in seven cases the index finger, in 14 cases the long finger, in 14 cases the ring finger and in 12 cases the little finger. It is essential to distinguish the supple boutonniere deformity without or after physical therapy (34 cases) and the stiff boutonniere deformity even after a hand physical therapy program (13 cases). Results were assessed on pain and active range of motion of the PIP joint as well as the range of motion of the DIP joint. Supple boutonniere deformities, except one treated by an isolated distal tenotomy of the extensor tendon (1/34), was treated by a procedure of reconstruction of the extensor apparatus including resection-suture of the central slip and redorsalisation of the lateral bands when there was a DIP hyperextension with a moderate flexion deformity of the PIP joint, and (33/34) with 90% of excellent and good results. Poor results (4/33) were due in two cases to the absence of physical therapy, in one case to septic osteoarthritis and in one to secondary rupture of the suture. For the 13 stiff boutonniere deformities, when the PIP flexion deformity was moderate, a distal tenotomy performed to correct the DIP hyperextension was satisfactory in three cases with a useful result (20 degrees-70 degrees). For destroyed PIP joint (osteoarthritis), two silicone spacers were implanted with also a satisfactory result (30 degrees-70 degrees). In the eight remaining cases, a teno-arthrolysis was performed combined with a reconstruction of the extensor apparatus as described. Six poor results were obtained with arthritic PIP joints (which should have required initially silicone implants), and two fair results (30 degrees-60 degrees) with non-destroyed PIP joints. Supple boutonniere deformity must always be treated by initial physical therapy. Surgical procedure with reconstruction of the extensor apparatus is satisfactory if the PIP joint is normal. When there is PIP osteoarthritis, it may be beneficial to perform a two-stage technique with tenoarthrolysis followed hand therapy and a secondary reconstruction of the extensor apparatus as these last procedure give satisfactory results on a supple boutonniere deformity.

[Isolated fifth digit localization in Dupuytren's disease]. / L'atteinte isolée du cinquième rayon dans la maladie de Dupuytren.

Isolated fifth digit localisation in Dupuytren's disease has a bad reputation. A series of this injury is reported with a special attention on recurrences. This series is composed of 30 cases in 26 patients (four bilateral cases): the majority of patients were male and 53.5 y was the average age. Extension loss of MP and PIP joints were present in 25 cases, MP isolated extension loss in two cases and PIP in three cases. The treatment performed was a percutaneous needle technique in five cases, surgical fasciectomy in 24 cases using a zigzag palmodigital longitudinal fasciectomy approach in 18 cases, an open palm technique in six cases and one isolated laterodigital flap. Assessment of correction was based on Tubiana's classification. Average follow-up was 22 months. Postoperative course was uneventful except for one case of precarious vascularisation which leads to an amputation. For the digitopalmar localisations: 15 stage 0 or 1, 7 stage 2, 1 stage 3 and 1 stage 4. Improvement percentage was 0.60 in combined cases, 0.65 in cases with a MP loss and 0.46 in PIP loss. Five recurrences were noted. Literature on this topic is coherent with the fact that isolated involvement of the fifth digit carry a bad prognosis, mainly due to the high recurrence rate in our series as in other papers. In severe injuries, an imperfect result should be the aim to prevent vasculonervous complications.