Subscapularis minor--an analogue of the Teres minor?

INTRODUCTION: The purpose of this study was to determine the role of the subscapularis (SSC) in forward flexion. We hypothesized that the inferior part of the SSC has a main role in the ability to preserve forward flexion in cases of anterosuperior rotator cuff tears. MATERIAL AND METHODS: Active forward flexion of the shoulder was prospectively evaluated in patients presenting with Grade 3 or higher SSC fatty degeneration, with superior and inferior SSC tears being evaluated separately. RESULTS: Thirty-two patients were enrolled in this study. Pseudoparalytic shoulders were found in 80% of cases when the inferior part of the SSC was torn, but never when only the superior part was torn. DISCUSSION: The inferior SSC or "Subscapularis minor" can be considered as an analogue to the teres minor in the posterior aspect of the shoulder. It must be preserved in cases of tears and fatty degeneration of the superior part, and repaired when possible. LEVEL OF EVIDENCE: Level II.

Simplified scaphoid reconstruction technique with Zaidemberg's vascularized radial graft.

For more than 10 years, we have been using a simplified reconstruction technique for scaphoid non-unions that involves the use of a graft first described by Zaidemberg et al. [1]. This approach requires that an island bone graft harvested from the radial styloid and pedicled on the 1,2-intercompartmental supraretinacular artery be embedded into the site of the non-union. The objective of our technical modifications was to simplify the harvesting and handling of the graft and the internal fixation. This technique is only used for cases of scaphoid non-union with avascular changes in the proximal fragment, repeated non-union after bone grafting and internal fixation, chronic non-union with osteophyte formation in the dorso-radial aspect and fracture secondary to Preiser disease.

The arthritic wrist. II--the degenerative wrist: indications for different surgical treatments.

For the patient (and the surgeon) the ideal wrist is one that has good mobility, however very often the optimal surgical treatment is one that provides effective pain relief. The patient must be informed of the potential complications and limitations of each procedure. The patient's psychological profile and functional requirements will determine how well he/she adapts to the changes. Also, each surgeon has beliefs and personal experiences that influence the treatment decision and final result. Proximal row carpectomy (PRC) and the Watson procedure are two reference operations for osteoarthritis secondary to scapholunate instability and scaphoid non-union (SLAC and SNAC). Beyond the early complications and drawbacks specific to each, they provide good results that are maintained over time. PRC, which can be performed up to Stage II, is mainly indicated in patients with moderate functional demands, while the Watson procedure is more often done on a patient who performs manual labour, as long as the radiolunate joint space is maintained. Complete denervation is effective in three out of four cases and preserves the remaining mobility. Because of its low morbidity, the procedure can be suggested in patients with a mobile wrist and low functional demands or in older patients, independent of their wrist mobility. Total wrist fusion is not only a rescue procedure. For a young patient who performs heavy manual labour with extensive osteoarthritis and progressive forms of Kienböck's disease, this procedure provides the greatest chance of returning to work and not being socially outcast. The role of osteochondral autografts, implants and wrist prostheses in the treatment arsenal need to be better defined.

The arthritic wrist. I--the degenerative wrist: surgical treatment approaches.

UNLABELLED: The primary goal in treating a degenerative wrist is to provide pain relief, while maintaining strength and mobility if possible. After failure of the recommended conservative treatment, the choice of approaches can be made from a large collection of techniques, some which are well validated. Partial wrist fusion, particularly the Watson procedure, results in a pain-free wrist in 80% of cases, with 50% of the mobility preserved, good grasping strength and stable results for at least 10 years. Proximal row carpectomy provides similar results if the cartilage on the head of the capitate is preserved and the patient is not involved in heavy manual labour. Complete denervation provides pain relief in almost 80% of cases while preserving motion and strength. This is a safe and effective option, with no age limit, that still allows other procedures to be performed in the future. Total wrist fusion also has its place in revision, and even as first-line treatment, because of the reliable outcome in terms of pain and strength, high satisfaction rates, little to no repercussions linked to the loss of mobility and fewer complications. Other techniques are now available. The partial or complete resection of a carpal bone and placement of an implant is back in vogue because of the availability of pyrocarbon. Such implants are an option in the future for localized osteoarthritis or even diffuse affections, and a useful alternative to more invasive procedures. The use of a rib cartilage graft to partially or completely replace a carpal bone or resurface the radius has promising results in terms of pain reduction and fusion. The role of total joint replacement must be defined relative to the classic, reliable techniques that have long-term outcome data. LEVEL OF PROOF: IV.

[Acute closed injuries of the digital proximal interphalangeal joints]. / Les traumatismes fermé récents des IPP des doigts.

Acute closed injuries of the digital proximal interphalangeal (PIP) joints are frequent and can leave sequelae because of imprecise diagnosis of the lesions, poorly adapted treatment, or insufficient follow-up. The therapeutic options proposed in this presentation are advocated by all of the participants and are based on their personal experience and evidence reported in the literature. After a brief anatomic review necessary for the understanding of PIP joint pathophysiology we have presented the longterm outcomes of PIP joint injuries, which are central to the therapeutic decision-making process in terms of risk benefit ratio. To facilitate the presentation, we have separated lesions "with" and "without" fracture. A specific chapter is devoted to surgical approaches essential for successful management of these injuries and another to particular problems related to the seldom reviewed topic of traumatic injury of the PIP joint during bone growth.

[Gouty arthritis of the wrist. Five case reports]. / Arthropathie goutteuse du poignet à propos de cinq cas.

Gout is rarely localized to the wrist. Based on five new cases of this condition and literature review, the authors outline the clinical and radiographic signs which differentiate gout from other causes of isolated unilateral chronic synovitis of the wrist. On the clinical basis, this localization was the first appearance of the disease in three of the five cases. On the X-rays, large defects and joint destructions were present. A scapholunate dissociation was evident in 4/5 cases with sometimes bone condensation. Other diagnoses should be eliminated as chondrocalcinosis, rheumatoid arthritis or wrist infections in subacute forms. Final diagnosis is provided by histological examination, demonstrating specific microcrystals.

[Rupture of extensor tendons due to an isolated lesion in the distal ulnar extremity]. / Rupture des tendons extenseurs par lésion isolée de l'extrémité ulnaire distale.

Rupture of the extensor tendons is a well known complication of rheumatoid arthritis involving the wrist or any form of diffuse arthrosis. It is much less common in the context of isolated arthrosis of the distal radioulnar joint. The authors report ten cases of this disease in patients without rheumatoid arthritis. All patients in this series were over sixty years of age and reported insidious development of an extension deficit of the little finger, followed by the ring finger. The typical radiographic image of erosion into the sigmoid notch of the radius should be noted and should lead to arthrography in order to determine the status of the joint capsule. Surgical intervention should be performed before major tendon rupture occurs. The results presented here were adversely affected by the delay in surgical treatment. Once rupture of the extensor digiti minimi has occurred, the articular and tendinous pathology must be both be treated, including tendon repair and plasty of the dorsal retinaculum.