[Treatment of scaphoid waist fractures by shape memory staples. Retrospective evaluation on 60 cases]. / Le traitement des fractures du corps du scaphoïde carpien par agrafes a mémoire de forme. Etude rétrospective de 60 cas opérés.

OBJECTIVES: In carpal scaphoid fractures, treatment with screws is considered the gold standard: ostheosynthesis with mini-staples is not the usual choice of treatment. The authors report a study on fractures of the middle third of the scaphoid treated by mini shape memory staples, in order to test the quality of reduction and ostheosynthesis, functional results, time of union and complications. MATERIALS AND METHODS: A retrospective analysis of 60 patients, with average age 39 years old and follow-up 36 months, was performed. Evaluation criteria were: the grade of pain, flexion-extension and pronation-supination wrist range, hand grip strength, radiographic consolidation of fractures and lateral intrascaphoid angle of flexion as described by Amadio. RESULTS: Pain was absent in 86% of the cases, the average flexion-extension range achieved was 107 degrees and the average pronation-supination range 171 degrees. Hand grip strength values achieved were comparable to those of the controlateral wrist in 85% of cases. Radiographic consolidation of the fracture was achieved in all patients within three months of surgery and the average value of the lateral intrascaphoid angle of flexion was 37 degrees. No cases of algodystrophy were observed. CONCLUSIONS: Our results show the safety and the practicality of ostheosynthesis with mini shape memory staples in fresh unstable fractures of the middle third of the scaphoid. Stable fixation, continuous compressive force on fragments and the ability to allow early active movement, are the main advantages.

["Square sail" flap in median nerve lesions at the wrist. Anatomical elements and review of twenty operated cases]. / Le lambeau à "voile carrée" dans les lésions du nerf médian au poignet. Eléments d'anatomie et revue de vingt cas opérés.

INTRODUCTION: Following an anatomical study on the vascular supply of the upper limb, we propose a new adipo-fascial flap at the wrist. The fat pad of pronator quadratus lies over the muscle and is vascularised by a recurrent branch arising from the anastomotic "cross-road" of the anterior interosseous, radial and ulnar arteries, at the radio-carpal joint. The peripheral extensions of the adipose tissue have to be anchored to the palmar fascia of the muscle in order to hoist the flap as a "square sail". The flap is then distally rotated in order to cover the traumatized median nerve segment at the wrist, for 2.5-3 cm of length. METHODS: The authors present a review of the clinical applications (1995-2001) on painful neuromas of the median nerve at the wrist, where traumatic and iatrogenic injuries frequently occur. The surgical procedure consists of external neurolysis followed by coverage of the nerve using this vascularised flap. RESULTS: The results confirm the usefulness of vascularised fat flaps in creating an optimal perineural environment in terms of biological and mechanical quality. The advantage offered by this particular local flap is that it can be speedily raised. Because of its limited length the flap is only able to cover the median nerve at the level of the carpal tunnel: its indications are therefore very selective but not rare, due to the frequency of median nerve injuries at this level. DISCUSSION: Clinical results were very satisfactory: in the twenty cases reviewed, resolution of the symptoms of algodystrophy and causalgia was consistently observed, sometimes to an extraordinary degree, and associated with an improvement in the neurological deficit.

The dorsal flap of the first web.

In the first web space region, there are communications between the dorsal arteries which arise from the dorsal branch of the radial artery and the digital arteries of the thumb and the index finger. These allow a distally based flap to be raised in the first dorsal intermetacarpal area. This flap has been used in 15 cases of soft-tissue loss from the thumb and index finger. The donor sites were closed primarily in all but two patients. There were no complications, and the results show that this flap is useful for soft-tissue defects on the tip and the palmar and dorsal surfaces of the thumb. Moreover, it may be used as a "cross-finger" flap.

The neurocutaneous flap based on the dorsal branches of the ulnar artery and nerve: a new flap for extensive reconstruction of the hand.

Soft-tissue repair in the hand often requires skin flaps due to exposure of bone, tendons, nerves, and arteries. However, alternatives for flap surgery are very limited, especially in dealing with palmar hand reconstruction. In the present report, the dorsal branch of the ulnar nerve and its accompanying artery were studied anatomically, and a neurocutaneous flap distally based on these structures was developed. The flap was raised on the medial aspect of the hand and distal half of the forearm, and its rotation point was located dorsally near the metacarpalphalangeal joints. The clinical use of this flap for the repair of skin defects in the hand is reported. All the clinical flaps survived completely, including a 3.5 x 13-cm large flap. Donor site morbidity was minimal. This flap represents a new alternative in hand reconstruction.

Direct and reversed flow proximal phalangeal island flaps.

The vascularization of the skin over the proximal phalanx was studied in 64 digital microdissections from eight fresh upper limbs injected via the brachial artery with latex neoprene. Two branches of the proper digital artery reached the dorsal aspect of the proximal phalanx to supply the skin. The proximal branch diameter was 0.2 mm in average, and the distal branch diameter was 0.4 mm in average. A vascular arcade overlying the extensor tendon border linked these branches. Based on the anatomic findings, two cutaneous axial island flaps are presented: the direct and reversal flow proximal phalangeal island flaps. Five direct proximal phalangeal island flaps were harvested from the hands of five patients. The clinical results were satisfactory; all the flaps survived well. These flaps are useful to repair skin losses over the proximal and middle phalanges.

[A case of primary intraneural ossification of the ulnar nerve]. / Sur un cas d'ossification intraneurale primitive du nerf cubital.

The authors report a case of ossification of the ulnar nerve at the elbow. The dense bone tissue spread into the interfascicular space while the epineurium and the fasciculi were undamaged. The pathological tissue was removed and the patient recovered. No similar report has been found in the literature.

Palmar subluxation of the carpus in rheumatoid disease: a radiological evaluation.

The authors present a radiological assessment of palmar subluxation of the carpus in rheumatoid disease. The radiological measurements have been taken with reference to the long axis of the radius, the radiological centres of the lunate and the capitate and expressing their reciprocal distances as a ratio which we have termed the radio-carpal and inter-carpal indices. Using a control group of a 100 serial radiographs of normal wrists it was possible to determine the normal indices and their normal range. A subsequent analysis of 100 rheumatoid wrists enabled them to accurately determine the degree of anterior carpal subluxation, and allowed this form of radio-carpal malalignment to be differentiated from other forms of carpal instability.

[Analgesic and anti-inflammatory effect of nabumetone in osteo-articular diseases in the acute phase]. / Effetto analgesico ed antiflogistico del nabumetone in patologie osteo-articolari in fase acuta.

Twenty patients, 7 males, 13 females, age range 27-69, average 46 years, with highly painful and inflammatory osteo-articular pathology were treated with a nabumetone preparation (one 1 g capsule at night before going to bed), for a minimum of 6 and a maximum of 10 days (average 9.70 days). Already during the first days of treatment, pain and joint function were improved and reactive edema diminished. The authors believe the drug to have a preventive analgesic effect which may at first consist in an increased pain threshold at the level of capsular receptors and may subsequently involve algoreceptors situated in the tendons. In addition to its analgesic efficacy, the drug has the advantage of being easy to handle neither general nor local side effects were observed. Only two patients complained of digestive side effects (dyspepsia and minor gastric pain in one case; gastric pain and vomiting in the other: both leading to withdrawal of the drug after 6 days). Five patients had excellent results, 9 reported good results, in 5 the result was fair.

[Early passive mobilization in surgery of the hand]. / Mobilisation précoce passive en chirurgie de la main.

The authors present their experience of early passive mobilisation in hand surgery, by a continuous-cycle motorized device. This method of treatment has been applied to various pathological conditions (post-operative management following such operative procedures as stable osteosynthesis of fractures of the long bones, tenolysis and teno-myolysis, arthrolysis and treatment of complex trauma of the hand), demonstrating very good efficacy. This device allows continuous passive mobilisation of the fingers and represents useful complement in the rehabilitation program of the hand.