Treatment of scaphotrapeziotrapezoid osteoarthritis with the Pyrocardan® implant: Results with a minimum follow-up of 2 years.

The aim of this study was to report the results of arthroplasty using a mobile pyrocarbon implant (Pyrocardan®) for isolated scaphotrapeziotrapezoid (STT) osteoarthritis. The hypothesis was that this arthroplasty leads to functional improvement without carpal instability. Twenty patients (22 implants) were included with a minimum follow-up of 2 years and an average age of 59.6 years. Outcome criteria were pain (VAS scale), QuickDASH and PRWE scores, strength (grip and pinch), wrist mobility, the Kapandji index, carpal height and the capitolunar angle measured on X-rays. The preoperative data was compared to the postoperative data. The average follow-up was 3.8 years. There was a significant improvement in pain, clinical scores and pinch strength. In terms of range of motion, we found that amplitudes were maintained except for a significant decrease in wrist extension. X-rays did not show any carpal instability; carpal height was maintained and the capitolunar angle was significantly improved. No implant dislocation was reported. The good functional and radiographic outcomes, and the absence of surgical complications are evidence that the Pyrocardan® resurfacing implant is a valid option for treating STT osteoarthritis. If this arthroplasty procedure fails, another procedure can still be done. However, a long-term assessment of this technique is still needed.

[Spare-parts concept in pediatric hand: About one bilateral syndactyly]. / Principe du doigt-banque en main congénitale : à propos d'une syndactylie bilatérale.

INTRODUCTION: The spare-parts concept is well described in traumatology of the hand. Tissues of a scarified ray are used to reconstruct another damaged finger. We will detail an application in pediatric hand through a clinical case. MATERIALS AND METHOD: We describe a patient presenting a bilateral complete and non-complex syndactyly of the third web space associated with a bilateral hexadactyly classified as type B according to the Temtamy and Mc Kusick's classification. The treatment of the syndactyly was performed with a dorsal flap for the web space and with longitudinal zigzag incisions in mirror. Skin loss of the lateral sides of the fingers was covered by the full-thickness graft taken on the supernumerary finger which was treated in the same surgical time. DISCUSSION: This application of the spare-parts concept allows only one surgical site with absence of scar on the donor site and a skin graft close to the skin loss on the finger. CONCLUSION: The spare-parts concept can be applied in some cases of pediatric hand and must be a tool for the surgeon.

[Hand burns in children and Aquacel(®) Burn gloves, an alternative to prolonged hospital stays]. / Brûlures des mains de l'enfant et gants Aquacel(®) Burn, une alternative aux hospitalisations prolongées. À propos de 20 cas.

AIM OF THE STUDY: Occlusive dressings for second-degree hand burns in children must prevent infection and promote healing. For good management of analgesia, these treatments often require children to be hospitalized. Our goal was to find an alternative to conventional care protocol that would reduce the number of dressings and therefore the length of hospitalization. We report our experience with the use of Aquacel(®) Burn. PATIENTS AND METHOD: Non-randomized monocentric prospective study was conducted from 2012 to 2014. The glove was used in the operating room within 72hours after the burn in children younger than 15 years old with isolated superficial to deep 2nd degree hand burns. Once the glove was perfectly stuck to the burn, the children could go back home. We saw them 10 to 12 days after the accident to be sure there was no indication of skin graft. RESULTS: Twenty gloves were used in 16 children aged from 16 months to 13 years. The average length of stay (ALOS) was five days to put the glove on and one day to remove it. Four hands were grafted. CONCLUSION: Once we get used to the product, Aquacel(®) Burn gloves have reduced the ALOS before skin graft in cases of isolated hand burns in children.

[Interest of dermal substitute (Matriderm ©) to cover long fingers after congenital syndactyly: About 20 commissures]. / Intérêt d'un substitut dermique en 1 temps (Matriderm ©) dans la couverture des pertes de substance de la face latérale des doigts longs lors d'une cure de syndactylie congénitale: à propos de 20 commissures.

INTRODUCTION: Surgical treatment of congenital syndactylies is based on the creation of a new commissure - with a commissural flap - and on the management of fingers lateral faces - with mirror zigzag incisions. Lateral skin defects are covered by full-thickness skin graft. Since their discover 30 years ago, dermal substitutes applications have been enlarged. We have wandered if these technique could be interesting for the treatment of these lateral skin defects. MATERIALS AND METHOD: We have launched a monocentric and retrospective study with only one surgeon. The assessor and the operator were different. Included patients have a simple or complex congenital syndactyly, complete or not, associated with a syndrome or not. Children with a first web space syndactyly were excluded. Surgical treatment was performed with a dorsal commissural flap, with mirror incisions and with a lateral skin defects coverage by dermal substitute (Matriderm(©)) and split-thickness skin graft taken from the scalp. The initial assessment criterion was the quality of the scare measured by the OSAS score. Web creep (Whitney's scale) and time of surgery were two minor criteria. RESULTS: Twenty commissures (11 children) have been included between 2008 and 2013. Fourteen complex syndactylies were noted. The average aftercare was equal to 2.7 years (0.5-5.5 years). Interventions were performed at the age of 1.8 years (0.5-4 years). Surgical time was equal to 44.6 min (22-95 min). Patients OSAS score was 11.9 (6-18). It was 12.2 (60-20) for complex forms and 11.9 (10-16) for simple forms. Graft weren't hairy. There was no complication on the donor site. Whitney's score was 1.2 (0-3) and three web spaces were reoperated. CONCLUSION: We think that the use of dermal substitute Matriderm(©) is a new and serious alternative to treat congenital syndactylies. Results have to be confirmed by a new study which would compare this material to full-thickness skin graft, gold standard technique for these skin defects.

[Carpal tunnel syndrome in children. About 10 clinical cases]. / Syndrome du canal carpien chez l'enfant. À propos de 10 cas cliniques.

INTRODUCTION: The carpal tunnel syndrome is a common peripheral neuropathy in adults but is rare in children. We report a series of 10 carpal tunnel syndromes in children. METHODS: We have supported five children, two males and three females, with a bilateral carpal tunnel syndrome. We studied the clinical history (history, symptoms, stage of disease), therapeutic management and remote development. Three children were diagnosed with a mucopolysaccharidosis, the fourth with VATER association. For the last child, it was a form considered idiopathic. Two children were referred for night pains, the others for under-utilization of their first three fingers, two of which had a thenar atrophy. Four children underwent an electromyogram for diagnostic confirmation. We realized open surgical treatment at one time, by section of the carpal ligament. RESULTS: The average age of our patients was 4years. The average decline in the surgical study was 19 months. Postoperatively, we noted, in all patients, complete regression of the painful symptoms, a sensory improvement and recovery of the opposition of the thumb. CONCLUSION: The scarcity of carpal tunnel syndrome in children and the atypical symptoms may cause diagnostic delay, with serious consequences. We keep vigilant and ready to access to additional tests (electromyogram). For our team, the therapeutic approach is a systematic open surgical treatment.