Post-traumatic AV Fistula of the Hand Successfully Treated With Percutaneous Endovascular Laser Ablation: Report of a Case.

Acquired arteriovenous fistula (AVF) in the hand can occur after trauma, fracture, or surgery. It is a rare condition, and only a few cases have been reported in the literature. Clinically they appear as palpable or painful lesions that persist long after the local hematoma has resolved. We report a case of a young patient presenting with long-standing and invalidating pain of the hand caused by a post-traumatic AVF, treated with percutaneous endovascular laser ablation.

[Support algorithm for lateral elbow pain syndrome in adults]. / Douleurs latérales du coude chez l'adulte : algorithme de prise en charge.

Lateral elbow pain syndrome in adults is a frequent complaint leading to consultation in primary care medicine. The lateral side of the elbow joint represents a complex anatomy with close proximity of bony structures (humerus, radius, and ulna), ligaments (lateral ligament complex), tendons (origin of the extensors of the wrist and fingers), and nerves (branches of the radial nerve) making diagnostic and therapeutic management demanding. This article aims to provide a basis for reflection to better define treatment options for pathologies frequently encountered in clinical practice.

Les douleurs de la face latérale du coude chez l'adulte sont un motif fréquent de consultation en médecine de premier recours. La face latérale de cette articulation représente une anatomie complexe avec une proximité des structures osseuses (humérus, radius et ulna), ligamentaires (complexe ligamentaire latéral), tendineuses (origine des extenseurs du poignet et des doigts) et nerveuses (branches du nerf radial) rendant l'orientation diagnostique et la prise en charge thérapeutique exigeantes. Cet article propose une base de réflexion pour mieux définir les options de prises en charge des pathologies fréquemment retrouvées en pratique clinique.

Lipomatosis of Nerve: More than a Focal Distal Disease.

Lipomatosis of nerve is a rare, ill-defined, fibrofatty tumor intermingled among nerve fascicles. The classic presentation of lipomatosis of nerve describes focal distal involvement of the median nerve at the wrist. The purpose of this study was to determine the level of proximal lesion extension in cases of upper extremity lipomatosis of nerve using magnetic resonance imaging. The authors' study confirms that lipomatosis of nerve is more than a focal distal disease. Lipomatosis of nerve has the potential for multiple nerve involvement and for proximal nerve involvement extending to the nerve roots. Magnetic resonance imaging of the entire upper extremity may be indicated in patients with lipomatosis of nerve, especially when the ulnar nerve is affected.

Radial nerve palsy after the use of an adjuvant hinged external fixator in a complex fracture-dislocation of the elbow: a case report and review of the literature.

BACKGROUND: The combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture is known as "terrible triad" injury of the elbow. This injury is one of the most challenging injuries of the musculoskeletal system and almost always causes instability of the elbow. The use of an adjuvant hinged external fixator in such injuries is still debated. CASE PRESENTATION: In this case report we present a case of radial nerve palsy after setting up an adjuvant hinged external fixator in a complex fracture-dislocation of the elbow. The patient was a 39-year-old white man. A revision of his radial nerve was undertaken at 7 weeks. A radial nerve injury at two levels facing the humeral apex pins was found intraoperatively; the pins were carefully removed and partial nerve grafts done. The functional outcome at 18 months was excellent. CONCLUSION: This case report highlights that the use of an adjuvant hinged external fixator in complex fracture -dislocation of the elbow is technically demanding and not without risk.

[The hand : review of the main pathologies for the primary care physician]. / La main : revue des pathologies les plus fréquentes pour le médecin de premier recours.

The general practitioner is often the first person to have to assess and treat a patient complaining about his hand, especially in areas far away from an emergency health center. The hand is the largest sensitive area of our cortex. It is the most used part of our body and is therefore prone to traumas, cuts, infections, tendinous inflammation and compressive nerve disorders. This article summarises the main pathologies a primary care physician has to deal with.

Le médecin généraliste est souvent le premier à évaluer un patient avec une plainte de la main, en particulier dans les secteurs les plus éloignés d'un centre d'urgences. La main occupe la plus grande zone sensitive de notre cortex, relativement à sa surface cutanée. C'est la partie de notre corps que l'on utilise le plus et elle est donc particulièrement sujette aux traumatismes, aux plaies, aux infections, aux inflammations tendineuses et aux pathologies de compressions nerveuses. Cet article vise à développer les principales pathologies que le médecin de premier recours peut être amené à prendre en charge ainsi que leurs traitements.

3-T direct MR arthrography of the wrist: value of finger trap distraction to assess intrinsic ligament and triangular fibrocartilage complex tears.

PURPOSE: To determine the value of applying finger trap distraction during direct MR arthrography of the wrist to assess intrinsic ligament and triangular fibrocartilage complex (TFCC) tears. MATERIALS AND METHODS: Twenty consecutive patients were prospectively investigated by three-compartment wrist MR arthrography. Imaging was performed with 3-T scanners using a three-dimensional isotropic (0.4 mm) T1-weighted gradient-recalled echo sequence, with and without finger trap distraction (4 kg). In a blind and independent fashion, two musculoskeletal radiologists measured the width of the scapholunate (SL), lunotriquetral (LT) and ulna-TFC (UTFC) joint spaces. They evaluated the amount of contrast medium within these spaces using a four-point scale, and assessed SL, LT and TFCC tears, as well as the disruption of Gilula's carpal arcs. RESULTS: With finger trap distraction, both readers found a significant increase in width of the SL space (mean Δ = +0.1mm, p ≤ 0.040), and noticed more contrast medium therein (p ≤ 0.035). In contrast, the differences in width of the LT (mean Δ = +0.1 mm, p ≥ 0.057) and UTFC (mean Δ = 0mm, p ≥ 0.728) spaces, as well as the amount of contrast material within these spaces were not statistically significant (p = 0.607 and ≥ 0.157, respectively). Both readers detected more SL (Δ = +1, p = 0.157) and LT (Δ = +2, p = 0.223) tears, although statistical significance was not reached, and Gilula's carpal arcs were more frequently disrupted during finger trap distraction (Δ = +5, p = 0.025). CONCLUSION: The application of finger trap distraction during direct wrist MR arthrography may enhance both detection and characterisation of SL and LT ligament tears by widening the SL space and increasing the amount of contrast within the SL and LT joint spaces.

Current status of brachial plexus reconstruction: restoration of hand function.

Although restoration of hand function in brachial plexus patients remains a formidable challenge, the past decade has brought significant improvement in our ability to restore hand function even in the most severe cases. Today, the following options are available to restore hand function: (1) direct nerve repair; (2) nerve grafting; (3) nerve transfers from intraplexal or extraplexal sources; (4) tendon transfers (and tenodesis); (5) free functioning muscle transfer; (6) arthrodesis; and (7) a combination of these techniques. Opportunity for future improvement exists, and the next decade will no doubt bring further innovation.

The internal brachial ligament versus the arcade of Struthers: an anatomical study.

Management of the distal part of the medial intermuscular septum and the internal brachial ligament (both described by Struthers in 1854), the medial head of the triceps, and the "arcade of Struthers" (a concept created by Kane et al. in 1973) is still unclear regarding anterior transposition of the ulnar nerve because of anatomical controversies. Dissection of the medial aspect of 30 arms was performed. The internal brachial ligament was found in 22 of 30 cases (73 percent). It separated from the medial septum at an average distance of 11.5 cm above the medial epicondyle, ran medially and then anterior to the ulnar nerve, and finally joined back at the septum at an average distance of 8.2 cm. In the other 27 percent of cases, the ulnar nerve traveled down the arm, passing entirely posterior to the septum. When the internal brachial ligament was present, it always supported the origin of the most superficial layer of the medial head of the triceps, from the inferior border of the teres major to its fusion back to the septum. This layer appeared as an oblique muscular curtain covering the medial aspect of the ulnar nerve. No local thickening was found in the brachial fascia covering these muscular fibers. Muscular fibers were not observed medial to the nerve when the internal brachial ligament was absent. This anatomical study confirms the descriptions of the internal brachial ligament made by Struthers. Foranatomical reasons, the authors propose cancelling the concept of the arcade of Struthers.