Reconstruction strategies after rupture of the extensor pollicis longus tendon: A systematic review.

Ruptures of the extensor pollicis longus (EPL) tendon result in a major loss of function. The most practiced reconstruction surgery appears to be extensor indicis proprius (EIP) transfer, which is contraindicated in certain cases. The objective of this review was to present the various reconstruction methods for the EPL tendon. A systematic review was conducted of the literature from 2010 to 2020 on strategies for reconstructing the EPL tendon. A search of the PubMed database was done using the following keywords: 'extensor', 'pollicis', 'longus', and 'thumb'. Data analyzed were the type of study, the number of patients, surgery, follow-up, and results. Of the 142 articles selected from PubMed, only 18 (12.7%) were included in the analysis. Follow-up ranged from 6 months to 6 years, with an average of 28 months, and the total number of patients was 515. Numerous strategies exist for reconstruction following rupture of the EPL tendon. The preferred modality seems to be a transfer of the EIP tendon with intraoperative testing of applied tension with the interphalangeal joint in extension, hand flat, forearm in pronation, and neutral wrist position. When the EIP is not available, other transfers should be considered if the patient has significant tendon attrition, or a graft should be considered if an isolated defect is present.

Hand injury without any deficit: Is systematic surgical exploration justified?

Out of 100,000 inhabitants, 700 to 4000 suffer a hand wound each year. Numerous hand wounds that may not have a clinically evaluated deficit, actually have damage to a major structure after surgical exploration in the operating room (OR). The aim of our study was to evaluate the incidence of major structure damage within a population of patients presenting a hand wound with no deficit on the clinical examination. Every patient older than 12 years, consulting for a wound deeper than the dermis with no clinical signs of major structure damage underwent surgical treatment and exploration of the wound under regional anesthesia in the OR. After each surgery, the surgeon filled out an anonymous study form describing the wound characteristics and the potential findings of major structure damage. Of the 145 wounds with normal clinical examination, we found that 58.6% had a major structure damaged. Given that damage to any major structure in the hand can lead to functional sequela, and the fact that a well-conducted clinical examination by a qualified hand surgeon is not sufficient to eliminate major structure damage, we recommend systematic surgical exploration of hand wounds, even when no clinical deficit is evident. LEVEL OF EVIDENCE III.: Type of sudy: diagnostic study.

Idiopathic bilateral lunate and triquetrum avascular necrosis: A case report.

We report on the case of bilateral avascular osteonecrosis (AVN) of the lunate and triquetrum in a 45-year-old woman without any relevant medical history for which the cause could not be established. She was treated conservatively with splinting and analgesics. The patient was able to pursue her work and hobbies with subnormal range of motion at 1-year follow-up. AVN of the triquetrum is very rare, as it is a richly vascularized bone. The presence of AVN in multiple carpal bones has only been described in patients receiving high doses of corticosteroids. To our knowledge, there are no other cases of idiopathic AVN of multiple carpal bones in the literature.

Balloon humeroplasty reconstruction for acute Hill-Sachs injury: A technical note.

Posterior Hill-Sachs humeral defects are present in 80% to 100% of cases of anterior shoulder dislocation and are a factor in recurrent instability. Several techniques have been described to fill the defect and avoid recurrence. We developed a percutaneous technique to fill the newly created defect in which a percutaneous balloon, analogous to the one used in vertebral kyphoplasty, is used to reduce the defect, which is then filled with calcium phosphate cement. One patient with an acute anterior dislocation of the shoulder with no previous history was treated using this method. Early imaging results showed adequate reduction of the defect and no cement resorption. The patient was followed for 12 months; he had normal function of the shoulder and no recurrent dislocation. Shoulder computed tomography (CT) arthrography with contrast after 3 months showed an intact capsule and no recurrence of the defect. While this technique is certainly in its infancy, we have demonstrated that emergency reduction of the defect in acute first occurrence anterior shoulder dislocation is feasible, helps to restore normal anatomy of the humeral head and leads to good clinical results. Whether it can improve clinical results and prevent recurrent shoulder dislocation remains to be evaluated.

Avulsion fracture of the extensor carpi radialis longus carpal insertion due to a basketball injury: case report and literature review.

Articular fractures of the base of the 2nd metacarpal involving the extensor carpi radialis longus insertion are unusual and poorly understood. There is no consensus as to how these fractures should be treated. We report the case of a 2nd metacarpal base fracture in a professional basketball player that was treated surgically with open reduction and internal fixation using cannulated screws. The management of this case is compared to similar cases in the literature.

[Electrophysiologic evaluation and follow-up of patients with a syncopal episode of unknown origin]. / Evaluation électrophysiologique et suivi des patients ayant présenté un épisode syncopal d'étiologie inconnue.

The etiology of syncope of presumed cardiac origin can be determined by clinical and electrocardiographic examination with Holter monitoring in about 50 per cent of cases. The aim of this study was to review the data of electrophysiological investigation and the outcome of the patients in whom a cardiac pacemaker was eventually implanted, in those cases in whom the initial work-up had been negative. Ninety four patients, all of whom underwent standardised electrophysiological investigation, were included. The results of the investigations enabled us to identify three groups of patients: Group I: patients in whom the criteria did not suggest a cardiac origin of syncope; Group II: with criteria possibly suggesting a cardiac origin and Group III in which the criteria were strongly suggestive of a cardiac origin. A cardiac pacemaker was implanted systematically for AV block in Group III; on the other hand, this was very rare (only 1 patient) in Group I, and the indication in Group II depended on age and the history of recurrent syncope. Ninety patients (96%) were followed up for an average of 39.3 +/- 15.3 months. There was a very low incidence of recurrent syncope irrespective of the original classification, so confirming the value of electrophysiological investigations for cardiac pacemaker implantation in this type of patients. In addition, negative electrophysiological investigations allowed identification of a group of patients with a low mortality and low risk of recurrent syncope.