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Au cours des dernières décennies, les administrations locales en Europe, de plus en plus pressurisées, ont fait face à de multiples défis. Il en a résulté une vague de réformes politiques et administratives, visant à alléger cette pression, qui a modifié la gestion des collectivités locales dans de nombreux pays. D’une part, les collectivités locales sont responsables de l’efficience de l’administration, de la délivrance de services de très haute qualité, et de la bonne application de la règlementation. D’autre part, elles sont garantes de la légitimité, de la participation démocratique et de la confiance, tout ceci dans un contexte d’austérité. Cet ouvrage présente les résultats des recherches effectuées dans le cadre d’un projet international sur le service public local dans 31 pays et en tire des leçons pour les décideurs politiques afin de dessiner l’avenir des collectivités locales en Europe. Les auteurs abordent les thèmes de réformes classiques ainsi que les caractéristiques majeures de la gouvernance locale telles que l’autonomie, la performance et la participation. Cet ouvrage vise un public de chercheurs, d’étudiants et de praticiens intéressés par le futur des collectivités locales.

Réformes aux multiples facettes et tendances contraires – Le besoin de cohérence et de « transposition » Les trois concepts clés utilisés ici pour comprendre les évolutions et les effets de la réforme des administrations locales en Europe sont l’autonomie, les performances et la participation. L’amélioration des performances au profit des administrés (en termes d’efficacité, d’efficience et de légitimité) est une fonction essentielle des réformes du secteur public local. Dans ce domaine, la r...

Réformes du secteur public local en Europe : les domaines fondamentaux de la modernisation Au cours des décennies passées, les administrations publiques locales en Europe ont été soumises à une pression croissante face à une multitude de nouveaux défis : évolution démographique, changement climatique, dette publique, virage numérique, demande accrue de participation et crise migratoire dans certains pays, pour n’en citer que quelques-uns. En conséquence, une vague de réformes politiques et ad...

Cet ouvrage présente les résultats de l’action COST IS1207 « Réformes du secteur public local (LocRef) » menée durant quatre ans, entre mars 2013 et mars 2017, dans le cadre du programme Horizon 2020 de l’Union européenne. Ce projet avait pour objectif principal d’identifier les différentes approches en matière de réformes du secteur public local ainsi que les effets de ces réformes en les comparant à l’échelle internationale, d’expliquer ces approches et ces effets et d’en tirer des enseigne...

Note portant sur l’auteur « Lili ma petite fille il faut passer, n’importe comment ! » Toute l’œuvre de Céline est placée sous le signe du mouvement, du départ, du transit comme si les personnages, refusant une fixité qu’ils savent d’avance mortifère, s’étaient voués à une errance infinie. Et lorsque le héros croit entrevoir une lueur de tendresse et de bienveillance dans cet univers désespérément hostile, une irrépressible inquiétude le pousse à nouveau sur les routes. La belle et admirable ...

Omniprésentes dès l'origine dans la mythologie et les arts, les figures du passeur, « l'homme-nef », ont traversé toutes les époques et essaimé tous les domaines des sciences humaines, de la culture et de la technique. Plus que jamais d'actualité, du fait de la période que nous traversons, cette antique notion est devenue un des grands vecteurs de la médiation ; c'est aussi une des figures clés de l'anthropologie, entendue comme pensée de la relation et de la traduction, et de la médiologie, qui s'intéresse aux modes de transport des messages et des hommes à travers l'espace et le temps. Archétype du corps conducteur, le passeur est sans conteste une des figures emblématiques d'une (post)modernité placée sous le signe de la communication, de la circulation de l'information et des échanges les plus divers ; il était donc opportun de s'y intéresser. Dans les vingt-deux contributions réparties en trois chapitres (I. Transitions, Transactions, Transgressions ; II. Initiations, Transformations, Transmutations ; Transferts, Traductions, Trans-culturations) de cet ouvrage collectif, le lecteur découvrira des données originales concernant le passeur, entité protéiforme et exemple rare sinon unique de figure mythologique et archétypale acquérant, après s'être sécularisée et banalisée, la pertinence et la polyvalence d'un principe explicatif.

Le terme « passeur » se traduit en allemand par Fährmann, composé logique des éléments : Fähre (f) qui signifie le bateau servant à traverser un fleuve ou une mer (bac, ferry) et qui est apparenté à fahren : marcher, conduire, piloter -führen : conduire, guider, gouverner – Furt (f) : le gué – (étymologie : mhd : ver(e), vern ; ahd : ferjan / le mot ferry vient de l’ancien allemand farjon -moyen de passage). Mann qui, en tant qu’indice de fonction, entre dans la formation de nombreux signifia...

Cinquante et une pièces anatomiques ont été disséquées et les diverses amplitudes des articulations trapézo-métacarpiennes et métacarpo-phalangiennes de 33 d’entre elles ont été mesurées. Les amplitudes articulaires de 33 sujets endormis ont également été mesurées et de nombreux animaux ont été observés en semi-liberté ou dans de grandes volières. 419 squelettes de mains de primates ont été mesurés et les mesures converties en pourcentage par rapport à la longueur du 3e métacarpien, afin de les comparer en dépit de leur différence de taille (collections du Musée d’Histoire Naturelles de Paris). Les différences morphologiques ou fonctionnelles de l’articulation trapézo-métacarpienne et des modes de préhension pollici-digitales permettent de ranger les primates en trois catégories.Chez les prosimiens, l’articulation est concave/convexe. La concavité s’inscrit dans un grand axe vertical. Les surfaces articulaires sont congruentes. Elle fonctionne comme un cardan. Elle a seulement deux degrés de liberté. Elle ne peut réaliser l’opposition qu’avec une ouverture maximum de la première commissure. De très longs doigts sont nécessaires pour réaliser une pince. Le quatrième doigt est le plus long.Chez les platyrhiniens l’articulation est aussi concave/convexe, mais, soit un peu oblique et un peu moins congruente (Cebidae), soit condylienne (Callitrichinae). Tous les doigts sont longs, mais spécialement le troisième. Le ligament transverse inter-métacarpien de la première commissure entrave l’ouverture de celle-ci. Il n’y a qu’une pseudo-opposition possible chez les Cebidae, et pas d’opposition du tout chez les Callitrichinae.Chez les Catarhiniens, l’articulation est inclinée à 45 degrés et les surfaces ne sont pas congruentes. L’ancrage, réalisé par les ligaments trapézo-métacarpiens à la base médiale du premier métacarpien, provoque une rotation selon son axe longitudinal. Il y a trois degrés de liberté. L’inclinaison médiale est accompagnée par une pronation, qui peut être obtenue avec un très faible déplacement du pouce. Tous les doigts sont plus courts que ceux des prosimiens ou ceux des platyrhiniens. Le pouce est particulièrement court. Le macaque seul a un pouce presque aussi long que celui de l’homme. Deux (sous-) familles échappent à la règle. Les Atelinae chez les Platyrhiniens et les Colobinae chez les Catarhiniens. Leur premier rayon est atrophique et immobile ; le pouce pratiquement enfoui dans l’éminence thénar.L’articulation métacarpo-phalangienne est condylienne et instable chez presque tous les primates. Cette instabilité interdit la prise de force de précision. Seul l’homme a une articulation métacarpo-phalangienne stable. Cette stabilité s’avère un facteur essentiel lors des manipulations. Son pouce est relativement long pour un catarhinien.L’ensemble des données est interprété en termes d’utilité de la mobilité pollicale lors des manipulations et de la locomotion des primates. Ces constatations permettent de pressentir les caractères primitifs de la main des primates et d’envisager une partie de l’évolution du pouce vers sa libération. Fifty one anatomical specimens were dissected and the amplitudes of the trapeziometacarpal and metacacarpophalangeal joints of 33 were measured. These amplitudes were also measured on 26 animals asleep and many other animals were observed in relative freedom or in large aviaries. 419 skeletons of primates’ hands were measured and the measures converted in percentage with regard to the length of the 3rd metacarpal, in order to compare species in spite of their difference of size (collection of the Museum of Natural History in Paris). The morphological and functional differences of the trapeziometacarpal joint and the modes of pollicidigital prehension, help arranging primates in three categories.Among prosimians, the joint is concave/convex. The concavity follows a large vertical axis. Its articular surfaces are congruent. It works like a universal joint with two-degrees of freedom. Opposition with the two last fingers is only obtained with a maximum opening of the first commissure. Very long fingers are necessary to make a pinch. The 4th finger is the longest.Among platyrhinians, the joint is also concave/convex, but either slightly oblique or a little less congruent, or of condylar type (Callitrichinae). All fingers are long, especially the 3rd. The transversal intermetacarpal ligament of the first commissure hinders its opening. There is only pseudo-opposition in Cebidae and no opposition in Callitrichinae.In catarhinians, the joint has a 45 degrees tilt and its surfaces are not congruent. The attachment of the medial trapezométacarpal ligaments at the base of the metacarpal induces a rotation around its longitudinal axis. There are three degrees of freedom. Medial inclination is accompanied by pronation, which may be obtained with a very small displacement of the thumb. All the fingers are shorter than those of prosimians or platyrhinians. The thumb is particularly short. Only Macacus has a thumb almost as long as that of man. Two (sub-) families fall outside the rule. the Atelinae among the platyrhinians and the Colobinae among the catarhinians. Their first ray is atrophic and motionless; the thumb is almost buried in the thenar eminence.The metacarpophalangeal joint is condylar and unstable in almost all primates. This instability prohibits a powerfull and accurate grip. Only the human has a stable metacarpophalangeal joint. This stability is a critical factor during handling. The thumb is relatively long for a catarhinian. All these data on the pollical mobility are useful to understand the handling and the locomotion of the primates. These observations should help finding primitive characters of the hand of primates and to reconstitute a part of the evolution of the thumb toward its liberation.

Le présent article évalue les résultats et les impacts de la modernisation administrative en Allemagne après dix ans d’expérience dans le domaine de la Nouvelle Gestion Publique. Il concerne les communes allemandes, échelon le plus avancé dans les réformes du secteur public. Recourant à une importante base de données, obtenue dans le cadre d’un projet de recherche relatif à l’évaluation de la Nouvelle Gestion Publique en Allemagne, les auteurs traitent les questions suivantes : Le secteur public allemand est-il toujours caractérisé aujourd’hui par des structures bureaucratiques classiques (« wébériennes ») ou, au contraire, les réformes ont-elles laissé des traces durables dans le sens d’une administration managérielle ? Les autorités locales sont-elles aujourd’hui plus performantes et cela peut-il être expliqué par la modernisation ? Les résultats montrent qu’aucun changement de paradigme, de la bureaucratie wébérienne vers la Nouvelle Gestion Publique, n’a eu lieu à ce jour. Malgré une plus grande performance, le nouveau mélange d’instruments de pilotage entraîne une série de conséquences non intentionnées faisant partiellement réémerger l’administration « wébérienne ». For the last ten years a New Public Management perspective has inspired public administration reforms launched in Germany, in particular at the communal level. The paper assesses their achievements and outcomes. It relies on a rich data basis collected by a research project aimed at evaluating NPM in Germany. Addressed questions are:- is the public sector in Germany still dominated by “classic” (= a Weberian type) bureaucratic structures, or have recent reform initiatives left sustainable imprints of a managerial administration structure?- are local authorities today more and better performing than yesterday, and how far is this linked to modernization initiatives?Analysis suggests that no major change of action paradigm has occurred yet. NPM has not taken over and Weberian bureaucracy still dominates. Despite higher performance levels new governance tool kits generate a series of unintended consequences that favor to some extent a return of Weberian bureaucracy.

The length of the carpus and tarsus, the metacarpus and metatarsus, the fingers and toes of 142 prosimian apes was measured. The relationship expressed as a percentage was drawn up for each individual between the length of each osseous part and that of its third metacarpal in order to eliminate the differences related to the size of the rest of the body. This ratio was compared with that of man. The characteristic variations appeared at the level of the subfamilies. CONCERNING THE HAND: The carpus presented the same values as that of man except for that of the indris, which was shorter. The thumb had proportionally the same length as that of man, sometimes longer and sometimes smaller as in the Eulemurs, Hapalidea, Megalapidea, Indrises, Daubentonia and Perodictus. The different metacarpals, including the fourth, were a little shorter than the third. In these subfamilies, the second ray was also often shorter and even much shorter in the Megalapidea and the Perodictus. The other rays were a little longer, in particular the fourth which could exceed the third in rather many subfamilies. CONCERNING THE FOOT: The length of the tarsus was extremely variable. It was twice larger in the Galagoidae, definitely larger in the tarsius and discreetly in the Hapalidae, a little smaller in the other Lemurs and much smaller in the other Prosimian apes, joining in that the near totality of the simians. The hallux was proportionally as long as that of man and sometimes even longer. The metatarsals were sometimes a little longer, sometimes less long, but always appreciably of the same length between them. The other toes were short at the aye aye (daubentonia), of which the foot appeared even smaller than that of man. The toes of the other prosimious resembled much to the fingers and in the propithecus and the perodictus, the fourth took gigantic proportions. There has been establishment of an anatomical relation and functional calculus between the length of the last three rays of the hands and the feet of prosimian apes and the biomechanics of their trapezometacarpal and their first cuneometacarpal joints.

To study the articular amplitude of the first ray of both hands and feet using passive mobilisation, either on fresh human cadavers or on living primates after anesthesia (namely eight pongidae, 15 cercopithecidae, two platirrhinii, eight lemuroidae, three daubentonidae, two loridae and two galagonidae). Plans slightly parasagittal and parafrontal have been chosen to obtain the maximum dorsal and palmar or plantar inclinations and the maximum lateral and medial inclinations. The pronosupination of the first ray has been evaluated in relation of these plans and alike for the hand of the simian primates on the plan of the concavity and the convexity of trapezial surface. The results have been compared with these obtained in the man. The pronosupination of the first ray, so denominated by analogy with the pronosupination of the fore-arm is the movement which allows the pulp of the thumb or of the hallux to look now forward or now backward in order to be opposed at the other fingers during the pollici- or the hallucidigital pinch. It can be considered like "effective" unless if there is rotation around the longitudinal axis of its metacarpus (or metatarsus). The prosimian primates had great and sensibly similar circular amplitude of their first metacarpus and first metatarsus, which reached more than 90 degrees in all the directions. It allowed a pronosupination of 90 degrees, but this was only "apparent" because it has been obtained by the alone combined action of the two orthogonal axes at the basis of the ray by simple effect of cardan joint. The anthropoids had only limited circular amplitude, not exceeding 45 degrees. It was associated with an "effective" pronosupination according to a longitudinal axis. The rotation reached 90 degrees. It was produced around the point of anchorage made up by the medial ligaments for the trapezometacarpal articulation and the lateral ligaments for the cuneometatarsal. This movement was possible because of the peculiar relief of the articular surfaces: modified cardan for the trapezometacarpal and spiraled trochoid for the cuneometacarpal joint. The man was the sole primate, which had practically no mobility at the level of the first ray of his foot. However, the morphology of his cuneometatarsal articulation was similar to that of the other anthropomorphous primates. The muscles which was inserted on the first metacarpus (or metatarsus) played an active role in the circular amplitude and in the apparent circular amplitude, but very discreet in the effective circumduction. The transversal fascicle of the short abductor of the thumb and of the hallux had a little pronator effect. At the level of the foot, the tendon of the fibular longus had an action of pronation and the abductor longus muscle an action of supination. The metacarpophalangeal and the metatarsophalangeal articulations of all the primates were condylar with laterality movements, which were able to reach 40 degrees and which were then unsteady. The metacarpophalangeal articulation of the man was the single exception. He was the sole one with a really steady thumb.

Kuhlmann Sabine, Marcou Véronique. I. La réforme politique et institutionnelle des collectivités locales allemandes : entre transformation et continuité. In: Annuaire des collectivités locales. Tome 28, 2008. Où en est la gestion locale ? pp. 189-207.

Dissection of the first ray and the connecting structures of the hand and the foot of simian primates, conserved by freezing or embalming and observation of 325 skeletal pieces of specimens of the Museum of Natural History of Paris. The trapezometacarpal articulation is a saddle joint with a trapezial concavity according to its great oblique axis directed at 45 degrees with respect to a sagittal plan for the whole of the simian primates, with a trapezoidal concavity according to a great axis directed in a sagittal plan for the loridae, the galagonidae and the daubentonidae and with a counter fort supported by a mediopalmar apophysis or a sesamoid bone for the lemurpides. The whole of the mediopalmar ligaments is inserted distally on the medial tubercle at the basis of the first metacarpus. This insertion was fibrocartilaginous for the gorilla. The mediopalmar ligaments are very more developed than the laterodorsal ligaments in all the hominidae and the catarhinious. The both groups are equivalent for the platyrhinious and the prosimious. An intracapsular ligament may reinforce the laterodorsal by the lemoridae. The cuneometatarsal articulation presents a sagittal great axis. It was in fact a spiral trochoid joint with a cuneiform convexity in all the simian primates except for the humans. In this late case, the articular surface was less high, more narrow, with less marked relief. The form of this articulation is that of a saddle with a sagittal concavity in the prosimious with a strong lateral and palmar cuneiform tuberosity and a big lateral opposite apophysis at the basis of the first metatarsus. The tendon of the long lateral fibular muscle and one fascicle of the tendon of the anterior tibialis is fixed on the both side of the basis of the first metatarsus, except for human beings in which the tendon was undivided and was principally inserted of the navicular bone. The disposition of the cuneometatarsal ligaments is similar to that of the trapezometacarpal ligaments. The distal insertions of the lateral ligaments are fibrocarlilaginous in the cerpopithecidae. All the metacarpophalangeal and metatarsophalangeal are condylar, except for the metacarpophalangeal of the humans which looks like bicondylar; the interphalangeal articulations are bicondylar. The ligamentous devices include the glenoidal and collateral ligaments with their metacarpal- and metatarsophalangeal fascicles and their interphalangeal and phalangeoglenoidal fascicles.

The carpal height, the length of the metacarpus, the metatarsus, and of all the phalanges of 269 simians were measured, then for each specimen, converted to percentage taking the 3rd metacarpus as the reference unit. They were then compared despite differences between specimens. The average values were determined for the different species, subspecies or families. Mathematical ratios were established: height of the carpus divided by the 3rd metacarpus, carpus divided by the 1st metacarpus, 1st ray of the hand divided by the 2nd, 1st ray of the hand divided by the 1st ray of the foot. CONCERNING THE HAND: For little monkeys, the length of the carpus and the medial metacarpus were similar to those observed in humans. Colobinae exhibited a relatively short thumb column. The length of the thumb was slightly shorter for the platyrrhinii and cercopithecinae, especially macacus. Some hapalidae had a relatively longer thumb than humans. All of their medial fingers were longer than those observed in humans. The big monkeys had a smaller carpus and thumb column, sometimes much smaller than in humans, with a similar length for the metacarpi and the medial fingers, except for gibbons, whose medial fingers were longer. CONCERNING THE FOOT: The 1st ray in humans is nearly as long as the 2nd toe, the other toes being very short. The 1st ray of the hallux of all monkeys was always longer than the ray of the thumb, but shorter than the hallux of humans. The other metatarsi of little monkeys were similar to those in humans, except for the platyrrhinii which had a shorter 2nd metatarsus. The lateral toes, which were much longer than in humans, were very similar to fingers though slightly longer, except for platyrrhinii with much longer toes. The big monkeys had very short metatarsi and slightly smaller lateral toes than humans.

Tumoral calcinosis is characterised by deposits of hydroxyapatite in the soft tissues. The authors report an observation of localization at the level the P.I.P. joint of a ring finger. The lesion appeared to be a subcutaneous tumour but had completely eroded the distal epiphysis of the middle phalanx. The diagnosis was made radiographically and was confirmed by histology. Calcinosis presents in two very different forms; either disseminated or localised. The localised form can invade the juxta-articular gliding spaces. It may exhibit one of two clinical courses: one is acute and diffuse. The other is chronic, localised and insidious and gives rise to tumoral masses arising near joints, but without invading them. An erosive tumoral calcinosis is exceptional. It is characterized by bony right up to the articular surfaces. At the level of the wrist and the hand, tumoral forms are rare and we could only find one other case in the literature and it was localized in the middle finger.

We looked for the anatomic origin and mechanism of constitution of the so-called "ganglions" of the wrist.Fifty-nine formations considered to be synovial ganglions were dissected and removed according to the same protocol by the same surgeon. Eleven were re-examined by a pathologist. All ganglions were extra-articular but had intra- and extra-capsular components. The extra-capsular part was the clinically palpable main cyst. The intra-capsular part was composed of the cystic stalk and its base of implantation. An intra-capsular stalk was present in 58 cases. The stalk was situated between the joint synovium and the capsula which it perforated at a weak point between two ligaments, forming a collar before expanding outwardly. Based on our findings, we propose a topographical systematization and natural history of ganglions of the wrist.The stalk's implantation base was always located on bone and found in the intermediate area of Colomniati and Soubbotine, which lies outside the articular cartilage between the synovium and the ligamentous capsula. This area is exposed to mechanical stress initiating histological degenerative lesions, particularly mucoid degeneration. At the radiocarpal joint, the stalk's base of implantation was located at the distal end of the lateral dorsal or volar edge of the lunate bone or at the corresponding part of the scaphoid. The collar of the proximal ganglions was situated between the dorsal radiocarpal and transverse scaphotriquetral ligament. The collar of distal dorsal ganglions was situated between the transverse scaphotriquetral and the trapezotriquetral ligament. The collar of the lateral ganglions was situated between the lateral collateral and the transverse ligament. The collar of the volar ganglions was situated between the stylocarpal ligament and the radiolunotriquetral ligament, or between the different stylocarpal ligaments. At the level of the scaphotrapezal joint, the stalk's base of implantation was located near the collateral edge of the distal surface of the joint with the collar between the distal scaphoidal ligaments. The palmar cysts exhibited a collar between the stylocarpal ligaments and the radiolunotriquetral ligament or between the different stylocarpal ligaments.At pathology examination, the lesions were not found to be different from those observed in other connective tissues exposed to overuse or repeated microtrauma (sports, occupational exposure). Anatomic conditions inside the joint capsula excluded extension of the mucoid degeneration transversally. The only issue was through the capsula, allowing the mucus enclosed in the connective tissue fibers to form the main cyst.Knowledge of these different processes enabled a topographical systematization useful for complete surgical or arthroscopic removal of the ganglion. Complete resection would prevent recurrence.

To correct chronic instability of the trapeziometacarpal joint, the authors reconstructs the posteromedial ligamentous complex using flaps of extensor retinaculum. Two small dorsal incisions allow harvesting free segments of extensor retinaculum detached from the proximal portion of extensor retinaculum to repair dorsal injuries when these prove to be superficial. When necessary, a clip passed via a small palmar cunter incision allows a complementary palmar reconstruction. For repair of anterior ligaments, the palmar incision can be extended and a pedicled flap derived from the retinaculum is used. There is a detailed description of technique and results.

Pronation and supination of the human thumb has both a practical and a symbolic importance. In supination the thumb caresses but in pronation it grasps. The articular surfaces of the trapezium and first metacarpal are not congruent enough in themselves to assure pronation and supination, but their reciprocal saddle shape causes them to have two distinct orthogonal "fundamental" axes of rotation, and hence two "privileged" planes of rotation. The one corresponds to the movements of the lateral pinch grip and the other to opposition and counter-opposition of the thumb. The important ligaments are situated on both sides of the trapeziometacarpal joint. The posteromedial ligamentous complex is composed of the posterior oblique ligament, the anterior oblique ligament, the intermetacarpal ligament, and a fourth or more anteromedial ligament which we have called the retinaculometacarpal ligament by reason of its proximal insertion. It plays an essential role in suspending and anchoring the base of the first metacarpal. By its action it induces two types of motion: 1) a discrete translation of the metacarpal along the articular concavity of the trapezium in lateral pinch grip; 2) a more important motion characterised by a prosupination of 90 degrees during its rotation in the plane of opposition. The anterolateral ligament's action is restricted to strengthening the action of the posteromedial ligaments in the extreme positions of closing of lateral pinch and thumb opposition. In cases of trapeziometacarpal subluxation it prevents a complete dislocation. These various observations have significant clinical and therapeutic implications.

The mediocarpal force, determined by the distal articular surface of both, lunate and triquetral bones, abuts against the double bolt, composed of the scaphoid and the radial styloid process. An important wrist trauma can rupture this bolt and cause a proximal and lateral translation of the distal carpal row. This situation may present under 3 forms: fracture of the scaphoid bone and midcarpal dissociation; fracture of the radial styloid process with scapholunate dissociation; scapholunate dissociation, associated with a dorsal radiotriquetral ligament rupture and medial translation of the lunotriquetral block. Experimental and clinical illustration of this process, discussion and treatment.

The authors report the observation of a patient, in whom coexisted a hypersolicitation of the wrists, a congenital lunatotriquetral fusion, a stress fracture of the hook of the hamate and a VISI, giving evidence of a medial carpal instability. They analyse the factors, which allow to understand the relations between these different elements. They caution against arthrodesis, advocated in the treatment of VISI.

A boxer suffered from a painful extensor digitorum brevis muscle. The pathology involved the proximal insertion on the lunate and caused a specific form of carpal instability. On excision of the muscle the pain disappeared.

After resecting the lateral collateral ligament of the knee in 56 male mature rats, the authors replaced it by an autogenous transplant of the same size, made of fascia lata, ligament or patellar tendon. The authors then studied this transplant after an evolution of 2 days to 5 1/2 months. This lapse of time can be divided into three stages: an initial stage (first week), marked by transplant necrosis and acute inflammation--an early stage (from the second to the fourth week), which shows the migration of the cells from the host to the transplant and the rebuilding of collagen fibers. Tissues with a loose, extensible, but weak texture, such as the fascia lata, are totally colonized by the fibroblasts. Tissues with a dense, strong, but less extensible texture, as the patellar tendon, are soon destroyed and recolonized at the periphery, whereas their center is destroyed and recolonized by fibroblasts later and more irregularly--a late phase of consolidation (from the second to the fifth month), which shows the rebuilding of a dense collagen network and its reorientation. In fascia lata transplants, this new collagen is homogeneous and is made of parallel bundles. In tendon transplants, the network is not homogeneous. It has a persistent nodular aspect at the periphery and well-oriented bundles, separated by calcified or granulomatous foci at the center. In the case of ligament transplants, the new collagen network shows an intermediate aspect between the two described above. The weakest regular connective tissues are the best for ligamentoplasties, and tendons are the worst.

Eleven superficial aponeuroses have been examined in order to study their biomechanical and structural properties. Specimens were taken from 5 fresh cadavers, 3 males, 2 females with a mean age between 40 and 60 years. The study was done by two methods: biomechanical and histological. Aponeuroses can be classified in 2 biomechanical and histological groups that match perfectly. The first group has biomechanical and histological properties similar to those of tendons, and the second group similar to those of tendons, and the second group similar to those of ligaments. Ignoring the biomechanical and histological properties of tendons, ligaments and aponeuroses can be the cause of failure of a number of ligament and tendon plasties. The surgeon has an important role in choosing the transplants according to the histological properties (thickness, length of structures, bundle orientation) and biomechanical properties (solidity and extensibility).

The frondiformis ligament is a part of the retinaculum extensorum of the instep. Actuated by the tendons of the extensor digitorum longus, it takes a direct effect on the talus and the calcaneum, induces the valgus of the tarsus and contributes to the stability of the ankle and the foot.

Firmly established lateral carpal instability may be practically corrected by a ligamentoplasty of the distal scaphoidal ligamentous complex. It may be entirely and definitively cured by a double ligamentoplasty of the distal scaphoidal complex and of the scapholunate ligament. Four cases with a postoperative follow-up of more than 2 years are presented.