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Resume Le collapsus carpien se definie comme une perte de hauteur du carpe. Il correspond a une desorganisation des pieces osseuses carpiennes entres elles, qui basculent les unes par rapport aux autres entrainant une dysfonction de la dynamique du carpe responsable d’une usure cartilagineuse progressive. Cette arthrose provoque des douleurs et un enraidissement du poignet qui prend un aspect « empâte ». On differencie deux grands groupes de collapsus carpiens : ceux qui resultent d’une anomalie de depart intracarpienne, qu’il s’agisse d’un cal vicieux, d’une pseudarthrose, d’une arthrose microcristalline ou d’une lesion ligamentaire et ceux qui resultent d’une desorientation radiocarpienne consecutive a un cal vicieux du radius que l’on appelle « collapsus carpien d’adaptation ». Ces derniers modifient l’orientation de la surface articulaire inferieure du radius auquel le carpe s’adapte en se reorientant avec une perte de hauteur. Une fois au stade de collapsus, il est important d’en connaitre l’origine pour adapter au mieux la prise en charge therapeutique et apprecier le pronostic. Cette demarche diagnostique retrospective necessite de connaitre quelques caracteristiques anatomiques des structures osteoligamentaires carpiennes ainsi que le mode d’analyse radiologique de l’orientation et de la hauteur du carpe. L’evolution des arthroses par collapsus carpien est alors previsible et stereotype en fonction de leurs causes et differents traitements sont envisageables en fonction du stade evolutif. Le traitement initial de la lesion a l’origine du collapsus reste toutefois le plus a meme d’eviter le recours a un traitement palliatif en general seul possible aux stades evolues.

Purpose We report a series of 5 patients (mean age, 41 y) presenting with ulnar styloid impingement syndrome (USIS) and treated by an oblique ulnar styloid osteotomy. The purpose of the study was to determine whether the osteotomy is an effective method for treating USIS. Methods The diagnosis of USIS was made based on a history of ulnar-sided wrist pain supported by clinical and radiological findings. Clinical assessment included provocative tests to differentiate USIS from pain associated with ulnocarpal impaction syndrome. The ulnar styloid length was assessed with a posteroanterior X-ray using the methods of Garcia-Elias and Biyani. The ulnar styloid was deemed excessively long if the ulnar styloid process index was greater than 0.21 or if the overall styloid length was greater than 6 mm. Ulnar variance was recorded. All wrists were assessed by computed tomography arthrography and magnetic resonance imaging studies to rule out any associated soft tissue abnormalities, including ligamentous injuries. Preoperative and postoperative pain levels were recorded using a pain scoring system. Results Patients were followed up for a mean of 46 months. Before surgery, the mean styloid length was 10 mm, and the ulnar styloid process index was 0.32. The reported pain score was significantly reduced following surgery and all patients, except one, returned to premorbid levels of activity. Conclusions Oblique ulnar styloid osteotomy is an effective means of relieving impaction of the ulnar styloid while preserving the integrity of the intrinsic ulnar styloid ligaments. Type of study/level of evidence Therapeutic IV.

Percutaneous local ablation of osteoid osteoma has largely replaced surgery, except in the small bones of the hands and feet. The objective of this study was to describe the technical specificities and results of computed tomography (CT)-guided percutaneous laser photocoagulation in 15 patients with osteoid osteomas of the hands and feet. We retrospectively examined the medical charts of the 15 patients who were treated with CT-guided percutaneous laser photocoagulation therapy at our institution between 1994 and 2004. The 15 patients had a mean age of 24.33 years. None of them had received any prior surgical or percutaneous treatment for the osteoid osteoma. The follow-up period was 24 to 96 months (mean, 49.93). The pain resolved completely within 1 week. Fourteen patients remained symptom-free throughout the follow-up period; the remaining patient experienced a recurrence of pain after 24 months, underwent a second laser photocoagulation procedure, and was symptom-free at last follow-up 45 months later. No adverse events related to the procedure or to the location of the tumor in the hand or the foot were recorded. CT-guided percutaneous laser photocoagulation is an alternative to surgery for the treatment of osteoid osteomas of the hands and feet.

The high demands placed on the upper extremity in athletic ball sports make the hand susceptible to a great variety of injuries. Fractures of the metacarpals frequently result in lost time off play and altered playing performance. Mechanisms of injury usually involve low-energy forces, resulting in simple fracture patterns and minimal soft tissue injury. With the increasing demands of today’s society and the financial significance of professional athletes’ performance and playing time, the physician may be pressured to alter management of hand fractures in the athlete. The physician should have a variety of methods available to him or her and make treatment decisions that keep the patient’s overall athletic career and future hand performance in mind [1].

We present a 5-year follow-up of a patient with bilateral necrosis of the trapezoid that improved clinically and radiographically with nonoperative treatment.

Background Compression of the median nerve by a tumour in the elbow and forearm region is rare. We present a case of neuropathy of the median nerve secondary to compression by giant lipoma in the proximal forearm. Case presentation A 46-year-old man presented with a six month history of gradually worsening numbness and paresthesia on the palmar aspect of the left thumb and thenar eminence. Clinical examination reveals a hypoaesthesia in the median nerve area of the left index and thumb compared to the contralateral side. Electromyography showed prolonged sensory latency in the distribution of the median nerve corresponding to compression in the region of the pronator teres (pronator syndrome). Radiological investigations were initially reported as normal. Conservative treatment for one month did not result in any improvement. Surgical exploration was performed and a large intermuscular lipoma enveloped the median nerve was found. A complete excision of the tumour was performed. Postoperative revaluation the X-ray of the elbow was seen to demonstrate a well-circumscribed mass in the anterior aspect of the proximal forearm. At follow-up, 14 months after surgery, the patient noted complete return of the sensation and resolution of the paresthesia. Conclusion In case of atypical findings or non frequent localization of nerve compression, clinically interpreted as an idiopathic compression, it is recommended to make a pre-operative complementary Ultrasound or MRI study.