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International audience; Objective: To establish international recommendations for the management of spastic equinovarus foot deformity. Design: Delphi method. Setting: International study. Participants: A total of 24 international experts (N=24) in neuro-orthopedic deformities, from different specialties (Physical and Rehabilitation Medicine physicians, neurologists, geriatricians, orthopedic surgeons, neurosurgeons, plastic surgeons). Interventions: Experts answered 3 rounds of questions related to important aspects of diagnosis, assessment, and treatment of spastic equinovarus foot deformity. Main Outcome Measures: A consensus was established when at least 80% of experts agreed on a statement Results: A total of 52 items reached consensus. Experts recommend assessing effect of the deformity on functional activities before treatment. Before treatment, it is crucial to differentiate spastic muscle overactivity from soft tissue contractures, identify which muscles are involved in the deformity, and evaluate the activity of antagonist muscles. Motor nerve blocks, 2-dimensional video analysis, and radiologic examinations are often required to complement a clinical examination. The treatment of equinovarus foot depends on the correctability of the deformity and the patient's ability to stand or walk. The preoperative assessment should include an interdisciplinary consultation that must finalize a formal agreement between physicians and the patient, which will define personalized attainable goals before surgery. Conclusion: The establishment of guidelines on managing equinovarus foot will help physicians and surgeons, specialists, and nonspecialists to diagnoses and assess the deformity and direct patients to a network of experts to optimize patient functional recovery and improve their autonomy.

Elbow flexion paralysis is one of most significant deficiencies in the upper limb. When secondary to brachial plexus palsy or nerve trunk lesions, restoration of elbow flexion by means of early nerve surgery or palliative transfers should be part of a comprehensive treatment plan. Tendon transfers are indicated in long-standing palsies, in those who are poor candidates for nerve surgery or when the results of nerve surgery are inadequate. A regional pedicled muscle transfer is performed if available. In this case, a "strong" donor is preferred (pectoralis major with pectoralis minor transfer, triceps brachii to biceps brachii transfer, or bipolar latissimus dorsi transfer). A "weak" transfer is indicated in patients who have incomplete recovery of elbow flexion (MRC 2 strength): isolated pectoralis minor transfer, medial epicondylar muscle transfer according to Steindler technique, or advancement of biceps brachii tendon on forearm. When no donor muscle is available, a free reinnervated muscle transfer may be indicated if age and nerve regeneration conditions are favorable.

The aim of our study is to describe the assessment of the upper limb in tetraplegic patients to follow his (her) neurological progression and to define the medical or surgical treatment program. We selected upper limb assessment tools and scales for tetraplegic patients described in the medical literature through a PubMed search over the last four decades. For each method, we present the implementation rules and its metrological properties, including its validity in French. We selected five clinical scales for functional evaluation of grasping, as well as four scales for evaluating the overall function of these patients. Finally, we identified three complementary precision assessment tools. The AIS (ASIA Impairment Scale) classification describes the level and the severity of the spinal cord lesion. The Giens classification is more practical for describing the upper limb in middle and low tetraplegia. Impairments can be assessed with most common generic scales and nonspecific measurement devices: range of motion, strength, sensory loss, spasticity, joint pain. Measurement of pinch and grip strength is widely used and easy to perform. The Capabilities of Upper Extremity (CUE) and the Jebsen Taylor Test are the best validated and usable scales. At a general functional level, the Spinal Cord Independence Measure (SCIM) is the most relevant scale in these patients. Motor nerve blocks, electromyography, movement analysis and echography are promising additional methods. Assessment of the upper limb of tetraplegic patients relies both on generic and specific assessment tools and scales.

Purpose Quantifying changes in shoulder external rotation range of motion and strength after lower trapezius transfer in children with obstetric brachial plexus palsy (OBPP). Methods This prospective study included five children with sequelae of OBPP, with a mean age of 6.4 years (range: 4-12 years) who underwent lower trapezius tendon transfer to restore active external rotation (ER) of the shoulder. Pre-operatively and at a 12-month follow-up assessment, we analyzed the passive and active shoulder ER, the modified Mallet score, and the shoulder rotator muscles strength using an isokinetic device. Results Clinical parameters improved significantly after trapezius transfer pre-operative passive ER from -8° (range: -20-0°) to 37° (range: 15-50°) (p = 0.035), the modified Mallet score from 13 (range: 10-15) to 18 (range: 17-19) (p = 0.035). Strength testing revealed improved ER muscle strength in all five cases; the mean Peak Torque increased from 1.95 to 4.46 N·m, albeit non-significantly (p = 0.062). Two patients exhibited a winged scapula post-operatively. Conclusion Lower trapezius transfer seems encouraging to restore shoulder external rotation in OBPP children but with non-significant strength improvement. Trial registration 18/07/31/5783, December 22, 2018.

Resume Les tumeurs de la main representent une problematique tres frequente en chirurgie de la main. Ces lesions sont le plus souvent benignes mais les lesions malignes sont parfois de presentation atypique et de decouverte tardive, trop souvent au decours d’une prise en charge inadaptee. Afin d’optimiser la prise en charge des tumeurs de la main et de limiter les erreurs de traitement ou de diagnostic, nous proposons dans ce travail de presenter les grands principes diagnostiques et therapeutiques et les tableaux cliniques les plus frequents.

Resume Les patients en fauteuil representent 2 % de la population generale. Dans cette population, l’epaule assure la fonction locomotrice et presente, avec l’âge, des pathologies degeneratives, notamment de la coiffe des rotateurs (CDR). L’association epaule locomotrice et rupture de la CDR pose plusieurs questions : par quels mecanismes la propulsion du fauteuil et les transferts surchargent-ils l’epaule, et quelles en sont les specificites lesionnelles ? Elles surviennent chez des patients plus jeunes que dans le reste de la population, apres une duree d’utilisation du fauteuil assez constante, d’une quinzaine d’annees. A cote de l’atteinte classique du supra-spinatus, une extension anterieure de la CDR est la plus frequente. La presentation clinique en cas de rupture est-elle particuliere dans cette population ? L’epaule ne pouvant pas etre fonctionnellement protegee, la douleur est constante et les ruptures de coiffe asymptomatiques sont rares. Toute douleur apres 12 ans de fauteuil devra faire l’objet d’une exploration morphologique. En quoi differe la strategie therapeutique de l’epaule locomotrice ? Plus que par la classique recherche de compensations, en cas d’epaule locomotrice, la CDR devra etre preservee de toute agression locale par des gestes systematiques de recalibrage de l’espace sous-acromial et une reparation de toutes les lesions pour eviter leur extension. Faut-il craindre des resultats fonctionnels inferieurs dans cette population ? A condition de respecter une protection prolongee de la suture par une reprise des transferts uniquement apres 4 mois, et la mise en place quotidienne de mesures de protection de l’epaule, les resultats analytiques et les taux de cicatrisation sont comparables a ceux de la population generale. Par contre, les complications generales et cutanees sont plus frequentes et necessitent preventivement une prise en charge postoperatoire en centre specialise.

Surgery for trapeziometacarpal osteoarthritis after failure of medical treatment remains controversial. The aim of this study was to determine the long-term results of the MAÏA® trapeziometacarpal prosthesis (Lépine, Genay, France). This was a retrospective clinical and radiographic study of 191 MAÏA® trapeziometacarpal prostheses implanted between 2001 and 2016 from a single centre. The survival rate of the implants at the final follow-up of 12 years (range 17 days to 140 months) was 88%. Median pain score was 1/10. The median Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 20. The rate of major complications was 9% (5% dislocations and 4% loosening) with all dislocations needing revision surgery. The risk of prosthetic dislocation was highest during the first 3 years, most often related to malposition of the trapezium implant. The MAÏA trapeziometacarpal prosthesis represents a long-term solution for surgical treatment of thumb rhizarthrosis. Level of evidence: IV

The aim was to evaluate the results of radial head prostheses (RHP) in Essex-Lopresti injury (ELI) and to compare results after RHP between acute and chronic ELI. Thirty-one patients treated with RHP for ELI were selected from a multicenter retrospective series of 310 RHP, with follow-up greater than two years. Two groups were acute ELI group (n=19, average diagnosis = 5+/−9 days) and chronic ELI group (n=12, average diagnosis 8.4+/−7.1 months). RHP was associated in some cases with K-wires: during acute ELI to stabilize the distal radio-ulnar joint (n=4) or during chronic ELI with ulnar osteotomy or palliative surgery (n=4). Clinical and radiologic evaluation was performed including analysis of the complications and revisions rates, pain level, range of motion, and MEPS (Mayo Elbow Performance Score) and DASH score (Disabilities of the Arm, Shoulder and Hand). At last follow-up (71+/−38 months), survival of RHP in the acute ELI group was 84% (16/19) and 92% (11/12) in the chronic ELI group without statistically significant difference. Flexion (acute=131degrees+/−13.4 vs chronic=22+/−12.8, p=0.041) and supination (ELI=71+/−16.8 vs chronic=58+/−17.4; p=0.045) were better in acute ELI group. The DASH score was also better in the acute group (15+/−9.1 versus 24+/−15.2, p=0.048). There was more advanced stage of humero-radial osteoarthritis in the chronic ELI group (0.7+/−0.5 versus 1.4+/−0.6, p=0.041). RHP in acute ELIs provide better clinical results, although RHPs are part of the therapeutic arsenal to treat chronic ELI.

Resume Introduction L’omarthrose avant l’âge de 50 ans est rare et sa prise en charge delicate. Si le traitement choisi est une prothese d’epaule, les risques evolutifs a long terme, plutot frequents avec un fort taux de revision, rendent l’indication discutable chez un patient jeune et actif. Le but de cette etude etait de connaitre les caracteristiques epidemiologiques des arthroses du patient de moins de 50 ans et d’evaluer les resultats cliniques des alternatives therapeutiques proposees. Hypothese L’hypothese principale etait qu’un traitement non chirurgical bien conduit pouvait retarder la mise en place d’une prothese. L’hypothese secondaire etait qu’une prothese totale anatomique restait le traitement a privilegier en cas d’echec des autres traitements. Materiels et methodes Il s’agit d’une etude multicentrique retrospective incluant les arthroses primitives (AP) ou post-instabilite (API) chez les patients âges de 50 ans ou moins au debut des symptomes. Ont ete exclues les arthroses post-traumatiques, les polyarthrites rhumatoides et les necroses. Ont ete inclus 266 patients (273 epaules) issus de 13 centres specialises dans la chirurgie de l’epaule. Deux traitements non chirurgicaux (28 PRP et 88 viscosupplementations), 73 arthroscopies et 150 protheses dont 62 hemiarthroplasties humerales (10 « hemi-metal », 24 « hemi-pyrocarbones », 28 hemi-resurfacages), 77 protheses totales anatomiques et 11 protheses inversees ont ete analyses. Le recul minimum etait de 12 mois pour le traitement non chirurgical, et de 24 mois pour les patients ayant beneficie d’une arthroplastie, certains ayant eu deux types de traitements. Les criteres d’evaluation suivants etaient analyses : score de Constant, Subjective Shoulder Value (SSV) et le nombre de complications/revisions. Resultats L’âge moyen au moment de la prise en charge etait de 43 ans (23–65), avec une predominance masculine (75 %). Le debut des symptomes etait plus precoce pour les API que pour les AP : 36 vs. 39 ans (20–50). PRP et viscosupplementation permettaient de retarder de 3,5 ans la pose d’un implant dans 86 % des cas et l’arthroscopie dans 56 %. La limitation de la RE1 etait le facteur le plus pejoratif. Au recul moyen de 74 mois pour les hemiarthroplasties et de 95 mois pour les protheses totales anatomiques, le score de Constant moyen etait significativement inferieur pour les hemiprotheses (56 vs. 67 ; p = 0,004), avec un taux plus eleve de complications (31 % vs. 11 % respectivement) et de changements de protheses (13 % vs. 9 % respectivement). Discussion/Conclusion PRP, viscosupplementation et arthroscopie peuvent retarder la mise en place d’une prothese avant que l’epaule ne devienne raide et douloureuse. En cas d’echec, la prothese totale anatomique reste la solution la plus efficace a moyen terme. Niveau d’evidence IV a, Therapeutic Studies - Investigating the Results of Treatment.

Background In palliative surgery on the distal radio-ulnar joint (DRUJ), ulnar head resection and the Sauve–Kapandji procedure are often followed by instability and radio-ulnar convergence. The objective of this study was to evaluate the stability of the DRUJ after modified matched distal ulnar resection performed alone or with partial or complete wrist arthrodesis. Hypothesis A modification of matched distal ulnar resection, consisting in reconstruction of the sixth compartment and dorsalisation of the extensor carpi ulnaris, minimises these complications, regardless of the cause and associated procedures. Patients and methods A single-centre retrospective study was conducted in 46 patients (50 wrists) who underwent modified matched distal ulnar resection. The 50 wrists fell into three groups: total wrist arthrodesis according to Millender, n = 21 (TWA group); radius to proximal row arthrodesis, n = 17 (RPRA group); and isolated matched distal ulnar resection, n = 12 (IMDUR group). Seventy per cent of patients had rheumatoid arthritis. Each patient underwent a clinical and radiographic assessment, with an analysis of radio-ulnar convergence, DRUJ stability, and ulno-carpal impingement, as well as of ulnar translation of the carpus in the IMDUR group. Results After the mean follow-up of 8.2 ± 5.4 years, 62% of patients were pain-free, with a mean VAS pain score of 1.3 ± 2.1, and 90% of patients said they would have the procedure again. Clinical and radiographic instability due to excessively proximal resection was noted in 2 (4%) wrists, of which 1 required repeat surgery. Ulno-carpal impingement due to excessively distal resection occurred in 2 (4%) wrists. No significant ulnar translation of the carpus was noted in the IMDUR group (DiBenedetto: 0.011 ± 1.9). Range of motion was similar in the three groups (mean pronation = 77 ± 17°; and mean supination = 79 ± 8°) (p > 0.05). Mean grip strength was 85 ± 35% compared to the other side. Discussion Our modification of matched distal ulnar resection minimises the complications specific of other ulnar head resection techniques or of the Sauve–Kapandji procedure, namely, radio-ulnar convergence and DRUJ instability. Level of proof IV; retrospective comparative study.

Resume Introduction Dans le cadre des lesions traumatiques du plexus brachial, l’obtention d’une epaule mobile, stable et forte fait partie des objectifs prioritaires. Les arthrodeses scapulo-humerales (ASH) restent principalement utilisees en complement ou apres echec d’une chirurgie nerveuse initiale. Notre objectif etait de comparer les resultats obtenus au niveau de l’epaule apres chirurgie nerveuse directe (CND) ou ASH dans les paralysies supra-claviculaires traumatiques du plexus brachial. Hypothese Les ASH, consideree comme un traitement palliatif, peuvent etre considerees comme une alternative therapeutique aux CND. Materiel et methodes Cinquante-huit patients, d’âge moyen 24 ans, ont ete retrospectivement inclus avec un recul minimum de 2 ans. Vingt patients ont fait l’objet d’une neurotisation du nerf spinal accessoire partiel sur le nerf supra-scapulaire (groupe CND) et 38 patients d’une ASH. Nous avons evalue les mobilites de l’epaule, la force musculaire isometrique et le score DASH. Resultats Le recul moyen etait de 46 mois (24–156). Il n’existait pas de difference statistiquement significative entre les deux groupes concernant les mobilites de l’epaule. La dispersion des donnees etait statistiquement plus importante dans le groupe CND que dans le groupe ASH en antepulsion (p = 0,0011), abduction (p Conclusions Nos resultats contrastent avec ceux classiquement admis selon lesquels la neurotisation du nerf supra-scapulaire permettrait l’obtention de meilleurs resultats cliniques que les ASH. Nous n’avons pas retrouve cette superiorite dans la presente etude. Les differences de dispersion des donnees indiquent que la chirurgie nerveuse procurerait des resultats imprevisibles et heterogenes en opposition avec l’ASH qui procurerait des resultats modestes, mais homogenes et predictibles. Niveau de preuve IV, etude retrospective, serie clinique.

To evaluate the clinical outcome of lateral clavicle malunion treated with all-arthroscopic coracoclavicular (CC) stabilization.Retrospective, case series.Department of hand and upper extremity surgery, university hospital center.Forty-five patients with unstable and displaced lateral clavicle fracture treated between January 2015 and August 2019 were included in the study.Closed reduction and arthroscopic CC stabilization using cortical buttons.Shoulder pain and active motion. Patient-reported outcome measures included the Constant score, the Subjective Shoulder Value, the AcromioClavicular Joint Instability score, and the Specific AcromioClavicular Score. Radiographic evaluation assessed bony union and malunion.Mean duration of follow-up was 25 months (12-60 months). Five patients (11%) had lateral clavicle nonunion and 7 (16%) had lateral clavicle malunion (5 in the coronal plane and 2 in the axial plane). Lateral clavicle malunion did not significantly affect clinical or functional outcomes (P0.05). Mean active shoulder motion was forward flexion 163 degrees (SD 28), abduction 162 degrees (SD 26), and external rotation 63 degrees (SD 21). On average, the patients scored 88.3 (SD 17.7) in the Constant score, 90% (SD 12) in the Subjective Shoulder Value, 88.8 (SD 9.4) in the AcromioClavicular Joint Instability score, and 11.4 (SD 8.5) for SACS. The overall complication rate was 38% (including 7 malunions, 5 nonunions, 2 adhesive capsulitis, and 3 button malpositions).Closed reduction and internal fixation of lateral clavicle fracture with all-arthroscopic CC stabilization using cortical button potentiates bony union but may generate lateral clavicle malunion, which does not affect the clinical or functional outcome. This result can be attributed to CC ligament healing and acromioclavicular joint congruence. All-arthroscopic CC stabilization is a minimally invasive but demanding surgical alternative for managing unstable and displaced lateral clavicle fracture.Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

There is no "gold standard" for the type of plate to be used for distal extra articular humeral fractures; the most used is plating of each column. The objective was to evaluate the short-term clinical and radiological results of a Y- anatomical and innovative locking plate (YALP).The hypothesis is: this anatomical and innovative locking plate will produce satisfactory and reliable results on extra-articular distal humerus fracture superior to double plate fixation.In a retrospective observational multicenter study, all patients with a distal humerus fracture type 13 A2.2 according to AO classification fixed with a new Y-plate (YALP) were compared to the results of double plate fixation for the same type of fracture. With a follow-up of more than 12 months, the objective and subjective clinical elbow criteria as well as the overall function of the upper limb and radiological assessment were collected.With an average follow up of 24 ± 11 months, 26 patients met the inclusion criteria and received a YALP and 24 patients received double plate. All patients whose fracture had healed except one were pain-free (mean VAS 0.3 ± 0.6). All patients had good subjective results (mean SEV 96% ± 4). Elbow function was excellent (mean total MEPS 96 ± 4) with normal triceps strength (23/24 patients had a triceps strength graded 5/5 and one patient 4/5) and range of motion (flexion 139 ± 8, extension -7 ± 8 and pronosupination greater than 155 degrees). The operating time was shorter in the YALP group (84+/-23 minutes versus 97+/-28 minutes, p=0.03). The double plate group had more complications; The overall complication rate was significantly higher (p=0.02) in the double90-degree plate group (12/24, 50%) with four nonunions, four symptomatic ulnar nerves, three hardware removals for pain and one radial nerve injury versus 5/26 complications (19%, p=0.02) in the Y-plate group : one iliac graft for nonunion, 1 plate removal due to functional discomfort, 1 twisted YALP, 1 broke interfragmentary screw and one symptomatic ulnar nerve. DASH, SEV, MEPS scores and flexion-extension range were better in the YALP group Discussion: YALP produces satisfactory results in supracondylar fractures of the distal humerus. The results of YALP appear to be better than the results with two 90 plates for the same fracture type with a shorter operative time and easier management of fractures with proximal diaphyseal extension.III; Case control study.

Total wrist arthrodesis in severe wrist flexion deformities (greater than 60°) due to spasticity represents a valid therapeutic option. It aims to improve the hand's appearance, hygiene, function and to prevent the deformity from getting worse. The objective of this study is to evaluate the clinical and anatomical results of wrist shortening arthrodesis using a classic volar plate in the dorsal position in functional surgery for central spastic hands. We conducted a single-center analysis of a series of patients who underwent this shortening arthrodesis. The review at a minimum 1-year follow-up included a clinical evaluation (House score, INOM score, patient satisfaction and complications), and anatomical evaluation (arthrodesis position, bone healing and carpometacarpal arthropathy). Twenty-eight patients with a mean age of 40.6 years (18-74) were included at a mean follow-up of 30.6 months (12-75). The fusion rate was 100%. No carpometacarpal arthropathy was noted. The mean position of the fused wrist was 11° extension and 15° ulnar tilt. There were two complications (7%): one postoperative hematoma and one case of discomfort due to impingement that required plate removal. The House score was significantly improved postoperatively (2.4 (0-5) versus 1.8 (0-4), p < 0.001), as was the INOM score (45 (12-64) versus 63 (36-84), p < 0.001). The patient satisfaction rate was 93%. The use of a simple and common material (volar plate in dorsal position) during this challenging surgery (spastic wrist contracture), provides good anatomical results and high patient satisfaction. LEVEL OF EVIDENCE: Level 4, case series, therapeutic study.

Introduction: Repeated transfers and wheelchair propulsion in patients with a neurological deficit of the lower limbs overloads the upper limbs mechanically, particularly the shoulders, which become weight-bearing. Under these conditions, arthroplasty implants are subjected to large stresses, even though this indication is controversial in such a context. We hypothesized that joint replacement in weight-bearing shoulders will relieve pain and improve range of motion, with a positive impact on function and autonomy, without increasing the complication rate relative to the able-bodied population. Materials and Methods: This retrospective study involved 13 implants in 11 patients (4 total shoulder arthroplasty, 4 hemi-arthroplasty and 3 reverse shoulder arthroplasty) who had a mean follow-up of 33.7 ± 27 months (12-85 months). The clinical assessment included active and passive range of motion, pain, Constant score, and the Wheelchair User’s Shoulder Pain Index (WUSPI). Radiographs were evaluated to look for signs of loosening and scapular notching. The patients’ autonomy was evaluated through the number of transfers, means of locomotion (manual or electric wheelchair) and the functional independence measure (FIM). Two subgroups were defined based on the initial pathology: neurological shoulder or functional shoulder. Results: The 11 patients had a mean age of 64 ± 19 years (23-85 years) and were all long-term wheelchair users (electrical or mechanical). The pain level on VAS decreased from 8 ± 3 preoperatively to 4 ± 2 postoperatively (p = 0.003). The mean Constant score increased 90% from 22 ± 11 preoperatively to 42 ± 23 postoperatively (p = 0.008). The WUSPI score decreased by 73% from 80 ± 30 to 21 ± 15 (p = 0.001). The range of motion improved in the subgroup of patients with functional shoulders but not in the subgroup of patients with neurological shoulders. The means of locomotion was altered in five patients (63%) by the acquisition of an electric wheelchair, but with no significant change in the number of daily transfers. There were no radiographic signs of implant loosening at the final assessment. Two implants had to be revised: one anatomical prosthesis was converted to a reverse configuration because of a secondary rotator cuff rupture; one case of early infection required a two-stage implant change. Discussion: Joint replacement in weight-bearing shoulders is an effective medium-term solution for cuff tear arthropathy and glenohumeral OA, mainly for addressing pain, with slight improvements in range of motion, depending on the initial pathology. This intervention requires lifestyle adaptations such as changes in daily transfer practices and means of locomotion. Level of evidence: IV, retrospective study.

Shoulder pain associated with tendinopathy of the long head of biceps (LHB) is common. Surgical treatment with arthroscopic tenotomy of the LHB has been shown to be effective. However, it's efficacy is inconsistent. The objective of this study was to assess the pre-operative clinical and radiological prognostic factors of arthroscopic tenotomy of the long head of biceps, and to establish a predictive score for good responses to treatment; the IBTIS score (Isolated Biceps Tenotomy Index Score).Prognostic factors representing a good response to treatment of LHB tendinopathy by arthroscopic tenotomy exist.We conducted a retrospective monocentric study including 64 patients who underwent surgery of the LHB by arthroscopic tenotomy (with or without tenodesis) between January 2018 and March 2020. We identified 2 patient groups (good responder group and poor responder group) from a 3-month post-operative clinical assessment, which included a subjective assessment comprising Single Shoulder Value (SSV), Constant score, C-Test, and pain level. Prognostic factors of a good response were then sought from the 2 groups using interviews, clinical examinations and pre-operative imaging. Based on these findings, a predictive score for a good response was established.All evaluation criteria demonstrated post-operative improvement: mean SSV (72.2 vs 50.7; p0.001), relative constant (78.2 vs 64.3; p0.001), pain level (3.2 vs 7; p0.001) and C-Test (94.1 vs 85.6; p=0.07). 34 patients (58.6%) were considered good responders, while 24 patients (41.38%) were considered poor responders. There was a trend towards a favourable result for: age65 years (p=0.01), rotator cuff rupture on preoperative imaging (p=0.01), Cross Arm Test (p=0.02), nocturnal pain (p=0.08), Yergason's test (p=0.16) and Speed's Test (p=0.22). Manual labour appeared to be an unfavourable factor (p=0.07). These factors were incorporated into the 10-point IBTIS score. A score greater than 5 was associated with a favourable result in more than 80% of patients (p0.001).Our score consists of 7 items. We identified 7 pre-operative prognostic factors for a good result after LHB tenotomy. Over 65 years of age was found to be statistically significant in univariate analysis, as was visualization of rotator cuff rupture on pre-operative imaging. The Cross Arm Test was included given its high statistical significance. The Speed's Test and Yergason's Test are ubiquitous in the literature. Nocturnal pain was found in more than 80% of patients. Undertaking manual labour represented an unfavourable prognostic factor after arthroscopic surgery of the LHB.The IBTIS score (Isolated Biceps Tenotomy Index Score) is a pre-operative clinico-radiological score for the surgical treatment of arthroscopic tenotomy of the long head of biceps. Further studies are required to validate its prognostic accuracy.III; case-control.

Background No surgical management is better than another regarding functional recovery for trapeziometacarpal joint osteoarthritis. Metacarpophalangeal (MCP) hyperextension, directly due to the shortening of thumb height, appears to be a factor of poor prognosis. Hypothesis MCP hyperextension can be corrected by implantation of a trapeziometacarpal prosthesis (TMP), as opposed to trapeziectomy and ligamentoplasty (TL), and pinch strength is greater with TMP in this indication. Material and methods Sixty-nine patients (41 TMP and 28 TL) were retrospectively evaluated. The following were evaluated: pain, mobility of the metacarpophalangeal joints, palmar grip and pinch strength. Thumb height was measured on radiographs as a post/preoperative ratio. Results The mean follow-up was 20 months (6–38). The TMP group showed greater reduction of the metacarpophalangeal hyperextension in all hyperextension groups, especially hypertension >30°, compared with TL. The TMP group provided significant greater pinch strength in all the subgroups with preoperative MCP hyperextension. Patient with postoperative MCP hyperextension had a significant lower grip and pinch strength compared with patient without MCP hyperextension. Radiographic analysis showed that thumb height changes were related to the degree of preoperative hyperextension. Postoperatively, patients with postoperative MCP hyperextension had a significant lower thumb height than patient without MCP hyperextension. Discussion Metacarpophalangeal hyperextension appears to be a factor of poor prognosis for surgical treatment of trapeziometacarpal osteoarthritis when it is not managed. TMP provides better metacarpophalangeal stabilization by restoring thumb length and would avoid surgery on the metacarpophalangeal joint. TMP may be recommended in patients having symptomatic trapeziometacarpal joint osteoarthritis and MCP joint hyperextension. Level of evidence III, retrospective observational case control study.

Perilunate dislocations and fracture-dislocations are severe injuries that often have serious functional sequelae. Our goal was to evaluate the long-term clinical and radiological results of these perilunate injuries, and to look for prognostic factors of a poor clinical outcome.All patients who suffered perilunate injuries in their wrist have functional sequelae and long-term radiographic changes despite optimal treatment with anatomical surgical reduction.We did a single-center, retrospective study of 32 patients who had either an isolated perilunate dislocation (n=7) or fracture-dislocation (n=25) in their wrist. Pain, range of motion, strength and functional scores (MWS, PRWE, QuickDASH) were evaluated. Radiographs were analyzed to look for signs of osteoarthritis or carpal instability.The mean follow-up time was 9.9years (3.5-24). The wrist joint had a mean flexion-extension of 86° (0-140), radioulnar deviation of 38° (0-65) and pronosupination of 153° (120-180). The mean grip strength was 35kg (5-56). The mean MWS, PRWE and QuickDASH scores were 65/100, 32/100 and 29/100, respectively. At the final assessment, 23 patients (79%) had radiographic signs of osteoarthritis while 5 patients (16%) had residual carpal instability. Three patients subsequently underwent palliative treatment. Opening the carpal tunnel and the magnitude of the lunate's displacement are significant predictors of a poor long-term functional outcome (p0.05). Older age at the time of injury was a predictor for the development of osteoarthritis.Despite optimal treatment, perilunate dislocations and fracture-dislocations at the wrist cause functional sequelae such as pain, stiffness, strength deficit and posttraumatic arthritis in nearly 80% of patients. The functional outcomes are determined by the amount of lunate displacement (stage) and the patient's age. We do not recommend opening the carpal tunnel, even when signs of median nerve compression are present; reducing the dislocation helps to relieve the neurological symptoms.IV; retrospective observational study.

International audience; No abstract available

Resume Introduction Dans la chirurgie palliative de l’articulation radio-ulnaire distale (RUD), resection de tete ulnaire et intervention de Sauve-Kapandji sont frequemment compliquees d’instabilite et de convergence radio-ulnaire. L’hypothese est que les resultats de la resection oblique basse de l’ulna selon Watson modifiee avec reconstruction du plancher du 6e compartiment et dorsalisation de l’extenseur ulnaire du carpe minimise ces complications quels que soit les etiologies et les gestes associes. Materiels Il s’agit d’une etude monocentrique retrospective de 46 patients (50 poignets) operes d’une arthroplastie RUD selon Watson modifie comportant 3 groupes : 21 arthrodeses totales du poignet selon la technique de Millender (groupe AT) ; 17 arthrodeses radius-premiere rangee (groupe ARP) ; 12 resections partielles isolees selon Watson (groupe RI). Soixante pour cent des patients avaient une polyarthrite rhumatoide. L’evaluation a ete clinique et radiographique avec analyse de la convergence radio-ulnaire, de la stabilite RUD, des eventuels conflits ulno-carpiens et du glissement ulnaire du carpe dans le groupe RI. Resultats Avec un recul moyen de 8,2 ± 5,4 ans, 62 % des patients etaient non douloureux avec une EVA moyenne de 1,3 ± 2,1 et 90 % des patients referaient l’intervention. Il y avait 4 % d’instabilite clinique et radiographique par resection trop proximale (2 cas dont 1 reopere). Quatre pour cent de conflit ulno-carpien par resection trop distale ont ete notes. Le glissement ulnaire du carpe n’etait pas significatif dans le groupe RI (DiBenedetto : 0,011 ± 1,9). Les mobilites etaient comparables entre les 3 groupes (pronation moyenne = 77 ± 17° ; supination moyenne = 79 ± 8°) (p > 0,05). La force moyenne du Grasp etait de 85 ± 35 % par rapport au cote controlateral. Discussion La technique de resection basse de tete ulnaire selon Watson modifiee permet de minimiser les complications specifiques aux autres techniques de resection de tete ulnaire ou a l’intervention de Sauve-Kapandji a type de convergence radio-ulnaire et d’instabilite RUD. Niveau de preuve IV ; etude retrospective comparative.

International audience; Thumb metacarpophalangeal instability is commonly found in conjunction with trapeziometacarpal osteoarthritis. If not corrected, it can have detrimental effects on the outcome. The authors describe the two types of metacarpophalangeal deformities - hyperextension and valgus - their pathophysiology and the surgical repair techniques available to surgeons. An algorithm for treating this instability is presented.

Morbidity is considered to be negligible in Leechavengvongs transfer (LT) of the long head of the triceps onto the axillary nerve, but the assessment methods used may lack reproducibility. We assessed triceps strength after LT objectively by the isokinetic technique, addressing the following questions: Is strength lowered after LT compared to the healthy limb? And 2) is there a good correlation between isokinetic dynamometry and subjective assessment?Isokinetic measurement shows a decrease in triceps strength at peak torque after LT compared to the healthy limb, and this morbidity is underestimated on subjective assessment.This single-center retrospective study included patients undergoing LT for axillary nerve trunk palsy between 2008 and 2020, with M5 triceps preoperatively on the British Medical Research Council (BMRC) scale. Twenty patients, with a mean age of 25±9years (range, 15-48years) were assessed at a mean 58±47months (range, 6-174months). Elbow extension strength was assessed on a standardized questionnaire, BMRC isometric test and isokinetic test on an angular course of 90° at 60°/sec and 180°/sec concentrically and 30°/sec excentrically.Strength at 60°/sec and 180°/sec concentrically and 30°/sec excentrically was significantly lower than in the healthy limb: respectively, -17Nm, -15Nm, and -16Nm, (p0.001) for a mean -23%. Loss of strength was mainly severe on isokinetic testing and mild on isometric testing. Seven patients reported contracture (35%), 12 fatigue (60%), and 3 weakness (15%). Satisfaction with extension strength was excellent or good for respectively 12 (60%) and 8 patients (40%). Triceps strength was graded BMRC M4 in 9 triceps (11%) and M5 in 11 (55%).After LT, isokinetic measurement found generally severe loss of triceps strength, but without subjective impact on everyday life.IV; retrospective study.

The aim of this study was to assess the clinical and radiographic outcomes after radioscapholunate (RSL) fusion for posttraumatic osteoarthritis. This was a retrospective, dual-center study of all patients who underwent RSL fusion between 1995 and 2015 for posttraumatic radiocarpal osteoarthritis. Patients were assessed at the final review to determine clinical (pain, wrist range of motion and strength), self-reported (QuickDASH, PRWE and MWS scores) and radiological (degenerative osteoarthritis in the scaphotrapeziotrapezoid (STT) or midcarpal joint and radiocarpal fusion) outcomes. We analyzed three groups: RSL fusion alone, RSL fusion with distal scaphoid excision (DSE) and RSL fusion with DSE and triquetrum excision (TE). Eighty-five patients were included; 10 were lost to follow-up and 11 required conversion to total wrist fusion before the final review. Finally, 64 patients had both clinical and radiographic evaluations. The mean follow-up was 9.1 years (range 1-21.4). RSL fusion alone was performed in 29 patients, RSL fusion with DSE in 23 and RSL fusion with DSE and TE in 12. At the final follow-up, the three groups did not differ in their pain or wrist motion. Overall, 47 (73%) patients were satisfied or very satisfied with the procedure. DSE significantly decreased STT osteoarthritis and radiocarpal non-union. The total wrist osteoarthritis rate after RSL fusion was 55%. RSL fusion is an effective procedure to preserve some motion in wrists with posttraumatic radiocarpal osteoarthritis. DSE prevents STT osteoarthritis by removing bony impingement and increases the fusion rate. LEVEL OF EVIDENCE: Level IV, Case series, Therapeutic studies.

Hand tumors are a very common problem in hand surgery. While these lesions are most often benign, malignant lesions often have an atypical presentation and are discovered late, very often during an inappropriate treatment. To optimize the care of hand tumors and to reduce diagnostic and treatment errors, we will review the broad diagnostic and therapeutic principles and the most common clinical presentations.

International audience; Composite-allograft reverse shoulder arthroplasties are a surgical alternative in malignant tumor reconstructions following segmental bone resection of the proximal humerus. They allow reinsertion of the rotator cuff tendons and reliable restoration of humeral height, increasing prosthetic stability and mobility. Preoperative local tumor extension assessment must be thorough and a strict surgical technique must be followed to obtain satisfactory functional results. The indications for this procedure include a strictly intraosseous tumor of the proximal humerus corresponding to an S3-S4 A resection following criteria provided by the Musculoskeletal Tumor Society as described by Enneking and colleagues in 1990. Certain conditions must question the procedure such as extended S3-S4-S5 bone resections, partial sacrifice of the deltoid muscle, preoperative deltoid impairment, and glenohumeral arthrectomy. Here, we report technical details and indications of composite-allograft reverse shoulder arthroplasty in the context of tumor segmental resection of the proximal humerus, especially in the humeral preparation.

Cardiovascular risk factors have been shown to be relevant to onset of rotator cuff tear, but their influence on healing remains to be determined.To assess the individual and cumulative impact of cardiovascular risk factors on tendon healing after arthroscopic rotator cuff repair.A single-center prospective study included 90 patients undergoing arthroscopic repair of isolated distal supraspinatus tendon tear. Only isolated full-thickness tears without anteroposterior extension, retraction (Patte stage ≤ 2) or fatty involution were included. Tendon healing was assessed on ultrasound according to the 5 types of the Sugaya classification. Clinical and functional assessment at 12 months used Constant score. Cardiovascular comorbidities were screened for in the preoperative anesthesiology consultation and control consultation: smoking, high blood pressure, dyslipidemia, diabetes, obesity, cardiovascular history, and obstructive sleep apnea syndrome.Ninety patients with a mean age of 59.6±6.95 years were included for analysis. 77.7% of cuffs showed healing on ultrasound, without signs of retear (stage 1-3), 16.6% showed partial retear (stage 4) and 6.6% showed no healing, with tendon retraction (stage 5). Mean Constant score improved by 37.5 points (p=0.001), for a global score of 78 at 12 months. Multivariate analysis identified several significant cardiovascular factors for poor healing: active smoking (p=0.002), dyslipidemia (p=0.006), high blood pressure (p≤0.001) and obesity (p=0.02). Cumulative comorbidity was associated with poor tendon healing, with significant impact as of 2 cardiovascular risk factors. Constant score decreased significantly according to healing stage (p≤0.001).The present study confirmed the involvement of cardiovascular risk factors in bone-tendon healing disorder, with significant impact as of 2 factors.IV; low-power prospective clinical series.

Objectives: Shoulder pain related to long head of biceps tendinopathy is common. Surgical treatment by arthroscopic tenotomy has proven to be effective. The objective was to evaluate the preoperative clinical and radiological prognostic factors of arthroscopic tenotomy of the long head of biceps, and to establish a predictive score of good response to treatment. Methods: We conducted a retrospective single-center study including 64 patients who underwent surgery between January 2018 and March 2020 by arthroscopic LHB tenotomy, whether or not associated with tenodesis. We identified 2 groups of patients based on a clinical evaluation 3 months postoperatively, which included subjective assessment by the Single Shoulder Value (SSV), Constant, C-Test, and pain scores: a good responder group and a poor responder group. Prognostic factors for good response were then identified in the 2 groups based on questioning, clinical examination and preoperative imaging. Based on these factors, a predictive score for a good response was established. Results: All evaluation criteria showed postoperative improvement: Mean SSV (72.2 vs 50.7; p 65 years (p = 0.01), cuff tear on preoperative imaging (p = 0.01), the Cross Arm Test (p = 0.02), night-time pain (p = 0.08), Yergason’s test (p = 0.16), the Speed Test (p = 0.22). Manual labor appeared to be a factor in an unfavorable outcome (p = 0.07). These factors were incorporated into the 10-point IBTIS score. A score above 5 was associated with a favorable outcome in more than 80% of the patients (p Conclusion: The IBTIS (Isolated Biceps Tenotomy Index Score) is a preoperative clinical and radiological score with 7 items for surgical treatment by arthroscopic tenotomy of the long head of biceps. Further studies are required to validate the prognostic accuracy.