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Primary trigger finger is a common hand disorder for which nonoperative treatment or release of A1 pulley is usually effective. For resistant or recurrent cases, there are different surgical techniques including partial or complete opening of A2 pulley, reduction tenoplasty, and resection of the ulnar slip of the flexor digitorum superficialis tendon. Here, we present our minimally invasive technique for ulnar superficial slip resection surgery. Our indications are the patients with persistent residual proximal interphalangeal joint contracture after A1 pulley release and also the recurrent cases. Then, we report the clinical outcomes of our patients operated using this technique.

Resume Introduction L’urilisation du greffon osseux, vascularise par l’artere supraretinaculaire intercompartimentale 1,2 (1,2 ICSRA), est indique pour le traitement des pseudarthroses, avec necrose du pole proximal du scaphoide, sans perte osseuse ni deformation intracarpienne. Nous decrivons un artifice permettant de derouter le greffon sous les tendons du premier compartiment des extenseurs, pour ensuite aborder le scaphoide sur sa face palmaire, afin de permettre le traitement de pseudarthroses plus distales que le pole proximal. Le but de cette etude etait d’evaluer les resultats cliniques et radiologiques des patients operes avec cette technique avec l’hypothese qu’elle permettrait de traiter des pseudarthroses plus distales. Patients et methodes Cette etude retrospective a inclus des patients presentant des pseudarthroses du tiers moyen ou distal du scaphoide traitees avec ce greffon osseux vascularise dependant de l’artere 1,2 ICSRA, apres avoir ete detourne en palmaire. L’etude a inclus les donnees epidemiologiques, les resultats cliniques et la consolidation osseuse radiologique. Les scores QuickDASH et Mayo ont ete calcules ainsi que les mobilites et la force de prehension. Resultats Dix-neuf patients ont ete suivis pendant 33 mois (extremes : 6–75 mois). Le score QuickDASH moyen postoperatoire etait de 10 (extremes : 0–45), et le Mayo Wrist score moyen etait de 85 (extremes : 50–100). La flexion et l’extension, la deviation ulnaire et radiale etaient statistiquement differentes entre les cotes operes et les cotes sains (p Discussion Cette modification technique a permis de bons resultats fonctionnels et une consolidation du scaphoide. Elle elargit les indications classiques du greffon osseux vascularise par l’artere 1,2 ICSRA pour des pseudarthroses plus distales. Niveau de preuve IV.

"Glomus tumors of the fingers. Glomus tumors of the fingers are benign lesions. The main symptom is a paroxysmal pain with particular hypersensiti¬vity to temperature changes. They are rare in their census, but there is very probably a very high rate of misdiagnosis, due to the very ignorance of their existence by the medical corpus. Their diagnosis is based on a typical clinical exami¬nation and characteristic imaging. The only treatment is their complete surgical resection, which is essential for recovery. Different surgical techniques have been described in the medical literature to achieve a painless finger without nail deformity after tumor resection, while limiting recurrences.""Tumeurs glomiques des doigts. Les tumeurs glomiques des doigts sont des lésions bénignes. Le symptôme principal est une douleur paroxystique à leur contact et au changement de température. Elles sont rares dans leur recensement, mais il existe très probablement un taux de défaut diagnostique très élevé, dû à la méconnaissance de leur existence par le corps médical. Leur diagnostic repose sur un examen clinique et une imagerie caractéristiques. Le seul traitement est la résection chirurgicale complète, essentielle à la guérison. Différentes techniques chirurgicales ont été décrites dans la littérature médicale pour aboutir à un doigt indolore sans déformation unguéale après résection tumorale, tout en limitant les récidives."

Pull-out suture fixation is widely used to fix zone one flexor tendon injuries. The original technique of Bunnell generally has good results. However, in some cases, it may result in complications, including nail deformity and infection. The all-inside techniques for fixation of the tendon at this zone cannot totally replace the Pull-out technique. In this article, we propose a modification of the pull-out technique, which can reduce the complications and report the results of our patients’ series.

Resume Contexte Les lesions du tendon du subscapularis (LSSC), puissant rotateur interne, sont souvent sous-estimees. L’objectif principal de cette etude est de confronter un index de suspicion radioclinique preoperatoire des LSSC a la realite lesionnelle arthroscopique. L’objectif secondaire est de comparer les index de suspicion du chirurgien et du radiologue pour en deduire le plus precis. Hypothese L’analyse d’une coupe d’imagerie transversale, passant sous la pointe du processus coracoide, combinee a l’examen clinique, constituerait la reference pour detecter les LSSC. Patients et methodes Cette etude est prospective sur 50 malades consecutifs, operes par arthroscopie d’epaule. En preoperatoire, quatre tests cliniques des LSSC – Lift-Off, Internal Rotation Lag Sign, Bear-Hug, Belly-Press – sont realises. Un cliche d’arthroscanner, passant sous la pointe du processus coracoide, est analyse par le chirurgien. Il en deduit son index de suspicion radiologique des LSSC, puis un index de suspicion radioclinique base sur l’examen clinique. Enfin, le chirurgien note l’index de suspicion du radiologue. Les trois index de suspicion sont compares avec la realite lesionnelle arthroscopique. Resultats L’index de suspicion radioclinique du chirurgien est similaire a son index de suspicion radiologique seul. Les deux index du chirurgien sont superieurs a l’index de suspicion du radiologue. La prevalence des LSSC etait de 58 %. Discussion Nous preconisons de multiplier les tests cliniques qui sont complementaires pour detecter une LSSC, car chacun active une partie anatomique differente du muscle. Nous conseillons aux chirurgiens de completer l’examen clinique, par l’analyse specifique de la premiere coupe d’imagerie sous la coracoide, comme cliche de reference pour le depart des LSSC. Niveau de preuve IV, etude prospective de diagnostic sur des patients consecutifs.

Volar locking plates (VLPs) are increasingly used for distal radius fractures (DRFs) with minimally invasive plate osteosynthesis (MIPO), but surgery learning curves could be long. The purpose of this study was to assess a new extra-short plate with two locking diaphyseal divergent screws, specifically designed for MIPO, preserving the pronator quadratus muscle. This retrospective study consisted of three phases: (i) the evaluation of surgical comfort with the incision size and the duration of 59 consecutive surgeries using the extra-short plate in DRFs; (ii) the verification of the implant ability to maintain radiographic indices compared immediately postoperatively and at consolidation. They included radial inclination (RI), volar tilt (VT) and ulnar variance (UV); (iii) the assessment of clinical outcomes at last follow-up through: pain measured on the visual analogue scale (VAS), QuickDASH score, patient-rated wrist evaluation (PRWE) score, grip strength, range of motion and complications. In the first phase: mean incision size was 32 mm, and mean operative time was 28.5 min. In the second phase, there was no statistical difference between the two measures of the indices studied. In the third phase, mean follow-up time was 14.2 months, VAS score was 1.1, QuickDASH score was 11.4/100, and PRWE score was 9.5/100. Flexion was 91%, extension was 94%, and grip strength was 86% compared to the contralateral side. The surgical comfort may be related to short operative time and incision. The implant allowed maintaining the radiographic indices without secondary displacement. Functional clinical outcomes were satisfactory. This extra-short plate design belongs to a novel generation of VLPs.

The sense of body ownership is being increasingly studied by manipulating incoming signals from the periphery with local anesthetics. We sought to understand how altered proprioception induced by anesthesia triggered a traumatic jersey finger, immediately postoperatively, in two patients who underwent surgical carpal tunnel release. Multiple mechanisms contributed to these postoperative injuries associated with a fall. Hand anesthesia deprives the brain of important afferent sensory information and modifies hand size perception in the brain. Moreover, it blocks efferent motor signals that contribute to the perception of hand position with sensory afferent signals. When the patients fell, their movement control was inadequate, generating a strong contraction of the hand extrinsic flexor muscles, against forceful distal phalanx extension. Lastly, both patients had removed their numb operated hand from their arm sling. Disrupted sensory and motor paths modify self-attribution of the hand, and thus halt adequate efferent commands. Protecting the operated hand until full sensory and motor control is regained could have prevented such rare accidents from happening. Level of evidence: V.

Background The bone graft vascularized by the 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) placed on the scaphoid by a dorsal approach is a technique used to treat scaphoid nonunions with avascular necrosis of the proximal pole and without significant bone loss or carpus collapse. We present the results of patients treated with a volar rerouting of the 1,2 ICSRA graft under the tendons of the first extensor compartment to treat more distal scaphoid nonunions than the proximal pole. The aim of this study was to assess the clinical and radiological outcomes of patients operated with this technique with the hypothesis that it would allow to treat more distal nonunions than those of the proximal pole. Patients and methods This retrospective study involved patients treated by a volar rerouting of the 1,2 ICSRA graft for nonunions of the middle and distal thirds of the scaphoid. Assessments included clinical outcomes and radiological bone consolidation. QuickDASH and Mayo Wrist scores were computed. Range of motion and grip strength were evaluated for both the operated and the contralateral sides. Results Nineteen patients were followed-up for 33 months (range: 6-75). Mean postoperative QuickDASH score was 10 (range: 0-45), and mean Mayo wrist score was 85 (range: 50-100). Flexion and extension, ulnar and radial deviations were statistically different between the affected and healthy sides (p Discussion This technical modification allowed good functional outcomes and scaphoid consolidation. It expands the classic indications of the vascularized 1,2 ICSRA bone graft to more distal nonunions than the proximal pole. Level of evidence IV.

Background The prevalence of subscapularis (SSC) tendon tears is often underestimated. This negatively impacts the shoulder function because the SSC muscle is a powerful internal rotator. The primary aim of this study was to compare a blended clinical and radiological preoperative index of suspicion for SSC tears to the arthroscopic findings. The secondary aim was to compare the surgeon's and radiologist's index of suspicion to determine which is more accurate. Hypothesis Analyzing a transverse image passing under the tip of the coracoid process, in combination with clinical examination, will be the standard for detecting SSC tears. Methods This prospective study enrolled 50 consecutive patients who underwent shoulder arthroscopy. Preoperatively, four clinical tests were doneto detect SSC tears: lift-off, internal rotation lag sign, bear-hug, belly-press. A CT arthrography slice passing under the coracoid process tip was analyzed by the surgeon. The surgeon deduced a radiological index of suspicion for SSC tears then a blended clinical and radiological index of suspicion based on the clinical examination. Lastly, the surgeon looked at the radiologist's findings and index of suspicion for a lesion. The three indexes of suspicion were compared with the actual arthroscopy findings. Results The surgeon's blended clinical and radiological index of suspicion was similar to his radiological index. Both of the surgeon's indexes of suspicion were higher than the radiologist's. The prevalence of SSC tears was 58 %. Discussion We recommend doing multiple clinical tests as they complement each other in detecting SSC tears, since each one activates a different portion of the muscle. We advise surgeons to supplement their clinical examination by analyzing a specific image of the tendon below the coracoid, as the reference view for the starting point of SSC tears. Level of evidence IV, prospective diagnostic study on consecutive patients.

This retrospective, single-centre study was carried out on patients with digital subungual glomus tumours. We describe a subperiosteal approach with a ‘shark mouth’ flap containing the nail plate and nail bed as a single unit, providing ideal exposure and easy access to the tumour. It combines the advantages of the transungual and lateral approaches, whether the subungual tumours are located centrally, peripherally or under the germinal matrix. The ‘shark mouth’ flap approach was used by the same surgeon in 24 patients with solitary glomus tumours of the fingers. Clinical outcomes at the early postoperative phase and at the last follow-up were satisfactory. Pain relief and wound healing were quickly achieved. No complications, such as fingertip numbness or nail deformities, were observed, and there was only one recurrence. This approach is reliable, nail-sparing and less time-consuming than other techniques. Level of evidence: IV

The palmar fracture-dislocation of the proximal interphalangeal (PIP) joint of fingers is an uncommon injury. We report a complex form in a 16-year old teenager, associating a palmar fracture-dislocation and a fracture of the base of the middle phalanx with the dorsal fragment dislocated between the neck of the proximal phalange and the palmar plate. The management was surgical with open reduction and fixation of the fragments by K-wires and temporary PIP arthrorisis. The result at 6months of follow- up after removal of the wires and physiotherapy was satisfactory. The patient was painless with a range of motion of 115°. Clinically, the sagittal and frontal stability of the joint both in flexion and extension was maintained. Osseous healing was obtained on X-ray control. The patient went back to his usual activities. A focus on palmar fracture-dislocations of PIP joint is presented through incidence, mechanism and treatment.

Introduction It was commonly considered that a non-displaced or minimally displaced isolated scaphoid fracture was mechanically incompatible with a lesion of the scapholunate ligament (SL). However, some authors who described such an association have recently challenged this statement. The aim of this prospective study was to determine, after screw fixation and using arthroscopy, the existence and incidence of lesions of the SL as associated with acute non-displaced or minimally displaced isolated fractures of the scaphoid. Methods Between December 2009 and January 2011, the study included all patients presenting with an acute non-displaced or minimally displaced isolated fracture of the scaphoid waist, eligible for percutaneous screw fixation and accepting the procedure after informed consent. The surgical protocol included a first retrograde arthroscopically controlled percutaneous screwing of the scaphoid, followed by a second arthroscopy seeking only lesions of the SL. Geissler's classification was used for the classification of SL lesions. Results Eighteen patients were included in the study. The mean was 29 years. In 17 cases, the scaphoid fracture was due to a low-energy fall, and in 1 case, to a road accident. No SL lesion was evidenced by the diagnostic arthroscopy. Conclusion Unlike some published reports, we did not observe any SL lesion associated with non-displaced or minimally displaced isolated fractures of the scaphoid. Nevertheless, despite such results and based on the literature, we recommend arthroscopy with percutaneous scaphoid screw fixation, with the triple advantage of providing reduction control, adequate screw fixation verification, and diagnosis of potential associated ligament lesions.

SummaryIn cases of non-union of the humerus with segmental bone defect, if a conventional treatment has failed, free fibular transfer should be considered as a reliable option to allow satisfactory bone union. We reported five cases of aseptic and multi-operated non-union of the humerus from trauma. In each case, a free fibular flap was performed after failure of a conventional treatment and bony union was demonstrable radiologically within six months. Some technical points such as harvesting of the fibula, humerus approach, fibula placement and fixation are highlighted in order to simplify the transfer and to standardise the technique.

Les tumeurs glomiques sont benignes, rares et retrouvees principalement au niveau de la derniere phalange des doigts, souvent en sous-ungueal. L’exerese chirurgicale complete est le seul traitement permettant le soulagement definitif des symptomes et evitant la recidive. Differentes voies d’abord ont ete decrites mais ne font pas l’unanimite. Nous proposons une voie unique avec un lambeau « en gueule de requin » (GDR) quelque soit la localisation de la tumeur, avec des resultats cliniques satisfaisants. La technique consiste en une levee en GDR d’un lambeau pulpo-ungueal jusqu’en sous-perioste. Apres exerese de la lesion et curetage de la logette phalangienne, le lambeau est repositionne et suture. L’etude clinique retrospective monocentrique a porte sur 21 malades traites par cette technique entre 2011 et 2018 par le meme operateur. Ont ete inclus uniquement les patients ayant des tumeurs solitaires, documentees par IRM. Les localisations etaient : 13 sous-ungueales, 3 matricielles et 5 laterodigitales. Les criteres d’evaluation clinique preoperatoires etaient les tests de Love's pin et Hildreth. En postoperatoire, l’EVA, le score QuickDASH, la mobitile digitale, la sensibilite peri-cicatricielle et l’aspect de la tablette ungueale ont ete etudies. En preoperatoire, le Love's Pin Test etait positif chez tous les patients et celui de Hildreth dans 64 %. En postoperatoire, l’EVA etait de 0, le QuickDASH etait de 0,2 (0–2) et les mobilites digitales etaient completes. Aucun patient n’avait de douleur cicatricielle. 2 patients avaient la meme dystrophie ungueale qu’en preoperatoire + les 19 autres n’en avaient pas. La duree du suivi moyen etait de 28,1 mois (6–77). Un patient a recidive. Notre technique peut etre generalisee aux differentes localisations digitales de tumeurs glomiques, en se limitant a une levee partielle du lambeau pour les lesions laterodigitales. Le lambeau en GDR permet d’eviter les dystrophies ungueales survenant dans les abords transungueaux et un jour excellent sur la lesion. Les patients operes ainsi ont de tres bons resultats fonctionnels, esthetiques et une indolence complete. L’abord avec le lambeau « en gueule de requin » pour les tumeurs glomiques des doigts est prometteur car fiable et reproductible. Cette lesion etant rare, notre etude est faite d’un echantillon restreint. Le recours d’autres chirurgiens a cette technique et des etudes prospectives multicentriques incluant un nombre plus eleve de malades seraient interessants pour conforter nos resultats.

The terrible triad is the combination of a posterior dislocation of the elbow, radial head and coronoid process fractures. The goal of this study is to evaluate our clinical results after medial capsulo-ligamentar plan reinsertion, radial head replacement and lateral collateral ligament reinsertion, through a lateral approach. This is a retrospective study of 13 patients with terrible triad whose radial head fracture is non-reparable, operated between 2005 and 2010. The mean follow-up was 39 months. At latest follow-up, the mean Mayo Elbow Performance Scale was 88/100, the mean Quick Dash was 23/100, and the mean Broberg and Morrey score was 93/100. The mean range of motion of the elbow was 120°. The mean flexion was 137°, and the mean extension -17°. The strength and the stability was 100%. Three complications occurred. The standard surgical technique used provided good functional outcome.

The terrible triad is the combination of a posterior dislocation of the elbow, radial headand coronoid process fractures. The goal of this study is to evaluate our clinical results aftermedial capsulo-ligamentar plan reinsertion, radial head replacement and lateral collateralligament reinsertion, through a lateral approach.This is a retrospective study of 13 patients with terrible triad whose radial head fracture isnon-reparable, operated between 2005 and 2010.The mean follow-up was 39 months. At latest follow-up, the mean Mayo ElbowPerformance Scale was 88/100, the mean Quick Dash was 23/100, and the mean Broberg andMorrey score was 93/100. The mean range of motion of the elbow was 120°. The meanflexion was 137°, and the mean extension -17°. The strength and the stability was 100%.Three complications occurred.The standard surgical technique used provided good functional outcome.