Metaphyseal and physeal fractures of the distal radius are common in children. Most cases are bes... more Metaphyseal and physeal fractures of the distal radius are common in children. Most cases are best treated with closed reduction and cast immobilization. Long-term outcomes of these injuries are excellent when specific treatment principles of reduction and casting are followed. Surgical indications are limited and include open fractures, intra-articular fractures, non-reducible fractures, unstable fractures, and the presence of associated nerve injury. Closed reduction and percutaneous pin fixation is the most commonly used surgical option. The clinician should be aware of delayed complications such as growth disturbance of the distal radius, and understand how to manage these problems to ensure successful long-term outcomes. Epiphysiodesis is uncommon but growth plate injuries need to be followed for one year.
Introduction: The Percutaneous Needle Aponeurotomy (PNA) is a known and validated non-surgical tr... more Introduction: The Percutaneous Needle Aponeurotomy (PNA) is a known and validated non-surgical treatment for Dupuytren's disease with a low rate of complications. Initially described for purely palmar forms, the indications extended to digital adhesions. Numerous surgeons remain hesitant about performing the PNA for digital treatment because of the risk of lesions in the noble structures. In literature, one complication is still rare, even non-existent, i.e. the tendon rupture. Case presentation: We are reporting here the case of a rupture of the deep common flexor tendon, secondary to a needle aponeurotomy, for a recurring digital form in a 72-year-old woman. We performed surgical treatment by tenodesis of the distal stump and resection of the proximal stump. The result was satisfactory. Conclusion: The purpose of describing this case is to report this rare complication leading to surgical revision. Within our team, we do not recommend performing PNAs for digital cases, and even less so for recurrences. For those who wish to perform the PNA, they need to know some technical artifices that enable these complications to be reduced, albeit not eliminated.
EMC - Técnicas Quirúrgicas - Ortopedia y Traumatología, 2011
Los traumatismos osteoligamentarios recientes del carpo abarcan un amplio espectro de lesiones qu... more Los traumatismos osteoligamentarios recientes del carpo abarcan un amplio espectro de lesiones que suelen afectar a pacientes jovenes como resultado de traumatismos de alta energia. La lesion osea pura mas comun es la fractura del escafoides. Las lesiones ligamentarias estan representadas basicamente por la disociacion escafosemilunar y la luxacion perisemilunar del carpo. En la practica, el diagnostico suele ser dificil y tardio, y las lesiones son a menudo mixtas: ligamentarias y oseas. El tratamiento es con frecuencia quirurgico: debe ser preciso y ha de estar dirigido a reparar las lesiones oseas y ligamentarias en la misma intervencion, con aplicacion de las nuevas tecnicas de miniosteosintesis, artroscopia y cirugia percutanea. El objetivo terapeutico es doble: restaurar la funcion (movilidad, falta de dolor) y prevenir la aparicion de la artrosis postraumatica. La preocupacion principal es la evolucion espontanea inevitable hacia la artrosis (muneca SLAC, acronimo ingles de colapso avanzado escafosemilunar, y muneca SNAC, acronimo de colapso avanzado con seudoartrosis del escafoides). El pronostico de estas lesiones, sobre todo si se presentan combinadas, suele ser grave, debido a las secuelas habituales: rigidez, dolor, artrosis, etc.
Sensory changes are common manifestations of nerve complications of carpal tunnel surgery. Divisi... more Sensory changes are common manifestations of nerve complications of carpal tunnel surgery. Division or contusion of a superficial communicating branch between the median nerve and the ulnar nerve, the communicating branch of Berrettini, can explain these symptoms. The aim of this study was to describe the potential value of high-resolution sonography to examine this branch. We conducted a study on eight fresh cadaver hands. An ultrasound assessment of the communicating branch of Berrettini, accompanied by an injection of methylene blue, was performed by a senior radiologist. Subsequent dissections confirmed that the eight guided ultrasound injections allowed the methylene blue to be placed around the origin and termination of the communicating branch of Berrettini. This study extends the limits of ultrasound both in the postoperative diagnosis of potential nerve complications and its possible use in ultrasound-guided carpal tunnel release.
Author Contributions CYKT researched literature, was involved in protocol development, gaining et... more Author Contributions CYKT researched literature, was involved in protocol development, gaining ethical approval, patient recruitment, radiographic measurements, data analysis and wrote the first draft of the manuscript. BF was involved in radiographic measurements. BKKF conceived the study was involved in protocol development, patient recruitment and advice in the manuscript. MFWM was involved in protocol development, patient recruitment and advice in the manuscript. All authors reviewed and approved the final version of the manuscript.
L’anastomose de Berrettini (BCB) est une branche communicante sensitive entre le nerf ulnaire et ... more L’anastomose de Berrettini (BCB) est une branche communicante sensitive entre le nerf ulnaire et median a la main participant a l’innervation du 3e et 4e doigt. Son rapport etroit avec le retinaculum des flechisseurs la predispose aux lesions iatrogenes lors des chirurgies du canal carpien, notamment endoscopiques. Les lesions de cette branche ont une expression variable et sont donc difficiles a reconnaitre, surtout si on ignore son existence. Une bonne connaissance de cette branche et des zones de dangers est primordiale avant toute chirurgie du canal carpien. Nous avons realise une etude anatomique sur 50 mains de cadavres frais dans le but de decrire cette branche, de definir sa zone de danger. Nous avons trouve une incidence de 92 % de l’anastomose de Berrettini. Elle etait issue dans 90 % des cas du nerf ulnaire (type I de Meals et Shanner) et innervait le bord radial du 4 et le bord ulnaire du 3. Elle etait en rapport etroit avec le bord distal du retinaculum des flechisseurs...
Introduction: The Percutaneous Needle Aponeurotomy (PNA) is a known and validated non-surgical tr... more Introduction: The Percutaneous Needle Aponeurotomy (PNA) is a known and validated non-surgical treatment for Dupuytren’s disease with a low rate of complications. Initially described for purely palmar forms, the indications extended to digital adhesions. Numerous surgeons remain hesitant about performing the PNA for digital treatment because of the risk of lesions in the noble structures. In literature, one complication is still rare, even non-existent, i.e. the tendon rupture. Case Presentation: We are reporting here the case of a rupture of the deep common flexor tendon, secondary to a needle aponeurotomy, for a recurring digital form in a 72-year-old woman. We performed surgical treatment by tenodesis of the distal stump and resection of the proximal stump. The result was satisfactory. Conclusion: The purpose of describing this case is to report this rare complication leading to surgical revision. Within our team, we do not recommend performing PNAs for digital cases, and even le...
The present study describes the macroscopic and microscopic features of the squared ligament of t... more The present study describes the macroscopic and microscopic features of the squared ligament of the elbow (SLE). In addition, the SLE biomechanical behavior and contribution to the forearm stability were also examined. Ten forearms from freshly frozen cadavers were used for this work. Each forearm was mounted in an experimental frame for quantification of longitudinal and transverse stability. Macroscopic features and biomechanical behavior were analyzed on dynamic videos obtained during forearm rotation. Then, the SLE was harvested from the 10 forearms for microscopic analysis on histological slices stained with hematoxylin-eosin-saffron. Two main SLE configurations were identified. One in which the SLE had three distinct bundles (anterior, middle, posterior) and another in which it was homogeneous. The anterior part of the SLE had a mean length of 11.2 mm (±2.4 mm) and a mean width of 1.2 mm (±0.2 mm) while the posterior part had a mean length of 9.9 mm (±2.2 mm) and a mean width of 1 mm (±0.2 mm). Microscopic examination showed that the SLE is composed of a thin layer of arranged collagen fibers. During forearm rotation, the SLE progressively tightens upon pronation and supination by wrapping around the radial neck. Tightening of the SLE during forearm rotation provides transverse and longitudinal stability to the forearm, mainly in maximal pronation and supination. The SLE is a true ligament and provides forearm stability when it is stretched in pronation and supination.
Metaphyseal and physeal fractures of the distal radius are common in children. Most cases are bes... more Metaphyseal and physeal fractures of the distal radius are common in children. Most cases are best treated with closed reduction and cast immobilization. Long-term outcomes of these injuries are excellent when specific treatment principles of reduction and casting are followed. Surgical indications are limited and include open fractures, intra-articular fractures, non-reducible fractures, unstable fractures, and the presence of associated nerve injury. Closed reduction and percutaneous pin fixation is the most commonly used surgical option. The clinician should be aware of delayed complications such as growth disturbance of the distal radius, and understand how to manage these problems to ensure successful long-term outcomes. Epiphysiodesis is uncommon but growth plate injuries need to be followed for one year.
Introduction: The Percutaneous Needle Aponeurotomy (PNA) is a known and validated non-surgical tr... more Introduction: The Percutaneous Needle Aponeurotomy (PNA) is a known and validated non-surgical treatment for Dupuytren's disease with a low rate of complications. Initially described for purely palmar forms, the indications extended to digital adhesions. Numerous surgeons remain hesitant about performing the PNA for digital treatment because of the risk of lesions in the noble structures. In literature, one complication is still rare, even non-existent, i.e. the tendon rupture. Case presentation: We are reporting here the case of a rupture of the deep common flexor tendon, secondary to a needle aponeurotomy, for a recurring digital form in a 72-year-old woman. We performed surgical treatment by tenodesis of the distal stump and resection of the proximal stump. The result was satisfactory. Conclusion: The purpose of describing this case is to report this rare complication leading to surgical revision. Within our team, we do not recommend performing PNAs for digital cases, and even less so for recurrences. For those who wish to perform the PNA, they need to know some technical artifices that enable these complications to be reduced, albeit not eliminated.
EMC - Técnicas Quirúrgicas - Ortopedia y Traumatología, 2011
Los traumatismos osteoligamentarios recientes del carpo abarcan un amplio espectro de lesiones qu... more Los traumatismos osteoligamentarios recientes del carpo abarcan un amplio espectro de lesiones que suelen afectar a pacientes jovenes como resultado de traumatismos de alta energia. La lesion osea pura mas comun es la fractura del escafoides. Las lesiones ligamentarias estan representadas basicamente por la disociacion escafosemilunar y la luxacion perisemilunar del carpo. En la practica, el diagnostico suele ser dificil y tardio, y las lesiones son a menudo mixtas: ligamentarias y oseas. El tratamiento es con frecuencia quirurgico: debe ser preciso y ha de estar dirigido a reparar las lesiones oseas y ligamentarias en la misma intervencion, con aplicacion de las nuevas tecnicas de miniosteosintesis, artroscopia y cirugia percutanea. El objetivo terapeutico es doble: restaurar la funcion (movilidad, falta de dolor) y prevenir la aparicion de la artrosis postraumatica. La preocupacion principal es la evolucion espontanea inevitable hacia la artrosis (muneca SLAC, acronimo ingles de colapso avanzado escafosemilunar, y muneca SNAC, acronimo de colapso avanzado con seudoartrosis del escafoides). El pronostico de estas lesiones, sobre todo si se presentan combinadas, suele ser grave, debido a las secuelas habituales: rigidez, dolor, artrosis, etc.
Sensory changes are common manifestations of nerve complications of carpal tunnel surgery. Divisi... more Sensory changes are common manifestations of nerve complications of carpal tunnel surgery. Division or contusion of a superficial communicating branch between the median nerve and the ulnar nerve, the communicating branch of Berrettini, can explain these symptoms. The aim of this study was to describe the potential value of high-resolution sonography to examine this branch. We conducted a study on eight fresh cadaver hands. An ultrasound assessment of the communicating branch of Berrettini, accompanied by an injection of methylene blue, was performed by a senior radiologist. Subsequent dissections confirmed that the eight guided ultrasound injections allowed the methylene blue to be placed around the origin and termination of the communicating branch of Berrettini. This study extends the limits of ultrasound both in the postoperative diagnosis of potential nerve complications and its possible use in ultrasound-guided carpal tunnel release.
Author Contributions CYKT researched literature, was involved in protocol development, gaining et... more Author Contributions CYKT researched literature, was involved in protocol development, gaining ethical approval, patient recruitment, radiographic measurements, data analysis and wrote the first draft of the manuscript. BF was involved in radiographic measurements. BKKF conceived the study was involved in protocol development, patient recruitment and advice in the manuscript. MFWM was involved in protocol development, patient recruitment and advice in the manuscript. All authors reviewed and approved the final version of the manuscript.
L’anastomose de Berrettini (BCB) est une branche communicante sensitive entre le nerf ulnaire et ... more L’anastomose de Berrettini (BCB) est une branche communicante sensitive entre le nerf ulnaire et median a la main participant a l’innervation du 3e et 4e doigt. Son rapport etroit avec le retinaculum des flechisseurs la predispose aux lesions iatrogenes lors des chirurgies du canal carpien, notamment endoscopiques. Les lesions de cette branche ont une expression variable et sont donc difficiles a reconnaitre, surtout si on ignore son existence. Une bonne connaissance de cette branche et des zones de dangers est primordiale avant toute chirurgie du canal carpien. Nous avons realise une etude anatomique sur 50 mains de cadavres frais dans le but de decrire cette branche, de definir sa zone de danger. Nous avons trouve une incidence de 92 % de l’anastomose de Berrettini. Elle etait issue dans 90 % des cas du nerf ulnaire (type I de Meals et Shanner) et innervait le bord radial du 4 et le bord ulnaire du 3. Elle etait en rapport etroit avec le bord distal du retinaculum des flechisseurs...
Introduction: The Percutaneous Needle Aponeurotomy (PNA) is a known and validated non-surgical tr... more Introduction: The Percutaneous Needle Aponeurotomy (PNA) is a known and validated non-surgical treatment for Dupuytren’s disease with a low rate of complications. Initially described for purely palmar forms, the indications extended to digital adhesions. Numerous surgeons remain hesitant about performing the PNA for digital treatment because of the risk of lesions in the noble structures. In literature, one complication is still rare, even non-existent, i.e. the tendon rupture. Case Presentation: We are reporting here the case of a rupture of the deep common flexor tendon, secondary to a needle aponeurotomy, for a recurring digital form in a 72-year-old woman. We performed surgical treatment by tenodesis of the distal stump and resection of the proximal stump. The result was satisfactory. Conclusion: The purpose of describing this case is to report this rare complication leading to surgical revision. Within our team, we do not recommend performing PNAs for digital cases, and even le...
The present study describes the macroscopic and microscopic features of the squared ligament of t... more The present study describes the macroscopic and microscopic features of the squared ligament of the elbow (SLE). In addition, the SLE biomechanical behavior and contribution to the forearm stability were also examined. Ten forearms from freshly frozen cadavers were used for this work. Each forearm was mounted in an experimental frame for quantification of longitudinal and transverse stability. Macroscopic features and biomechanical behavior were analyzed on dynamic videos obtained during forearm rotation. Then, the SLE was harvested from the 10 forearms for microscopic analysis on histological slices stained with hematoxylin-eosin-saffron. Two main SLE configurations were identified. One in which the SLE had three distinct bundles (anterior, middle, posterior) and another in which it was homogeneous. The anterior part of the SLE had a mean length of 11.2 mm (±2.4 mm) and a mean width of 1.2 mm (±0.2 mm) while the posterior part had a mean length of 9.9 mm (±2.2 mm) and a mean width of 1 mm (±0.2 mm). Microscopic examination showed that the SLE is composed of a thin layer of arranged collagen fibers. During forearm rotation, the SLE progressively tightens upon pronation and supination by wrapping around the radial neck. Tightening of the SLE during forearm rotation provides transverse and longitudinal stability to the forearm, mainly in maximal pronation and supination. The SLE is a true ligament and provides forearm stability when it is stretched in pronation and supination.
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