Search

Resume La technique d’arthrodese mediocarpienne la plus utilisee dans le traitement des SNAC et SLAC wrists de grade 3 est la plaque circulaire dont la complication principale est la pseudarthrodese. Le but de notre travail etait de mettre au point une technique d’arthrodese mediocarpienne par vis-broches autocassables pour diminuer le risque de pseudarthrodese. Notre serie preliminaire comprenait dix patients. L’arthrodese a ete realisee par deux vis-broches auto-secables a double pas compressif de diametre 2 mm. Aucune greffe osseuse n’a ete utilisee. Au recul de 26,3 mois (11–44), nous avons evalue des criteres subjectifs (douleur, « Quick-DASH », reprise des activites) et objectifs (force, mobilite). Toutes les variables etaient significativement ameliorees apres l’intervention sauf la mobilite. Parmi les complications, on notait un retard de consolidation avec un bon resultat final et une consolidation radiologique. L’arthrodese mediocarpienne par voie dorsale montee par deux vis-broches a compression nous parait une technique interessante, ne necessitant pas de greffe osseuse, avec un cout raisonnable.

The treatment of traumatic partial injuries of the flexor tendons of the fingers is seldom published. The only published clinical series states that the therapeutic approach depends on the existence or absence of a preoperative trigger. We hypothesized that the therapeutic attitude mainly depends on the percentage of the injured cross-section. Our retrospective series included 36 partial lesions of 31 fingers in 29 patients. The average age was 42 years, there were 19 men. We noted 8 lesions in zones I, 21 in zone II and 2 in zone III. The average percentage of the injured cross-section was 35% and ranged from 10% to 90%. If the lesion was less than 50% (29 tendons), a tangential resection was performed. If the lesion exceeded 50% (seven tendons), a direct suture was performed, supplemented by a running suture. At a follow-up of 34 months, the average pain on a visual analogue scale was 0.7. The average percentage of strength compared to the contralateral side was 93%. The Quick DASH score was 6.2. The range of motion averaged 214° with extremes ranging from 90° to 260°. We observed no cases of hypertrophic callus, neither through the MRI nor through the ultrasonography. Complications such as trigger finger, pseudoblocage or rupture were not observed. Based on our results, in case of partial injury of a flexor tendon, we propose to perform a tangential resection in cross-section lesions up to 50%, and a suture for those which exceeded 50%.

The fixation of distal radius fractures by pinning or locking plates remains controversial. The aim of this prospective continuous study was to compare the results of 28 anterior locking plates with 23 intrafocal cross-pinning HK2(®) systems. The mean age of group I (SVP(®), SBI™ plate) was 61 years. There were 15 extra-articular and 13 articular fractures. The mean age of group II (HK2(®), Arex™) was 63 years, with 13 extra-articular and 10 articular fractures. Twelve clinical variables were measured: pain, wrist strength, supination strength, pronation strength, quick DASH score, range of wrist motion in flexion, extension, pronation, and supination, ulnar variance, radial slope, and radial volar tilt. At 40 weeks follow-up, there was no difference between the two groups for 10 variables; two variables showed differences between the two groups: mean quick DASH score was 10.7 for group I, 19.7 for group II, and mean ulnar variance was -0.95 mm for group I, and 1.16 mm for group II. Six transient complications were noted for group I: five tenosynovitis, and one carpal tunnel syndrome. We noted 12 complications in group II: four superficial infections, two secondary displacements, one pin migration, two CRPS type II, two tendon ruptures and one nerve irritation. Generally, plates provided a more stable fixation associated with less complications while the HK2(®) system was quicker and less costly. The indications for its use need to be refined with a larger series and longer follow-up.

Indication of midcarpal fusion is SNAC or SLAC wrist grade 3. The main complication of circular plate (most common technique) is non-union. In this context, the purpose of our work was to propose the use of break-away compression screws to decrease the rate of non-union. Our series included ten patients. The fusion was fixed using two break-away compression screws (2mm diameter). No bone graft was used. As assessment, subjective (pain, Quick-DASH) and objective (strength, mobility) criteria were reviewed at follow-up. All the criteria were significantly improved after operation except mobility. Among the complications, we noticed one delayed bone-healing with a good outcome and a radiological consolidation. Midcarpal fusion by dorsal approach using break-away compression screws appears to us a technique of interest, not requiring a bone graft, with good cost effectiveness.