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Understanding the biomechanics of the trapeziometacarpal (TMC) or first carpometacarpal (CMC1) joint, the pathophysiology of basal thumb arthritis, the design and performance of surgical procedures require a solid anatomical basis. This review of literature summarizes the most recent data on the descriptive, functional, and comparative anatomy of healthy and arthritic TMC joints.

Introduction: Surgery that incorporates perforator flaps has developed rapidly in recent years. However, this type of surgery is hindered by anatomical variations in the location of the perforating arteries. These anatomical variations require preoperative imaging to plan the surgery properly. Through a Doppler ultrasound study of living subjects, the authors aim to map the perforators of the trapezius muscle. Materials and Methods: Doppler color ultrasound was carried out in 22 healthy volunteers over the integuments covering the trapezius muscle. Using bone landmarks (spinous process line, inferior angle and spine of the scapula), all the identified perforators were inventoried based on their location, dimensions and direction. Results: Fourteen women and eight men were included in the study. Their mean age was 25.8 years and their mean height was 1.74 meters. The average number of perforators found on each side of the spinous process line was 10.64. The mean diameter of these perforators was 0.82 millimeters. Conclusion: Preoperative Doppler ultrasound is useful for surgeons using trapezius perforator flaps, as it can accurately specify the location, diameter, trajectory of a perforator, and in a more general manner, its reliability. Keywords: Preoperative Doppler ultrasonography, Trapezius muscle, Perforator flaps, Anatomical variations.

The descriptive anatomy of the inferior epigastric, subscapular and internal thoracic vascular pedicles of domestic animals is not fully known. Improvement of our knowledge in this field could lead to better development of animal models for both pedagogical purposes and surgical experimentation. The objective of this comparative study was to describe the descriptive anatomy of the inferior epigastric, subscapular and internal thoracic pedicles in three domestic mammals commonly used as animal models for experimentation. Our study focuses on the anatomical description of these vascular pedicles in the rat (Rattus norvegicus) (n=1), the rabbit (Oryctolagus cuniculus) (n=1) and the pig (Sus scrofa domesticus) (n=1). A comparative and analytical study of these vessels (origin, path, caliber, termination) with those of humans was carried out. The superficial inferior epigastric vascular pedicles have been identified only in rats and pigs. The deep inferior epigastric, subscapular and internal thoracic pedicles were identified in the three mammals studied. No perforator vessels for the subcutaneous tissue and skin were identify from the deep inferior epigastric pedicles. The anatomical characteristics (origin, path, termination) of these vascular pedicles in rabbits seems to be the closest to that of humans. However the caliber of these vessels is around a millimeter compared to a 2.0-3.0mm in humans. This comparative study allowed us to identify and better characterize the morphological characteristics of these vascular pedicles in three domestic mammals, a step prior improving the development of animal models intended for pedagogical or experimental purposes in the field of microsurgical free flaps.

Lateral epicondylitis is a condition whose pathophysiology is poorly understood and whose optimal treatment divides physicians. Arthroscopy has proven its worth, with results similar to or better than open surgery. The purpose of this study was to look for prognostic factors for the outcomes of arthroscopic treatment of lateral epicondylitis. This was a retrospective, single-center study involving 39 cases (36 patients). Patients were split into two groups based on the Mayo Elbow Performance score (MEPS). A good result was defined as a score of 75 or better. The variables of interest were gender, age, body mass index, smoking habits, recognition as an occupational disease, duration of absence from work, cartilage involvement, presence of a capsular lesion and length of follow-up. The mean follow-up at review was 37.2 months (± 17.4). The average MEPS was 77.44 (± 15.51). Smoking was statistically related to a poor result (P = 0.0422) and a longer follow-up was statistically related to a good result (P = 0.0396). We identified two prognostic factors for lateral epicondylitis treated by arthroscopy. Smoking has a negative effect and ideally, patients should quit before surgical treatment. Time has a positive effect; thus patients should be informed that it will take several months or even years for their ailment to improve. Taking these factors into consideration will improve the functional outcomes of this surgery.

The trapezius muscle is a good option for soft tissue defects in the cervical and thoracic regions. However, pedicled flaps raised from perforators in the trapezius are rare. Through a series of cadaver dissections, the authors aim to map the perforating arteries in the trapezius muscle. Dissection of 58 anatomical regions in 32 cadavers was carried out. The perforating arteries of the trapezius were inventoried based on their location, dimensions and frequency using the scapular spine and spinous process line as landmarks. In 78% of cases, the main perforators of the trapezius were located along two vertical lines parallel to the spinous process line, 5–6 cm on either side of it, between the scapular spine laterally, the tip of the scapula caudally and the superior margin of the trapezius cranially. On each side of the spinous process line, we found an average of 16 perforators (range 5–27) with an average diameter of 0.6 mm (range 0.1–2.6 mm). Our study shows that surgeons can use fixed landmarks when developing trapezius perforator flaps.

Aggressive giant cell tumors are rare at the distal ulna. We report the results of two patients who were treated surgically using a distal ulna prosthesis stabilized by ligament reconstruction with the brachioradialis tendon. At the maximum follow-up of 18 months, the two patients were satisfied. Joint range of motion and functional scores were improved. X-rays showed no recurrence or subluxation; however gradual impingement of the ulnar notch of radius by the prosthesis was visible. Our technique seems to be a viable alternative when compared with the treatments described in other published case reports.

Summary Introduction The deep inferior epigastric perforator (DIEP) flap is a reliable and reproducible technique for autologous microsurgical breast reconstruction. Several recipient vessels sites for microvascular anastomosis have been described such as the internal thoracic vessels, the thoracodorsal vessels, and the circumflex scapular vessels. Nonetheless, the choice of the recipient site depends mainly on individual operator's experience and preferences, and currently the best recipient vessel site is under debate. This anatomical observational study aimed to determine whether anatomy could address this dilemma by determining the best vessel diameter to match the donor with these three recipient sites. Methods Our series reports 80 dissections of the three anatomical regions of interest. Forty formalin-preserved female cadavers were dissected bilaterally. Internal vessels diameter measurements were recorded with a vascular gauge ranging from 1.0 to 5.0 mm with successive half-millimeter graduations. Results The median diameter of the deep inferior epigastric (DIEA), internal thoracic (ITA), circumflex scapular (CSA), and thoracodorsal arteries (TDA) were: 2.0, 2.5, 2.5, and 1.5 mm, respectively. The median diameter of the deep inferior epigastric, internal thoracic, circumflex scapular, and thoracodorsal veins were: 3.0, 3.0, 3.0, and 2.5 mm, respectively. At the individual level, the perfect match between DIEA and ITA was significantly more frequent than between DIEA and TDA (p = 0.002), and it was more frequent between DIEA and CSA than between DIEA and TDA (p = 0.009). Conclusions This study supports the use of the internal thoracic pedicle as the first recipient vessel choice, which should be considered, at least anatomically, as the best one with the closest diameter matching with the donor pedicle.

Resume Introduction Le nerf radial est souvent atteint dans les fractures humerales ; 30 % ne recuperent pas spontanement. Les facteurs pronostiques de ces paralysies sont peu etudies dans la litterature. Les objectifs etaient de : 1) determiner les facteurs pronostiques des paralysies radiales, 2) evaluer l’interet de l’exploration du nerf dans les paralysies preoperatoires. Hypothese Des facteurs pronostiques des paralysies radiales peuvent etre identifies. Methodes Trois cent soixante-treize patients ont presente une fracture de la diaphyse humerale entre 2005 et 2012. Quarante-trois presentaient une paralysie radiale ; 26 etaient perdus de vue. Dix-sept patients operes etaient revus retrospectivement a 26 mois (12–84). Les criteres etudies etaient : l’âge, le tabagisme, l’energie du traumatisme, le type et le deplacement fracturaire, l’ouverture cutanee et l’aspect du nerf en peroperatoire. Resultats Treize des 17 paralysies etaient preoperatoires. Trois etaient deficitaires (groupe PRD), 10 ont completement recupere (groupe PRND). Une osteosynthese par plaque a ete realisee chez tous, ainsi qu’une exploration du nerf radial. Dans le groupe PRND, on retrouvait un nerf contus chez 6 patients et incarcere dans 2 cas. Dans le groupe PRD, deux presentaient des lesions nerveuses macroscopiques et le troisieme un nerf contus avec antecedent d’amyotrophie spinale. Seuls l’âge et la presence de lesion nerveuse macroscopique etaient significativement differents entre les deux groupes ; on notait une tendance a la difference significative concernant l’ouverture cutanee et le deplacement fracturaire. Quatre des 17 paralysies etaient postoperatoires. Deux ont completement recupere et deux partiellement. La moyenne d’âge de ces deux derniers etait plus elevee. Discussion Ces resultats sont semblables a ceux des rares series s’interessant aux facteurs pronostiques des paralysies radiales. Les facteurs tels que le deplacement fracturaire important, une ouverture cutanee de haut grade doivent favoriser les lesions nerveuses macroscopiques. L’incidence elevee de nerf incarceres et etires rend le controle systematique du nerf radial souhaitable lors de l’osteosynthese en cas de paralysie radiale preoperatoire. Niveau de preuve Niveau IV, etude retrospective sans groupe temoin.

Several techniques have been described for fusion of the distal interphalangeal joint. The intramedullary Lync® implant (Novastep™) may be superior to other options as it is available in straight or bent configurations, does not need to be removed and does not require fingertip incisions. The objective of our prospective study was to determine the effectiveness of finger distal interphalangeal (DIP) arthrodesis with Lync® implants. Between February 2016 and June 2017, we performed 22 cases of DIP arthrodesis with this implant. Pain was assessed with a visual analog scale, the joint range of motion was measured using a digital goniometer, the pulp to palm distance was measured using a ruler, and the QuickDASH Questionnaire was filled out. AP and lateral X-rays were used to look for secondary displacement at 3 weeks and joint fusion at 6 weeks, 3 months, 6 months and 12 months. The primary endpoint was clinical and radiological union defined as the presence of trabecular bone bridges across the arthrodesis site. The patients’ mean age was 57.8 years ± 9.9 (36–73). The mean follow up was 10 months ± 4.9 (3–15). The pre-operative pain level was 6/10 ± 2.4 (0–10) and it was 1.3/10 ± 1.7 (0–6) at 3 months post-operative (P

Extensive anatomical knowledge is needed in order to correctly treat distal radius fractures: normal and pathological osteology of the distal radius, distal radio-ulnar joint and radiocarpal joint-both on the descriptive and functional level-the neurovascular and muscular environments of the distal radius-which are essential to the surgical approaches-and the angles that need to be restored during the reduction. All of these concepts are broached in this article.

Proximal row carpectomy (PRC) and four-corner arthrodesis (4CA) are the two most commonly performed surgical procedures to treat wrist arthritis. Postoperative strength is one of the criteria for choosing between the two techniques. Some authors believe that strength is correlated with residual carpal height. The goal of this study was to determine if postoperative carpal height was predictive of postoperative strength. This study consisted of two parts: a clinical evaluation of grip strength after 4CA or PRC; anatomical and radiological measurements of carpal height before and after 4CA or PRC. Grip strength was better preserved after PRC (87.5%) than after 4CA (76.1%), when expressed relative to the opposite hand (P=0.053). There was a significant decrease in carpal height for the PRC group with a Youm's index of 0.37 versus 0.50 for the 4CA group (P

Objectif Le lambeau deep inferior epigastric perforators (DIEP) pour reconstruction mammaire autologue microchirurgicale est une technique fiable et reproductible [1] . Plusieurs sites receveurs pour les microanastomoses vasculaires ont ete decrits : le pedicule thoracique interne, le pedicule thoracodorsal et le pedicule circonflexe scapulaire [2] . L’objectif de cette etude etait de determiner le meilleur site receveur pour les microanastomoses vasculaires entre 3 pedicules receveurs decrits dans la litterature en reconstruction mammaire autologue microchirurgicale par lambeau DIEP. Materiel et methode Notre serie rapporte 50 dissections des 3 regions anatomiques d’interet representant 25 cadavres feminins conserves par formol. Les mesures des diametres des vaisseaux (arteres et veines) ont ete realisees a l’aide d’un calibreur vasculaire de diametre croissant allant de 1 a 5 mm comportant les demi-millimetres. Resultats La moyenne d’âge de notre population etait de 78 ans (limites : 71–89 ans). La moyenne de l’indice de masse corporelle (IMC) etait de 25,5 kg/m 2 . Le diametre median de l’artere epigastrique inferieure profonde etait de 2,0 mm. Le diametre median de la veine epigastrique inferieure profonde etait de 3,0 mm. Le diametre median de l’artere thoracique interne etait de 2,5 mm. Le diametre median de la veine thoracique interne etait de 3,0 mm. Le diametre median de l’artere thoracodorsale etait de 2,0 mm. Le diametre median de la veine thoracodorsale etait de 2,5 mm. Le diametre median de l’artere circonflexe scapulaire etait de 2,5 mm. Le diametre median de la veine circonflexe scapulaire etait de 3,0 mm. Conclusion Les pedicules thoracique interne et circonflexe scapulaire ont une parfaite correspondance de diametre avec le pedicule epigastrique inferieur profond. En conclusion, le diametre des vaisseaux seul ne permet pas de determiner le meilleur pedicule receveur pour le lambeau DIEP.

Objet La connaissance des differentes variations anatomiques des branches terminales de l’artere thoraco-acromiale est indissociable a toute chirurgie tegumentaire de la region anterieure de l’epaule [1] , [2] . Elle est surtout indispensable a la chirurgie des lambeaux de reconstruction de cette region, dont l’utilisation est croissante ces dernieres annees. Notre travail avait pour objectif de rapporter les modalites de division terminale de l’artere thoraco-acromiale. Materiel et methodes Nous avons realise une injection directe et selective de 24 arteres thoraco-acromiales, sur des cadavres conserves dans une solution faiblement formolee et riche en glycerine. L’injectant etait fait d’un melange de bleu de methylene et de gelatine. La dissection cadaverique a ensuite permis d’etudier la localisation, le nombre, et le trajet des branches terminales de l’artere thoraco-acromiale. Resultats Dans l’epaisseur du tissu cellulo-graisseux, l’artere thoraco-acromiale donnait au minimum deux et au maximum quatre branches terminales : deux volumineuses branches constantes (les branches deltoidienne et pectorale) et deux petites branches inconstantes (les branches acromiale et claviculaire). Cependant, des variations anatomiques ont egalement ete trouvees dans le trajet et la localisation de chaque branche terminale : ainsi les branches deltoidienne et pectorale avaient un trajet vertical descendant ou oblique. Conclusion Les variations anatomiques observees sur les branches terminales de l’artere thoraco-acromiale peuvent hypothequer toute chirurgie des teguments de la region anterieure de l’epaule [3] , [4] et devraient etre connues des chirurgiens.

Introduction Le conflit ulno-lunaire est lie a un exces de charge sur la partie mediale du carpe. Plusieurs techniques permettent la decompression ulno-carpienne. Parmi celles-ci, on peut distinguer les osteotomies diaphysaires de l’ulna (distal ulnar osteotomy DUO), des osteotomies metaphysaires (metaphyseal ulnar osteotomy MUO) selon Sennwald. Peu d’etudes ont compare leurs resultats cliniques et fonctionnels, c’est l’objectif de notre etude. Materiel et methodes Nous avons entrepris une etude retrospective bicentrique entre 2007 et 2016. Le conflit ulno-carpien etait confirme cliniquement et morphologiquement. Les patients ayant beneficie d’une osteotomie de l’ulna-preventive associee a une osteotomie du radius dans le cadre d’une maladie de Kienbock etaient egalement inclus. Les mobilites articulaires du poignet, la force de prehension et le score PRWE etaient mesures, de meme que le gain de variance. Le critere de jugement principal comprenait le score PRWE, la force de prehension et la restitution d’un index radio-ulnaire distal negatif. Le critere de jugement secondaire etait le gain de variance. Resultats Onze patients ont ete inclus dans le groupe MUO et 12 dans le groupe DUO. Sur l’ensemble de l’echantillon, il existait une difference significative (p Discussion Notre etude montre l’efficacite des techniques d’osteotomie diaphysaire et metaphysaire pour la restitution d’un index radio-ulnaire negatif et pour l’amelioration des forces de prehension en postoperatoire. L’etude comparative des deux techniques d’osteotomie ne montre pas de differences sur les resultats postoperatoires en ce qui concerne la force de prehension et le PRWE moyen. Conclusion Les osteotomies metaphysaires semblent realiser des accourcissements plus faibles que les osteotomies diaphysaires.