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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.

Typically, the axillary arch is defined as a fleshy slip running from latissimus dorsi to the anterior aspect of the humerus. Phylogeny seems to give the most relevant and plausible explanation of this anatomical variant as a remnant of the panniculus carnosus. However, authors are not unanimous about its origin. We report herein the incidence of axillary arch in a series of 40 human female dissections and present an embryologic and a comparative study in three domestic mammals. Forty formalin-preserved Caucasian human female cadavers, one rat (Rattus norvegicus), one rabbit (Oryctolagus cuniculus) and one pig (Sus scrofa domesticus) cadavers were dissected bilaterally. A comparative, analytical and a descriptive studies of serial human embryological sections were carried out. We found an incidence of axillary arch of 2.5% (n = 1 subject of 40) in Humans. We found a panniculus carnosus inserted on the anterior aspect of the humerus only in the rat and the rabbit but not in the pig. The development of the latissimus dorsi takes place between Carnegie stage 16–23, but the embryological study failed to explain the genesis of the axillary arch variation. However, comparative anatomy argues in favour of a panniculus carnosus origin of the axillary arch. With an incidence of 2.5% of cases, the axillary arch is a relatively frequent variant that should be known by clinician and especially surgeons. Moreover, while embryology seems to fail to explain the genesis of this variation, comparative study gives additional arguments which suggest a possible origin from the panniculus carnosus.

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.

Introduction The synovial wrist ganglion is a particularly common pathology of which the first "complication" is recidivism. The main objective of our study was to determine the rate of recurrence of this pathology in a series of arthroscopic patients. The secondary objective was to assess patient satisfaction well after the operation. Material and methods Our study was observational and retrospective and involved 30 patients (17 dorsal and 13 palmar cases) aged 41 years on average. The patients underwent an arthroscopic procedure for a palmar or dorsal ganglion of the wrist between March 2007 and April 2013. The data were collected by re-reading the files and conducting telephone interviews. Each patient answered a questionnaire about the operation, after-treatment, and their satisfaction well after the surgery. At the end of the interview, we calculated the Patient Rated Wrist Evaluation (PRWE) score. Results The mean follow-up was 4.6 years. A recurrence was noted in 4 (13%) cases, at an average delay of 9 months (6 months–1 year). There were only 2 patients (6.7%) that experienced the complication of complex regional pain syndrome type 1. Twenty-eight (93%) patients experienced improvement in postoperative pain. For 27 (90%) patients, firm-handed activities could be practised without limitation. The average time to resumption of activities of daily living was 27.1 days (1–240 days), resumption of firm-handed activities was 56 days (15–360 days), and return to work was 47.5 days (1–360 days). The mean PRWE score was 6.9/50 (0–34) for pain and 1.38/50 (0–8) for function. Conclusion The 13% recurrence rate is on the average of what is observed in the literature. Later satisfaction with the intervention is very good, and complications remain rare.Studies tend to show a lower rate of complications and recurrence following arthroscopic treatment, but to date, no randomized comparative series between the two methods has yet revealed any significant difference in these two points. A study of this type on a large scale could make it possible to highlight one of these treatment approaches.

In spastic patients, shortening wrist arthrodesis (SWA) is indicated in cases of severe fixed flexion contracture. At present, the most commonly used technique is dorsal plate osteosynthesis. Ideally, fixation with smaller hardware volume farther from the tendons would limit postoperative tendon irritation and reoperation rates for hardware removal. The objective of our study was to evaluate the efficacy of Rush pin SWA in adults. A retrospective study included all patients with a central neurological impairment, undergoing SWA using a Rush pin inserted through the head of the third metacarpal, and with at least 6 months' follow-up. Attainment of preoperative objectives was evaluated by Global Assessment of Response to Treatment (GART, ranging from -4 to +4) and, for functional objectives, the House score and the Frenchay Arm Test. Consolidation and any degenerative changes in the third metacarpophalangeal joint were assessed on X-ray. Fifteen patients were included, with a mean follow-up of 13 months (range, 6-29). In general, the preoperative objectives were attained: mean GART score was 2.7 (range, 1-4). Functional objectives were attained in 3 of the 11 patients followed up (27%). In all cases, the arthrodesis had healed at a mean 74 days (range, 39-102). Three had hardware removed after consolidation; 1 experienced discomfort at the head of the third metacarpal. Rush pin arthrodesis is an interesting alternative to plate arthrodesis in the management of severe wrist flexion contracture in spastic patients. It gives satisfactory results with regard to preoperative objectives and is not associated with complications. LEVEL OF EVIDENCE: IV, retrospective study without control group.

Objectives: Tissue defects in the lateral triangle of the neck and the anterior cervical region represent a high demand for plastic and reconstructive surgery. Their management most often requires regional or free flaps. The perforator flap based on the deltoid branch of the thoracoacromial artery (TAA) may be a good solution for these indications. The objective of this work is to propose anatomical landmarks to raise perforator flaps pedicled on the deltoid branch of the TAA. Methods: We carried out dissection of 24 perforator flaps based on the deltoid branch of the TAA, in body donor specimens preserved in a glycerin-rich, formalin-free solution. The TAA was first injected with methylene blue. The vascular territory, location of perforators relative to known landmarks, along with the flap’s potential amplitude and arc of rotation were studied. Results: The main perforating arteries of the flap were located in the middle of the deltopectoral groove, often surrounded by adipose tissue in 18 out of 24 dissections. In 22 out of 24 dissections, there were at least 2 perforator arteries originating from the deltoid branch. The average diameter of the perforator arteries was 1 mm. The flap’s amplitude of movement made it possible to reach in all cases the lateral triangle of the neck and the anterolateral cervical region. Conclusion: The thoracoacromial artery has already been used for perforator flaps. However, the individualization of its deltoid branch offers to practitioners new surgical options. This anatomical study of the perforator flap based on the deltoid branch of the TAA made it possible to review the anatomical bases for the raising of this flap, and to fix useful landmarks for the surgeon in order to propose an easily feasible surgical technique.

Low back pain is a common, expensive, and disabling condition in industrialized countries. There is still no consensus for its ideal management. Believing in the beneficial effect of traction, we developed a novel external dynamic distraction device. The purpose of this work was to demonstrate that external distraction allows limiting the pressure exerted in standing-up position on the lower intervertebral discs. Numerical and cadaveric studies were used as complementary approaches. Firstly, we implemented the device into a numerical model of a validated musculoskeletal software (Anybody Modeling System) and we calculated the lower disc pressure while traction forces were applied. Secondly, we performed an anatomical study using a non-formalin preserved cadaver placed in a sitting position. A pressure sensor was placed in the lower discs under fluoroscopic control through a Jamshidi needle. The intradiscal pressure was then measured continuously at rest while applying a traction force of 200 N. Both numerical and cadaveric studies demonstrated a decrease in intradiscal pressures after applying a traction force with the external device. Using the numerical model, we showed that tensile forces below 500 N in total were sufficient. The application of higher forces seems useless and potentially deleterious. External dynamic distraction device is able to significantly decrease the intradiscal pressure in a sitting or standing position. However, the therapeutic effects need to be proven using clinical studies.

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.

International audience; This paper deals with the formulation, development and validation of a newly developed micromechanical-based model for the modeling of the nonlinear ductile fracture of human humerus. The originality of the present works concerns the coupling between the micromechanical formulation based on the Mori-Tanaka homogenization scheme for cylindrical voids and the Marigo nonlinear ductile damage model based on the porosity growth. The proposed model was implemented as a User Material UMAT within the explicit dynamic software LS-DYNA and validated by numerical and experimental analysis conducted by a drop tower impact of human humerus. The outcome of the proposed multi-scale model appears to correctly predict the general trends observed experimentally via the good estimation of the ultimate impact load and the fracture patterns of the human humerus.

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.

Few studies investigated whether trochlear and patellar design enhancements improve long-term outcomes of total knee arthroplasty (TKA). This study aimed to compare the long-term survival and complication rates of two consecutive generations of the same TKA system with identical tibiofemoral geometry, but different patellofemoral designs. The authors retrieved the records of 93 patients (104 knees) operated with the HLS II system and 116 patients (122 knees) operated with HLS Evolution system. Patients were evaluated preoperatively and at a minimum of 10 years noting all complications. Kaplan–Meier (KM) survival was compared for two endpoints: (1) revision of all components and (2) revision of any component. From the HLS II series, the incidence of revision of all components was 6.4%, and of any component was 9.8%. From the HLS Evolution series, the incidence of revision of all components was 4.1%, and of any component was 5.1%. Comparing the survival at equivalent follow-up of 14 years, considering revision of all components, the HLS II had higher survival than the HLS Evolution (98.9% vs 95.9%), while considering revision of any component, the HLS II had lower survival than the HLS Evolution (93.0% vs 94.9%). The differences in survival of the two implants were not significant, neither at equivalent follow-up of 14 years (n.s.), nor at maximum follow-up of each cohort (n.s.). The complication rate was higher for the HLS II series compared to the HLS Evolution (28% vs 12%, p = 0.009), but patellofemoral complications were not more frequent (8% vs 6%, n.s.). Though the differences in survival of the two implants were not significant, conflicting findings are observed due to partial revisions for patellar fractures (5 in the HLS II series and 1 in the HLS Evolution series) which could be related to patellofemoral design enhancements. This study highlights the importance of patello-femoral geometry, which is often overlooked in TKA. Retrospective comparative study, Level III.

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.

Our study aimed to compare the anatomical result after treatment of intraarticular distal radius fracture with locking volar plates with and without arthroscopy. This was a retrospective, single-center study of intraarticular fractures. A volar locked plate was used for fracture fixation in all patients. Twenty patients were operated on with fluoroscopy only (“plate” group) and 20 operated using arthroscopy assistance (“arthroscopy” group). All patients underwent a CT scan before surgery and at 3 months postoperative. The main outcome measure was the residual intraarticular step-off (measured in millimeters). Other studied outcomes were the residual gap between fragments and extra-articular reduction. The two groups were similar preoperatively in all aspects except the size of the gap between fragments. The residual step-off was significantly less in the arthroscopy group: 1.9 mm (Q1 1.7; Q3 2.25) for plate versus 0.8 mm (Q1 0.7; Q3 1.5) for arthroscopy (P = 0.001). The change from the preoperative to the postoperative measurement was significantly greater in the arthroscopy group: 0.1 mm (Q1 −0.5; Q3 0.8) for plate and −1 mm (Q1 −1.9; Q3 −0.6) for arthroscopy (P = 0.0002). The residual gap was similar between both groups: 2.4 mm (Q1 1.9; Q3 3.5) for plate vs. 2.3 mm (Q1 1.1; Q3 2.8) for arthroscopy (P = 0.37). The change in gap was not significantly different between the two groups: −0.9 mm (Q1 −1.8; Q3 −0.1) for plate vs. −2.9 mm (Q1 −4.4; Q3 −1.7) for arthroscopy (P = 0.32). There was no difference in the extra-articular reduction. Damage was found to the scapholunate ligament in 30% and the TFCC in 30% of arthroscopy cases. Arthroscopy improves intraarticular reduction without altering extra-articular reduction in patients with intraarticular fractures of the distal radius, and it allows for assessment and treatment of any injuries discovered. We must now follow these patients over the long-term to assess the clinical benefit. Level of evidence 3.

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.

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

International audience; This paper investigates the characterization and numerical modeling of the elastic behavior of the human humerus bone using a recently developed micromechanical approach coupled to nanoindentation measurements. At first, standard three-point bending experiments were conducted under low static loading, using several humerus diaphysis in order to identify the apparent elastic modulus of the bone in static regime. Then, a drop tower impact experiment was used on the same set of humerus diaphysis specimens, in order to assess the elastic modulus in dynamic regime. These measurements will be used as reference bases for comparison purpose. The originality of this work, lies in the coupling between a two-phase micromechanical approach based on Mori-Tanaka homogenization scheme for cylindrical voids and nanoindentation measurements of the elastic modulus of the bone matrix phase. This model has been implemented using a user defined material subroutine VMAT in ABAQUS© Explicit code. The bone mechanical response prediction using the proposed methodology was validated against previous standard experimental data. Finally, it was shown that the numerical predictions are consistent with the physical measurements obtained on human humerus via the good estimation of the ultimate impact load.

While anatomical variations of the subscapular vessels are frequently encountered during axillary dissection, little is found in the literature. The aim of this cadaveric study was to define arterial and venous anatomical variations and frequencies of the subscapular vascular pedicle and its terminal/afferent vessels in women. We performed 80 dissections of the axillary region on forty female formalin-embalmed cadavers. Each anatomical arrangement was photographed and recorded on a scheme before analysis. We propose a new classification of the subscapular pedicle variations. We observed three types of subscapular arterial variation. The type Ia was the most frequent arrangement (71% of our dissections), the type Ib was observed in 11% and the type II in 18% of cases. We observed four types of subscapular venous variation. The type Ia was observed in 63% of cases, the type Ib in 14%, the type II in 14% and the type III in 10% of cases. This knowledge of the anatomical variation arrangement and frequencies of the subscapular vascular pedicle will assist the surgeon when dissecting the axillary region for malignant or reconstructive procedures.

Elbow dislocation can lead to instability and stiffness of the elbow. The main goal of this study was to list the initial elbow ligaments injuries caused by simple posterolateral elbow dislocations. The secondary goals were to assess ligament healing 2 months after the initial dislocation, to research a correlation between ligaments injuries and clinical course, and to search for predictive factors of instability. Patients who had simple posterolateral elbow dislocation for the first time between January 2015 and May 2016 were included. Each patient had an MRI scan of their traumatised elbow on the day of the dislocation and then again 2 months later. The assessment was performed thanks to a clinical examination and calculation of functional recovery scores. The Mann–Whitney U test was used to research a correlation between the healing of ligaments injuries and clinical course. Twenty-five patients were included in the study. The initial MRI scans showed 70% and 54% ligament rupture, respectively, for the anterior band (ant MCL) and the posterior band (post MCL) of the medial collateral ligament (MCL), as well as 79% for the ulnar (ULCL) and 50% for the radial (RLCL) lateral collateral ligaments. The healing rate 2 months after dislocation was fairly low from 18% for the ULCL up to 41% for the anterior band of the MCL. No correlation was found between the ligament healing noticeable on MRI scans and clinical course. No elbow instability was diagnosed during the 4-month follow-up. Elbow dislocation is particularly damaging for ligaments. There is no predominance on medial or lateral ligament for rupture. The low healing rate 2 months after the initial dislocation could be explained by performing a follow-up MRI scan too early.

Objective The anatomy of the perineum and the pelvic diaphragm of woman is complex. A numerical complete three-dimensional (3D) model of every muscle of the woman pelvis doesn't exist. The pathophysiology of genital prolapse is still debated. Knowledge of anatomy is essential to better understand its mechanisms. The aim of this research was to build a complete three-dimensional model of the female perineum and pelvic floor muscles. Study Design To model the pelvic muscles we reconstructed them in three dimensions from tracing a magnetic resonance imaging (MRI) of a female pelvis from a cadaver. Results We obtained a complete anatomical model of the muscles of the perineum and pelvic floor. Each muscle was built thanks to the MRI. Conclusion We obtained the first complete anatomical model of the perineal muscles and pelvic diaphragm. It could be a good educational and simulation tool for better understanding normal and pathological pelvic mobility.

International audience; The complex architecture of bone has been investigated for several decades. Some pioneer works proved an existing link between microstructure and external mechanical loading applied on bone. Due to sinuous network of canals and limitations of experimental acquisition technique, there has been little quantitative analysis of three-dimensional description of cortical network. The aim of this study is to provide an algorithmic process, using Python 3.5, in order to identify 3D geometrical characteristics of voids considered as canals. This script is based on micro-computed tomographic slices of two bone samples harvested from the humerus and femur of male cadaveric subject. Slice images are obtained from 2.94 μm isotropic resolution. This study provides a generic method of image processing which considers beam hardening artefact so as to avoid heuristic choice of global threshold value. The novelty of this work is the quantification of numerous three-dimensional canals features, such as orientation or canal length, but also connectivity features, such as opening angle, and the accurate definition of canals as voids which ranges from connectivity to possibly another intersection. The script was applied to one humeral and one femoral samples in order to analyse the difference in architecture between bearing and non-bearing cortical bones. This preliminary study reveals that the femoral specimen is more porous than the humeral one whereas the canal network is denser and more connected.

Introduction The dorsal scapular artery Arteria dorsalis scapulae is often described as the last collateral branch of the subclavian axis It anastomoses extensively with the transverse artery of the neck arteria transversa cervicis to irrigate the trapezius muscle However its origin can be very variable The objective of this work was to study the different modalities of birth of the arteria dorsalis scapulae from the subclavian artery Material and methods We performed dissection of supraclavicular regions from bodies preserved in a non formalin solution rich in glycerine The subclavian artery arteria subclavia was exposed as well as all its collateral branches The arteria dorsalis scapulae was identified by its location as collateral and its route and then injected with a solution of methylene blue and gelatin Results Our results were divided into types according to the mode of birth and the branch of origin In cases the arteria dorsalis scapulae and the arteria transversa cervicis were born from a common trunk stemming from the arteria subclavia type I In cases the arteria dorsalis scapulae was born directly from the arteria subclavia while the arteria transversa cervicis came from the thyro cervical trunk or truncus thyrocervicalis type II In cases the dorsalis scapulae and transversa cervicis arteries all represented collateral branches of the thyro cervical trunk type III Conclusion The formation of the arteria dorsalis scapulae from the subclavian axis can present numerous anatomical variations These variations must be taken into account during the surgery of flaps of the trapezius muscle

Many conditions can cause foot drop, which makes walking difficult because the foot easily bumps into obstacles, or the knee must be kept more flexed than usual during the swing phase of gait, especially when going up stairs. Several techniques that have been described to correct foot drop rely on bone procedures or tendon transfer, with or without bone fixation. In this article, we describe a simple technique that is heavily used in leprosy-endemic countries and provides long-lasting results. It requires a double tendon transfer through the interosseous membrane of leg; the tibialis posterior and flexor digitorum longus are sutured to the tibialis anterior, and extensor hallucis longus and extensor digitorum longus, respectively, proximally to the extensor retinaculum.

Introduction The morphological diversity of the trapezius muscle is important even if statistically these variations are rare The authors of this work study anatomical variations of trapezius muscle in literature Material and methods A systematic review of the literature using several databases has identified the main anatomical variations present on the trapezius muscle Anatomical variations The most frequently reported anatomical variations are agenesis and unilateral or bilateralaplasia trapezius hypoplasia the presence of accessory portions of the muscle and accessory nerve abnormalities However variations in their bony insertions and asymmetries predominate by their frequency in the trapezius muscle Conclusion The anatomical variations of trapezius muscle are real despite their rarity They can have important functional consequences

In mutilans rheumatoid arthritis (RA) patients with major wrist destruction, wrist arthrodesis is recommended. This type of arthrodesis needs carpal reconstruction and stable fixation. The goal of this study was to assess the functional and anatomical outcomes of an iliac crest graft and internal fixation with two medullary pins. Six wrists in three patients suffering from RA were reviewed clinically and radiologically at an average follow-up of 25 months. We assessed the fusion of the iliac graft with the radius and the metacarpus, the preoperative and postoperative carpal height, and the bone stock in front of the thumb. All the patients had improved functionally. The iliac graft fused with the radius in all cases and fused with the metacarpus in 5 out of 6 cases; the non-union occurred in the wrist where only one pin was used. Restoration of carpal height was associated with improvements in hand function. The bone stock was sufficient to allow implantation of a trapezial cup during a total arthroplasty of the thumb trapeziometacarpal (TMC) joint. No major complications occurred. An iliac graft and two pins through the 2nd and 3rd metacarpals were used to reconstruct the carpal height and to obtain wrist fusion. Internal fixation with only one pin is not recommended. Functional improvement can be attributed to the normal tension within the extrinsic flexors and extensors of fingers and thumb being restored because the carpal height was restored. A secondary TMC arthroplasty is theoretically possible.

Despite advances in microsurgery, digital nerve repair remains a challenge due to the lack of reproducible procedures with satisfactory functional results. The aim of this study was to compare the sensory and functional results of direct microsurgical sutures protected by a Revolnerv(®) nerve regeneration conduit, with results of a series of direct sutures without a protective conduit in the literature. From November 2009 to April 2010, 35 patients were treated by direct epiperineural suture for digital nerve injury, protected by a Revolnerv(®) nerve regeneration conduit at the FESUM centre "SOS-mains Lesquin/CHRU de Lille". Sensory recovery was assessed by the static two-point discrimination Weber test (WS) and the Semmes-Weinstein (SW) test at postoperative months 1, 3, and 6. The final evaluation was performed after a minimum follow-up of 6 months. Statistical analysis of sensory results (WS and SW) was mainly performed with non-parametric tests (Wilcoxon, Mann and Whitney). P

Introduction Although Charnley-Kerboull metal-on-polyethylene 22.2 mm cemented total hip arthroplasty (THA) is considered to be the gold standard in France, results with this prosthesis are conflicting, in particular in relation to Scandinavian registers. The goal of this retrospective study was to confirm the validity of this prosthesis at a minimum of 10 years follow-up. Hypothesis Survival of this type of THA would fulfill NICE conditions (survival at 10 years of at least 90%). Materials and methods One hundred and five primary THA were performed in 93 patients (30 men and 63 women) mean age 72.6 years old (60–86) between January 1998 and March 2001. After a mean follow-up of 10.6 years (10–13 years), 21 patients (23 THA) were lost to follow-up and 32 (35 THA) had died leaving 40 patients (47 THA) for clinical analysis (Merle d’Aubigne and Oxford scores) and X-ray assessment. Survival was calculated with revision for any cause and radiological loosening with or without revision as end-points. Results The mean Oxford score at the final follow-up was 22/60 (13–45), the PMA score was 14.2 (11–17). Eight patients underwent revision surgery after a mean 7.5 years (2–11) (1 early dislocation and 7 acetabular cup loosenings). Survival at 10 years was 89.4% (CI95%: 78–95) for all causes of revision and 78% (CI95%: 61–91) for loosening with ( n = 7) or without ( n = 3) revision. No cases of septic or femoral loosening were observed. Twelve of the 47 revised hip replacements (25.5%) presented wear ≥ 2 mm. Discussion Although functional results were acceptable for this elderly population, survival did not reach the NICE value and was lower than results in the literature for this type of implant. Cup loosening and wear were the main causes of revision. Level of evidence IV: retrospective.

The functional consequences of spasticity can be corrected by local, pharmacological or surgical treatments once the spastic muscle has been identified. However, this diagnosis can be tricky when the muscle in question is rarely involved in spasticity or when its mechanical action is unusual or poorly characterized. Here, we present the case of a man presenting with left hemiplegia after an ischaemic stroke. His gait was perturbed by foot clonus in the sagittal plan, which persisted after selective neurotomy of the gastrocnemius and soleus but disappeared after neurotomy of the peroneus longus. Clonus triggered by pushing up under the whole of the forefoot in the direction of dorsiflexion may not be related to spasticity of the triceps surae. We recommend screening for foot clonus by first pushing up on the sole of the foot under all five metatarsals. In a second step, selectively pushing up under the first metatarsal joint enables the physician to evidence spasticity of the peroneus longus.

Tendon injuries are common in hand wounds and their functional consequences are not negligible. In emergency, tendon repairs techniques are well codified to restore function. These tendon repairs can be made in one session, in two sessions, or even use tendon transfers. Tendon transfers are not usual in the emergency but more common in the treatment of sequelae or failure of primary repair. We report one case of transfer to restore thumb flexion in emergency.

Lateral epicondylitis of the elbow is a relatively common pathology and would involve 1-3% of the overall population. Lack of consensus on surgical techniques reflects the difficulty of understanding and treating this disease. Our prospective study reports the results of its arthroscopic treatment on 14 patients operated on between 2009 and 2012. The mean follow-up was 7.15 months. All patients underwent a well conducted medical treatment for an average of 32.5 months. The operation was carried out under regional anesthesia in an outpatient. The technique included a time of joint exploration, joint capsulotomy and a transverse division of the pathological tendon of extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC). The value on the visual analogic scale (VAS) at rest and during exercise increased from 2.85 to 0.43 and from 7.71 to 2.43, respectively, then remained stable over time. Professional activity was resumed on average at 9.1 weeks. Neither intraoperative nor postoperative complications were found. No laxity was observed. The Mayo Clinic and DASH scores were significantly improved from 52.14 to 92.5 and from 54.11 to 9.7, respectively. Overall, we observed 11 very good and three good results. Although our prospective series has a few patients and limited follow-up, our results are better or similar than those reported in the literature on pain relief and functional recovery. In contrast, the average recovery of professional activity was longer. Elbow arthroscopy, less invasive than open procedures, and allowing further joint exploration, seems an excellent alternative technique in this indication.

Background Tibialis posterior transfer (TPT) is the treatment most widely used to palliate foot drop due to dorsiflexor palsy. TPT has been extensively studied in patients with peripheral neurological causes of foot drop. In contrast, data are scarce on central foot drop, in which TPT is often blamed for causing flattening of the arches. The primary objective of this study was to assess the impact on foot alignment of TPT in patients with central foot drop. The secondary objective was to determine whether TPT combined with other surgical procedures improved gait. Hypothesis TTP can induce flattening of the medial arch of the foot. Patients and Methods We retrospectively identified 13 patients managed with TPT (1 foot per patient). Mean follow-up was 65 months (range, 12–108 months). The causes were stroke (n = 5), head injury (n = 3), spinal cord injury (n = 2), cervical spondylotic myelopathy (n = 1), cerebral palsy (n = 1), and a brain tumour (n = 1). The clinical assessment focused chiefly on forefoot alignment and footprint parameters. The following variables were collected from weight-bearing radiographs: Djian-Annonier angle, Meary-Tomeno angle, lateral arch angle, and calcaneal pitch angle in the sagittal plane; talo-metatarsal angle in the transverse plane; and rearfoot valgus angle in the coronal plane. Results Of the 13 feet, 6 had normal footprint parameters and 7 pes cavus. There were no cases of flatfoot. Pronation deformities and supination deformities were each found in 2 patients. Comparing the radiographic parameters between the two feet in each patient identified differences only for the lateral arch angle and calcaneal pitch angle, which indicated pes cavus on the operated side (operated side: 142.7° [range, 136°–156°], p = 0.041; and 24° [range, 14°–33°], p = 0.028, respectively). Discussion In contrast to the working hypothesis, we found no evidence of progression to valgus flatfoot after TPT transfer performed to treat central foot drop. Level of evidence IV, retrospective study with no control group.

Background Radial nerve injury is common in humeral shaft fractures and fails to recover spontaneously in 30% of cases. Few studies have evaluated predictors of recovery. The objectives of this study were to identify predictors of radial nerve palsy recovery and to assess the usefulness of surgical radial nerve exploration in patients with preoperative radial nerve palsy. Hypothesis Factors predicting the outcome of radial nerve palsy can be identified. Methods Of 373 patients with humeral shaft fractures between 2005 and 2012, 43 had radial nerve palsy, including 23 who were lost to follow-up and 17 who were evaluated retrospectively at a mean of 26 months (range, 12–84 months) after internal fixation. The following were studied: age, smoking history, energy of the trauma, fracture type and displacement, skin integrity and intra-operative appearance of the radial nerve. Results Of the 17 palsies, 13 were present preoperatively, including 10 that recovered (PreR group) and 3 that did not recover (PreNR group). Plate fixation and radial nerve exploration were performed in all patients. Of the 10 PreR patients, 6 had nerve contusion and 2-nerve entrapment. Of the 3 PreNR patients, 2 had gross nerve damage and 1 nerve contusion and a history of spinal muscular atrophy. Only age and presence of gross nerve damage differed significantly between the PreR and PreNR groups; trends towards significant differences were noted for skin breach and fracture displacement. Of the 4 postoperative radial nerve palsies, 2 recovered fully and 2 partially; mean age was higher in the 2 patients with partial recovery. Discussion These findings are consistent with the few previous studies of outcome predictors in radial nerve palsy. Factors such as major fracture displacement and high-grade skin wounds probably promote the occurrence of gross nerve lesions. The high incidence of nerve entrapment and stretching supports routine nerve exploration during internal fixation in patients with preoperative radial nerve palsy. Level of evidence IV, retrospective study with no control group.

Our goals were to carry out an anatomical description of the internal architecture of the supinator muscle in order to describe potentially compressive structures for the deep branch of the radial nerve (DBRN) and to establish reference landmarks for the surgical treatment of radial tunnel syndrome. Thirty upper limbs were dissected. The pennation angle of proximal and distal arcades of the supinator to the radial shaft axis was measured. Possible compressive structures of both superficial and deep heads of supinator were recorded. Proximal and distal arcades of the superficial layer of the supinator were classified according to their fiber content as tendinous, musculo-tendinous, muscular or membranous. The distances of superficial layer of the supinator muscle to the humeroradial joint line and lateral epicondyle were measured. Pennation angle was 33.6° (±4.2°) for the superficial layer and 50.2° (±6.6°) for the deep layer. The difference was statistically significant (p

The design and the realization of vascularized osseous grafts at the hand and the wrist require a precise knowledge of the general and regional anatomy. This article gives first a progress report on current knowledge about the general organization of arterial and venous vascularization, of the long bones (number and localization of the nutrient foramina, communication between the epiphyseo-metaphyseal and diaphyseal networks) and of the short bones, in the adult and the child, before the closing of the growth plate. The general organization of arterial vascularization of the hand and the wrist is pointed out, with the current nomenclature and the contribution of the recent publications, in particular in these, which relate to the distal extremity of the radius. The vascularization of each bone (radius and ulna, carpal bones, metacarpals and phalanges) is then described; making way, the anatomical bases of each vascularized bone graft, which can be harvested there, are described. The last technical projections are included, in particular the realization of the reverse flow vascularized bone grafts harvested from the metacarpals. This article still gives a progress report on the osseous vascularization of the short bones, in particular of those which are exposed the most to the osteonecrosis (scaphoid, lunatum). It has the ambition to light the reader and to prepare him (her) with the reading of the following chapters.

Introduction/Background Little is known about shoulder hypertonia in patients with brain injury. The principal aim of our study was to assess the results of spastic shoulder surgery in our team experience. Material and method Sixteen patients (18 shoulders) were retrospectively reviewed. The following were studied: etiology of hypertonia, shoulder deformation schemes, initial aims of surgery, shoulder pre- and postoperative mobility, impact of surgery on limb function when possible. None limb was functional preoperatively. Spontaneously, shoulders were all in a medial rotation, in adduction in 15 cases, in abduction in 3 cases. One had spontaneous retroposition. Therapeutic aim was hygienic in all and pain-relief in 6. Ten neurotomies of the lateral pectoral nerve (LPN), 8 intramuscular lengthening of the latissimus dorsi (LD), 9 percutaneous tenotomies of the pectoralis major (PM), one neurotomy of the motor nerve for the long head of triceps brachii (LHTB) and one intramuscular lengthening of the teres major (TM) were performed. Results Mean age at surgery was 52.1 (24–73). Etiology was vascular in 11, anoxic in 2, one had traumatic brain injury, one multiple sclerosis, one cervicarthrosic myelopathy. Preoperatively, the mean results for passive abduction of the shoulder was 50.6° (10–90) and for the passive lateral rotation was −5° (−70; 20). Postoperatively, there were respectively improved at 87.7° (60–160) and 6.7° (−20; 20). Only 3 muscles presented with residual tightness (two PM and 1TM) in patients where an isolated neurotomy of the lateral pectoral nerve (LPN) had been achieved. All of the initial objectives of the surgery were satisfied. One patient recovered a partial functionnal limb thanks to a recovered active shoulder flexion. Conclusion In classical medial rotation-adduction deformation schemes, surgery performed on the 3 main involved muscles (PM, LD, TM) offers good results in term of passive mobility of the shoulder and pain-relief.

Fascias can be used for reconstruction of gliding surfaces of upper and lower extremities or when thin, pliable coverage is required. Free large and well-vascularised fascial flaps are not very many and harvesting is seldom onto upper limb. The aim of this work was to study blood supply of the posterior brachial fascia in order to define the anatomical bases of a new free fascial flap. Our study included dissection on 18 anatomic specimens from 10 cadavers. Measures of the flap and blood supply were studied. Histological study was performed to analyse vessels location and measures into flap thickness. The posterior brachial fascia was thin, with a broad surface area and easily separable from the subcutaneous and muscular plane. Its average surface size is 115-mm length and 54-mm width. It was richly vascularised by two major pedicles: the cutaneous posterior brachial pedicule and the fascial branch of the superior ulnar collateral artery. Satellite venous elements were always present. A rich vascular network exists within the thickness of the fascia. Surgical procedure of flap harvesting is described. Harvesting of the flap can be carried out by a posteromedial approach into upper limb, without significant donor-site morbidity. This flap is adapted to cover and reconstruct gliding tendinous surfaces onto hand or fingers.

The medical art is more and more legally regulated. The case-law about civil medical liability has widely changed these past years. The reversal of the burden of proof regarding patient’s information, the presumption of responsibility in case of nosocomial infection, the medical liability without fault, the therapeutic risk and finally the law of 4 March 2002 are just a few examples of these changes. Regarding this judicial tendency of the medical practice, it appears interesting to study the contentious matters between doctors and patients in the orthopaedic and traumatologic surgery activity of a regional university hospital. Over a 20-year-period activity, at a rate of 3,000 patients per year, we found 20 files. The first complaints occurred 12 years after the medical event; they have become more frequent in the past 3 years. The most frequent reasons of complaint are the nosocomial infections and the lack of information to the patients. The rare medical errors could have had less effect if discussed beforehand with the patients. Nowadays fact sheets are available to the public and the committee for the prevention of nosocomial infection (CLIN) is positively involved. The complaints’ handling process is still slow, and therefore delays the compensation of victims. The increasing number of complaints made to the Regional commission for conciliation and compensation (CRCI) could be a solution to address those delays.

This study was undertaken to evaluate tourniquet tolerance in healthy people. An arm tourniquet was inflated to 100 mmHg above systolic blood pressure for 21 minutes. We measured pain and grip strength before, during and at various times after deflation. We tested 40 subjects (20 women and 20 men) with an average age of 38 (range 22–58) years. Eight individuals did not tolerate the tourniquet for this length of time and the test was stopped. Visual analogical scale had a globally linear increase during tourniquet application. We noted a sensation of well-being just after deflation, quickly replaced by pain in the tested limb due to limb reperfusion. We also noted a significant loss of strength in the tested limb, which completely recovered by 48 hours. We also observed a significant loss of strength in the contralateral hand, which also recovered by 48 hours. The possible reasons for these temporary losses of strength in both the ipsilateral and contralateral limbs are discussed.

Spastic pes equines, possibly associated with varus posture or spastic claw of the toes, can require neurosurgical treatment. In these cases, a selective fascicular neurotomy can be proposed, which consists of a partial section of some motor collateral branches of the tibial nerve. In order to avoid sensory and trophic complications after surgery due to an excessive manipulation of the nerve, accurate anatomical data must be collected. Therefore, biometric, histological and ultrastructural studies were carried out. A total of 50 dorsal compartments of the leg were dissected. The distance between the emergence of each muscular branch of the tibial nerve and anatomical landmarks were measured. Complementary histological study was processed on three specimens with slices stained by Masson's trichromatic method. Eventually, electronic microscopy observation was processed on two other specimens. In 16 cases (32%), we found a common muscular branch for all the muscles of the dorsal leg compartment, which emerged from the nerve trunk near the tendinous arch of the soleus (67 +/- 29 mm from the femorotibial articular line). In the other cases, muscular branches of the nerve emerged from its ventral lateral aspect, with variable origins (inferior nerve for the soleus: 82 +/- 31 mm from the femorotibial articular line, nerve for flexor digitorum longus: 116 +/- 41 mm, nerve for tibialis posterior: 106 +/- 51 mm, with a second nerve in 9/50 cases, nerve for flexor hallucis longus: 129 +/- 48 mm, with a second nerve in 6 cases). Histological and ultrastructural analysis confirmed the presence of the motor nervous fibers in the ventral lateral part of the nerve trunk. These new anatomical findings allow a more precise dissection during operative procedure, in order to avoid sensory or trophic complications.

During the last few years, several types of vascularized bone grafts have been described for the treatment of scaphoid nonunions reporting rates of union often higher than 90%. The goal of this study was to evaluate the results, complications and failures of Kuhlmann's vascularized bone graft. Thirty patients who had benefited from this graft between 2000 and 2005 were reexamined. The average age was 27 years (15-66 years). Seventeen patients were smokers. There were two cases of proximal pole necrosis. The average follow-up was 28 months (eight to 60 months). Osteosynthesis was carried out in 23 cases using a Herbert screw, in seven times with pins alone. Average immobilization time was six weeks. Twenty-two nonunions healed, that is to say a 73% union rate. Neither of the two cases of proximal pole necrosis cases united. Two articular radius fractures occurred during the harvesting of the graft. Five patients underwent a second intervention after this vascularized bone graft: four proximal row carpectomies and one conventional bone graft. Our union rate is disappointing, particularly compared to nonvascularized bone grafts for which the success rate is usually higher than 80%. This technique has many advantages thanks to its unique volar approach, but its realization requires a learning curve and important complications can occur at the beginning of experiment.

Background: The aim of this study was to clarify the arrangement of the zygomaticus major muscle by means of topographic examination, and to evaluate the anatomical variations in the insertion of the zygomaticus major at the perioral region. Methods: After a detailed dissection in the modiolar region, the insertion area of the zygomaticus major was observed in 70 embalmed cadavers. Results: At the perioral region of the dissected specimens, the anatomical aspects of the muscular arrangement and attachment of the zygomaticus major muscle were classified into four categories. In type I, the superficial muscle band of the zygomaticus major is blended and interlaced with the levator anguli oris, whereas the fibers of the deep muscle band blend into the buccinator, passing deeper to the levator anguli oris; this was the situation most commonly encountered (54.3 percent). It was found that the insertion of the zygomaticus major was divided into superficial and deep bands (types I and IV) [42 cases (60 percent)] and into three layers of superficial, middle, and deep fibers (type II) [17 cases (24.3 percent)]. The others were cases where the zygomaticus major was inserted deep into the levator anguli oris as a single muscle band (type III) [11 cases (15.7 percent)]. Conclusion: The arrangement and insertion patterns of the zygomaticus major in this study are expected to provide critical information for surgical planning for the procedure of facial reanimation surgery.

The use of Fuji films is simple but their manipulation and result interpretation seem to be difficult in the framework of medical research. The reliability and reproducibility of Fuji films have been proved by many previous studies. This study was undertaken to know precisely the articular zones of the elbow and to determine the compressive stress these areas undergo during different activities, in order to assess the importance of different articular contact areas. These data indicate the need for better-adapted elbow prosthesis and can be eventually used to design more durable prosthesis for the elbow. The compressive stress on the radial head was less than 25% in extension. The stress on the radial head varied from the neutral position (23% of the stress), to full pronation (11% of the stress) and to full supination (6% of the stress). The Humero-ulnar compartment had the maximum impact. Coronoid process seemed to be a fundamental element of the elbow joint in extension (60% of total compressive stress). The Medial humero-ulnar compartment was less stressed than the lateral compartment. The radial head does not seem to play a major role in the stability of the elbow in extension if the ulnar collateral ligament exists. The ulnar collateral ligament is essential to the elbow joint stability. The lifespan of a non-constrained prosthesis would depend on the existence of the couple: radial head/ulnar collateral ligament; the absence of radial head could compromise the humero-ulnar stability. This work paved the way for the designing of new non-constrained elbow prosthesis with the reconstruction of the radial head.

The infraorbital nerve (ION) supplies the skin and mucous membranes of the middle portion of the face. This nerve is vulnerable to injury during surgical procedures of mid-face. Severe pain and loss of sense are noted in patients whose infraorbital nerve is either entirely or partially lost after these surgeries. We investigated the distribution area and topography of the ION, about which little is currently known, by dissecting 43 hemifaces of Korean cadavers. The ION produced four main branches, the inferior palpebral, internal nasal, external nasal, and superior labial branches. The inferior palpebral branch was generally bifurcated, giving off a medial and a lateral branch (58.1%). The internal nasal branch ran superior to the depressor septi muscle, along the ala of the nose. It supplied the skin of the philtrum and gave off a terminal branch that supplied the nasal septum and the vestibule of the nose. The external nasal branch was distributed diversely supplying areas between the root and the ala of the nose. The superior labial branch was the largest branch of the ION produced the most subbranches. These subbranches were divided into the medial and lateral branches depending upon the area that they supplied.

We report an unusual case of bifocal fracture of the sternal part of clavicle, combining a metaphysodiaphysal fracture of the sternal end of the clavicle, a proximal physeal fracture, and a ligament avulsion of sternoclavicular joint, without neurovascular damage. Its surgical repair used an osteosynthesis with K-wires and tension band wiring and synthetic ligamentoplasty of the anterior and posterior sternoclavicular ligaments, without any reconstruction of the costoclavicular ligament. The clinical and radiographic results at six months are presented and the operative technique used in this case of pseudodislocation of sternoclavicular joint is discussed and compared to those previously published.