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The two approaches most often used for placing implants and trapeziometacarpal prostheses are the laterodorsal approach and the lateropalmar approach. The advantages and disadvantages of these two approaches are set out. Each one allows optimal joint exposure while preserving or repairing the peritrapezial musculotendinous structures. They allow the insertion of partial or total trapeziometacarpal implants and modern coupled trapeziometacarpal prostheses. Each approach must be practiced and mastered on cadaver specimens before being used for trapeziometacarpal surgery.

The IVORY® prosthesis is a total trapeziometacarpal joint prosthesis used for the treatment of symptomatic trapeziometacarpal osteoarthritis. The aim of this prospective study was to evaluate its long-term outcomes with a minimum follow-up of 10 years. From 2004 to 2007, 110 trapeziometacarpal prostheses (95 patients) were implanted. The implant survival curve was constructed using the Kaplan–Meier method. Five patients were lost from follow-up and two died. Six prosthesis (5.5%) were removed after dislocation or fracture of the trapezium. The survival rate of the prosthesis was 95%. After 10 years, the mean visual analogue pain score was 0.24/10 and the key-pinch force was similar to the other hand. Dislocations occurred for eight implants (7.3%). No radiological loosening was noted. In conclusion, the long-term results with the IVORY® prosthesis are very satisfactory in terms of pain relief, function and survival. Level of evidence: II

Background: New generation of total trapeziometacarpal joint prosthesis using double mobility concept has been used for several years. The aim of this study was to evaluate the dislocation rate with this implant after a minimal 3 years of follow-up. Methods: From September 2013 to August 2015, 200 trapeziometacarpal prostheses were implanted in 179 patients. Clinico-radiological follow-up was performed with an average of 48.2 months (36-60 months). Survival rate and dislocation rate were analyzed. Loosening of the implants and other intercurrent events were noticed. Results: Visual analog scale, Quick-DASH, strengths and range of motion improved significantly. We report a survival rate of 97% with only 0.5% of dislocation of prosthesis at 48 months of follow-up. Intercurrent events rate were similar to the ones found in literature or other studies. Conclusions: After a minimal of 3 years of follow-up, prosthesis with double mobility seemed to bring better stability in implant for thumb prosthetic replacement.

Introduction Amputation of the hand is a rare and extremely intense trauma. Replanting and allografting after this type of injury require a major reorganization of the brain. Brain plasticity, though better known in the context of disorders of the central nervous system, is just as indispensable when the extremities are damaged. Materials and methods A 17-year-old patient underwent replantation of the nondominant hand after transmetaphyseal amputation after traumatic injury. After 18 days in hospital and subsequent treatment in a physical rehabilitation center, the patient attended clinical and radiology follow-up sessions over the next 2 years. Results The management of this patient led to an excellent functional outcome in conjunction with successful social and professional reintegration. Electromyography at 18 months confirmed nerve regrowth. Functional magnetic resonance imaging was done at 2 years to evaluate cerebral plasticity. Motor function, largely dependent on the primary motor area, is aided by the addition of secondary and accessory motor areas for both simple and complex movements. A change in sensory information is stimulation in its own right hemisphere and increases solicitation of the contralateral precentral and postcentral gyrus. Conclusions There seems to be a real reversible dynamic plasticity under the balance of inhibitory and excitatory influences exerted on the cortical neurons. Any disruption of this balance requires the brain to adapt to the new circumstances to reestablish the hand as a functioning part of the body.

Introduction High-energy trauma of the hand often causes tissue loss involving bone, tendon and skin and is sometimes accompanied by devascularization of digits. Bone stabilization is the first step in the management of such injuries. Materials and methods A young patient presented composite tissue loss of the dorsum of his right (dominant) hand following an accident with a surface planer. Tissue loss involved the diaphyses of the first 4 metacarpals, tendons and skin with almost complete amputation of the 3rd finger. Bone stabilization comprised osteosynthesis using pins associated with cement to fill the bone defect. Hunter tendon rods were used for tendon repair and a pedicle groin flap (McGregor) was used to achieve skin coverage. The cement was replaced with autologous cortico-cancellous bone graft combined with bone paste (Nanostim) 3 months after the cement stabilization. Results Eleven months after the accident, the patient was able to return to work as a carpenter. Pinch and Grasp strength in the injured hand were half that in the contralateral hand, but there was no loss of sensitivity. Mobility was very satisfactory with a Kapandji score of 9 and a mean TAM of 280°. The patient can write, open a bottle and does not feel limited for everyday activities. Radiographically, the bone of the 3 reconstructed metacarpals appears consolidated. Conclusion The induced membrane technique allowed the reconstruction of small bone deficits in the long bones of the hand in a two-step procedure, the first step taking place in an emergency context of composite tissue trauma.

IF 0.308 (2017); International audience; This study was a retrospective evaluation of 18 patients with traumatic bone loss affecting the fingers, hand and wrist who were treated using the induced-membrane technique. Sixteen men and two women, mean age 54years (27-74) presented a hand injury including bone loss. Sixteen patients were treated on an emergency basis and two following nonunion of their fractures. There were 13 cases of open fracture of the phalanx and 5 cases of metacarpal fractures. These patients were treated with debridement and the injuries were covered when necessary. To address the bone loss, the first step of the induced-membrane technique involved placing a cement spacer (polymethylmethacrylate [PMMA]) without antibiotics in the defect. During the second step, the cement spacer was removed and replaced by autologous cancellous bone graft. The graft was placed within the biological tube left empty after removal of the cement. For each patient, bone union was assessed with radiographs and/or CT scan. Failure was defined as nonunion at 1year. In 16 patients, the fractures had healed after 4months (1.5-12months) on average. Two failures were noted (one nonunion treated using a PIP prosthesis and one case of delayed union). Mobility of the fingers, evaluated using the Total Active Motion (TAM) was 145° (75°-270°). The Kapandji score reached 8 for the thumb. Grip strength reached 21kg/F and pinch strength was 5kg/F; these values were 50% of those in the healthy hand. The induced-membrane technique is simple and can be used to treat traumatic bone loss in an emergency, thus avoiding amputation and limb shortening, while preserving limb function. It provides immediate stability and allows early mobilization.

Resume Les patients a operer sont photographies en pre-, et postoperatoire et parfois en preoperatoire. Sept mille quarante-huit dossiers ont ete traites. Cette methode est utile pour la prise en charge multidisciplinaire, en particulier pour le kinesitherapeute et pour le suivi des ortheses, pour l’information du patient et eventuellement du medecin du travail et du medecin expert. Il faut en revanche gerer au jour le jour l’information.

Summary Dorsal perilunate wrist dislocations are rare. Associated carpal bones or radial styloid process fractures can occur and be included in the current classifications. The authors report an unusual association of dorsal perilunate wrist dislocation with a multifragmentary distal radius fracture. Such traumatic entity has never been previously described. Poor functional outcome may justify the inclusion of associated complex forearm bone fractures in wrist dislocation classifications.

Introduction Les defects osseux traumatiques ou infectieux au niveau de la main font discuter l’amputation et les sequelles sont constantes. Nous rapportons 26 cas traites par la technique de la membrane induite. Patients et methode Vingt-trois patients de 51 ans (26 lesions, 85 % d’hommes, 65 % d’accident du travail) presentant un defect osseux a la main (19 cas traumatiques, 7 cas septiques) ont ete inclus dans cette evaluation prospective multicentrique (3 centres). La taille du defect osseux atteignait 2 cm (0,5–7 cm). Trente-huit pour cent des lesions etaient extra-articulaires. La technique consiste en une fixation rigide, un lambeau de couverture si necessaire et le comblement du defect osseux par du ciment PMMA. Cette technique necessite une seconde operation (delai - 3,7 mois 1–14) ou le ciment est remplace par une autogreffe spongieuse (radius distal - 86 %). Le point cle consiste a respecter la membrane a corps etranger qui s’est formee autour de l’entretoise en ciment creant une chambre biologique. La consolidation osseuse etait evaluee par un chirurgien independant (radios ou scanner). L’echec etait defini comme une pseudarthrose a un an ou une complication septique non controlee. Resultats Deux cas de defect traumatiques n’ont pas consolide, aucune complication septique n’a ete retrouvee et tous les cas septiques ont ete gueris. La consolidation osseuse a ete effective a 5 mois (1–14) dans 92 % des cas. Deux biopsies ont permis de retrouver un tissu osteoide + le TAM des doigts blesses atteignait 114 (20–250), le QDash, 19 (4–40) et le retour au meme poste etait effectif au sixieme mois (1–24). Tous les doigts etaient inclus meme si les sequelles etaient constantes. Discussion Masquelet est le premier a avoir rapporte 35 cas de defect osseux du tibia traite par la membrane induite lors de pseudarthroses septique. Cette technique permet de traiter de grands defects une autogreffe spongieuse uniquement. L’entretoise en ciment permet d’induire une membrane (neo-perioste) qui constitue une chambre biologique. Les modeles animaux reportes par Pelissier et Viateau ont montre les proprietes de cette membrane (secretion de facteurs de croissance et activites osteogeniques des cellules). Utiliser cette technique est possible en urgence ou dans des situations septiques ailleurs qu’a la jambe. A la main et en urgence, cette technique permet une mobilisation immediate car la stabilisation du squelette et le comblement du defect sont plus simple et plus stables qu’une autogreffe en urgence qui expose a l’infection.

Objet Les contraintes auxquelles nous sommes appeles nous semblent etre les suivantes : avoir un dossier medical documente, mettre en commun des informations propres a chaque patient, assurer la prise en charge et le suivi en ambulatoire et aider le patient dans son investissement reeducatif et dans son choix therapeutique. La main constituant un espace privilegie d’investigation photographique, la photo numerique nous a semble apporter une reponse interessante a ce cahier des charges. Apres une presentation sommaire du materiel, les auteurs rapportent leur experience de quatre annees d’utilisation. Resultats – un dossier medical documente a travers des exemples de chirurgie traumatique ou reglee, les auteurs montrent la simplicite de la methode, l’interet et la fiabilite ; – la mise en commun des informations est indispensable pour une prise en charge pluridisciplinaire, cette methode permet de partager l’information avec d’autres praticiens (urgentiste, med traitant, psychiatre) de facon conviviale ; – assurer le suivi en ambulatoire, le patient etant photographie a chaque consultation il est souvent facile de regler par simple conversation telephonique un probleme de pansement ou d’appareillage. Le stockage des donnees permet de faciliter l’etude de serie de patients ou d’elaborer des protocoles reeducatifs ; – aider le patient dans sa reeducation et son choix therapeutique, la photo numerique apporte un reconfort au patient dans les reeducations longues, permettant de visualiser l’etape initiale, les etapes de la reeducation et ainsi de faire percevoir les progres realises, la photo numerique peut aider les patients a prendre une decision therapeutique eclairee par l’etude d’autres dossiers dont on peut apprecier le resultat. Conclusion La photo numerique est devenue un element a part entiere dans le dossier medical de nos patients, cette technique encore evolutive, simple et conviviale ouvre des debouches interessantes dans le suivi des patients et la gestion des pathologies.