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Progression to dorsal extension of the lunate after distal scaphoidectomy was described more than a decade ago. Still, this technique remains a popular choice for surgical treatment of isolated scaphotrapeziotrapezoid osteoarthritis (STT OA). This study aimed to investigate short-term postoperative function, patient satisfaction and radiographic outcomes of distal scaphoidectomy with tendon interposition for isolated STT OA in the wrist. Scaphoid resection width, amount of DISI and postoperative complications were also assessed. We evaluated all distal scaphoidectomies done at our hospital from 2012 to 2018. Postoperative clinical analysis consisted of grip and key pinch strength, joint amplitude, pain on visual analog scale (VAS), hand usability (VAS) and functional scores (QuickDASH and PRWHE scores). On follow-up radiographs, we measured the amount of DISI, resection height and scaphoid working length and compared them to functional scores. Eighteen patients with 21 operated wrists were eligible. Average time to postoperative evaluation was 36 (5-78) months. We observed DISI in 95% of the cases (n=19). A mean increase of 13° (±6) in radiolunate angle was noted when comparing pre- and postoperative radiographs. Neither the amount of DISI nor the resection height was significantly correlated with the functional scores. No revision surgery for advanced wrist collapse was reported. Four concomitant surgeries were needed. Distal scaphoid excision with tendon interposition yields good short-term results in isolated STT OA. While 95% of cases developed a DISI deformity, there were no cases of functional impairment. Longitudinal studies with long-term follow-up are required to further evaluate lunate extension and possible clinical implications., (Copyright © 2020 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Closed flexor tendon pulley ruptures are relatively rare injuries. All previously reported cases have been in the long finger pulleys. To our knowledge, there has not been a case of closed thumb flexor tendon pulley rupture reported in the literature. This paper presents two cases of this pathology and discusses appropriate treatment of it.

Twenty-eight extensor carpi ulnaris lesions at the wrist were treated surgically between 1990 and 2002. Fifteen patients had an isolated extensor carpi ulnaris tenosynovitis or tendinopathy, five had extensor carpi ulnaris dislocation, four had an extensor carpi ulnaris subluxation and four had an extensor carpi ulnaris rupture. Seventeen patients first developed their symptoms while playing sports. At a mean follow-up of 23 months, twenty-two patients had returned to their previous activities. Seven of the 27 patients had lost more than 30% of their grip strength and five had restricted wrist motion. Two needed an extensor carpi ulnaris tenolysis. Pure isolated extensor carpi ulnaris lesions are rare and associated ulnar sided lesions (eleven triangular fibrocartilage complex tears and four lunotriquetral ligament tears), as well as possible predisposing factors (seven anomalous tendon slips, four ulnar styloid non-unions and one flat extensor carpi ulnaris tendon groove), were frequent. A classification of extensor carpi ulnaris tendon and subsheath lesions was developed to allow the surgeon to adequately evaluate the different components of these lesions.

Surgical release of the A1 pulley for treatment of trigger finger normally produces excellent results. However, in patients with long-standing disease, there may be a persistent fixed flexion deformity of the proximal interphalangeal joint. This is sometimes due to a degenerative thickening of the flexor tendons and may be treated by resection of the ulnar slip of flexor digitorum superficialis tendon. One hundred seventy-two patients (228 fingers) who had undergone this procedure were reviewed at a mean follow-up of 66 months. Mean pre-operative fixed flexion deformity of the proximal interphalangeal joint was 33 degrees. All but eight fingers were improved by surgery and there was an average gain of 26 degrees in passive extension (7 degrees residual fixed flexion deformity) of the proximal interphalangeal joint. Full extension was attained in 141 of the 228 fingers, and in all 101 fingers with a pre-operative loss of passive extension of 30 degrees or less. This technique is indicated for patients with loss passive extension in the proximal interphalangeal joint and a long history of triggering.

We report a complication following trapeziectomy and tendon interposition. Subcutaneous herniation of the tendon interposition occurred in 3 of 412 cases in which trapeziectomy, ligament reconstruction, and tendon interposition were performed. This herniation occurred posterolaterally in the early postoperative period and resulted in dorsal swelling and superficial pain. Magnetic resonance imaging was helpful in confirming the diagnosis and excision of the herniated interposition material resulted in satisfactory pain relief and functional outcome as long as metacarpal stability was present.

The authors report a series of 41 dissections of the forearm intended to study the orientation of the fibers of the flexor carpi radialis (FCR). This shows that there is a constant torsion of the fibers of the FCR by an average of 180 degrees. Half of this torsion occurs in the forearm and half in the sheath of the FCR at wrist level. Awareness of this torsion is particularly useful surgically when the tendon is employed in ligamentoplasty, particularly after trapeziectomy. Our study of the orientation of the fibers was aimed at the ability to perform subcutaneous splitting of the fibers for use of part of the tendon.

The authors report their experience in dealing with 43 cases of secondary surgery on the flexor pollicis longus tendon between 1970 and 1982. After an anatomical and biomechanical survey, the results of the different techniques used are analyzed: tenolysis (12 cases). tenodesis (one case), one- (3 cases) or two-stage (4 cases) grafts, flexor digitorum superficialis (FDS) transfer (11 cases) and secondary sutures (12 cases). The overall outcome was very disappointing, with 50 per cent poor results. Compared with the other techniques, secondary suture fared best, and it can be combined, if need be, with tendon lengthening at the wrist and metacarpo-phalangeal pulley reconstruction. Considering these results, therapeutic indications are proposed. The functional requirements of the patient may lead to prefer simple interphalangeal fusion to any dynamic method.

The author presents his experience with an established technique of flexor tendon lengthening by tenotomy at the musculotendinous junction. This technique can be used for digital stiffness of forearm origin when active extension is possible on flexion of the wrist. There must not be adherence in the carpal tunnel or in the digital sheath, and active flexion must be preserved. It can also be used for digital stiffness in addition to other techniques. This kind of lengthening has some advantages: there are no sutures in the tendon itself, and it allows early reeducation in association with dynamic extension splinting. Active flexion is preserved immediately and there is good tendon healing. It is possible to lengthen selectively the superficial flexor or the deep flexor and in some cases both. Results are presented according to cause.