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International audience; Objective: To establish international recommendations for the management of spastic equinovarus foot deformity. Design: Delphi method. Setting: International study. Participants: A total of 24 international experts (N=24) in neuro-orthopedic deformities, from different specialties (Physical and Rehabilitation Medicine physicians, neurologists, geriatricians, orthopedic surgeons, neurosurgeons, plastic surgeons). Interventions: Experts answered 3 rounds of questions related to important aspects of diagnosis, assessment, and treatment of spastic equinovarus foot deformity. Main Outcome Measures: A consensus was established when at least 80% of experts agreed on a statement Results: A total of 52 items reached consensus. Experts recommend assessing effect of the deformity on functional activities before treatment. Before treatment, it is crucial to differentiate spastic muscle overactivity from soft tissue contractures, identify which muscles are involved in the deformity, and evaluate the activity of antagonist muscles. Motor nerve blocks, 2-dimensional video analysis, and radiologic examinations are often required to complement a clinical examination. The treatment of equinovarus foot depends on the correctability of the deformity and the patient's ability to stand or walk. The preoperative assessment should include an interdisciplinary consultation that must finalize a formal agreement between physicians and the patient, which will define personalized attainable goals before surgery. Conclusion: The establishment of guidelines on managing equinovarus foot will help physicians and surgeons, specialists, and nonspecialists to diagnoses and assess the deformity and direct patients to a network of experts to optimize patient functional recovery and improve their autonomy.

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 etiology and the complexity of losses of substances from the chest wall cause technical difficulties during their reconstruction. In order to obtain the best possible functional and morphological results, it is important to appreciate the lesions. When considering soft tissue reconstruction, the dimensions, location and shape of losses of substances, as well as the reliability and the arc of rotation of the chosen flap, must be taken into account. The perforator flap of the thoracoacromial artery and its vascular anatomical bases have been recently studied, concerning the pectoral and deltoid branches. The clavicular branch has only been rarely studied. We propose to study anatomically the clavicular branch of the thoracoacromial artery, in terms of constancy, dimensions and direction, in order to give to practitioners an additional option in the surgery of perforator flaps of the cervical region. Material and methods: We carried out a direct and selective injection of 24 thoracoacromial arteries, on corpses preserved in a low-formalin solution rich in glycerin. The injected solution was made from a mixture of methylene blue and gelatin. Cadaveric dissection was then used to study the location, frequency, and path of the clavicular branch of the thoracoacromial artery. Results: The clavicular branch was absent in more than half of the dissections. The length of its extrafascial pedicle varied between 0.5 and 2.5cm. The length of the pedicle after transmuscular dissection varied between 3 and 6cm. The general direction of this clavicular branch was ascending and medial. Conclusion: Our work shows that when it is present the clavicular branch of the thoracoacromial artery has an extrafascial pedicle which measures 0.5 to 2.5cm, and a transmuscular pedicle from 3 to 6cm. And that its vascular skin territory projects slightly below the clavicle.

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.

Introduction La chirurgie des lambeaux perforants a pris de l’essor ces dernieres annees. Cependant, ce type de chirurgie doit faire face a de nombreuses variations anatomiques en rapport avec la localisation des vaisseaux perforants. Ces variations anatomiques necessitent la realisation d’une imagerie preoperatoire permettant de mieux planifier la chirurgie. A travers une serie d’echographies Doppler sur sujets vivants, les auteurs se proposent de cartographier la vascularisation perforante du muscle trapezius. Materiel et methodes Une echographie Doppler couleur a ete realisee chez 22 sujets volontaires en regard des teguments recouvrant le muscle trapezius. A l’aide de reperes osseux (ligne des processus epineux, angle inferieur et epine de la scapula), toutes les perforantes trouvees etaient repertoriees selon leur localisation, leurs dimensions et leur direction. Resultats Quatorze femmes et 8 hommes ont ete inclus dans l’etude. L’âge moyen de l’echantillon etait de 25,8 ans et la taille moyenne de 1,74 metres. En moyenne, le nombre de perforantes trapeziennes trouvees de chaque cote de la ligne des processus epineux etait de 10,64. Le calibre moyen des perforantes etait de 0,82 millimetres. Conclusion L’echographie Doppler preoperatoire est interessante pour le praticien dans la realisation des lambeaux perforants du muscle trapezius, car elle est capable de preciser la localisation, le calibre, le trajet de la perforante et de facon generale la fiabilite de son utilisation.

Introduction Les pertes de substances du triangle lateral du cou et de la region cervicale antero-laterale representent une forte demande en chirurgie reparatrice. Leur prise en charge requiert le plus souvent la realisation de lambeaux regionaux ou a distance. Le lambeau perforant base sur la branche deltoidienne de l’artere thoraco-acromiale (ATA) peut constituer une bonne solution a ces indications. Il offre plusieurs avantages techniques en regard des sites donneur et receveur. Materiel et methodes Nous avons realise la dissection de 24 lambeaux perforants bases sur la branche deltoidienne de l’ATA, sur des sujets anatomiques conserves avec une solution faiblement formolee et riche en glycerine. Une injection selective prealable de l’ATA avait ete realisee avec du bleu de methylene. Le territoire vasculaire, la localisation de la perforante par rapport a des reperes connus, ainsi que l’amplitude et l’arc de rotation possibles du lambeau ont ete etudies. Resultats Les principales arteres perforantes du lambeau etaient situees au milieu du sillon delto-pectoral, souvent entourees par du tissu cellulo-graisseux dans 18 dissections sur 24. Dans 22 dissections sur 24, on trouvait au moins 2 perforantes naissant de la branche deltoidienne. Le diametre moyen des perforantes etait de 1 mm. L’amplitude de mobilisation du lambeau permettait d’atteindre dans tous les cas le triangle lateral du cou et/ou la region cervicale antero-laterale. Conclusion Cette etude anatomique du lambeau perforant base sur la branche deltoidienne de l’ATA a permis de revoir les bases anatomiques pour la levee de ce lambeau et de fixer des reperes utiles au chirurgien afin de proposer une technique chirurgicale facilement realisable.

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.

International audience; A systematic survey of lichens was performed in 2019 in four of the five territories constituting the French Scattered Islands (Europa Island, Juan de Nova, Glorioso Islands, and Tromelin) focusing on the genus Ramalina. Species were characterized using morphological (macroscopic and microscopic) features and an accurate chemical profiling method based on high-performance liquid chromatography coupled with diode-array detection and electrospray ionization tandem mass spectrometry (HPLC-DAD-MS). Five species were found in these territories. Two of them, Ramalina dumeticola and R. ovalis, are already known. Three species are introduced here as new to science: Ramalina gloriosensis sp. nov., R. hivertiana sp. nov., and R. marteaui sp. nov. An identification key is provided for the species found in the area and morphologically closely related taxa. © 2021 W. Szafer Institute of Botany, Polish Academy of Sciences.

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.

International audience; An adult skeleton has over 200 bones. Each bone has a specific function. These different functions bring different types of mechanical loadings. To ensure a healthy behavior of the bone, a throughout life process occurs on the micro-architecture of the cortical bone. This process highly depends on the stress applied on the bone. The micro-architecture is able to supply blood and nutrients into the bone matrix and acts on the bone remodeling process. The architecture is formed by vascular canals where the orientation depends on the main axis of the mechanical loading. Vascular canals of the cortical bone located in long bone diaphysis are mainly oriented along the longitudinal axis of the diaphysis. Moreover, the canal network is tortuous and several geometrical features should affect the macroscopic behavior of the bone. The novelty of this work is to use a method which accurately describes the vascular architecture of the cortical bone based on micro-computed tomography and to correlate these results with the macroscopic mechanical behavior of the cortical bone. This experimental study is based on the extraction of cortical bone samples from four cadaveric human subjects. For each human subject, left and right humeri and femurs are studied. Dumbbell-shaped bone specimens are prepared from each bone. Care was taken to preserve bone properties after extraction: a maximum of 15 days was fixed between the extraction and the mechanical testing. Samples were constantly kept hydrated and stored at 4 °C in order to avoid frost/defrost cycles. Specimens are scanned and subsequently mechanically loaded to failure. Results will show the impact of the laterality of the bone on the architecture, the impact of loading on the bone on the architecture by comparing humeral and femoral samples for each human subject and finally the impact of the architecture on the mechanical behavior of the bone.

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.

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.

International audience

Introduction et objectifs Les subependymomes sont des tumeurs du systeme nerveux central begnines (OMS grade I), rares, se developpant en bordure des cavites ventriculaires mais dont l’origine cellulaire demeure incertaine [1] . Dans une etude precedente, nous avons mis en evidence une population de cellules presentant un profil antigenique de cellules souches neurales (nestine/sox2/vimentine/GLAST/GFAP+) en bordure des ventricules cerebraux, avec, par endroits, des bourgeonnements de la paroi ventriculaire enrichis en marqueurs de cellules souches neurales [2] . Afin d’explorer si ces cellules souches neurales sont susceptibles d’etre a l’origine des subependymomes, nous avons recherche si les subependymomes expriment le meme profil antigenique que les cellules souches neurales periventriculaires. Methode Nous avons realise des co-immunomarquages fluorescents afin de determiner l’expression d’un panel de marqueurs de cellules souches neurales (nestine, sox2, vimentine, GLAST, GFAP) dans une serie de 14 subependymomes. Nous avons egalement evalue l’expression du marqueur de proliferation Ki67, du marqueur astrocytaire S100b et du marqueur neuronal NeuN. Resultats Les immunomarquages revelent la presence de Sox2, nestine, vimentine, GLAST, GFAP dans toutes les tumeurs analysees. Les marqueurs nestine, vimentine, GLAST et GFAP sont detectees dans la quasi-totalite des cellules. Le marqueur Sox2 est largement detecte avec cependant, une heterogeneite au sein du tissu tumoral. Des cellules Ki67-positives co-exprimant Sox2 et nestine sont aussi observees. Le marqueur astrocytaire S100b est detecte a des taux variables entre tumeurs dans la majorite des echantillons analyses. Aucune tumeur n’exprime le marqueur neuronal NeuN. Conclusion Notre etude montre que les subependymomes contiennent des cellules exprimant le meme profil antigenique que les cellules souches neurales periventriculaires, et permet de proposer une origine cellulaire a ces tumeurs.

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.

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

Resume Introduction Le transfert du muscle tibialis posterior (TTP) est le traitement palliatif le plus realise pour pallier le deficit neurologique des releveurs du pied. S’il a ete bien etudie apres atteinte peripherique, il reste peu evalue en cas d’atteinte centrale, ou il est souvent accuse de provoquer un effondrement de la voute du pied. Aussi nous avons mene une etude retrospective afin de : (1) de mesurer son retentissement sur la statique du pied, (2) savoir si ce transfert associe a d’autres gestes chirurgicaux permettait une amelioration des conditions de marche. Hypothese Le TTP peut provoquer un effondrement de l’arche mediale du pied. Patients et methodes Treize patients (13 pieds) ont ete revus a 65 mois (12–108) apres une chirurgie incluant un TTP. Les etiologies etaient 5 accidents vasculaires cerebraux, 3 traumatismes crâniens, 2 traumatismes medullaires, une myelopathie cervicarthrosique, une paralysie cerebrale et une tumeur cerebrale. Cliniquement, les principales evaluations portaient sur la statique de l’avant-pied et le type d’empreinte plantaire au podoscope. Radiographiquement, on relevait sur des cliches en charge, (1) sagittalement : l’angle de Djian, l’angle de Meary-Tomeno, l’angle de l’arche laterale et l’inclinaison calcaneenne, (2) transversalement et frontalement, l’angle talo-metatarsien et l’angle Djian-Annonier. Resultats Cliniquement, on relevait 6 empreintes plantaires normales et 7 pieds creux. Aucun ne presentait de pied plat. Deux patients presentaient des deformations en pronation et 2 en supination. Radiologiquement, les seules les differences entre les 2 pieds concernaient l’angle d’arche laterale et l’angle d’inclinaison calcaneenne en faveur de pieds creux du cote opere (respectivement, cote opere, 142,7° [136–156] ; p = 0,041 et 24° [14–33] ; p = 0,028). Discussion Contrairement a notre hypothese, on ne notait pas de tendance a la decompensation en pied plat valgus des patients avec atteinte centrale chez qui a ete realise un transfert du tibial posterieur sur le dos du pied. Niveau de preuve IV, etude retrospective sans groupe temoin.

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.

Déclaration de liens d’intérêtsRecherches cliniques/travaux scientifiques : oui [KERIMEDICAL].Consultant, expert : oui [KERIMEDICAL].; International audience; Les lésions nerveuses sans perte de substance de la main et des doigts sont des causes fréquentes de prise en charge chirurgicale aux urgences. La suture directe peut être accompagnée de la mise en place d’une gaine de couverture apportant une protection neurorégénératrice.L’objectif de notre étude est de rechercher l’apport biomécanique de l’utilisation des gaines de chitosan (REAXON®) dans les sutures directes nerveuses.Nous avons réalisé une étude in vitro anatomique, comparative, contrôlée en ouvert sur des nerfs digitaux propres et communs. Après dissection de nerfs issus de cadavres, des segments nerveux calibrés ont été répartis dans 3 groupes de suture nerveuse. Un groupe avec suture simple directe (groupe 1), un groupe avec suture directe simple associée à la mise en place d’une gaine REAXON® (groupe 2). Enfin, un groupe avec mise en place d’une gaine REAXON® sans suture nerveuse directe (groupe 3). La force de rupture de la suture a été évaluée pour chaque groupe sur cellule d’effort Dynacell® 3000 N. La médiane de rupture a été calculée pour chaque groupe et comparée entre les groupes par un test de Kruskal-Wallis.La force de rupture médiane du groupe suture simple est de 2,97 [2,5–3,7] Newtons (N) ; pour le groupe tube seul la force de rupture médiane est de 1,82 [1,7–2,3] N. Enfin, pour le groupe suture associée au tube la force médiane de rupture est de 4,17 [3,2–4,7] N. Il n’existe pas de différence significative entre les groupes suture simple et tube seul (p = 0,1209) ni entre les groupes suture simple et suture associée au tube (p = 0,3853). Il existe une différence significative entre les groupes suture associée au tube et tube seul (p = 0,0011).La mise en place d’une gaine de protection REAXON® ne semble pas apporter de supériorité mécanique comparativement à la suture simple. La mise en place d’une gaine REAXON® sans suture nerveuse est associée à de moindres performances mécaniques et une rupture plus précoce qu’avec suture simple nerveuse.

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.

Resume Introduction La dystonie en extension de l’hallux et/ou des petits orteils peut etre observee dans le cadre de lesions pyramidales et extrapyramidales et entrainer des douleurs des orteils concernes, spontanees ou a la marche, des difficultes et un inconfort lors de l’habillage ou le chaussage et des lesions cutanees des orteils. L’objectif de cette etude etait d’evaluer l’efficacite et la tolerance de la neurotomie des branches du nerf fibulaire profond destinees aux muscles long extenseur de l’hallux (LEH) et/ou long extenseur des orteils (LEO) dans le cadre du traitement de la dystonie en extension de l’hallux et/ou des orteils. Patients et methode Une neurotomie fibulaire profonde a ete realisee chez 20 patients ( n = 19 pour le LEH, n = 6 pour le LEO). Efficacite et tolerance du traitement ont ete analysees retrospectivement et via une entrevue telephonique permettant de mesurer l’impact subjectif sur les differentes genes du patient et son niveau de satisfaction. Resultats La dystonie avait disparu totalement dans 15 cas (75 %), elle persistait a un niveau minime chez les autres patients. Les patients rapportaient une diminution du niveau de douleurs ( p p Discussion La neurotomie des branches du nerf fibulaire profond pour le LEH et/ou le LEO semble etre un traitement efficace de l’hyperextension de l’hallux et/ou des orteils et de ses consequences chez le patient adulte neurologique. Cependant, ces resultats preliminaires encourageants doivent etre confirmes par des travaux prospectifs a plus long terme. Niveau de preuve IV.

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

Resume De nombreuses affections sont responsables d’un pied tombant, qui gene considerablement la marche, le pied butant facilement sur un obstacle, ou le genou devant etre plus flechi que normalement au cours de la phase oscillante du pas, notamment lors de la montee des escaliers. Plusieurs techniques ont ete decrites afin d’y remedier, faisant appel a des gestes osseux ou a des transferts tendineux, plus ou moins a fixation osseuse. Les auteurs decrivent une technique simple, tres pratiquee en zone d’endemie lepreuse, et qui donne des resultats durables ; elle fait appel a un double transfert tendineux a travers la membrane interosseuse crurale, utilisant le tibial posterieur et le long flechisseur des orteils qui sont sutures en amont du retinaculum des extenseurs, respectivement au tibial anterieur et aux longs extenseurs de l’hallux et des orteils.

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.