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Background: The purpose of this study is to research the type of lesions to the hand and fingers in the sport of surfing.Methods: All surfing related hand injuries reported to our hospital between January 2008 and September 2015 were analyzed.Results: Thirty-seven patient files held a clear description of a trauma related to the surf sport. We found three finger sprains, five wounds needing suture, including one digital nerve lesion and one ring finger with flexor tendon injury, three fingertip amputations and twenty-six digital fractures. The fracture type was similar in twenty-one patients: an open extra-articular transverse fracture of the distal phalanx. Thirty-one injuries were caused by the surf leash.Conclusions: From this case series we can conclude that surfing may lead to significant trauma to the fingers, mainly due to the leash. This can be caused by grasping the leash while it snaps to tension, which may lead to hyper flexion of the distal phalanx, resulting in a typical trans-phalangeal fracture. Also, when the leash is wrapped around a finger or grasped near the attachment of the leash to the board, ring avulsion-like trauma may occur, leading to open fractures or (partial) amputations. Recognizing that surf leash trauma causes a particular type of fracture to the distal phalanx, may lead to better education of surfers and the development of safer surfing equipment.

When implanting the Maia® trapeziometacarpal prosthesis, surgeons will be faced with a variety of complications they must be able to recognize and anticipate. Their ability to deal with these complications and possibly even failures is governed by their knowledge of the right steps to take. The aim of this retrospective study was to assess the incidence of complications reported during implantation of the Maia® prosthesis, to describe their nature and potential predisposing factors, and to study failures and their outcomes. Between January 2008 and December 2012, 156 Maia® prosthetic joints were implanted in 139 patients at one center by one surgeon. Clinical and radiological parameters were analyzed before, during and after surgery. The implant characteristics were documented and the surgical technique used was analyzed. The overall postoperative complication rate was 35.9%. The most common complication (16%) was tendinopathy. Prosthesis dislocation (4.5%) and trapezoid loosening (2.6%) were the primary causes of failure. Eighteen patients required secondary surgical revision (11.5%) and the implant was removed in 12 cases (failure rate of 7.7%). Two factors were significantly correlated with the onset of complications, independent of their nature and irrespective of whether secondary surgical revision was required: a deformed thumb prior to surgery and the position of the trapezial cup. Mediocre trapezium bone quality was a statistically significant factor for secondary surgical revision. The survival rate of the Maia® prosthesis was 90.8% at 62months. These factors influence the onset of complications and must be taken into account in the pre-surgical workup in order to identify the best candidates for successful Maia® joint replacement. For the most part, the failure rate in our series was due to inappropriate surgical technique rather than an inherent defect in the prosthesis. A meticulous, precise surgical technique is therefore essential.

Il s’agit d’une etude prospective mono-operateur de 86 protheses Maia® double mobilite (9 hommes et 68 femmes) analysees et revues par un observateur independant. L’effectif est compose d’un groupe STT+ de 12 patients traites dans le meme temps d’une resection du pied du scaphoide avec ou sans interposition d’un pyrocardan suivi en moyenne 16 mois (6–27) et d’un groupe comparable sans geste sur la STT (STT − ) de 65 patients (74 protheses) suivi en moyenne 15 mois (6–39). Dans le groupe STT− : a 6 mois, sur les 31 patients actifs, 30 ont repris le travail a 3,4 mois en moyenne, le DASH est passe de 77,5 a 8,5, l’EVA de 7,9 a 0,9. La mobilite, en particulier la retropulsion et l’ouverture commissurale etaient jugees bonnes et tres bonnes dans 97 %. Le Kapandji etait de 9,8. La force etait normale ou legerement diminuees sans retentissement fonctionnel chez 93 % des patients. Ces resultats sont restes stables ou se sont legerement ameliores au dernier recul. Dans le groupe STT+, au meme delai, le DASH est passe de 74 a 15,3, l’EVA de 8,2 a 1,5, la mobilite etait bonne dans 83 %, l’ouverture commissurale dans 91 %. Le Kapandji etait de 9,9. La force etait normale ou legerement diminuees sans retentissement fonctionnel chez 75 % des patients. Les scores sont restes stables sans amelioration significative a plus d’un an de recul. Les patients etaient satisfaits ou tres satisfaits dans 99 % dans le groupe STT− et 92 % dans le groupe STT+. On deplore : une fracture du trapeze peroperatoire exclus de l’analyse fonctionnelle, deux cas d’algodystrophie, deux de Quervain, deux dysesthesies cicatricielles. Radiologie : aucun lisere, ni ossification, ni enfoncement de cupule, ni luxation, ni descellement. Un stress-shielding asymptomatique de la base metacarpienne. Avec une recuperation fonctionnelles rapide et tres satisfaisante, aucune luxation, aucune reprise chirurgicale ni probleme radiographique, nous considerons les resultats tres encourageants de la prothese Maia® double mobilite. Nous n’avons pas trouve de difference significative entre le groupe STT− et le groupe STT+. Ces resultats necessitent un suivi a plus long terme avec un effectif plus important.

When implanting the Maia

Resume Les pseudo-kystes mucoides sont des tumeurs benignes peu frequentes qui touchent l’ensemble des nerfs peripheriques au voisinage des articulations. Rapportes pour la premiere fois dans la litterature en 1891, la question de leur nature n’est pas resolue a ce jour. Identifier l’origine de ces kystes peut influencer la prise en charge et le risque de recidive de ces lesions. Vingt-trois patients (21 hommes et 2 femmes) de 38 ans en moyenne (extremes de 13 a 56 ans) ont ete suivis avec un recul moyen de 6 ans. Le kyste mucoide siegeait 16 fois au niveau du fibulaire commun au col de la fibula, 1 fois au niveau du nerf tibial au genou, 1 fois au niveau du nerf median, dans 3 cas au niveau du nerf ulnaire et dans 2 cas au niveau du nerf suprascapulaire. La symptomatologie douloureuse a ete locale dans 18 cas, irradiante dans le territoire concerne dans 20 cas. Dans 17 cas, le mode de decouverte a ete un deficit moteur. L’EMG a ete realise dans tous les cas, l’echographie dans 15 cas, le scanner dans 7 cas et l’IRM dans 10 cas. Tous les patients ont ete operes. La neurolyse a ete faite sous microscope pour les kystes intra-neuraux. La recherche d’un pedicule communiquant avec l’articulation voisine a ete systematique. Une communication articulaire a ete retrouvee dans 17 cas. Le delai moyen de recuperation d’une force musculaire a 5 et/ou d’une sensibilite normale a ete de 7 mois dans 16 cas, on notait une absence totale de recuperation dans 1 cas. Il y a eu trois recidives necessitant une arthrodese tibio-fibulaire. Des trois theories avancees (degenerescence kystique de certains schwannomes, degenerescence du tissu conjonctif de la gaine nerveuse), c’est la theorie articulaire qui nous a semble la plus probable. L’existence d’un pedicule reliant une articulation dans plus de 60 % des cas, la situation anatomique peri-articulaire des nerfs touches, parfois la migration le long d’un nerf articulaire et leur contenu mucoide, sont en faveur d’une origine articulaire. La notion de recidive apres des excisions completes et minutieuses est egalement en faveur de la physiopathologie articulaire. Il faut evoquer un kyste mucoide devant toute lesion neurologique, d’apparition rapide, au voisinage d’une articulation. La recherche d’une communication articulaire en pre et en peroperatoire est importante notamment pour limiter le risque de recidive.

Axillary nerve injuries still go undiagnosed far too often despite their frequency. However the quality of the outcome depends on expert management and prompt surgery. To optimise the latter, we re-examined 83 operated cases of traumatic lesions of the axillary nerve. We analysed the neurological and functional recovery of these patients by means of a follow-up evaluation at 6 years postop. The results were classified by age, mechanism of injury, delay to surgery and the presence or otherwise of associated neurological or osteo-articular lesions. We highlighted that a high index of suspicion ought to exist in all cases of trauma to the shoulder in a patient aged more than 40, any injury associated with palsy of the long head of triceps and in the case of an osteo-articular lesion due to high-velocity trauma. A complete lack of shoulder abduction must always prompt a search for a lesion of the axillary nerve as well as a suprascapular nerve palsy or rotator cuff lesion. There are few literature reports of surgical management of this particular nerve injury. An early MRI scan as part of the management should improve results by a reduction in the delay before surgery. As a result of our investigation we conclude that a lesion of the axillary nerve without signs of recovery at 3 months should be referred to a centre specialized in peripheral nerve surgery.

A mole gun is a weapon, which is used to trap and kill moles. This report provides an overview of the state of knowledge of mole gun injuries, comparable to blast injuries caused by fireworks, explosive or gunshot. Over a 2-year period, the authors reported their experience with ten hand injuries caused by mole gun. Radial side of the hand was often concerned, particularly the thumb. The authors explain their choices in the management of such lesions. Surgery was performed primarily and a large debridement currently seemed to offer the best outcome for the patient. Blast, crush, burns and lacerations may explain the higher rate of amputation to the digits. A long period of physiotherapy, specifically of the hand, was needed before the patient could return to work. This ballistic hand trauma encountered by surgeons requires knowledge and understanding of these injuries. It should be in accordance with firearms law because of severe injuries encountered and possible lethal wounds.

Mucoid cysts compressing the common peroneal nerve have been reported. Whether these cysts are schwannoma or are synovial in nature is the subject of controversy in the medical literature. To contribute to this debate, the present study was designed to detail the anterior innervation of the proximal tibiofibular joint. We dissected 10 knees of five fresh cadavers after staining the tibiofibular joint under fluoroscopic guidance. Through a lateral approach near the fibular head, the common peroneal nerve was isolated then dissected distally to determine whether it or its branches ramified over the proximal tibiofibular joint. In all 10 legs, only one collateral branch was observed on the common peroneal nerve proximal to its terminal division. This collateral sent a branch to the proximal tibiofibular joint before penetrating the tibialis anterior muscle. The articular branch coursed in a superior and posterior direction approximately 1 cm to attain the tibiofibular joint. In no specimen did the deep or superficial peroneal nerves send a twig to the tibiofibular joint. This study confirms and clarifies prior descriptions of the innervation of the anterior aspect of the proximal tibiofibular joint. It clarifies the mechanisms of compression of the common peroneal nerve by synovial cysts that originate from the proximal tibiofibular joint and provides anatomical landmarks that should facilitate complete resection of these cysts.

Mucoid pseudocysts are infrequent benign tumors which can develop on all peripheral nerves near joints. The origin of these cysts remains to be determined. We searched for arguments favoring an articular origin which would have an impact on management and risk of recurrence.Twenty-three patients (21 men and 2 women, mean age 38 years, age range 13-56 years) presented mucoid pseudocysts and were followed for a mean six years. The mucoid pseudocyst was located on the common fibular nerve at the neck of the fibula in 16 patients, on the tibial nerve at the knee in one, on the median nerve in one, on the ulnar nerve in one, and on the suprascapular nerve in two. Pain was local in 18 patients and irradiated to the concerned nerve territory in 20. Motor deficit was the inaugural feature in 17 patients. EMG was performed in all patients, ultrasound exploration in 15, computed tomography in 7 and magnetic resonance imaging in 10. All patients included in this series underwent surgery: pathological diagnosis of mucoid intra-neural pseudocyst was established in all. Systematic search for communication with the neighboring joint was performed in all cases.An articular communication was found in 17 patients. Mean time to recovery of muscle force (scored 5) and/or normal sensitivity was seven months in 17 patients. One patient did not achieve full recovery. Three patients experienced recurrence and required tibiofibular arthrodesis.Three theories have been proposed (cystic degeneration of schwannoma, degeneration of nerve sheath connective tIssue, and an articular origin). The articular theory appears to be the most probable. The presence of an articular pedicle in 60% of the patients, the anatomic juxtaposition between the nerves involved and neighboring joints, and occasional migration along the articular nerve as well as the cyst's mucoid content argue in favor of the articular theory. The notion of recurrence after complete minute excision is also in favor of an articular pathogenic mechanism. The diagnosis of mucoid cyst should be retained as a possibility in patients with rapidly progressive signs of nerve compression near a joint. It is important to search for articular communication before and during the surgical excision in order to limit the risk of recurrence.

Axillary nerve injuries still go undiagnosed far too often despite their frequency. However the quality of the outcome depends on expert management and prompt surgery. To optimise the latter, we re-examined 83 operated cases of traumatic lesions of the axillary nerve. We analysed the neurological and functional recovery of these patients by means of a follow-up evaluation at 6 years postop. The results were classified by age, mechanism of injury, delay to surgery and the presence or otherwise of associated neurological or osteo-articular lesions. We highlighted that a high index of suspicion ought to exist in all cases of trauma to the shoulder in a patient aged more than 40, any injury associated with palsy of the long head of triceps and in the case of an osteo-articular lesion due to high-velocity trauma. A complete lack of shoulder abduction must always prompt a search for a lesion of the axillary nerve as well as a suprascapular nerve palsy or rotator cuff lesion. There are few literature reports of surgical management of this particular nerve injury. An early MRI scan as part of the management should improve results by a reduction in the delay before surgery. As a result of our investigation we conclude that a lesion of the axillary nerve without signs of recovery at 3 months should be referred to a centre specialized in peripheral nerve surgery.

The role of distribution, cooperation, and coordination issues in the domain of network management is discussed. IDEAL, the framework under development to investigate distributed network management solutions is presented. An example is given of distributed network management which shows how set diagnosis agents cooperate and coordinate themselves to diagnose multiple problems. >

Earlier work has demonstrated possible paralysis of the long head of the triceps brachii (LTB) after surgical repair of traumatic injury to the axillary nerve. Anatomy textbooks describe the motor branch of the LTB arising from the radial nerve within the body of the triceps. We studied the position of the motor branch for the LTB to determine its exact origin.Three groups were studied: Group I included 9 traumatic injuries of the axillary nerve associated with clinical involvement of the LTB; Group II included 20 secondary posterior trunks dissected from cadaver specimens; Group III included 15 dissections of the infraclavicular plexus with complete dissection of the secondary posterior trunk. The position of the axillary nerve injury was retrieved from the operative reports for Group I. The precise origin of the motor branch for the LTB was identified for Group II. Neurostimulation was used to identify the origin of the motor branch for the LTB in Group III.For Group I: injury to the axillary nerve was situated 10 mm (mean) from the bifurcation of the secondary posterior trunk in 6 cases and at the bifurcation in 3. Type IV injury was identified in 4 cases and type V in 5. For Group II: the motor branch for the LTB arose 6 mm (mean) from the bifurcation of the secondary posterior branch in 13 cases, at the bifurcation in 5, and 10 mm proximally in 2, but never from the radial nerve. For Group III: the motor branch for the LTB arose 4.5 mm (mean) from the bifurcation of the secondary posterior trunk in 11 cases, at the bifurcation in 4, and never from the radial nerve.Observed injuries to the axillary nerve with an associated paralysis of the long head of the triceps brachii were located proximally and were severe. Our dissections always located the motor branch of the LTB arising from the axillary nerve or the secondary posterior branch. We thus deducted that associated LTB paralysis is a sign of poor prognosis. In patients with axillary nerve injury it is a sign favoring a proximal and severe lesion of the axillary nerve.When examining patients with traumatic injury involving the axillary nerve, it is important to search for paralysis of the long head of the triceps brachii. If present, it is a sign of a severe axillary nerve lesion requiring early repair at 3 months.

Much work has focused on the short-term outcome after external fixation with the Ilizarov apparatus for treatment of severe recurrent or neglected foot deformity. No series has provided sufficient follow-up to allow an analysis of long-term stabilization.We reviewed a series of 17 patients (21 feet) treated with the Ilizarov apparatus between 1988 and 1998 and reexamined after a mean 6-year follow-up. We assessed the risk of degradation of the initial result and quantified the need for secondary arthrodesis surgery. This series included 18 congenital clubfeet and 3 cases of acquired talipes equinus. Mean patient age was 15 years.Pain, morphology, weight bearing attitude and quality of shoe fit were assessed. Results at treatment end were very good in 16 cases, good in 4 and poor in 1. Two early recurrences required arthrodesis. At last follow-up, results were very good in 17 cases, good in 3, and poor in 1 (late recurrence with arthrogryposis).With 3 recurrences among 21 cases, results were maintained well over time in this series. Most of the recurrences were observed during the first year and never completely reproduced the initial deformation. In 2 out of 3 cases, the recurrence occurred on a secondary talipes equinovarus. Age was not a risk factor (only 2 feet have not reached maturity to date). The lack of over-correction at treatment end is a factor predictive of poor outcome.Long-term outcome demonstrated the stability of the results and the absence of severe complications and foot shortening, emphasizing the important contribution of Ilizarov fixation for severe foot deformity.