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Treatment of digital nerve injuries, particularly in case of a gap, is challenging. Recovery of finger sensitivity is often incomplete and can impair personal and occupational activity. The need for better nerve regeneration has given rise to alternative treatments such as nerve conduits. This study aimed to evaluate the safety and efficacy of a conduit of freeze-dried inverted human umbilical cord vessel for regeneration in digital nerve section. Twenty-three patients with a mean nerve gap of 6.11 mm (range 2-30 mm and static 2-point discrimination (s2PD) 15 mm underwent surgical repair of digital nerve section using a nerve regeneration conduit. The primary endpoint was recovery of sensitivity after conduit implantation. Secondary endpoints comprised progression of pain, functional symptoms, pressure threshold, hand-specific symptoms and disabilities, and restored innervation. Mean follow-up was 10.1 ± 4.1 months (range 1-14 months). Sensitivity recovered progressively in the months following implantation. There was a mean decrease of 8.54 mm in s2PD between baseline and last follow-up (p 0.001). Complete innervation recovered in 83.3% of cases at last follow-up. Pressure threshold and hand-related quality of life improved significantly and symptoms due to nerve sectioning (pain, cold intolerance, hypoesthesia, hyperesthesia) resolved almost completely. There were no safety issues related to the nerve conduit. These results indicate that freeze-dried inverted human umbilical vessels can be a safe and effective option as conduit for digital nerve regeneration.

The treatment of proximal interphalangeal joints (PIP) after a traumatic injury has produced disappointing outcomes. The objective of this study was to evaluate the functional results of emergency hinged or gliding arthroplasty for destroyed PIP joints. A two-center retrospective study was carried out in 24 patients with open and closed trauma of the PIP joint of the fingers from 2007 to 2019. Fifteen hinged silicone implants (NeuFlex®) and nine gliding implants (Tactys®) were used. Pain on a visual analog scale (VAS), stability and total active motion (TAM), grip and pinch strength (Jamar®), QuickDASH and PRWE and satisfaction were assessed, and X-rays were performed. With a mean follow-up of 48 months, 24 patients aged 58 years on average were reviewed. Pain on VAS was 0.2/10, the TAM was 72% of the contralateral side, the QuickDASH was 15.6/100 and the PRWE was 24.5/100. PIP flexion was ≥50% of the contralateral side in 75% of patients. PIP and DIP extensor lag of 9° was significantly larger with the Tactys® than with the NeuFlex®, with no significant difference in the TAM. Three clinodactylies in fingers with the NeuFlex® and three reducible swanneck deformities in fingers with the Tactys® were noted. Three-quarters of patients were very satisfied or satisfied with the outcome. Emergency PIP arthroplasty with Tactys® seems to provide functional results that are as good as with NeuFlex®. Clinodactyly was found with NeuFlex® use. A significant PIP and IPD extensor lag of 9° and swan-neck deformities were found with Tactys® without significant functional impairment.

Trapeziometacarpal arthroplasty is a well-known treatment of thumb basal joint arthritis. However, only a few studies have been done on its use specifically in men, with one of the most recent showing a high implant failure rate. Our study was a retrospective analysis of the ISIS prosthesis exclusively in men. Our hypothesis was that it is a viable therapeutic solution. Between 2010 and 2020, 23 ISIS prostheses were implanted in 19 patients. A radiological and functional analysis was done, combined with a self-evaluation by multiple validated outcome scores (visual analog scale for pain, QuickDASH, PRWE, SF36, and Kapandji scores). The median follow-up was 76 months (13-134) with a median age of 69 years. The mean pain level was 1/10, the QuickDASH was 22.7, the PRWE was 14.2, the SF-36 was 61.1 and the Kapandji score was 8.9. One dislocation occurred in one patient; two patients had to be reoperated for periprosthetic ossifications. Radiolucency was found around the cup in one patient and around the metacarpal shaft in one patient. There was no implant failure and only one case of asymptomatic loosening, with a survival rate of 94% at 111 months. In the medium-term, clinical, and functional outcomes were satisfactory with pain relief similar to that of published studies, with a low rate of complications. ISIS arthroplasty appears to be a suitable treatment for thumb basal joint arthritis in men, although a non-negligible rate of periprosthetic ossifications required revision surgery in half of the cases.

Traumatic lesions around the base of the thumb have special features due to the location and structure of the joint and its inherent potential instability. This causes different fracture patterns, which are mostly isolated around the metacarpal base but can also involve just the trapezium or both. Exceptionally, there may be isolated dislocation. Fracture patterns are variable and influence the type of surgery. The most common fracture is Bennett's fracture accounting for 4% of all hand fractures and sometimes associated with trapezium fracture, usually in male subjects. Different fracture mechanisms have been proposed. Apart from intra-articular fractures of the metacarpal base and the trapezium, proximal metaphyseal fractures can exceptionally be treated conservatively by immobilization. All other fractures require open or closed reduction combined with different types of temporary pinning or open reduction and internal fixation with screws or locking plate in case of comminution. Immobilization depends on the type of surgical treatment and can be removable or non-removable. Close follow-up is mandatory to avoid the inconveniences of secondary swelling with non-removable plaster and resin casts. Extra-articular malunion may be tolerated, but articular malunion must be corrected surgically by intra-articular osteotomy to restore the joint. In case of posttraumatic joint degeneration, treatment will focus on a case-by-case basis on the patient's complaints. Arthrodesis or prosthetic surgery can be proposed in case of severe problems caused by osteoarthritis.

The objective of this work was to assess whether the injury mechanisms are responsible for histological arterial lesions. This prospective single-center study included adults with wrist or hand arterial injury. Arterial resection of at least 2 mm from the proximal and distal stumps was performed before the arterial anastomosis. Histological analysis of the arterial stumps was performed. An ultrasound was performed 1 month postoperatively to check arterial patency. A clinical and functional evaluation was done at 1 month postoperative, then every 3 months. From 2018 to 2020, 46 patients were included with a maximum follow-up of 13 months. There were 35 cuts, 2 crush injuries, 8 amputation and 1 blast injury. Macroscopically, 37% of the margins were considered damaged. Histological analysis showed significant damage in 59% of the sections (27 out of 46 patients) with 50% for crush injury, 55% for cuts by mechanical tool, 62% for cuts by power tool, 62% for amputations and 100% for blasts. The failure rate was 9%: 2 replantations and 2 asymptomatic thromboses diagnosed by ultrasound. Postoperative pain on VAS was 1.75/10, range of motion was 87%, Quick DASH was 8%, SF36 PCS was 69% and SF36 MCS was 70%. Factors influencing the success or failure of anastomosis were the mechanism of injury (p = 0.02), associated nerve damage (p = 0.014) and length of proximal arterial cut (p = 0.046). Histological arterial lesions seem to correlate with the injury mechanism. Cuts caused by glass or crush injuries do not seem to require arterial resections of more than 2 mm. A continuation of the study with a larger number of subjects may generate statistically significant results.

Chondromas are the most frequent benign tumors of the skeleton. The surgical treatment of these tumors consists of curettage of the tumor, which may be associated with a filling of the defect. One of the filling techniques uses bone substitutes. The primary objective was to evaluate the resorption of phosphocalcic injectable cements and their evolution in bone sites. The secondary objectives were to evaluate the function of the finger and to look for a possible recurrence of the chondroma. We performed a bi-centric study and reviewed 13 patients with 14 phalanx or metacarpal chondromas operated on by phosphocalcic cement filling technique with a minimum follow-up of 2years. An X-ray at the longest follow-up was performed as well as a QDASH, a "finger score" and a measurement of the amplitudes. Cement disappearance was observed in 100% of 5 patients. An average of 30% of cement remained at the last follow-up (0-80%). The disappearance of cement was significantly inversely proportional to the time since the last radiograph (P0.01). On average, total disappearance of cement was found at about 6years postoperatively. The mean QDASH score was 6.1 (0; 40.91). The mean finger score was 3 (0-24). The disappearance of the cement seems to occur in the medium term after its installation but does not predict the functional recovery and satisfaction of patients operated on for the cure of a chondroma of the hand.

To study the coverage period influence and various parameters concerning the microsurgical act on the patient clinical outcomes.We report 23 cases of reconstruction of lower limb loss of substance by free flap operated from 2010 to 2021. Among them, 9 patients were operated on as an emergency versus 14 in the secondary or late phase of the trauma.The average age of injured patients operated on emergency was 42 years (17-68 years) and 34 years for the patients who undergo deferred surgery (17-57 years). The sex ratio (female/male) was 22% in patients operated on urgently and 7% in patients operated on later. Regarding the type of free flap, it was Serratus anterior muscle flap in 10 cases, Latissismus dorsi flap in 9 cases, ALT flap in 3 cases and Gracilis muscle flap in 1 case. There were 2 failures of vascularized free transfer (8.7%) with complete necrosis of the flap and 3 revision surgeries on venous thrombosis which finally made it possible to obtain 3 flap successes. We analyze the results (complications/osteitis) according to the time to coverage.In our study, we did not find any significant difference between the groups operated in emergency and at a distance concerning the rate of infection and failure of the flaps.

Resume Introduction Les traumatismes du quart distal de jambe presentent un risque important de necrose cutanee et d’exposition du foyer de fracture sous-jacent ou du materiel d’osteosynthese ayant pour consequence une infection osteo-articulaire. En cas d’exposition osseuse de petite ou moyenne taille, les muscles locaux peuvent constituer une des meilleures solutions pour la couverture du membre inferieur. Nous decrivons notre experience de l’utilisation du lambeau du muscle court extenseur des orteils dans un contexte d’infection osteo-articulaire post traumatique chez quatorze patients. Notre objectif principal est d’evaluer les resultats et la morbidite du site donneur du lambeau de muscle court extenseur des orteils. Materiels et methodes Un recueil retrospectif de 2014 a 2018 et monocentrique dans un centre referent en infections osteo-articulaires concernait les traumatismes avec complications cutanees et infection osteo-articulaire qui ont necessite une couverture par lambeau de muscle court extenseur des orteils. Les complications precoces et tardives ont ete recherches chez 14 patients, 11 hommes et 3 femmes d’âge moyen de 51,4 ± 17,72 (19–71) ans. Dans 7 cas il s’agissait de fractures ouvertes et dans 9 cas de fractures du pilon tibial. La morbidite du site donneur a ete evaluee chez 9 patients. Resultats Les complications precoces relatives au lambeau correspondaient a 2 cas (14,2 %) d’hematome, un cas (7,1 %) de necrose partielle et 4 cas (28,5 %) de desunion du site donneur. Les complications tardives relatives a la persistance de l’infection ont ete retrouvees chez 2 patients (14,2 %) avec un cas (7,1 %) d’osteoarthite chronique et un cas (7,1 %) de pseudarthrose septique. D’un point de vue fonctionnel et esthetique, 8 patients (89 %) etaient satisfaits a tres satisfaits. Conclusion Dans les cas complexes d’infection osteo-articulaire, l’experience et l’approche multidisciplinaire sont indispensables a la strategie therapeutique. Le lambeau de muscle court extenseur des orteils est un lambeau fiable en cas de petites pertes de substance avec infection sous-jacente. Il permet de par sa nature musculaire une resistance a l’infection et une bonne diffusion des antibiotiques. Niveau de preuve IV.

Scaphotrapeziotrapezoid osteoarthritis (STT OA) is common and often associated with thumb basal joint arthritis. Pain at the base of the thumb on the volar aspect and during resisted extension is characteristic of symptomatic STT OA. If conservative treatment fails, surgical treatment may be offered. In case of STT OA, treatment may range from arthrodesis to trapeziectomy (isolated or associated with ligament reconstruction and/or interposition). Any preoperative intracarpal instability (DISI) can be exacerbated by resecting more than 3 or 4 mm of the distal pole of scaphoid. For peritrapezial osteoarthritis, trapeziectomy is the logical solution, but it exposes the patient to known complications: loss of strength, long recovery, trapeziometacarpal impingement. Initial treatment of thumb basal joint arthritis by arthroplasty is also an option. Treatment of both sites is also possible by interposition of pyrocarbon implants. In all cases (isolated or associated STT OA) and no matter the technique chosen, maintaining the scaphoid height (arthrodesis, resection < 3 mm and/or associated interposition) and performing oblique trapezoidal osteotomy (to prevent scaphoid–metacarpal impingement) are the two crucial elements of surgical treatment.

Long finger skeletal fractures are common injuries. In displaced forms, surgical treatment is required. With the advent of headless cannulated screws, the technique has been simplified and allows reduction in both planes. The objective of our study was to evaluate the functional recovery of patients operated on by this technique.We conducted a retrospective single-center study between 2019 and 2022. Eleven patients were followed and 12 fractures analyzed. A radio-clinical follow-up was carried out at 1 month then at the last follow-up with an evaluation of the articular amplitudes and a quality of life score (QuickDash, QD). The time to return to professional and sporting activities, pain (EVA) was collected. An anatomical/scannographic evaluation was performed to assess tendon and cartilage damage.At the last follow-up, the average global flexion was 266° and the extension was total. An average QD score of 15.9 and a Jamar force of 106% compared to the healthy side were observed. The return to physical and professional activities was earlier and the pain quickly tolerable. No secondary displacement was objectified and all were consolidated at the last follow-up, without malunion. No patient had been operated on secondarily.This technique seems to be a safe and non-traumatic. It allows a faster return to sports and professional activities with fewer complications and no need to remove the material.

The occurrence of a symptomatic neuroma on a digital amputation stump, whether traumatic or not, is a frequent complication that affects the patient's quality of life. The objective of this study was to analyze the complications inherent to the various techniques used to manage the nerves when performing digital amputation. We compared different surgical nerve management techniques to determine if one technique is more effective than another in preventing neuroma occurrence. We reviewed 105 patients over a 5-year period. A DN4 score greater than 4 and the modified Tinel test (percussion) showing a trigger zone allowed us to clinically diagnose symptomatic neuroma-related pain. We found 23 symptomatic neuromas out of 131 digital amputations. Twelve neuromas were found when the nerves had been neglected (12/33), eight were found in nerves treated by stripping (8/60), three when nerves were treated by stripping and thermal ablation (3/18). No neuroma was found in the five cases of centrocentral union of the two proper palmar digital nerves, in the 5 nerves buried in the bone or in the 9 nerves subjected to thermal ablation only. Management of the nerve is essential for the prevention of neuromas in digital amputations. New techniques such as bone burial and centrocentral union of the two stumps appear to be particularly effective.

La funcion de la mano es el resultado de la combinacion de la estructura osea, la estabilidad ligamentaria y la potencia muscular intrinseca y extrinseca. El tratamiento de una fractura digital tiene como objetivo recuperar la mejor funcion con el minimo de secuelas (dolor, rigidez). En ciertos tipos de fracturas es posible la inmovilizacion cuando esta es corta (menos de 4 semanas), adecuada (en buena posicion) porque el dedo permanece virgen (no operado). El tratamiento quirurgico se hace necesario cuando existe una fractura abierta, lesiones asociadas o un desplazamiento inaceptable; se basa en una reduccion y una fijacion estables. En caso de tratamiento quirurgico, la reaccion cicatricial relacionada con la exposicion que se sobreanade a las lesiones solo se puede combatir con una movilizacion inmediata. Esta movilizacion solo es posible si la cicatrizacion de los tejidos blandos y el dolor estan bajo control. Independientemente del tratamiento realizado, es necesario un seguimiento regular para descartar complicaciones: desplazamiento secundario, mal control del dolor, exclusion del dedo.

The proximal interphalangeal (PIP) joint is particularly vulnerable to trauma. In comminuted fractures, arthroplasty with a silicone implant is a treatment option that may be controversial in an emergency setting. This joint destruction is usually accompanied by soft tissue injuries (skin and tendon damage, devascularization) making the reconstruction all the more complex. The aim of our work was to evaluate emergency finger silicone implants for complex and comminuted fractures of the PIP joint as well as clinical and radiological complications. In this single-center, retrospective study, 13 patients operated between January 2007 and January 2019 on an emergency basis with a Neuflex® PIP arthroplasty were reviewed. This PIP joint reconstruction was associated with the soft tissue repair at the same time (skin cover, tendons, nerves) in all patients. The average age was 57.7 years with a male predominance (92%). The injuries were caused by a domestic accident in 61% of cases. The average follow-up was 4.7 years. The average total active motion arc was 183.8°. The average QuickDASH score was 24. There was one case of broken implant with no functional consequence. No infection or instability was reported. Silicone implant arthroplasty is a simple, reliable, fast, and durable solution for complex PIP fractures when conservative treatment is impossible. This solution is an alternative to arthrodesis or even finger amputation.

Background Patients with both vascular and osteoarticular injuries require multidisciplinary management. Vascular injuries may be function- and/or life-threatening. The lower limbs are predominantly affected. Traffic, domestic, and work-related accidents contribute most of the cases. The primary objective of this study was to describe the management of patients with concomitant vascular and osteo-articular injuries, with special attention to the rates of amputation and fasciotomy. The secondary objective was to suggest a management sequence to optimise our surgical practice. Hypothesis The management sequence is a crucial consideration in patients with both vascular and osteo-articular injuries. Material and methods A 6-year, retrospective, observational study was conducted in patients with concomitant vascular and osteo-articular injuries. Results The study included 36 patients with a mean age of 40.6 ± 22.1 years. The main sources of injury were traffic accidents (n = 19, 52.8%), crush injury (n = 8, 22.2%), and falls (n = 5, 13.9%). A compound fracture was present in 20 (55.6%) patients. Evidence of ischaemia in 25 (69.4%) patients, and bleeding in 11 (30.6%) patients. Pre-operative imaging, by ultrasonography or computed tomography, was performed in 27 (75.0%) patients. The lower limb was involved in 30 (83.3%) patients, who had osteoarticular injuries to the femur and leg combined with injury to the popliteal artery. Fasciotomy was performed in 11 (30.6%) patients and secondary amputation in 7 (19.4%) patients. The limb salvage rate was 80.6%. Median patient survival was 9.3 [0–74.8] months. Discussion Coordinated work by two surgical teams is crucial to manage concomitant vascular and osteo-articular injuries. The management sequence must be defined clearly. Computed tomography angiography is the investigation of choice and should be performed at the slightest suspicion of vascular injury. Level of evidence IV, retrospective observational study.

Riassunto La funzione della mano e il risultato della combinazione della struttura ossea, della stabilita legamentosa e della potenza muscolare intrinseca ed estrinseca. Il trattamento di una frattura digitale ha come obiettivo il ritrovamento della migliore funzione con le minime conseguenze (dolori, rigidita). L’immobilizzazione e possibile in certi tipi di fratture, se breve (meno di 4 settimane), adattata (in buona posizione), per mantenere il dito vergine (non operato). Un trattamento chirurgico e reso necessario da un’apertura della frattura, da lesioni associate o da uno spostamento grave; esso poggia su una riduzione e una fissazione stabile. In caso di trattamento chirurgico, la reazione cicatriziale legata all’apertura che si sovrappone alle lesioni puo soltanto essere combattuta da una mobilizzazione immediata. Questa mobilizzazione e possibile solamente se la cicatrizzazione delle parti molli e il dolore sono sotto controllo. Qualunque sia il trattamento, e necessario un controllo regolare per individuare una complicanza: spostamento secondario; cattivo controllo del dolore; esclusione del dito.

This study aimed to understand the experiences of middle school girls who have engaged in non-suicidal self-injury (NSSI) and have received professional help for these behaviors. Participants described engaging in NSSI in response to uncomfortable feelings and invasive negative thoughts. They reported that engaging in NSSI decreased their uncomfortable feelings. While each participant had at least one person in her life who knew about her NSSI, participants did not feel supported or validated by these people. Participants were not completely honest with their therapists because they were afraid of being misunderstood, dismissed, or getting others into trouble. Despite these things, participants wanted support and understanding about who they are as unique individuals, why they are struggling, and why they self-injure. They also wanted to be in a transparent therapeutic relationship where they felt respected and accepted. Unfortunately, they did not describe relationships with their therapists as possessing these qualities. Professionals would better meet the need of adolescents by clearly discussing confidentiality, boundaries, conveying respect and acceptance, and recognizing the uniqueness of their clients. Assessing for self-harm and treatment reluctance should be done in the context of resistance to therapy and a sensitivity to judgment.

We sought to evaluate the long-term quality of life and functional outcome of patients who underwent digital replantation after amputation. A retrospective single-center study was conducted of patients treated between January 2010 to May 2016. Twenty-eight patients who underwent successful replantation after single or multiple digital amputation were reviewed in person after at least 2years' follow-up (mean 4.6years). Total active range of motion, grip and pinch strength were assessed. Functional outcomes were evaluated using the SF-36 and DASH questionnaires. The patients' occupational status and daily activities were reported. Mean total active range of motion was 42% of the contralateral healthy side. Better active mobility and higher grip strength were found when the amputation was distal to the insertion of the common flexor tendon. Mean grip and pinch strength were 80% and 65%, respectively. Fusion did not significantly influence active mobility. The mean DASH score was 22.3. In our study, 77% of the patients returned to the same job and 75% experienced cold intolerance. The majority of patients who underwent digital replantation maintain a quality of life that allows them to return to work. Fusion, especially in the thumb, can be performed with few functional consequences. Even many years after the replantation procedure, sensory recovery remains poor.

Introduction Traumatic injuries to the distal quarter of the leg present a significant risk of skin necrosis and exposure of the underlying fracture site or the osteosynthesis material that often result in bone and joint infection. In the case of small or medium-sized bone exposure, local muscles may be one of the best options for lower extremity coverage. We describe our experience using the extensor digitorum brevis muscle flap in a context of posttraumatic bone and joint infection in fourteen patients. Our main objective was to assess the outcomes and the donor-site morbidity of the extensor digitorum brevis muscle flap. Materials and methods A single-center retrospective study in a French reference center for bone and joint infection from 2014 to 2018 reviewed cases of traumatic injuries with skin complications and bone and joint infection that required an extensor digitorum brevis muscle flap coverage. Fourteen patients were evaluated for early and late complications, 11 men and three women with a mean age of 51.4 ± 17.72 (19–71) years. Seven of these were open fractures and nine cases were pilon fractures. Donor-site morbidity was assessed in nine patients. Results Early flap complications included two cases (14.2%) of hematoma, one case (7.1%) of partial necrosis and four cases (28.5%) of donor-site dehiscence. Late complications caused by persistent infection were found in two patients (14.2%), with one case (7.1%) of chronic osteoarthritis and one case (7.1%) of septic pseudarthrosis. From a functional and cosmetic point of view, eight patients (89%) were satisfied, to very satisfied. Conclusion Experience and a multidisciplinary approach are keys in providing an optimal treatment strategy for complex cases of bone and joint infection. The extensor digitorum brevis muscle is a reliable flap for small defects with underlying infection. Being made up of muscle tissue, this flap offers good resistance to infection and enables satisfactory distribution of antibiotics. Level of evidence IV.

Background We explored the relation between adverse outcomes after acute pulmonary embolism (PE)and renal dysfunction classified by estimated glomerular filtration rate (eGFR) using the CKD-EPI equation. We assessed the incremental value of adding eGFR CKD-EPI to the ESC score for predicting 30d mortality. Methods Prospective, multicenter study of 1664 acute PE admitted from 01/2011 to 12/2017. Pts were categorized in 4 eGFR groups: Group 1 (eGFR ≥60 ml/min/1.73m2, n=1178), group 2 (45–59; n=257); group 3 (30–44; n=150), group 4 (≤29; n=79). Results All-cause and CV death at 30 days and 6 months were higher in group 3 (p=0.005 and p=0.03) and group 4 (p Without eGFR CKD-EPI OR (95% CI) With eGFR CKD-EPI OR (95% CI) ESC algorithm 2.59 (1.95–3.43) 2.30 (1.72–3.07) eGFR CKD-EPI – 2.60 (1.62–4.7) Measures of fit Bayes information criterion 607.30 599.32 Akaike information criterion 596.47 583.06 C-statistic 0.71* 0.77* P (Hosmer-Lemeshow) 0.057 0.43 Integrated discrimination improvement – 0.054 (0.052–0.056) Net reclassification improvement – 0.93 (0.90–0.95) Prognostic performance Sensitivity 62.5 (51.2–72.3) 76.2 (61.5–90.2) Specificity 64.2 (49.1–74.4) 69.9 (47.6–83.5) Positive predictive value 10.1 (8.2–11.3) 16.2 (14.2–18.2) Negative predictive value 0.97 (0.96–0.98) 98.1 (97.2–99.2) Positive likelihood ratio 1.96 (1.12–3.41) 2.12 (1.54–3.12) Negative likelihood ratio 0.50 (0.25–1.81) 0.54 (0.20–1.56) Youden index 0.31 (0.28–0.34) 0.39 (0.36–0.41) Difference in C-statistic: *p=0.04. Conclusion Renal function impairment increases the rate of adverse events after acute PE. Combined with the ESC early mortality risk score, eGFR improves risk classification.

The aim of our study was to evaluate the interest of the mechanical anastomosic coupling device for venous anastomoses in a series of cervico-facial reconstructions after carcinologic excision.Between January 2010 and December 2017, 46 patients underwent free flap cervico-facial reconstruction. We performed 54 venous anastomoses for 51 free flaps. Mechanical venous anastomoses were performed with a coupler (Coupler®). Thrombotic complications and choice of recipient vessels were assessed for the entire series.Venous anastomoses were performed using a coupler in 33.3% of the flaps (n=18). Mean operative time was lower for reconstructions with mechanical coupler anastomoses, and significantly for fibula flaps. Of eight thromboses, six were venous, two of which after the coupler anastomosis. The thrombosed veins were the branches of the internal jugular vein and the anterior jugular veins. The diameter of the couplers used was respectively 2.5mm and 2mm.The use of the microvascular coupling system for venous anastomoeis would help reduce the occurrence of venous thrombosis, but larger and prospective studies should be conducted. This coupling system, relatively easy to use, would overcome the lack of congruence of anastomosing veins and reduce the risk of intimal injury. Regarding the recipient vessels, the anterior jugular vein should not be used as first line because the risk of vascular complications seems more important.

The goals of distal radius fracture treatment in patients above 65 years of age would not change over time if the fracture were the only factor to consider. However, people change, and fixation methods also change. Since this fracture heals in nearly every case and volar plates have eliminated the worry of malunion, we are left with two main goals. In active patients with weakened bones, the aim is to help them regain their quality of life as quickly as possible while avoiding iatrogenic conditions. This compromise is possible because of new tools—but at what price?

Rib cartilage grafts are widely used in maxillofacial surgery, but not in orthopedic surgery. The aim of this technical note is to describe the technique used to harvest this graft and to report on donor site complications in the 136 cases we have published on up to now. Harvesting is carried out at the osteochondral junction of the eighth rib. The osteochondral junction is located under the external oblique muscle and a perichondrium layer, which is retracted to allow safe harvesting. The amount of cartilage harvested depends on the size of the area being grafted. Harvesting of a rib osteochondral graft is easy to carry out, provides a considerable amount of hyaline cartilage for the reconstruction of degenerative and traumatic lesions on a joint surface and results in few donor site complications.

L’objectif de ce travail etait d’evaluer les resultats fonctionnels et radiologiques de la prothese trapezo-metacarpienne ISIS dans la rhizarthrose dans une population uniquement masculine. Treize patients presentant une rhizarthrose ont ete operes par une prothese Isis entre decembre 2010 et septembre 2015 et evalues au plus grand recul. Ces patients ont ete operes dans 2 centres par 5 chirurgiens. Tous les patients ont ete evalues par leur operateur puis revus par un operateur independant unique au recul minimum de 14 mois afin d’evaluer la douleur, la fonction, la force de la pince et de la poigne, le niveau d’activite ainsi que la survenue de complication. Une evaluation radiologique realisee par 2 lecteurs recherchait en preoperatoire la severite de l’atteinte, et en postoperatoire la survenue de complications telle que le descellement. Nous avons inclus 17 protheses dans l’analyse de survie avec un recul moyen de 36,7 mois (14–69). Aucune prothese n’a necessite de chirurgie de revision. Aucune luxation n’a ete rapportee. Un total de 17 protheses chez 13 patients a ete inclus dans l’evaluation clinique. L’âge moyen etait de 65.4 ans (54–80) et le suivi moyen etait de 36,7 mois (14–69). A 5 ans de suivi, le Quick-DASH moyen etait ameliore de 78,7 ± 501 a 8 ± 1,2, la mobilite du pouce a ete restauree a une amplitude de mouvement comparable a celle du pouce controlateral. L’opposition, definie par le score Kapandji, etait presque normale a 8,5/10, (5–10), de meme que le pinch et le grasp moyens, qui s’amelioraient respectivement de 32 % et de 45 %. Les amplitudes et la force augmentent alors que la douleur diminue apres la chirurgie et ces resultats demeurent constants durant la periode de suivi. Bien qu’asymptomatiques, les liseres autour des pieces prothetiques semblent etre la principale evolution a surveiller. Conclusion Dans notre serie, la prothese ISIS chez les patients de sexe masculin souffrant de rhizarthrose s’est averee etre un implant fiable et efficace.

Le traitement des pertes de substance nerveuse des nerfs collateraux digitaux peut necessiter une greffe ou l’utilisation d’un conduit nerveux. L’objectif etait d’evaluer la tolerance chez l’Homme d’un guide de regeneration nerveuse issu de vaisseau de cordon ombilical humain retourne contenant de la gelee de Wharton, devitalise, deshydrate et sterilise. Cette etude multicentrique prospective a inclus 18 patients avec une section de nerf digital collateral et une perte de substance nerveuse superieure a 2 mm, immediatement apres ou a distance d’un traumatisme. Une evaluation clinique (s2PD, m2PD, test au monofilament, douleur, hyperesthesie, sensibilite au froid et paresthesies) et fonctionnelle (QuickDASH) etait realisee a j + 30, M + 3, M + 6 et M + 12. Tous les evenements indesirables ont ete recueillis et evalues. Vingt conduits ont ete evalues chez 18 patients d’âge moyen 38 ans [20–66]. Le delai moyen depuis le traumatisme etait de 9 jours [0–92] et la perte de substance nerveuse initiale moyenne de 5,4 mm [2–20]. Douze greffons ont ete utilises comme manchon de suture directe et 8 comme conduit. D’un score moyen superieur a 15 mm, le s2PD descendait a 8 mm a 6 mois et a 7 mm a 12 mois. Soixante-six pour cent des patients a 6 mois n’avaient plus de Tinel et 73 % a 12 mois. La douleur etait a 0,4 a 6 mois. Les signes globaux d’hyperesthesie, de sensibilite au froid et de paresthesies sont passes de 2,02 [0–16] a 0,45 [0–5]. A l’inclusion, 54 % des patients avaient un test de monofilament a 200 g et 46 % a 4 g, alors qu’a 6 mois 18 % etaient a 4 g, 55 % a 2 g et 27 % a 0,2 g. Le QuickDASH initial de 35 [0–84] a 13 [0–45]. Un cas d’infection du site operatoire a necessite une reprise chirurgicale a j + 10 : l’implant etait toujours en place et a pu etre conserve. Les resultats fonctionnels et la bonne tolerance chez l’Homme confirment les resultats du modele experimental chez le rat, qui montrait une repousse axonale et une myelinisation en 8 semaines. Le produit combine les caracteristiques connues des conduits vasculaires et l’apport mecanique et biologique de proteoglycanes et de facteurs de croissances. Cette etude confirme l’interet de ce conduit dans les sections des nerfs digitaux, qui devra etre etudie dans les nerfs de plus gros calibre.

60 peritrochanteric fractures treated with a lamina-plate with stay were studied. Their socio-professional caracteristics were similar to the whole sample. The functionnal results and the Duke's score were lower than the other osteosyntheses methods, despite a low number of complications. These results could be explained by systematic early weight bearing for the patients. This causes pain which is not well endured by patients included in this study. These patients, in good general and intellectual health, are able to bear, and prefer, prolonged decubitus (without pain). But while early weight bearing is not a priority for this population, it remainds fundamental for the patients with low intellectual function, who most frequently present with this type of fracture.

Pyogenic flexor tenosynovitis (PFT) is a functional emergency in hand surgery; however, its diagnosis can be difficult to make. It should always be considered when a patient presents with an inflamed finger. The goal of this study was to investigate the usefulness of ultrasound in the diagnosis of early PFT. Seventy-three patients with suspected pyogenic flexor tenosynovitis were candidates for the study. Since the diagnosis of PFT was obvious in 16 patients, they were excluded from the study and immediately underwent surgery. The remaining 57 patients underwent a clinical examination by a senior surgeon, a blood test for C-reactive protein levels and an ultrasound (US). The US results were compared to the intraoperative findings if the patients were operated or to the clinical outcome in non-operated patients. Seventeen patients had the US diagnosis of PFT confirmed intraoperatively. In 10 patients, the US diagnosis of PFT was not confirmed intraoperatively. In 29 other patients, the diagnosis of PFT was ruled out by US; they all had good outcomes after being treated with antibiotics. In one patient for whom the diagnosis of PFT had been ruled out by US, PFT was actually present. Ultrasound had 94% sensitivity, 65% specificity, 63% positive predictive value, and 95% negative predictive value. Ultrasound is useful as a diagnostic tool for managing early PFT thanks to its excellent negative predictive value and specificity. This objective examination complements the surgeon's subjective clinical examination.

Cemented stem remains the gold standard for prosthesis in trauma. The purpose of this study was to evaluate the functional and radiological outcomes of a cementless, trauma-specific locked stem (hemi and reverse) for 3- and 4-part proximal humeral fractures. One hundred and thirty-four 3- and 4-part fractures have been treated by locked stem, 69 with hemiarthroplasty [mean age 68 years (50–90)] and 65 with reversed [mean age 78 years (66–91)]. The length of the stem was 15 cm with a proximal coating of HA automatic locking system (two screws) and four different diameters. Preliminary cadaver study allowed us to validate the system (22 shoulders, no injuries of nerves, locking system efficient). In the group of hemi, Constant score with ponderation reached 72 (11–120) and QDash 31.2 (4.5–77.27) with a mean FU of 25 months (6–96). In the group of reversed, Constant score with ponderation reached 77.6 (28.8–119) and QDash 36.2 (2–84) with a mean FU of 15 months (6–41). Specific complications due to locking system reached 3% but without reoperation. Other complications were capsulitis and infection. In this population of elderly patient, new fall with periprosthetic fracture or infection led the surgeon to remove the stem. At shoulder level, the removal of a cemented stem remains a highly demanding procedure with sometimes bad functional results and elevated level of complications. This series is the first one of locked stem without significant complications. Locked stem remains a new but logical tool in trauma.

L’objectif de ce travail etait d’evaluer les resultats fonctionnels et radiologiques de la prothese trapezo-metacarpienne ISIS dans l’arthrose peri-trapezienne. Vingt patients presentant une arthrose peri-trapezienne ont ete operes par une prothese Isis entre septembre 2010 et mars 2016 et evalues au plus grand recul. Ces patients ont ete operes dans 2 centres par 4 chirurgiens. Tous les patients ont ete evalues par leur operateur puis revus par un operateur independant unique au recul minimum de 18 mois afin d’evaluer la douleur, la fonction, la force de la pince et de la poigne, le niveau d’activite ainsi que la survenue de complication. Une evaluation radiologique realisee par 2 lecteurs recherchait en preoperatoire la severite de l’atteinte, et en postoperatoire la survenue de complications telle que le descellement. Nous avons inclus 21 protheses dans l’analyse de survie avec un recul moyen de 46,9 mois (18–111). Aucune prothese n’a necessite de chirurgie de revision. Aucune luxation n’a ete rapportee. Un total de 21 protheses chez 20 patients a ete inclus dans l’evaluation clinique. L’âge moyen etait de 66,4 ans (54–84) et le suivi moyen etait de 46,9 mois (18–111). A 5 ans de suivi, le Quick-DASH moyen etait ameliore de 70,3 ± 3,2 a 13,2 ± 1,5, la mobilite du pouce a ete restauree a une amplitude de mouvement comparable a celle du pouce controlateral. L’opposition, definie par le score Kapandji, etait presque normale a 9,45/10, (5–10), de meme que le pinch et le grasp moyens, qui s’amelioraient respectivement de 30 % et de 46 %. Les amplitudes et la force augmentent alors que la douleur diminue apres la chirurgie et ces resultats demeurent constants durant la periode de suivi. Bien qu’asymptomatiques, les liseres autour des pieces prothetiques semblent etre la principale evolution a surveiller. Dans notre serie, la prothese ISIS chez les patients souffrant d’arthrose peri-trapezienne s’est averee etre un implant fiable et efficace.

SummaryWork-related musculoskeletal disorders (WRMSDs) of the upper limb have become a serious concern in many countries and have been steadily progressing for several decades. The cause of WRMSDs is assumed to be the direct consequence of repetitiveness, extreme postures, and intensive efforts in a problematic psychosocial environment. Therapy should therefore associate the occupational physician and the regulatory bodies. It may be necessary to modify the individual workstation and to reorganize the company. Such upper limb pathologies may be surgically treated but the results are often delayed and poorer when compared to the general population.

The aims of this study were to evaluate the function and quality of life in patients who have undergone replantation of the hand or forearm. We carried out a retrospective single-center study of cases performed between 1977 and 2015. Our hospital's database was searched for patients who underwent replantation of the distal half of the forearm and hand (except the fingers). The evaluation included sensitivity, joint mobility, strength and quality of life. Conventional functional scores were used. Seventeen replantation cases were identified. Four patients were lost to follow-up. Of the 13 available patients, two suffered a replantation failure. Ultimately 11 patients were included in the study. Three patients were evaluated based on their medical records and eight were reviewed in person. The mean patient age was 31 ± 11.8 years. The sensory evaluation resulted in five patients being classified as S1 and one as S3+. The mean Kapandji score was 4.3 ± 2.3 [0–6]. The mean grip strength was 39.4 ± 20% [0–80], and the pinch strength was 36.2 ± 16% [0–60] compared to the healthy contralateral side. The mean DASH was 36.2 ± 30.4 [4.5–79.5]. According to Chen's classification, two patients were at stage IV. For 50% of patients, the overall quality of life was at least equivalent to that of the general population. Replantation of the distal half of the forearm and hand should be attempted whenever possible. Although replantation causes some disability, good quality of life seems to be maintained.

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 Le « reaming-irrigating-aspirating » (RIA) est un dispositif qui permet un alesage centromedullaire des os longs, combine a une irrigation et une aspiration. L’utilisation premiere du RIA est le recueil du produit d’alesage, sous forme d’une pâte epaisse de particules osseuses dont l’analyse a revele la riche teneur en cellules souches et en facteurs de croissance. La quantite de greffe osseuse, extraite d’un femur d’adulte, correspond au volume d’os spongieux preleve sur deux cretes iliaques, anterieure et posterieure. L’assemblage du dispositif et la technique d’utilisation requierent un apprentissage pour eviter une fracture du femur, principale complication potentielle. Les indications electives de la greffe RIA sont le comblement des epiphyses et les pertes de substance metaphysaires. Les pertes de substance diaphysaires peuvent egalement etre traitees par greffe RIA sous reserve que la greffe soit placee dans un systeme contraint (membrane induite) pour eviter sa dispersion dans les parties molles, et qu’elle soit aeree par un materiau poreux pour favoriser sa revascularisation. Les autres indications du RIA concernent le traitement des infections osseuses et l’enclouage des fractures pour limiter le risque d’embolie graisseuse.

Resume La perte de substance osseuse (PSO) diaphysaire est un probleme difficile a resoudre en traumatologie en raison notamment des lesions des parties molles et de la frequence d’une infection associee. Le Symposium 2010 de la Societe francaise de chirurgie orthopedique et traumatologique (Sofcot) a permis de confirmer les conclusions issues d’experiences anterieures isolees. L’etude, retrospective et multicentrique, a concerne 204 dossiers de PSO diaphysaires des os longs (humerus, radius, ulna, femur, tibia). Les techniques de reconstruction osseuse etaient les greffes traditionnelles, les transferts vascularises, les techniques de mobilisation osseuse, la technique de la membrane induite et la technique de Papineau. La consolidation a ete acquise dans 93 % des cas, dans un delai moyen de 14,7 mois. Le delai de consolidation n’etait pas lie a l’etendue de la perte de substance et etait similaire quelle que soit la technique. La technique de la membrane induite, par la simplicite de sa mise en œuvre et son caractere programme en deux temps en cas d’infection, a ete la technique la plus utilisee dans cette serie. Les facteurs de mauvais pronostic etaient l’infection, les lesions importantes des parties molles et l’exposition initiale du foyer de fracture. Les grands principes qui gouvernent la reconstruction d’une PSO sont la guerison prealable de l’infection associee et la reparation des parties molles chaque fois que faire se peut. La tendance actuelle est a l’hybridation des procedes de reconstruction en elaborant des strategies s’appuyant a la fois sur le raccourcissement delibere, toutes les formes de greffe traditionnelle, la mobilisation osseuse et la membrane induite. Au segment jambier, la greffe intertibiofibulaire doit etre consideree comme la cle de voute de toute reconstruction etendue. Niveau de preuve Niveau IV : etude d’observation retrospective.

Resume Pour le patient (et le chirurgien) le poignet ideal est un poignet mobile mais, le plus souvent, le traitement chirurgical optimal est celui qui soulage efficacement la douleur. Chaque intervention a des complications potentielles et des limites que le patient doit connaitre et auxquelles il s’adaptera plus ou moins en fonction de son profil psychologique et de ses exigences fonctionnelles. Enfin, chaque chirurgien a ses convictions et une experience personnelle qui vont influer sur la decision therapeutique et le resultat final. La resection de la premiere rangee du carpe (RPRC) et l’intervention de Watson sont les deux operations de reference pour les arthroses sur instabilite scapholunaire et pseudarthrose du scaphoide (SLAC et SNAC). Au-dela des complications precoces et des inconvenients qui leurs sont specifiques, elles donnent de bons resultats qui se maintiennent a long terme. La RPRC, realisable jusqu’au stade II, est essentiellement indiquee chez un patient avec une demande fonctionnelle moderee alors que l’intervention de Watson sera plutot proposee chez un manuel actif, sous reserve que l’interligne radio-lunaire soit preserve. La denervation totale est efficace trois fois sur quatre et permet de preserver la mobilite restante. Elle peut etre proposee chez un patient ayant un poignet mobile avec une demande fonctionnelle pas trop importante et, chez un sujet âge, quelle que soit la mobilite du poignet du fait de sa faible morbidite. Quant a l’arthrodese totale (AT), ce n’est pas seulement une intervention de sauvetage. Dans les arthroses diffuses et les formes evoluees de la maladie de Kienbock, c’est l’operation qui donnera le plus de chances a un sujet jeune, manuel lourd, de reprendre son activite et de ne pas se retrouver desocialise. Enfin, les autogreffes osteochondrales, les implants partiels et les protheses de poignet ont probablement une place dans l’arsenal therapeutique mais celle-ci reste a definir precisement.

Los materiales osteoinductores son motivo de numerosos estudios de investigacion experimental y clinica desde hace varias decadas, debido a la perspectiva terapeutica que representan en las diversas situaciones de dificultades de consolidacion que suelen observarse en ortopedia. Las proteinas morfogeneticas oseas (BMP) son las unicas moleculas que hasta ahora han demostrado poseer autentico potencial osteoinductor. Para las BMP recombinantes producidas por ingenieria genetica (BMP-7 y BMP-2) existen aplicaciones clinicas restringidas (con autorizaciones de comercializacion). Se presenta aqui el estado actual de la investigacion sobre estas moleculas, asi como los principales estudios clinicos de las BMP recombinantes disponibles en el mercado.

Riassunto Da molti anni i materiali osteoinduttori sono l’oggetto di numerosi lavori di ricerca sperimentale e clinica, tenuto conto della speranza terapeutica che rappresentano nelle diverse situazioni di difficolta di consolidamento che si incontrano in ortopedia. A oggi le Bone Morphogenic Proteins (BMP) sono le sole molecole che hanno dato prova di un reale potenziale osteoinduttore. Esistono applicazioni cliniche ristrette (con autorizzazione per l’immissione sul mercato) per delle BMP ricombinanti prodotte con ingegneria genetica (BMP-7 e BMP-2). Gli Autori presentano lo stato di avanzamento della ricerca su queste molecole, cosi come i principali studi clinici sulle BMP ricombinanti disponibili in commercio.

L’objectif de cette evaluation etait de mesurer les resultats fonctionnels et radiologiques de la prothese trapezometacarpienne ISIS. Quatre-vingt-neuf patients presentant une rhizarthrose ont ete operes par une prothese Isis entre novembre 2006 et septembre 2016 et evalues au plus grand recul. Ces patients ont ete operes dans 2 centres par 6 chirurgiens. Tous les patients ont ete evalues par leur operateur puis revus par un operateur independant unique au recul minimum de 12 mois afin d’evaluer la douleur, la fonction, la force de la pince et de la poigne, le niveau d’activite ainsi que la survenue de complication. Une evaluation radiologique realisee par 2 lecteurs recherchait en preoperatoire la severite de la rhizarthrose, et en postoperatoire la survenue de complications ainsi que l’apparition d’un lisere autour des pieces prothetiques. Quatre-vingt-neuf patients avec 107 protheses ont ete evalues avec un recul de 45,6 mois. Aucune reprise chirurgicale n’a ete realisee. Le score de Dell etait de 2,44. Un lisere autour de la cupule trapezienne au plus long terme etait visible dans 9 cas et autour de la tige dans 1 cas mais sans aucune consequence clinique. La lecture des radiographies etait concordante entre le senior et l’interne. Quatre-vingt-huit patients etaient tres satisfaits. Toutes les valeurs cliniques evaluees ont ete ameliorees. Le score d’Alnot passait de 3,6 a 0,1. L’EVA estimee a 7,9 passait a 0,23. Le QDASH moyen passait de 77,4 a 10,47. Le score de Kapandji passait de 7,9 a 9,6. La force de la pince de 2,75 a 6,3 kg F et de poigne de 12 a 23. Dans les suites on note 2 cas d’algoneurodystrophie, 2 cas de tendinites de De Quervain, 1 cas de desunion cicatricielle et 1 cas d’hypoesthesie. La survie de la prothese etait de 100 % a 10 ans pour les reprises chirurgicales et de 86,9 % a 10 ans pour l’apparition de liseres peri-prothetiques. Les courbes anatomiques de la piece metacarpienne modulaire s’associant de facon retentive avec la cupule semblent pouvoir repondre aux contraintes biomecaniques de la region trapezometacarpienne. Bien qu’asymptomatiques, les liseres autour des pieces prothetiques semblent etre la principale evolution a surveiller. Dans ce travail d’evaluation, la prothese Isis est un implant qui donne de bons resultats cliniques a ce recul.

Depuis le debut des annees 1990, nous utilisons des greffons de cartilage costal pour diverses indications–rhizarthrose, maladie de Kienbock, cal vicieux du radius, necrose du pole proximale du scaphoide. Le prelevement chondro-costal s’effectue au niveau du huitieme ou du neuvieme arc costal idealement sous anesthesie generale Apres une incision cutanee horizontale sous le mamelon de 8 cm, medialement a la ligne mamelon – epine iliaque anterieure, la dissection des muscles intercostaux permet d’acceder a la jonction os (blanc et dur) – cartilage (rose, plus mou). La dissection se fait en passant entre la cote et le perichondre posterieur afin d’eviter de leser la plevre. On realise le prelevement a la scie oscillante sur le versant osseux, en conservant le perichondre anterieur, ce qui permet une bonne vascularisation du greffon. La taille du prelevement depend du defect a combler mais le greffon ne depassera pas 1 cm3. Le greffon est alors sculpte pour venir s’emboiter au niveau du site a greffer. Ce greffon peut etre fixe en site osseux (cal vicieux, osteochondrite) ou laisse libre (kienbock, SNAC, SLAC). En cas de fixation la preparation et le vissage doivent etre prudents pour ne pas fissurer la zone cartilagineuse. Les complications pleuropulmonaires redoutees sont exceptionnelles et sur plus de 200 prelevements seuls 3 patients ont eu une breche pleurale dont une seule a ete drainee 2 jours. La douleur au niveau costal n’est presente que chez 1 3 patient, moins importante qu’une fracture de cote traumatique et disparait en 3 semaines. Demystifier le prelevement permet d’utiliser cette greffe osteochondrale ou chondrale pure, libre ou fixee. L e prelevement du perichondre est une alternative simple permettant de resurfacer des articulations detruites sans s’approcher de la plevre. L’indication ideale reste la destruction articulaire limitee chez un(e) patient(e) de moins de 50 ans a haute demande fonctionnelle.