Faculty Bibliography

Publisher: La fasciite necrosante est une infection a l'evolution rapide et au potentiel fatal. Selon les recommandations actuelles, il faut administrer des antibiotiques et proceder a un debridement chirurgical rapide et agressif. Une operation agressive s'associe a une morbidite elevee, qui laisse les patients avec une importante perte de tissus et des plaies complexes. Les auteurs decrivent un cas de fasciite necrosante presumee traite au moyen d'une chirurgie minimale.Un homme de 48 ans auparavant en sante a consulte en raison d'un erytheme, d'un oedeme et d'une vesication croissants du bras gauche. Malgre une presentation clinique systemique benigne, la main et l'avantbras laissaient croire a une fasciite necrosante, ce qui a suscite un traitement chirurgical. L'exploration chirurgicale a revele une grande quantite de liquide intradermique et subdermique clair. Il a ete entendu de limiter l'importance du debridement. On a pose un diagnostic de syndrome de Wells, ou cellulite a eosinophiles. Traitees aux steroides, les plaies ont gueri sans incident.Il est important d'envisager le bilan clinique complet avant d'entreprendre un traitement chirurgical agressif. Des antecedents negatifs de diabete, une presentation clinique atypique et des observations chirurgicales benignes sont evocatrices d'un diagnostic plus benin. OABL- FRE

Publisher: La maladie de Dupuytren demeure un probleme clinique important en raison des complications connexes et d'un taux de recurrence pouvant atteindre 60 %. La peau operee a souvent tendance a former de nouvelles cicatrices. Les auteurs presentent deux cas pour lesquels ils ont utilise de la nitroglycerine topique apres le traitement chirurgical de la maladie de Dupuytren, selon l'hypothese que l'ischemie locale representait un facteur etiologique. Chez ces patients, aucune cicatrice surelevee ne s'est formee. Au moins six mois apres l'operation, il n'y avait pas eu de recurrence de la maladie, et les patients et le chirurgien avaient fait etat d'une meilleure qualite de la peau. Dans la presente etude, le recours a de la nitroglycerine topique, un vasodilatateur local, a semble prevenir la formation de cicatrices recurrentes, peut-etre en prevenant une ischemie locale. D'autres etudes et un suivi s'imposent. OABL- FRE

Our understanding of wrist osteoarthritis (OA) lags behind that of other joints, possibly due to the complexity of wrist biomechanics and the importance of ligamentous forces in the function of the wrist. Scaphotrapeziotrapezoidal (STT) OA is common, but its role in wrist clinical pathology and biomechanics is unclear. We identified the prevalence of radiographic STT joint OA in our hand clinic population and defined the relationship between STT and radiocarpal OA in wrist radiographs. One hundred consecutive wrist clinical and radiographic exams were retrospectively reviewed. Radiographs were evaluated for the presence and stage of OA. The mean age was 61.3 (+/-14.5) years. The radiographic occurrence of STT joint OA was 59% and of radiocarpal (RC) OA was 29%. Radiographic STT and RC joint OA were inversely related. Tenderness over the STT joint in physical exam was not associated with OA in the STT or other joints. STT OA in our series was not related to wrist pain. These findings support the discrepancy between radiographic and cadaver findings and clinically significant OA in this joint. The inverse relationship between STT and RC OA, as seen in scapholunate advanced collapse (SLAC) wrist, requires further biomechanical study.

BACKGROUND: Complications with the use of the Artelon spacer in thumb carpometacarpal (CMC) joint arthritis include inflammation, osteolysis, and persistent pain. We evaluated our short-term results and complications. METHODS: A retrospective review of 29 patients was performed. Pre- and postoperative radiographs, operative techniques, complications, and subsequent surgeries were analyzed. Pearson's and chi-squared testing was used to identify associations between complications and surgical technique or preoperative radiographic criteria. The average age was age 51 +/- 7.7 (34-66), average follow-up was 8 months (1-26). RESULTS: Twelve patients sustained complications. Nine patients displayed postoperative osteolysis. Four patients underwent conversion to CMC suspensionplasty due to persistent pain. The rate of revision surgery and radiographic postoperative osteolysis were not significantly associated with preoperative arthritis grade, metacarpal subluxation, or surgical techniques: fixation method, the bony surface(s) involved in the osteotomy, or spacer modifications. CONCLUSIONS: Our study found a significant short-term complication rate following Artelon spacer arthroplasty of the CMC joint. This is higher than previously described. We could not identify any factors that were significantly associated with the complications. It is possible that the inherent instability of the joint or the material of the spacer is involved in implant failure. Further study is necessary to better define the indications for use and specific techniques for the use of the implant.

Multiple studies have compared the outcome of surgery for cubital tunnel syndrome (CUTS), yet there remains no clear guidelines for treatment. We describe an approach to CUTS that includes tailoring the procedure to the pathology found at surgery. Patients treated surgically were retrospectively reviewed. Following in situ neurolysis, nerve stability within the cubital tunnel was assessed, and the nerve was left in situ, or transposed accordingly. We evaluated demographic information, presenting features, intraoperative and postoperative findings. Statistics included paired t test and logistic regression analysis. A total of 63 patients (standard deviation = 10.3 years) were reviewed. Fourteen nerves were transposed (22.5%). Postoperatively, sensation (71%), static 2-point discrimination, and motor strength improved. Grip strength compared with the uninvolved side was 94.8% postoperatively. Overall, 90% of the patients reported improvement in function. Our results compare favorably with other studies. Since CUTS originates from numerous causes, basing the operative plan on intraoperative findings produces excellent results.

We report a rare case of transradial styloid radial perilunate dislocation in a patient who presented with ulnar nerve symptoms, and we describe our treatment approach to this unusual injury. In a literature search, we found no other report of such an injury.

PURPOSE: To determine the amount of scaphoid and lunate translation that occurs in normal cadaver wrists during wrist motion, and to quantify the change in ulnar translation when specific dorsal and volar wrist ligaments were sectioned. METHODS: We measured the scaphoid and lunate motion of 37 cadaver wrists during wrist radioulnar deviation and flexion-extension motions using a wrist joint motion simulator. We quantified the location of the centroids of the bones during each motion in the intact wrists and after sectioning either 2 dorsal ligaments along with the scapholunate interosseous ligament or 2 volar ligaments and the scapholunate interosseous ligament. RESULTS: In the intact wrist, the scaphoid and lunate statistically translated radially with wrist ulnar deviation. With wrist flexion, the scaphoid moved volarly and the lunate dorsally. After sectioning either the dorsal or volar ligaments, the scaphoid moved radially. After sectioning the dorsal or volar ligaments, the lunate statistically moved ulnarly and volarly. CONCLUSIONS: Measurable changes in the scaphoid and lunate translation occur with wrist motion and change with ligament sectioning. However, for the ligaments that were sectioned, these changes are small and an attempt to clinically measure these translations of the scaphoid and lunate radiographically may be limited. The results support the conclusion that ulnar translocation does not occur unless multiple ligaments are sectioned. Injury of more than the scapholunate interosseous ligament along with either the dorsal intercarpal and dorsal radiocarpal or the radioscaphocapitate and scaphotrapezial ligaments is needed to have large amounts of volar and ulnar translation.

Distal radius fracture alignment and stabilization can be a surgical challenge in the face of severe comminution and bone loss. We describe a technique using a calcium phosphate/sulfate bone cement, as an adjunct to internal fixation. This bone cement is biocompatible, osteoconductive, and sets quickly with an isothermic reaction. The use of bone cement eliminates the need for primary autologous bone grafting and allows for easier reduction and retention of reduction at the time of surgery. Bone cement is employed for the following purposes in comminuted fractures: (1) to fill a void due to lost or crushed cancellous bone, (2) to hold larger unstable fragments while hardware is placed, and (3) to retain fragments too small to take hardware. Available bone cements, studies involving the use of bone cement for distal radius fractures, indications, and surgical technique will be reviewed.

Two cases of combined dorsal trapezoid dislocation and multiple finger carpometacarpal joint dislocations are described. In both cases, a common mechanism involved a head-on motor vehicle collision while the subjects held tightly to the steering wheel. The patients were treated with open reduction and pinning, with good short-term results.