Separation of congenital embryonic syndactylies in children: dorsal or volar flap? About a comparative retrospective series.

Congenital syndactylies account for 1 to 2 out of 2000 birth defects. Although several types of syndactylies exist, we only studied embryonic syndactylies. The goal of our study was to compare 2 types of coverage flap for the reconstruction of the finger web spaces: a volar flap described by Blauth and a dorsal flap described by Gilbert.

Correction of Clinodactyly by Early Physiolysis: 6-Year Results.

Purpose: To review results at least 6 years after physiolysis for treatment of the delta phalanx associated with clinodactyly.

Methods: We present 22 cases of clinodactyly treated with physiolysis in which we removed the central part of the epiphysis, which is the portion restricting longitudinal growth unilaterally and inducing progressive finger deviation, and placed a fat graft in the resultant defect.

Results: This retrospective study reports the results of early physiolysis in 27 fingers with radial clinodactyly, including 17 fingers from 17 patients previously reported and 10 little fingers from 5 additional patients.

Primary care of nail traumas.

Injuries to the nail complex are common in adults and children. These complex injuries often involve the paraungueal tissues, fingertip and bone. Specialized primary care is essential to limiting the sequelea that are typically difficult to repair secondarily.

[Early physiolysis in the correction of clinodactyly].

The principle of early treatment by physiolysis without osteotomy is based on the removal of the deforming tether. We retrospectively studied the effects of early physiolysis on the growth and correction of deformity with a minimal follow-up of 6 years in 17 cases. The mean correction at follow-up was 82% of the pre-operative angle.

["Principalisation" of pollicization in congenital conditions. Technical modifications for functional and aesthetic improvement].

After reviewing our experience of pollicization in congenital differences, we found that classical techniques have several weak points concerning function and appearance. Abduction is frequently insufficient and adduction quite weak. Aesthetically, the thumb has a slender aspect and the web fold is absent and the commissure looks more as a cleft.

[Flexion deformities of the thumb: clasped thumb and trigger thumb].

Congenital clasped thumb in palm corresponds to a spectrum of anomalies leading to a loss of thumb extension and abduction. Intrinsic muscles and skin shortening are not infrequent. Conservative orthopedic treatment should be undergone as soon as possible.

The preliminary results of treatment of symptomatic carpal boss by wedge joint resection, radial bone grafting and arthrodesis with a shape memory staple.

There is no consensus regarding the aetiology or treatment of carpal boss. Recurrences or carpometacarpal instability is reported after simple resection. Carpometacarpal arthrodesis has been proposed as a primary treatment and after failure of simple resection.

Anterior tenoarthrolysis for severe flexion contracture of the fingers (the "TATA" operation): a review of 50 cases.

The "hook finger", with both proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint flexion contractures, often after multiple previous operations, is difficult to treat. This paper reports the results of 50 fingers in 49 patients in which the TATA (Téno-Arthrolyse Totale Antérieure) salvage procedure, described by Saffar in 1978, was carried out. Thirty-seven of 50 (74%) of these fingers had had at least one previous operation, most on the flexor apparatus.

Conservative treatment versus scaphotrapeziotrapezoid arthrodesis for Kienbock's disease. A retrospective study.

Efficiency of surgical treatment in Kienböck's disease has never been proven in the long term. We retrospectively reviewed the charts of the 104 patients treated by various techniques for Kienböck's disease from 1981 to 1999 in our unit. A comparison was made between 19 cases treated conservatively (amongst 59) and 11 cases (amongst 25) treated by scaphotrapeziotrapezoid (STT) arthrodesis with a mean follow-up of 13 years.

Camptodactyly as a spectrum of congenital deficiencies: a treatment algorithm based on clinical examination.

Background: Camptodactyly is a frequent congenital hand disorder, but its cause and treatment remain a matter of controversy. Although it is difficult to establish the primary cause of camptodactyly, careful clinical examination allows the assessment of all the structures involved (e.g.

First carpometacarpal joint denervation: anatomy and surgical technique.

The main goal of first carpometacarpal arthritis surgery is to relieve pain. The main disadvantage of the classic techniques (trapeziectomy, implant arthroplasty) is that they are extensive surgeries with potential complications, such as radial nerve paresthesia and synovitis. In the author's opinion, denervation of the first carpometacarpal joint is a viable option in selected cases.

Denervation of the proximal interphalangeal joint: a realistic and simple procedure.

Pain relief in osteoarthritis of the proximal interphalangeal joint is a difficult problem. Joint denervation, a technique yielding good reproducible results in wrist and first carpometacarpal joint osteoarthritis, is, at the proximal interphalangeal joint level, a good alternative to implant arthroplasty or arthrodesis. The surgical technique is simple and may be performed under local anesthesia.

Radial shift of the ulnar fingers: a new technique for special cases of longitudinal central deficiency.

Treatment of central longitudinal deficiencies is well defined, with different techniques established for the classical clefts. However, none of these techniques is easily applied to the treatment of very deep clefts accompanied by a significant divergence of the metacarpal bones. In such cases, the results of current techniques are disappointing.

Reconstruction of fingertip defects with the neurovascular tranquilli-leali flap.

For many years, bipedicled palmar advancement flaps were used rarely in fingers because they sacrificed the dorsal branches of the digital arteries, risking dorsal skin necrosis. In 1995, a short bipedicled neurovascular VY advancement flap raised distally to the PIP flexion crease, which spared the dorsal blood supply, was described by Elliot et al. (1995).

Relationship between dorsal ganglion cysts of the wrist and intraosseous ganglion cysts of the carpal bones.

Soft tissue ganglion cysts are the most common benign tumours of the wrist; their pathogenesis remains controversial. We prospectively screened the radiographic appearance of the wrists of 51 patients presenting to a single surgeon with dorsal wrist ganglions during a one-year period. Postero-anterior and lateral radiographs were systematically performed looking for possible associated intraosseous ganglion cysts.

Principalization of pollicization of the index finger in congenital absence of the thumb.

After reviewing our experience with pollicization in congenital cases of thumb hypoplasia or aplasia, we found that classic techniques have several weak points concerning function and appearance. Abduction is frequently inadequate, and adduction is quite weak. Esthetically the thumb has a slender aspect, the web fold is absent, and the commissure looks more like a cleft.

[Joint denervations in hand surgery: a plea].

Since the original description of wrist denervation, the principle of joint denervation in hand surgery has been extended to other joints like the first carpometacarpal, interphalangeal and metacarpophalangeal joints. At the wrist level as at the digital level, the results are comparable to those obtained with other surgical alternatives. In case of unsatisfactory results, a more traditional intervention remains always possible.

[The ulnar longitudinal deficiency: proposition of a descriptive classification].

Ulnar longitudinal deficiency is an extended malformation sometimes involving the whole upper extremity, even including sometimes the opposite side. The clinical and radiological aspects are variable and none of the existing classifications takes into account all the possible deformities. Multiple decisive factors in the surgical indications are missing such as shoulder stability, elbow position (extension or flexion with or without pterygium), orientation of the hand (internal rotation), wrist inclination and number of digits.

[Technical note: ulnar "pseudo-pollicisation" in congenital hand differences].

In certain rare cases of thumb aplasia or hypoplasia, pollicisation of the second finger is not recommended or impossible. It happens when the most radial fingers are hypoplastic or abnormal or when an ulnar prehension pattern has already developed. In these cases, if functional, pollicisation of the most ulnar finger in not suitable because of the ugly cosmetic result.

Pollicization in congenital differences.

Pollicization of the index finger is a well established procedure for some cases of thumb hypoplasia. We reviewed our experience of 27 "normal" index-finger pollicizations with a mean follow-up of seven years, excluding those cases with more extensive radial hypoplasia and abnormal fingers. Even in such an "ideal" situation, strength was deceptive and the frequently slender aspect of the new thumb with quite extensive dorsal scar formation and the "cleft" appearance of the first web disappointing.

A severe complication of muscle transfer: clostridial myonecrosis.

We present a case of gas gangrene as a severe complication of muscle transfer for opponensplasty. After debridement, the extensive palmar wound was covered by a free gracilis muscle transfer. This complication of muscle transfer has to our knowledge never been reported previously.

Giant cell tumours of the tendon sheath: lack of correlation between nm23-H1 expression and recurrence.

Some authors attribute recurrences of giant cell tumours to biological factors which are only expressed in some tumours. Grover et al. (1998) suggested that the risk for recurrence is associated with the down-regulation of the nm23-H1 gene.

[A case report of desmoid tumor of the finger].

We report the case of a 20-year-old woman with a desmoid fibroma of the finger, which is an extremely rare location. Desmoid fibromas are benign but very infiltrative tumors, known for their frequent recurrences. Because of the many vascular and nervous structures concentrated in the finger, complete surgical excision is difficult.

[The "candlestick" technique for the correction of certain types of congenital metacarpal synotosis].

Metacarpal synostosis is a rare congenital hand malformation requiring only occasionally a surgical correction. However in case of divergent epiphyses there is a progressive accentuation of the deformity. In the "Y" type of symmetrical synostosis, the authors propose a trapezoidal osteotomy with upside down relocation allowing realignement of the epiphyses without distant bone donor site.