Purpose: Functional outcome after shoulder arthrodesis was evaluated to assess indications for the treatment of posttraumatic partial and total brachial plexus paralysis in adults.

Material and methods: Twenty-seven patients who underwent glenohumeral arthrodesis for posttraumatic brachial plexus paralysis were reviewed. Eleven had radicular paralysis (C5, C6 and C5, C6, C7) and sixteen total paralysis. All patients recovered active elbow flexion. Shoulder reinnervation had failed in eleven patients. Before the arthrodesis, 22 patients could no use their paralysed limb. Mean time between direct neurological surgery and arthrodesis was 30 months for partial paralyses and 20 months for total paralyses. Glenohumeal screw fixation was used for the arthrodesis which was associated with an external fixation in 21.

Results: Mean postoperative follow-up was 70 months. There were two cases of non-union which fused after revision and three cases of humerus fracture which occurred during the first six months after surgery. Pain related to inferior subluxation improved in six patients. There was no significant difference between the two groups for position of the fusion, or postoperative active motion (60° flexion, 60° abduction, 45° internal rotation and 7 to −9° external rotation). There was a significant difference in force which was greater for superior paralyses (11 kgf versus 7 kgf in flexion, 12 kfg versus 7 kgf in abduction, 6 kgf versus 2 kgf in external rotation and 11 kgf versus 4 kgf in internal rotation). The same was true for hand movement. The differences were statistically correlated with force of the pectoralis major.

Conclusion: Glenohumeral arthrodesis provides significant improvement in function in patients with supraclavicular brachial plexus paralysis, even with a paralytic hand. Arthrodesis also allows reorienting surgical reinnervation to other functions such as hand movement. Shoulder force and hand movement are directly correlated with force of the pectoralis major.

Introduction: Intra-uterine vascular deficiency of the upper limbs is very rare.

Materials & Methods: Thirty two cases collected by 118 paediatric surgeons (GEOP) over the last 20 years were presented

Results: This series illustrates the large range of presentations of vascular deficiencies, from total ischaemia of both upper limbs to small scars of the hand. Three infants had diabetic mothers; nine children had a cerebral infarction; non disturbed haematologic screening was found; three new born had an intra-uterine thrombotic event.

Discussion: Our hypothesis is that such an intra-uterine thrombotic pathology can lead to thromboembolism. The embolus passing through the foramen ovale, arrives in the high pressure circulation and is transported directly to the upper limbs and brain. The size of embolus corresponds with the extent of the necrosis.

Purpose: Scaphotrapezotrapezoidal (STT) pain is common but often asymptomatic. Medical treatment may be proposed if symptoms become bothersome. In case of failure, several surgical solutions may be proposed. The purpose of this work was to assess outcome in a series of eleven STT arthrodeses performed for isolated STT osteoarthritis.

Material and methods: Ten patients, three men and seven women (11 hands), mean age 63 years, developed STT osteoarthritis which was treated by arthrodesis. All patients experienced pain for daily life activities and had diminished wrist movement. According to the Crosby radiographic classification, three were one grade I, four grade II, and five grade II with carpal misalignmen t. One patient had chondrocalcinosis and six had tendinitis of the flexor carpi radialis. The anterior approach was used for three patients and the lateral approach for seven. Nine patients had an iliac graft to fill bony defects resulting from anterior wear. Pin fixation was used in six cases and staple fixation in five. An antebrachiopalmar cast was maintained for at least six weeks after surgery.

Results: At mean follow-up of 62 months, the pain score improved in all patients (p=0.05). There was no significant difference in motion, excepting decreased wrist extension (12°, p=0.03). Grasp and pinch force were not modified by STT arthrodesis. All patients were able to resume their former recreational and occupational activities. There was no worsening of the five cases with intracarpial deaxation. Four patients developed non-union (three pin fixations, one staple fixation), which was symptomatic in only two. These patients underwent successful revision using the same fixation technique. There were no complications.

Discussion: Like other series reported in the literature, our series of STT arthrodeses demonstrated effective pain relief. However, unlike former work, we were unable to obtain a significant reduction in the radial inclination force, or radio-carpal conflict. The other therapeutic option is resection of the distal pole of the scaphoid which provides more rapid clinical results but which leads to inevitable misalignment of the carpus.

Conclusion: We have decided to retain STT arthrodesis with iliac graft for patients with STT osteoarthritis, especially for young patients.

A 55-year-old man developed a pseudoaneurysm of the popliteal artery after tibial valgization osteotomy performed for degenerative genu varum. A tourniquet was used for the procedure. A wedge osteotomy was performed two centimeters under the joint line; the correction angle was ten degrees. Immediately after the end of the procedure, the distal pulses disappeared for ten minutes. Doppler exploration of the arterial network did not demonstrate any anomaly. Ten days postoperatively, the patient complained of sudden onset pain in the knee and tension in the popliteal fossa. Arteriography demonstrated a pseudo-aneurysm of the popliteal artery. The lesion caused an interruption of arterial flow and was successfully treated by emergency resection and suture.

Purpose: Desmoid tumours are uncommon in the axillary region. We report the clinical course in seven patients operated for desmoid tumours of the axillary region.

Material and methods: Our series included two women and five men. Mean age was 52 years (39–60). One tumour was in the trapesium, two were in the retroplexic, two in the axillary fossa, one in the deltoid and one in the upper part of the arm. Biopsy and magnetic resonance imaging were obtained in all patients. Surgical margins were in healthy tissue in five cases; resection was limited to intratumoural tissue in one. The axillary nerve had to be sacrificed in two patients, the spinal nerve in one and the medial nerve in one. Chemotherapy was given to one patient prior to surgery.

Results: Mean follow-up was 51 months (23.2–162.1). Five patients experienced at least one relapse requiring one or two complementary procedures. Among the relapse cases, one patient required resection of the median nerve with bypass of the humeral artery. No amputations were necessary and the brachial plexus was not sacrificed. Four patients were given one to five adjuvant chemotherapy courses. Two were given radiotherapy. Shoulder motion was preserved in two patients, moderately reduced in five. Elbow and finger mobility was compromised due to the medial epicondylar site of the tumour in one patient whose median nerve had to be sacrificed.

Discussion: Even though the surgical margins were in healthy tissue, the risk of relapse was high in our patients as in other series reported in the literature. The course does however stabilise after several episodes of recurrence, an observation reported in the literature and confirmed in our patients. In case of brachial plexus involvement, several authors advocate preservation of upper limb function despite incomplete tumour resection, proposing postoperative radiotherapy.

Conclusion: Desmoid tumours of the axillary region seriously compromise upper limb function. Surgical resection should be as complete as possible but without sacrificing upper limb function.