Purpose of the study: The purpose of using distal metaphyso-epiphyseal osteotomy to shorten the ulna is to reduce healing time compared with diaphyseal shortening and to adapt the osteotomy to the distal radioulnar anatomy and associated conditions by using a variably oblique cut.

Material and methods: Oblique metaphyso-eiphyseal osteotomy of the distal ulna was performed in sixteen patients since 2000. Fourteen presented ulnocarpal pain. Among these, eight had associated distal radioulnar pain. Two patients had pain essentially limited to the distal radioulnar area. Radiographically, there was ulnocarpal impingement in fourteen wrists, and signs of early-stage distal radioulnar osteoarthritis in five. Local regional anesthesia was used in thirteen patients who underwent surgery in an outpatient clinic. The dorsoulnar approach was used. The direction of the osteotomy cut depended on the individual condition, and distal radioulnar anatomy and stability. Two headless canulated screws were used for fixation. The elbow and wrist were immobilized for three weeks followed by self-education of pronosupination beginning with a removable orthesis to stabilize the wrist.

Results: Outcome was assessed at maximum follow-up of four years. Preoperative pain had totally resolved in fourteen wrists with residual pain at forced pronosupination in two. Wrist motion was not modified in the frontal and sagittal planes. Complete pronosupination range of motion was achieved in thirteen patients, two patients had supination limited to 20° and one had pronation and supination limited to 30°. Force was 90% compared to the opposite side. Bone healing was achieved in all patients, in 3–4 weeks for fourteen wrists and after two months of elbow and wrist immobilization in two.

Discussion: Oblique metaphyso-epiphyseal osteotomy of the distal ulna reduced the healing time compared with diaphyseal shortening osteotomies. This technique enables adaptation of the direction and orientation of the ulnar cut to the individual distal radioulnar anatomy. Favorable clinical outcome in patients with early-stage distal radioulnar osteoarthritis has led us to progressively abandon certain indications for distal resection of the ulna and the Sauvé-Kapankji operation.

Purpose: Wound dressing is the last phase of any surgical intervention. The purpose is to isolate the surgical wound to reduce the risk of airborne contamination. In certain situations such as skin trauma, burns, acute or chronic loss of skin cover, or open fractures, wound dressings can however have a deleterious effect (maceration, adherence). Prevention of secondary infection of surgical wounds and spread of infection from septic patients is an integral part of our routine practice. We have developed a specific system useful in certain situations to isolate a septic or “at-risk” limb.

Material and methods: Our system is composed of a closed 100-cm polyvinyl chloride isolator measuring 40 cm in diameter. Two “absolute” filters allow internal ventilation with a variable flow filtered-air generator. Sterile products are introduced into the isolator via a shuttle chamber. With this system, the wound can be isolated without isolating the patient. We have used this system for more than 250 patients since 1986. A dedicated chart has been used to monitor results obtained with the system since 1993.

Results: The isolator was used for 258 patients, 185 men (71%), with 271 limb wounds on 227 lower limbs (83%) (63% legs and ankles). Half of the patients had open fractures associated with loss of skin cover. The clinical course was satisfactory in 75% of the patients (complete healing or complementary skin graft). The system was psychologically unacceptable for seven patients. There was only one case of a new germ isolated from a wound.

Conclusion: This dressing isolator requires a significant “logistic” investment but provides considerable bacteriological safety for difficult cases.