Used routinely in maxillofacial reconstructive surgery, the chondrocostal graft is also applied to hand surgery in traumatic or pathologic indications. The purpose of this overview was to analyze at long-term follow-up the radiological and histological evolution of this autograft, in hand and wrist surgery. We extrapolated this autograft technique to the elbow by using perichondrium. Since 1992, 148 patients have undergone chondrocostal autograft: 116 osteoarthritis of the thumb carpometacarpal joint, 18 radioscaphoid arthritis, 6 articular malunions of the distal radius, 4 kienbock's disease, and 4 traumatic loss of cartilage of the proximal interphalangeal (PIP) joint. Perichondrium autografts were used in 3 patients with elbow osteoarthritis. Magnetic Resonance Imaging (MRI) was performed in 19 patients with a mean follow-up of 68 months (4–159). Histological studies were performed on: Whatever the indication, the reconstruction by a chondrocostal/ostochondrocostal or perichondrium graft yielded satisfactory clinical results at long-term follow-up. The main question was the viability of the graft.
Despite the strong mechanical strain in the hand and wrist, chondrocostal graft is a biological arthroplasty that is trustworthy and secure over the long term, although it can cause infrequent complications inherent to this type of surgery. Despite the inevitable histological modification, the cartilage remains alive and is of satisfactory quality at long term follow-up and fulfills the requirements for interposition and reconstruction of an articular surface. The perichondrium graft constitutes a new arsenal to cure cartilage resurfacing. The importance of perichondrium for the survival of the grafted cartilage, as previously reported, as well as its role in resurfacing, is being investigated.
90 cases of reversed prosthesis have been evaluated and the aim of the retrospective multicenter study was to correlate the functional and radiological results depending on the type of implant. 90 patients have been operated (67 eccentric omarthrosis, 5 centered omarthrosis, 7 massive rotator cuff tear, 11 others), by 8 surgeons in 3 centers by a delto-pectoral approach (71%), and evaluated retrospectively by an independant surgeon. 3 types of prosthesis have been implanted: 1st generation of reversed prosthesis (Aequalis-Reversed, Tornier®: humeral neck angle of 155°), BioRSA (humeral neck angle of 155° but with lateralization of center of rotation, Tornier®), and a prosthesis with a more vertical angle of 145° (Humelock-Reversed, FX-Solutions®. A prospective study of the QuickDash score, Constant score and analysis of clinical and radiological complications by the surgeon and an independant surgeon at the time of longest follow up is reported.Introduction:
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20 cases of bone defect have been treated by the induced membrane technique avoiding allograft, microsurgery and amputation 9 cases of long bone defect (humerus and forearm) and 11 cases of bone defect at the hand have been included in this multicentre prospective study (3 centers). The aetiology in 11 cases was trauma, 7 cases were septic nonunions and 2 cases followed tumors. In the hand the bone loss was at least one phalanx, and for long bones the mean defect was 5 cm (3–11). All cases were treated by the induced membrane technique which consists in stable fixation, flap if necessary and in filling the void created by the bone defect by a cement spacer (PMMA). This technique needs a second stage procedure at the 2nd month where the cement is removed and the void is filled by cancellous bone. The key point of this induced membrane technique is to respect the foreign body membrane which appeared around the cement spacer and which creates a biologic chamber for the second procedure. Bone union was evaluated prospectively in each case by a surgeon not involved in the treatment, by X-ray and CT scan. Failure was defined as a nonunion at 1 year, or an uncontrolled sepsis at 1 month.Introduction:
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Tuberosity healing is strongly correlated with functional results in all series of three- and four-part fractures of the proximal humerus treated by hemiarthroplasty. We formed a working group to improve position of the implant and fixation of the tuberosities on an implant specifically intended for traumatology. An anatomic study on 11 cadavers and a prospective multicentre clinical study of 32 cases were performed to validate extrapolable original solutions at the patient scale: placement of the stem at a height indicated in relation to the insertion of the clavicular bundle of the pectoralis major, locking of the stem, placement (based on bone quality) of a variable volume metaphyseal frame (offset modular system® OMS®), avoiding medialisation of the tuberosities, and fixation of the tuberosities using strong looped sutures, brightly coloured so that they can be located more easily. Evaluation by Dash score and Constant score was correlated with positioning of the tuberosities using radiographs.Introduction:
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