INTRODUCTION:In the context of high-energy trauma or ballistic injury, wound healing is often compromised by underlying structural damage such as bone loss, infection, or instability. The induced membrane technique (IMT), a two-stage approach for segmental bone defects, is frequently used in the management of chronic infected wounds. Although a change in osteosynthesis is routinely performed between stages in clinical settings, no preclinical animal model has reproduced this key surgical step. We present a novel surgical technique in rats combining a reinforced polymethylmethacrylate (PMMA) spacer with a Kirschner wire during the first stage, followed by plate osteosynthesis during the second stage. This represents the first reported animal model of IMT that integrates a staged change in fixation. METHODS:Eleven Sprague Dawley rats underwent a 5-mm femoral bone defect creation stabilized with an intramedullary Kirschner wire and a PMMA spacer (stage one). Four weeks later, the spacer and wire were removed, and internal fixation was achieved using a locking plate system, after grafting the defect with cancellous bone (stage two). Clinical monitoring, radiographic imaging, and postmortem micro-CT analysis at 10 weeks post-second surgery assessed model feasibility and bone regeneration. RESULTS:All animals survived and maintained satisfactory weight and clinical status throughout the protocol. The mean bone volume of the newly mineralized bone into the defect was 64.05 ± 36.62 mm3. CONCLUSION:This is the first reproducible animal model of IMT incorporating a staged change in osteosynthesis, closely mimicking clinical management of chronic bone wounds. The technique offers a robust preclinical platform for studying the influence of fixation methods on membrane properties and bone healing. It is particularly relevant for translational research in wound-associated bone defects and infection control.

Introduction Macroreplantation is a rare yet technically challenging procedure performed following traumatic amputations. Despite advances in surgery, early failure rates remain high. The aim of this study was to identify predictors of early failure after macroreplantation. Methods We conducted a multicenter retrospective analysis of 43 macroamputations (from metacarpal level to proximal humerus) that were treated with replantation at four level-1 trauma centers in France between 2008 and 2024. Patients were classified into two groups: a failure group (defined as secondary amputation within six weeks) and a survival group. Pre-, intra- and postoperative data were collected and analyzed. Results Early failure occurred in 20 cases (47%) at a mean of 8 days post-replantation. Overall, 74% of patients experienced one or more postoperative complications, primarily vascular in nature. In the multivariate analysis, predictors for limb survival were: surgeon’s expertise level four (highly specialized; adjusted OR = 15.8) and the administration of gentamicin as part of the antibiotic prophylaxis (adjusted OR = 7.42). Smoking was independently associated with an increased risk of failure (adjusted OR = 0.10). Severe wound contamination was not significantly associated with failure (adjusted OR = 0.48). Conclusion Early failure in macroreplantation is significantly associated with smoking, suboptimal antibiotic prophylaxis, and limited surgical expertise. We advocate early, aggressive debridement; the use of broad-spectrum antibiotics; and the systematic involvement of senior microsurgeons in these rare, high-stakes cases. Level 4, retrospective study.

Cette note technique présente une option de sauvetage dans les pertes osseuses proximales massives de l’humérus, avec atteinte complète du deltoïde et de la coiffe des rotateurs. Il s’agit d’une arthrodèse associant la méthode de Masquelet en 2 temps et une autogreffe de fibula non vascularisée microperforée. Le blocage articulaire est réalisé dès le premier temps, par un montage stable, avec plaque scapulohumérale 4,5 fixée par au moins 4 vis proximales et distales. Après retrait de l’entretoise en ciment à 6–8 semaines, l’autogreffe de fibula est microperforée, et fixée lors du 2e temps par 2 vis proximales à la scapula et deux vis distales à l’humérus. Les résultats fonctionnels des 4 patients ayant bénéficié de cette technique ont été améliorés sans infection secondaire rapportée à 1 an. Cette technique simple et reproductible représente une alternative valable dans des contextes où la reconstruction par fibula vascularisée ou prothèse inversée n’est pas envisageable. Niveau de preuve IV.

Conservative management of traumatic bone defects of the distal femoral epiphysis presents a surgical challenge. Implant placement in the acute phase carries a significant risk of septic complications, joint stiffness, and early loosening; therefore, it is not an ideal treatment option for these patients, who are often young and have high functional demands. The use of a massive osteochondral allograft is a demanding alternative that requires obtaining a graft of appropriate size, but it allows for the restoration of a satisfactory joint contour with good functional outcomes in the medium term.

Background Management of high-energy wartime ballistic trauma is well established, but strategies for low-energy civilian injuries remain debated. This study analyzed injury patterns and treatment approaches for low-energy ballistic limb trauma in civilian and military French trauma centers (TCs). Methods We conducted a retrospective multicenter study in five Level 1 TCs (2 civilian, 3 military), including adults treated for low-energy ballistic limb injuries between 2012 and 2022. Demographics, injury mechanism and context, injury characteristics, surgical management, and outcomes were analyzed. Results Among 178 patients with a mean age of 33.4 years, 124 (70%) were treated in civilian TCs and 54 (30%) in military TCs. Most injuries were bullet-related (98%), predominantly due to urban violence (86%). The patients totalized 196 injuries including 103 (53%) soft-tissue injuries and 93 (47%) open fractures. Early total care was applied in 137 (70%) cases, and damage control orthopedics (DCO) in 59 (30%). The mean ISS was significantly higher in the DCO group. Early infection occurred in 20 cases, with 13 septic recurrences. At 25-month mean follow-up, bone union was achieved in 83%, with four persistent bone infections. Upper limb injuries more frequently involved nerves and temporary stabilization with splint. DCO was used more often in military TCs, but bone union and infection rates were comparable between groups. Conclusions Despite variability in surgical strategies, outcomes were generally favorable. Low-energy ballistic limb injuries in civilian practice can often be managed according to standard open fracture principles; however, DCO may be warranted when patient-related factors (particularly associated injuries) or the clinical context require a staged approach. Level of evidence IV; case series.

INTRODUCTION:Rollover hand injuries are uncommon but potentially devastating lesions. While typically described as dorsal injuries, cases involving the palmar side are rare. There are two different mechanisms of rollover hand injuries: the "grabbing" or the "hanging out" mechanism. The aim of this case-report was to describe a particularly severe pattern of rollover hand injury with palmar side injuries following the "grabbing" mechanism. CASE-REPORT:Three males patients sustained severe stage 3 lesions according to Coulet's classification following dune-buggy accidents with a "grabbing" mechanism. All cases exhibited combined dorsal and palmar injuries with bone, vascular, and tendinous involvement. Infectious complications were frequent, requiring serial debridement and flap coverage using posterior interosseous or groin flaps. One patient required a trans-metacarpal amputation due to ischemia. At a median follow-up of 21 months, all surviving digits demonstrated satisfactory healing and function, despite persistent intrinsic muscle paralysis. CONCLUSION:Buggy-specific hand injuries have so far been grouped under injuries caused by "rollover" mechanisms, involving vehicle overturning. However, the distinct mechanism of these injuries, which is linked to the presence of a safety cage, is more likely to result in palmar injuries with severe vascular damage. LEVEL OF EVIDENCE:IV.

Background: Ballistic trauma to the proximal humerus poses a significant challenge because of extensive bone loss and soft tissue damage, often involving the rotator cuff, deltoid muscle, and axillary nerve. In cases where limb preservation is the priority, scapulohumeral arthrodesis (SHA) remains a viable option, particularly when prosthetic reconstruction is contraindicated because of severe musculotendinous injury. The Masquelet 2-stage induced membrane technique has shown promising results in lower limb reconstruction, yet its application for upper limb arthrodesis in ballistic injuries remains underreported. This study aims to evaluate the outcomes of SHA using a non-vascularized fibular autograft in a 2-stage reconstruction approach following severe ballistic trauma. Materials and methods: This retrospective, multicentric case series included 4 male patients (mean age: 42 years, range: 30-52) treated between 2022 and 2023 for proximal humeral ballistic trauma. Inclusion criteria were significant humeral bone loss (>10.5 cm), rotator cuff and deltoid damage, and axillary nerve dysfunction. Exclusion criteria included scapular involvement and brachial plexus injuries beyond the axillary nerve. The first stage of the Masquelet technique involved radical debridement, resection of necrotic bone, and placement of an antibiotic-laden cement spacer. The second stage, performed 6 weeks later, involved removal of the cement, placement of a perforated non-vascularized fibular autograft, and stabilization with a scapulohumeral plate. Corticocancellous grafting from the iliac crest and femoral head allograft was used to enhance consolidation. Results: At the 1-year follow-up, all patients demonstrated significant functional improvement. The Constant score showed a substantial increase compared to preoperative values. Pain, assessed by the Visual Analog Scale (VAS), decreased both at rest and during movement. Radiographic analysis confirmed bone consolidation at a mean of 7 months (range: 6-11 months). No cases of recurrent infection or graft failure were observed. One patient required targeted antibiotic therapy because of positive microbiological cultures, but no clinical infection developed. Patient satisfaction was high, with an average rating of 8.5/10. Conclusions: Two-stage SHA using a non-vascularized fibular autograft may represent a viable treatment option for proximal humeral ballistic trauma with extensive bone and soft tissue damage, particularly in settings where microsurgical expertise is not available. Despite the encouraging early outcomes observed in this small series, further prospective studies with larger cohorts and longer follow-up are needed to validate this approach and assess its long-term efficacy and safety.

Ballistic limb injuries are increasingly encountered in both civilian and military settings, yet robust collaborative cohorts remain limited. We conducted a retrospective, multicenter study across six French trauma centers (three civilian, three military) from 2014 to 2022, including consecutive patients aged ≥ 16 years with ballistic limb injuries. Data collected included demographics, context (civilian vs. combat/terror), projectile type and velocity, lesion characteristics, and early management. The primary outcome was early surgical site infection (SSI, < 30 days). Secondary outcomes were late and persistent infection, reoperations, fracture union, and infection-free survival. Univariate tests and multivariable logistic regression identified predictors of early SSI; Kaplan–Meier analysis assessed infection-free survival after initial infection. Among 254 patients (mean age 33.3 ± 12.7 years), 238 (93.7

Background:Gunshot-related limb injuries are increasingly seen in civilian settings. Surgical management may follow either Damage Control Orthopaedics (DCO) or Early Total Care (ETC) principles. Methods:We retrospectively analyzed 222 civilian patients with gunshot-related limb injuries treated between 2012 and 2023 across five French trauma centers. Patients were grouped according to initial surgical strategy: DCO or ETC. The primary outcome was bone healing; secondary outcomes included infection rates and reoperations. Results:ETC patients showed significantly higher union rates (88 % vs. 76 %) and lower infection and reoperation rates. However, the DCO group presented significantly higher Injury Severity Scores and more frequent vascular and nerve injuries, reflecting greater injury severity. Conclusion:ETC may be associated with improved outcomes in selected civilian patients with gunshot limb injuries. However, significant selection bias limits the interpretation of comparative results. Further prospective studies are needed to validate these findings.

Massive post-traumatic bone loss of the distal humerus remains a challenging condition. We describe a one-stage reconstruction technique combining an osteoarticular allograft with a pedicled latissimus dorsi flap for simultaneous bone and soft-tissue reconstruction. Two patients with ballistic injuries achieved bone union and functional elbow motion at 12 months. This single-stage approach may represent a reliable reconstructive option for complex distal humeral defects in young and active patients, avoiding the mechanical complications associated with arthroplasties.

The emergence of large-scale combat operations (LSCOs), as seen in the Russo-Ukrainian war, challenges conventional limb injury management developed during asymmetric conflicts. 1 In LSCOs, delays in casualty evacuation and surgical care often lead to postponed wound debridement and soft tissue coverage. These delays contribute to high infection rates with multidrug-resistant organisms, compromising limb salvage and functional outcomes. 1 2 To address these challenges, we advocate for damage control orthopaedics (DCO) initiation at Role 1, followed by early limb reconstruction at Role 2/3, within an ‘Advanced Prolonged Field Care’ (Advanced PFC) concept (figure 1). This approach follows as far as possible the structured ‘6/7/8/9’ timeline developed by the French Military Health Service: life and limb salvage within 6 hours, soft tissue coverage by day 7, bone and nerve reconstruction within 8 weeks, and functional restoration within 9 months. 3 4 Prehospital Damage Control Orthopaedics at Role 1 Since it may take up to 24 hours for casualties to reach a stabilization point, wound decontamination must begin at Role 1, under sedation or regional anaesthesia. This includes wound cleaning, marginal debridement with deep irrigation, and specific antibiotic prophylaxis protocols. 5 Fractures can be stabilized non-invasively using plaster splints or improvised skeletal traction. Advanced Prolonged Field Care at Role 2/3 At Role 2/3, DCO continues with further debridement, bacteriological sampling when possible, and temporary external fixation of long bones. 3 Given potential delays of days or weeks before evacuation to higher-level care, early limb reconstruction must begin in forward surgical units, adapting the 6/7/8/9 framework to the advanced PFC context. 4 This strategy is based on three core principles: Aggressive Wound Decontamination Serial marginal debridement every 48–72 hours is the cornerstone of infection prevention, combined with copious saline irrigation. Between sessions, negative pressure wound therapy helps isolate wounds from environmental contamination. Systemic antibiotics should be maintained until skin closure or flap coverage and can be supplemented with local delivery using antibiotic-loaded cement beads. 3 4 Prompt Soft Tissue Coverage Soft tissue reconstruction within 7 days is critical, especially for Gustilo type III B injuries. 6 In forward settings, pedicled flaps are preferred for their simplicity and reliability. They can be combined to address large defects. We demonstrated that orthopaedic surgeons with basic knowledge of local vascular anatomy can safely harvest local, regional, or distant flaps to manage most combat-related defects without requiring microsurgical expertise. 3 4 7 Early Bone Reconstruction To avoid complications associated with prolonged external fixation, early conversion to internal fixation is preferred. In cases of bone loss, the induced membrane technique is the method of choice, using reinforced spacer tactics whenever possible. 3 4 8 A polymethylmethacrylate (PMMA) spacer, reinforced with minimal intramedullary support, is placed during soft tissue coverage to preserve the reconstruction space, provide stability during evacuation, and enable local antibiotic delivery. When PMMA is unavailable, polypropylene syringe bodies can be used as spacers if stable fixation is ensured. 8 Preventing infection is key to improving outcomes for limb injuries in LSCOs. This requires adapting conventional approaches by expanding the PFC concept to include DCO at Role 1 and early reconstruction at Role 2/3. With minimal additional training, deployed orthopedic surgeons can apply this protocol. Dedicated training in operational reconstructive surgery is essential to support this pragmatic and cost-effective approach. Lawry LL, Korona-Bailey J, Kanagaratnam A, Maddox J, Hamm TE, Janvrin M, Juman L, Berezyuk O, Amowitz Z, Schoenfeld AJ, Koehlmoos TP. Qualitative assessment of point of injury to role 2+ combat casualty care in Ukraine. Trauma Surg Acute Care Open . 2025; 10 (2):e001674. Kazmirchuk A, Yarmoliuk Y, Lurin I, Gybalo R, Burianov O, Serhii Derkach S, et al . Ukraine’s experience with management of combat casualties using NATO’s four-tier « changing as needed » healthcare system. World J Surg . 2022; 46 (12):2858–62. Mathieu L, Choufani C, Andro C, de l’Escalopier N. Management of combat-related extremity injuries in modern armed conflicts. Orthop Traumatol Surg Res . 2025; 111 (Suppl 1):104055. Mathieu L, Durand M, de L’escalopier N, Bertani A, Rongieras F, Collombet JM. Challenges and solutions for reconstruction of combat extremity injuries encountered during high-intensity warfare. Eur J Trauma Emerg Surg . 2024; 50 :1183–4. Causbie JM, Wisniewski P, Maves RC, Mount CA. Prophylactic antibiotic use for penetrating trauma in prolonged casualty care: a review of the literature and current guidelines. J Trauma Acute Care Surg . 2024; 97 (Suppl 1):S126–37. Mody RM, Zapor M, Hartzell JD, Robben PM, Waterman P, Wood-Morris R, et al . Infectious complications of damage control orthopedics in war trauma. J Trauma . 2009; 67 :758–61. Mathieu L, Plang S, de l’Escalopier N, Murison JC, Gaillard C, Bertani A, Rongiéras F. Correction to: Extremity soft tissue coverage in the combat zone: use of pedicled flap transfers by the deployed orthopedic surgeon. Mil Med Res. 2021; 218 :4. Mathieu L, Mourtialon R, Durand M, de Rousiers A, de l’Escalopier N, Collombet JM. Masquelet technique in military practice: specificities and future directions for combat-related bone defect reconstruction. Mil Med Res. 2022; 9 :48. Ethics approval : Not applicable. Consent for publication : Not applicable. Availability of data and materials : Not applicable. Competing interest : The authors declare that they have no competing interest. Funding : There is no funding source. Authors contribution : All co-authors contributed to the writing of the manuscript. Abstract A04 Figure 1 Adaptation of the 6/7/8/9 timeline to the concept of Advanced Prolonged Field Care in high-intensity conflicts. ATB = Antibiotic; Bact. = Bacterial; DCO = Damage Control Orthopaedics; D&I = Debridement and Irrigation; LS = Limb Salvage; NPWT = Negative Pressure Wound Therapy

INTRODUCTION:The management of open tibial fractures has greatly benefited from the development of the orthoplastic approach. Despite advances in soft tissue reconstruction techniques, the use of simple pedicled flaps performed by orthopedic surgeons remains a relevant option. HYPOTHESIS:In the context of orthoplastic reconstruction of tibial fractures, the use of pedicled flaps performed by orthopedic surgeons can optimize soft tissue coverage strategies. MATERIALS AND METHODS:A retrospective study was conducted on 63 patients treated for open tibial fractures requiring soft tissue reconstruction between July 1, 2012, and July 1, 2021. Two groups were compared: Group 1 included patients operated on before July 1, 2018, when flaps were performed exclusively by plastic surgeons; Group 2 included patients operated on after July 1, 2018, when flaps were performed by either plastic or orthopedic surgeons. Demographic and injury-related data, type of flaps used, and the 1-month flap failure rate were analyzed. Time to coverage, time to soft tissue healing, and time to secondary internal fixation were recorded and compared between groups. RESULTS:In Group 1, 28 out of 45 patients (62%) underwent soft tissue coverage using flaps, of which 30 out of 31 flaps (97%) were performed by plastic surgeons. The free-to-pedicled flap ratio was 16:15. In Group 2, all 18 patients (100%) underwent flap coverage, of which 18 out of 20 flaps (90%) were performed by orthopedic surgeons. The free-to-pedicled flap ratio in this group was 2:18. The median time to coverage was significantly reduced in Group 2, from 28 days to 7 days (p < 0.05). Healing times were shortened. Flap failure rates were not significantly different between groups. CONCLUSION:When the injury pattern allows, the use of pedicled flaps by orthopedic surgeons appears to reduce the time to coverage in open tibial fractures, thereby optimizing the orthoplastic reconstruction strategy. Training orthopedic surgeons in these simple, reliable, and reproducible reconstruction techniques is therefore recommended. LEVEL OF EVIDENCE:IV.

The management of extensive bone defects presents a significant challenge for military orthopedic surgeons, especially in the context of a high intensity conflict or when patients are fully treated in the field. The objective was to evaluate the induced membrane technique (IMT) including a multiperforated non-vascularized fibular graft (NVFG) for the reconstruction of massive bone defects performed in both the ideal conditions of military trauma centers and the austere environment of forward surgical units. A retrospective case study was conducted on patients who underwent the above procedure in various care settings between January 2019 and June 2023. Outcomes measured included the achievement of bone union, time to bone union, and the healing index (time to bone healing/length of reconstructed bone). Functional assessment was based on the Quick-DASH score and the lower extremity functional scale (LEFS). Nine patients with a mean age of 37 years were included: five were managed in a role 4 medical treatment facility (MTF) and four in a role 2 MTF. Five patients had an infected bone defect before IMT application. After debridement, the mean bone defect length was 14 cm, and the mean bone defect volume was 190 cm3. The mean interval between stages was 15 weeks. The mean follow-up was 20 months. Bone union was achieved in 8/9 cases with a mean time of 8.1 months and a mean healing index of 0.58 month/cm. Only the patient with persistent humeral nonunion had a poor DASH-score. The mean LEFS was 68

La plaque en distraction interne, ou spanning plate, fait partie des options thérapeutiques pour la prise en charge des fractures du radius distal. Les indications sont variées et incluent : les fractures complexes, les fractures-luxations, les patients polytraumatisés, les fractures avec impaction-séparation chez le sujet âgé, ainsi que les fractures sur os ostéoporotique ou avec perte de substance osseuse. Le principe repose sur une arthrodèse temporaire radio-carpienne mini-invasive, permettant de maintenir la réduction de la fracture (par taxis) en décomprimant l’articulation radio-carpienne et avec un effet de plaque console postérieur. En dépit du temps prolongé d’arthrodèse temporaire, les résultats rapportés dans la littérature sont satisfaisants, pour des fractures souvent complexes. Comme toute intervention chirurgicale, chaque étape de la prise en charge peut aggraver la situation clinique. Dès lors, comment compromettre la pose du matériel ? et comment entraîner un mauvais résultat fonctionnel pour le patient ? Nous rapportons dans cette communication notre expérience dans l’utilisation de la plaque en distraction interne pour les fractures du radius distal. Un total de 23 patients pour 24 poignets a été opéré de novembre 2023 à avril 2025 dans notre service. Il est possible de compromettre la situation :– “avant l’opération” : on n’a pas pris le temps de comprendre la situation ; on n’explique pas les suites postopératoires parce qu’on ne les connaît pas,– “pendant l’opération” : ON incise n’importe où ; On coupe la branche nerveuse sensitive du nerf radial ; on veut mettre la plaque de proximal en distal ; on fixe la plaque en proximal en premier car il y a plus de place ; on met la plaque dans la fracture ; on est jusqu’au-boutiste du mini-invasif parce que c’est la technique et on met la plaque sur les tendons ; on distracte comme un fou, car plus c’est mieux ; on oublie de réduire à minima ; on se met en pronation à fond car on est mieux pour opérer ; on ne fixe par les lésions ulnaires (instables) car on sait que ça ne sert à rien,– “après l”opération” : on enlève la plaque au plus vite car on a peur de trop enraidir le poignet, et de toute façon une fracture du radius ça consolide en 6 semaines ; On oublie de prescrire la rééducation immédiate.La plaque en distraction interne est un outil utile et qui comporte un certain nombre de trucs & astuces pour éviter d’aggraver la situation.

The reconstruction of large bone defects remains challenging for orthopedic surgeons. Autologous bone grafts (ABGs) are the gold standard treatment for limited size defects, but larger bone defects (> 5 cm) require the use of more sophisticated techniques, such as the Masquelet technique. Over the last three decades, the Masquelet or induced membrane technique (IMT) has become increasingly popular as it does not require high-precision microsurgery skills and the time taken to achieve bone consolidation is independent of the length of the defect. IMT is a two-stage procedure. In the first stage, a polymethylmethacrylate (PMMA) cement spacer is implanted into the bone lesion and a physiological immune reaction initiates the formation of a fibrotic induced membrane (IM) with both angiogenic and osteogenic properties. The second stage, performed several weeks later, involves removal of the spacer followed by the implantation of a standard ABG in the preserved IM cavity for subsequent bone repair. In this extensive review, we explain how the success of this surgical procedure can be attributed to the synergy of four key components: the inducer (the PMMA cement), the recipient (the IM), the effector (the bone graft) and the modulator (the mechanical environment). Conversely, we then explain how each key component can contribute to the failure of such treatment. Finally, we discuss existing or emerging innovative and biotechnology-oriented strategies for optimizing surgical outcome with respect to the four components of IMT described above.

Background:. The objective of this study was to evaluate the outcomes of neurotization of the musculocutaneous nerve (MCN) using intercostal nerves (ICNs) to restore elbow flexion in patients with complete brachial plexus paralysis (CBPP). We assessed quality of life through patient-reported outcome measures and examined the impact on respiratory function. Methods:. This retrospective study included 17 patients with CBPP who underwent ICN transfer to the MCN. The median follow-up was 3.5 years. Outcome measures included elbow flexion strength (British Medical Research Council grading), quality of life (Quick Disabilities of the Arm, Shoulder, and Hand and Short Form-36), and respiratory function. Patient-reported outcome measures were evaluated using the Overall Subjective Self-Assessment score. Results:. The median age at the time of injury was 24 years (interquartile range: 19–28 y). Seven (41%) patients achieved elbow flexion strength of M3 or higher. The median active elbow flexion was 120 degrees in patients with strength of M3 or higher, compared with 25 degrees in those with strength less than M3 (P < 0.001). The median Quick Disabilities of the Arm, Shoulder, and Hand score was 68 for patients with strength of M3 or higher and 84 for those with strength less than M3 (P = 0.04). The Short Form-36 score showed a median of 58 for patients with strength of M3 or higher and 47.5 for those with strength less than M3 (P = 0.14). No significant changes in respiratory function were observed. Conclusions:. Neurotization of the MCN with ICN in patients with CBPP can restore functional elbow flexion and improve quality of life without adversely affecting respiratory function. Although improvements remain modest, the restored elbow flexion significantly enhances upper limb function, supporting its continued use as a viable treatment option in the management of CBPP.

PURPOSE:Axillary nerve neurotization using a motor branch of the triceps brachii has become a therapeutic option in the management of deltoid paralysis. The purpose of this study was to report the medium to long-term outcomes of this procedure. MATERIAL AND METHODS:Twenty patients with a median age of 31 years (interquartile range - IQR, 29-53) were included in a single-operator retrospective study. A clinical evaluation was conducted, including the assessment of deltoid muscle strength using the British Medical Research Council grading system and a dynamometer with comparisons made between preoperative and postoperative outcomes. RESULTS:The median follow-up period was 6 years (IQR, 5-11). At last follow-up, the median active abduction was 160° (IQR 60-160), and 85% of patients recovered at least M3 abduction force. No donor site deficits were identified. DISCUSSION:The medium to long-term outcomes of the neurotization of a triceps brachii motor branch on the axillary nerve are comparable to the short-term outcomes. LEVEL OF EVIDENCE:IV.

To report the radiological outcomes and complications of the Masquelet induced membrane technique (IMT) for acute bone reconstruction in complex hand injuries. We retrospectively reviewed 22 patients treated primarily by the IMT for bone defect of the phalanx and/or metacarpals bones in 26 injured digits. The median bone defect length was 17 mm (IQR 13–25). Given the severity and variability of the lesions, revision parameters focused on bone healing and postoperative complications. At the median follow-up of nine months (IQR, 6–14 months), bone union was achieved in 25 digits (96

Introduction La prise en charge des fractures ouvertes de jambe a largement bénéficié du développement de l’approche ortho-plastique. En dépit des avancées dans les solutions de reconstruction des parties molles, le recours aux lambeaux pédiculés simples, réalisés par les chirurgiens orthopédistes, reste d’actualité. Hypothèse Dans le cadre de la reconstruction ortho-plastique des fractures de jambe, la réalisation de lambeaux pédiculés par le chirurgien orthopédiste permet d’optimiser la stratégie de couverture. Matériel et méthodes Une étude rétrospective a été menée chez 63 patients traités pour une fracture ouverte de jambe nécessitant une reconstruction de l’enveloppe cutanée entre le 1er juillet 2012 et le 1er juillet 2021. Deux groupes ont été distingués : le groupe 1 incluait les patients opérés avant le 1er juillet 2018 lorsque les lambeaux étaient effectués par les chirurgiens plasticiens exclusivement ; le groupe 2 incluait les patients opérés après le 1er juillet 2018 lorsque les lambeaux étaient effectués par des chirurgiens plasticiens ou des orthopédistes. Les données démographiques, lésionnelles, le type des lambeaux effectués, ainsi que leur taux d’échec à 1 mois ont été analysés. Les délais de couverture des fractures ouvertes, de cicatrisation de l’enveloppe cutanée et d’accès à une ostéosynthèse interne secondaire ont été calculés puis comparés entre les groupes. Résultats Dans le groupe 1, 28/45 (62 %) des patients ont été traités par des lambeaux de couverture, dont 30/31 (97 %) ont été réalisés par les plasticiens. Le ratio lambeaux libres/lambeaux pédiculés était de 16/15 dans ce groupe. Dans le groupe 2, 18/18 (100 %) des patients ont été traités par des lambeaux de couverture, dont 18/20 (90 %) ont été réalisés par les orthopédistes. Le ratio lambeaux libres/lambeaux pédiculés était de 2/18 dans ce groupe. Le délai médian de couverture a été réduit par quatre dans le groupe 2 en passant de 28jours à 7jours (p<0,05). Les délais de cicatrisation ont été diminués. Le taux d’échec des lambeaux n’était pas différent entre les groupes. Conclusion Lorsque la lésion le permet, l’utilisation de lambeaux pédiculés par le chirurgien orthopédiste semble permettre de réduire le délai de couverture des fractures ouvertes de jambe, et donc d’optimiser la stratégie de reconstruction ortho-plastique. Leur formation à ces techniques de reconstruction simples, fiables et reproductibles paraît ainsi recommandée. Niveau de preuve IV.

INTRODUCTION:Targeted muscle reinnervation (TMR) is a technique that has proven effective for the treatment and prevention of chronic pain following amputation, though its adoption remains limited. The authors report on their initial experience using TMR. METHODS:A prospective study was conducted in a military trauma center involving traumatic amputees treated with either curative or preemptive TMR. Their outcomes were compared to those of control patients who underwent neuroma burial or simple neurectomy during primary amputation. Data included a numerical rating scale (NRS) and patient-reported outcomes measurement information System (PROMIS) scores evaluating residual limb pain (RLP) and phantom limb pain (PLP). RESULTS:Eighteen patients with a median age of 45.5 years were included and followed up for a median period of 13 months. The curative TMR group consisted of 8 patients whose results were compared to those of 9 control patients. There was a significant reduction in almost all pain scores with TMR and only in RPL NRS scores with neuroma burial. Reduction in RLP and PLP scores was significantly greater with TMR. The preemptive TMR group included 10 patients whose results were compared to those of 18 control patients. No significant difference was observed in the postoperative evolution of RLP or PLP. CONCLUSION:These results confirm the benefits of TMR for the curative treatment of RLP and PLP. However, within the limits of this small sample size, preemptive TMR did not show added value. TMR appears to be a complex technique that requires a learning curve.