INTRODUCTION:Digital mucous cysts (DMCs) are common benign lesions of the distal interphalangeal joint that may cause pain, nail deformity or aesthetic dissatisfaction. Surgical treatment consists of cyst excision with local flap coverage to achieve satisfactory soft-tissue reconstruction. However, limited data are available comparing the aesthetic outcomes between flap techniques. METHODS:We conducted a retrospective study of patients who underwent surgical treatment for a DMC at our University Hospital between January 2019 and July 2024, with a minimum follow-up of 1 year. Two local flap techniques were used for skin coverage: the biquadrangular flap and the Hueston flap. Aesthetic outcomes were assessed using the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcomes included nail dystrophy, cyst recurrence, joint stiffness and postoperative infection. RESULTS:Fifty patients were included: 27 treated with a biquadrangular flap and 23 with a Hueston flap. No statistically significant differences were observed between the two groups in patient or observer POSAS scores. Likewise, there were no significant differences regarding secondary outcomes, including nail dystrophy, recurrence, joint stiffness or infection. CONCLUSION:Both biquadrangular and Hueston flaps yield comparable aesthetic satisfaction and clinical outcomes after surgical excision of digital mucous cysts. Flap selection does not appear to influence scar quality or postoperative complications and may therefore be guided by surgeon preference, anatomical considerations and patient expectations.

A distal posterior interosseous nerve (DPIN) neuroma related to prior surgery of the wrist can lead to disabling chronic pain. Ultrasound may represent a useful diagnostic tool due to its high resolution and ability to detect iatrogenic neuromas along small nerves of the limbs. However, the utility of ultrasound in the evaluation of both the normal sonographic appearance of the DPIN and traumatic neuromas is limited. We present a series of two patients who suffered from chronic dorsal wrist postoperative pain, where ultrasound detected histologically confirmed DPIN neuromas. After DPIN resection, the pain of our two patients completely disappeared without any functional deficit.

We used an artificial intelligence-based model to estimate finger range of movement from video recordings. The mean bias was 11° (standard deviation 34°), with an interclass correlation coefficient of 0.95, indicating high reproducibility.

OBJECTIVES:The primary objective of this study was to evaluate the return to previous work activities following surgery for lateral epicondylitis recognized as an occupational disease. The secondary objectives were to assess the relationship between preoperative and postoperative periods of work stoppage, and to determine the influence of different factors on the ability to return to previous activity. MATERIAL AND METHOD:The demographic, occupational and medical data of 49 patients were analyzed retrospectively with a mean follow-up period of 45.6 months. RESULTS:At last follow-up, 26.5% of patients had returned to their previous activity. Preoperative and postoperative time off work were correlated (R = 0.331; p = 0.0323). Preoperative time off work of less than 12 months was significantly associated with a better ability to return to previous work (p = 0.017). Postoperative time off work and return to previous activity were significantly related (OR = 0.65; p = 0.012). The length of preoperative time off work appears to be an important factor to take into account in the context of occupational disease. The duration of postoperative time off work was consistent with French literature, but highlights significant international variability. CONCLUSION:A quarter of patients who undergo surgery in a professional context return to their previous activity. Close collaboration among various stakeholders appears essential throughout the patient's care pathway. LEVEL OF EVIDENCE:IV. Retrospective study.

La rééducation après réparation d’une rupture de tendons fléchisseurs relève le défi de maintenir l’équilibre précaire entre cicatrisation tendineuse, enraidissement et rerupture. Les amplitudes articulaires sont un critère de suivi indispensable au cours de la rééducation. Le goniomètre est actuellement le gold standard parmi les outils du rééducateur mais souffre d’une variabilité inter opérateur et de défauts de positionnement. L’objectif principal de cette étude est d’évaluer les performances de la mesure de la flexion des doigts à partir d’un enregistrement vidéo.Nous avons développé un module d’acquisition vidéo (FlexRUMM) à partir de l’application RUMM fonctionnant sur des acquisitions photographiques. Une webcam nous a permis de réaliser les acquisitions vidéo. La technologie de Hand Tracking de Google Mediapipe a été utilisée pour estimer la position des mains dans l’espace. La flexion des articulations a été calculée géométriquement.La précision de l’application était déterminée en comparant la flexion estimée à celle mesurée par un goniomètre, et la reproductibilité à partir de la répétition des acquisitions. La flexion maximale des doigts était limitée par le port de 3 attelles thermoformées chez 10 volontaires sains.Au total, 2400 articulations ont été analysées.Pour la précision, le biais moyen était de 11 degrés (SD 27). Pour la répétabilité, l’indice de corrélation intraclasse ICC était de 0,95 (IC95 [0,94 ; 0,96]).Il existe une légère surestimation de la flexion avec un biais moyen de 11 degrés.Parmi les différentes articulations observées en flexion, il existe : une surestimation des IPP et une sous-estimation des MCP, qui nous permettront de calibrer l’outil avant étude clinique. Enfin, nous avons rapporté une plus grande dispersion des résultats en occlusion maximale ce qui nous paraît attendu compte tenu des difficultés de visualisation de la profondeur de champs et des articulations masquées par l’occlusion des doigts.L’outil FlexRUMM reste un outil d’une excellente reproductibilité pour l’estimation des amplitudes polyarticulaires.L’application FlexRUMM pourrait permettre de monitorer la progression clinique à l’aide d’un enregistrement vidéo, particulièrement dans le cadre de la supervision du protocole MAPP par le patient lui-même ou par le rééducateur, autorisant également un enregistrement au cours de téléconsultations.

Although goniometric measurement is considered the gold standard for the measurement of digital range of motion, visual estimation is often employed due to its simplicity despite being inconsistent with recommended guidelines. We evaluated the Rennes Universal Measurement Method, an innovative tool employing artificial intelligence to concurrently analyse hand joint angles based on a single photograph. We found a strong correlation between the goniometric method and the photograph-based approach (Spearman correlation coefficient 0.7). The mean standard error of measurement was −1° (SD 17°). Regarding reproducibility with different photographic angles, an excellent intraclass correlation coefficient of 0.9 was noted. The tool had a processing time of less than 0.1 s per hand, while traditional goniometric methods took 20–30 s per finger. Combining simplicity, high reproducibility and good inter-rater reliability, this is a potentially useful tool that can be used to monitor patient progress in place of traditional goniometry.

Objectives: The Tactys (R) prosthesis is an anatomical unconstrained sliding implant with 4 modular components, designed for proximal interphalangeal arthroplasty. The main objective of our study was to evaluate medium-term functional outcomes at a minimum follow-up of 1 year.Materials and methods: Forty-eight implants were studied, with a mean follow-up of 4.8 years. The study retrospectively analyzed functional, clinical and radiological results. Complications and re-interventions were also analyzed.Results: Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient-Rated Wrist Evaluation (PRWE) scores improved from 40.9 to 17.7 and from 47. 1 to 11 .2, respectively (p < 0.001) at last follow-up. Seventy-seven percent of patients rated their results as good or very good, and 83% were willing to undergo the procedure again. Pain on VAS improved significantly from 7.9 to 0.8/10 (p < 0.001). There was no significant difference in range of motion (53 degrees vs 48 degrees), grip strength (14.9 kgF vs 14.6 kgF), or pinch strength (3.4 kgF vs 3.4 kgF). There were no cases of fracture or loosening of implants. Periarticular ossification without functional impairment was observed in 31 patients. Axial deviation was generally corrected. Three surgical re-interventions were required, including 2 implant revisions using a silicone spacer. Five-year implant survival was 94%.Conclusion: The Tactys (R) prosthesis was a reliable and effective option for the management of proximal interphalangeal osteoarthritis. Patient satisfaction was generally good, with improvement in pain and function; however, longer-term follow-up is needed.

The Tactys® prosthesis is a total anatomical sliding, unconstrained implant with 4 modular components, designed for proximal interphalangeal arthroplasties. The main objective of our study was to evaluate the medium-term functional outcome of the Tactys® prosthesis with a minimum follow-up of 12 months. Forty-eight implants were studied with a mean follow-up of 4.8 years. This study retrospectively analyzed its functional, clinical, and radiological results. Complications and reinterventions were sought and analyzed. QuickDASH and PRWE scores were improved from 40.9 to 17.7 and from 47.1 to 11.2, respectively (P < 0.001) at the last follow-up. Seventy-seven percent of patients rated their results as good or very good, and 83% were willing to undergo the procedure again. The VAS was significantly improved from 7.9 to 0.8 (P < 0.001). There was no significant difference in range of motion (53° vs. 48°), grip strength (14.9 KgF vs. 14.6 KgF), or pinch strength (3.4 KgF vs. 3.4 KgF). There were no fractures or loosening of the implant. Periarticular ossifications were observed in 31 cases without functional impairment. Axial deviation was generally corrected. Three surgical reinterventions were required, including two implant revisions with a silicone spacer. The 5-year survival rate of the implants was 94%. The results of this study are globally similar to those already observed in the literature, with the exception of mobility and strength, described as significantly improved postoperatively in the first published series. The Tactys® prosthesis is a reliable and effective option in the management of proximal interphalangeal arthrosis. Patient satisfaction is generally good and related to improved pain and function. Long-term follow-up would confirm the good survival of the prosthesis.

The management of the fractures of the fifth metacarpal neck is still debated between surgical, orthopedic, and functional treatments. The main objective of our study was to report the functional results at two, six, and twelve weeks of patients treated with syndactyly for fifteen days for a fracture of the neck of the fifth metacarpal and to determine if these results were compatible with a short-term medical follow-up and if they allowed for a quick return to work. Thirty-nine patients were retrospectively included. Functional results and their variations were analyzed at two, six, and twelve weeks using self-questionnaires filled out during consultation (VAS scores, QuickDASH, EuroQol-5D-5L, and EuroQol- 5D-VAS). The duration of work leave was extracted from medical records. Two weeks after the trauma, patients mostly had a very moderate impact of their fracture on their daily life with an average VAS of 4.2±1, QuickDASH of 42.2±20.9, and EuroQol-5D-VAS of 78±11. QuickDASH and EuroQol-5D-VAS scores showed significant improvement between two and twelve weeks of follow-up, decreasing from 42.2±20.9 to 2.1±6 and from 78±11 to 96±6, respectively (p<0.0001). The dimensions of common activities, pain, and autonomy had the most patients in the "moderate impairment" subgroup at two weeks. Only the dimension of common activities still had 21% of patients moderately impacted. Twenty-five patients returned to work at an average of 21.8±1.5 days. Syndactyly treatment offers good functional results at two weeks that are confirmed during follow-up, compatible with reduced medical follow-up and early return to work.

Parosteal osteosarcoma (PO) is a rare malignant tumor arising from the surface of the bone. Locations in the hand are even more exceptional. This low-grade osteosarcoma shows non-specific clinical and radiological presentation, making diagnosis challenging. Moreover, histologic examination is extremely difficult and can easily lead to misdiagnosis. We report the case of a 21-year-old woman who presented PO of the right thumb, initially diagnosed as a "benign exostosis" 9 years previously. En-bloc resection followed by reconstruction using a free corticocancellous iliac crest autograft provided good esthetic and functional outcome. No recurrence occurred at 2 years' follow-up. Our literature review confirmed the rarity of PO of the hand, with only 8 cases reported in the past 60 years. Amputation was the main treatment, but some authors reported limb-sparing surgery. The present result and those in the literature review support conservative surgery when feasible, with little recurrence and better functional and esthetic results. These rare tumors should not be misdiagnosed, and should be treated in specialized centers to optimize outcome.

We investigated the reliability of the 4Fusion® quadripodal memory staple in a consecutive series of 59 four-corner arthrodeses in a single centre. Forty-one patients (46 wrists) had a radiological and clinical assessment at a mean follow-up of 7.4 years. Thirteen patients (13 wrists) were lost to follow-up. Bone union was achieved in all but one patient. Seven patients were reoperated, six for device removal and one for nonunion. Most patients were satisfied, had a functional range of wrist mobility, good strength and were free of pain, comparable with the best previously reported series.Level of evidence: IV.

A locked metacarpophalangeal joint (LMCP) is a rare condition often confused with trigger finger. Its causes are numerous and typically divided into two broad categories: acquired LMCP in younger patients, and degenerative LMCP in older patients. This pathology usually affects only one MCP. Even though several external reduction techniques have been described, the main risk of non-surgical reduction treatment is recurrence. Thus, its management is most often surgical. We report the case of a 60-year-old woman with 3 simultaneous LMCP (3rd, 4th, and 5th rays of the left hand) due to degenerative metacarpal heads. Surgical treatment was performed and found that locking was due to entrapment of the radial collateral ligament on metacarpal head osteophytes. Full extension was regained at the end of the surgery. The follow-up was uneventful, no recurrence occurred. This case highlights the need for careful examination to prevent medical and surgical wandering for a rare but well-described and easy to treat condition.

Ambulatory surgery has grown to be the most common procedure in developed countries. Efficient quality of care and safety often require calling patient at day one after outpatient surgery to check patient’s recovery and search for complications. This increasing flow in same day surgery centres motivates the use of automatic systems to contact patients. The overall objective of this study was to evaluate automated software sending text messages (TM) to patients at day 1 after ambulatory surgery compared to classical phone calls. This prospective study took place in Rennes Teaching Hospital, France, from June 1st, 2015 to December 15th, 2016. All patients owning a mobile phone were included, adults and children by means of their parents. The primary end point was the rate of successfully contacted patients, compared to usual phone calls in 2014. In cases of no response or an abnormal response, an automatic alert was sent to the ambulatory unit. Within the 7246 patients included, response rate to TM was significantly higher than response to phone calls in 2014 (87% vs 57%, respectively p < 0.0001). Most patients (85%) responded in less than 60 min. The TM algorithm detected 36% alerts (12% for lack of response to TM and 24% for TM’s content). The total of reached patients’ rate with TM and then phone call after an alert was 90%. Post ambulatory discharge follow-up using automated TM was successfully and easily experienced as more patients were contacted.

OBJECTIVES:Subcutaneous neuromas usually result from trauma and may lead to dissatisfaction in patients with a trigger point, loss of sensitivity in the relevant territory of innervation, and spontaneous neuropathic pain. Confirming clinically suspected cases of neuroma may prove difficult. The objective of this study was to evaluate the visibility and morphologic features of traumatic subcutaneous neuromas of the limbs with ultrasound (US).METHODS:Between January 2012 and August 2016, 38 consecutive patients clinically suspected of having subcutaneous neuromas were investigated with US. The diagnosis was confirmed on the basis of a focal morphologic abnormality of the nerve associated with trigger pain. Each neuroma was classified into 1 of 3 subtypes based on its injury pattern. The subtypes were terminal neuroma, spindle neuroma, and scar encasement, either isolated or associated with these subtypes.RESULTS:Forty-four lesions were found in the 38 patients, including 29 spindle neuromas (65.9%), 14 terminal neuromas (31.8%) and 1 scar encasement with no nerve caliber abnormality (2.3%). Fifteen neuromas (35% of all neuromas) were associated with scar encasement. In 13 cases that required surgery, the diagnosis of neuroma or scar encasement could be surgically proven and confirmed the validity of the US findings.CONCLUSIONS:Ultrasound can be used to show and classify subcutaneous nerves of the upper and lower limbs with high accuracy. The US trigger sign provides an indication of neuroma involvement in pain. This modality can play a substantial role both in the preoperative planning of neuroma surgery and in therapeutic US-guided procedures.

Lesion to subcutaneous nerves is a well-known risk of orthopedic surgery and a significant cause of postoperative pain and dissatisfaction in patients. High-resolution ultrasound can be used to visualize the vast majority of small subcutaneous nerves of the upper and lower limbs. Ultrasound detects nerve abnormalities such as focal hypoechoic thickening, stump neuroma, and scar encasement, and provides information not only about the peripheral nerve itself but also about its relationship to adjacent anatomical structures. The purpose of this review is to provide an overview of the anatomy of the main subcutaneous nerves damaged during orthopedic surgery, recall at-risk procedures, and offer useful anatomic landmarks to help the sonographer identify and follow the nerves when an iatrogenic lesion is suspected.

La rhizarthrose est fréquente chez la femme ménopausée. La littérature est abondante concernant les traitements chirurgicaux. Nous évaluons la trapézectomie avec ligamentoplastie-suspension selon la technique de Kleinman chez l'homme où la demande fonctionnelle sous des contraintes mécaniques importantes doit être assimilée. Le retentissement fonctionnel comparatif au côté controlatéral et à un groupe de femmes est analysé. Il s'agit d'une étude unicentrique, rétrospective, comparative entre deux groupes (20 hommes – 20 femmes) avec un âge moyen de 61,4 ans et un recul moyen de 4 ans. L'évaluation clinique répertorie la douleur, la force, les mobilités, l'indice de Kapandji et le QuickDASH. Les critères radiographiques sont la hauteur trapézienne (HT), l'index trapézien (IT), l'ascension et la subluxation du premier métacarpien (M1), en préopératoire, à 6 semaines et à la revue. Quatre-vingt-quinze pour cent des hommes étaient asymptomatiques. Les mobilités du pouce étaient améliorées sans hyperextension métacarpo-phalangienne. La force de grip était restaurée (31,3 kg), le pinch amélioré de 94,4 % (6,6 contre 7,3 kg du côté sain). Comparativement aux femmes, le retour aux activités était meilleur (85 % contre 75 %) et plus rapide (16,4 semaines contre 18,3). Soixante pour cent des hommes ont repris au même niveau. Le QuickDASH était significativement meilleur chez l'homme (13,8 contre 27,8) ainsi que le grip (31,3 kg contre 16,7 kg) et le pinch (6,6 kg contre 3,4 kg). L'indice de Kapandji était meilleur chez la femme mais non significatif (8,4 contre 9,2). La HT diminuait de 5 mm, était significativement meilleure chez l'homme à 6 semaines (9,2 mm contre 7,1 mm) puis redevenait comparable à la revue. L'ascension de M1 était de 11 mm pour les 2 groupes mais la subluxation était significativement plus importante chez l'homme (9,1 mm contre 6,2 mm). La perte de HT par recul de M1 est inévitable mais sans retentissement fonctionnel significatif. Indolence, force et mobilités sont rétablis. Les travailleurs manuels lourds exercent leurs activités même si le retour à l'état antérieur n'est pas systématique. Cette discordance radioclinique est en accord avec la littérature. Il n'a pas été prouvé que la force était meilleure avec l'arthrodèse considérée comme l'intervention de choix dans cette population mais non dénuée de complications. Les prothèses TM, malgré une récupération plus rapide, ne sont pas recommandées du fait des contraintes auxquelles elles seraient exposées. Cette intervention trouve sa place chez l'homme récupérant mieux et plus rapidement que la femme.

Le doigt a ressaut est une pathologie frequente traitee de facon efficace par une ouverture de poulie A1, associee a une resection de bandelette ulnaire du flechisseur commun superficiel (FDS) en cas de flessum persistant. Cependant, devant la forte demande fonctionnelle du patient, le delai de recuperation semble encore important. L’objectif de cette etude est d’evaluer une nouvelle technique chirurgicale par resection isolee de la bandelette ulnaire du flechisseur commun superficiel. Nous avons realise une etude de cohorte retrospective unicentrique, comparant 2 groupes de patients presentant un doigt a ressaut — l’un ayant beneficie d’une intervention par ouverture de poulie A1 isolee (Groupe 1), l’autre une resection de bandelette ulnaire du FDS isolee (Groupe 2). Chaque patient etait systematiquement revu a j8 postoperatoire. Le recueil des donnees a ete realise par un questionnaire telephonique. De janvier 2015 a fevrier 2018 inclus, nous avons inclus 61 patients, a un delai moyen de 16 semaines, sans aucun perdu de vue. Le groupe 1 etait compose de 45 patients et le groupe 2, de 16. Les deux groupes presentaient des caracteristiques comparables en termes de sexe et d’âge. Les doigts les plus atteints etaient le majeur et l’annulaire. A j8, 2 patients du groupe 1 presentaient des douleurs contre 1 dans le groupe 2. La totalite des patients du groupe 2 ont oublie la pathologie de leur doigt contre seulement 64 % dans le groupe 1. Il y avait plus de patients presentant une douleur residuelle dans le groupe 1 (40 % dans le groupe 1 contre 13 % dans le groupe 2). Parmi les patients, 100 % declarent presenter un enroulement complet et 94 % une extension complete avec possibilite de placer la main a plat sur une table. Alors que le groupe 1 declare 73 % d’enroulement complet et 69 % d’extension complete. La difference principale entre les 2 groupes etait le delai de recuperation avec un delai de 3,7 semaines en moyenne dans le groupe 2 contre 11 semaines dans le groupe 1. Nous deplorons dans le groupe 1, 4 patients pour qui l’etat anterieur etait plus acceptable. La technique de resection de bandelette ulnaire du FDS semble etre une technique avantageuse en termes de recuperation postoperatoire. Bien que plus consequente en temps operatoire, cette technique reproductible semble etre efficace. Il serait interessant d’evaluer cette technique a tous les stades de doigts a ressaut.

Nous rapportons le cas d’une tumeur vasculaire de localisation atypique à la main. Les examens morphologiques et les constatations peropératoires sont discutés. La patiente de 16 ans a été victime d’un accident de sport (handball). Le mécanisme lésionnel était un choc direct sur le talon de la main droite au décours d’une chute. Après un intervalle libre de 2 ans, un syndrome de masse du 3e espace intermétacarpien était responsable d’un déficit moteur partiel de l’appareil fléchisseur du majeur et de l’annulaire et un inconfort sans douleur du talon de la main. Aucune paresthésie par compression extrinsèque n’était retrouvée. L’examen morphologique a conclu au diagnostic erroné de tumeur à cellules géantes. L’examen macroscopique peropératoire retrouvait des thromboses veineuses redressant le diagnostic et orientait vers une tumeur vasculaire. La malformation était localisée dans le 3e espace disposée longitudinalement sur 25 × 10 × 10 mm « alimentée » en distal par une anastomose artérielle avec l’arcade vasculaire profonde. L’analyse anatomopathologique retrouvait un collet proximal veineux. Aucune récidive clinique n’était constatée au dernier recul. Les malformations vasculaires à la main sont classées au 4e rang des tumeurs les plus fréquentes. Même s’il doit être recherché à l’examen clinique un syndrome du marteau hypothénar est responsable de faux anévrysmes de l’artère ulnaire. Des cas de malformations artério-veineuses post-traumatiques, bien que rares, ont été rapportés dans la littérature. Une exploration par écho-Doppler controlatéral n’a pas permis de retrouver d’anomalie congénitale ou de variation anatomique vasculaire sur une artère médiane persistante. Le nerf médian était unifide de façon bilatérale sans pathologie canalaire. Un angio-IRM ou une imagerie thermographique sont les examens de choix dans le bilan préopératoire. Un traitement conservateur par embolisation peut être discuté avant d’envisager une chirurgie. L’imagerie préopératoire d’une MAV thrombosée peut être source d’erreur et ses rapports anatomiques doivent être rigoureusement analysés avec les arcades vasculaires de la main en excluant une variation anatomiques (artère médiane persistante).