PubMed · 14327294
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R KATAYAMA. 1965. [ARTIFICIAL JOINTS].. https://pubmed.ncbi.nlm.nih.gov/14327294/
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The most common cause of an arthritically damaged distal radioulnar joint is a malunion of a distal radius fracture. Therapeutically, ulnar head resection, hemiresection-interposition-technique, Kapandji-Sauvé procedure and implantation of an ulnar head prosthesis have been described. None of these procedures is able to restore the complete function of the joint. Therefore, anatomical reconstruction of the joint in acute or secondary correction osteotomy for malunited fractures of the distal radius should be performed to avoid the development of the arthrosis. Numerous clinical studies have demonstrated a similar reduction of the clinical symptoms for all procedures. Therefore, classification of the different procedures has to consider the number of complications. Biomechanically, partial resection of the distal ulna will destabilize the distal radioulnar context and clinically may lead to painful radioulnar and/or dorsopalmar instability of the distal ulnar stump. Biomechanically and clinically, this complication, next to secondary extensor tendon ruptures, has to be expected far more often following complete resection of the ulnar head than in the alternative procedures. We do not see any remaining indication for complete resection of the ulnar head. Clinical results and the occurrence of painful instability of the distal ulnar stump have been reported almost identically for the hemiresection-interposition technique and the Kapandji Sauvé procedure. Therefore, both procedures appear to be equally suitable for the treatment of painful arthrosis of the distal radioulnar joint. In patients with a preexisting instability of the distal radioulnar joint, or a major deformity of the radius or the ulna, we prefer to perform the hemiresection-interposition-technique. In these conditions we consider the remaining contact of the triangular fibrocartilage complex with the distal end of the ulna a biomechanical advantage to reduce the risk of secondary instability. Biomechanically as well as clinically, replacement of the ulnar head using a prosthesis has been shown to either avoid or solve the problem of instability. We therefore consider ulnar head replacement the treatment of choice in secondary painful instability following resection procedures at the distal end of the ulna. Primary ulnar head replacement should be considered in special indications until long-term follow-up results are available.
INTRODUCTION: To correct trapezium dysplasia we propose a new surgical technique. The operation consists of a double osteotomy of the trapezium and of the first metacarpal base, thereby harvesting the trapezo-metacarpal joint en-bloc. Vascularization is via the radial artery pedicle divided at the first web level. The articular block is then rotated 180 degrees on the longitudinal axis of the thumb. METHOD: An anatomic study was performed on six fresh cadaveric upper limbs. The radial artery was injected with colored latex, 5 cm above the wrist. The peri-articular vascular network was studied. The feasibility of harvesting and rotating the articular bloc after double osteotomy of the first metacarpal basis and the trapezium was also studied. RESULTS: In all the cases, the radial artery was present with branches supplying the peri-articular vascular network. After double osteotomy of the metacarpal base and of the trapezium, the articular bloc was harvested and rotated by 180 degrees. We describe the surgical technique. DISCUSSION AND CONCLUSION: The surgical technique has been confirmed with the first clinical cases. The double oblique osteotomy with rotation of the articular bloc corrects trapezium dysplasia and preserves first metacarpal abduction. This procedure appears to be a solution in cases of trapezium dysplasia associated with instability and early stage osteoarthritis.
When a metallic implant is in contact with human tissues, the organism reacts and a corrosion process starts. Consequently, we might observe liberation of metallic debris and wear. Our purpose is to measure the contamination and the migration of these metallic elements in the surrounding tissues of the implant. Two types of samples have been studied. First type is sample taken on post-mortem tissues around prostheses to study contamination gradients. Second type is sample taken on pathologic joints on periprosthetic capsular tissues in surgical conditions. These allow estimating contamination degree. The experiments were made on a Van de Graaff accelerator located at CERI (Centre d'Etude et de Recherche par Irradiation, Orléans, France). We measure elemental concentrations resulting from the contamination of the surface of each sample. Results are analysed in function of the pathology and the type of implants. According to the pathology and the location of the sampling, these measurements show a very heterogeneous contamination by metallic elements under particles and/or ionic species which can migrate through soft tissues by various mechanisms.