Laumonerie, Pierre

AimsThe primary aim of this study was to define the standard minimum follow-up required to produce a reliable estimate of the rate of re-operation after radial head arthroplasty (RHA). The secondary objective was to define the leading reasons for re-operation.Materials and MethodsFour electronic databases, between January 2000 and March 2017 were searched. Articles reporting reasons for re-operation (Group I) and results (Group II) after RHA were included. In Group I, a meta-analysis was performed to obtain the standard minimum follow-up, the mean time to re-operation and the reason for failure. In Group II, the minimum follow-up for each study was compared with the standard minimum follow-up.ResultsA total of 40 studies were analysed: three were Group I and included 80 implants and 37 were Group II and included 1192 implants. In Group I, the mean time to re-operation was 1.37 years (0 to 11.25), the standard minimum follow-up was 3.25 years; painful loosening was the main indication for re-operation. In Group II, 33 Group II articles (89.2%) reported a minimum follow-up of < 3.25 years.ConclusionThe literature does not provide a reliable estimate of the rate of re-operation after RHA. The reproducibility of results would be improved by using a minimum follow-up of three years combined with a consensus of the definition of the reasons for failure after RHA. Cite this article: Bone Joint J 2017;99-B:1561–70.

Background In 2014, Delclaux et al described a case wherein the Battiston and Lanzetta's technique, modified by utilization of the posterior interosseus nerve (PIN), was used to perform double neurotization of the ulnar nerve (UN). This study evaluates the feasibility of transfer of proprioceptive fascicles of the PIN to the superficial sensory branch of the UN (SSBUN). Methods The surgeries were performed on 16 fresh cadaveric wrist specimens. PIN transfer was performed through the interosseous membrane and sutured to the SSBUN. The diameter for each nerve, number of fascicles, and the percentage of fascicles without axons, under ×10, ×40, and ×100 magnifications were performed by two observers. Results Neurotization of the SSBUN by the PIN was successful in all cases. The median diameter of the SSBUN and PIN was 3.5 (3–4) and 2.3 mm (1.6–3), respectively. The SSBUN contained 5.5 fascicles (4–7), while the PIN contained 2 fascicles (0–4). The 16 PIN had limited (10 cases) or no axonal reserve (6 cases). Conclusion This study supports the surgical and anatomical feasibility of neurotization of the SSBUN by the PIN. However, the PIN's limited axonal reserve may partially or totally compromise recovery.

OBJECTIVE Nerve biopsy is useful in the management of neuromuscular disorders and is commonly performed in distal, noncritical cutaneous nerves. In general, these procedures are diagnostic in only 20%–50%. In selected cases in which preoperative evaluation points toward a more localized process, targeted biopsy would likely improve diagnostic yield. The authors report their experience with targeted fascicular biopsy of the brachial plexus and provide a description of the operative technique. METHODS All cases of targeted biopsy of the brachial plexus biopsy performed between 2003 and 2015 were reviewed. Targeted nerve biopsy was performed using a supraclavicular, infraclavicular, or proximal medial arm approach. Demographic data and clinical presentation as well as the details of the procedure, adverse events (temporary or permanent), and final pathological findings were recorded. RESULTS Brachial plexus biopsy was performed in 74 patients (47 women and 27 men). The patients' mean age was 57.7 years. All patients had abnormal findings on physical examination, electrodiagnostic studies, and MRI. The overall diagnostic yield of biopsy was 74.3% (n = 55). The most common diagnoses included inflammatory demyelination (19), breast carcinoma (17), neurolymphomatosis (8), and perineurioma (7). There was a 19% complication rate; most of the complications were minor or transient, but 4 patients (5.4%) had increased numbness and 3 (4.0%) had additional weakness following biopsy. CONCLUSIONS Targeted fascicular biopsy of the brachial plexus is an effective diagnostic procedure, and in highly selected cases should be considered as the initial procedure over nontargeted, distal cutaneous nerve biopsy. Using MRI to guide the location of a fascicular biopsy, the authors found this technique to produce a higher diagnostic yield than historical norms as well as providing justification for definitive treatment.