[Treatment of extra-articular distal radius fractures in active elderly patients]

Extra-articular distal radius fractures in active elderly patients are common and predominantly affect females. The high number of patients lost to follow-up compromises the evaluation of outcomes. Treatment aims to control the comminution and allow fast recovery of pre-injury activity levels. Fixation with volar locking plates is the gold standard. The role of bone substitutes in this type of injury is unclear.

[Salmonella glenohumeral arthritis]

We report the first case of glenohumeral Salmonella arthritis in an immunocompetent 86-year-old woman. There was no entry point. An empirical antibiotherapy was started then adapted according to culture results. Given the persistence of symptoms, an arthroscopy was performed at 72 hours for a joint lavage and synovectomy. Postoperative course was good. Apyrexia was obtained by 72 hours and inflammatory syndrome was normalized in 12 days. The patient was reviewed regularly until the 3rd month. She has no clinical sequelae. Her osteoarthritis remained stable throughout follow-up.

[Volar dislocation of four ulnar metacarpals: one case report]

We report a case of volar dislocation of four ulnar carpometacarpals. It's a very rare injury, especially as it affects all long fingers, it is volar and has no fractures. The treatment consisted in open-reduction with pinning carpometacarpal according to intraoperative stability. No complications was noted. The follow-up was a radiological evaluation (pain, strength, mobility) between 6th week and 6th month. The recovery was complete at 6 months without pain. We believe that open reduction allows carpometacarpal osteosynthesis to be the less invasive as possible, depending on the stability visualized and thus can reduce stiffness and residual pain.

[New treatment of advanced Kienböck disease: replacement of lunate with costochondral autograft]

Treatment of advanced Kienböck's disease (Lichtmann IV) is commonly proximal row carpectomy or partial arthrodesis. The purpose of this study is to evaluate a more conservative treatment of advanced Kienböck's disease for young people: replacement of the lunate with a costochondral autograft. Between 2007 and 2009, four patients of mean age 40 years (32-51) were operated by two surgeons using this technique. This is a prospective study with a final follow-up by an independent operator. Mean follow-up was 27 months (6-36). Surgery is in two stages: excision of lunate and replacement with costochondral autograft taken from the ninth rib. Patients were evaluated with DASH and Cooney scores, pain, satisfaction, mobility and strength. Results show disappearance of pain at rest and during daily activities for all patients and a mean DASH of 6. Flexion-extension was 108° and grip strength 83% compared with the opposite side. Radiological evaluation showed no disease evolution. No complication was noted. Functional improvement was significant with good results compared to conventional techniques. Alternative techniques have been proposed for the replacement of the lunate, each with its specific problems. Lunate replacement by a costochondral graft is possible because studies showed vitality of this free graft up to five years. It also allows subsequent surgery. The absence of carpal collapse and good functional results are encouraging but the follow up is short. A long-term study is needed to confirm findings.

[Fractures of the distal radius in patients over 70 years old: Volar plates or K-wires?]

In a growing elderly osteoporotic population, the management of distal radius fractures remains without consensus as to volar distal plate versus K-wires. The goal of this retrospective study was to evaluate these treatments in elderly people. In a series of 38 patients over 70 years, 21 were treated by a volar plate and 17 by percutaneous K-wire fixation. Follow-up was at least 6 months. Results were analyzed using the disabilities of the arm, shoulder and hand (DASH), patient-rated wrist evaluation (PRWE) and Herzberg score by an independent operator. Radiological parameters were radio-ulnar variance, radial inclination and palmar or dorsal tilt. Radio-ulnar variance was better for the plate group (-0.7mm versus -0.1mm in K-wires). Mean functional outcomes were good but there were more satisfied patients in the plate group (67% versus 39% for the K-wire group). Secondary displacements were frequent in both groups but more with K-wires (50% versus 37% in case of plates). Six articles about surgical treatment of elderly radius distal fractures were published up to 2009 showing similar results. However, they analyze only global mean scores. Volar plates give more stability and a higher rate of satisfaction, with similar results of wrist mobility and grasp strength. The main advantage of the plates is earlier return to daily activities.

Effects of mechanical treatment of whole canola seeds on performance, diet digestibility and rumen parameters of lambs fed grass silage

Thirty-three lambs (25.2 ± 2.7 kg body weight) were used to determine if mechanical treatment of canola seed could improve the performance of growing lambs and diet digestibility. All lambs received a basal diet of 179 g d−1 of a 16% crude protein (CP) commercial concentrate and grass silage fed ad libitum. The basal diet was supplemented with the following dietary treatments (dry matter basis): C, a control supplement supplying 182 g of a mixture of 66% canola meal and 34% canola oil; WCS, 187 g of whole canola seeds; RCS, 188 g of rolled canola seeds; and GCS, 189 g of ground canola seeds. Dry matter intake was similar for all diets. Average daily gain (ADG) was 20% lower (P < 0.001) for lambs fed whole or crushed canola seeds than for those fed the C diet. Lambs fed GCS had intermediate ADG between those fed C and those fed WCS and RCS diets. In general, apparent digestibility of C was higher (P < 0.01) than that of WCS and RCS and digestibility of GCS was intermediate. Rumen pH and molar proportions of individual volatile fatty acids (VFA) were not affected by treatments. Rumen ammonia-N concentration was similar among treatments. Utilization of whole canola seeds as a protein and energy supplement to grass silage resulted in lower performance of lambs compared to that obtained with a mixture of canola meal and canola oil. Key words: Canola seeds, silage, lamb growth

Effects of mechanical treatment of whole canola seeds on carcass composition and blood lipids of lambs fed grass silage

Thirty-three lambs (25.2 ± 2.7 kg BW) were used to study if mechanical treatment of canola seeds can exert an effect on carcass quality, blood lipids, and fatty acid profile of depot fat. All lambs received a basal diet of 179 g d−1 of a 16% CP commercial concentrate and grass silage fed ad libitum. The basal diet was supplemented with the following dietary treatments (dry matter basis): C, a control supplement supplying 182 g of a mixture of 66% canola meal and 34% canola oil; WCS, 187 g of whole canola seeds; RCS, 188 g of rolled canola seeds; and GCS, 189 g of ground canola seeds. Dressing percentage was higher (P < 0.05) for diet C (45.6%) than for WCS (42.5%) and RCS (41.9%). The highest and lowest carcass grades were obtained with diets C and RCS, respectively (P < 0.05). Blood lipid concentrations increased as the lambs grew older (P < 0.01). Lambs fed the GCS diet had lower plasma concentrations of total cholesterol and high density lipoprotein cholesterol than lambs fed the WCS or RCS diets (P < 0.05). Kidney fat of lambs on the C diet contained more trans -C18:1 and less C18:0 compared with the other diets (P < 0.01). The utilization of untreated or rolled canola seeds as protein and fat supplements decreased carcass quality, increased blood triglycerides and changed fatty acid composition of depot fat. Key words: Canola seeds, lambs, carcass composition, blood lipid

Determination of blood flow in the finger using near-infrared spectroscopy

Wavelengths in the near-infrared range have much better penetrance in organic substances than visible light. We used near-infrared spectroscopy to determine non-invasively blood flow in the fingertip. We used laser Doppler technology to measure skin blood flow as a comparison procedure. We performed several manoeuvres to change blood flow. These included restriction of flow, thermal stimulation and post-occlusion hyperaemia. Near-infrared measurements had coefficients of variation of 10-15% at the various wavelengths, contrasting with variability of 30-40% with laser Doppler measurement. With restriction of blood flow, there was a downward shift in the absorbance curve. With thermal stimulation and with post-occlusion hyperaemia, there was a rise in the curve. The flow-induced shifts in the absorbance curve were particularly pronounced in the range of 850-970 nm. The correlation between absorbance values and laser Doppler-determined blood flow was also highest in this range, averaging about 0.69 (n = 625). Near-infrared spectroscopy can therefore be used to scan the fingertip. The absorbances obtained do reflect changes in blood flow. There is a correlation with skin blood flow, although near-infrared measurements are affected by blood flow in the full breadth of the finger, not just the skin. We can measure this blood flow with significant reproducibility. It may be possible to use near-infrared spectroscopy to measure the concentration of individual blood components.