Carpal Tunnel Syndrome Associated with Bifid Median Nerve and Palmaris Profundus - Case Report and Literature Review

The anatomic variations of the median nerve and of the muscles of the wrist have been widely reported in literature. It is essential for the surgeon to be familiar with these variations in order to avoid accidental injury to the nerve during surgery. We report a rare case of bifid median nerve accompanied by an anomalous tendon of palmaris profundus discovered during the surgical release of carpal tunnel. The transverse carpal ligament was dissected and the anomalous tendon was left in situ because any direct compression over the median nerve was noticed intraoperatively. The patient was evaluated one year postoperatively clinically and radiologically (with MRI). At the follow up the resolution of symptoms was complete and the sleep disturbance was solved. The patient achieved a postoperative QuickDASH score of 9.1 and a Michigan Hand Questionnaire outcome score of 90 points

Dual mobility total hip arthroplasty in the treatment of femoral neck fractures: A retrospective evaluation at mid-term follow-up

Background and aim of the work: Partial or total hip replacement is the method of choice for displaced femoral neck fractures (FNF) treatment. Dislocation is a major complication, accounting for about 3.8% of cases for hemiarthroplasty (HA) and 10% for total hip arthroplasty (THA). Dual-mobility (DM) socket in total hip arthroplasty showed a very low rate of dislocation in both primary and revision setting THA. Some literature reports show good results with low dislocation rates also in FNF treatment at short term follow-up. Aim of the study was to evaluate clinical and radiographic results of DM-THA in FNF treatment at mid-term follow up. Methods: Study population counted 31 implants in 30 patients treated with DM-THA for FNF between January 2010 and December 2012. Dislocation rate was identified, and HHS and OHS were completed. Twenty-four patients underwent also radiographic evaluation to assess cup integration and sings of loosening. Results: No episodes of hip dislocation nor intraprosthetic dislocation were found. Other postoperative complications were recorded in 9,67%. HHS and OHS showed a mean value of 81,22 and 37,37, respectively. There were no cases of clinical and radiographic signs of implant loosening. Conclusions: The present study confirms the good clinical results, low complications and very low dislocation rate with DM THA for FNF treatment

Unemployment Dynamics of the ’Mezzogiornos of Europe’: Lessons for the Mezzogiorno of Italy

The unemployment dynamics in the Mezzogiorno of Italy seem to corroborate the New Economic Geography predictions, whereby, under some specific hypotheses, a stronger economic integration can amplify the regional polarisation of unemployment rates in Europe. It is, however, unclear which features characterize the South of Italy compared to other Peripheral areas in the Union. To answer this question, this work investigates the Core/Periphery pattern in the European Union and carries out a comparative analysis of unemployment rates of the different ‘Mezzogiornos of Europe’. Finally, some policy prescriptions are proposed to reduce unemployment in the South of Italy

Proposal of a New Dynamic Distraction Device to Treat Complex Periarticular Fractures of the Metacarpophalangeal Joint of Long Finger

Complex periarticular fractures of the metacarpophalangeal joint (MCPJ) are often challenging to treat. Conservative and operative treatments are often burdened with stiffness, loss of function, and poor clinical outcome. These phenomena could be a direct consequence of long period of immobilization. To promote a short time of immobilization and a quick return to daily activities, it is mandatory to stabilize the fracture maintaining the active range of motion (AROM) of the ray. A simple solution is to reduce the fragments by means of dynamic ligamentotaxis. The authors propose a new dynamic distraction device (DDD) for the MCPJ. METHODS: The DDD for the MCPJ was made of Kirschner wires bent and connected to counteract dislocation forces and to allow mobilization of the joint. The DDD was tested on a cadaver model under a simulated load in physiological conditions, and also in metacarpal and proximal phalanx (P1) fracture patterns. The effectiveness of the device was evaluated under fluoroscopy. RESULTS: The data showed that DDD is able to achieve fracture reduction through ligamentotaxis and primary fragments stability and to avoid secondary dislocation during AROM of complex periarticular fractures of the MCPJ. CONCLUSIONS: The frame could be an alternative option to treat periarticular fractures of the MCPJ. The DDD implant has several advantages: It is time efficient because assembly and application take only few minutes. Furthermore, it is very versatile; indeed, it can be used in all metacarpal and phalanx bones, even in the central rays