Treatment of scaphotrapezial trapezoidal osteoarthritis with resection of the distal pole of the scaphoid

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Adaptive Proximal Scaphoid Implant stability despite a perilunate dislocation: a case report

We present the case of a 22 y.o. male patient suffering from scaphoid non-union with avascular necrosis of the proximal pole and initial degenerative arthritis

Transcapho perilunate dislocation with palmar extrusion of the scaphoid proximal pole

Perilunate fracture-dislocations usually combine ligament ruptures, bone avulsions, and fractures in different patterns. Rarely a displaced fracture of the scaphoid can coexist with a scapho-lunate dissociation and can result in enucleation of the proximal pole. We report about a case of trans-scaphoid perilunate dislocation with palmar extrusion/enucleation of the scaphoid proximal pole, treated with scaphoid fracture open reduction and internal fixation with screw, scapho-lunate ligament repair with an anchor and vascularization of the scaphoid proximal pole with the 2nd intermetacarpal artery. At 52 months follow up we had good clinical and radiographic results. In conclusion, scientific literature including our experience about this rare complex lesion of the wrist is too weak to support an effective strategy of management but we think that the careful analysis of the single problems can be the key to solve the complexity. Goal of the treatment should be complete revascularization and healing of the scaphoid, avoiding non union and avascular necrosis; simultaneously a proper ligament reconstruction is fundamental to re-establish carpal stability. Prevention of carpal collapse for a SNAC o SLAC situation is essential to reach a good level of Quality of Life and satisfaction of the patient

Bone-ligament-bone Cuenod grafting technique modified by Saffar-Romano for the treatment of chronic scapho-lunate dissociation

The authors show their experience about six patients suffering of chronic scapho-lunate (S-L) dissociation treated with the Cuenod method modified by Saffar-Romano

Distal radius fracture plating: predictive factors influencing clinical outcome

BACKGROUND: Distal Radius Fractures (DRFs) are common and volar-locking-plating popular. We aimed to evaluate the disability after DRFs plating and its correlation with fracture-pattern and postoperative displacement. METHODS: Adult patients operated with locking-volar-plate for DRF between 01-01-2009 and 31-12-2019 were retro- spectively evaluated by Q-DASH and PRWHE questionnaires and by radiographs. Fracture displacement at X-ray was detected between surgery and 30-days-after. RESULTS: Mean follow-up was 57-months. Mean age 57\ub113 years (19-80). 91/133(62%) were women. 75/133(56.4%) of DRFs were extra-articular-AO-23-A, 39(29.3%) partial-articular-AO-B and 19(14.3%) complete-intra-articular-AOC. Seventeen (13%) DRFs displaced after surgery: 12%(N.=9/75) A; 15%(N.=6/39) B; 21%(N.=4/19) C. 11/95(12%) below-65-years, 6/38(16%) above-65. Mean-Quick-DASH-score was 16.07\ub118.9; 12.9\ub116.4 type A, 19.69\ub120.05 B, 21.18\ub124.3 C; 12.74\ub116.6 A65 years, 18.25\ub118.2 B65 years, 19.35\ub124.8 C65 years. Mean-PRWHE-score was 15.06\ub117.4; 16\ub16 (0-70) women, 14.61\ub116.70 (0-69) men; 12.38\ub114.9 type A, 17.10\ub119.02 B, 21.45\ub121.7 C; 11.95\ub114.50 A65 years, 16.07\ub117.14 B65 years, 23.68\ub122.87 C65 years. CONCLUSIONS: Our case series demonstrates a good clinical outcome, worse in elderly and in AO type B fractures than in type C. Volar-locking-plate risks to mechanically fail in 1/10 wrist, 1/5 of intra-articular fractures, mostly in elderly. From AO 1-to-3 the clinical-outcome tends to worsen, and this can depend on the number of fracture fragments and grade of instability independently from the articular involvement. Severity of disability after wrist plating may depend on age, quality-of-bone, fracture-pattern and postoperative displacement. Other predictive factors of clinical outcome can reside in the associated capsulo-ligamentous and/or tendon lesions, in the time of surgical exposure, in the delayed surgery, and in the surgical aggressiveness. Even if clinical and radiographic outcome is not always fully satisfactory despite volar-lockingplating, its goal was to optimize the clinical outcome compared to other synthesis devices or the conservative treatments

Osteoid Osteoma of the Hand: Surgical Treatment versus CT-Guided Percutaneous Radiofrequency Thermal Ablation

(1) Background: Osteoid osteoma (OO) is one of the most common benign bone tumors. This type of osteogenic tumor is generally characterized by a well-defined lytic area with a vascularized central nidus surrounded by sclerosis and bone thickening. The wrist and hand bones are infrequent sites for osteoid osteoma: only 10% of the cases arise in these areas. Standard treatments are surgical excision and radio-frequency ablation (RFA), both with advantages and disadvantages. This study aimed to compare the two techniques to prove if RFA could be a potential alternative to surgery in the treatment of OO of the hand. (2) Methods: Patients treated for OO of the hand between January 2011 and December 2020 were evaluated and data was collected regarding the lesions’ characteristics and the treatment outcome. Each patient was followed up for 24 months and VAS pain (Visual Analogue Scale), DASH (Disability of the Arm, Shoulder and Hand), and PRWE (Patient-Related Wrist Evaluation) scores were collected. (3) Results: A total of 27 patients were included in the study: 19 surgical and 8 RFA. Both treatments showed a significant improvement in pain and functionality. Surgery was associated with a higher complication rate (stiffness and pain), while RFA was associated with a higher recurrence rate (2/8 patients). RFA allowed for a speedier return to work. (4) Conclusions: We believe that osteoid osteoma treatment with RFA in the hand should be an available alternative to surgery as it allows rapid pain relief and a swift return to work. Surgery should be reserved for cases of diagnostic uncertainty or periosteal localization

Oncoplastic and reconstructive surgery in SENONETWORK Italian breast centers: lights and shadows

: • Despite the significance of oncoplastic procedure, an italian database is lacking. • Senonetwork established a multidisciplinary survey to assess their safety and efficacy. • Reconstructive outcomes were positive across low and high-volume centers. • After mastectomy, implant-based techniques are common. DTI reconstruction is advantageuos. • This contributes to the global understanding of effective strategies against breast cancer