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Acciaro AL, Gravina D, Pantaleoni F, Cataldo G, Adani R. Retrospective study of Ishiguro's technique for mallet bone finger in children: long-term follow-up and analysis of predictors in outcomes. INTERNATIONAL ORTHOPAEDICS 2024; 48:1501-1506. [PMID: 38561523 DOI: 10.1007/s00264-024-06162-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE There is no consensus on the optimal treatment of bony mallet finger in the paediatric population due to a lack of studies in children. The Ishiguro technique is simple and less invasive, and treatment with K-wire fixation seems to provide better results for extension lag in bony mallet finger according to the literature. A retrospective cross-sectional study with long-term follow-up was performed to evaluate the functional and clinical outcomes of this method in children. Preoperative and intraoperative predictors of outcome were investigated. METHODS From June to December 2022, we evaluated 95 children who underwent extension K-wire block from 2002 to 2012. Eighty-four children were included (mean age 14.8 ± 1.68 years) for a mean long-term follow-up of 11.6 ± 2.3 (8-16) years. Clinical and radiographic features were assessed. Pain and functional outcomes were assessed using Crawford criteria, range of motion (ROM) at the distal interphalangeal joint (DIPJ), loss of extension, and VAS scale. Univariate and multivariate regressions were used to assess which variables might predict the worst outcomes at long-term follow-up. RESULTS Bone union and pain relief were always achieved. There were no complaints of potential growth impairment or nail deformity. 82.1% of patients showed excellent and good results. Fifteen patients had fair results. CONCLUSIONS Although there are currently no significant differences between surgery and orthosis in adults, the Ishiguro technique is more effective in children when it comes to outcomes in the treatment of mallet fingers. A high percentage of excellent and good results were achieved, and no epiphyseal damage or nail deformity was reported. A strong and significant correlation was found between the worst outcomes and either delayed treatment time or excessive flexion angle.
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Affiliation(s)
- Andrea Leti Acciaro
- Department of Hand Surgery and Microsurgery, AOU Policlinico Di Modena, Modena, Italy
| | - Davide Gravina
- Department of Hand Surgery and Microsurgery, AOU Policlinico Di Modena, Modena, Italy.
- Department of Orthopaedic and Traumatology, University of Modena and Reggio Emilia, AOU Policlinico Di Modena, Modena, Italy.
| | - Filippo Pantaleoni
- Department of Hand Surgery and Microsurgery, AOU Policlinico Di Modena, Modena, Italy
| | - Giacomo Cataldo
- Department of Orthopaedic and Traumatology, University of Modena and Reggio Emilia, AOU Policlinico Di Modena, Modena, Italy
| | - Roberto Adani
- Department of Hand Surgery and Microsurgery, AOU Policlinico Di Modena, Modena, Italy
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Leti Acciaro A, Lana D, Fagetti A, Cherubino M, Adani R. Plate fixation in challenging traumatic carpal scaphoid lesions. Musculoskelet Surg 2022; 106:179-185. [PMID: 33393002 DOI: 10.1007/s12306-020-00689-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Complex fractures of the carpal scaphoid with poles fragmentation, edges comminution, bone loss and non-union of fractures previously treated by screw fixation remain challenging for hand surgeons. The authors present the indications, advantages and results of scaphoid plating, underlining the importance of correct plate positioning well shaped onto the bone. MATERIALS AND METHODS The study includes 11 patients presenting acute fracture with distal pole fragmentation, acute fracture with comminution and non-union after prior failure of screw fixation. All patients were treated with volar locked plate fixation, adding a cortical bone graft in cases of non-union. RESULTS Bone consolidation was achieved in all cases; excellent outcomes in fracture healing and relevant improvement in symptoms and functions were obtained in non-union group that are consistent with the literature. Only one patient underwent early further surgery (first row carpectomy) with poor results. CONCLUSION The treatment of the selected scaphoid lesions with volar locked plate is a surely efficient technique. The plate can be easily adjusted to the shape of the scaphoid and can achieve an adequate correction of bone deformity and high degree of stability both in non-union and fractures.
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Affiliation(s)
- A Leti Acciaro
- C.S. of Hand Surgery and Microsurgery, AOU Policlinico of Modena, Largo del Pozzo 71, 41125, Modena, Italy
| | - D Lana
- C.S. of Hand Surgery and Microsurgery, AOU Policlinico of Modena, Largo del Pozzo 71, 41125, Modena, Italy.
| | - A Fagetti
- SSD of Hand Surgery and Microsurgery, ASST Settelaghi, Varese, Italy
| | - M Cherubino
- SSD of Hand Surgery and Microsurgery, ASST Settelaghi, Varese, Italy
| | - R Adani
- C.S. of Hand Surgery and Microsurgery, AOU Policlinico of Modena, Largo del Pozzo 71, 41125, Modena, Italy
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Brand P, Cejas CP, Rivero AD. Childhood focal compressive mononeuropathies during the COVID-19 pandemic in Buenos Aires, Argentina. Muscle Nerve 2022; 65:590-593. [PMID: 35083751 PMCID: PMC9015344 DOI: 10.1002/mus.27507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 11/20/2022]
Abstract
Introduction/Aims Focal peripheral neuropathies are infrequently seen in pediatric patients. The COVID‐19 pandemic has disrupted normal life for many people, including complete lockdowns and school closing for long periods of time in many countries, which prompted children to stay at home. Our aim is to assess whether there has been an increased incidence of focal compressive peripheral neuropathies in the pediatric population during COVID‐19–associated lockdown. Methods Clinical, electrophysiological, and imaging characteristics were reviewed for patients referred to the electrodiagnostic (EDx) laboratory with suspicion of a focal neuropathy. The incidence of focal compressive peripheral neuropathies seen during the period of March to September 2020 was compared with the same time period in 2019. Results An increased incidence of focal neuropathies was seen in 2020 (31%) compared with 2019 (6.8%). During 2020, 7 fibular (peroneal) mononeuropathies and 2 ulnar neuropathies were diagnosed. Most patients with focal neuropathies were underweight and acknowledged prolonged screen time periods. Electrophysiological findings consisted of mostly demyelinating lesions with an overall good clinical outcome. Discussion In this study we raise awareness about a possible increased incidence of focal compressive peripheral neuropathies in children during COVID‐19–associated lockdown, which may be prevented with changing positions during sedentary activities.
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Leti Acciaro A, Garagnani L, Lando M, Cataldo G, Adani R. Retrospective study of radial dome osteotomy with volar plate fixation versus K-wires in Madelung's deformity: long-term follow-up. INTERNATIONAL ORTHOPAEDICS 2021; 46:281-289. [PMID: 34850246 DOI: 10.1007/s00264-021-05266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The emerging role of the locking plate improved the technique also in corrective osteotomies in Madelung's deformity, but there is a lack of analyses between the fixation techniques, as well as little information in functional outcomes and long-term follow-up. The current study compared the outcomes, pitfalls, and advantages of volar plate and screws fixation versus K-wires fixation in a long-term follow-up. METHODS Twenty-eight children presenting the "distal radius" variant of Madelung's deformity underwent Vickers ligament release and distal radial dome osteotomy between 2009 and 2015. Twenty-three children (20 females and 3 males, mean age 15 years and 7 months at surgery and 24 years and 8 moths at follow-up), with 26 operatively treated wrists, were available for follow-up. A retrospective two-cohort study, evaluating clinically and radiologically results, has been conducted with a mean eight years and seven months follow-up. RESULTS Bone union and pain relief were obtained in all cases, as well as improvements in wrist motion and radiographic indices. A statistically significant correlation was identified between the volar plate fixation and an improved lunate subsidence on X-ray, and a trend towards an improved DASH score in the cohort with plate and screws, as well as significant improvement in wrist extension and supination always in the plate fixation cohort. CONCLUSIONS The long-term follow-up enabled the patients to report on more definitive outcomes in terms of functional and cosmetic improvements. Volar plate fixation is an effective technique allowing for simple post-operative management and earlier rehabilitation program with improved clinical and radiographic outcomes.
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Affiliation(s)
- Andrea Leti Acciaro
- Department of Hand Surgery and Microsurgery, AOU Policlinico, L.go del Pozzo, 71, 41124, Modena, Italy.
| | - Lorenzo Garagnani
- Hand Unit/Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mario Lando
- Department of Hand Surgery and Microsurgery, AOU Policlinico, L.go del Pozzo, 71, 41124, Modena, Italy
| | - Giacomo Cataldo
- Department of Orthopaedic and Traumatology, University of Modena and Reggio Emilia, AOU Policlinico, Modena, Italy
| | - Roberto Adani
- Department of Hand Surgery and Microsurgery, AOU Policlinico, L.go del Pozzo, 71, 41124, Modena, Italy
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Rüsch CT, Knirsch U, Weber DM, Rohrbach M, Eichenberger A, Lütschg J, Weber K, Broser PJ, Stettner GM. Etiology of Carpal Tunnel Syndrome in a Large Cohort of Children. CHILDREN (BASEL, SWITZERLAND) 2021; 8:624. [PMID: 34438514 PMCID: PMC8392332 DOI: 10.3390/children8080624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/17/2021] [Accepted: 07/21/2021] [Indexed: 01/22/2023]
Abstract
(1) Background: Carpal tunnel syndrome (CTS), a compressive mononeuropathy of the median nerve at the wrist, is rare in childhood and occurs most frequently due to secondary causes. (2) Methods: Medical history, electrodiagnostic findings, and imaging data of patients with CTS from two pediatric neuromuscular centers were analyzed retrospectively. The etiology of CTS was investigated and compared with the literature. (3) Results: We report on a cohort of 38 CTS patients (n = 22 females, n = 29 bilateral, mean age at diagnosis 9.8 years). Electrodiagnostic studies of all patients revealed slowing of the antidromic sensory or orthodromic mixed nerve conduction velocities across the carpal tunnel or lack of the sensory nerve action potential and/or prolonged distal motor latencies. Median nerve ultrasound was diagnostic for CTS and confirmed tumorous and vascular malformations. Etiology was secondary in most patients (n = 29; 76%), and mucopolysaccharidosis was the most frequent underlying condition (n = 14; 37%). Idiopathic CTS was rare in this pediatric cohort (n = 9; 24%). (4) Conclusion: Since CTS in childhood is predominantly caused by an underlying disorder, a thorough evaluation and search for a causative condition is recommended in this age group.
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Affiliation(s)
- Christina T. Rüsch
- Neuromuscular Center Zurich and Department of Pediatric Neurology, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (C.T.R.); (U.K.)
- Division of Pediatric Neurology, Children’s Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland; (J.L.); (P.J.B.)
| | - Ursula Knirsch
- Neuromuscular Center Zurich and Department of Pediatric Neurology, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (C.T.R.); (U.K.)
| | - Daniel M. Weber
- Division of Hand Surgery, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland;
| | - Marianne Rohrbach
- Division of Metabolism, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland;
| | - André Eichenberger
- Division of Radiology, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland;
| | - Jürg Lütschg
- Division of Pediatric Neurology, Children’s Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland; (J.L.); (P.J.B.)
| | - Kirsten Weber
- Division of Hand Surgery, Children’s Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland;
| | - Philip J. Broser
- Division of Pediatric Neurology, Children’s Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland; (J.L.); (P.J.B.)
| | - Georg M. Stettner
- Neuromuscular Center Zurich and Department of Pediatric Neurology, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (C.T.R.); (U.K.)
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Leti Acciaro A, Ramponi L, Adani R. Outpatient paediatric hand surgery: strategy in healthcare implementation and cost-efficient manner. Musculoskelet Surg 2021; 106:449-455. [PMID: 34292504 DOI: 10.1007/s12306-021-00723-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022]
Abstract
The increasingly cost of health care is a relevant problem as well as prolonged waiting time for admission also in emergencies. Effective cost containment measures and expenditure controls are needed to achieve and maintain clinical and organizational appropriateness. Outpatient management has proven to be the most useful method for lower-cost treatment in less severe pathologies, requiring surgery without hospitalization. The current study provided to evaluate how this model was successfully applied also to the paediatric population in hand surgery. Methods. A retrospective cohort study of 645 patients from 8 to 18 years (mean age 14.9) was performed in children treated in outpatient setting from 2015 to 2019. The direct costs were evaluated as well as the mean waiting time for surgery, comparing the data with the previous five-year period. The mean reduction in waiting time for children emergencies was 57% (from 72 to 31 h) due to the Outpatient setting into a dedicated Day-Surgery Service organizational model. The visual graphed data showed a general clear growing trend towards outpatient surgery in adults and children. The overall effect was a 29.2% of reduction in spending between expected and achieved costs, recovering resources toward the increasing technology and innovation expenditures. Outpatient paediatric hand surgery was an effective and attractive option which leaded to decreased individual and social costs, with increased clinical and organizational appropriateness. Thus, reduced delay in treatment and provided benefits for children and familiars.
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Affiliation(s)
- Andrea Leti Acciaro
- Hand Surgery and Microsurgery Department, AOU Policlinico of Modena, L.Go del Pozzo, 71, 41124, Modena, Italy.
| | - Laura Ramponi
- Research Hospital Rizzoli Orthopedic Institute: Clinic of Orthopedic and Traumatology 1, Bologna, Italy
| | - Roberto Adani
- Hand Surgery and Microsurgery Department, AOU Policlinico of Modena, L.Go del Pozzo, 71, 41124, Modena, Italy
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Leti Acciaro A, Lando M, Starnoni M, Giuca G, Adani R. Piezoelectric Bone Surgery. Overview in Applications and Proof of Feasibility in Hand and Plastic Surgery. Indian J Orthop 2021; 56:66-72. [PMID: 35070144 PMCID: PMC8748595 DOI: 10.1007/s43465-021-00454-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/02/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Piezoelectric bone surgery was already extensively used in a number of surgical procedures ranging from dental to maxillofacial surgery. The authors aimed to determine whether piezosurgery was suitable and advantageous for performing osteotomies in Hand and Plastic reconstructive surgery. METHODS The authors overviewed a variety of applications for Piezosurgery® Device, from Mectron, in bone reconstructive surgery with over the last 8 years. An overall number of 156 bone cutting procedures in adults and children was described at the phalanges, metacarpal bones and distal radius level, as well as in bone graft harvesting and bone remodeling following carpal scaphoid nonunion, scapho-lunate bone-ligament-bone reconstruction and fibula free flap in maxillofacial defects. RESULTS The consolidation rate was 87.5% in scaphoid nonunion grafting and fixation. Bone healing was achieved in all other cases. No intra-operative complications were recorded. CONCLUSION Piezosurgery® allowed high precision in bone cutting as well as custom-made graft and surface roughness were obtained, while preserving nerves, vessels and tendons integrity. The instrument may be handling moved into the surgical space in absence of vibrations, with a clear view onto the bone. The mechanical and biological characteristics of the piezoelectrical effect perfected this technique as an effective and useful instrument in Hand and Plastic surgery. The selective bone cutting properties avoided injuries to the surrounding soft tissues and thermal damage of the bony cells. Best advantages were described in feasibility and flexibility for intra-articular osteotomies, custom-made grafts and reconstructive microsurgical techniques.
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Affiliation(s)
- Andrea Leti Acciaro
- Hand Surgery and Microsurgery Department, AOU Policlinico of Modena, L.Go del Pozzo, 71, 41124 Modena, Italy
| | - Mario Lando
- Hand Surgery and Microsurgery Department, AOU Policlinico of Modena, L.Go del Pozzo, 71, 41124 Modena, Italy
| | - Marta Starnoni
- Clinic of Plastic and Reconstructive Surgery, AOU Policlinico of Modena, Modena, Italy
| | - Giuliano Giuca
- Hand Surgery and Microsurgery Department, AOU Policlinico of Modena, L.Go del Pozzo, 71, 41124 Modena, Italy
| | - Roberto Adani
- Hand Surgery and Microsurgery Department, AOU Policlinico of Modena, L.Go del Pozzo, 71, 41124 Modena, Italy
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Andre E, Hamel A, Perrot P, Duteille F. [Median nerve compression in the carpal tunnel in children - a delayed diagnosis. About 20 clinical cases]. ANN CHIR PLAST ESTH 2021; 66:298-304. [PMID: 34144846 DOI: 10.1016/j.anplas.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/04/2021] [Accepted: 04/11/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The carpal tunnel syndrome is rare in children. We performed a retrospective study of 10 children. The aim is to show that the diagnosis of carpal tunnel syndrome is difficult in children. PATIENTS AND METHODS We identified all children with median nerve compression in the carpal tunnel between 2010 at 2020, managed in our service. RESULTS Ten children with 20 hands included. There was different etiologies of carpal tunnel syndrome: 5 lysosomal storage diseases, 4 idiopathic carpal tunnel syndrome, 1 genodermatose, 1 Byler syndrome and 1 VACTERL syndrome. Common presenting symptoms were pain (five patients) and under use of fingers (five patients). Two children had opposition deficit of the thumb. We operated 19 hands. Median age at diagnosis was 4 years and 7 months. One children or 2 hands had a reanimation of opposition by tendinous transfer of flexor digitorum superficialis tendon of the ring finger. All children had a complete regression of the painful symptoms, a use improvement of fingers and recovery of the opposition of the thumb. CONCLUSION The diagnosis of carpal tunnel syndrome is difficult in children. It is common to be confronted with an advanced clinical symptoms. The atypical symptoms may cause diagnostic delay. Due to the quality of the clinical results obtained, we recommend open carpal tunnel release even when the diagnosis seems delayed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- E Andre
- Service de chirurgie orthopédique pédiatrique, CHU de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France.
| | - A Hamel
- Service de chirurgie orthopédique pédiatrique, CHU de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France
| | - P Perrot
- Service de chirurgie plastique et reconstructrice, Centre des Brûlés, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - F Duteille
- Service de chirurgie plastique et reconstructrice, Centre des Brûlés, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
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Leti Acciaro A, Garagnani L, Lando M, Lana D, Sartini S, Adani R. Modified dome osteotomy and anterior locking plate fixation for distal radius variant of Madelung deformity: a retrospective study. J Plast Surg Hand Surg 2021; 56:121-126. [PMID: 34106811 DOI: 10.1080/2000656x.2021.1934845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Dome osteotomy of the distal radius with Vickers ligament release is an established method of treatment for Madelung deformity. Many different surgical procedures have been proposed in literature but techniques, patient inclusion and efficacy evaluations are heterogeneous. MATERIALS AND METHODS A retrospective review of children affected by 'distal radius' Madelung deformity and treated with a standardized surgical procedure (modified reverse dome osteotomy of the distal radius and volar fixation with a small locking plate) between 2010 and 2018 at a single center was performed. The technique used in this study, reversing the shape of the classical dome osteotomy, allowed for an improved three-planar correction of the distal radial epiphysis and volar plate fixation allowed for an increased stability and reduced soft tissue morbidity. A structured follow-up including a prompt post-operative rehabilitation program (without wrist immobilization) was established. Pain relief, functional outcome and cosmetic appearance were assessed with a structured clinical assessment, DASH Score and radiographic assessment, accordingly. RESULTS A total of 15 wrists in 13 children (12 females, mean age of 15.6 years, range 11-19) were included. The mean follow-up time was 3.8 years. Bone union and pain relief were obtained in all cases. Improvement in the range of motion was detected in extension, supination and flexion of the wrist. Radial inclination was increased by 15.3° and lunate subsidence by 4.1 mm. CONCLUSIONS The use of volar fixation with a small locking plate and immediate post-operative rehabilitation for reverse dome osteotomy of the distal radius in pediatric patients affected by 'distal radius' Madelung's deformity is stable and effective.
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Affiliation(s)
- Andrea Leti Acciaro
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Lorenzo Garagnani
- Hand Unit/Department of Orthopedics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mario Lando
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Debora Lana
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Silvana Sartini
- Hand Rehabilitation Unit, University Hospital of Modena, Modena, Italy
| | - Roberto Adani
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
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Starnoni M, Benanti E, Acciaro AL, De Santis G. Upper limb traumatic injuries: A concise overview of reconstructive options. Ann Med Surg (Lond) 2021; 66:102418. [PMID: 34141410 PMCID: PMC8188247 DOI: 10.1016/j.amsu.2021.102418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/17/2021] [Indexed: 12/02/2022] Open
Abstract
Different options for upper limb reconstruction are described in literature: advancement or rotation flaps, regional flaps and free flaps are the most common. Local and regional flaps can represent the reconstructive options for small defects while large wounds require the use of free flaps or distant pedicled flaps. In case of large wound, the use of free flaps rather than distant pedicle flaps is usually preferred. To choose the best reconstructive option, it is essential for the surgeon to have a general overview about the different methods. In this review the Authors will refer to the most commonly used methods to cover soft tissues injuries affecting the dorsum and the palm of the hand and the forearm (excluding fingers). The aim is to show all flap reconstructive options so as to support the inexperienced surgeon during the management of traumatic injuries of the upper limb. Reconstruction of traumatic injuries of the upper limbs can be challenging. Small defects can be covered by local and regional flaps while large wounds need the use of free or distant pedicled flaps. The literature shows different opinions whether to use pedicled flaps (regional or distant) or free flaps. Dermal substitutes can be considered in patients who are not suitable for flaps reconstruction. Patient related factors and surgical background can significantly interfere with the surgical reconstructive solution.
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Affiliation(s)
- Marta Starnoni
- Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Benanti
- Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy
| | - Andrea Leti Acciaro
- Department of Orthopaedics and Traumatology, Division of Hand Surgery and Microsurgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy
| | - Giorgio De Santis
- Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy
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Outcomes of Pediatric and Adolescent Carpal Tunnel Release. J Hand Surg Am 2021; 46:178-186. [PMID: 33139118 DOI: 10.1016/j.jhsa.2020.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 07/10/2020] [Accepted: 09/22/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate carpal tunnel syndrome (CTS) presentation and long-term outcomes of carpal tunnel release (CTR) in children and adolescents. METHODS All pediatric and adolescent patients who underwent CTR between February 2003 and June 2018 were identified. Patients were grouped by etiology: lysosomal storage disease (11 hands), idiopathic (6 hands), acute traumatic (7 hands), delayed traumatic (5 hands) and tumorous (2 hands). Medical records were reviewed for presenting symptoms and preoperative treatments. Final outcomes were assessed via phone interviews, chart review, the Boston Carpal Tunnel Questionnaire (BCTQ), and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. RESULTS All 25 patients (31 hands) identified were included in the study; median age at surgery was 12.7 years (range, 2.5-23.3 years). Eighteen patients completed surveys at a median of 4.7 years after surgery (range, 8 months-16 years). Common presenting symptoms in lysosomal storage disease were numbness/tingling (7 hands); pain was only reported in 1 hand. The most frequent indication for acute traumatic CTR (7 hands) was palmar hand swelling at the carpal tunnel (4 hands). Delayed traumatic and idiopathic CTS most often presented with numbness/tingling (4 hands and 6 hands, respectively) and pain (3 hands, 4 hands, respectively). Of the original 4 lysosomal storage disease surgeries included in long-term follow-up, all experienced gradual recurrence of symptoms after years of relief (range, 3-14 years). Two patients underwent revision CTR and were symptom-free at follow-up. All patients with acute traumatic and tumorous etiologies had full resolution of symptoms. Delayed traumatic and idiopathic etiologies frequently experienced recurrent or recalcitrant symptoms (4 of 5 and 3 of 6 surgeries, respectively). CONCLUSIONS Carpal tunnel release often alleviates symptoms in children with lysosomal storage disease for years to decades. Carpal tunnel release successfully relieves symptoms in acute traumatic cases, but is not always sufficient to relieve symptoms associated with delayed traumatic etiologies. Approximately half of patients with idiopathic CTS experience recalcitrant or recurrent symptoms. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Leti Acciaro A, Montanari S, Venturelli M, Starnoni M, Adani R. Retrospective study in clinical governance and financing system impacts of the COVID-19 pandemic in the hand surgery and microsurgery HUB center. Musculoskelet Surg 2021; 106:291-296. [PMID: 33528801 PMCID: PMC7851813 DOI: 10.1007/s12306-021-00700-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/22/2021] [Indexed: 12/16/2022]
Abstract
Introduction The authors presented a retrospective study in the surgical activity of the HUB center for Hand Surgery and Microsurgery in Emilia-Romagna comparing the data between March and April 2020, in the peak of Covid pandemic, with the same period in 2019. Materials and methods During the two months period of March–April 2020 versus 2019 the authors analyzed the surgical procedures performed in elective and emergency surgery with hospitalization and Day or Outpatient surgery regime. Surgical treatments with no hospitalization were planned in the Day-Surgery Service. The financing system impacts were analyzed according to the Diagnosis Related Groups (DRG), the costs accounting method mostly used in European countries. Results An overall reduction of 68.5% was recorded in surgical procedures, with a more relevant reduction of 92.3% in elective surgery and a significantly less relevant reduction of 37.2% in urgent one. Replantation did not present a reduction in number of cases, while cutting lesions of tendons at the hand and fingers increased such as the bone and ligament injuries during domestic accidents. The negative impact in the financial system recorded a reduction of 32.5%. Discussion The epidemiology of hand trauma looks not only at the artisanal and industrial injuries, but also mostly at the accidents in daily life activities. The data of the study evidenced the significantly increase in the injuries occurring in the domestic environment. Elective surgery was canceled. The 86% of surgical procedures performed were urgent ones and the 72.8% of these were possible in Day and Outpatient surgery with significantly reduction in hospitalization. All procedures followed a rigid process for patient and healthcare workers with regard for personal protection and safety. Telemedicine was arranged in emergencies, and economic damage was analyzed also in the following rebound effect during summer period. Conclusions The significantly less reduction recorded in urgent surgery vs the more relevant reduction in elective one showed how the hand injuries remained a major issue also during the lockdown. The data highlighted the relevant role of the organizational aspects of the surgical procedures and planning in hand trauma. Despite the financial impact of the elective surgery, the presence of a functional and skill Emergency Service and Day-Surgery Service resulted fundamental in the efficacy and efficiency of the patient management and in containment of economic damage. The telemedicine was significantly limited by liability and risk management issues.
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Affiliation(s)
- A Leti Acciaro
- Department of Hand Surgery and Microsurgery, Azienda Ospedaliero Universitaria Modena, Largo del Pozzo, 71, 41125, Modena, Italy.
| | - S Montanari
- Department of Hand Surgery and Microsurgery, Azienda Ospedaliero Universitaria Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - M Venturelli
- Department of Hand Surgery and Microsurgery, Azienda Ospedaliero Universitaria Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - M Starnoni
- Department of Plastic Surgery, Azienda Ospedaliero Universitaria Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - R Adani
- Department of Hand Surgery and Microsurgery, Azienda Ospedaliero Universitaria Modena, Largo del Pozzo, 71, 41125, Modena, Italy
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