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The purpose of the present study was to determine clinical and radiographic outcomes in patients treated with limited-open retrograde intramedullary headless screw fixation for metacarpal neck and shaft fractures (group I) versus percutaneous antegrade and retrograde intramedullary double pinning linked by a connector (group II). We designed a retrospective comparative study, with the inclusion of two groups (20 patients each) of metacarpal unstable fractures. Both groups showed similar outcomes at the final follow-up, except for extension lag (significantly better in group II) and return to sport (significantly better in group I). Intramedullary screw fixation did not accelerate bone union and range of motion recovery in the early follow-up. In conclusion, limited-open retrograde intramedullary headless screw fixation and percutaneous connected antegrade and retrograde intramedullary double pinning are both reliable techniques of fixation for metacarpal neck and shaft fractures. LEVEL OF EVIDENCE: III.

Nonunion is a rare complication of metacarpal fractures and is usually associated with compound, open fractures with tissue loss and infection, or after failed surgical treatment. Repair by rigid osteosynthesis with plate and screws combined with autologous bone grafting has always been the treatment of choice for most patients. Such method allows early motion, although it has been proven that the presence of hardware may cause local soft tissue irritation. Often, hardware removal and tendon releases are necessary. We describe an original technique with a fixation method for the treatment of metacarpal nonunions, considering the excellent results attained with an intramedullary, headless screw for metacarpal fracture fixation. We report a series of three cases that evolved to bone healing with excellent clinical, functional, and radiographic outcomes.

Purpose Evaluate the Scratch Collapse Test in an objective way, by replacing the subjective evaluation made by the physician with an objective evaluation measure, made with a digital dynamometer. Methods Observational study carried out, in 90 patients divided into three groups of 30 patients, taking into account the electromyographic study of the median nerve in the carpal tunnel (no alteration, moderate, severe).The external rotation of the shoulder was measured in four different situations (no scratch, scratch over the carpal tunnel, scratch in the dorsum of the wrist and scratch in the shoulder). Results There were no statistical differences in the result of the strength in any of the four different situations in patients without carpal tunnel of with moderate carpal tunnel syndrome. However, there were statistical differences between the basal measurement (without scratching) and the measurement after tunnel scratching in patients with severe carpal tunnel syndrome. But this statistical difference was only 0.08 kg in the average measure, and this difference is clinically undetectable and far for producing a real collapse of the external rotation of the shoulder. Conclusion The Scratch Collapse Test is not a valid diagnostic exam for carpal tunnel syndrome if the strength is measured in an objective manner.

Our purpose was to review the clinical usefulness of the scratch collapse test (SCT) in the diagnosis of proximal entrapment of the median nerve in the forearm. Eighteen consecutive cases were reviewed. The diagnosis was based on the patient’s symptoms and signs. The SCT was positive in the affected forearm in all clinical assessments before surgery and it was negative in all after median nerve release. An anatomical reason for nerve compression was identified in all cases at operation. The SCT is a useful tool for the diagnosis of the proximal entrapment of the median nerve. Level of evidence: IV

Purpose To study the time to wound healing and recurrence rate achieved in the treatment of distal interphalangeal joint mucous cysts using the Zitelli modified bilobed flap. Methods We surgically treated 33 patients from January 2006 to June 2015. We assessed demographic data, comorbidities, location and size of the cyst, time to wound healing, and complications. Results The most affected finger was the right middle finger. All flaps survived and wounds healed in 14 days on average. The mucous cyst recurred in 1 of 33 cases. There were no major complications. Conclusions The Zitelli bilobed flap can provide good-quality skin coverage over the distal interphalangeal joint in a short period. Type of study/level of evidence Therapeutic IV.

Background: The trigger finger is characterized by the painful blocking of finger flexor tendons of the hand, while crossing the A1 pulley. It is a rare disease in children and, when present, is usually located in the thumb, and does not have any defined cause. Methods: We report 2 pediatric trigger finger cases affecting the long digits of the hand that were caused by an osteochondroma located at the proximal phalanx. Both children held the diagnosis of juvenile multiple osteochondromatosis. They had presented at the initial visit with a painful finger blocking. Surgical approach was decided with wide regional exposure, as compared with the trigger finger traditional surgical techniques, with the opening of the A1 pulley and the initial portion of the A2 pulley, along with bone tumor resection. Results: Patients evolved uneventfully, and recovered the affected finger motion. Conclusion: It is important to highlight that pediatric trigger finger is a distinct ailment from the adult trigger finger, and also in children is important to differentiate whenever the disease either affects the thumb or the long fingers. A secondary cause shall be sought whenever the long fingers are affected by a trigger finger.

Proximal radioulnar synostosis is a rare but highly disabling posttraumatic complication in periarticular elbow injuries. Surgical treatment is an option for functionally limiting proximal radioulnar synostosis; however, the approach can endanger local neurovascular structures, especially if the synostosis affects the level of the bicipital tuberosity. We report two cases of proximal radioulnar synostosis with a preoperative prono-supination range of motion of 0° and 15° treated by a reverse Sauve-Kapandji procedure resecting a 1-cm section of the radial shaft distal to the bicipital tuberosity and leaving the synostosis in place. An improvement in prono-supination arc of motion of 82.5° was achieved at 2 years of follow-up with no complications associated with the technique. The reverse Sauve-Kapandji procedure could be an option in the treatment of proximal radioulnar synostosis in selected cases.

A 40-year-old woman presented with Madelung deformity and severe arthritic changes at both the radiocarpal and the distal radioulnar joints. She was treated by using her lunate as an osteochondral graft into the radius allowing reconstruction of the lunate fossa. The scaphoid and triquetrum were removed concomitantly and a Sauve-Kapandji procedure was performed. Complete bone healing was achieved. Ten years later, an excellent functional result was maintained, with a pain-free wrist, an acceptable wrist joint range of motion, as well as a favorable aesthetic appearance. This procedure may be indicated for patients with severe Madelung deformity with painful radiocarpal and distal radioulnar joints associated with severe arthritis changes.

We evaluated the clinical and occupational outcomes of arthroscopic treatment with electrothermal shrinkage for triangular fibrocartilage complex (TFCC) tears. We retrospectively reviewed 162 patients. All patients had ulnar-sided wrist pain that limited their occupational and sporting activities. The surgical technique consisted of electrothermal collagen shrinkage of the TFCC. Pain relief, range of motion, complications, reoperation rate, time to return to work and workers' compensation claims were evaluated. Exclusion criteria were distal radioulnar joint instability and association of other wrist lesions. Complete pain relief was noted in 80.3% of the patients, incomplete pain relief in 14.8%, and only 4.9% required reoperation because of pain-persistence. The average range of motion was over 90% compared to the opposite hand. Worker's compensation claims were introduced by 20 patients, of which 6 did not return to their previous occupation. Electrodiathermy may be a useful option for arthroscopic treatment of TFCC tears in cases without distal radioulnar joint instability.

BACKGROUND The corticoperiosteal flap from the medial femoral condyle has become the workhorse in the management of recalcitrant nonunions with vascularized periosteum. Inclusion of the outer condylar cortex has been advocated to avoid damaging the osteogenic capacity of the periosteum and is at present an ordinary technical step in the procedure. PATIENTS A clinical prospective study was undertaken to evaluate the effectiveness of periosteal-only microvascular transfers from the medial femoral condyle associated with bone grafts in the treatment of recalcitrant nonunions. A group of 8 patients with periosteal-only flaps (study group) is compared with a corticoperiosteal control group (13 patients). A statistical analysis is made of the results. RESULTS We had 100% union rate in both the study and control groups. Evaluation of early signs of bone healing by two independent evaluators did not found differences between the groups (4.5 months in the study and 4.9 months in the control group). CONCLUSIONS Although not statistically significant because of the small sample size, our study might support the idea that both periosteal and corticoperiosteal flaps from the medial femoral condyle are effective, when associated with a bone graft, in the treatment of recalcitrant nonunions with small gaps. A further analysis of the results suggests, albeit no statistical significant, that structural and nonstructural bone grafts are both effective when associated with a vascularized periosteal or corticoperiosteal transfer from the medial femoral condyle.

Non-surgical approaches have been developed to enhance nerve recovery, which are complementary to surgery, and are an adjunct to the reinnervation process. A search of PubMed, Medline, CINAHL, DH data and Embase databases was performed using the keywords ‘peripheral nerve injury’ and ‘treatment’. Most of the conservative therapies are focused to control neuropathic pain after nerve tissue damage. Only physical therapy modalities have been studied in humans and their effectiveness is not proved. Many modalities have been experimented with to promote nerve healing and restore function in animal models and in vitro studies. Despite this, none have been actually translated into clinical practice. The hypotheses proved in animals and in vitro should be translated to human clinical practice.