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The present work analyses the main weather patterns over the period 1981-2010 in the Central Apennines (Italy), drawing upon data from 23 monitoring stations spanning a wide elevation range (260-1750 m asl). Cluster analysis was used to identify homogeneous units and to verify the effectiveness of the bioclimatic classification by crossing the results derived from the application of hierarchical and non-hierarchical classification techniques. The results reveal a diversified picture of five clusters that depends on several factors as elevation, the geographic position within or outside the mountainous range, and the regional morphological traits. Although Mediterranean and Temperate climatic features coexist, the Mediterranean pattern in the southern areas and internal valleys better expresses the overall mixed characteristics of Central Italy. The use of a mixed methodology of hierarchic and partitioning methods of cluster analysis improves the bioclimatic classification, especially to quantify the level of humidity and the mediterraneity degree.

Objective: We aimed to review and pool recent large methodological studies evaluating the diagnosis performance of ultrasonography vs electrodiagnostic testing (EDX)., Methods: Using the keywords: "carpal tunnel syndrome", "ultrasound", and "validity", recent articles evaluating ultrasonography compared with a reference including EDX were selected from 4 databases (PubMed, Embase, Web of science, and BDSP) and from previous review for older articles, after 2 rounds. Relevant data for different thresholds of cross-sectional area of the median nerve were extracted from the articles to calculate the pooled sensitivity, specificity, and likelihood ratios. Different analyses were also performed to study potential sources of heterogeneity, such as calculation of area under the curve, using summary receiver operating characteristic curve., Results: Among the 189 articles found, 13 articles were included. A cross-sectional area of the median nerve between 9.5 and 10.5 mm(2) (study included once only), found for 11 studies, gave the pooled sensitivity as 0.84 [0.81 to 0.87] and the likelihood ratio for a negative test as 0.21 [0.17 to 0.27]. Specificity (0.78 [0.69-0.88]) and the likelihood ratio for a positive test (3.74 [2.30-6.10]) were heterogeneous. For a threshold at 7.0 to 8.5 mm(2), pooled sensitivity was 0.94 [0.87 to 1.00], and for 11.5 to 13.0 mm(2) specificity was 0.97 [0.91 to 1.00]. The only significant variable on potential sources of heterogeneity was the cross-sectional area of the median nerve threshold and area under the curve was 0.87 (asymmetric)., Conclusions: Pooling recent articles seems to confirm that sonography using cross-sectional area of the median nerve could not be an alternative to EDX for diagnosis of carpal tunnel syndrome but could give complementary results., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objectives: The purpose of this study was to clarify the definition, classification and treatment of the disorder known as the locked metacarpophalangeal (MCP) joint of long fingers, through the analysis of 15 cases and a literature review., Patients and Methods: We carried out a retrospective study of 15 patients with locked MCP joint of long fingers, all treated between 1997 and 2007. All patients underwent some imaging investigations including lateral, anteroposterior and Brewerton X-ray examinations. All these patients had been treated by surgery, which allowed us to describe the concerned lesions., Results: The patients were 47 years old on average, 70% of the locks involved the index and the middle finger. Twelve fingers were locked in flexion. In nine of these cases, the cause was a blocking due to a clinging of the radial or ulnar accessory collateral ligament that overlapped a prominent metacarpal condyle or an osteophyte of the metacarpal head. Three fingers were locked in extension due to an imprisonment of a strap of the palmar plate. One patient was lost to follow-up. The remaining 14 patients had an average follow-up of 12.6 months. All recovered normal mobility without any recurrence., Conclusion: This study and the literature review show that there are in fact two clinical presentations depending on the etiologies. We suggest a modification of both Posner's definition and Harvey's classification; a new classification should focus on the causes depending on the clinical presentation of the locking, so as to improve the correlation between clinical presentation, etiology and treatment., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Purpose: This study presents an autograft technique for the surgical management of chronic posttraumatic instability of the thumb metacarpophalangeal (MCP) joint by using a bone-retinaculum-bone graft from the second compartment of the extensor retinaculum., Methods: The bone-retinaculum-bone graft was harvested from the second compartment. The graft ends were fixed into the host site with screws. Fourteen patients (12 ulnar, 2 radial collateral ligament tears) had the procedure. All patients were reviewed by an independent observer using objective and subjective criteria, the mean follow-up time was 20 months., Results: Results were satisfactory overall (8 excellent, 4 good, 1 fair, 1 poor that subsequently was fused). All patients returned to their former jobs. All but one had a clinically stable first MCP joint; grasp was 87%, pinch was 80%, MCP joint range of motion (ROM) was 91%, and interphalangeal joint ROM was 98% of the unoperated side., Conclusions: Early results are encouraging. This procedure preserves ROM of the MCP and interphalangeal joints of the thumb, improves strength, and gives the stability required for proper thumb function.

The thenar flap is a satisfactory reconstruction technique for the treatment of extensive loss of the distal phalanx of the index and middle fingers. As we observed in this series of 20 patients, this flap is reliable and provides tissue that closely matches the missing finger pulp. Flap sensibility is good (average Weber of 6.5 mm). Transferring a distally based flap prevents proximal interphalangeal joint contracture and allows the surgeon to better reconstruct the outlines of the distal phalanx, thereby reducing the risk of a clawed nail. Finally, we did not observe major postoperative complications at the donor site.

Purpose of the Study: The authors report their experience of digital pulp reconstruction by free toe pulp transfer. Fifteen patients were treated with the lateral great toe hemipulp., Material and Methods: 15 cases of post-traumatic finger tip reconstruction were reviewed including 9 thumbs, 5 index, 2 medius, and one ring finger. There were 6 emergency cases and 9 secondary reconstructions (7 after inconvenient spontaneous healing and 2 after groin flap coverage)., Results: We noted 2 partial necrosis, and 4 patients suffered from cold intolerance. The flap sensibility, according to the American Society for Hand Surgery criteria, was excellent in 1 case good in 6 cases, fair in 7 cases and bad in 1 case. The value of the mean two point discrimination test was 10 mm, the mean moving two points discrimination test equalled 9 mm. We had 1 excellent functional result, 6 good, 6 fair and 2 bad. The subjective evaluation found 12 patients satisfied and 3 disappointed., Discussion: A wide range of procedures from spontaneous healing to thenar flap, neuro vascular flap or toe pulp transfer can be proposed to treat digital pulp loss. In the case of moderate thumb pulp avulsion and homodigital volar flap can be proposed; if microsurgery is contra-indicated, an hetero-digital flap from the index can be performed. When the other fingers are concerned, a homodigital flap can be proposed for moderate defects. For more important trauma, the thenar flap is convenient to cover the index and the medius pulp. Ring and little fingers can be treated by a reverse digital artery flap or by a cross finger flap. When a toe pulp transfer is indicated we recommend the lateral great toe hemipulp for the thumb and a second or third toe pulp transfer for the other fingers when digital vascular anastomosis are possible. The great toe hemipulp transfer represented a good indication for complete digital pulp loss reconstruction where the thumb is concerned. Performing this reconstruction during the acute phase may improve the management of those trauma by reducing the time needed for cicatrisation and the length of work inability.

The glomus tumors of the finger tip are benign. Their diagnosis is clinic but their precise localization is quite difficult by classic imaging. MRI with gadolinium injection seemed a good method to check exactly this lesion and have been tested on 20 patients suspected suffering of glomus tumor. On 18 glomus tumors surgically and histologically confirmed MRI examination have been positive for 16. In two cases MRI and surgery were negative. A good correlation seems observed with surgery for the size (7 tumor of 2 mm) the localization and osseus extension. Addition of T2 and T1 before and after injection weighted acquisitions improved the results. Precise informations on topography and size seems improved the surgical approach.