Hyperselective neurectomy (HSN) procedures in the spastic upper limb aim to reduce tone by excising some branches of the involved peripheral motor nerves, at the point of entry of each motor ramus into the target muscle. In this prospective study, 42 patients with upper limb spasticity were treated by HSN for the muscles of elbow flexion, forearm pronation and wrist flexion and evaluated for their short-term results (average 6 months) and long-term outcomes (average 31 months). Results at both time points showed an effective reduction of the spastic tone, with no decrease of muscle strength in the operated spastic muscles. Comparison of results between the two time points showed durability of the improvement, which remained statistically significant despite a slight relapse in spasticity. The results of HSN compare favourably with the other techniques of partial neurectomy; however, the technique requires a detailed knowledge of upper limb motor anatomy. Level of evidence: II

Up to a decade ago, to treat patients with chronic wrist pain due to advanced stages of arthritis, surgeons had four main solutions: partial or total wrist arthrodesis, total wrist prosthesis and proximal row carpectomy (PRC). Since 2010, a new technique has been described in literature using the Resurfacing Capitate Pyrocarbon Implant (RCPI), combined to PRC. The aim of this article is to review the literature and determine the indications, outcomes and complications associated with RCPI. An electronic literature research was carried out and pertinent articles were selected. Surgical technique, results and complications described in those articles are presented. From this review of the literature, authors conclude that Resurfacing Capitate Pyrocarbon Implant can be considered as a good alternative to arthrodesis and total wrist arthroplasty, at any ages, when proximal row carpectomy alone would not be indicated.

Flexor tendon injuries are extremely challenging conditions to manage for hand surgeons. Over the last few years enormous progress has been made for the treatment of these lesions with new surgical approaches being performed. One of these is the wideawake local anesthesia no tourniquet (WALANT) technique, also known as Wide Awake Technique that allows tendon repair under local anesthesia, enabling the tendon to move actively during surgery. Dynamic movement of the tendon during surgery is crucial for the orthopedic surgeon in order to understand if the tendon has been correctly repaired before leaving the operatory table. An electronic literature research was carried out on Pubmed, Google Scholars and Cochrane Library using ((Flexor tendon injury) OR (flexor tendon) OR (injury muscle tendon) OR (flexor pollicis longus tendon) AND ((wide awake repair) OR (wide awake) OR (wide awake hand surgery))as search terms. Authors believe that WALANT is an enormous add-on in the management of patients with flexor tendon injuries mainly because it allows direct visualization of the repair during flexion and extension movement of the fingers and also because it avoids general anesthesia or brachial plexus being more cost effective. The aim of these review was therefore to sum up the evidences available so far on the wade awake technique as an emerging treatment for patients with flexor tendon injuries.

Avulsions of the volar plate of the finger proximal interphalangeal joint (PIPJ) following sprains are often undiagnosed in the acute setting. Therefore, the chronic outcomes of this injury are most frequently the object of study and treatment. Different techniques for volar plate chronic avulsion repair are described in the literature. The most used among these are mainly two: the direct suturing with or without the use of bone anchors and the tenodesis techniques with flexor digitalis superficialis (FDS). The aim of this systematic review is to determine outcomes and complications associated with these surgical treatments of post-traumatic volar plate avulsions without phalangeal fractures. An electronic literature research was carried out and pertinent articles were selected. Surgical techniques details, outcomes and complications for direct sutures and tenodesis technique are discussed. Outcomes (Range of motion and pain) seem to be comparable, whereas authors that use the direct suture technique describe more frequently PIPJ flexion contracture complication. From this review of the literature, authors believe that both techniques are available for the repair of chronic injuries of the volar plate of the PIPJ, although direct suturing can be considered as less reproducible.

Rhizarthrosis is a progressive and disabling pathology affecting the carpometacarpal joint. It’s very common in elderly patients and typically affects postmenopausal women. The diagnosis of rhizarthrosis is mainly made by using different physical examination tests and by evaluating the type of pain and it’s then confirmed by imaging. Over the last few years increasing attention has been devoted to the assessment of new treatment techniques for rhizarthrosis. In this context intra-articular injection of autologous fat grafting for cartilage regeneration has demonstrated promising results in experimental settings as an alternative to open surgery procedures. The aim of this study was therefore to sum up the evidences available so far on autologous fat grafting as an emerging treatment for patients affected by carpometacarpal rizarthrosis. An electronic literature research was carried out on Pubmed, Google Scholars and Cochrane Library using “fat grafting”, “fat graft”, “adipose”, “fat transfer” and “lipoaspirate” as search terms. Authors believe autologous fat grafting is an interesting technique, that hand surgeon should keep in mind especially in early stages of rhizarthrosis were pain has not been solved with non-surgical treatment.

Background Deep periprosthetic infection after total hip arthroplasty (THA) is a serious and challenging complication for the orthopedic surgeon. Muscular flaps may represent a valid management option for the treatment of this condition. We present a systematic literature review about the use of muscular flaps for the treatment of hip prosthetic joint infection. Methods The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventy-seven articles, out of 279 titles, were considered eligible for the full-text analysis. Finally 15 studies that met inclusion criteria were included in this review. Results Overall, 210 patients (49% males, 48.6% females and 2.4% not reported) suffering from THA infection treated with muscular flaps were collected. The mean age was 69.6 years. Mean follow-up, reported in all studies, was 3.3 years. The results presented by the different authors, highlight the effectiveness of muscular flaps for the treatment of periprosthetic infection, in terms of function, limb salvage, prevention of the recurrences, cost-effectiveness, and quality of life postoperatively. Conclusions Muscle flaps provide an excellent management option for patients with persistent infection after total hip arthroplasty.

IntroductionDistal radius fractures are one of the most common injuries. Open reduction and internal fixation (ORIF) are the most diffused between surgical treatments. Carbon-fiber reinforced (CFR) polyetheretherketone (PEEK) plates have been proposed to prevent effects linked to stainless steel or titanium alloy traditional plates, such as radio-opacity, mismatch of bone-plate elasticity modulus, corrosion, limited fatigue life, osseointegration. ObjectiveThis review aims to evaluate the actual safety and reliability of CFR-PEEK plates to treat distal radius fractures. MethodsElectronic databases PubMed, Google Scholars, and Cochrane Library were searched in December 2020. Eligible studies were published in peer-reviewed journals. Three authors independently selected relevant articles and discussed those. Searching identified 13 titles and abstracts, 11 manuscripts were considered eligible for the full-text analysis. Of these 11 papers, 7 studies were included in our review. Results215 patients were analyzed in this systematic review. The mean age of enrolled patients was 52,8 years. 34% were males and 66% were females. Fractures were classified according to AO/ASIF classification system. We reported 12 cases of complications specific to this device, such as intraoperative plate and screws rupture, erosive flexor tendons synovitis, and loosening. ConclusionCFR-PEEK distal radius plates are potentially an alternative to traditional ones. But we believe that the use of this device does not entail a significant advantage in the treatment of distal radius fractures, as safe and low-cost traditional devices are available. Further comparative studies are needed to demonstrate the superiority of carbon devices.

Proximal row carpectomy (PRC) is a long-time, wellaccepted, easy-to-reproduce procedure for the treatment of several painful degenerative conditions of the wrist, when capitate pole and radius lunate fossa are preserved. It has been reported to relieve pain and preserve a substantial wrist range of motion, although a partial loss of strength has to be expected because of the decreased length of the carpus. Since 2010, a new technique has been described in the literature using the resurfacing capitate pyrocarbon implant, combined with PRC. This implant has been designed to perform PRC even in the presence of degenerate joint surfaces, and thus resolves the limited indications of this procedure; however, if a resection of the capitate pole is performed to set up the implant, similar to PRC it may not positively influence the recovery of strength. The authors propose an resurfacing capitate pyrocarbon implant technique without any capitate bone resection, to preserve as much as possible the carpus length and so to improve the functional recovery. The surgical technique, is described in detail and preliminary results are discussed.