Introduction Since COVID‐19 has become a pandemic, extensive literature has been produced. The commonest symptoms of COVID‐19 disease are fever, cough, anosmia, and lymphocytopenia. However, other apparently less common clinical symptoms have been described, including skin lesions. We conducted a systematic review to evaluate skin involvement in COVID‐19. Methods The authors performed a systematic review of literature, in accordance with the Preferred Reporting Items for Systematic and Meta‐Analysis (PRISMA). The search was reiterated until May 06, 2020. Results Overall, 1593 patients (M/F ratio: 1 : 9) with suspect of COVID‐19 were examined. The mean age was 37.8 (range 0–91) years. Among the analyzed patients, 84 (5.3%) were pediatrics (<18 years). Chilblains are very common among skin lesions and represent almost half of all skin lesions reported (46%); in 75% of patients with cutaneous manifestation, the latter presented before other typical clinical manifestation of COVID‐19. Vasculitis or thrombosis was identified in almost 70% of patients who suffered from skin manifestations. Conclusion The present study highlights the importance of skin involvement in COVID‐19. Limbs should be examined to eventually foresee the onset of further typical symptoms. Chilblains can be considered typical features. Studies with higher scientific evidence are required.

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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.

Background: Proximal Row Carpectomy (PRC) is a widespread, safe and effective salvage surgical procedure for wrist arthritis. Some authors believe that PRC results in low grip strength (GS), due to the loss of carpal height, supporting the idea to discourage PRC in high-demanding patients. Resurfacing Capitate Prosthesis Implant (RCPI) allows extending the indication for PRC also in case of deformity and/or arthritis of the head of capitate, with possible implications of clinical outcomes, including GS. Methods: Retrospective multicentre study on a population of active workers, affected by secondary post traumatic wrist arthritis, who underwent PRC (27 patients) or PRC + RCPI (20 patients), Primary outcome was to assess GS between PRC and PRC + RCPI. Secondary outcome was to assess CHR and to search for any possible contributors to GS. Active range of motion (AROM), hand function (DASH, Work-DASH, VAS, PRWHE), pain, time to return to work, job maintenance, major complications and general satisfaction were also assessed. Results: PRC + RCPI results in more GS maintenance compared with PRC alone, with higher values of CHR. CHR values were associated with GS with a good correlation. According to linear regression model analysis within PRC + RCPI group (GS–CHR), it is esteemed that the increase in parameter CHR is associated with an increase in parameter GS. Looking at a multiple linear regression model analysis built on the whole sample (GS% increase – (group × CHR) + GS% pre-operative). It is estimated that the increase of one unit of the GS coefficient is associated with an increase in GS% increase. Furthermore, higher pre-operative GS values positively influence post-operative GS. No differences were revealed between the two treatments in terms of the remaining secondary outcomes. Conclusions: PRC alone and PRC + RCPI are both effective salvage procedures for wrist arthritis. RCPI provides a better GS preservation, in part due to the carpal height preservation.

Background: Childrens' distal forearm fractures (DFFs) could be treated conservatively with closed reduction and immobilisation, but post-reduction displacements often occur. Displaced DFF should be surgically fixed, to avoid further displacement. Nevertheless, immobilisation after surgery is recommended. Epibloc system (ES), a system of stable elastic nail fixation, is widely used to stabilise adults extra-articular distal radius fractures, with advantages to not requiring post-surgical immobilisation. The present investigation represents a retrospective analysis of paediatric patients with DFF treated with ES applied with a minimal technical variation, to fix both ulna and radius fractures using a unique device. Materials and Methods: A retrospective analysis was performed on 44 children (age 6–11 years) who underwent closed reduction and internal fixation because of DFF (both ulna and radius). Group A (21 patients): ES fixation. Group B (23 patients): K-wires and short arm cast fixation. The primary outcome was the subsistence of reduction monitored through X-rays. The secondary outcome was the measurement of active range of motion (AROM) and the time of recovery. Results: No differences were observed comparing Group A and B in terms of the maintenance of reduction ( P > 0.05). Seven days after the implant removal, patients in Group A reached significantly better results compared to patients in Group B in terms of AROM ( P < 0.05). No differences were revealed in terms of complications between the two groups. Conclusion: ES applied with a minimal technical variation is safe and effective in treating distal ulna and radius fractures, with minimal requirement of post-surgical rehabilitation.

Primary lymphoma of the peripheral nerve is very rare and occurs most frequently in sciatic nerves. We describe the first patient reported in literature with a primary lymphoma in a pure sensory peripheral nerve of the upper limb. A woman in her 40s, with painful swelling and dysaesthesias in her left forearm in the past 3 months, was presented at our unit. Clinical MRI and ultrasound findings revealed a lesion that showed signs of a peripheral nerve sheath tumour. After complete excision, morpho-pathological evaluation revealed a primary B-cell lymphoma. The patient underwent radiotherapy and at the last follow-up there were no signs of residual pathology. Peripheral neuropathy may be caused by a lymphoma involving the nerve. Hand surgeons have to distinguish primary lymphoma of the peripheral nerves from schwannoma for their different clinical behaviour.

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