Lunate Shift Index (LSI): A New Parameter for the Evaluation of Residual Ulnar Side Wrist Pain in Patients with Wrist Osteoarthritis Undergoing Three-Corners Arthrodesis vs. Four-Corners Arthrodesis-A Retrospective Comparative Study with Minimum 2 Years of Follow-up.

Purpose: Both scaphoid non-union advanced collapse wrist (SNAC) and scapho-lunate advanced collapse wrist (SLAC) at stage II-III are common indications for limited wrist fusions including four-corners fusion (4CF) and three-corners fusion (3CF). The aim of this study was to assess the clinical and radiological outcomes in patients undergoing 3CF vs. 4CF. A new radiological index called Lunate Shift Index (LSI) was devised to evaluate the importance of the lunate displacement relative to the radiolunate joint. Materials and Methods: Twenty-eight patients undergoing 3CF and 40 patients undergoing 4CF were clinically evaluated. The radiolunate angle, the carpal height, and the LSI were recorded radiographically. The LSI corresponds to the ratio between the distance from the lunate centre to the middle of the intermediate column and the length of the intermediate column of the distal radius. Results: A statistically significant correlation was observed between LSI and clinical outcomes. The lunate displacement was associated with an increased incidence of wrist ulnar pain. No statistically significant differences were observed between 3 and 4CF in all parameters compared. Conclusions: The osteoarthritis of piso-triquetral joint has been identified as the cause of wrist ulnar pain in patients undergoing 4CF. The lunate correct positioning allows to maintain the carpal height and to increase the contact area at the level of the radiolunate joint. A good reduction of the lunate could be obtained with the 3CF compared to 4CF. This study showed how proper realignment of the lunate following midcarpal arthrodesis correlates with a better clinical outcome. Level of Evidence: Level III, Retrospective comparative study.

Total Wrist Arthroplasty with Integra Freedom® Implants: A Pilot Study with a New Evaluation System.

Introduction: Recent innovations in wrist arthroplasty implants have led to remarkable improvements in terms of results with improved stability and preservation of bone stock. Despite the advances in such implants, poor outcomes and frequent complications still affect this procedure, not allowing a wider use of this treatment in wrist arthritis.The purpose of this study is to assess the preliminary mid-term results of a Wrist Arthroplasty System (Freedom®, Integra Lifesciences, Princeton, USA) in patients with rheumatoid arthritis or secondary osteoarthritis of the wrist and to propose a new classification system. Materials and Methods: We examined 12 patients (7 with rheumatoid arthritis and 5 with secondary osteoarthritis of the wrist) who underwent total wrist arthroplasties performed by a single surgeon using the fourth-generation prosthesis. Pre- and post-operative pain on a visual analogue score, functional parameters measured with Mayo Wrist score, patient-rated wrist evaluation score, range of motion, and radiographic analysis were collected. Results: At a mean follow-up of 48 (SD 16.9) months a significant improvement (p < 0.0001) of the mean visual analogue, Mayo and PRWE scores following total wrist arthroplasty was observed. Wrist movements improved significantly (p < 0.001). Conclusion: We achieved significant improvements in pain relief, performance, and satisfaction both in rheumatic and non-rheumatic patients, confirmed by our scoring system. Level of Evidence: Level IV, case series.

Hand and Upper Limb Malformations in Italy: A Multicentric Study.

Background: Although hand and upper limb malformations are quite frequent, up to now very few reports have been published on epidemiology. The aim of this study is to evaluate the number of infants who presented with hand and upper limb malformations from 2010 to 2015 in Italy. Methods: A retrospective analysis of a pediatric population presenting with hand and upper extremity malformations was carried out, gathering reports achieved from eight Italian Centers of pediatric hand surgery. Other factors such as gender, date and region of birth, family distribution of malformations and associated syndromes, were analysed. Results: Out of 3,100,421 live births, 765 children presented with hand and upper limb malformations. The incidence was 2,5/10,000 live births with a predominance of males and the right side. Radial polydactyly was the anomaly with the highest percentage, closely followed by simple syndactyly, simbrachidactyly and complex syndactyly. Less common conditions were the triphalangic thumb, thumb in palm, proximal radioulnar synostosis and Sprengel deformity. Inheritance of and familial predisposition to those malformations was recorded in 25 cases, while 84 children presented with syndromes related to hand anomalies. Conclusions: In conclusion the incidence of hand and upper extremity malformations in Italy is lower than that registered in other countries. The retrospective nature of the study combined with the fact that some defects frequently evade pediatric hand surgeon consultations are some possible limitations of the study. However, our data confirmed that, in spite of the decrease in the birth rate in Italy, the trend of congenital hand disorders maintained a stable trend. We aim to integrate this study with a prospective analysis and to involve the institutional health authorities in other countries so as to register the correct incidence of hand and upper extremity defects.

Reconstructive surgery for thumb osteomyelitis: a new way of remodelling the vascularized medial femoral condyle flap. A case report.

BACKGROUND: Authors propose a technical innovation for the remodelling of the medial femoral condyle flap (MFCF) for reconstruction of small to medium bone defects performed after the surgical treatment of a thumb osteomyelitis. MATERIALS AND METHODS: A 45 year old male had thumb proximal phalanx osteomyelitis after a crush trauma of the dominant right hand and multiple previous unsuccessful surgical attempts in other hospitals. In our centre he underwent to a two stage surgical treatment of the infection through bone and soft tissue reconstruction with a MFCF shaped in a new three dimensional (3D) approach with multiple osteotomies. RESULTS: Bone union was achieved after 30 days with a stable thumb reconstruction and good soft tissue healing. No vascular complication occurred after surgery. There was no sign of infection recurrence. CONCLUSIONS: MFCF offers a variety of options for its 3 D shaping which make it a good solution in hand surgery reconstructions after surgical excision of small and medium size bony segments.