Preservation of terminal branches of the palmar cutaneous branch of the median nerve in open carpal tunnel release.

PURPOSE: Post-operative pain in the palm and scar area is the most common complication after carpal tunnel release and injury to the terminal branches of the palmar cutaneous nerve is generally considered one of the causes for this complication. The Authors performed an intraoperative study preserving the terminal branches of the palmar cutaneous branch of the median nerve and verifying the frequency, location and direction of the branches that cross an interthenar incision. METHOD AND MATERIAL: Eighty-five consecutive patients (57 F - 28 M, mean age 66 y) underwent carpal tunnel release between February and June 2021. The cutaneous branches crossing the incision were identified and preserved by careful dissection. Subsequently they were counted and classified by their direction and distance from the proximal border of the transverse carpal ligament. RESULTS: Sensory branches were found in 40 % of cases (34/85) and their origin was observed at an average of 1.05 cm (0-1.8 cm) distal from the proximal border of the carpal tunnel. A total of 44 branches were observed of which 23 branches crossed the incision with a transverse course and 21 with an oblique, generally proximal-distal radio-ulnar course. The subcutaneous layer overlying the distal third of the transverse carpal ligament was found to be devoid of sensory branches, therefore it can be considered a relatively safe area. CONCLUSION: Isolation and protection of palmar sensory branches is important for improving carpal tunnel release results. This goal can be more easily achieved by locating the skin incision on the distal third of the transverse carpal ligament, where the sensory branches have a lower frequency, possibly associated with a second proximal incision (biportal technique) to better visualize the proximal portion of the ligament and antebrachial fascia.

Outcomes of Percutaneous Calcaneoplasty for Insertional Achilles Tendon Problems.

BACKGROUND: Percutaneous procedures have been used recently to treat insertional Achilles tendon problems. The present study reports our results of this treatment approach. METHODS: Patients undergoing percutaneous calcaneoplasty for insertional Achilles tendon problems were retrieved. Patients completed the visual analog scale (VAS) for pain and the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire before the operative procedure and at the last follow-up. At the last follow-up, we asked the patients whether they were completely satisfied, moderately satisfied, or unsatisfied after the procedure. Complications were also recorded. RESULTS: A total of 27 patients were enrolled. The average follow-up was 26.5 months (range 6-68). The mean age of patients was 56.2 years (24-82). The mean VAS score before surgery was 8.1 ± 0.9 decreasing by the last follow-up to 2.4 ± 2.3 (P < .0001). The mean VISA-A score improved from 20.7 ± 5.4 to 75.7 ± 25.5 at last follow-up, an improvement of 55% (P < .0001). At the last follow-up, 84.5% (22 of 27) patients were completely satisfied with the procedure, 7.4% (2 of 27) moderately satisfied, and 11.1% (3 of 27) were not satisfied. These last 3 patients presented recurrence of symptoms, requiring revision surgery. CONCLUSION: For the selected patients, we found percutaneous calcaneoplasty to be an effective treatment for insertional Achilles tendon problems. LEVEL OF EVIDENCE: Level III, retrospective study.

The burden of proximal femur fractures and other skeletal injuries during the Covid-19 pandemic lockdown: a retrospective comparative study.

Limiting people's movement is one of the main preventive measures deployed for the control of coronavirus 2019­nCoV pandemic. This study aims to assess the impact of COVID-19 lockdown on the incidence of the most common skeletal injuries and to provide a management algorithm specific for hospitalized fractured patients.We comparatively analysed the Emergency Department (ED) admissions between March 9th and May 4th 2020 with the same period in 2019. The frequency of the most common skeletal injuries has been derived. Data from the pre-hospitalization phase to discharge of all patients were considered. The impact on clinical orthopaedic consulting has been evaluated. All patients requiring orthopaedic care followed different pathways of hospitalization based on COVID positivity. Data of surgical activity has been analysed.During the 9 weeks of lockdown the access of patients to ED drastically decreased: 11726 accesses compared to 21501 in the same period of 2019. This trend was followed by the most common skeletal injuries but not by proximal femur fracture (PFF) that showed the same absolute numbers compare to the previous years (64 vs 63). If analysed in relation to the total ED access, PFF showed a relatively increase in their frequency.The data from this experience suggest that healthcare providers should strategically allocate resources for management and treatment of PFF during the COVID-19 pandemic. With the begin of the reopening phase, a "rebound effect" for orthopaedic care was observed leading to delayed treatments with a potential overall increased morbidity.

A silent massive ossification of Achilles tendon as a suspected rare late effect of surgery for club foot.

We report the case of a 66-year-old male patient with massive ossification of the distal portion of the Achilles tendon, as a late consequence of a surgical release for club foot conducted in his childhood. The singularity of the case report derives from its clinical features: the bone mass was of abnormal dimensions, almost substituting the entire tendon; the condition had always been asymptomatic, without deficits in range of motion, in absence of either pain or biomechanical defects with age. In fact, the condition was diagnosed just recently as a consequence of a tear. Despite an ultrasound diagnosis after the injury, only during the surgical treatment, a proper evaluation of the entity of the pathology was possible. Although the ossification of Achilles tendon is a rare clinical condition with a complex multifactorial etiology, in our case report, some of the elements in the patient's medical history could be useful for the pathogenesis and early diagnosis of the disease. The aim of this case report is to emphasize the importance both of a correct evaluation of clinical history and of an accurate diagnosis, in order to conduct a proper management of this pathology.