Retrospective study of Ishiguro's technique for mallet bone finger in children: long-term follow-up and analysis of predictors in outcomes.

PURPOSE: There is no consensus on the optimal treatment of bony mallet finger in the paediatric population due to a lack of studies in children. The Ishiguro technique is simple and less invasive, and treatment with K-wire fixation seems to provide better results for extension lag in bony mallet finger according to the literature. A retrospective cross-sectional study with long-term follow-up was performed to evaluate the functional and clinical outcomes of this method in children. Preoperative and intraoperative predictors of outcome were investigated. METHODS: From June to December 2022, we evaluated 95 children who underwent extension K-wire block from 2002 to 2012. Eighty-four children were included (mean age 14.8 ± 1.68 years) for a mean long-term follow-up of 11.6 ± 2.3 (8-16) years. Clinical and radiographic features were assessed. Pain and functional outcomes were assessed using Crawford criteria, range of motion (ROM) at the distal interphalangeal joint (DIPJ), loss of extension, and VAS scale. Univariate and multivariate regressions were used to assess which variables might predict the worst outcomes at long-term follow-up. RESULTS: Bone union and pain relief were always achieved. There were no complaints of potential growth impairment or nail deformity. 82.1% of patients showed excellent and good results. Fifteen patients had fair results. CONCLUSIONS: Although there are currently no significant differences between surgery and orthosis in adults, the Ishiguro technique is more effective in children when it comes to outcomes in the treatment of mallet fingers. A high percentage of excellent and good results were achieved, and no epiphyseal damage or nail deformity was reported. A strong and significant correlation was found between the worst outcomes and either delayed treatment time or excessive flexion angle.

Post-traumatic entrapment of the median nerve in the ulno-humeral joint: Diagnosis, treatment and literature review.

BACKGROUND: The incidence of median nerve injuries in pediatric elbow dislocations is approximately 3% and avulsion of the open medial epicondylar epiphysis in the pediatric population is one predisposing factor that may explain this age predilection. These lesions can be difficult to diagnose in the acute phase because symptoms tend to be mild or delayed, consequently their management can be challenging and functional outcome poorer. METHODS: We present the case of an unrecognized median nerve entrapment in a 16-year-old boy with posterior dislocation of the elbow and a medial epicondyle fracture, treated initially with close reduction and open stabilization with a cannulated screw. Assessment is supported by a review of similar reported cases available in literature. RESULTS: We discuss the diagnostic approach and the surgical options that can be used for this type of injury. CONCLUSIONS: High clinical suspicion of entrapment is imperative in presence of signs of damage to the median nerve in the pediatric patient immediately after the reduction of an elbow dislocation. If diagnosis of entrapment is made the therapeutic choice between neurolysis and nerve graft depends on the lesion severity. In the presence of a Fourrier's type 4 lesion, neurolysis should be avoided, while nerve resection and grafting are recommended.

Retrospective study of radial dome osteotomy with volar plate fixation versus K-wires in Madelung's deformity: long-term follow-up.

PURPOSE: The emerging role of the locking plate improved the technique also in corrective osteotomies in Madelung's deformity, but there is a lack of analyses between the fixation techniques, as well as little information in functional outcomes and long-term follow-up. The current study compared the outcomes, pitfalls, and advantages of volar plate and screws fixation versus K-wires fixation in a long-term follow-up. METHODS: Twenty-eight children presenting the "distal radius" variant of Madelung's deformity underwent Vickers ligament release and distal radial dome osteotomy between 2009 and 2015. Twenty-three children (20 females and 3 males, mean age 15 years and 7 months at surgery and 24 years and 8 moths at follow-up), with 26 operatively treated wrists, were available for follow-up. A retrospective two-cohort study, evaluating clinically and radiologically results, has been conducted with a mean eight years and seven months follow-up. RESULTS: Bone union and pain relief were obtained in all cases, as well as improvements in wrist motion and radiographic indices. A statistically significant correlation was identified between the volar plate fixation and an improved lunate subsidence on X-ray, and a trend towards an improved DASH score in the cohort with plate and screws, as well as significant improvement in wrist extension and supination always in the plate fixation cohort. CONCLUSIONS: The long-term follow-up enabled the patients to report on more definitive outcomes in terms of functional and cosmetic improvements. Volar plate fixation is an effective technique allowing for simple post-operative management and earlier rehabilitation program with improved clinical and radiographic outcomes.

Thumb Reconstruction With Thin Proximal Ulnar Perforator Free Flap.

Soft tissue defects of the thumb with exposure of tendons, periosteum, or neurovascular bundles require a complex reconstruction aimed at restoring both skin coverage and the essential function of pinching and manipulation. When large defects are involved, a free tissue transfer is indicated. The proximal ulnar perforator flap represents an interesting solution without the drawbacks of other more widespread free flaps. This report describes the case of a patient with a squamous cell carcinoma of the thumb that required circumferential resection of the soft tissue of the distal phalanx and the interphalangeal joint. The exposed structures were covered with pliable and texture-matching skin harvested from the proximal volar forearm and based on the proximal ulnar perforator. After 12-month follow-up, the patient was satisfied with the aesthetic outcome. Donor-site morbidity was minimal and no functional impairment in daily-life activities was reported. Even though a skilled microsurgical technique is required for the dissection of the perforator, its constant vascular anatomy and the low risk of damage to the main neurovascular bundle should make this flap reliable for the majority of hand surgeons.

Pediatric medial epicondyle fractures with intra-articular elbow incarceration.

BACKGROUND: Intra-articular incarceration of the epicondylar fragment occurs in 5-18 % of all cases of medial epicondyle fracture. It requires stable fixation to allow early motion, since elbow stiffness is the most common complication following medial epicondyle fracture. In this retrospective study, we report the clinical and functional outcomes and the complications that occurred following open reduction and screw fixation of medial epicondyle fractures with intra-articular fragment incarceration. METHODS: Thirteen children who had a fracture of the medial epicondyle with incarceration of the fragment in the elbow joint (type III) were surgically treated in our university hospital between 1998 and 2012. There were eight male and five female patients. The mean age at the time of injury was 13 years (range 9-16). Operative treatment consisted of open reduction and internal fixation with one or two 4.0-mm cannulated screws under fluoroscopic control. RESULTS: All of the patients were clinically reviewed at an average follow-up of 29 months. The overall range of motion limitation was about 5° for flexion-extension and 2° for pronation-supination. The score was excellent in all patients (mean 96.3). Complications occurred in four (31 %) children: two cases of symptomatic screw head prominence, irritation with partial lesion of the distal triceps myotendinous junction in one patient, and median nerve entrapment syndrome in one patient. CONCLUSIONS: In conclusion, open reduction and screw fixation yielded excellent clinical and functional outcomes for the treatment of medial epicondyle fractures with intra-articular fragment incarceration. However, particular attention is should be paid when treating these potentially serious injuries in order to minimize the risk of possible complications. LEVEL OF EVIDENCE: Therapeutic IV.

Schwannomas of the upper extremity: analysis of 34 cases.

BACKGROUND: Schwannomas are the most common benign tumours developing in peripheral nerves. They usually present as a slow-growing mass, sometimes associated with pain and paraesthesia. The aim of this study is to define the correct preoperative diagnosis, to review the surgical treatment employed and to evaluate short- and long-term neurological deficits. METHODS: Thirty-four patients affected by schwannoma in the upper limbs were treated in the period 1995-2011. In 15 patients the tumour was located on the ulnar nerve, in 8 on the median nerve, in 2 on the radial nerve, in 1 on the anterior interosseous nerve, in 1 on the muscle-cutaneous nerve, and in the remaining 7 on the digital nerves. All patients were surgically treated using a microsurgical approach. RESULTS: The enucleation of the mass was possible without fascicle lesion in 12 cases. In 22 cases resection of the indissociable fascicles was performed. Postoperative paraesthesia was present in 28 out of 34 treated patients; this clinical sign regressed in a mean period of 12 months in 27 patients. CONCLUSIONS: When approaching a palpable mass in the upper limbs, the possibility of a peripheral nerve tumour should always be considered. It is important to look for typical signs of schwannomas, such as a positive Tinel sign and peripheral paraesthesia. Imaging assessment with magnetic resonance imaging (MRI) and ultrasonography enables the determination of where the tumour takes its origin and from which nerve. Microsurgical techniques and know-how are recommended in approaching the resection in order to respect as many nerve fibres as possible.

Use of integra artificial dermis to reduce donor site morbidity after pedicle flaps in hand surgery.

PURPOSE: To assess the results obtained with Integra artificial dermis to cover donor site following the harvesting of pedicle flaps for hand reconstruction. METHODS: Between April 2010 and August 2013, 11 patients (8 men and 3 women; mean age, 37 y) were treated with Integra Dermal Regeneration Template (Integra LifeSciences, Inc., Plainsboro, NY) to cover donor defects after raising pedicle flaps for hand and finger reconstruction: radial forearm flap (4 cases), ulnar artery perforator flap (2 cases), and heterodigital island flap (5 cases). After neodermis formation the silicone layer of the artificial dermis was removed (on average after 22 days) and a split- or full-thickness epidermal autograft placed. RESULTS: No infections, hematoma, or bleeding were recorded during the entire phase in which the artificial skin was applied. Two patients experienced a partial skin graft loss. Median follow-up was 20 months, and results included an average Vancouver Scar Scale rating of 2.7 and an average DASH score of 39. There were no cases of graft adherence to the underlying tendons or muscles. CONCLUSIONS: Favorable cosmetic and functional outcomes were obtained using a dermal regeneration template for the treatment of donor site defects. Despite the drawback of an additional surgical procedure (secondary skin graft), the use of this artificial skin produced soft-tissue augmentation and graft-skin quality, reducing donor site morbidity. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Treatment of painful median nerve neuromas with radial and ulnar artery perforator adipofascial flaps.

PURPOSE: To review the outcomes of 8 patients with painful median nerve neuromas at the wrist treated with external neurolysis and covered with pedicled perforator adipofascial flaps. METHODS: Between 2004 and 2010, we treated 8 patients, who had a mean age of 37 years, and who had posttraumatic painful median nerve neuromas at the level of the wrist but with retained median nerve function . All of them reported neuropathic pain and had a positive Tinel's sign over the site of the presumed neuroma. The surgical procedure included external neurolysis and coverage with an ulnar artery perforator adipofascial flap (4 patients) or with a radial artery perforator adipofascial flap (4 patients). Patients were reviewed after a mean follow-up of 41 months (range, 18-84 mo). Preoperative and postoperative pain was measured with a visual analog scale. RESULTS: Pain improved from a preoperative mean value of 7.8 to a postoperative mean value of 3.6. There was complete resolution of pain in 5 patients, mild pain persisted in 2 patients, and 1 patient reported no improvement. No complications occurred at the donor site. CONCLUSIONS: Vascularized soft tissue coverage of painful median nerve neuromas is an effective treatment. We do not believe that a free flap is of any particular advantage over a local pedicle flap which we suggest using to protect the median nerve. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Simple and comminuted displaced olecranon fractures: a clinical comparison between tension band wiring and plate fixation techniques.

INTRODUCTION: The purpose of this retrospective study is to compare the clinical, functional outcome and complications occurrence between tension band wiring (TBW) and plate fixation both for simple and comminuted displaced olecranon fractures. MATERIALS AND METHODS: Between January 2005 and June 2012 (minimum 1-year follow-up), 78 consecutive patients with Mayo type IIA and IIB fractures were treated with the following methods: tension band wire or plate and screws fixation. The primary outcome of this study was the functional outcome, assessed by the following self-administered evaluation scales: the disabilities of the arm, shoulder and hand, and the Mayo Elbow Performance Score. Secondary outcome measures included the assessment of pain level, analysis of passive range of motion, and the occurrence of any early or late complications. RESULTS: Comparing the clinical results between the two groups, at mean 33 months follow-up, no significant differences in the functional and clinical outcome were observed. Complications were reported in 48 and 17 % of cases, following TBW and plate fixation in patients treated for type IIA fractures, and similarly in 40 and 23 % of cases in type IIB fractures, respectively. Hardware removal was more frequently performed in TBW group: 38 versus 17 % for type IIA fractures and 20 versus 6 % for type IIB fractures. CONCLUSIONS: The findings of this study indicate that both with the use of TBW and plate fixation excellent/good clinical outcomes with minimal loss of physical capacity, little pain and disability can be obtained in the majority of patients with simple and comminuted displaced olecranon fractures. Hardware removal was most frequently observed after TBW.

Malunited extra-articular distal radius fractures: corrective osteotomies using volar locking plate.

BACKGROUND: Multiple techniques for corrective osteotomy have been developed in recent years with the same aims: to improve the radiographic parameters and improve motion, pain and grip strength. Volar fixed-angle plates have added a new concept to the treatment of distal radius fractures thanks to the low morbidity of the surgical approach and the strength of the final construct, allowing early mobilization and return to function. MATERIALS AND METHODS: Between 2005 and 2012, 20 patients with symptomatic dorsally malunited extra-articular fractures of the distal radius underwent corrective osteotomy using a volar locking plate without additional bone graft. At a mean follow-up of 50 months, all the patients were clinically and functionally evaluated. RESULTS: All measurements of pain, final range of motion and grip strength significantly improved compared with preoperative measurements. The mean preoperative DASH score reduced from 54 points preoperatively to 25 postoperatively. Based on the modified Mayo wrist score, we obtained 14 excellent and six good results. Palmar tilt improved from an average of 23° to 11°. Radial inclination improved from an average of 29° to 22°, and ulnar variance decreased from an average of 3.6 mm to 0.9 mm. There were two cases of transient median neuroapraxia that resolved before the 6-week follow-up appointment. No other major complications, including non-union and infection, were observed. CONCLUSION: The volar approach and locking plate, without necessarily the use of bone grafting, proved to be an effective approach for addressing symptomatic and even severe deformities of the distal radius. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

A new volar plate made of carbon-fiber-reinforced polyetheretherketon for distal radius fracture: analysis of 40 cases.

BACKGROUND: Implants based on the polyetheretherketon (PEEK) polymer have been developed in the last decade as an alternative to conventional metallic devices. PEEK devices may provide several advantages over the use of conventional orthopedic materials, including the lack of metal allergies, radiolucency, low artifacts on magnetic resonance imaging scans and the possibility of tailoring mechanical properties. The purpose of this study was to evaluate the clinical results at 12-month follow-up using a new plate made of carbon-fiber-reinforced polyetheretherketon for the treatment of distal radius fractures. MATERIALS AND METHODS: We included 40 consecutive fractures of AO types B and C that remained displaced after an initial attempt at reduction. The fractures were classified according to the AO classification: 21 fractures were type C1, 9 were type C2, 2 were type C3, 2 were type B1 and 6 were type B2. RESULTS: At a 12-month follow-up no cases of hardware breakage or loss of the surgically achieved fracture reduction were documented. All fractures healed, and radiographic union was observed at an average of 6 weeks. The final Disabilities of Arm, Shoulder and Hand score was 6.0 points. The average grip strength, expressed as a percentage of the contralateral limb, was 92 %. Hardware removal was performed only in one case, for the occurrence of extensor tenosynovitis. CONCLUSION: At early follow-up this device showed good clinical results and allowed maintenance of reduction in complex, AO fractures. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Fingertip injuries and their reconstruction, focusing on nails.

The fingertip is a complex anatomical structure that is frequently injured, especially in manual workers. Different classifications have been reported, considering injury orientation, level and geometry. To optimize treatment planning, the area of soft-tissue defect should be considered. Treatment aims to conserve as long a finger as possible, restore sensation (S3 + or more) and ensure a pleasant esthetic appearance. When amputation occurs, the best treatment is replantation when conditions allow. When this is not possible, the fingertip should be used as a composite graft or the nail complex can be grafted and soft tissue reconstructed, according to the preferred method. In defect without amputation or if the distal part of the finger is not present or not useful, many reconstructive techniques have been described. Depending on the injury, patient characteristics and requirements and the surgeon's skills and experience, the treatments vary from secondary healing to free flaps. In this paper, the various treatment options are described and discussed. Nowadays, considering most variables, the best treatment in fingertip injury is secondary healing with occlusive or non-occlusive dressing, even in case of bone exposure. This simple solution is able to restore a nearly normal fingertip with good sensation without further injuring the hand.

Patient-matched osseointegrated prostheses for thumb amputees: a cadaver and feasibility study.

Thumb amputations affect 50% of hand functionality. Common solutions consist of microsurgical treatments or silicone vacuum prosthesis. Not all patients are eligible for microsurgical treatment and the use of vacuum prosthesis is often discouraged because of their instability. On the contrary, osseointegrated prosthesis provide stable retention and osseoperception. This cadaveric study evaluated the process of a patient-matched osseointegrated prosthesis for the treatment of thumb amputees. Computed tomography (CT) medical images reconstruction provided information on metacarpal stump, used as input for the parametric screw design. Preoperative planning guided the surgeons in the surgery: postoperative placement confirmed the accuracy of the preoperative planning. Surgeons were directly involved in the implant design to meet their requirements and patient needs. Implants were inserted into cadaveric specimens in one-stage surgery. A similar process can be adopted and exploited for the treatment of different levels of thumb amputations and long finger amputations.

Combined repair of scapholunate ligament (SL) and triangular fibrocartilage complex (TFCC) lesions in chronic trauma of the wrist: surgical treatment of 14 patients.

PURPOSE: Injuries of the scapholunate ligament (SL) and of the triangular fibrocartilage complex (TFCC) represent the main ligament injuries of the traumatic wrist. A double injury of the SL and TFCC ligaments is quite common in the trauma setting, and clinical examination is fundamental. MRI allows to detection of a TFCC and SL ligament injury, but wrist arthroscopy is still the gold standard for diagnosis. We present the clinical results of the combined reconstruction of chronic scapholunate ligament and TFCC injury. MATERIALS AND METHODS: Fourteen patients were treated at our hospital with a combined scapholunate ligament and TFCC complex repair. All patients were surgically treated by the same senior author, after a diagnostic arthroscopy that revealed a lesion of both structures. A comparison between the pre-operative and post-operative pain and function was carried out using VAS, Disability of Arm, Shoulder and Hand score (DASH) and Patient-Related Wrist/Hand Evaluation score (PRWHE). Wrist range of motion and strength were also compared following surgery. RESULTS: All patients had a mean follow-up of 54 months. A statistically significant improvement was observed both with the reduction in pain (VAS from 8.9 to 5) and with the improvement of functionality scores (DASH from 63 to 40 and PRWHE from 70 to 57) and with the increase in ROM and strength. In only one patient (7%), because of pain and instability, a supplement operation was needed (Sauve-Kapandji procedure) 3 months after the initial surgery. CONCLUSIONS: The simultaneous repair of the SL and TFCC complex has shown a good success rate in both decreasing pain and regaining functionality.

Ultramicronized Palmitoylethanolamide and Luteolin: Drug Candidates in Post-COVID-19 Critical Illness Neuropathy and Positioning-Related Peripheral Nerve Injury of the Upper Extremity.

Coronavirus disease 2019 (COVID-19) is the most dramatic pandemic of the new millennium and patients with serious infection can stay in intensive care unit (ICU) for weeks in a clinical scenario of systemic inflammatory response syndrome, likely related to the subsequent development of critical illness polyneuropathy (CIP). It is in fact now accepted that COVID-19 ICU surviving patients can develop CIP; moreover, prone positioning-related stretch may favor the onset of positioning-related peripheral nerve injuries (PNI). Therefore, the urgent need to test drug candidates for the treatment of these debilitating sequelae is emerged even more. For the first time in medical literature, we have successfully treated after informed consent a 71-year-old Italian man suffering from post-COVID-19 CIP burdened with positioning-related PNI of the left upper extremity by means of ultramicronized palmitoylethanolamide 400 mg plus ultramicronized luteolin 40 mg (Glìalia), two tablets a day 12 hours apart for 6 months. In the wake of our pilot study, a larger clinical trial to definitively ascertain the advantages of this neuroprotective, neurotrophic, and anti-inflammatory therapy is advocated.

Results of replantation of 33 ring avulsion amputations.

PURPOSE: Despite microsurgical advances, it is still difficult to achieve satisfactory functional results in cases of replantations following complete ring avulsion amputations. Our aim is to report the experience we have collected since the early 1990s in the treatment of this type of injury. METHODS: We replanted 33 fingers on 33 patients (age, 15-54 y) with complete ring avulsion amputation injuries. Twenty-eight amputations were distal to the insertion of the flexor digitorum superficialis, and 5 were complete degloving injuries with intact tendons. Vascular transpositions and vein grafts were used, and in all cases, only 1 of the digital nerves was repaired. RESULTS: The 29 successful cases were tracked over an average follow-up of 89 months. The average total active motion of the reconstructed finger was 185°. Sensibility evaluated by static 2-point discrimination varied from 9 to 15 mm and by moving 2-point discrimination from 8 to 15 mm. Five patients complained of cold intolerance. CONCLUSIONS: Resection of the avulsed digital artery and vein is the most crucial part of the procedure.Vessels reconstruction can be performed using various methods, but vessel transfers from the middle finger appear to be the most reliable solution. The outcome of the cases demonstrates that replantation should be attempted. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Alternative method for thumb reconstruction. Combination of 2 techniques: metacarpal lengthening and mini wraparound transfer.

Amputation at the proximal phalanx or at the metacarpophalangeal joint can be treated by pollicization of a finger, osteoplastic reconstruction, free microvascular transfer of a toe, or distraction lengthening. The best technique to use to treat these cases depends on the place of amputation and the patient's age, sex, occupation and functional demands. In the past 6 years, we treated 4 patients by lengthening the thumb metacarpal ray and adding a mini wraparound flap from the great toe. All the subjects were female with an average age of 22 years. All 4 patients had sustained traumatic amputations: 2 at the metacarpophalangeal joint and 2 at the base of the proximal phalanx. Distraction was completed approximately 65 days after osteotomy, obtaining an average lengthening of 23 mm. To achieve bone consolidation, the lengthener was left in place for 127 days on average. Microsurgical thumb reconstruction was performed around 3 months after consolidation of the osteotomy. There were no failures or cases of postoperative vascular compromise. The average pinch power was 66% of the opposite hand. The static 2-point discrimination of the reconstructed thumb was 8 mm (range, 7-10 mm). All patients reported being satisfied with the treatment, although 1 patient was partially dissatisfied due to the prolonged length of the treatment. Donor site morbidity was minimal. This procedure is mainly chosen by selected patients who refuse standard microsurgical thumb reconstruction because it requires a longer treatment period.

Shape-modified radial forearm flap: does it still have a role in upper extremity reconstruction?

OBJECTIVES: To carry out a radial forearm flap, the radial artery is usually harvested, incurring severe donor site morbidity. Advances in anatomical knowledge discovered constant radial artery perforating vessels, enabling the subdivision of the flap into smaller components suitable for a wide range of differently shaped recipient sites, with marked reduction of downsides. MATERIAL AND METHODS: Eight pedicled or free shape-modified radial forearm flaps were used to reconstruct upper extremity defects between 2014 and 2018. Surgical technique and prognosis were examined. Skin texture and scar quality were assessed on the Vancouver Scar Scale while function and symptoms on the Disabilities of the Arm, Shoulder and Hand score. RESULTS: At a mean follow-up of 39 months, no cases of flap necrosis, impaired hand circulation or cold intolerance were found. CONCLUSION: The shape-modified radial forearm flap is not a new technique, but is poorly known by hand surgeons; in contrast, our experience showed it to be reliable, with acceptable functional and esthetic outcomes in selected cases.

P3 Flap: Technique for Fingertip Reconstruction.

Fingertip amputations represent an important spectrum of injuries, and most are avulsions or crush trauma. There is no consensus about one single standard treatment, and a wide number of techniques are available. The authors present the P3 flap as an option for covering fingertip defects with bone exposure, avoiding painful scars in the pulp area, without a donor site. This study included 12 fingertips with amputated segment not available for replantation. Volar oblique fingertip defects and transverse amputations with bone exposure, not more proximal than Hirase Zone IIB, were included. Defects were less than 2 cm. The patients were followed up for an average of 6 months. The aesthetic and functional outcomes and fingertip discrimination recovery were evaluated at 6 months by the static two-point discrimination (2-PD) test and DASH score (quick version). The average postoperative 2-PD test at 6 months was 5.9 mm (range from 5 to 8 mm). The mean healing time of the fingertip was 4 weeks. Nail deformity was reported in three cases with level IIB of amputation. None of the P3 flaps failed, and local infection was not reported. The average DASH score at 6 months was 1.1. The mean time to return to work was 38 days (range from 30 to 53). The P3 flap proposed in this study demonstrates a reliable single-stage technique, performed under local anesthesia, for fingertip defect reconstruction, avoiding skin incision and scars in the pulp region and preserving digital length and nail bed.

Osteoid Osteoma of the Hand: Surgical Treatment versus CT-Guided Percutaneous Radiofrequency Thermal Ablation.

(1) Background: Osteoid osteoma (OO) is one of the most common benign bone tumors. This type of osteogenic tumor is generally characterized by a well-defined lytic area with a vascularized central nidus surrounded by sclerosis and bone thickening. The wrist and hand bones are infrequent sites for osteoid osteoma: only 10% of the cases arise in these areas. Standard treatments are surgical excision and radio-frequency ablation (RFA), both with advantages and disadvantages. This study aimed to compare the two techniques to prove if RFA could be a potential alternative to surgery in the treatment of OO of the hand. (2) Methods: Patients treated for OO of the hand between January 2011 and December 2020 were evaluated and data was collected regarding the lesions' characteristics and the treatment outcome. Each patient was followed up for 24 months and VAS pain (Visual Analogue Scale), DASH (Disability of the Arm, Shoulder and Hand), and PRWE (Patient-Related Wrist Evaluation) scores were collected. (3) Results: A total of 27 patients were included in the study: 19 surgical and 8 RFA. Both treatments showed a significant improvement in pain and functionality. Surgery was associated with a higher complication rate (stiffness and pain), while RFA was associated with a higher recurrence rate (2/8 patients). RFA allowed for a speedier return to work. (4) Conclusions: We believe that osteoid osteoma treatment with RFA in the hand should be an available alternative to surgery as it allows rapid pain relief and a swift return to work. Surgery should be reserved for cases of diagnostic uncertainty or periosteal localization.