Problems and Opportunities of a Smartphone-Based Care Management Platform: Application of the Wald Principles to a Survey-Based Analysis of Patients' Perception in a Pilot Center.

(1) Background: Mobile health (mHealth) solutions can become a means of improving functional recovery and reducing the peri-operative burden and costs associated with arthroplasty procedures. The aim of this study is to explore the objectives, functionalities, and outcomes of a platform designed to provide personalized surgical experiences to qualified patients, along with the associated problems and opportunities. (2) Methods: A survey-based analysis was conducted on patients who were prescribed the use of a specific care management platform and underwent primary robotic total knee arthroplasty (rTKA) between January 2021 and February 2023. (3) Results: Patients registered on the platform who have undergone primary robotic TKA (rTKA) were considered. The mean age of registered patients is 68.6 years. The male (M)/female (F) ratio is 45.1%/54.9%. The patients interviewed were at an average distance of 485 days from the intervention, with a standard deviation of 187.5. The survey highlighted appreciation for the app and its features, but also limitations in its use and in its perception by the patients. All these data were evaluated according to the Wald principles and strategies to improve patient recruitment, enhance adherence, and create a comprehensive patient journey for optimized surgical experiences. (4) Conclusions: This patient care platform may have the potential to impact surgical experiences by increasing patient engagement, facilitating remote monitoring, and providing personalized care. There is a need to emphasize the importance of integrating the recruiting process, improving adherence strategies, and creating a comprehensive patient journey within the platform.

Isolated compression of the ulnar motor branch due to carpal joint ganglia: clinical series, surgical technique and postoperative outcomes.

The entrapment of the ulnar nerve in Guyon's canal (GC) is a well-known wrist canalicular syndrome which is usually followed by a gradual combination of both sensitive and motor symptomatology. However, GC nerve compression could also cause a pure hand motor dysfunction. This condition, less frequent than the classic Guyon's syndrome, can be difficult to diagnose. Authors report a case series of eight patients affected by isolated compression of the ulnar nerve motor branch, due to piso-triquetrum or triquetro-hamate joint ganglia. Surgical technique and postoperative outcomes are discussed in this paper. The isolated compression of the ulnar nerve motor branch is a very rare clinical condition which is often linked to several causes. The rarity of the pathology is probably due to lack of knowledge and therefore to the difficulty in formulating a correct diagnosis. Surgical treatment appears to be decisive in most cases, although late diagnosis often leads to incomplete functional recovery.

F. Brunelli Ligamentoplasty as Treatment in Thumb Basal Joint Arthritis: Up to 9 Years Follow-up.

Thumb basal joint arthritis treatment with biological arthroplasty is a widely used procedure in hand surgery centers. The several described techniques are based on the use of different tendons of the wrist, implying frequently a tenoplasty around flexor carpi radialis or transosseous tunnels to stabilize the articulation. The authors have been using, for many years, the technique conceived by F. Brunelli that relies on the anchorage of the volar band of the abductor pollicis longus tendon to the first intermetacarpal ligament, to obtain a suspension arthroplasty. Technical details are discussed. Sixty-seven patients in Eaton-Littler stage 2 or 3 with >4 years follow-up after surgery were evaluated. Each patient expressed a subjective evaluation relating to pain, functionality, strength, esthetic aspect, and general satisfaction. The following parameters have been considered as objective data: the angle of the first web space, the abduction and opposition of the first digit, the pinch, and the strength. X-rays were also performed to verify the distance between the scaphoid and the first metacarpal. In 84% of cases, a significant improvement was found in the considered parameters. Joint space was maintained in 76% of cases at radiologic follow-up. No patient needed surgical revision. The tenoplasty conceived by F. Brunelli presents several advantages, including the simple and reproducible execution, short surgical time, and comfortable postoperative course for the patient. After mid-term follow-up, authors believe this procedure is particularly respectful of the anatomy and physiology of the first ray and gives optimal results in most of the cases, but, in patients with severe subluxation of the 1st metacarpal (identifiable as Eaton-Littler stage 3), it is less reliable, because of the degeneration of the intermetacarpal ligament.

Empirical measurement of pressure in negative pressure wound therapy for infected wounds: How long can it really stay under pressure?

Surgical site infections represent one of the most common surgical complications. Negative pressure wound therapy is considered an effective wound management system, based on the principle that a negative pressure inside the wound can suction fluids and approximate wound edges. With the negative pressure wound therapy systems commercially available it is assumed that the pressure inside the wound is stable at the set values. We conducted a prospective experimental study to investigate this. The negative pressure level achieved inside the dressing was investigated at a standard distance from the pad of suction and at specific times in patients with surgical site infections. Pressure measurements were performed in 28 dressings in 14 patients admitted to the Emergency Surgery Department between April 2016 and June 2017. In general, the machine was set at a pressure of -100 mmHg. Negative pressure was measured with a portable pressure reader in the dressing sponge at a distance of 0, 1.5, and 3 cm from the suction pad at the time of dressing change at 24 and 48 hours. The data suggest that there is a significant decrease in negative pressure at both 1.5 and 3 cm from the suction pad at 48 hours from the dressing change (p = 0.0001 and p < 0.0001, respectively). This preliminary study shows with statistical significance that the pressure inside the sponge of a negative pressure wound therapy system decreases after 48 hours, confirming that the pressure inside the system is not the same as the pressure reported by the machine and, instead of being stable, changes overtime.