Trapeziectomy and suspension arthroplasty with the flexor carpi radialis tendon for treatment of trapeziometacarpal osteoarthritis.

Excision of the trapezium is the common step in most arthroplasties for treating trapeziometacarpal arthritis. Trapeziectomy can be supplemented by several techniques intended to stabilize the first metacarpal but none of these has been proven superior. The aim of this study was to verify if a simplified suspension arthroplasty with the flexor carpi radialis (FCR) tendon, requiring only a single short surgical incision, no intraosseous tunnels and no interposition of prosthetic material, yields equal clinical outcomes to more complex techniques and if the clinical outcomes remain stable over the long term. A cohort of 299 patients was reviewed retrospectively at a follow-up ranging from 3 to 12 years (mean follow-up time 6 years) following total trapeziectomy and suspension arthroplasty using a half-tendon strip of FCR. At this long-term follow-up, the mean DASH score improved from 52 preoperatively to 20 postoperatively. Pain at follow-up was subjectively rated by patients as absent or improved in 92% cases. Thumb opposition assessed on the Kapandji scale was rated 9 or 10 in 144 (76%) hands, 7 or 8 in 30 (16%) hands and <7 in 15 hands (8%). Mean palmar flexion and radial abduction were 45° and 42°, respectively. Mean key pinch and grip strength were 4.7 Kg and 23.5 kg, respectively. When treating trapeziometacarpal osteoarthritis, surgical techniques that do not require complex procedures, bone tunnels, K wire stabilization or interposition of prosthetic materials can be considered and maybe preferred. Our technique of trapeziectomy and suspension arthroplasty with the FCR tendon produces good long-term results.

Neurolysis versus anterior transposition of the ulnar nerve in cubital tunnel syndrome: a 12 years single secondary specialist centre experience.

BACKGROUND: Various conservative treatments and surgical techniques have been reported in the literature as efficient and feasible measures to treat the cubital tunnel syndrome. However, there has been no consensus on the best management of the syndrome, and uniform standardised guidelines have not yet been accepted or introduced. With our study, we present our experience on the clinical efficacies and outcomes of the surgical techniques of neurolysis alone and neurolysis associated with ulnar nerve anterior transposition at the elbow joint in patients with neuropathic symptoms due to cubital tunnel syndrome. MATERIALS AND METHODS: A total of 107 patients with cubital tunnel syndrome were retrospectively enrolled, surgically treated and followed up in our study. The cohort was divided into two groups: 41 patients treated only with neurolysis of the ulnar nerve (Group 1), and 66 patients treated with neurolysis and anterior transposition (Group 2). Of the participants, 35 were women and 72 were men. The average age was 54 years. Significant comorbidities were preoperatively diagnosed in 26 patients. Conservative measures had been considered, followed by surgical management if appropriate. A pre-op electromyography was performed for all patients. All surgical procedures were performed by the same surgical team. A post-operative follow-up was carried out, and the findings were recorded. The "McGowan" and "Wilson and Krout" classifications and the DASH score were used. A satisfaction questionnaire was administered to all patients post-operatively at 2 weeks). RESULTS: Ulnar nerve neurolysis and anterior transposition surgery were all successfully performed. Overall complications were post-operative haematoma (8%) and wound problems (5%). In 6% there was recurrence of symptoms. In 11% there was no improvement of symptoms. Pre-op McGowan classifications for groups 1 and 2 were 0% and 0% (grade 0), 21% and 24% (grade 1), 46% and 44% (grade 2), and 33% and 34% (grade 3), respectively. The post-op McGowan classifications were 34% and 37% (grade 0), 39% and 40% (grade 1), 23% and 20% (grade 2), and 4% and 3% (grade 3), respectively. The post-op Wilson and Krout classifications were 45% and 46% (excellent), 26% and 28% (good), 19% and 15% (fair), and 10% and 11% (poor), respectively. The DASH score means for groups 1 and 2 were 14.8 and 15.2, respectively. A negative Froment's sign was present in 73.2% and 71.2%, respectively. In Group 1, the post-op satisfaction questionnaire scores were 0 for one patient, 1 for four patients, 2 for seven patients, 3 for ten patients, 4 for twelve patients and 5 for seven patients. In Group 2, the post-op satisfaction questionnaire scores were 0 for three patients, 1 for nine patients, 2 for twelve patients, 3 for fifteen patients, 4 for eighteen patients and 5 for nine patients. CONCLUSIONS: In our experience, the surgical technique to treat the cubital tunnel syndrome most efficiently and feasibly has not yet been established in terms of indications and outcomes. This is supported by the data present in the international literature. Good and similar results were obtained with neurolysis alone and neurolysis associated with anterior transposition of the ulnar nerve (in line with the international data). In conclusion, more high-quality studies of greater statistical power are needed to provide a consensus on the surgical indications and techniques to treat the cubital tunnel syndrome and to establish internationally standardised guidelines.

Lesser mealworm (Alphitobius diaperinus) powder as a novel baking ingredient for manufacturing high-protein, mineral-dense snacks.

Increasing interest in consuming foods that are high in protein, vitamin, amino acid, and mineral contents is steering growth in the market for fortified snacks. The aim of the present study was to evaluate the use of lesser mealworm (Alphitobius diaperinus) powder (LP) (at 10 or 30% substitution for wheat flour) for the protein and mineral fortification of crunchy snacks (rusks). Hence, the technological, microbiological, nutritional, and sensory characteristics of the fortified rusks were evaluated. The protein content was enriched up to 99.3% in rusks with 30% substitution; moreover, a notable increase in the essential amino acids content was observed, with histidine fortification reaching up to 129.1% in rusks with 30% substitution. The incorporation of LP has led to an enrichment of almost all the minerals considered here, and especially Fe, P and Zn, with Zn showing fortification percentages of up to 300% in rusks with 30% substitution for LP. The experimental rusks showed pleasant sensory traits and low aw values. In view of the potential industrial manufacturing of insect-based rusks, the proposed product can be assigned to level 4 (validation in a laboratory environment) of the Technology Readiness Level (TRL) scale, and it is thus ready to be tested in a simulated production environment.

Microbial dynamics of model Fabriano-like fermented sausages as affected by starter cultures, nitrates and nitrites.

The present study promotes the valorization of Fabriano-like fermented sausages, which are central-Italy salami with an origin that dates to the early 17th century, for the possible future selection of autochthonous starter cultures to be used with respect to local traditions. To the best of the authors' knowledge, this study represents the first attempt to define the microbial dynamics in Fabriano-like fermented sausage and the effect of nitrates/nitrites and starter cultures on its natural bacterial biota. Culture and RNA-based techniques (RT-PCR-DGGE and Illumina sequencing) were used to assess the microbial ecology of model Fabriano-like fermented sausages together with the impact of starter cultures and different nitrate and nitrite concentrations. The meat batter was used to produce two batches of fermented sausages that were prepared as follows: i) without commercial starters or ii) with the use of starter cultures composed of Pediococcus pentosaceus and Staphylococcus xylosus. Each batch was further divided into three different batches with the addition of 0/0 mg kg-1 nitrate/nitrite, 75/60 mg kg-1 nitrate/nitrite and 150/125 mg kg-1 nitrate/nitrite to the first, second and third batch, respectively. The samples, which were produced in triplicate, were analyzed on the day of production and after 7, 21, and 42 days of ripening. Enterobacteriaceae counts were always higher in model Fabriano-like sausages produced without the use of starter cultures at all of the sampling times irrespective of the tested nitrate/nitrite concentrations. Lactobacilli counts were positively influenced by the starters, although this influence was not evident over time; moreover, the effect of nitrates and nitrites on the counts of lactobacilli differed over time. As a general trend, coagulase-negative cocci counts were apparently not influenced by the tested nitrate/nitrite concentrations. Regarding the effect of nitrates/nitrites on the microbial diversity revealed by RT-PCR-DGGE, the higher the concentration, the lower the presence of some genera/species such as Pseudomonas spp., Serratia liquefaciens and Staphylococcus spp. However, Illumina sequencing detected Pseudomonas spp. as a minority species after 7, 21 and 42 days of ripening irrespective of the nitrate/nitrite concentration. The presence of Staphylococcus species was highlighted by both RT-PCR-DGGE and Illumina sequencing at all of the stages of ripening, although its presence was massively detected in fermented sausages produced without the use of nitrates/nitrites at the end of ripening. Overall, the data collected clearly highlighted the dominance of Lactobacillus sakei in all of the fermented sausages during ripening (from day 7 to day 42) and irrespective of the nitrate/nitrite concentration and added starter cultures. Moreover, Pediococcus spp. was principally detected in model Fabriano-like fermented sausage with added starter cultures irrespective of the nitrate/nitrite concentration.

Experimental accelerated shelf life determination of a ready-to-eat processed food.

The most direct way to estimate the shelf life of a product is to conduct simulation tests which are time consuming and expensive. Conversely, accelerated shelf life tests can be successfully used for stable products having long expected shelf life. The aim of the study was directed to verify the possibility to apply an accelerated shelf life test to perishable food products having a short-expected shelf life, such as a new ready-to-eat processed food preparation, composed mainly by cereals, tuna and chicken, packed in thermo-sealed trays and pasteurised. Different samples of the product were stored in thermal abuse conditions, collected periodically and subjected to determinations of TVB-N, pH and sensorial characteristics. Q10 and activation energy were calculated allowing to obtain a predictive evaluation of the product shelf life at the 4°C recommended temperature. The product shelf life was assessed at 26 days vs the 30 days expected by the manufacturer, showing the possibility to apply successfully ASLT for products having short shelf life, saving both time and money.

Evaluation of the quality of foods for special diets produced in a school catering facility within a HACCP-based approach: a case study.

A study was carried out to verify the appropriateness of the Hazard Analysis and Critical Control Point (HACCP) plan adopted in a school catering facility. To that end, the microbiological quality of foods, the correct implementation of special diets (lactose- and gluten-free) and the nutritional value of foods were assessed. Thirty-six samples of lactose-free and 87 samples of gluten-free special diet food preparations were subjected to microbiological, chemical, and nutritional analyses. The data collected demonstrate the effectiveness of the HACCP plan in reducing the occurrence of microbial and chemical (lactose and gluten) cross-contamination. The data obtained from the nutritional analyses showed that the dietary intake provided by the meals under study was satisfactory.

Efficiency of Hyaloglide in the prevention of the recurrence of adhesions after tenolysis of flexor tendons in zone II: a randomized, controlled, multicentre clinical trial.

Hyaloglide is a hyaluronan-based gel based on a novel auto-crosslinked technology designed to reduce postsurgical adhesions. Its efficacy was assessed in a multicentred randomized controlled trial comparing the results of flexor tenolysis in zone 2 following failed flexor tendon repairs. In the control group a standard release was performed. In the treated group, Hyaloglide was applied into the flexor sheath and around the site of tenolysis. Forty-five patients, 19 controls and 26 treated with Hyaloglide, were enrolled in 13 centres. All the patients were evaluated at 30, 60, 90 and 180 days after surgery by testing Total Active Motion, Quick-DASH questionnaire and number of working days lost after surgery. Patients in the Hyaloglide group had a statistically better recovery of finger motion at all time intervals and returned earlier to work and daily activities. The use of Hyaloglide did not appear to increase the complication rate.

Treatment of post-traumatic hand Staphylococcus aureus osteomyelitis with oral linezolid.

The Authors report on the use of linezolid for the treatment of three patients with osteomyelitis. All three patients had post-traumatic multisensitive hand bone methicillin-susceptible Staphylococcus aureus osteomyelitis, which did not respond to antimicrobial regimens including drugs in vitro active against the isolated strains. Clinical cure and microbiologic eradication was obtained with oral linezolid in all three patients. Linezolid was well tolerated. Mild thrombocytopenia was observed in one patient at the end of the third week of treatment and it was promptly resolved after the discontinuation of linezolid. Linezolid minimum inhibitory concentrations (MICs) consisted of 2 mg/l for all three S. aureus isolates while the bactericidal activity in vitro was not present up to the linezolid concentration of 32 mg/l. In spite of a lack of in vitro bactericidal activity, linezolid was effective in curing the patients and eradicating the infection. Trough and peak plasma concentrations of linezolid were above the MICs of the isolates. These values ranged from 3.93 to 14.95 mg/l at trough and 5.03 to 25.91 mg/l at peak. The oral bioavailability, pharmacokinetic profile and antibacterial spectrum of linezolid make this oxazolidonone antimicrobial an attractive drug for the treatment of chronic osteomyelitis. Prolonged administration requires careful surveillance for side effects, until these complications are better understood.

Early and late displacement of fractures of the distal radius. The prediction of instability.

One hundred fractures of the distal radius with dorsal displacement were treated by closed reduction and a plaster cast. The mean age of the patients was 55 years. Radiographs were taken after 1, 2 and 5 weeks to evaluate the frequency of early and late displacement. Dorsal angulation occurred in 71 patients, shortening of the radius in 47 and flattening of the radial angle in 32. Late displacement was more frequent than early. Statistical analysis showed a greater incidence of secondary shortening in Older's types III and IV fractures. The severity of the initial radial shortening was the most reliable indication of instability.

Results of primary repair of digital nerves.

Recovery of sensitivity following repair of 54 digital nerves was evaluated after one to seven years. Normal two-point discrimination has been regained in only seven cases (13%), two-point discrimination between 6 and 10 mm in 20 (37%), between 11 and 15 mm in 13 (24%) and protective sensation in 14 (26%). A close correlation between age and recovery of sensation after repair has been confirmed by statistical analysis. Microsurgical repair of digital nerves gives satisfactory results, since a normal or good two-point discrimination can be obtained in one-half of cases while sensation improves in the others. However a high rate of complete recovery of sensation is to be expected only in children.

Comminuted articular fractures of the distal radius. Results of conservative treatment.

Fifty-nine comminuted articular fractures of the distal radius which had received conservative treatment were reviewed after an average of 3 1/2 years. The results--excellent in 15 patients, good in 30, fair in 12, and poor in 2--were closely linked to the quality of the articular reduction. In patients with a residual malalignment greater than 2 mm, a relatively high incidence of both degenerative arthritis (31%) and unsatisfactory results (56%) was found. The presence of a "die punch" fragment often precluded acceptable fracture reduction and was therefore responsible for many poor clinical and radiographic results. The quality of the extraarticular reduction proved to be of little importance to the final outcome.

Surgical treatment of the rheumatoid hand.

Multiple involvement of joints and tendons of the hand by rheumatoid disease is frequent and may result in severe deformities. Surgery plays a major role in an integrated treatment program that considers the patient's possibilities for improvement. Extensor and flexor tenosynovitis requires an early synovectomy to prevent tendon ruptures, to restore tendon gliding and to decompress the median nerve at the wrist level. Ruptured tendons are usually widely degenerated and restoration of function is provided by end-to-side repair, tendon grafts or tendon transfers. Joint synovectomies must be preformed at an early stage to be effective. Restoration of function in eroded, dislocated or unstable joints can be attained by arthroplasty or arthrodesis. A resection arthroplasty, usually completed by a silicone implant, corrects the deformity while preserving or restoring a functional range of motion. Flexible implant arthroplasty is very often performed in the metacarpophalangeal joints, and less frequently in the wrist and interphalangeal joints. Arthrodesis is a satisfactory procedure for those joints where stability is more important than motion.

Surgical release of the median nerve under local anaesthesia for carpal tunnel syndrome.

Carpal tunnel release was performed under local anaesthesia in 124 wrists of 108 patients. The local anesthetic was injected into the carpal tunnel and into the subcutaneous tissue under the line of the skin incision. A tourniquet was used in all cases. Analgesia was complete in all but six patients. Only one patient had real difficulty in tolerating the tourniquet. In 18 cases the median nerve, when exposed at operation, showed evidence of some damage caused by the needle or by injection of local anaesthetic but, at follow-up, no symptoms or signs related to this damage were found.

Perilunate dislocations of the carpus. A long-term review.

The long-term results of 19 perilunate dislocations of the carpus (including 9 transscapho-perilunate dislocations) were: good, 7 cases; fair, 8; poor, 4. The 9 transscapho-perilunate dislocations gave worse results than simple dislocations, with pseudarthrosis in 5 cases. Arthrosis was found in more than half the cases, more frequently in transscapho-perilunate dislocations and in cases associated with a fracture of the radial styloid. Radiographic signs of instability were observed in 8 wrists. The unstable wrists had a high incidence of arthrosis and showed decidedly worse clinical results compared to stable wrists (good, 1; fair, 4; poor, 3, as compared to good, 6 and fair 4). In all the unstable wrists we therefore believe that the results may be improved if the radiographic signs of instability are specifically looked for immediately after reduction so that abnormal anatomical relationships in the carpus can be corrected early.

Ulnar nerve compression at the elbow level.

The long-term results are reported (average 9 years) of anterior transposition of the ulnar nerve into a muscular groove in the treatment of ulnar nerve compression at the elbow level. The series of 27 elbows consisted mostly of patients with muscle deficit. The results were examined in relation to the preoperative duration of symptoms, particularly weakness and wasting of muscles, and were satisfactory in 78% of cases in that recovery of the muscle deficit was either complete or showed marked improvement. When the duration of symptoms exceeded one year, the results were less satisfactory.

Long-term results of conservative treatment of fractures of the distal radius.

The long-term results of the conservative treatment of wrist fractures were observed in a follow-up study of 297 cases over a period of one and one-half years to six years. The evaluation of the results was based on clinical parameters, both subjective and objective, as well as radiological features. The results were: excellent in 38% of cases, good in 49%, fair in 11.5%, and poor in 1.5%; considerably worse were the subjective results (20% fair to poor). No statistically significant relation could be found between results and type of fracture. Clinical deformities and pain in the area of the distal radioulnar joint were frequent. Decrease in grip strength was observed in 17.8% of cases. A limitation of wrist movement was not frequent. Numerous compressive neuropathies were found (41 in 35 patients), especially of the median nerve. The values relative to the three radiographic parameters under investigation (that is, radial deviation, volar tilt, and radioulnar index) were often found to be out of the normal range. The comparative study of postreduction and follow-up radiograms show the loss of reduction to be frequent, especially as far as the volar tilt is concerned. The frequent radiologic deformities are associated with significantly bad results only in cases of extremely abnormal values. However, fractures of the distal radius are not to be underestimated. Long-term results following conservative treatment may not be as acceptable as is generally assumed.

Osteosynthesis of closed femoral shaft fractures by plate fixation: indications and results.

Osteosynthesis of fractures of the shaft of the femur by plating is not so widely used as intramedullary nailing. It does, however, have precise indications in certain situations that preclude the use of nails or render them inadvisable. The purpose of the present paper is to make a contribution to this aspect of the problem, the literature on which is by no means extensive. The results of forty-seven cases, performed on the basis of the writers' indications, are reported after a long term follow up period.