A. Landi

Tetraplegia: update on assessment.

The overall assessment in the tetraplegic patient should be comprehensive and detailed. This paper discusses aspects of the medical and physical assessment that normally may go unrecognized but are extremely important in the outcome of the tetraplegic patient. A comprehensive classification also is provided as a new guideline for rehabilitation and surgery. Additionally, the power of [figure: see text] cultural, social, and personal dimensions of disability are illustrated and the importance of these dimensions as they relate to assessment is examined. Finally, the COPM is introduced as an outcome measure capable of crossing cultural [table: see text] boundaries and allowing for the comparison of interventions.

Hyaluronic acid scaffold for skin defects in congenital syndactyly release surgery: a novel technique based on the regenerative model

Syndactyly release may require skin grafting to fill the skin defects, which might lead to complications or poor cosmetic outcomes. A simple graftless technique for syndactyly release with a hyaluronic acid (HA) scaffold used to cover the bare areas is described. Between 2008 and 2011, release of 26 webs in 23 patients was performed. All skin defects were covered with Hyalomatrix® PA. One patient was excluded due to early post-operative infection that required HA scaffold removal before its integration. Web creep, secondary deformities, scar quality, and patient and parental satisfaction were assessed. Mean follow-up of the group of 22 patients was 24 months. There were no secondary deformities and minimal degree of web creep. All patients had close to normal pigmentation and good pliability at the sites of scaffold application. The results confirm the use of a HA scaffold as a promising alternative to skin grafting in syndactyly release surgery.

An arthroscopic-assisted minimal invasive method for the reconstruction of the scapho-lunate ligament using a bone–ligament–bone graft:

We report the outcomes of an arthroscopic-assisted minimally invasive technique to reconstruct the scapho-lunate ligament using a bone–ligament–bone graft in 11 patients (11 wrists). The mean follow-up time was 29 months (range 20 to 38). The preoperative mean wrist flexion, extension, grip strength and patient-rated wrist evaluation score values were 61°, 54°, 115 N and 54, respectively. The postoperative mean values were 64°, 58°, 142 N and 15, respectively. There were no statistical differences between the pre- and postoperative wrist flexion and extension, whereas changes in grip strength and patient-rated wrist evaluation score were significant. Scapho-lunate angles decreased significantly from 69° to 60°. Based on our clinical outcomes, this method provides a reliable alterative for the reconstruction of the scapho-lunate ligament in patients with persistent Geissler type 3 and 4 lesions in the short-term. Level of evidence: IV

Acrometastasis showing an occult lung cancer.

Abstract The purpose of this paper was to present a case of an occult lung cancer diagnosed by the presenceof a carpal bone metastatic lesion.

Carpal Tunnel Syndrome: Rare Causes

Carpal tunnel syndrome (CTS), in its idiopathic form, is an extremely frequent entrapment neuropathy in the clinical practice.

Ricostruzione d’emergenza del pollice nell’adulto dopo amputazione traumatica

Riassunto Il trattamento in emergenza rappresenta la migliore opportunita per ricostruire un pollice completamente o parzialmente amputato. Il reimpianto del pollice, considerato uno degli atti chirurgici piu gratificanti, dovrebbe essere tentato tutte le volte che e possibile, in assenza di gravissime controindicazioni generali e locali. Il livello dell’amputazione rappresenta un punto fermo, poiche l’amputazione distale puo non interferire con la normale attivita quotidiana. D’altra parte, il reimpianto distale deve essere considerato su basi individuali, poiche gli sforzi chirurgici sono senz’altro gratificanti. In passato, lesioni avulsive e sguantamenti comportavano una prognosi infausta ed erano affrontati per lo piu in modo tradizionale. Da allora sono state messe a punto diverse procedure microchirurgiche, che hanno modificato questo atteggiamento “dogmatico”. Quando il reimpianto non e possibile, le procedure ricostruttive d’emergenza spaziano da tecniche altamente sofisticate (trapianto parziale dell’alluce, trapianto del complesso ungueale) ai comuni lembi locali, utili per preservare la lunghezza e un’articolazione vicina di salvataggio in previsione di procedure secondarie. In questo capitolo si trattano le indicazioni degli Autori e le rispettive tecniche chirurgiche per una ricostruzione post-traumatica del pollice.