Andrea Atzei - Academia.edu (original) (raw)
Papers by Andrea Atzei
Journal of Wrist Surgery, 2021
Background In recent years, new arthroscopic techniques have been introduced to address the irrep... more Background In recent years, new arthroscopic techniques have been introduced to address the irreparable tears of the triangular fibrocartilage complex (TFCC) (Palmer type 1B, Atzei class 4) by replicating the standard Adams–Berger procedure. These techniques, however, show the same limitations of the open procedure in relation to the anatomically defective location of the radial origins of the radioulnar ligaments (RUL) and the risk of neurovascular and/or tendon injury. Aiming to improve the quality of reconstruction and reduce surgical morbidity, a novel arthroscopic technique was developed, with the advantages of reproducing the anatomical origins of the RUL ligaments and providing all-inside tendon graft (TG) deployment and fixation. Description of Technique The Allinside anatomic arthroscopic (3A) technique is indicated for TG reconstruction of irreparable TFCC tears in the absence of distal radioulnar joint (DRUJ) arthritis. Standard wrist arthroscopy portals are used. A small...
Chirurgie De La Main, Nov 1, 2006
L'arthroscopie est une technique qui a fait ses preuves pour l'évaluation et le traitement de dif... more L'arthroscopie est une technique qui a fait ses preuves pour l'évaluation et le traitement de différentes pathologies intra-articulaires au niveau des grosses articulations et maintenant au poignet. Elle nécessite une instrumentation adaptée et miniaturisée aidée par un système de traction spécifique pour distendre l'articulation. La seule distraction articulaire externe est souvent suffisante pour une exploration diagnostique complète (technique « à sec »). L'exécution de nombreux gestes thérapeutiques peut être réalisée en évitant l'épanchement dans le tissu sous-cutané périarticulaire. La distension de l'espace articulaire par l'injection d'une solution saline (technique par distension liquide ou « mouillée ») est néanmoins la plus pratiquée. La connaissance des repères anatomiques du poignet et une technique chirurgicale soigneuse sont essentielles pour la réalisation de différentes voies d'abord afin d'éviter les lésions des nombreux éléments nobles voisins. On décrit des voies d'abord au niveau de l'articulation radio-et médiocarpienne. Par chaque voie d'abord, on peut visualiser les différentes structures osseuses cartilagineuses, synoviales et ligamentaires. Le chirurgien peut facilement choisir les voies d'abord les mieux adaptées pour l'introduction d'optique et des instruments en fonction des différentes nécessités diagnostics et chirurgicales.
Arthroscopy techniques, Aug 1, 2022
The triangular fibrocartilage complex (TFCC) is the most important stabilizer of the distal radio... more The triangular fibrocartilage complex (TFCC) is the most important stabilizer of the distal radioulnar joint (DRUJ). Its injury is the main cause for ulnar sided pain after wrist trauma. In recent years, advancements of wrist arthroscopy improved the diagnostics and treatment of the TFCC tears. The purpose of this article is to describe a variant of radial tears (1D according to Palmer), in which the radio-ulnar ligaments were ruptured in the midsubstance just before (Pre) their insertion on the sigmoid notch and illustrate the arthroscopic surgical technique used for its treatment. We name this variant of the Palmer 1D lesion, the pre-1D TFCC lesion.
Journal of Hand Surgery (European Volume), Jun 19, 2012
The aim of the study was to evaluate the reliability and validity of the Italian SWAL-QOL (I-SWAL... more The aim of the study was to evaluate the reliability and validity of the Italian SWAL-QOL (I-SWAL-QOL). The study consisted of five phases: item generation, reliability analysis, normative data generation, validity analysis, and responsiveness analysis. The item generation phase followed the five-step, cross-cultural, adaptation process of translation and back-translation. A group of 92 dysphagic patients was enrolled for the internal consistency analysis. Seventy-eight patients completed the I-SWAL-QOL twice, 2 weeks apart, for test-retest reliability analysis. A group of 200 asymptomatic subjects completed the I-SWAL-QOL for normative data generation. I-SWAL-QOL scores obtained by both the group of dysphagic subjects and asymptomatic ones were compared for validity analysis. I-SWAL-QOL scores were correlated with SF-36 scores in 67 patients with dysphagia for concurrent validity analysis. Finally, I-SWAL-QOL scores obtained in a group of 30 dysphagic patients before and after successful rehabilitation treatment were compared for responsiveness analysis. All the enrolled patients managed to complete the I-SWAL-QOL without needing any assistance, within 20 min. Internal consistency was acceptable for all I-SWAL-QOL subscales (a [ 0.70). Test-retest reliability was also satisfactory for all subscales (ICC [ 0.7). A significant difference between the dysphagic group and the control group was found in all I-SWAL-QOL subscales (p \ 0.05). Mild to moderate correlations between I-SWAL-QOL and SF-36 subscales were observed. I-SWAL-QOL scores obtained in the pretreatment condition were significantly lower than those obtained after swallowing rehabilitation. I-SWAL-QOL is reliable, valid, responsive to changes in QOL, and recommended for clinical practice and outcome research.
Springer eBooks, 2000
Widespread use and acceptance of the AO system of internal fixation has fostered in surgeons a pr... more Widespread use and acceptance of the AO system of internal fixation has fostered in surgeons a preference for the surgical treatment of diaphyseal fractures of the forearm. This is due not only to the problems involved in achieving and maintaining reduction by conservative means, but also because the latter involves prolonged immobilization and is associated with a fairly high incidence of pseudarthrosis or malalignment. At the present time, therefore, there is little scope for the treatment of these fractures in a plaster cast (with the exception of fractures in paediatric patients), although some authors still recommend attempting a noninvasive treatment in all cases before embarking on a surgical solution.
Arthroscopy techniques, Jul 1, 2021
Fracture of the base of the thumb metacarpal (M1) is a common finding in hand trauma. Closed redu... more Fracture of the base of the thumb metacarpal (M1) is a common finding in hand trauma. Closed reduction and K-wire fixation and open reduction–internal fixation are traditional treatments of choice. The arthroscopic assisted technique has been introduced to improve intra-articular fragment reduction and to preserve fragment vascularization and capsular and ligamentous integrity along with joint stability. Indications for arthroscopic assistance are all types of intra-articular fractures or pending malunions involving the base of M1 and/or the trapezium. The aim of this article is to describe the surgical technique used in managing articular fractures of the base of M1, with arthroscopic assistance. Our experience with this technique confirms the advantages of a minimally invasive method that provides articular reduction under direct vision, with limited soft-tissue damage, and allows early rehabilitation (from day 1 after surgery). This technique is extremely valuable for high-demand patients such as manual workers or athletes. The relative disadvantage of the technique is its technical difficulty, which requires experience with small-joint arthroscopy.
Microsurgery, 2005
This study reports on the long-term functional outcomes of a homogeneous series of 10 cases of su... more This study reports on the long-term functional outcomes of a homogeneous series of 10 cases of successful replantation of an avulsed proximal forearm and its acceptance on the part of patients. After a minimum follow-up of 3 years (average, 4.7 years), muscular and sensory recovery was evaluated with the Medical Research Council scale, and global function according to the demerit score system of Chen (China Med 5:392À397, 1967). Subjective evaluation and patient satisfaction were investigated by means of a questionnaire. One patient was classified as grade 2, 4 patients as grade 3, and 5 patients as grade 4 according to Chen (China Med 5:392À397, 1967). However, in spite of the poor objective results, patient satisfaction was obtained in 90% of cases, and the replanted extremity was considered of help for common activities of daily living. In conclusion, replantation of an avulsed proximal forearm should be considered only in patients who are strongly motivated to maintain body integrity, and who are aware of the expected functional limitations.
Journal of wrist surgery, Feb 13, 2015
Traumatic disruption of the Triangular Fibrocartilage Complex (TFCC) is a common cause of ulnar-s... more Traumatic disruption of the Triangular Fibrocartilage Complex (TFCC) is a common cause of ulnar-sided wrist pain and is often associated with decreased grip strength and impaired function. The Palmer classification 1 defines traumatic tears involving the ulnar periphery of the TFCC as type 1-B. However, according to the magnitude and direction of the traumatic force, the TFCC may rupture in a variable manner, and the ulnar styloid may also fracture, producing different subtypes of type 1-B tears. Treatment options are variable, depending on the tear's features. We proposed a treatmentoriented classification system 2 that subdivided type 1-B TFCC tears into five classes, allowing differentiation between distal and proximal lesions (i.e., involving the foveal insertions of the TFCC), as well as reparable or irreparable lesions (►Table 1). The European Wrist Arthroscopy Society (EWAS) endorsed the classification. Recently, it was updated Keywords ► triangular fibrocartilage complex ► TFCC ► foveal repair ► arthroscopy ► DRUJ instability
Springer eBooks, Nov 17, 2021
Minerva orthopedics, May 1, 2021
SUMMARY Introduction: Arthroscopy allows for accurate staging of TFCC injuries and its direct rep... more SUMMARY Introduction: Arthroscopy allows for accurate staging of TFCC injuries and its direct repair. In case of degenera- tion or massive disruption, when direct repair is impossibile, we performed arthroscopic reconstruction by tendon graft. Materials and methods: Three patients showing TFCC degeneration or massive disruption associated with distal radio-ulnar joint instability (2 cases bi-directional instability and 1 mono-directional ) underwent
Springer eBooks, Oct 9, 2014
The Journal of Hand Surgery, 2003
satisfaction rate of the patients is very high, all the more so since there are no cutaneous sutu... more satisfaction rate of the patients is very high, all the more so since there are no cutaneous sutures and no wrist immobilization.
Springer eBooks, Dec 29, 2005
... Chondritis/Osteochondritis/ Posttraumatic arthritis Fracture and Malunion Nonunion SNAC Radiu... more ... Chondritis/Osteochondritis/ Posttraumatic arthritis Fracture and Malunion Nonunion SNAC Radius—ulna Scaphoid SLAC Scaphoid Capitate Piso-triquetral arthrosis ... Fractures Lunate hamate Fractures Pisiform Hook of the hamate Arthrosis Post-traumatic Piso-triquetral* Lig. ...
Chirurgie De La Main, Nov 1, 2006
La raideur du poignet est une complication des traumatismes ou de la chirurgie du poignet. La réé... more La raideur du poignet est une complication des traumatismes ou de la chirurgie du poignet. La rééducation reste le traitement de choix pour améliorer la mobilité du poignet. Depuis 1988, nous réalisons des arthrolyses du poignet par arthroscopie. Les critères d'inclusion sont les raideurs du poignet avec ou sans douleurs, avec échec de la rééducation après trois à six mois. Entre 1988 et 2003, nous avons opéré 47 cas (45 patients : 35 hommes pour dix femmes) avec un age moyen de 36 ans. Toutes les voies d'abord radio-et médiocarpiennes ont été utilisées en fonction du site de la raideur. Le recul moyen était de 58 mois (entre 3 et 176 mois). Nous n'avons eu aucunes complications. Tous les patients étaient indolores. La mobilité moyenne en flexion-extension est passée de 92°en préopératoire à 106°en postopératoire. La mobilité moyenne en pronosupination est passée de 145°en préopératoire à 155°en postopératoire. La force de serrage moyenne est passée de 25 à 31 kgf. Le Mayo Wrist Score a été amélioré de 39 à 87, et le questionnaire DASH a obtenu une moyenne postopératoire de 21.
Injuries of hand involving zone II are burdened by a significant number of treatment failures due... more Injuries of hand involving zone II are burdened by a significant number of treatment failures due to the development of adherences that prevent normal gliding of tendons. Surgical adherences are the result of the physiological process of tendon healing during the first 14 days following surgery. Due to the high frequency of hand traumas and the poor results of surgical treatment, numerous studies have been carried out on various anti-adhesion strategies, although no definitive solution has been found. In this manuscript, we report our experience on a hyaluronan-based gel (Hyaloglide) as a preventive measure of surgical adherences due to tenolysis and tendon repair in zone II of the hand. Based on the homogeneity of the results obtained, we propose a treatment protocol based on the efficacy of the device tested
Journal of Hand Surgery (European Volume), Aug 26, 2009
Hyaloglide Õ is a hyaluronan-based gel based on a novel auto-crosslinked technology designed to r... more Hyaloglide Õ is a hyaluronan-based gel based on a novel auto-crosslinked technology designed to reduce postsurgical adhesions. Its efficacy was assessed in a multicentred randomised 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 Õ was applied into the flexor sheath and around the site of tenolysis. Forty-five patients, 19 controls and 26 treated with Hyaloglide Õ , 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 Õ 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 Õ did not appear to increase the complication rate.
Journal of wrist surgery, Feb 20, 2015
Congress Abstract Introduction One surgical option for the treatment for SLAC and SNAC stage III°... more Congress Abstract Introduction One surgical option for the treatment for SLAC and SNAC stage III° is the midcarpal arthrodesis with scaphoidectomy. Various methods of synthesis for arthrodesis are used from simple K-wires to headless screws and intercarpal plates.
Journal of Wrist Surgery, 2021
Background In recent years, new arthroscopic techniques have been introduced to address the irrep... more Background In recent years, new arthroscopic techniques have been introduced to address the irreparable tears of the triangular fibrocartilage complex (TFCC) (Palmer type 1B, Atzei class 4) by replicating the standard Adams–Berger procedure. These techniques, however, show the same limitations of the open procedure in relation to the anatomically defective location of the radial origins of the radioulnar ligaments (RUL) and the risk of neurovascular and/or tendon injury. Aiming to improve the quality of reconstruction and reduce surgical morbidity, a novel arthroscopic technique was developed, with the advantages of reproducing the anatomical origins of the RUL ligaments and providing all-inside tendon graft (TG) deployment and fixation. Description of Technique The Allinside anatomic arthroscopic (3A) technique is indicated for TG reconstruction of irreparable TFCC tears in the absence of distal radioulnar joint (DRUJ) arthritis. Standard wrist arthroscopy portals are used. A small...
Chirurgie De La Main, Nov 1, 2006
L'arthroscopie est une technique qui a fait ses preuves pour l'évaluation et le traitement de dif... more L'arthroscopie est une technique qui a fait ses preuves pour l'évaluation et le traitement de différentes pathologies intra-articulaires au niveau des grosses articulations et maintenant au poignet. Elle nécessite une instrumentation adaptée et miniaturisée aidée par un système de traction spécifique pour distendre l'articulation. La seule distraction articulaire externe est souvent suffisante pour une exploration diagnostique complète (technique « à sec »). L'exécution de nombreux gestes thérapeutiques peut être réalisée en évitant l'épanchement dans le tissu sous-cutané périarticulaire. La distension de l'espace articulaire par l'injection d'une solution saline (technique par distension liquide ou « mouillée ») est néanmoins la plus pratiquée. La connaissance des repères anatomiques du poignet et une technique chirurgicale soigneuse sont essentielles pour la réalisation de différentes voies d'abord afin d'éviter les lésions des nombreux éléments nobles voisins. On décrit des voies d'abord au niveau de l'articulation radio-et médiocarpienne. Par chaque voie d'abord, on peut visualiser les différentes structures osseuses cartilagineuses, synoviales et ligamentaires. Le chirurgien peut facilement choisir les voies d'abord les mieux adaptées pour l'introduction d'optique et des instruments en fonction des différentes nécessités diagnostics et chirurgicales.
Arthroscopy techniques, Aug 1, 2022
The triangular fibrocartilage complex (TFCC) is the most important stabilizer of the distal radio... more The triangular fibrocartilage complex (TFCC) is the most important stabilizer of the distal radioulnar joint (DRUJ). Its injury is the main cause for ulnar sided pain after wrist trauma. In recent years, advancements of wrist arthroscopy improved the diagnostics and treatment of the TFCC tears. The purpose of this article is to describe a variant of radial tears (1D according to Palmer), in which the radio-ulnar ligaments were ruptured in the midsubstance just before (Pre) their insertion on the sigmoid notch and illustrate the arthroscopic surgical technique used for its treatment. We name this variant of the Palmer 1D lesion, the pre-1D TFCC lesion.
Journal of Hand Surgery (European Volume), Jun 19, 2012
The aim of the study was to evaluate the reliability and validity of the Italian SWAL-QOL (I-SWAL... more The aim of the study was to evaluate the reliability and validity of the Italian SWAL-QOL (I-SWAL-QOL). The study consisted of five phases: item generation, reliability analysis, normative data generation, validity analysis, and responsiveness analysis. The item generation phase followed the five-step, cross-cultural, adaptation process of translation and back-translation. A group of 92 dysphagic patients was enrolled for the internal consistency analysis. Seventy-eight patients completed the I-SWAL-QOL twice, 2 weeks apart, for test-retest reliability analysis. A group of 200 asymptomatic subjects completed the I-SWAL-QOL for normative data generation. I-SWAL-QOL scores obtained by both the group of dysphagic subjects and asymptomatic ones were compared for validity analysis. I-SWAL-QOL scores were correlated with SF-36 scores in 67 patients with dysphagia for concurrent validity analysis. Finally, I-SWAL-QOL scores obtained in a group of 30 dysphagic patients before and after successful rehabilitation treatment were compared for responsiveness analysis. All the enrolled patients managed to complete the I-SWAL-QOL without needing any assistance, within 20 min. Internal consistency was acceptable for all I-SWAL-QOL subscales (a [ 0.70). Test-retest reliability was also satisfactory for all subscales (ICC [ 0.7). A significant difference between the dysphagic group and the control group was found in all I-SWAL-QOL subscales (p \ 0.05). Mild to moderate correlations between I-SWAL-QOL and SF-36 subscales were observed. I-SWAL-QOL scores obtained in the pretreatment condition were significantly lower than those obtained after swallowing rehabilitation. I-SWAL-QOL is reliable, valid, responsive to changes in QOL, and recommended for clinical practice and outcome research.
Springer eBooks, 2000
Widespread use and acceptance of the AO system of internal fixation has fostered in surgeons a pr... more Widespread use and acceptance of the AO system of internal fixation has fostered in surgeons a preference for the surgical treatment of diaphyseal fractures of the forearm. This is due not only to the problems involved in achieving and maintaining reduction by conservative means, but also because the latter involves prolonged immobilization and is associated with a fairly high incidence of pseudarthrosis or malalignment. At the present time, therefore, there is little scope for the treatment of these fractures in a plaster cast (with the exception of fractures in paediatric patients), although some authors still recommend attempting a noninvasive treatment in all cases before embarking on a surgical solution.
Arthroscopy techniques, Jul 1, 2021
Fracture of the base of the thumb metacarpal (M1) is a common finding in hand trauma. Closed redu... more Fracture of the base of the thumb metacarpal (M1) is a common finding in hand trauma. Closed reduction and K-wire fixation and open reduction–internal fixation are traditional treatments of choice. The arthroscopic assisted technique has been introduced to improve intra-articular fragment reduction and to preserve fragment vascularization and capsular and ligamentous integrity along with joint stability. Indications for arthroscopic assistance are all types of intra-articular fractures or pending malunions involving the base of M1 and/or the trapezium. The aim of this article is to describe the surgical technique used in managing articular fractures of the base of M1, with arthroscopic assistance. Our experience with this technique confirms the advantages of a minimally invasive method that provides articular reduction under direct vision, with limited soft-tissue damage, and allows early rehabilitation (from day 1 after surgery). This technique is extremely valuable for high-demand patients such as manual workers or athletes. The relative disadvantage of the technique is its technical difficulty, which requires experience with small-joint arthroscopy.
Microsurgery, 2005
This study reports on the long-term functional outcomes of a homogeneous series of 10 cases of su... more This study reports on the long-term functional outcomes of a homogeneous series of 10 cases of successful replantation of an avulsed proximal forearm and its acceptance on the part of patients. After a minimum follow-up of 3 years (average, 4.7 years), muscular and sensory recovery was evaluated with the Medical Research Council scale, and global function according to the demerit score system of Chen (China Med 5:392À397, 1967). Subjective evaluation and patient satisfaction were investigated by means of a questionnaire. One patient was classified as grade 2, 4 patients as grade 3, and 5 patients as grade 4 according to Chen (China Med 5:392À397, 1967). However, in spite of the poor objective results, patient satisfaction was obtained in 90% of cases, and the replanted extremity was considered of help for common activities of daily living. In conclusion, replantation of an avulsed proximal forearm should be considered only in patients who are strongly motivated to maintain body integrity, and who are aware of the expected functional limitations.
Journal of wrist surgery, Feb 13, 2015
Traumatic disruption of the Triangular Fibrocartilage Complex (TFCC) is a common cause of ulnar-s... more Traumatic disruption of the Triangular Fibrocartilage Complex (TFCC) is a common cause of ulnar-sided wrist pain and is often associated with decreased grip strength and impaired function. The Palmer classification 1 defines traumatic tears involving the ulnar periphery of the TFCC as type 1-B. However, according to the magnitude and direction of the traumatic force, the TFCC may rupture in a variable manner, and the ulnar styloid may also fracture, producing different subtypes of type 1-B tears. Treatment options are variable, depending on the tear's features. We proposed a treatmentoriented classification system 2 that subdivided type 1-B TFCC tears into five classes, allowing differentiation between distal and proximal lesions (i.e., involving the foveal insertions of the TFCC), as well as reparable or irreparable lesions (►Table 1). The European Wrist Arthroscopy Society (EWAS) endorsed the classification. Recently, it was updated Keywords ► triangular fibrocartilage complex ► TFCC ► foveal repair ► arthroscopy ► DRUJ instability
Springer eBooks, Nov 17, 2021
Minerva orthopedics, May 1, 2021
SUMMARY Introduction: Arthroscopy allows for accurate staging of TFCC injuries and its direct rep... more SUMMARY Introduction: Arthroscopy allows for accurate staging of TFCC injuries and its direct repair. In case of degenera- tion or massive disruption, when direct repair is impossibile, we performed arthroscopic reconstruction by tendon graft. Materials and methods: Three patients showing TFCC degeneration or massive disruption associated with distal radio-ulnar joint instability (2 cases bi-directional instability and 1 mono-directional ) underwent
Springer eBooks, Oct 9, 2014
The Journal of Hand Surgery, 2003
satisfaction rate of the patients is very high, all the more so since there are no cutaneous sutu... more satisfaction rate of the patients is very high, all the more so since there are no cutaneous sutures and no wrist immobilization.
Springer eBooks, Dec 29, 2005
... Chondritis/Osteochondritis/ Posttraumatic arthritis Fracture and Malunion Nonunion SNAC Radiu... more ... Chondritis/Osteochondritis/ Posttraumatic arthritis Fracture and Malunion Nonunion SNAC Radius—ulna Scaphoid SLAC Scaphoid Capitate Piso-triquetral arthrosis ... Fractures Lunate hamate Fractures Pisiform Hook of the hamate Arthrosis Post-traumatic Piso-triquetral* Lig. ...
Chirurgie De La Main, Nov 1, 2006
La raideur du poignet est une complication des traumatismes ou de la chirurgie du poignet. La réé... more La raideur du poignet est une complication des traumatismes ou de la chirurgie du poignet. La rééducation reste le traitement de choix pour améliorer la mobilité du poignet. Depuis 1988, nous réalisons des arthrolyses du poignet par arthroscopie. Les critères d'inclusion sont les raideurs du poignet avec ou sans douleurs, avec échec de la rééducation après trois à six mois. Entre 1988 et 2003, nous avons opéré 47 cas (45 patients : 35 hommes pour dix femmes) avec un age moyen de 36 ans. Toutes les voies d'abord radio-et médiocarpiennes ont été utilisées en fonction du site de la raideur. Le recul moyen était de 58 mois (entre 3 et 176 mois). Nous n'avons eu aucunes complications. Tous les patients étaient indolores. La mobilité moyenne en flexion-extension est passée de 92°en préopératoire à 106°en postopératoire. La mobilité moyenne en pronosupination est passée de 145°en préopératoire à 155°en postopératoire. La force de serrage moyenne est passée de 25 à 31 kgf. Le Mayo Wrist Score a été amélioré de 39 à 87, et le questionnaire DASH a obtenu une moyenne postopératoire de 21.
Injuries of hand involving zone II are burdened by a significant number of treatment failures due... more Injuries of hand involving zone II are burdened by a significant number of treatment failures due to the development of adherences that prevent normal gliding of tendons. Surgical adherences are the result of the physiological process of tendon healing during the first 14 days following surgery. Due to the high frequency of hand traumas and the poor results of surgical treatment, numerous studies have been carried out on various anti-adhesion strategies, although no definitive solution has been found. In this manuscript, we report our experience on a hyaluronan-based gel (Hyaloglide) as a preventive measure of surgical adherences due to tenolysis and tendon repair in zone II of the hand. Based on the homogeneity of the results obtained, we propose a treatment protocol based on the efficacy of the device tested
Journal of Hand Surgery (European Volume), Aug 26, 2009
Hyaloglide Õ is a hyaluronan-based gel based on a novel auto-crosslinked technology designed to r... more Hyaloglide Õ is a hyaluronan-based gel based on a novel auto-crosslinked technology designed to reduce postsurgical adhesions. Its efficacy was assessed in a multicentred randomised 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 Õ was applied into the flexor sheath and around the site of tenolysis. Forty-five patients, 19 controls and 26 treated with Hyaloglide Õ , 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 Õ 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 Õ did not appear to increase the complication rate.
Journal of wrist surgery, Feb 20, 2015
Congress Abstract Introduction One surgical option for the treatment for SLAC and SNAC stage III°... more Congress Abstract Introduction One surgical option for the treatment for SLAC and SNAC stage III° is the midcarpal arthrodesis with scaphoidectomy. Various methods of synthesis for arthrodesis are used from simple K-wires to headless screws and intercarpal plates.
onenuti nell'arco di dieci anni nel trattamento di tale patologia con innesto osseo spongioso e v... more onenuti nell'arco di dieci anni nel trattamento di tale patologia con innesto osseo spongioso e vite cannulata. Materiale e Metodo: Presso la I Cinica Ortopedica Universitaria di Pisa, dal 2001 al 2011, sono stati trattati 75 pazienti con pseudoartrosi (uomini 51, donne 24, età media 35.2, mano dominante 65 casi). L'intervento è avvenuto in anestesia di plesso brachiale ed accesso volare allo scafoide. Il focolaio di pseudoartrosi è stato ravvivato con fresa e borrato con osso spongioso prelevato dall'olecrano omolaterale. Ripristinato l'orientamento spaziale dello scafoide, la sintesi è stata eseguita con vite cannulata da spongiosa. Nel post operatorio l'immobilizzazione è stata mantenuta per quattro settimane con stecca e nelle successive quattro con tutore Pollex. I p azienti sono stati valutati con il Mayo Score e radiografie in tre proiezioni. Risultati: La consolidazione radiografica è avvenuta nella totalità dei casi in un tempo medio di 60 giorni. Dopo follow-up medio di 7 anni: 62 risultati ottimi, 9 buoni, 3 discreti e 1 cattivo. Casi ottimi e buoni: scomparsa pressoché costante del dolore con miglioramento o stabilizzazione del deficit di flessione del polso; caso cattivo: necrosi del polo prossimale, trattata con protesi APSI. Nessun effetto avverso sulla vite (eccetto il caso evoluto in necrosi) ch e, anche in assenza di consolidazione, ha garantito la stabilità primaria dei monconi senza dolore o successiva instabilità di polso. Discussione e Conclusioni: I risultati confermano la validità della tecnica che, unendo le proprietà biologiche dell'innesto a quelle meccaniche della vite, abbrevia i tempi di immobilizzazione, tuttavia riteniamo controindicato il semplice innesto a press-fit (come nella tecnica originaria secondo Matti-Russe), le sintesi con fili di Kirschner o gli innesti ossei senza stabilità meccanica della vite. Dopo circa 90 giorni dall'intervento i pazienti sono tornati alle loro attività quotidiane senza dolore e soddisfacente recupero funzionale.
L'articolazione radio-ulnare distale (RUD) è l'articolazione trocoide che costituisce lo snodo di... more L'articolazione radio-ulnare distale (RUD) è l'articolazione trocoide che costituisce lo snodo distale del sistema articolare responsabile del movimento di prono-supinazione dell'avambraccio. L'articolazione RUD è in connessione con l'articolazione radio-ulno-carpica (RUC) attraverso un complesso legamentoso-cartilagineo specializzato, definito complesso della fibrocartilagine triangolare (TFCC) 1 . Questa struttura svolge la funzione primaria di mantenere la connessione tra radio e ulna durante la prono-supinazione, e di consentire il trasferimento dei carichi assiali tra il comparto ulnare del carpo e l'ulna, tra i quali è interposta.
