Matteo Guzzini

Background/Objectives: Thumb basal joint arthritis is a common degenerative condition often requiring surgery when conservative treatment fails. Dual mobility trapeziometacarpal prostheses are increasingly used, but the optimal anesthetic strategy remains debatable. This study aimed to explore whether WALANT provides intraoperative analgesia and short-term safety comparable to axillary block in dual mobility trapeziometacarpal arthroplasty. Methods: A prospective observational comparative study was carried out on 21 patients (11 WALANT, 10 axillary block) undergoing dual mobility trapeziometacarpal prosthesis for stage II–III in thumb basal joint arthritis according to Eaton–Littler classification at two hospital facilities of ASL Roma 5, from February–December 2025. Patients treated with the WALANT technique were assigned to Group A, whereas those undergoing an axillary block were assigned to Group B. Pain intensity was recorded on a 0–10 visual analogue scale at three stages: during anesthetic administration, during surgery, and 3 h after the procedure. Group A received a field infiltration with 1% mepivacaine combined with epinephrine 1:100,000 and sodium bicarbonate, while Group B underwent an ultrasound-guided brachial plexus block using 0.5–0.7% ropivacaine and a pneumatic tourniquet inflated to 250 mmHg. Results: Pain during anesthesia induction was similar between groups (Group A 3.18 ± 2.89 vs. Group B 2.20 ± 2.37, p = 0.393). Intraoperative pain did not differ significantly (Group A 2.27 ± 1.79 vs. Group B 2.00 ± 2.71, p = 0.898). At 3 h postoperative, Group B showed a trend toward lower pain levels (Group A 4.36 ± 2.54 vs. Group B 3.00 ± 3.08, p = 0.244). No anesthetic failures, no conversion to general anesthesia, and no neurological or ischemic complications occurred in either group. Conclusions: In this prospective observational comparative cohort, WALANT and axillary block provide comparable intraoperative analgesia for dual mobility trapeziometacarpal prosthesis, with comparable safety profiles. WALANT offers advantages in ease of administration, absence of tourniquet-related risks, and potential for intraoperative functional testing. Axillary block provides more prolonged postoperative analgesia in the first 3 h. The choice between techniques should be individualized based on patient-specific factors, anxiety profile, and local expertise. These results should be interpreted as preliminary and hypothesis-generating, given the exploratory design, the small sample size, and the limited statistical power of the study.

Purpose: Thumb osteoarthritis is a debilitating condition that affects a large portion of the elderly population. Conservative treatments for this condition often fail, and a surgical solution is required. Many different surgical techniques have been described, but the current literature has not yet demonstrated the superiority of one over the others. In this study, we analyzed the clinical and radiological findings of a population of 26 patients who were operated on both hands but with different techniques. Methods: One hand underwent trapeziectomy with suspension arthroplasty, while the other hand was operated on with a double mobility trapeziometacarpal prosthesis. Results: Our findings show that, while on the long-term follow-up the two techniques are equally valid, in the short term, the hands that were operated on with the prosthesis had a faster recovery of strength and pain. Conclusion: Therefore, we reckon that double mobility trapeziometacarpal prostheses are a better choice of treatment, especially for patients who require a faster recovery for work or leisure activities.

Background: Thumb carpo-metacarpal arthritis, a form of arthritis at the base of the thumb, causes pain, swelling, and limited mobility, significantly affecting patients' quality of life. This study aimed to evaluate the efficacy of an exercise protocol, comparing standard treatment with an app-assisted approach. Methods: Two groups of 10 patients each were randomly assigned standard treatment or standard treatment plus a Hand Rehab App. Both groups received physiotherapy sessions over three phases spanning three months. Results: Both groups showed improvement, with Group 0 showing more significant improvements in several variables. However, the clinical significance of these improvements differed between groups. Discussion: Group 0 had significant improvements in FLEX IF, FLEX MF TT, and VAS AT NIGHT, while Group 1 had significant improvements in FLEX MF and TT. Group 1 showed greater improvement in JAMAR and TT, while both groups showed similar improvements in other variables. Overall, Group 1 showed more improvement in key measurements. Conclusion: This study suggests that adding a specific app to exercise therapy may enhance outcomes for trapeziometacarpal osteoarthritis patients, particularly in terms of pain relief and functionality.

Article: The use of medial femoral condyle corticoperiosteal flap in the treatment of nonunions of upper and lower limbs - Minerva Orthopedics 2024 June;75(3):224-32 - Minerva Medica - Journals

The Kinesio Taping (KT) is being increasingly applied in physical therapy and rehabilitation. The aim of this study was to evaluate the effect of KT on an early rehabilitation program, in combination with the standard protocol after ACL reconstruction (ACLR). This study enrolled 52 male patients, aged 18 to 45 years, who underwent ACLR with doubled gracilis and semitendinosus tendon (DGST) autograft. The patients were randomized into 2 groups: Group A (the control group) which received a standard rehabilitation protocol, and Group B (the experimental group), which had the same rehabilitation protocol plus the KT application. Pain intensity, range of motion, edema, thigh circumference, Tegner-Lysholm Scale and KOOS scale were measured at the second and fourth week follow-ups. Patients in the experimental group showed significant results during the second week for both pain and edema reduction compared to the control group (p< 0.05). After 4 weeks of rehabilitation, pain intensity in the two groups was similar (n.s.), while edema reduction in the experimental group showed a significant result compared to the control group (p< 0.05). Nevertheless, the other outcomes did not show significant differences. The application of KT after ACLR contributed to relieve pain and reduce edema in the early postoperative rehabilitation period. Other potential benefits of KT on muscle activation and strength should be investigated through a longer follow-up and a targeted test.

The COVID-19 outbreak heavily attacked Italy, putting a strain for an extended time on the National healthcare system. Hospitals fastly rearranged the activity to cope with the crisis. This retrospective comparative study intended to investigate the impact of the lockdown imposed in Italy, in two different periods, during the COVID-19 outbreak on acute orthopedic trauma, in order to identify significant issues for improvement and future preparation. We obtained data on total trauma access to a single University hospital DEA (Department of Emergency and Acceptance) in Rome during two periods of the COVID-19 pandemic lockdown in Italy: from March 9th, 2020 to May 4th, 2020(Phase 1), from May 10th, 2020 to June 30th, 2020(Phase 2) and then comparing them with the analogous period in 2019. We recorded demographic data; the characteristics of the lesion, including the anatomical area, fracture, sprain, dislocation, contusion, laceration, whether the lesion site was exposed or closed, where the trauma occurred and polytrauma. We also reported the waiting time in the emergency room and the mode of transport. The study sample was composed of 1655 patients, 894 (54%) males and 761 (46%) females. The overall number of admissions in 2019 (pre-COVID-19 period) was 995; then it was 204 during Phase 1 and increased again to 456 during Phase 2. The average age of the Phase 1 group was 51.9 ± 24.8 years, significantly higher than that of the 2019 group (41.4 ± 25.7) and Phase 2 group (42.2 ± 22.5 years) (p=65 years) were the most commonly involved in the Phase 1 group, while in the pre-COVID-19 period and in Phase 2 they were middle-aged adults (15-44 years) (p<0.0001). The injury occurred at home in 66.2% of cases in the Phase 1 group, in 32.3% of cases in the Phase 2 group and in 32.3% of patients in the 2019 group. Concerning the injury type, in all groups, the most frequent injury was a fracture (45.1% in 2019; 62.7% in Phase 1; 50% Phase2) (p<0.0001). The most injured anatomical section during Phase 1 was the upper limb (43.1%), while in the pre-COVID-19 group and in Phase 2 group the most frequent injury location was the lower limb (48.3% and 40.8% respectively). Despite the decrease of overall acute trauma referral rates during the COVID-19 outbreak in Italy, the incidence of fractures in elderly people remained constant, indicating that not all trauma presentations would inevitably decrease during such circumstances.

The purpose of this study is to evaluate the clinical and radiological outcomes of scaphoid non unions surgically treated with bone graft versus medial condyle corticoperiosteal free flaps. 32 patients were divided in 2 groups. Group A (17 patients 12male, 5 females, mean age 35 years old) treated with bone grafts; Group B (15patients 11 male, 4 females, mean age 33 years old) treated with medial condyle cortico periosteal free flap. A radiological follow up was performed about every 30 days after surgery until the complete healing and at 12-month follow-up. The clinical follow up was performed at 6 and 12 months from surgery. Functional assessment was provided by Mayo wrist score and Visual Analogic Scale (VAS). The average length of follow up was 12.52 months ± 1.36. In group A 60% of patients healed in 4.4 ± 1months with a reduction of 28.4% of healing times in group B (p<0.05).In Group B all nonunion sites healed primarily at an average time period of 3.2 ± 1 months. Statistical analysis showed a significant difference (p<0.001) about the preoperative and the postoperative VAS and Mayo Wrist Score evaluation in both groups at 6 and 12-month follow-up, moreover we recorded a statistical difference between groups at the 6-month and 12-month follow-up (p<0.05). The present study showed that the free flaps showed better clinical and radiographic results for the surgical treatment of scaphoid nonunions. In fact, despite the good results of the bone graft, the flaps seems to be preferable in the treatment of these nonunions.

Kienbock's Disease, or lunatomalacia, has uncertain etiopathogenesis, it is more common in male from 20 to 45-year-old. The Lichtman's classification is the most used by authors and it divides Kienbock's Disease in 4 stages according to radiographic parameters. In early stages could be performed a conservative treatment, but failure rate is high; various surgical techniques are available in case of failure or higher stages. We report a case of a 26-year-old female volleyball player affected by stage I Kienbock's Disease who underwent distal radius osteotomy core decompression synthesized with Carbon-Peek plate fixation. Follow-up was performed with clinical evaluation (ROM analysis, VAS score, Quick Dash Score), wrist radiographs and wrist MRI.

Background The all-inside graft-link technique for anterior cruciate ligament reconstruction is performed with two cortical suspension devices with adjustable loops on both femur and tibia. This technique requires meticulous graft preparation. The aim of this study was to biomechanically test three different graft configurations resulting from differences in initial graft length. Materials and methods Thirty bovine digital extensor tendons were arranged in three different ways: “half-quadrupled”, “tripled” and “quadrupled”. The final graft length was 65–75 mm. The specimens were fixed vertical to the loading axis of a tensile testing machine. After a static pre-conditioning of 50 N for 5 min, a load to failure test was performed and data regarding the ultimate failure load (UFL), the stiffness and mode of failure were recorded. Results The evaluation of UFL showed a significant differences between group means as determined by one-way analysis of variance (F = 21.92, p = 0.002). Post hoc comparisons showed a significantly better UFL of “tripled” (p = 0.007) and “quadrupled” preparations (p = 0.014) compared to the “half-quadrupled” configuration, with no significant differences between “tripled” and “quadrupled” grafts (p = 0.061). No significant differences were found when evaluating the stiffness between the groups. Failure occurred by tendon slippage across the suture in all specimens. Conclusion The “quadrupled” tendon achieved the best UFL, with even the “tripled” configuration having sufficient biomechanical characteristics to withstand the loads experienced during early rehabilitation. For this reason, with a total semitendinosus length of less than 260 mm it could be better to “triple” instead of “half-quadruple” it to achieve better performance of the graft.