Introduction:Kienböck’s disease is characterized by avascular necrosis of the lunate that may proceed to sclerosis and collapse of the bone, wrist instability, and ultimately, end-stage arthrosis. Although considered a rare clinical entity, the disease often
requires surgical treatment due to symptoms of progressive wrist pain and loss of function.
Methods:October 2022-october 2023, We performed arthroscopic STT arthrodesis for two patients with Kienböck's disease (IIIB) . Arthroscopic debridement for the wrist and STT joint, then we performed arthrodesis the STT joint with Kirschner wire fixation. X-ray films were taken at 1 month, 2 months and 3 months after operation. The Kirschner wire was pulled out after bone fusion of STT joint. The Wrist Mayo score was recorded preoperatively and 6 months postoperatively.
Results: Both patients were followed up after operation. 2 months after operation, the STT joint had fused and the Kirschner wire was pulled out. Six months after surgery, the wrist Mayo scores were 60 and 55, respectively. The average score was 57.5.

Conclusion: Arthroscopic-assisted STT Arthrodesis is a common surgical method used to treat Kienböck’s disease. It involves removing the cartilage between the scaphoid-trapezium - trapezoid, and then fixing these two bones together to distribute pressure evenly in the wrist joint, reducing pain and discomfort for the patient.

Objective: This case report aims to present the outcomes of a minimal invasive arthroscopic assisted radial styloidectomy combined with a reduction and association of the scapholunate (RASL) procedure and radio-scaphoid joint tendon interposition in the management of early-stage scapholunate advanced collapse (SLAC) of the wrist. Methods: A 63-year-old female diagnosed with stage I SLAC wrist resulted from the neglected scapholunate ligament injury. She underwent wrist arthroscopic assisted radial styloidectomy and RASL procedure with radio-scaphoid joint tendon interposition for stabilization of the scapholunate joint and the osteoarthritis wrist symptoms relief. The pain score according to the visual analog scale (VAS), wrist range of motion, grip strength, radiographic outcomes and functional outcomes according to the Modified Mayo Wrist Score (MMWS) were evaluated preoperatively and postoperatively during the follow‐up period. Results: The patient reported significant improvement in VAS and grip strength postoperatively. Follow-up image demonstrated maintained scapholunate alignment. The patient achieved good to excellent results according to the MMWS. Conclusion: At a minimum of a year follow up, the patient with stage I SLAC wrist who underwent arthroscopic assisted radial styloidectomy and RASL procedure with radio-scaphoid joint tendon interposition resumed her previous activities and had satisfactory results as well. Further studies with larger sample sizes are warranted to evaluate the long-term efficacy and outcomes of this technique.

Introduction: Thumb carpometacarpal (CMC) osteoarthritis (OA) is a prevalent condition causing significant pain and functional impairment. This study evaluates the efficacy and feasibility of thumb CMC joint denervation as a targeted therapy for CMC OA patients, in a local district general hospital (London, UK). Inclusion Criteria: (1) Clinical and radiological evidence confirming CMC OA (2) Satisfactory thumb posture (3) Exclusion of hypermobile patients due to unsuitability for procedure (4) Absence or minimal subluxation of CMC joint. Methods: A retrospective cohort study was conducted involving 12 patients who underwent CMC joint denervation between June 2017 and October 2021. Data on clinical outcomes were collected through telephone interviews at one-year post-operation and at present-day. Results: 12 patients, three were excluded due to advanced dementia. The remaining cohort, predominantly male (M:F ratio 8:1), exhibited CMC arthritis ranging from Eaton-Littler stages 2-4, with a mean age of 58 years. Significant improvements observed in pain scores, decreasing from 85.5 preoperatively to 21.1 at one-year post-operation and 24.4 at present day. Functional Index of Hand Osteoarthritis (FIHOA) scores also improved from 18.19 preoperatively to 7.39 at present day. Postoperative complications included; paraesthesia reported by three patients, and hypoesthesia around base of the thumb reported by two patients. Conclusion: Thumb CMC joint denervation provides short to medium-term benefits, including pain reduction and improved function. However, careful patient selection and consideration of potential complications are essential. This study contributes valuable insights into the treatment strategies for CMC OA patients, offering enhanced patient care in local DGH.

Introduction: Wide-awake, local anesthesia, no tourniquet (WALANT) is a technique that removes the requirement for operations to be performed with a tourniquet, general or regional anesthesia. We share our experience of Walant surgery. Methods : Between May, 2021 and Octobe, 2023, 409 (293 females and 116 males) patients with a mean age of 38 years (18–78 years) were operated under walant surgery. In addition to classic upper limb pathologies such as carpal tunnel syndrome, trigger finger and synovial cyst of the wrist, walant has also been practiced in traumatology (fractures, wounds) and tumors surgery. A standard walant protocol was applied for all patients. The quantity injected depended on the pathology. Results : Walant surgery procedures were correlated with high overall satisfaction about surgery and the postoperative care. 86% of patients were very comfortable during the surgical porcedure and 87% of them had a score of 0 or 1 on the hamilton anxiety rating scale. No distal ischemia or necrosis have been reported. Minimal cardiac manifestations : palpitations were reported in 4 patients, probably related to the use of adrenaline. Discussion : Many surgeries can be performed safely and painlessly under walant. The patient does not have to fast and can come to hospital unaccompanied and back home immediately afer surgery, permitting to free up hospital places. Conclusion : WALANT has been developed to improve utilisation of operating theatre time and inpatient stay with a high overall satisfaction about surgery and the postoperative care for patients.

Introduction:
Spaghetti wrist is described as lacerations between the distal wrist (Zone V) that involve at least three transected structures, including at least one nerve and often an artery. These are devastating injuries leading to lifelong disability and psychological, social and economic consequences. Recently WALANT technique has been advocated as a safe and effective anesthetic alternative for various hand surgery procedures.
Patients and methods:
A retrospective study was performed prospectively on thirty patients with spaghetti wrist injury who under-went primary repair using the WALANT technique.
Patient satisfaction with the anesthesia technique was rated from 1 to 5 points: 5 points, very satisfied; 4 points, satisfied; 3 points, neutral; 2 points, dissatisfied; and 1 point, very dissatisfied.
Results:
Mean waiting time from admission to operation was 40 minutes. Mean operating time was 110 minutes (range 90–180). During the operation, the mean VAS pain rating was 1.5 points (range 0-3). All patients were either very satisfied (n: 18) or satisfied (n: 12) with the overall treatment and the anesthesia technique.
Discussion:
The results of our study showed that spaghetti wrist lacerations could be safely managed with the WALANT technique. According to the present findings, WALANT is a safe and effective technique for major arterial anastomosis ; local anesthesia associated to adrenaline don't aggravate ischemia or increase the risk of thrombosis.
Conclusion:
WALANT can be used with success in spaghetti wrist injury. It could be the standard anesthesia technique almost for all types of hand and microsurgical procedures in the future.

Objectives:The treatment of dorsal fractures and dislocations of the proximal interphalangeal joint (PIP) presents a challenge,with the essential need to restore adequate joint congruence to achieve stability and prevent late complications such as recurrent dorsal subluxation and degenerative arthritis of the PIP joint.We describe hemihamate graft arthroplasty as an appropriate method for treatment.Materials and Methods:An 18-year-old male suffered trauma to the 4th finger of his right hand 3 months ago.Clinically,he presented with pain,swelling and dorsal subluxation of the PIP joint, with flexion less than 40° and an extension deficit of 20°.Radiographically, a dorsal fracture-dislocation of the base of the middle phalanx (Eaton type IIIB, comminuted) was observed.Surgical intervention was planned, and hemihamate graft arthroplasty was performed.Results: Intraoperative stability was confirmed, with a normal range of motion of the proximal interphalangeal joint.After 1 year of follow-up, radiographs showed joint congruence, the patient was pain-free, with a flexion range greater than 90° and an extension deficit less than 10°.Quantitatively, the patient had a QuickDASH score of 6.8.There was a reported mild sensory alteration associated with the graft harvest site.Discussion and Conclusion:The stability of the PIP joint and the involvement of the base of the phalanx determine the need for surgery.Considering the repair capacity and the extent of the articular lesion, there are several surgical options: reinsertion of the volar plate, osteosynthesis, or defect reconstruction.Hemihamate graft arthroplasty stands out as a reliable technique in scenarios of irreconstructible fractures,offering mechanical stability, anatomical reconstruction of the articular surface, and minimal morbidity at the donor site.

Introduction: Osteoarthritis of the first carpometacarpal joint is one of the most common arthritis of the hand. Its prevalence increases notably in women after the age of 40 years and can compromise quality of life and work capacity. Patients with basilar thumb arthritis who present with refractory symptoms despite nonoperative measures may benefit from surgical treatment. Results: Twelve patients were operated between 2017 and 2024 in the same institution and by the same surgeon (the low sample being related to the loss of a few patients due to the SARS-CoV-2 pandemic). All of the patients were women with a median age of 67.1 years and had Eaton-Littler stage III and IV disease. Four patients were submitted to trapeziectomy and ligament reconstruction with flexor carpi radialis interposition, two to trapeziometacarpal joint replacement and six to trapeziectomy and suture-button suspensionplasty. Overall, the outcomes are good as the patients recovered quickly, with a mean QuickDASH of 15.72. However, in the group of suspensionplasty, one patient had hardware intolerance, for which a reoperation was necessary to remove the implant, having afterwards residual pain and discreet loss of grip strength. In the group of ligament interposition, two patients had residual pain with movement. Discussion: There is a multitude of surgical procedures to treat basilar thumb arthritis that offer similar functional results depending on patient’s age, functional demands, arthrosis stage and surgeon experience, each one with its associated complications. Suture-button suspensionplasty is a newer technique that offers good results with less subsidence of the first ray.

Introduction: Treatment of advanced Kienbock disease has been accomplished by many methods. Most claim approximate results. Methods were selected according to the available facilities and patient preferences. Removal of the dead fragmented Lunate and, Scaphoid- Capitate arthrodesis is an option for minimal demands. Purpose: To assess the results of Lunate bone excision and Scaphoid-Capitate arthrodesis in relieving the symptoms and, improvement of the functions of the hand. Methods: A prospective study of treating 28 patients (18 males, 10 females), mean age was 35 (22-48), with stage III and IV Kienbock disease by excision of the Lunat and fusion of the Scaphoid and Capitate bones with temporary fixation by K Wiers, with or without bone graft. The mean follow-up was twelve months (8-20). Assessment of the outcomes included pain, range of motion of the wrist, grip strength, complications, and Mayo Clinic hand score. Results: Scaphoid-Capitate union gained in all 28 candidates, pain decreased, and power of grip improved, however, range of motion decreased. Mayo's hand score improved. No significant carpal collapse was noticed through the short follow-up. No significant complications were noticed. Conclusion: Lunate removal and scaphoid-capitate fusion is a useful method of treatment of advanced Kienbock disease with low-available facilities.
Type of study/ level of evidence: Therapeutic IV
Keywords: Arthrodesis of scaphoid & capitate, Kienbock disease, Lunate excision.

Background: Metacarpal fractures are the most common hand injuries. The choice of the method of treatment depends on different clinical and radiological factors. The goal of the treatment of metacarpal shaft fractures is restoration of the hand function. Aim: To compare the results of fixation of oblique and spiral metacarpal shaft fractures with mini plate versus mini screws. Methodology: Randomized control trial for 28 patients with oblique and spiral metacarpal shaft fractures who had open reduction and internal fixation with mini plate or mini screws over a period of 18 months with 6 months follow-up afterwards. Results: The first group operated with the mini plate while the second group operated with mini screws, both groups were 14 patients. The mini plate group patients had better outcome regarding the time to return to work if compared to the mini screws group, 2 mean values of TAM and DASH scores were higher in the mini plate group however this was only in the first follow up, the function was the same at the second and third follow-ups for both groups. Regarding the fracture union, all the patients in both groups ended up healing. However, there was one case with delayed union in mini plate group and two cases in the mini screws group. Conclusion: Both groups operated with mini plate or screws had the same functional outcomes after the end of the follow-up.

Trapeziectomy and suture-button suspensionplasty (TSBS) has emerged as a crucial technique for treating end-stage trapeziometacarpal (TMC) osteoarthritis, providing an alternative to conventional methods using autologous graft. Medium-long term results of this procedure are, however, still controversial in the literature. This study presents a comprehensive clinical and radiological review of TSBS treatment ingrade III-IV Eaton TMC osteoarthritis. A total of 34 patients, predominantly female (86%), underwent this procedure in the period of 2015-2022, in a central care hospital. All cases were operated by the Institution´s Hand and Wrist team. The minimum follow-up period was 12 months. Clinical and radiological evaluation was performed at follow-up consults. Patient-reported outcomes revealed high satisfaction rates, with 62% reporting a Visual Analog Scale (VAS) score less than 3, and a Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score at the final assessment was 21. Average Kapandji score was 9. The average time to return to previous activities was 2.4 months.Additionally, 56% of patients reported being “Satisfied/Extremely Satisfied” with the procedure. Complication rates and radiological measurements such as first metacarpal subsidence were also recorded and presented. This study demonstrates overall good functional results associated with TSBS. IT highlights the efficacy and also the shortcomings of the treatment with TSBS, providing valuable insights for the treatment of Basilar Thumb Arthritis.

Introduction: Despite being the most frequent tumor of the peripheral nerve, schwannoma (neurilemmoma) is frequently misdiagnosed or delayed in diagnosis due to its low incidence, slow growth, and ambiguous symptoms. The study's objective is to present a series of upper limb schwannomas, some of which have extremely uncommon occurrences.
Materials and methods:
A retrospective single center study was carried out on 18 patients with an isolated peripheral schwannoma operated between 2018 and 2024. Clinical examination and imaging tests were used to make the diagnosis; no prior biopsy was ever carried out. The decision to undergo surgery was made in response to symptoms or neurological deficit. The diagnosis of schwannoma was verified in each case. Histological and immunohistochemical analyses were used to confirm the diagnosis of schwannoma in each case.
Results:
Under a surgical microscope, a full tumor enucleation was carried out for each patient. Two years following surgery, there was no sign of recurrence. Patient satisfaction was high, and every case had full socio-professional integration. The average preoperative tumor volume measured on MRI was 2.54 cm. The most common preoperative symptoms were paresthesia (83%) and pseudo-Tinel sign (74%) and hypoesthesia (24%) were observed. On the other hand, preoperative neurological motor manifestations remained exceptional (6 %). The rates of new post-operative motor deficits, paresthesias, and sensory deficits were nil.
Conclusion:
Surgical resection may be a safe procedure for peripheral nerve schwannoma treatment with satisfying functional results and an acceptable risk of nerve injury.

Limited availability of cement-free artificial joint replacements for the PIP hand joint poses a challenge commercially. The HAPTic prosthesis by Implantcast addresses this need exclusively, comprising a titanium-nitrite hardened proximal component with a bioactive surface and a hydrocarbon compound socket component for the middle phalanx. In our establishment, 10 such prostheses were implanted between January and April 2023, with promising initial results following a proposed surgical technique.

Initial follow-up, including a 6-month prospective study on 10 patients (average age: 61.6 years; 4 men, 6 women), demonstrated encouraging outcomes. Parameters such as range of motion (ROM), Visual Analog Scale (VAS) scores, Disability of the Arm, Shoulder, and Hand (DASH) scores, pinch grip strength, and collateral ligament stability were assessed. Mobility improved from 67° to 83°, VAS scores decreased from 5.9 to 3 points, and DASH scores improved from 34 to 18 points. Although pinch grip strength decreased slightly, all joints remained stable, with complete osteointegration observed radiologically after 6 months.

Close clinical and radiological monitoring is planned for further evaluation, with one-year results expected to be presented at the SICOT congress in Belgrade. In conclusion, the HAPTic prosthesis shows promise as a reliable solution for PIP joint replacement and we will continue to use this implant.