Methods: we performed a retrospective review of the Maia® arthroplasties implanted between 2010 and 2020 at the Hospital Universitario de Navarra. The Maia® prosthesis is a non-cemented prosthesis with hydroxyapatite coating on its components. A total of 227 patients are included in the analysis and a total of 275 prosthesis. A Kaplan Meier analysis is carried out. The mean follow-up time is 59.6 months (range 24-128 months) and the mean age of the patients included in the study is 62 years (range 41-84 years). Results: after the analysis carried out, a mean follow-up of the patients of 59.6 months and a survival of 95.8% at 50 months were obtained, assuming results consistent with the existing literature to date. Of the total number of patients included in the study, 17 are men (7.4 %) and 210 are women (92.6%). The most intervened hand is the right (53%). The most important complications derived from this procedure have been loosening and dislocation requiring reintervention due to loosening in 4 prostheses (1.4%). We have registered 17 cases of dislocation (6.1%). We expose different rescue methods depending of the situation of the prosthesis. Conclusion: in our experience, the Maia® prosthesis is a reliable method for the treatment of rhizarthrosis resistant to conservative treatment, obtaining a mean survival of 95.8% with a mean follow-up of 59.6 months. The complication rate is low with 6.1% of dislocation and 1.4% of loosening.

Background: Scaphoid fractures are common. Recently drafted BSSH guidelines guide management based on best available evidence. We performed an audit of local practice in a large University Hospital, using these guidelines as the standard to evaluate the management of suspected scaphoid fractures. Methods: Using electronic patient records, we retrospectively reviewed all patients that attended fracture clinic at our centre between January 2021 - June 2021. We identified those patients with diagnosed or suspected scaphoid injuries and identified how they were diagnosed and managed. Results: 121 patients (122 injuries) were identified, 80 suspected scaphoid fractures and 42 confirmed scaphoid fractures. 6/122 (4.9%) had five-view scaphoid series radiographs at ED presentation or initial clinic visit, the remaining had fewer views. 34/42 patients with confirmed scaphoid fracture had a specialist clinic appointment within 7 days. Among those with suspected scaphoid fracture 59/80 had MRI as per the standard, of these 4 had confirmed scaphoid fracture (6.8%). Of those patients managed non-operatively 36/42 (85.7%) had radiographs or CT by 6 weeks post-injury to assess for union. 5 suspected scaphoid waist non-unions were picked up at 6 weeks and subsequently 4 underwent fixation (1 declined). 1 proximal pole non-union presented following discharge and subsequently underwent fixation. Conclusion: Our single-centre study highlights considerable variability in the management of suspected scaphoid fractures and indicates the need for the implementation of a clear investigation and treatment protocol. The incoming BSSH guideline will be of value in standardising the diagnosis and management of scaphoid fractures in the future.

Objective : Flap operation is commonly seen in the field of micro reconstruction.. Ferroptosis is critical in skin flap survival, and fluoxetine can up-regulate Nrf to inhibit ferroptosis. Our aim was to investigate the effect of fluoxetine on inhibiting ferroptosis by regulating Nrf2 signaling pathway and promoting the survival of random skin flap in rats.
Methods : The model of random skin flap in rats was established. SD rats were randomly divided into three groups: low dose group, high dose group and control group, and received intraperitoneal injection of Flu daily. The activity of malondialdehyde (MDA) and superoxide dismutase (SOD) were detected by colorimetry and thiobarbital, respectively. Microvascular density was detected by HE staining. Microcirculation blood perfusion was measured by laser Doppler flowmeter. Lead oxide gelatin angiography shows new blood vessels. Ferroptosis was observed by electron microscope. The expression of related proteins was detected by WB and immunohistochemistry.
Results : Compared with the control group, the survival rate and SOD activity of the skin flap in the experimental group were higher, MDA activity was lower, microcirculation blood flow angiogenesis and VEGF expression was increased, and the number of ferroptosis mitochondria in the cell was decreased. The expressions of TNF-α, IL-1β, IL-6, Nrf2, FTH1, GPX4, GCLc, and NQO1 were also decreased (p < 0.05).
Conclusion : Fluoxetine can promote the survival of random skin flaps in rats by promoting angiogenesis, up-regulating Nrf2 and inhibiting iron death. Therefore, fluoxetine may be a potential therapeutic agent for the repair of damaged skin flap.

Introduction: Several series have reported successful outcomes for arthroscopic repair of superficial TFCC tears using the outside-in technique. Described techniques entail using special instruments for the passage of sutures and/or using many incisions. We describe an arthroscopic technique for repair of the superficial part of TFCC through the 6R portal by a single hypodermic needle, with no additional skin incisions or special equipment. Technique Description: This article describes an arthroscopic technique for repairing the TFCC's superficial part through the 6R portal using only one hypodermic needle and no additional skin incisions or special equipment. Proximal to the 6R portal, a loaded needle with a PDS loop is aimed distally and volar at the tear. The free limb is retrieved through the 6R portal, while the other suture limb is retrieved subcutaneously. A part of the defect is closed when the vertical suture is tensioned. Methods: Surgery was performed on 19 wrists that underwent arthroscopic outside-in repair for superficial TFCC tears. Results were evaluated in the form of a range of motion, grip strength, and functional scores using the Modified Mayo wrist score (MMWS), Quick Disability of the Arm, Shoulder, and Hand (Q-DASH), Visual Analogue Scale (VAS) for pain and satisfaction criteria, and Patient-Related Wrist Evaluation score (PRWE). Results: There was a postoperative improvement in all functional outcome measures (MMWS, VAS, ROM, and power grip). Conclusion: Our technique is a quick, easy, and reproducible method for suturing superficial TFCC tears with single skin penetration with an improvement in functional outcomes.

Closed treatment of a Colles fracture will depend on accurate reduction and adequate immobilization. It has been suggested that the use of finger-trap traction results in a better reduction and a lower rate of re-displacement than manual manipulation does, We compared these two methods in a prospective, randomized controlled trial. METHODS; Forty eight and twenty-three patients with seventy one displaced Colles-type fractures were randomized to treatment with closed reduction with either finger-trap traction (33 patients) or manual manipulation (38 patients). The reduction were performed under GA or Regional Pier Block The fractures were assessed clinically and radio graphically by measurement of the radial angle, and dorsal tilt, before reduction, immediately after reduction, and at one and four weeks after reduction. RESULTS; The age, sex, side of injury and fracture grade of each group were, compared . No significant differences were found between the alignment of the fractures in the two treatment groups at any time. The position were considered acceptable clinically and x-rays , in 89.2% of the patients. seven patients ( 3+4) The failure rates did not differ significantly between the two groups. CONCLUSIONS; The two methods of fracture reduction did not differ with regard to the eventual position of the fracture or the rate of failure. Although closed reduction was successful for the majority of fractures.

Introduction: NICE guidelines advise that MRI directly from emergency should be considered for suspected scaphoid fractures, however, only a minority off centres offer this. Patients may either be seen in OPD or discharged, the latter risking a missed diagnosis. This study reports on the real-life value of further imaging in cases of suspected scaphoid fractures, particularly with negative initial radiography, as observed in routine practice at a DGH. Methods:This study involved 222 patients with suspected scaphoid fractures who were assigned to a ‘scaphoid pathway’ after initial radiography. They were seen in 2 weeks and assessed for anatomical snuffbox or tubercle tenderness; if these signs were present, they were sent for repeat radiographs. If these second radiographs were negative, a CT or MRI was requested. Results:Of 222 patients suspected of scaphoid fractures, 40 (18%) had positive initial radiography. Of the remaining 182 with negative initial radiographs, 4 (2%) had a positive second radiograph. Of the remaining 178 with two negative radiographs, 2 (1%) had positive scan results, 1 of which was CT and the other MRI. Conclusion:The overwhelming majority of scaphoid fractures were diagnosed on initial radiography (87%) with repeat radiography accounting for a much smaller proportion of diagnoses (9%). The remainder of diagnoses were made by CT or MRI and represented only a tiny fraction of the total amount (4%). Due to lengthy outpatient follow-up and the cost of imaging, attention must be paid to the latter’s value in diagnosing scaphoid fractures that have not been detected on initial radiography.

Introduction: The aim of the study was to compare the percutaneous and open scaphoid screw osteosynthesis. It has been hypothesized that the open technique leads to a better radiological result due to the anatomical conditions.

Methods: Between 2001 to 2015 n = 621 patients with scaphoid fractures were operated in our center. Patients with a surgical care and a minimum follow-up of 5 years were enrolled. Two groups were formed, group I - open (n = 56), group II - percutaneously (n = 44) (mean follow up 11a). To objectify the outcome, the VAS, the Quick DASH (QD) and the Sane Score (SS) were collected. All adverse events were documented and a total axial deviation was defined by CT measurements.

Results: The open group had an average total axial deviation of 13.3°. In the percutaneous collective, a statistically significant total axis deviation of 16.3° was objectified. {p = 0.029} There were no relevant differences in 10 cases (group I, 18%, n = 10/56) versus six cases (group II, 14%, n = 6/44) with regard to adverse courses. The average functional outcome: VAS: 0.25 (I) vs. 0.18 (II) {p = 0.743}, QD: 11.5 (I) vs. 13.1 (II) {p = 0.207}, 89% (I) vs. 91% (II) {p = 0.899}.

Conclusions: Both methods have proven to be equivalent in terms of functional outcome and complication rate in long-term outcome. Statistically significantly better screw positions were observed in the open group, which may be due to the anatomical conditions in the percutaneous technique.