Chronic osteomyelitis is a challenging problem, and malignant transformation is a rare occurrence. We report a case of a patient with squamous cell carcinoma arising from an osteomyelitic hotbed and discuss through a literature review the etiopathogenesis, diagnosis, and treatment of this lesion. A 69-year-old Italian man had sustained an exposed tibial fracture 40 years ago during a road accident, for which he had undergone various surgical osteosynthesis treatments with multiple antibiotic therapies. He presented to our hospital because of recurrence of a fistula at the proximal third of the anterior region of the tibia. For 2 months, we treated the lesion with antibiotics, and local medication with curettage. We saw no evidence of lesion improvement, and we advised the patient to undergo a knee amputation, which he refused. The alternative we chose was a surgical toilet of the osteomyelitic hotbed and used bioglass as a bone substitute. After 2 months of follow-up, we noticed a fulminating, budding formation in the area of the surgical wound that turned out to be a squamous cell carcinoma on biopsy. The patient again refused the amputation and underwent a wide-margin surgical debridement. After 2 months, the carcinoma recurred, and an above-the-knee amputation was performed. Our experience with this case indicates that amputation is the most appropriate treatment for squamous carcinoma occurring in patients with chronic osteomyelitis. To avoid risks of lymphonodular and organ metastasization, this radical surgical procedure should not be delayed. Early diagnosis and timely therapy can prevent amputation only in selected cases. Surgeons who treat osteomyelitis and chronic wounds should be aware of the risk of tumor degeneration. Squamous cell carcinoma associated with chronic osteomyelitis has a low-grade malignancy, but implications of lymphonodular involvement and organ metastasis should not be excluded.

Background: Trapeziometacarpal (TM) joint arthritis is a common condition causing pain and functional limitations, particularly in activities requiring pinch and grip strength. Surgical options such as interposition trapeziectomy and prosthetic joint replacement have demonstrated varying degrees of success. However, the role of post-operative rehabilitation in optimizing outcomes for these procedures remains underexplored. Effective rehabilitation may be critical for restoring strength, range of motion (ROM), and overall hand function; yet, no consensus exists on the best approach for either surgical modality. This study aims to evaluate the impact of post-operative rehabilitation on functional and clinical outcomes in patients undergoing interposition trapeziectomy versus prosthetic replacement for TM joint arthritis. Methods: A retrospective cohort study was conducted on patients treated for TM joint arthritis between November 2023 and October 2024. Patients were divided into two groups based on the surgical procedure: interposition trapeziectomy and prosthetic replacement. Patients randomly followed post-operative rehabilitation protocols, auto-assisted exercises, or no type of rehabilitation. The outcomes assessed included pain (VAS), return to work or heavy activities, post-operative complications, hand function (DASH score), and patient satisfaction at 1 and 6 months after surgery. Results: The prosthesis group consisted of 30 patients, while 31 patients underwent interposition trapeziectomy. Patients in both groups showed good improvements in pain, ROM, and hand function post rehabilitation. The prosthetic group demonstrated a faster recovery of strength and higher early satisfaction scores, but in the long term, the results were overlapping. No significant differences were observed in long-term functional outcomes or patient satisfaction at 6 months. In the trapeziectomy group, for patients who followed a rehabilitation program, no significant differences were found. Conclusions: Post-operative rehabilitation finds its place in recovery after both interposition trapeziectomy and prosthetic replacement for TM joint arthritis. While prosthetic replacement allows for quicker functional recovery, interposition trapeziectomy offers comparable long-term results with a lower complication profile. Tailored rehabilitation protocols may enhance outcomes and should be considered an integral part of TM joint arthritis management in selected patients.

Background: Secretan’s syndrome is a rare and under-recognized condition characterized by chronic, indurated, non-pitting edema of the dorsal hand with thumb sparing. Twelve studies reporting 17 patients have been published worldwide, mostly as isolated case reports, and its pathogenesis remains debated between traumatic, inflammatory, and factitious mechanisms. This article presents a surgically managed hyperplastic case and a literature review, highlighting how precision medicine principles can guide diagnosis and treatment. Materials and Methods: A 36-year-old healthcare worker developed progressive dorsal swelling of the left hand following minor trauma, with marked restriction of metacarpophalangeal flexion. Laboratory tests and radiographs were normal. MRI demonstrated peritendinous fibrosis encasing the extensor tendons. Psychiatric evaluation excluded factitious behavior. Due to functional limitation and MRI evidence of fibrosis, selective fasciotomies and tenolysis were performed. A systematic literature review was conducted, in accordance with the PRISMA 2020 guidelines, to summarize epidemiology, clinical and imaging features, histopathology, and management options. Results: Histology revealed fibro-adipose tissue with chronic inflammatory changes and CD68+ histiocytic aggregates; microbiological cultures were negative. Postoperative rehabilitation enabled significant functional recovery. The literature review confirmed the scarcity of published cases and the absence of standardized guidelines. MRI proved the most informative imaging tool, while surgery was described only in refractory forms. Conclusions: This case and review illustrate how a precision medicine approach can optimize management of rare disorders. Early MRI-based diagnosis, multidisciplinary assessment, and phenotype-driven surgical intervention allowed tailored treatment and favorable outcome. Personalized care that integrates clinical features, imaging findings, and patient-specific factors may improve results despite the limited evidence base.