As a consequence of trauma or surgical interventions on peripheral nerves, scar tissue can form, interfering with the capacity of the nerve to regenerate properly. Scar tissue may also lead to traction neuropathies, with functional dysfunction and pain for the patient. The search for effective antiadhesion products to prevent scar tissue formation has, therefore, become an important clinical challenge. In this review, we perform extensive research on the PubMed database, retrieving experimental papers on the prevention of peripheral nerve scarring. Different parameters have been considered and discussed, including the animal and nerve models used and the experimental methods employed to simulate and evaluate scar formation. An overview of the different types of antiadhesion devices and strategies investigated in experimental models is also provided. To successfully evaluate the efficacy of new antiscarring agents, it is necessary to have reliable animal models mimicking the complications of peripheral nerve scarring and also standard and quantitative parameters to evaluate perineural scars. So far, there are no standardized methods used in experimental research, and it is, therefore, difficult to compare the results of the different antiadhesion devices.

Purpose The aim of this study was to evaluate the effectiveness and the safety of performing a four-bone arthrodesis (FBA) with dorsal locking plate in patients suffering from stage III scapholunate advanced collapse/scaphoid nonunion advance collapse (SLAC/SNAC) wrist. Methods We evaluated retrospectively 20 patients surgically treated by a FBA with the use of locking dorsal plate. All the patients were clinically evaluated at follow-up for grip strength, range of motion, and pain (visual analog scale), and with the Disability of the Arm, Shoulder and Hand score and the Mayo wrist score. Imaging evaluation was performed on standard X-rays. Results The mean follow-up was 6 years (range: 1–11 years). During follow-up, the patients showed good clinical outcomes in terms of pain relief and grip strength. Revision surgery was necessary only in one case because of screws loosening. In all cases, a solid bone fusion was achieved except in one patient, who presented a healing of lunocapitate joint. This condition did not affect the clinical outcomes. Conclusion FBA performed using a dorsal locking plate is a salvage procedure effective in treating stage III SLAC/SNAC wrist. In our study, this technique provided good clinical outcomes at mid-term follow-up with a very low complication rate. Level of Evidence Level IV, therapeutic case series.

Background/Objective: Traumatic injuries to the flexor tendons of the hand are frequently treated by hand surgeons. Late repair is not classically considered to be feasible due to the high risk of failure and functional complications. The present study aims to present the functional results of primary flexor tendon repairs performed more than three months after trauma, along with evidence regarding the time limit for primary flexor tendon repair. Methods: The clinical outcomes of direct flexor tendon repairs in zones 1 and 2 of the long fingers or thumb are reported herein. A scoping review was undertaken using Medline and CINHAL to identify studies reporting the functional outcomes of flexor repair following trauma. Results: In this series, four patients were treated with direct M-Tang and epitendinous suture or pull-out reinsertion. Accessory procedures were required to perform a direct repair. The mean delay was 5.5 months, and the follow-up period was 24 months. The mean total active movement was 195°. Extension lags of 10° and 20° were registered at the proximal interphalangeal and distal interphalangeal joints, respectively. While a literature review showed that most cases treated with primary repair after three months resulted in functional complications, these procedures were performed around 40 years ago and no recent reports were found. Conclusions: In the small cohort of patients here reported it has been possible to repair flexor tendons in zones 1 and 2, and to reinsert a jersey finger, even three months after trauma. Accessory procedures were required. Accurate patient selection and counseling is mandatory before surgery to inform patients about alternatives. The literature review confirmed that no positive results have previously been reported in the literature on this topic. It is thought that modern materials and surgical techniques for flexor tendon repair should extend the edge for primary repair in selected patients, as compared to previous practices.

INTRODUCTION: As a result of wrist trauma there are many possibilities to develop post-traumatic osteoarthritis: both because of fractures and of untreated ligament injuries. The review below shows the causes of trauma-related osteoarthritis and surgical options so far known in the literature. EVIDENCE ACQUISITION: An extensive research has been performed on Medline with the following phraseology: "wrist arthritis AND distal radius fractures AND/OR perilunate dislocations and/or scaphoid nonunion and/or lunate dislocation" limited to systematic reviews and randomized controlled trials, to consider only studies with high statistical power. The resulting papers were screened by title and abstract and further papers were retrieved by the reference list of each article. EVIDENCE SYNTHESIS: The aim of surgical treatment is to remove the pain while maintaining a range of motion; when preserving a complete range of motion is not possible, partial or total arthrodesis of the wrist could be a solution. Different partial wrist fusions have been proposed, depending on the joint affected by arthritis. In case of osteoarthritis of the radio-lunate joint, if midcarpal joint is preserved, an alternative solution could be the resection of the first carpal row. Wrist prostheses can certainly be a solution in patients who do not want fusion and do not need strength; they should be aware of the possible need for further surgical treatment. CONCLUSIONS: Wrist post-traumatic arthritis can benefit of different surgical procedures, the choice is related on the stage and the anatomical location of the degeneration, considering patient's functional needs.