A Pagliei

Catholic University of the Sacred Heart , Roma, Latium, Italy

Are you A Pagliei?

Claim your profile

Publications (14)1.58 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: In carpal scaphoid fractures, treatment with screws is considered the gold standard: ostheosynthesis with mini-staples is not the usual choice of treatment. The authors report a study on fractures of the middle third of the scaphoid treated by mini shape memory staples, in order to test the quality of reduction and ostheosynthesis, functional results, time of union and complications. A retrospective analysis of 60 patients, with average age 39 years old and follow-up 36 months, was performed. Evaluation criteria were: the grade of pain, flexion-extension and pronation-supination wrist range, hand grip strength, radiographic consolidation of fractures and lateral intrascaphoid angle of flexion as described by Amadio. Pain was absent in 86% of the cases, the average flexion-extension range achieved was 107 degrees and the average pronation-supination range 171 degrees. Hand grip strength values achieved were comparable to those of the controlateral wrist in 85% of cases. Radiographic consolidation of the fracture was achieved in all patients within three months of surgery and the average value of the lateral intrascaphoid angle of flexion was 37 degrees. No cases of algodystrophy were observed. Our results show the safety and the practicality of ostheosynthesis with mini shape memory staples in fresh unstable fractures of the middle third of the scaphoid. Stable fixation, continuous compressive force on fragments and the ability to allow early active movement, are the main advantages.
    Chirurgie de la Main 01/2005; 24(3-4):153-60. · 0.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives. – In carpal scaphoid fractures, treatment with screws is considered the gold standard: ostheosynthesis with mini-staples is not the usual choice of treatment. The authors report a study on fractures of the middle third of the scaphoid treated by mini shape memory staples, in order to test the quality of reduction and ostheosynthesis, functional results, time of union and complications.Materials and methods. – A retrospective analysis of 60 patients, with average age 39 years old and follow-up 36 months, was performed. Evaluation criteria were: the grade of pain, flexion-extension and pronation-supination wrist range, hand grip strength, radiographic consolidation of fractures and lateral intrascaphoid angle of flexion as described by Amadio.Results. – Pain was absent in 86% of the cases, the average flexion-extension range achieved was 107° and the average pronation-supination range 171°. Hand grip strength values achieved were comparable to those of the controlateral wrist in 85% of cases. Radiographic consolidation of the fracture was achieved in all patients within three months of surgery and the average value of the lateral intrascaphoid angle of flexion was 37°. No cases of algodystrophy were observed.Conclusions. – Our results show the safety and the practicality of ostheosynthesis with mini shape memory staples in fresh unstable fractures of the middle third of the scaphoid. Stable fixation, continuous compressive force on fragments and the ability to allow early active movement, are the main advantages.
    Chirurgie De La Main - CHIR MAIN. 01/2005; 24(3):153-160.
  • A Pagliei, A Tulli, L Rocchi
    [Show abstract] [Hide abstract]
    ABSTRACT: Following an anatomical study on the vascular supply of the upper limb, we propose a new adipo-fascial flap at the wrist. The fat pad of pronator quadratus lies over the muscle and is vascularised by a recurrent branch arising from the anastomotic "cross-road" of the anterior interosseous, radial and ulnar arteries, at the radio-carpal joint. The peripheral extensions of the adipose tissue have to be anchored to the palmar fascia of the muscle in order to hoist the flap as a "square sail". The flap is then distally rotated in order to cover the traumatized median nerve segment at the wrist, for 2.5-3 cm of length. The authors present a review of the clinical applications (1995-2001) on painful neuromas of the median nerve at the wrist, where traumatic and iatrogenic injuries frequently occur. The surgical procedure consists of external neurolysis followed by coverage of the nerve using this vascularised flap. The results confirm the usefulness of vascularised fat flaps in creating an optimal perineural environment in terms of biological and mechanical quality. The advantage offered by this particular local flap is that it can be speedily raised. Because of its limited length the flap is only able to cover the median nerve at the level of the carpal tunnel: its indications are therefore very selective but not rare, due to the frequency of median nerve injuries at this level. Clinical results were very satisfactory: in the twenty cases reviewed, resolution of the symptoms of algodystrophy and causalgia was consistently observed, sometimes to an extraordinary degree, and associated with an improvement in the neurological deficit.
    Chirurgie de la Main 07/2003; 22(3):125-30. · 0.30 Impact Factor
  • A Pagliei, A Tulli, L Rocchi
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction. – Following an anatomical study on the vascular supply of the upper limb, we propose a new adipo-fascial flap at the wrist. The fat pad of pronator quadratus lies over the muscle and is vascularised by a recurrent branch arising from the anastomotic “cross-road” of the anterior interosseous, radial and ulnar arteries, at the radio-carpal joint. The peripheral extensions of the adipose tissue have to be anchored to the palmar fascia of the muscle in order to hoist the flap as a “square sail”. The flap is then distally rotated in order to cover the traumatized median nerve segment at the wrist, for 2.5–3 cm of length.Methods. – The authors present a review of the clinical applications (1995–2001) on painful neuromas of the median nerve at the wrist, where traumatic and iatrogenic injuries frequently occur. The surgical procedure consists of external neurolysis followed by coverage of the nerve using this vascularised flap.Results. – The results confirm the usefulness of vascularised fat flaps in creating an optimal perineural environment in terms of biological and mechanical quality. The advantage offered by this particular local flap is that it can be speedily raised. Because of its limited length the flap is only able to cover the median nerve at the level of the carpal tunnel: its indications are therefore very selective but not rare, due to the frequency of median nerve injuries at this level.Discussion. – Clinical results were very satisfactory: in the twenty cases reviewed, resolution of the symptoms of algodystrophy and causalgia was consistently observed, sometimes to an extraordinary degree, and associated with an improvement in the neurological deficit.
    Chirurgie de la Main 06/2003; 22(3):125-130. · 0.30 Impact Factor
  • Pagliei A, Tulli A, Rocchi L
    Chirurgie de la Main 05/2003; 22(3):125-130. · 0.30 Impact Factor
  • A Pagliei, L Rocchi, A Tulli
    [Show abstract] [Hide abstract]
    ABSTRACT: In the first web space region, there are communications between the dorsal arteries which arise from the dorsal branch of the radial artery and the digital arteries of the thumb and the index finger. These allow a distally based flap to be raised in the first dorsal intermetacarpal area. This flap has been used in 15 cases of soft-tissue loss from the thumb and index finger. The donor sites were closed primarily in all but two patients. There were no complications, and the results show that this flap is useful for soft-tissue defects on the tip and the palmar and dorsal surfaces of the thumb. Moreover, it may be used as a "cross-finger" flap.
    The Journal of Hand Surgery British & European Volume 05/2003; 28(2):121-4. · 0.04 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Concernant les fractures des métacarpes, les morphotypes qui ont posé le plus de problèmes au niveau du traitement sont les fractures diaphysaires et métaphysaires distales, transversales et obliques courtes. Afin d’éviter les complications liées à l’exposition du foyer de fracture (retards de consolidation, pseudarthrose, infections), ainsi que la rigidité qui survient souvent à la suite d’un traitement chirurgical à ciel ouvert ou à ciel fermé par une voie d’abord rétrograde transcapsulaire, les auteurs utilisent depuis environ quatre ans, pour traiter ces morphotypes de fracture, une technique originale d’ostéosynthèse intramédullaire antérograde à ciel fermé, qu’ils ont eux-mêmes conçue. Compte tenu des prem iers résultats encourageants, la technique a été également appliquée aux fractures obliques longues et aux fractures diaphysaires plurifragmentaires. Cent quatre-vingt fractures métacarpales ont été traitées suivant cette méthode : 80 métadiaphysaires distales (obliques courtes), 35 diaphysaires transverses et obliques courtes, 20 diaphysaires spiroïdes, 15 diaphysaires plurifragmentaires, 30 métaphysaires proximales (obliques courtes). Cette technique prévoit l’utilisation d’un instrument original permettant d’introduire les broches de Kirschner dans le canal médullaire. Cet instrument simplifie beaucoup la technique car il permet d’utiliser, sans les plier, des broches de 1,5 – 1,8 mm de calibre, à pointe émoussée, afin d’éviter de perforer la corticale palmaire du métacarpe. Après avoir embroché l’os en utilisant comme point d’entrée l’épiphyse proximale et avoir réduit la fracture sous contrôle radioscopique, on obtient une bonne orientation en rotation des moignons en exploitant le mécanisme de centrage automatique lié au mouvement de flexion – extension des articulations métacarpophalangiennes et interphalangiennes. La mobilisation active immédiate du rayon digital intéressé, évite ainsi les défauts de consolidation en rotation secondaires, complication redoutable du traitement de ces morphotypes de fracture. Enfin, aucune immobilisation n’étant prévue étant donné la stabilité de la synthèse réalisée, on obtient une reprise fonctionnelle immédiate de la main, en évitant les rigidités et les syndromes algodystrophiques.
    Chirurgie De La Main - CHIR MAIN. 01/2000; 19(6):328-328.
  • Journal of Hand Surgery-british and European Volume - J HAND SURG-BRIT EUR VOL. 01/1997; 22(1):34-34.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The authors report a case of ossification of the ulnar nerve at the elbow. The dense bone tissue spread into the interfascicular space while the epineurium and the fasciculi were undamaged. The pathological tissue was removed and the patient recovered. No similar report has been found in the literature.
    Annales de Chirurgie de la Main et du Membre Supérieur 02/1992; 11(2):157-62.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Los autores presentan un caso de osificación del nervio cubital a nivel del codo. La lesión, exclusivamente intraneural, se produce por metaplasia ósea del tejido conjuntivo interfascicular, con conservación de la integridad del epineuro y de los fascículos. La resección de la lesión fue posible con una mejoría clínica. En lo referente a la literatura hemos constatado que ningún caso ha sido señalado precedentemente.
    Annales de Chirurgie de la Main et du Membre Supérieur 01/1992; 11(2):157–162.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Twenty patients, 7 males, 13 females, age range 27-69, average 46 years, with highly painful and inflammatory osteo-articular pathology were treated with a nabumetone preparation (one 1 g capsule at night before going to bed), for a minimum of 6 and a maximum of 10 days (average 9.70 days). Already during the first days of treatment, pain and joint function were improved and reactive edema diminished. The authors believe the drug to have a preventive analgesic effect which may at first consist in an increased pain threshold at the level of capsular receptors and may subsequently involve algoreceptors situated in the tendons. In addition to its analgesic efficacy, the drug has the advantage of being easy to handle neither general nor local side effects were observed. Only two patients complained of digestive side effects (dyspepsia and minor gastric pain in one case; gastric pain and vomiting in the other: both leading to withdrawal of the drug after 6 days). Five patients had excellent results, 9 reported good results, in 5 the result was fair.
    La Clinica terapeutica 07/1990; 133(6):379-86. · 0.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The authors present their experience of early passive mobilisation in hand surgery, by a continuous-cycle motorized device. This method of treatment has been applied to various pathological conditions (post-operative management following such operative procedures as stable osteosynthesis of fractures of the long bones, tenolysis and teno-myolysis, arthrolysis and treatment of complex trauma of the hand), demonstrating very good efficacy. This device allows continuous passive mobilisation of the fingers and represents useful complement in the rehabilitation program of the hand.
    Annales de Chirurgie de la Main 02/1989; 8(4):356-61.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: SUMMARY Purpose :T reatment of flexor tendon injuries in the digital sheath still represents a challenge in hand surgery. Established treatments require splinting and/or pull-out buttons to protect the sutures from excessive loading but, in doing so, the active motion is somewhat limited for several weeks. Furthermore, sutures modify the diameter and shape of tendons' cross-section. These factors can lead to an unsuccessful functional recovery. The author's present a first report on the use of an innovative tendon repair system. Materials and methods: The Teno FixTM device is composed of two intratendinous stainless steel anchors to be inserted in the proximal and distal tendon stumps re- spectively, united by multifilament 2.0 stainless steel suture. Upon tensioning the central wire and locking it by two beads, both ends of the sectioned tendon can be tightened together. A continuous circumferential nylon suture comple- tes the repair. 12 patients with complete lesions of FDP, FDS, or FPL tendons by sharp blade injuries at zone 2 or at the border of zones 1-2 received the treatment. Active mobilization was allowed the first day post-operation with both the wrist and MP joints flexed 30° in a plaster of Paris until the 14th day post-operation (cutaneous su- ture removal), thus allowing full active range of motion. Results: Clinical follow-up showed 83% of good/excellent functional recovery according to the IFSSH evaluation scale. Dynamic x-ray films (in full flexion and extension) showed the efficient tightening of the tendon by the steel suture device over a long period of time (longest f/u 26 months). Conclusions: This clinical study prospects the Teno FixTM device as an effective solution for flexor ten- don repair in the digital sheath. The device's main properties are as follows: straightforward surgical technique, high resistance to rupture, low encumbrance, tendon vascularity preservation and possibility of early active mobilization. Riv Chir Mano 2005; 1: 7-16
  • [Show abstract] [Hide abstract]
    ABSTRACT: The authors present their experience of early passive mobilisation in hand surgery, by a continuous-cycle motorized device. This method of treatment has been applied to various pathological conditions (post-operative management following such operative procedures as stable osteosynthesis of fractures of the long bones, tenolysis and teno-myolysis, arhtrolysis and treatment of complex trauma of the hand), demonstrating very good efficacy. This device allows continuous passive mobilisation of the fingers and represents useful complement in the rehabilitation program of the hand.
    Annales de Chirurgie de la Main. 8(4):356–361.