Andrea Atzei

PRO-Mano Treviso - Italy

Introduction The use of wrist arthroscopy has become a prerequisite for diagnosis and treatment of triangular fibrocartilage complex (TFCC) disorders. Since Palmer's landmark paper, many new arthroscopic descriptions of TFCC tears have been published but there is no currently available updated comprehensive arthroscopic classification of TFCC lesio...

Objectives: The purpose of this agreement was to establish evidence-based consensus statements on imaging of distal radioulnar joint (DRUJ) instability and triangular fibrocartilage complex (TFCC) injuries by an expert group using the Delphi technique. Methods: Nineteen hand surgeons developed a preliminary list of questions on DRUJ instability...

Trapezium fractures are unusual; however, they represent the third most frequent fracture of the carpal bones. As they usually follow a high-energy trauma, they are associated with distal radius, Bennett, or Rolando fractures in 80% of cases. Traditional treatment options include, closed reduction and percutaneous pinning, or open reduction and int...

The triangular fibrocartilage complex (TFCC) is the most important stabilizer of the distal radioulnar joint (DRUJ). Its injury is the main cause for ulnar sided pain after wrist trauma. In recent years, advancements of wrist arthroscopy improved the diagnostics and treatment of the TFCC tears. The purpose of this article is to describe a variant o...

Purpose Post-operative pain in the palm and scar area is the most common complication after carpal tunnel release and injury to the terminal branches of the palmar cutaneous nerve is generally considered one of the causes for this complication. The Authors performed an intraoperative study preserving the terminal branches of the palmar cutaneous br...

Secondary wrist stiffness usually occurs following trauma or surgery and is classified as intra-articular, capsular, or extra-articular. Arthrofibrosis affects the radiocarpal, midcarpal, ulnocarpal, and/or distal radioulnar joints. Conservative treatment is the mainstay of management. Once conservative modalities fail, surgical arthrolysis, either...

Wrist stiffness is a debilitating condition that may complicate a traumatic injury to the wrist or follow immobilization of the wrist in a brace or plaster cast. This stiffness may be due to intra- and extra-articular causes. Arthrofibrosis is the predominant intra-articular pathology encountered and may involve the radiocarpal, radioulnar, and uln...

Wrist arthroscopy is a reasonable recently introduced technique but has continued to evolve rapidly. It has equipped the orthopedic surgeon with an excellent tool to assess and treat intra-articular pathologies with dedicated small optics and miniaturized instruments. Meticulous knowledge of the normal wrist anatomy is essential for performing wris...

Background In recent years, new arthroscopic techniques have been introduced to address the irreparable tears of the triangular fibrocartilage complex (TFCC) (Palmer type 1B, Atzei class 4) by replicating the standard Adams–Berger procedure. These techniques, however, show the same limitations of the open procedure in relation to the anatomically d...

The indications of wrist arthroscopy are expanding with the advancement of technical and instrumental development. Most of the diseases in the joint can be managed by this minimally invasive technique with proper portal selection and establishment. This chapter describes in detail the various portals of radiocarpal and midcarpal joint and indicatio...

The triangular fibrocartilage complex (TFCC) is the major stabilizer of the distal radioulnar joint. TFCC disorders may have traumatic or degenerative etiology. TFCC is most often lacerated at its ulnar periphery. According to the magnitude and direction of the traumatic force, the TFCC may rupture in a variable manner, and the ulnar styloid may al...

Recent technical and technological developments in wrist arthroscopic surgery allow for advanced treatments of difficult wrist disorders. In this review, world leaders of wrist arthroscopy describe bone graft for scaphoid nonunion, transosseous repair for triangular fibrocartilage fovea avulsion, palmaris longus reconstruction of the triangular fib...

Objectives The purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique. Methods Nineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the...

Fracture of the base of the thumb metacarpal (M1) is a common finding in hand trauma. Closed reduction and K-wire fixation and open reduction–internal fixation are traditional treatments of choice. The arthroscopic assisted technique has been introduced to improve intra-articular fragment reduction and to preserve fragment vascularization and capsu...

The wrist has a very complex structure and alteration of its components due to trauma creates challenging scenarios for the hand and wrist surgeon. Wrist arthroscopy was developed in 1979 as a diagnostic instrument for intraarticular pathologies but in recent years due to development of technology small optics and working instruments were introduce...

Purpose To evaluate the accuracy of the Trampoline and Hook tests, used in the arthroscopic assessment of triangular fibrocartilage complex (TFCC) tears compared to arthroscopic direct visualization of the radiocarpal joint (RCJ) and of the distal radial ulnar joint (DRUJ). Methods 135 patients (97 males, 38 females, mean age 43.5 years) were divi...

Introduction The appearance of a symptomatic neuroma following finger amputation is a devastating consequence for patient's quality of life. It could be cause of chronic neuropathic pain. The prevention of neuroma formation is a challenging effort for hand surgeons. The biological mechanisms leading to neuroma formation are mostly unknown and diffe...

The development of wrist arthroscopy has been useful in diagnosis, prognosis, and treatment of both ligament and osseous injuries. As the treatment indications and techniques become more refined, this article explores the role of dry arthroscopy to treat radial-sided disorders of the wrist.

Background: The purpose of this study was to describe the technique of arthroscopic resection of the scaphoid head and evaluate both the clinical and radiographic results of scapho-trapezium-trapezoid osteoarthritis cases. Methods: Seventeen cases (13 men and 4 women) with a mean age of 57 years (24-74 years) were operated on from 2002 to 2015. Inc...

We report our 11-year experience of performing arthroscopically assisted triangular fibrocartilage complex reconstruction in the treatment of chronic distal radio-ulnar joint instability resulting from irreparable triangular fibrocartilage complex injuries. Eleven patients were treated. Three skin incisions were made in order to create radial and u...

The classical definition of 'Palmer Type IB' triangular fibrocartilage complex tear, includes a spectrum of clinical conditions. This review highlights the clinical and arthroscopic criteria that enable us to categorize five classes on a treatment-oriented classification system of triangular fibrocartilage complex peripheral tears. Class 1 lesions...

Technical details and clinical results are reported of arthroscopic assisted bone grafting of the lunate, which is indicated in early stages of Kienbock’s disease. Using standard wrist arthroscopic technique, a cavity is created into the lunate by drilling its dorso-ulnar aspect and filled with cancellous bone harvested from the distal radial metap...

Wrist stiffness is a debilitating condition that may complicate a traumatic injury to the wrist or follow immobilization of the wrist in a brace or plaster cast. This stiffness may be due to intra and extra-articular causes. Arthrofibrosis is the predominant intra-articular pathology encountered and may involve the radiocarpal, radioulnar, and ulno...

Wrist arthroscopy is a reasonable recently introduced technique but has continued to evolve rapidly. It has equipped the orthopedic surgeon with an excellent tool to assess and treat intra-articular pathologies with dedicated small optics and miniaturized instruments. Meticulous knowledge of the normal wrist anatomy is essential for performing wris...

Introduction One surgical option for the treatment for SLAC and SNAC stage III° is the midcarpal arthrodesis with scaphoidectomy. Various methods of synthesis for arthrodesis are used from simple K-wires to headless screws and intercarpal plates.

Introduction Palmar midcarpal instability (PMCI) is a painful condition characterized by a kinematic dysfunction of the proximal carpal row (PCR). Although its etiology is still poorly understood, it is believed to be due to congenital (or traumatic) laxity of the ligaments that stabilize the PCR, primarily, the dorsal radiotriquetral (DRT) ligamen...

Background Foveal disruption of the triangular fibrocartilage complex (TFCC) is associated with distal radioulnar joint (DRUJ) instability. TFCC fixation onto the fovea is the suitable treatment, which is not achieved by conventional arthroscopic techniques. We describe an all-inside arthroscopic technique that uses a suture anchor through distal D...

The Authors describe a novel hinged orthosis that permits selective midcarpal mobilization along the plane of the dart throwing motion. This orthotic device can be used to assist rehabilitation protocols aimed to limit radiocarpal joint mobility and scapho-lunate ligament overload and to accelerate wrist functional recovery after ligamentous injuri...

The aim of this study was to assess the objective and subjective functional outcomes after foveal reattachment of proximal or complete ulnar-sided triangular fibrocartilage complex lesions by two surgical procedures: an open technique or an arthroscopically assisted repair. The study was done prospectively on 49 wrists affected by post-traumatic di...

This paper is a review of the various surgical techniques used in repair or reconstruction of the scapholunate ligament according to the clinical stages and anatomic-pathologic findings. Arthroscopy permits a direct evaluation of the scapholunate injury and the status of the articular surfaces. Specific indications for each type of scapholunate lig...

The triangular fibrocartilage complex (TFCC) is a specialized tridimensional structure, composed by a “proximal component” that inserts into the fovea ulnaris and is responsible for the stability of the distal radioulnar joint (DRUJ). Though frequently overlooked, the foveal area is of outmost importance also for the stability of the ulnar carpus,...

An Italian version of the patient-rated wrist/hand evaluation (PRWHE) questionnaire was obtained through the standardized process of cross-cultural adaptation. The PRWHE-Italian (IT) was tested on 63 patients in order to evaluate comprehension, reliability and validity as correlated to the validated version of the disabilities of the arm shoulder a...

The development of wrist arthroscopy was the natural evolution of the successful application of arthroscopy to the other joints of the human body. © 2012 ESSKA Executive Office Luxembourg Centre Médical - FNM 76, rue d'Eich 1460 Luxembourg LUXEMBOURG. All rights are reserved.

During the last two decades, increased knowledge of functional anatomy and pathophysiology of the triangular fibrocartilage complex (TFCC) have contributed to a change in surgeons' perspective toward it. The earlier concept of the TFCC as the "hammock" structure of the ulnar carpus has updated to the "iceberg" concept, whereby the much larger "subm...

Median nerve compression above the elbow is rare. Entrapment of the median nerve at this level is due to a supracondylar process or a ligament arising from the supracondylar process extending to the medial humeral epicondyle. Clinical symptoms are similar to those of median nerve compression below the elbow, but pain localization is almost 5 cm abo...

Diagnosis-related groups (DRGs) are a patient classification system grouping related types of patients treated to the resources they consumed. In this analysis we compared the Italian and the German DRG systems regarding hand surgery with an emphasis on reimbursement of clinical cases. The 15 most common hand surgical diagnoses and their correspond...

Distal radius fractures (DRF) are usually the result of a high-energy injury to the whole wrist joint.

To compare the diagnostic accuracy and radiation exposure of cone beam computed tomography (CBCT) and multislice computed tomography (MSCT) in the evaluation of finger fractures. In a 3-year period, 57 consecutive patients with post-traumatic fractures of the metacarpal-phalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DI...

We treated a prospective series of 18 patients (nine men and nine women) with a mean age of 35 years (range 15 to 57), with chronic predynamic or dynamic scapholunate instability by a dorsal intercarpal ligament capsulodesis using the modified Mayo technique. All the patients were assessed by the modified Mayo wrist score and DASH questionnaire. Wr...

Hyaloglide is a hyaluronan-based gel based on a novel auto-crosslinked technology designed to reduce postsurgical adhesions. Its efficacy was assessed in a multicentred randomized controlled trial comparing the results of flexor tenolysis in zone 2 following failed flexor tendon repairs. In the control group a standard release was performed. In the...

Advances in radiocarpal and distal radioulnar joint (DRUJ) diagnostic arthroscopy permits a treatment-oriented classification of triangular fibrocartilage complex (TFCC) peripheral tears: 1) repairable distal tears; 2) repairable complete tears; 3) repairable proximal tears; 4) non-repairable tears; and 5) tears associated with DRUJ arthritis. Clas...

Osteoarthritis of distal radioulnar joint (DRUJ) leads to chronic wrist pain, weakness of grip strength, and limitation of motion, all of which affect the quality of life of the patient. Over the years, several procedures have been used for the treatment of this condition; however, this condition still remains a therapeutic challenge for the hand s...

There is still controversy regarding the value of arthroscopic suture of triangular fibrocartilage complex (TFCC) peripheral tears compared with open transosseous repair because only the latter method restores foveal insertions of TFCC in case of distal radioulnar joint (DRUJ) instability. Five classes of TFCC peripheral tears are recognized in a t...

We analysed LCP efficiency in type B and type C wrist fractures (according to the AO Classification). We treated 58 wrist fractures (19 B-type fractures and 39 C-type fractures) in 35 male and 23 female patients, aged 19 to 87 years. Forty-one cases were followed up for an average period of 13 months. We performed a volar approach on 32 patients, a...

To evaluate the results of this surgical procedure in patients affected by wrist stiffness after wrist fracture. Criteria for patient inclusion in our preoperative and postoperative study were wrist stiffness with or without pain, decreased grip strength, and unsuccessful results 3 to 6 months after following a rehabilitation program. From 1988 to...

The GRS (Guided Release System)consists of a disposable kit plus two resterilizable elements:an anatomic guide (right and left)(Fig.30.1),that follows the physiological biplanar curve of the ulnar side of the carpal tunnel,and a probe with two ends:one smooth to beused as a dilator for the soft tissues of the carpal tunnel, the other one spoon-shap...

Ten patients diagnosed with scaphoid pseudoarthrois underwent palmar wedge bone graft and internal fixation. Clinical and radiographic evaluation of the carpal joint relationships was performed. Follow up at a median of 33.8 months showed healing of the fracture nonunion with good clinical and functional results in all cases. Measurements performed...

The distal lateral arm flap (DLAF) was used to reconstruct six extensive defects of the digits: 2 degloving injuries of the thumb and 4 major skin losses of the fingers. Two adjacent fingers were involved in 1 patient. Flap size ranged from 3 x 7 cm to 9 x 14 cm. Four flaps were reinnervated using the posterior cutaneous nerve of the forearm. All f...

A controlled clinical trial was performed to investigate the safety and efficacy of the hyaluronate-based gel polymer Hyaloglide after microsurgical reconstruction of peripheral nerves of the hand. Thirty patients were randomized to receive either no postsurgical treatment (n = 16) or Hyaloglide (n = 14) and were clinically evaluated at various int...

The middle third defects of the face following total or partial oncologic maxillectomy include very important facial structures, both for esthetical and for functional reasons. Among the outcomes, large oronasal or oromaxillary fistulas due to destruction of big bone segments and soft tissues have long been the consequences of such extensive surgic...

Arthroscopy is an accepted technique for evaluation of intra-articular pathology and treatment of a variety of disorders even in the wrist joint. Dedicated miniaturized instrumentation is needed along with a specific traction system. The external distraction alone (dry technique) allows for complete joint exploration and several type of arthroscopi...

Wrist stiffness is a complication of wrist trauma or surgery. Rehabilitation is the treatment of choice to improve the wrist range of motion. Since 1988 we used the arthroscopic wrist arthrolysis. Criteria for patient inclusion in our preop and postop study were wrist stiffness with or without pain, unsuccessful results from rehabilitation after 3...

Wrist stiffness is a complication of wrist trauma or surgery. Rehabilitation is the treatment of choice to improve the wrist range of motion. Since 1988 we used the arthroscopic wrist arthrolysis. Criteria for patient inclusion in our preop and postop study were wrist stiffness with or without pain, unsuccessful results from rehabilitation after 3...

SUMMARY Introduction: Wrist arthroscopy have lead higher diagnostic and treatment accuracy as regards posttraumatic di- sorders, giving us the chance to reduce fractures and evaluate the associated lesions. Materials and methods: From 1998 to 2005, 22 patients have been operated on. In all the patients arthroscopy was used in order to get reduction...

Arthroscopy represents a new and promising technique for the diagnosis and treatment of disorders of the wrist. Causes predis posing to clinical failure can arise during any phase of the approach to a patient who is a candidate for arthroscopic treatment. The author examine the causes of failure during pre-operative diagnostic workup, operative pro...

Objectives. – Arthroscopy represents a new and promising technique for the diagnosis and treatment of disorders of the wrist. Causes predisposing to clinical failure can arise during any phase of the approach to a patient who is a candidate for arthroscopic treatment. The authors examine the causes of failure during pre-operative diagnostic workup,...

Pain localization of the wrist is the most common cause of referral to consultation in the office of many hand and wrist surgeons. In many cases, patients’ complaints are readily recognized as typical symptoms and the history pathognomonic of defined disorders. Accurate physical examination, supplemented by standard X-rays, often yields a prompt di...

The use of the anconeus muscle in the treatment of chronic lateral epicondylitis (CLE), recurrences, and infection is presented. In chronic lateral epicondylitis, a wide degenerative area of epicondyle tendon is not frequently found, but when it occurs, its treatment is quite difficult. Recurrences of CLE and superficial or articular infections of...

Injuries of hand involving zone II are burdened by a significant number of treatment failures due to the development of adherences that prevent normal gliding of tendons. Surgical adherences are the result of the physiological process of tendon healing during the first 14 days following surgery. Due to the high frequency of hand traumas and the poo...

In the last decade, immediate reconstruction of maxillary bones following extensive trauma, large oncological defects, or late effects of radiation therapy has proved to be a reliable morpho-functional reconstruction technique. Use of the vascularized iliac crest with an internal oblique flap has become our flap of choice for mandible reconstructio...

This study reports on the long-term functional outcomes of a homogeneous series of 10 cases of successful replantation of an avulsed proximal forearm and its acceptance on the part of patients. After a minimum follow-up of 3 years (average, 4.7 years), muscular and sensory recovery was evaluated with the Medical Research Council scale, and global f...

Widespread use and acceptance of the AO system of internal fixation has fostered in surgeons a preference for the surgical treatment of diaphyseal fractures of the forearm. This is due not only to the problems involved in achieving and maintaining reduction by conservative means, but also because the latter involves prolonged immobilization and is...

In a left index finger amputee, appropriate stimulation of skin areas of the remnant left fingers or left lower face evoked veridical sensations as well as sensations localized to the phantom finger. Five months after the amputation, there was a systematic correspondence between positions of digital and facial stimuli and positions of stimuli felt...