Pyrolytic carbon implants for trapeziometacarpal (TMC) arthritis have been extensively studied, but there is still discrepancy in the literature concerning the mid-term functional results. Our group describes the clinical and radiological results after five years of surgical management of TMC arthritis with Pyrodisk (Integra Life Sciences, Plainsboro, NJ, US). A total of 19 patients (2 males and 17 females) aged 56.45 ± 5.95 (range: 44 to 67) years were reviewed with a mean follow-up of 74.05 ± 14.43 (range: 60.00 to 105.83) months. At the final follow-up, the score on the Visual Analogue Scale (VAS) for pain was of 1.76 ± 2.05, the average score on the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire was of 22.73 ± 22.33, and all functional parameters were above the 90% barrier of the contralateral side. The progression of radiolucency was 89% at 1 year and 11% at 5 years of follow-up respectively, but it was not related to the clinical outcomes. The prevalence of subluxation (around one-fourth of the center of the implant) was of 24% in asymptomatic patients, and dislocation was not observed. The overall survival of the implant was of 89%. Revision took place in 11% of the cases due to persistent pain and implant breakage after direct impact. More than 75% of the patients were very or highly satisfied with the treatment. In conclusion, Pyrodisk enabled us to obtain good functional mid-term results, with an acceptable survival of the implant and low risk of dislocation. Radiological findings do not necessarily translate into clinical symptoms.

Background Dorsal wrist ganglia are the commonest soft tissue tumor in the upper extremity. Management with arthroscopic excision yields good results and few complications, but recurrence is still a matter of concern. Purpose To address the influence of dorsal capsulodesis in postoperative results. Patients and Methods Two groups with eight patients each were evaluated: group A – simple arthroscopic resection (SAR), and group B – arthroscopic resection combined with dorsal capsulodesis (ARDC). Results The mean age of group A was of 36.10 ±  7.96 (range: 28–53) years, and that of group B was of 34.17 ±  29.60 (range 18–44) years. The duration of the follow-up was of 30.67 ±  13.90 (range: 13.45–53.55) months and 29.60 ±  16.80 (range 12.68–62.13) months, respectively. Both groups achieved a a significant decrease in the postoperative score on the Visual Analog Scale (VAS) (of around 2/10), and the scores on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were below 5/100. All the functional parameters (range of motion and strength) were above 80% on the contralateral side, with no differences between groups. More than 75% of the patients were completely satisfied. Group A (37.5%) had a significantly higher recurrence rate than that of group B (12.5%). Conclusions In conclusion, SAR and ARDC provided good clinical results, with no significant differences. Dorsal capsulodesis resulted in an important decrease in the recurrence rate. Level of Evidence Level III (Retrospective Comparative Study).

Partial physeal bars may develop after injury to the growth plate in children, eventually leading to disturbance of normal growth. Clinical presentation, age of the patient, and the anticipated growth will dictate the best treatment strategy. The ideal treatment for a partial physeal bar is complete excision to allow growth resumption by the remaining healthy physis. There are countless surgical options, some technically challenging, that must be weighted according to each case’s particularities. We reviewed the current literature on physeal bars while reporting the challenging case of a short stature child submitted to a femoral physeal bar endoscopic-assisted resection with successful growth resumption. This case dares surgeons to consider all options when treating limb length discrepancy, such as the endoscopic-assisted resection which might offer successful results.

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Objective: We intend to demonstrate the functional results of a patient with post-traumatic radiocarpal arthrosis due to a scaphoid nonunion advanced collapse who underwent surgical treatment with proximal row carpectomy and capitate resurfacing with pyrocarbon implant. Material and Methods:A 51-year-old male patient, working as a sculptor, presented to our consultation with a scaphoid nonunion advanced collapse due to a non-treated scaphoid fracture 20 years before. Clinically he had pain and radiocarpal instability. Radiographically, there was collapse of the scaphoid and lunate, advanced radiocarpal osteoarthritis and proximal migration of capitate.In 2018, he underwent proximal row carpectomy and capitate resurfacing with pyrocarbon implant through a dorsal approach. The patient was immobilized with a wrist cast for 4 weeks. physical rehabilitation started after remove of the cast. Unrestrained activities were allowed at 12 weeks after surgery. Every 6 months the patient was observed in our consultation.Results: After two and a half years of follow-up, the patient presents a presented a significant improvement on wrist pain, with an initial Visual Analogue Scale score of 9/10 and a current one of 3/10 and a satisfactory wrist mobility, with approximately 20º of extension and 30º of flexion, which allows the execution of his work activity. He refers, however, to a decrease in grip strength. On reassessment radiographs, there is a periprosthetic radiolucent line of 1mm, with progression of radiocarpal arthrosis. Conclusion:Post-traumatic radiocarpal arthrosis has a negative impact on patients' quality of life. There are several surgical treatment options varying from proximal row carpectomy, total wrist prosthesis, partial or total arthrodesis. In the present case, capitate resurfacing with pyrocarbon implant associated with proximal row carpectomy proved to be a good surgical option, with satisfactory results, especially in the reduction of pain, providing the patient wrist mobility compatible with the daily living activities.