Introduction Dupuytren's disease (DD) is a benign fibroproliferative disorder of the palmar and digital fasciae of the hand leading to progressive thickening and shortening of the pre-tendinous bands and to functionally limiting flexion contractures. The role of acute trauma, repetitive microtrauma or elective hand surgery (like trigger finger release or open carpal tunnel release) as triggering factors in predisposed individuals has lately been affirmed by scientific evidence. The aim of this systematic review is to evaluate the incidence of Dupuytren's disease in adults following acute trauma, chronic microtrauma, or elective hand surgery. Methods A systematic review was conducted in accordance with the PRISMA 2020 guidelines and was prospectively registered with PROSPERO (CRD420251110336). An extensive search of four databases was performed to identify studies evaluating new-onset Dupuytren's disease following elective hand surgery, acute trauma, or chronic microtrauma. The Joanna Briggs Institute tool was used to assess the risk of bias, and overall certainty of evidence was appraised using GRADE. Results Of 822 records identified, 25 studies were included. Due to substantial heterogeneity, meta-analysis was not possible and results were reported descriptively. Acute surgical trauma showed postoperative incidence ranging from 0.80% to 11.5%, while chronic microtrauma was the most frequently studied exposure, with prevalence ranging from 1.9% to 26.6%. The certainty of the evidence was mostly low to very low according to GRADE. Conclusions Despite a limited overall certainty, current evidence suggests a possible association between acute trauma, elective hand surgery, and chronic microtrauma with earlier onset or accelerated progression of DD. The interaction of multiple risk factors in biologically predisposed individuals seems to lead to DD, with mechanical insults that may contribute as initiating or enhancing “second hits” rather than isolated causative factors. Regarding elective surgery and acute trauma, it remains unclear whether they primarily act as initiating events or rather accelerate a pre-existing but subclinical disease process.
Background Coronoid process fractures are uncommon injuries in the pediatric population, accounting for less than 2% of all elbow traumas. These lesions represent a diagnostic and therapeutic challenge due to their rarity and frequent association with elbow dislocation. The aim of this study is to analyze the management strategies for pediatric coronoid fractures and to present a case series of 11 patients with satisfactory clinical and functional outcomes. Methods This retrospective study reviewed 11 pediatric patients (mean age: 10.27 years; range: 5–13) treated for coronoid process fractures, with or without associated elbow dislocation, across two hospitals in northern Italy between January 2011 and December 2023. After applying inclusion criteria, all 11 patients were evaluated clinically and radiographically with a minimum follow-up of 12 months and then included in the study. Treatment strategy—conservative or surgical—was determined based on fracture morphology and associated injuries. Outcome measures included radiographic healing, range of motion, complications, and QuickDASH score. Results Seven cases (64%) involved elbow dislocation. Conservative treatment was employed in 8 patients (73%), while 3 underwent surgical fixation. At a mean follow-up of 8.45 years, the mean QuickDASH score was 3.3, indicating excellent functional outcomes. At the last follow-up visit, the patients all had full elbow ROM. Radiographic healing was observed in all patients, with no cases of nonunion or secondary displacement. Only one asymptomatic ossification was reported. Conclusion Pediatric coronoid fractures, although rare, can be successfully managed with individualized treatment plans. Favorable outcomes were achieved with both conservative and surgical treatments, which were selected according to fracture morphology and elbow stability. These treatments had low complication rates and yielded good long-term functional results Loe IV
Purpose Microsurgical techniques were established in the 1960s and has been applied to the field of musculoskeletal tumors. Vascularized osteo-cutaneous and composite grafts are greatly beneficial for reconstruction following the resection of malignant bone tumors. Beside them, if we consider the more basic role, the greatest merit lies in the ability to magnify and visualize tissue. Soft tissue tumors arising in the hand are often small and even benign tumors may exhibit invasive growth, which may lead to an incomplete resection and can therefore result to an increased probability of local recurrence. We have applied microsurgery primarily to the excision of tumors originating in the hand. Methods and results In this review, we discuss the utility of microsurgery for benign tumors, involving tenosynovial giant cell tumors, schwannomas, glomus tumors and Vater-Pacini neuromas, lipomas as well as other tumor-like lesions, where microsurgery is considered particularly beneficial. Clinical outcomes of these tumor excision are successfully improved with micro-dissection and resection. Conclusion In hand surgery, microsurgery is an extremely useful tool for the dissection and resection of small or infiltrative benign soft tissue tumors. Curative resection is possible and safety is enhanced by preserving normal tissue.
