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The Use of Modularity in Total Hip Arthroplasty.
No full textModularity is defined as separation of a system into independent parts or modules that can be treated as logical and may be separated and recombined. Historically, the modularity represents the evolution of the concept of "low friction arthroplasty" developed by Sir J. Charnely in 1960. The disadvantage of a one-piece stem is the difficulty of restoring the biomechanical feature of the hip. Thus, the natural evolution was the introduction of modularity on both sides, the acetabulum and the femur. Modularity allows the surgeon to accurately match the anatomic characteristics of each patient to obtain improved range of motion, joint stability, abductor strength, and leg length equality. Disadvantages are related to the introduction of different interfaces, which could be sites of wear and corrosion. In accordance with the most recent literature, in primary total hip arthroplasty (THA) the modularity can be reduced to the head and the acetabular component, while a one-piece stem can manage the majority of cases. On the other hand, we believe that during revision surgery, a complete modularity is necessary
Simple posterior elbow dislocations: Conservative management and role of ulnar-bone coverage angle
No full textBACKGROUND: In simple posterior elbow dislocations, not associated with fracture, conservative treatment consists of a closed reduction with the restoration of joint relationships and a subsequent immobilization in a cast in the absence of any postreduction instability. The functional outcome is usually satisfactory, but several complications are possible. The aim of this study was to determine the outcomes of simple elbow dislocation treated conservatively and the possible role of an open ulnar bone converge angle (UBCA) as a risk factor. METHODS: A retrospective case series study with a follow-up of 60.96 months (range, 24-95) was performed, analyzing simple elbow dislocation cases, treated at Unit of Orthopedics and Trauma, Varese, Italy, from October 2012 to September 2018. The population consisted of 28 patients, 17 men and 11 women, with an average age of 53 (range, 26-90). A conservative treatment, consisting in closed reduction and immobilization in plaster cast, was applied if there was no instability after reduction. The Disability of the Arm, Shoulder and Hand (DASH), the Mayo Elbow Performance Score (MEPS) questionnaires were used. CT-scan were analyzed to calculate the UBCA. RESULTS: At the last follow-up there was a reduction of the affected elbow ROM compared to the contralateral: 52.6% of patients had an extension deficit, 15.9% of flexion, 10.6% of prone supination. Under no circumstances was post-traumatic residual instability. A statistically significant reduction was found for extension of the affected elbow (-3.05° vs. 3.26°) and for the entire flexion-extension motion (134.05° vs. 142.27°) compared to the healthy one. The average DASH score is 6.029 and the MAYO average score is 94.286, values considered excellent. The average UBCA was 171.59° (range, 147.50°-191.50°). In 3 patients (15.8%) prone-supination pain was reported, and of these 2 also to flexion-extension (10.5%). CONCLUSIONS: The outcome of posterior elbow simple dislocations, conservatively treated, was satisfactory. A UBCA, narrower than 180°, may represent a risk factor for dislocation
The efficacy of shoes modification and orthotics in hallux valgus deformity: a comprehensive review of literature
No full text: Hallux valgus (HV) is a frequent forefoot deformity affecting about 23% of adults and 35.7% of people over 65. The exact etiology is not fully understood. The first ray plays a significant role in walking cause it bears the principal amount of weight and maintains the position of the medial arch. Several factors that deteriorate the integrality of the first ray, such as foot deformities, restrictive footwear, and pes planus, may be ascribed to the HV occurrence. Before any surgical correction, conservative treatment should always be initiated first. Currently, there is no consensus that conservative management by shoe modification and foot orthoses could correct the pathology or terminate the clinical worsening of the condition.From a careful analysis of the literature, proper footwear should be a shoe with an adequate length, wide toe box, cushioned sole, and a lowered heel to not increase the load on the metatarsal heads and cause pain. Personalized 3D printed customized toe spreaders may be applied in patients with HV, improving symptoms and bringing pain relief. Compensating the subtalar joint hyperpronation through foot orthoses plays a fundamental role in the HV development, preventing or at least controlling the condition's progress; this, along with weight reduction and regular physical activity.Data obtained suggest that dynamic foot orthoses prefer a biomechanical type with 3/4-length, which is less likely to negatively affect the dorsal or medial pressures, which instead were noted to increase with the sulcus- and full-length orthoses.Although some studies suggest that foot orthoses would favor the correction of HV deformity, results have been very variable and just in few studies appear to correct HV or reduce its progression, improving symptoms and bringing pain relief. In the case of HV surgical correction, orthoses seem to maintain the correct position acquired over time
Surgical treatment of the “terrible triad” of the elbow: long-term outcomes at 5 years’ follow-up
No full textBACKGROUND: Terrible triad (TT) is one of the most challenging pattern of elbow injuries to treat and it often yields to severe complications. The aim of this study was to evaluate clinical and functional outcomes in 28 patients treated at our center from January 2011 to april 2019. METHODS: Fracture patterns, surgical technique and residual elbow instability, range of motion (ROM), grip and pinch strength were evaluated in all patients. Functional outcomes were assessed by Mayo elbow performance score (MEPS), disability of arm and shoulder and hand score (DASH) and visual analogue scale (VAS). Radiographic follow-up (FU) was possible in 18 patients to check heterotopic bone formation and arthritic changes. the mean FU was 60 months (range, 12-108). RESULTS: At the last FU a decreased ROM was observed in all patients compared to the contralateral elbow (an average of 7° in flexion, 15° in extension, 7.2° in supination, 5.2° in pronation), however only four of them (14%) had a functional limitation. also reduction of mean grip strength was observed (mean 5.11 kg, p=0.011). No elbow instability was detected at the last FU. After treatment, six minor and seven major complications were found; the major ones required second surgery. However mean Meps, dash and Vas were still satisfying. CONCLUSIONS: The surgical treatment of the tt of the elbow provides overall satisfactory results, although a considerable number of complications still persist and need to be addressed in the future
Outcomes after unstable fractures of the ankle: what’s new? A systematic review
Full text linkUnstable ankle fractures are very frequent. Given the instability, they often require surgical treatment, but literature scarcely reports on the outcomes of their management
Clinical and ultrasound results after arthroscopic repair of the rotator cuff
No full textThe literature reports good functional results obtained with arthroscopic repair of the rotator cuff, but the incidence of anatomical healing has not been sufficiently studied. Ultrasound examination makes it possible to accurately document the healing process of the tendon at the bone, gathering information that may be useful in a comparison with clinical data. A total of 43 consecutive arthroscopic repairs of rotator cuff injuries were considered, that had made use of anchors and non-resorbable suturing. A total of 42 patients were willing to undergo clinical monitoring with an associated ultrasound examination after 3, 6 and 12 months. When ultrasound examination after 6 and 12 months was carried out, 36 patients presented with anatomical healing of the rotator cuff. The total percentage of repair failures was 14.3% and increased to 23% if we take into consideration the subscapular tendon alone. Constant score went from a preoperative mean of 51.25 to a mean of 78.21 after 12 months (p<0.001). Arthroscopic repair of the rotator cuff leads to anatomical healing of the tendons in a high percentage of cases, obtaining good functional results. The absence of healing is associated with lower values for recovery of strength at clinical follow-up. The advanced age of the patients (p<0.001) and the extensive injuries that involve several tendons (p=0.002) are negative prognostic factors
Arthroscopic treatment of chronic acromioclavicular joint dislocation by modified Weaver-Dunn techinique [Trattamento artroscopico delle lussazioni croniche dell’articolazione acromion-claveare mediante tecnica di Weaver-Dunn modificata]
No full textThe authors describe an arthroscopic reconstruction technique for type III, IV and V acromioclavicular symptomatic chronic joint dislocation. It consists of a closed reduction and transfer of the acromial attachment of the coracoacromial ligament to the resected surface of the distal clavicle, associated to the positioning of a cannulated screw between the clavicle and the coracoid under arthroscopic control to achieve greater primary stability. Coracoacromial ligament is secured to the superior surface of clavicle by an Endobutton (Smith and Nephew, Andover, Massachusetts). The resection of the distal clavicle is minimal. The screw is finally removed under local anesthesia 12 weeks after surgery. The described procedure has been performed in three patients. Preliminary results show an excellent functional outcome without any residual pain. Among the advantages of the technique are a minimally invasive approach, the possibility of searching the glenohumeral joint for associated lesions and eventually treating them, and the benefits of not exposing the patient or surgical team to ionizing radiation
Rare shear-type fracture of the talar head in a thirteen-year-old child — Is this a transitional fracture: A case report and review of the literature
No full textBACKGROUND Talar fractures are exceedingly rare in childhood. There are very few studies on the clinical aspects, the long-term outcomes and the appropriate treatment of these fractures in pediatric patients. The mechanism of trauma consists of the application of a sudden dorsiflexion force on a fully plantar-flexed foot. Traumatic mechanism, symptoms and imaging of injuries of the talar head are similar to transitional fractures that are normally described at the distal epiphysis of the tibia: the so-called transitional fracture is defined as an epiphyseal injury when the growth plate has already started to close. CASE SUMMARY A thirteen-year-old girl reported a high-energy trauma to her right foot, due to falling from her horse. X-rays at the Emergency Department were negative. Because of persistent pain, the patient was assessed by an orthopedic surgeon after two weeks and computed tomography scans revealed a misdiagnosed displaced shear-type fracture of the talar head. Hence, surgical open reduction and fixation with two headless screws was performed. The girl was assessed regularly, and plain films at follow-up revealed complete healing of the fracture. Within six months after surgery, the patient returned to pre-injury sport activities reporting no complications. CONCLUSION Injuries of the talar head in childhood should be considered as transitional fractures. Open reduction with internal fixation aims to reduce malalignment and osteoarthritis. Computed tomography scans are recommended in these cases
Anterior knee pain: A rare case of patellar osteoma osteoid
No full textAnterior knee pain (AKP) is one of the most common musculoskeletal disorders and may cause severe disability and discomfort in children and in adolescents. Its etiology is heterogeneous and includes all causes of pain in the anterior aspect of the knee. Amongst rare causes, there are patellar tumors; in this paper we reported a unique case of patellar osteoma osteoid. In literature, nature and treatment of iuxta-articular osteoma osteoid remain controversial: some authors believe that iuxta-articular osteomas could lead to permanent deformity and advocate an early surgical treatment. Other authors report spontaneous regressions, good response to nonsteroidal anti-inflammatory drugs (NSAIDs) e risk of iatrogenic damages. In this paper, we reviewed current treatment concepts in view of our therapeutic choices
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