Traumatic anterior dislocation of a prosthetic knee, from trauma to delayed onset of vascular injury

Anterior dislocation of a prosthetic knee is a rare event. Only few episodes have been described in the past and have never been linked with neurovascular injury. This could lead orthopaedic surgeons to focus on the implant instability factors and underrate other complications. The authors report a case of a patient who experienced popliteal artery dissection 80 hours after traumatic anterior knee dislocation of a previously well-functioning total knee arthroplasty. Given that there is a lack of clinical cases that have established guidelines for management of this problem, the authors have focused on the importance of performing computed tomography angiography in the management of an anterior traumatic knee dislocation of a prosthetic knee

Surgical Treatment for a Relapsing Malleolar Bursitis in a Professional Figure Skating: Case Report

The increase of popularity in sports as Roller Skating, Figure Skating and Ice Hockey has simultaneously increased the number of skating-related injuries. Lesions of chronic dermatological nature and muscle and tendon lesions have high number of case reports. Ankle and foot are peculiarly involved and this condition suggests the correlation with the use of the skating boot, which with its high-cut and hard-fit changes the joint biomechanics and function and, as a result, the intergumentary system is continuously damaged by the compression and rubbing on the foot. The frequent onset of non-septic chronic relapsing bursitis at the level of the malleolar region is common in all sports requiring the use of skating boots. The conservative treatment is usually compromised by the repetition of the traumatic event due to the use of the skating boot. The case report of a 19 year old professional figure skater affected by non-septic relapsing malleolar bursitis at the level of the malleolar region is presented

Salvaging Pull-Out Strength in a Previously Stripped Screw Site: A Comparison of Three Rescue Techniques

Screw stripping during bone fixation is a common occurrence during operations that results in decreased holding capacity and bone healing. We aimed to evaluate the rescue of the stripped screw site using screws of different dimensions. Five screw configurations were tested on cadaveric specimens for pull-out strength (POS). The configurations included a control screw tightened without stripping, a configuration voluntarily stripped and left in place, and three more configurations in which the stripped screws were replaced by a different screw with either increased overall length, diameter, or thread length. Each configuration was tested five times, with each screw tested once. The POS of the control screw, measured to be 153.6 ± 27 N, was higher than the POS measured after stripping and leaving the screw in place (57.1 ± 18 N, p = 0.001). The replacement of the stripped screw resulted in a POS of 158.4 ± 64 N for the screw of larger diameter, while the screws of the same diameter but increased length or those with extended thread length yielded POS values of 138.4 ± 42 and 185.7 ± 48 N, respectively. Screw stripping is a frequent intraoperative complication that, according to our findings, cannot be addressed by leaving the screw in place. The holding capacity of a stripped screw implanted in cancellous bone can successfully be restored with a different screw of either larger diameter, longer length, or extended thread length

Proposal of a New Dynamic Distraction Device to Treat Complex Periarticular Fractures of the Metacarpophalangeal Joint of Long Finger

Complex periarticular fractures of the metacarpophalangeal joint (MCPJ) are often challenging to treat. Conservative and operative treatments are often burdened with stiffness, loss of function, and poor clinical outcome. These phenomena could be a direct consequence of long period of immobilization. To promote a short time of immobilization and a quick return to daily activities, it is mandatory to stabilize the fracture maintaining the active range of motion (AROM) of the ray. A simple solution is to reduce the fragments by means of dynamic ligamentotaxis. The authors propose a new dynamic distraction device (DDD) for the MCPJ. METHODS: The DDD for the MCPJ was made of Kirschner wires bent and connected to counteract dislocation forces and to allow mobilization of the joint. The DDD was tested on a cadaver model under a simulated load in physiological conditions, and also in metacarpal and proximal phalanx (P1) fracture patterns. The effectiveness of the device was evaluated under fluoroscopy. RESULTS: The data showed that DDD is able to achieve fracture reduction through ligamentotaxis and primary fragments stability and to avoid secondary dislocation during AROM of complex periarticular fractures of the MCPJ. CONCLUSIONS: The frame could be an alternative option to treat periarticular fractures of the MCPJ. The DDD implant has several advantages: It is time efficient because assembly and application take only few minutes. Furthermore, it is very versatile; indeed, it can be used in all metacarpal and phalanx bones, even in the central rays

Screw insertion torque as parameter to judge the fixation. Assessment of torque and pull-out strength in different bone densities and screw-pitches

Background: Pull-out strength is a critical parameter to judge screw fixation in orthopaedic implants. However, the insertion torque is the main feeling in the hand of a surgeon relating to the strength of synthesis. The correlation between pull-out strength and torque is not completely understood. This creates uncertainty about the key-question: Should the torque be considered a valid parameter to judge the quality of fixation? Methods: Using the ASTM F543 as reference, three screws differing only in pitch (1.5, 2.1, 2.8 mm pitches) were tested in three foam-block densities (10, 15, and 20 pcf). The correlation was investigated by assessing the role of density and screw geometry. Findings: Torque was related to pull-out strength in all configurations (R = 0.979, P = 0.000). No difference in pull-out strength was found when screws were tightened to a range of 71.6%, SD = 7.6, of torque to fail (P > 0.05). Torque and pull-out strength were stratified according to density that influenced the two parameters up to 524% (P < 0.000). Pitch determined pull-out strength up to 33% (P < 0.000) while the 2.1 mm screw pitch showed the highest pull-out strength and torque in all configurations. Interpretation: Insertion torque was demonstrated to be a valid parameter to judge the quality of bone under fixation and therefore, the strength of the synthesis. Surgeons should not tighten the screws to values approaching torque to fail to obtain the highest pull-out strength. Density was the main factor influencing pull-out strength and torque. Pitch is another parameter deciding screw holding capacity

Dominant vs nondominant arm in surgical repair of distal biceps tendon rupture. A case-control series of isotonic muscle strength evaluation

Background. This case-control study investigated arm recovery from surgery for a ruptured distal tendon in terms of maximal strength, power, and endurance compared to the healthy contralateral arm, taking into account limb dominance. Methods. An S-shaped single incision and suture anchor repair was used in all 15 patients. All patients were right-arm dominant and of them none participated in a specific postoperative physical therapy program. Outcomes were evaluated based on range of motion and with the Disability of the Arm, Shoulder and Hand (DASH) test, Mayo Elbow Performance Index (MEPI), and Bromberg and Morrey questionnaire. Muscle function was assessed with MuscleLab. Results. Average test scores were as follows: DASH, 3.53/100; MEPI, 93/100; and Bromberg and Morrey, 90.87/100. There were significant differences in supination (P = 0.007), maximum lifted weight (P = 0.005763), strength during endurance exercise (P = 0.004366), and maximum strength in flexion (P = 0.045584) between impaired and healthy arms. Conclusions. Limb dominance is not a critical issue for the choice of treatment and functional evaluation following surgical repair of ruptured distal tendon

The effect of viscosupplementation on early-stage knee osteoarthritis: Clinical evaluation and assessment of cartilage in vivo with 7 T MRI

Introduction: Viscosupplementation is a well-known strategy for managing early stages knee Osteoarthritis. However, despite its effectiveness in reducing symptoms, it has not yet been found to have an effect on joint cartilage. The aim of this study is to evaluate the clinical efficacy of a new product with gel-like behaviour and its in vivo effects on joint cartilage. Methods: 20 patients were treated by 2 consecutive injections of hyaluronan derivative Hymovis® at one-week interval. Clinical evaluation was performed before the treatment and at each time point during the follow-up using WOMAC and VAS. A 7 T magnet was used for cartilage evaluation at each MRI time point: T2 Relaxation Time (RT), T2∗ RT and cartilage parameters were evaluated before the first injection, after 45 days and at 6 months follow-up. Statistical analysis was obtained for each reported data. Results: We report significantly reduction in symptoms with an increase in knee and global activity functions. The T2 RT for lateral tibial compartment and T2∗ RT for Patello-Femoral compartment significantly decreased. A T2 RT reduction was observed in all knee compartments except for the medial tibial one, while a T2∗ RT reduction was observed in all knee compartments. We report an increase in cartilage volume and thickness in most of patients with a reduction of cartilage defects in 9 patients, but we didn't find MRI signals clearly referable to cartilage regeneration. Conclusions: MRI results have confirmed the possibility to employ 7T magnets to evaluate early changes in cartilage structure in vivo. HA VS has provided good clinical outcomes and an improvement in the global assessment of the knee joint, but it doesn't seem to significantly modify the cartilage over the time

L’artrodesi della tibio-astragalica. Nostra esperienza e revisione della letteratura [Tibio-Tarsal Arthrodesis. Our experience and literature review]

L’artrosi post-traumatica di caviglia rappresenta la maggior parte delle cause di artropatia degene- rativa della tibio-tarsica (ADTT). A fronte di una patologia che spesso si manifesta come altamente disabilitante per il paziente che ne è affetto, rimane una delle sfide più difficili da affrontare per il Chirurgo Ortopedico. La sostituzione protesica dell’articolazione tibiotarsica (Total Ankle Arthroplasty, TAA), benché in rapi- do sviluppo e con risultati sempre più incoraggianti risulta ancora gravata da limitazioni di indicazio- ne e risultati a lungo termine non pienamente soddisfacenti. L’artrodesi di caviglia (AnkleArthrodesis, AA) viene descritta ancora oggi come il gold-standard terapeutico di un quadro avanzato di ADTT. Riportiamo in questo articolo l’esperienza della I Clinica Universitaria di Ortopedia e Traumatologia di Pisa nel trattamento di 20 pazienti affetti da grave ADTT (grado 3-4) secondaria a trauma. Tutti i pazienti sono stati sottoposti ad intervento di artrodesi tibio-astragalica secondo medesima tecnica. Sono stati così sottoposti a controllo radiografici seriati e a valutazione clinica a 1 anno dall’intervento con AOFAS score e NRS score. Studio a medio termine con follow-up di 1 anno. I risultati ottenuti, in accordo con la Letteratura, si sono dimostrati positivi nell’80% dei casi e con- fermano come l’artrodesi della tibio-tarsica benché spesso percepita dal paziente e dal Chirurgo come un fallimento dei precedenti trattamenti, sia una soluzione terapeutica che può garantire la risoluzione di un quadro clinico altrimenti altamente disabilitant

MR Imaging Of Cartilage At 7 Tesla -Viscosupplementation With HYMOVIS® For The Management Of Osteoarthritis Of The Knee: A Prospective Cohort Study

The purpose of this study is to evaluate the efficacy of HA viscosupplementation in the management of early OA of the knee and its effect on patients symptoms and articular cartilage