Erratum to: Proximal humeral fractures in elderly patients

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Single-level anterior cervical discectomy and interbody fusion using PEEK anatomical cervical cage and allograft bone

BACKGROUND: In an effort to avoid the morbidity associated with autogenous bone graft harvesting, cervical cages in combination with allograft bone are used to achieve fusion. The goal of the current study was to assess the reliability and efficacy of anterior cervical discectomy and interbody fusion (ACDF) using a PEEK anatomical cervical cage in the treatment of patients affected by single-level cervical degenerative disease. METHODS AND MATERIALS: Twenty-five patients affected by single-level cervical degenerative pathology between C4 and C7 were enrolled in this study. The clinical findings were assessed using the Neck Disability Index and the Visual Analog Scale. Surgical outcomes were rated according to Odom's criteria at last follow-up. Fusion was graded as poor, average, good or excellent by assessing the radiographs. Cervical spine alignment was evaluated by sagittal segmental alignment and sagittal alignment of the whole cervical spine preoperatively, 6 months postoperatively and at the last follow-up. RESULTS: Twenty-five patients underwent ACDF using a PEEK anatomical cervical cage. All patients had a minimum 2 years of follow-up. The operative levels were C4-C5 in 5 patients, C5-C6 in 12 patients and C6-C7 in 8 patients. Preoperatively, average NDI was 34, 13 at 6 months, and 10 at latest follow-up. The mean preoperative VAS was 7; the mean postoperative VAS at latest follow-up was 3. Good or excellent fusion was achieved in all patients within 10 months (mean 5 months). Preoperatively, average sagittal segmental alignment (SSA) was 0.2\ub0 and average sagittal alignment of the cervical spine (SACS) 15.8\ub0. Six months after surgery, average SSA was 1.8\ub0 and average SACS 20.9\ub0, and at last follow-up, average SSA was 1.6\ub0 and average SACS 18.5\ub0. CONCLUSION: Anterior cervical discectomy and interbody fusion using PEEK anatomical cervical cages can be considered a safe and effective technique to cure cervical disc herniation with intractable pain or neural deficit in cases where conservative treatment failed

Congenital hip dysplasia treated by total hip arthroplasty using cementless tapered stem in patients younger than 50 years old: results after 12-years follow-up

Background Congenital hip dysplasia may lead to severe acetabular and femoral abnormalities that can make total hip arthroplasty a challenging procedure. We assessed a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using cementless tapered stem and here we report the outcomes at long-term follow-up. Materials and methods Twenty-eight patients (24 women and 4 men) aged between 44 and 50 years (mean 47 years) were observed. Clinical evaluation was rated with the Harris Hip Score. Radiographic evaluation consisted in standard anteroposterior and axial view radiographs of the hip. According to Crowe’s classification, 16 hips presented dysplasia grade 1, 14 grade 2, and 4 grade 3. All patients were treated with total hip arthroplasty using a cementless tapered stem (Wagner Cone Prosthesis). Six patients were operated bilaterally, with a totally of 34 hips operated. After surgery, the patients were clinically and radiographically checked at 3, 6, and 12 months and yearly thereafter until an average follow-up of 12 years (range 10–14 years). Results Average Harris Hip Score was 56 ± 9 (range 45–69) preoperatively, 90 ± 9 (range 81–100) 12 months after surgery, and 91 ± 8 (range 83–100) at last follow-up. Radiographic evaluation demonstrated excellent osteointegration of the implants. Signs of bone resorption were present in 6 hips, nevertheless no evidence of loosening was observed and none of the implants has been revised. Conclusions Even in dysplasic femur, the tapered stem allowed adequate stability and orientation of the implant. We consider tapered stem a suitable option for total hip arthroplasty in developmental hip dysplasia, also in case of young patients, thanks to the favourable long-term results

Congenital forward shoulder with clavicle hypoplasia: surgical lengthening by intercalary graft positioning and plate fixation

Background: Congenital forward shoulder with clavicular hypoplasia is a rare disease which can be caused by an alteration of clavicular development in such a way that the clavicles are short. Symptoms are often absent; in most cases the main problem is represented by the cosmetic implications. There is no general consensus about the correct management, and surgery is the only way to correct the deformity. Materials and methods: The aim of the study is to describe a new surgical treatment in patients with congenital forward shoulder and clavicular hypoplasia. In 2010, three patients suffering from bilateral congenital forward shoulder were managed surgically by a intercalary graft positioning with plate fixation aimed at the elongation of the clavicles. Results: Patients were followed by up to 2\ua0years. All the patients treated were satisfied with the results, regarding the resolution of mild pain, but especially from the cosmetic point of view. Conclusion: The intercalary graft positioning was found to be easy to perform and allowed an elongation of the clavicles with immediate stability

Proximal humeral fractures in elderly patients

Proximal humeral fractures are common in the setting of osteoporosis and they represent a problem not only for increased mortality risk factors, but also in terms of costs and management. Their increased incidence has resulted in an evolution of treatment options, but currently there is no scientific evidence that defines the best treatment to choose. The choice of treatment depends on a variety of factors, such as fracture dislocation, fracture classification, bone quality, patient's age, functional requirements and general medical conditions. The debate about the treatment is still open, both for the decision between surgical and conservative treatment, and between different types of surgical techniques; nowadays it remains unclear whether surgery will produce better outcomes in function and quality of life in elderly osteoporotic patients. \ua9 2013 Springer International Publishing Switzerland

Is a minimally invasive anterior approach effective in old patients? A pilot study

Minimally invasive approach to the hip is a blood preserving surgery, with rapid rehabilitation, and low dislocation rate. Intuitively, these characteristics render this approach extremely suitable in the elderly patient. The aim of this study was to analyze the early clinical and radiographic results in the first 30 consecutive patients above 70 years of age undergoing THR through a minimally invasive anterior approach. Clinical evaluations showed an improvement of the Harris Hip Score and WOMAC score after surgery. Radiographic assessment showed cup orientation averaging 47\ub0 (range 40\ub0\u9659\ub0) and no valgus stem aligned. Allogeneic blood transfusion was required in only 6 patients (19.8%). One patient experienced an intraoperative fracture of the greater trochanter. No early implant dislocation was observed in the study population. In conclusion we advise a minimally invasive anterior approach for THR in older patients when a careful patient selection has been done

La displasia congenita dell’anca

La displasia congenita dell’anca (DCA) è un difetto di sviluppo presente alla nascita a livello dell’articolazione coxo-femorale che di rado guarisce spontaneamente e che spesso evolve in quadri complessi di sublussazione o lussazione. La clinica varia a seconda del momento dell’osservazione e del grado di displasia; la tempestività della riduzione è fondamentale nel trattamento, che deve essere iniziato al momento della diagnosi. Il trattamento può essere conservativo o chirurgico: il primo si basa sull’uso di ortesi, mentre il secondo comprende la riduzione a cielo chiuso, la riduzione a cielo aperto, le osteotomie di bacino e di femore, fino alla sostituzione protesica. La gestione del paziente giovane adulto affetto da DCA rappresenta una sfida nel cercare di preservare un corretto rapporto articolare. Grazie alle metodologie di screening la necessità di eseguire interventi tardivi è diminuita negli ultimi anni. Nei rari casi osservati nella nostra esperienza nei paesi in via di sviluppo la riduzione a cielo aperto di lussazioni irriducibili ha permesso di ottenere ottimi risultati clinici ad un follow-up medio di 4 anni. Le protesi di superficie, risparmiando tessuto osseo, rappresentano una valida alternativa alla protesi totale in pazienti giovani con artrosi dell’anca secondaria a displasia di basso grado

Current Concepts in the Biopsy of Musculoskeletal Tumors: AAOS Exhibit Selection

BACKGROUND: A musculoskeletal tumor biopsy can involve fine needle aspiration, core needle biopsy, or incisional biopsy. Controversy regarding the diagnostic yield of these biopsy techniques continues. The purpose of this article is to summarize the current concepts in the biopsy of musculoskeletal tumors. METHODS: We performed a literature review of clinical articles reporting on the biopsy of bone and soft-tissue primary tumors. Clinical articles were excluded on the basis on abstract content if they represented case reports, review or opinion articles, or technique descriptions. Eighteen of the thirty-nine articles that remained were excluded because the results did not indicate the diagnostic accuracy of the various biopsy techniques. Thus, twenty-one articles with diagnostic data on the biopsy of bone and soft-tissue tumors were included in this review. RESULTS: Core needle biopsy appeared to be more accurate than fine needle aspiration, and incisional biopsy appeared to be more accurate than both of these techniques, but the differences did not reach significance. Incisional biopsy was more expensive than the percutaneous biopsy methods. In deep musculoskeletal tumors, incorporation of ultrasonography or computed tomography for guidance is easy and safe and can be useful for increasing the accuracy of the biopsy. Advantages of a percutaneous technique compared with an incisional one are the low risk of contamination and the minimally invasive nature. Certain anatomic locations and histologic types were associated with diagnostic difficulty. Vertebral tumors had the lowest diagnostic accuracy regardless of the biopsy technique. Myxoid, infection, and round cell histologies were associated with the lowest diagnostic accuracy. CONCLUSIONS: The current literature has not clarified the optimal biopsy technique for the diagnosis of bone and soft-tissue tumors. However, core needle biopsy is usually preferable to incisional biopsy because of the low risk of contamination and the low cost. In addition, the use of imaging guidance increases the diagnostic accuracy of musculoskeletal biopsies and reduces the risk of complications. If the result of a percutaneous biopsy is nondiagnostic, a small incisional biopsy should be performed

Isolate acetabular cup revision through the direct anterior hip approach: surgical technique, early experience and review of the literature

Direct anterior approach to the hip allows perfect exposure of the acetabulum and an easy proximal and medial extension that makes it eligible for isolate acetabular cup revision although it is seldom used and there are only few published studies. On 23 consecutive acetabular revision (16 cases Paprosky grade 1 or 2, 5 cases 3A, 1 case 3B and 1 case 4) at an average 28-month follow up, we did not record failures or major complications. Early complications included prolonged wound healing in 4 cases and transient femoral cutaneous nerve palsy in 2 cases, the mean postoperative Harris Hip Score was 82.2 with 82.5% of excellent and good results. Our results are consistent with those reported in the literature with similar techniques. The direct anterior approach has shown excellent results for isolated cup revision, though is probably better suited for surgeons that have some experience with the same approach for primary cases