External fixation for displaced intra-articular fractures of the calcaneum

A minimally-invasive procedure using percutaneous reduction and external fixation can be carried out for Sanders' type II, III and IV fractures of the os calcis. We have treated 54 consecutive closed displaced fractures of the calcaneum involving the articular surface in 52 patients with the Orthofix Calcaneal Mini-Fixator. Patients were followed up for a mean of 49 months (27 to 94) and assessed clinically with the Maryland Foot Score and radiologically with radiographs and CT scans, evaluated according to the Score Analysis of Verona. The clinical results at follow-up were excellent or good in 49 cases (90.7%), fair in two (3.7%) and poor in three (5.6%). The mean pre-operative Böhler's angle was 6.98° (5.95° to 19.86°), whereas after surgery the mean value was 21.94° (12.58° to 31.30°) (p < 0.01). Excellent results on CT scanning were demonstrated in 24 cases (44.4%), good in 25 (46.3%), fair in three (5.6%) and poor in two (3.7%). Transient local osteoporosis was observed in ten patients (18.5%), superficial pin track infection in three (5.6%), and three patients (5.6%) showed thalamic displacement following unadvised early weight-bearing. The clinical results appear to be comparable with those obtainable with open reduction and internal fixation, with the advantages of reduced risk using a minimally-invasive technique

Il trattamento delle fratture del terzo prossimale di omero mediante chiodo endomidollare "Polarus"

Proximal humeral fractures are complex lesions with difficult management problems and so they are a professional struggles for orthopaedic surgeons. In literature a lot of techniques of treatment are proposed for these kind of fractures. In our study we have reviewed 30 patients with a proximal humeral fracture (Neer 2-3) with a mean age of 75 years, treated in our clinic with Polarus nail, with a mean follow-up of 7 years.We obtained 73,3% of good and excellent results, in line with literature results. The complications involved 6 patients (20%) of our study, in particular 3 cases of proximal screw pull-out, 1 case of deep infection and 2 cases of acromioclavicula impingement. The aim of our study is a review of our cases, comparing them with the literature, analysing these kind of complex fractures and the type of treatments

Tibial plateau fractures: compared outcomes between ARIF and ORIF.

The purpose of this study is to compare arthroscopic assisted reduction internal fixation (ARIF) treatment with open reduction internal fixation (ORIF) treatment in patients with tibial plateau fractures. We studied 100 patients with tibial plateau fractures (54 men and 46 women) examined by X-rays and CT scans, divided into 2 groups. Group A with associated meniscus tear was treated by ARIF technique, while in group B ORIF technique was used. The follow-up period ranged from 12 to 116 months. The patients were evaluated both clinically and radiologically according to the Rasmussen and HSS (The Hospital for Special Surgery knee-rating) scores. In group A, the average Rasmussen clinical score is 27.62 \ub1 2.60 (range, 19\u201330), while in group B is 26.81 \ub1 2.65 (range, 21\u201330). HSS score in group A was 76.36 \ub1 14.19 (range, 38\u201391) as the average clinical result, while in group B was 73.12 \ub1 14.55 (range, 45\u201391). According to Rasmussen radiological results, the average score for group A was 16.56 \ub1 2.66 (range, 8\u201318), while in group B was 15.88 \ub1 2.71 (range, 10\u201318). Sixty-nine of 100 patients in our study had associated intra-articular lesions. We had 5 early complications and 36 late complications. The study suggests that there are no differences between ARIF and ORIF treatment in Schatzker type I fractures. ARIF technique may increase the clinical outcome in Schatzker type II\u2013III\u2013IV fractures. In Schatzker type V and VI fractures, ARIF and ORIF techniques have both poor medium- and long-term results but ARIF treatment, when indicated, is the best choice for the lower rate of infections

Current concepts in treatment of early knee osteoarthritis and osteochondral lesions; the role of biological augmentations

Early knee osteoarthritis and chondral lesions are a common cause of disability in younger patients. Surgical options, such as microfractures, ACI and OAT, provide good, but not fully satisfying, outcomes. Recent advance in biological knowledge introduced two different methodological approaches of delivering growth factors and stem cells into the articular environment. Platelet-Rich Plasma and Mesenchimal Stem Cells are supposed to change the way to approach early knee osteoarthritis and chondral lesions, though their indications and limits are yet to be determined

Femoroacetabular Impingement (F.A.I.): biomechanical and dynamic considerations.

Femoroacetabular impingement (F.A.I.) is a pathologic process caused by abnormality of the shape of the acetabulum, of the femoral head, or both. F.A.I. often referred to as idiopathic, may be secondary to slipped capital epiphysis, congenital hypoplasia of the femur, Legg-Calv\ue9 Perthes desease, post-traumatic mal-union and protrusio acetabuli. From 2009 to 2012 we studied 21 patients (14 males), with average age of 52 years old (33 y - 75 y) affected by idiopathic F.A.I. Every patient underwent to pelvic and hip joint X-rays and CT scan with 3D reconstructions, in order to evaluate morphology of the pelvis and the hip joint and the torsion of the lower limbs (femoroacetabular ante-retroversion). Our results show an average femoral ante-version angle of 12,4\ub0 (15\ub0- 20\ub0 physiological range) in patients affected by CAM impingement and an average acetabular ante-version angle of 13,5\ub0 (15\ub0 - 20\ub0 physiological range) for those with PINCER impingement.These values, in patients affected by F.A.I., are probably related to the morphologic and biomechanical features that may lead to the onset of the idiopathic femoroacetabular impingement. In literature, other studies partially support our findings, suggesting a more critical approach to the patient with idiopathic F.A.I. extending the evaluations to near articulations. Impingement femoro-acetabolare (F.A.I.) indica quadri anatomopatologici caratterizzati da anomalie morfologiche dell\u2019epifisi prossimale femorale e/o della cavit\ue0 acetabolare.Dal punto di vista eziopatogenetico si possono individuare F.A.I. secondari ad esiti di patologie dell\u2019infanzia (displasia congenita dell\u2019anca, Legg- Calv\ue9 Perthes, epifisiolisi), di mancate consolidazioni post-traumatiche, protrusio acetabuli e FAI idiopatici.Abbiamo studiato, presso la nostra clinica, dal 2009 al 2012, 21 pazienti (14 maschi) con et\ue0 media di 52 anni (33- 75 aa) affetti da FAI idiopatico con anamnesi silente per patologie o cause note.Tutti i pazienti sono stati sottoposti a radiologia convenzionale e TC con ricostruzioni 3D per valutazione degli angoli di antiversione femorale e acetabolare. I nostri risultati hanno evidenziato un valore medio di antiversione femorale di 12,4\ub0 (range di normalit\ue0 15-20\ub0) nei pazienti affetti da CAMimpingement e 13,5\ub0 (15-20\ub0) di antiversione acetabolare in quelli affetti da PINCER impingement. Queste misurazioni, in rapporto ai quadri strumentali di F.A.I. hanno evidenziato una probabile correlazione tra il vizioso orientamento reciproco di cotile e testa femorale e la genesi del F.A.I. stesso, considerato idiopatico. Il confronto dei nostri risultati con quelli riportati in letteratura parrebbe avallare solo in parte le nostre ipotesi biomeccaniche, suggerendo un\u2019analisi pi\uf9 critica e approfondita ed allargata ad altre articolazioni quando ci si approccia ad un paziente affetto da F.A.I. idiopatico

The biocompatibility of porous vs non-porous bone cements: a new methodological approach.

Composite cements have been shown to be biocompatible, bioactive, with good mechanical properties and capability to bind to the bone. Despite these interesting characteristic, in vivo studies on animal models are still incomplete and ultrastructural data are lacking. The acquisition of new ultrastructural data is hampered by uncertainties in the methods of preparation of histological samples due to the use of resins that melt methacrylate present in bone cement composition. A new porous acrylic cement composed of polymethyl-metacrylate (PMMA) and \u3b2-tricalcium-phosphate (p-TCP) was developed and tested on an animal model. The cement was implanted in femurs of 8 New Zealand White rabbits, which were observed for 8 weeks before their sacrifice. Histological samples were prepared with an infiltration process of LR white resin and then the specimens were studied by X-rays, histology and scanning electron microscopy (SEM). As a control, an acrylic standard cement, commonly used in clinical procedures, was chosen. Radiographic ultrastructural and histological exams have allowed finding an excellent biocompatibility of the new porous cement. The high degree of osteointegration was demonstrated by growth of neo-created bone tissue inside the cement sample. Local or systemic toxicity signs were not detected. The present work shows that the proposed procedure for the evaluation of biocompatibility, based on the use of LR white resin allows to make a thorough and objective assessment of the biocompatibility of porous and non-porous bone cements

The Italian Consensus Conference on FAI Syndrome in Athletes (Cotignola Agreement)

Background. Femoro-acetabular impingement (FAI) is an important topic in literature because of its strong relationship with sport populations. Methods. Sixty-five experts participated in "this Consensus Conference (CC)". They discussed, voted and approved a consensus document on the FAI syndrome in athletes. Results. The CC experts approved document provided suggestions concerning: 1) Epidemiology of FAI; 2) Clinical evaluation; 3) Radiological evaluation; 4) Conserva-tive treatment; 5) Surgical criteria; 6) Surgical techniques; 7) Post-surgical rehabilita-tion; 8) Outcome evaluation; 9) FAI-associated clinical frameworks. Conclusions. The CC offers a multidisciplinary approach to the diagnosis and treat-ment of FAI syndrome in athletes taking into account all the different steps needed to approach this pathology in sport populations

Luxa\ue7\ue0o de cotovelo: op\ue7\uf2es terap\ue9uticas

A Sociedade Brasileira de Ortopedia e Traumatologia (SBOT) oferece, por meio da Comiss\ue3o de Educa\ue7\ue3o Continuada (CEC), mais uma obra cujo conte\ufado \ue9 fundamental para os ortopedistas: Avan\ue7os em Alongamento e Reconstru\ue7\ue3o 3ssea. Estudo e atualiza\ue7\ue3o s\ue3o a base da educa\ue7\ue3o continuada, e esta obra, que reflete a expertise brasileira, atende a essas metas