Total ankle replacement in young patients

High physical demand and younger age are currently considered contraindications for total ankle replacement. The number of Total Ankle Replacements (TAR) is widespread increasing and indications are expanding thanks to a steady improvement in prosthetic designs and better outcome. Commentary of the literature: in 1999 a study of 100 uncemented STAR\u2122 (Waldemar-Link, Hamburg, Germany) prostheses showed a survival rate of 75% at 6.8 years in patients under 50 years old. Other studies (es, Barg et Al.) shows the risk of failure age-related in young patients compared to older group. A report of 780 TAR from the Swedish Ankle Register showed patients with primary or post-traumatic osteoarthritis under  60 years of age to have a 1.8 higher chance of revision compared to older patients. Discussion: ankle replacement has been traditionally reserved for patients older 50 years old and with low physical demand. Contrariwise this belief, TAR have already been used with a wide range of ages, sometimes even patients younger than 30 years old. Most of the "negative" score and results showed before are related to "second-generation" prosthetic designs, while recent studies used a "third-generation" prosthetic design. Conclusions: recent evidences showed better clinical results and higher satisfaction in people under the age of 50 compared to ankle arthrodesis with comparable rate of complications and survivorship. Younger people will have however a higher rate of reoperation but in the meantime, they will prevent progressive degeneration of adjacent joints

Central metatarsal fractures: a review and current concepts

Central metatarsal fractures (CMF) are common injuries. More frequently fractures are those of the fifth metatarsal, followed by CMF and therefore by the first metatarsal. Third metatarsal is injured most frequently than the others and up to 63% is associated with second or fourth metatarsal fractures and up to 28% with both. Anatomy and metatarsal kinematics merits attention due to its influence on function, injuries and treatment options. Diagnosis is based on the history of trauma and clinical examination, relating with instrumental exams. Fractures with less than 10\ub0 of angulation and 3-4 mm of translation in any plane are typically treated conservatively, while operative treatment is generally reserved for fractures out if these values. Intramedullary fixation with K-wires seem to be the most common and valid surgical treatment in simple fractures. Spiral fractures should be treated by interfragmentary screws, which positioning may result difficult due to the adjacent metatarsals. Therefore, an alternative approach is an osteosynthesis with a dorsal plate. Multiple metatarsal fractures often occur in the contiguous bones, so clinicians will also have to carefully inspect metatarsals and adjacent joints such as Lisfranc articulation. The clinical and functional outcomes are often influenced by the pattern of fractures and patient conditions and are reported in the literature up to 39% of poor results

Value of three-dimensional printing of fractures in orthopaedic trauma surgery

Objective Information technology-based innovation is playing an increasingly key role in healthcare systems. The use of three-dimensional (3D)-printed bone fracture replicas in orthopaedic clinical practice could provide a new tool for fracture simulations and treatment, and change the interaction between patient and surgeon. We investigated the additional value of 3D-printing in the preparation and execution of surgical procedures and communication with patients, as well as its teaching and economic implications. Methods Fifty-two patients with complex articular displaced fractures of the calcaneus, tibial plateau, or distal radius were enrolled. 3D-printed real-size models of the fractured bone were obtained from computed tomography scans and exported to files suitable for 3D-printing. The models were handled by trauma surgeons, residents, and patients to investigate the potential advantages and procedural improvements. The patients' and surgeons' findings were recorded using specific questionnaires. Results 3D-printed replicas of articular fractures facilitated surgical planning and preoperative simulations, as well as training and teaching activities. They also strengthening the informed consent process and reduced surgical times and costs by about 15%. Conclusion 3D-printed models of bone fractures represent a significant step towards more-personalized medicine, with improved education and surgeon-patient relationships

Navicular tenosuspension with anterior tibialis tendon (Young procedure) associated to calcaneo-stop for the treatment of paediatric flexible flatfoot: clinical and ultrasound study

Background and aim of the work: Flexible flatfoot is one of the most common deformities in pediatric orthopaedics. Arthroeresis procedures are designed to correct this deformity. Among them, calcaneostop is a procedure with both biomechanical and proprioceptive properties. There could be other surgical procedure combined, such as a percutaneous Achilles tendon lengthening and the Gould tibialis posterior retension or Young tibialis anterior navicular tenosuspension. This study analyzed the clinical and sonographic results of 36 patients following flexible flatfoot surgical treatment with a calcaneo-stop arthroeresis combined with Achilles lengthening and a Young procedure. Methods: From March 2001 to August 2014, 36 patients (54 feet) were treated with calcaneo-stop arthroeresis, percutaneous Achilles tendon lengthening and Young\u2019s tenosuspension. The clinical assessment and a sonography of the anterior tibialis tendon (ATT) were performed in all patients. Results: The average follow-up was 7.4 years (range 8 months-14 years) with a satisfactory outcome in 51 feet (94.5%). No major and minor complications were observed. In four cases the calcaneo-stop was removed for pain and low tolerance of the patient. The AOFAS score and the talocalcaneal angle did not have statistically significant in case of ATT was or not still inserted in the navicular at the follow-up. Conclusions: The calcaneo-stop procedure is a simple, reliable and minimally invasive procedure for the treatment of pediatric flexible flatfoot. Although the indications for the Young tenosuspension as an isolated procedure is very narrow, it can still be an effective procedure when combined to calcaneo-stop. The key to appropriate utilization is a thorough understanding of the biomechanics of the foot function and a specific appreciation of the function of the ATT

The burden of proximal femur fractures and other skeletal injuries during the Covid-19 pandemic lockdown: a retrospective comparative study

: Limiting people's movement is one of the main preventive measures deployed for the control of coronavirus 2019‑nCoV pandemic. This study aims to assess the impact of COVID-19 lockdown on the incidence of the most common skeletal injuries and to provide a management algorithm specific for hospitalized fractured patients.We comparatively analysed the Emergency Department (ED) admissions between March 9th and May 4th 2020 with the same period in 2019. The frequency of the most common skeletal injuries has been derived. Data from the pre-hospitalization phase to discharge of all patients were considered. The impact on clinical orthopaedic consulting has been evaluated. All patients requiring orthopaedic care followed different pathways of hospitalization based on COVID positivity. Data of surgical activity has been analysed.During the 9 weeks of lockdown the access of patients to ED drastically decreased: 11726 accesses compared to 21501 in the same period of 2019. This trend was followed by the most common skeletal injuries but not by proximal femur fracture (PFF) that showed the same absolute numbers compare to the previous years (64 vs 63). If analysed in relation to the total ED access, PFF showed a relatively increase in their frequency.The data from this experience suggest that healthcare providers should strategically allocate resources for management and treatment of PFF during the COVID-19 pandemic. With the begin of the reopening phase, a "rebound effect" for orthopaedic care was observed leading to delayed treatments with a potential overall increased morbidity

Impalement injuries of the shoulder: a case report with literature review

The management of penetrating skeletal extremity trauma is a clinical challenge even for experienced surgeons. While the treatment of associated vascular injuries should be prioritized, there is still a lack of evidence regarding the management of foreign bodies in case of bone fractures or neurological injuries. Here we present a case of impalement of the right proximal humerus with a construction steel rod. The 54-year-old man was successfully treated without vascular, neurological, and thoracic sequelae. A review of the current literature about the most appropriate extrication sequences and soft tissue reconstruction following massive foreign body injuries was carried out

P.D.O. Percutaneous Distal Osteotomy

Surgical treatment of mild to moderate hallux valgus can be performed by a minimally invasive surgical percutaneous approach with a distal osteotomy of the first metatarsal. The osteotomy is fixed by means of a single Kirschner wire

P.D.O. (Percutaneous Distal Osteotomy)

Controversies on surgical treatment of hallux valgus by minimally invasive percutaneous procedures: P.D.O. percutaneous distal osteotomy. Rationale, indications, sugical technique, clinical results and Literature review

Le infezioni post-chirurgiche

Surgical site infections in foot and ankle. Definition, epidemiology, pathophysiology. Non- surgical and surgical treatment, literature review and experts' opinion