“Open-book” pelvic fracture with soft tissue serious damage in a child

Open-book fractures of the pelvis are uncommon during childhood and require urgent treatment from the association with other abdominal, vascular or nervous injuries. The case discussed is an open-book fracture (type B1, Tile classification) associated with triradiate cartilage injury (type I, Salter–Harris classification) in an 11-year-old female. Surgical treatment was delayed for 2 months due to an associated extensive cutaneous lesion which required an adequate treatment. The delayed intervention did not affect the radiological and clinical healing of the fracture

Hip joint hydatidosis after prosthesis replacement

Summary Hydatidosis is a rare parasitic disease caused by the Echinococcus tapeworm, which only occasionally affects the musculoskeletal tissues. In this article we describe the case of a patient who underwent a total hip replacement procedure for a pathological fracture of the femur neck. At the next histological examination it was shown to be a consequence of secondary bone hydatidosis. This clinical case is exceptional in that the infection spread to the cotyloid and femoral prosthesis components and, in the following years, caused repeated episodes of joint dislocation

Plasma Technology Reduces Blood Loss in Adolescent Idiopathic Scoliosis Surgery: A Prospective Randomized Clinical Trial

Study Design: Prospective randomized clinical trial. Objectives: To assess the effectiveness of PEAK Plasmablade (PPB), compared with bipolar sealer and standard electrocautery, in the posterior spinal instrumentation and fusion (PSF) surgery performed for adolescent idiopathic scoliosis (AIS). Methods: Ninety-three patients undergoing PSF surgery for AIS were randomized in 2 groups: group-A patients (n = 45) underwent PSF surgery using PPB; group-B patients (n = 48) were treated with bipolar sealer and standard electrocautery. Demographic and surgical data was recorded. All the patients underwent serial blood tests on the day before surgery (T0) and at 24 (T1), 48 (T2), 72 (T3), and 96 (T4) hours postoperatively. Visual analogue scale for pain (VAS) score, the percentage of paracetamol assumption, and the blood transfusion rate were recorded in the time-lapse T1 to T4. Intergroup variability was assessed. Pearson correlation test was performed. A P value <.05 was considered significant. Results: In group A, a significantly shorter total operative time ( P = .0087), a significantly lower total intraoperative blood loss (TBL) ( P = .001), and a higher postoperative hemoglobin (Hb) ( P = .01) were recorded. A significant higher mean Hb concentration and mean albumin value was recorded in group A at 24 and 48 hours postoperatively. A significant correlation between TBL and hospital stay was recorded in both groups (group A, P = .00 001; group B, P = .00 006); moreover, in both groups, a significant correlation was observed between TBL and mean VAS at 72 hours postoperatively (group A, P = .0009; group B, P = .0001) and at 96 hours postoperatively (group A, P = .000 044; group B, P = .00 001). Conclusions: PPB reduces the intraoperative blood loss in PSF performed for AIS, thus allowing a patient's faster recovery

Reducing periprosthetic joint infection: What really counts?

Periprosthetic joint infection (PJi) remains one of the most challenging complications after joint arthroplasty. Despite improvements in surgical techniques and in the use of antibiotic prophylaxis, it remains a major cause of implant failure and need for revision. PJi is associated with both human host-related and bacterial agentrelated factors that can interact in all the phases of the procedure (preoperative, intraoperative and postoperative). Prevention is the first strategy to implement in order to minimize this catastrophic complication. The present review focuses on the preoperative period, and on what to do once risk factors are fully understood and have been identified

New Variant of the Treatment of Acromion-Clavicular Dislocation with TightRope®System in a Mini - Open Approach: A Preliminary Clinical Study

Background: Many different surgical techniques have been described to stabilize the acromion-clavicular (AC) dislocations. So far many of these procedures are performed only in arthroscopy. Objectives: In this study, we describe a new technique that utilizes the tightrope with a mini-invasive open approach for the acute stabilization of the acromion-clavicular joint (ACJ) dislocation. Patients and Methods: We set an prospective study aimed to verify the efficacy of this new surgical technique. We treated 28 patients with acute ACJ dislocation with ACJ TightRope ® System with dual mini access. We retrospectively reviewed the data of 34 patients treated with arthroscopic technique. They were considered as the control group. Results: At 6 month’s follow-up, all the 28 patients showed a stable joint during clinical examination and obtained an average Constant score of 98.62/100, with a complete recovery of ROM and strength in abduction. The mean operation time was of 33.7 minutes. The mean recovery duration was 102.8 days. No significant difference was found between the experimental and control groups (P &gt; 0.05). Conclusions: Results of this trial suggest the effectiveness of this new mini-invasive surgical technique in producing clinical and functional recovery in patients with ACJ dislocations

Mason type II and III radial head fracture in patients older than 65: is there still a place for radial head resection?

Purpose: To evaluate the clinical outcomes of radial head excision for multifragmentary radial head fracture in patients over 65&nbsp;years old. Methods: We retrospectively examined 30 patients over 65&nbsp;years of age treated with radial head excision for comminuted radial head fractures. Patients were evaluated through clinical examinations, administrative questionnaires (DASH—Disabilities of the Arm, Shoulder and Hand; MEPS—Mayo Elbow Performance Score, VAS—Visual Analog Scale) and plain films. Results: The mean follow-up was 40&nbsp;months (range 24–72&nbsp;months); 27 out of 30 patients claimed to be satisfied. The mean DASH score was 13 (range 3–45.8) and mean MEPS was 79 (range 65–97). The radiographic evaluation showed 21 cases of elbow arthritis; only two of them complained about pain. Heterotopic ossification was evident in six cases with functional impairment in only one patient. Six patients with increased ulnar variance had clinical distal radio-ulnar joint instability. Discussion: Radial head excision has been considered a safe surgical procedure with satisfactory clinical outcomes. Development in biomechanical studies and prosthetic replacement of the radial head question the validity of radial head excision. In current literature, there are neither long-term follow-up studies on radial head prosthesis outcomes nor studies which consider elderly patient samples. Conclusion: Radial head resection remains a good option when a radial head fracture occurs in elderly patients, taking into account the influence of poor bone quality and comorbidities on the outcome. Radial head excision is not indicated in the presence of associated lesions, because of the risk of residual elbow instability; complications associated with advanced age must be considered and a strict follow-up granted

Do prior intra-articular injections impact on the risk of periprosthetic joint infection in patients undergoing total hip arthroplasty? A meta-analysis of the current evidences with a focus on the timing of injection before surgery

Purpose: Intra-articular injection is a well-established and increasingly used treatment for the patient with mild-to-moderate hip osteoarthritis. The objectives of this literature review and meta-analysis are to evaluate the effect of prior intra-articular injections on the risk of periprosthetic joint infection (PJI) in patients undergoing total hip arthroplasty (THA) and to try to identify which is the minimum waiting time between hip injection and replacement in order to reduce the risk of infection. Methods: The database of PubMed, Embase, Google Scholar and Cochrane Library was systematically and independently searched, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To assess the potential risk of bias and the applicability of the evidence found in the primary studies to the review, the Newcastle-Ottawa scale (NOS) was used. The statistical analysis was performed by using the software 'R' version 4.2.2. Results: The pooling of data revealed an increased risk of PJI in the injection group that was statistically significative (P = 0.0427). In the attempt to identify a 'safe time interval' between the injection and the elective surgery, we conducted a further subgroup analysis: in the subgroup 0-3 months, we noted an increased risk of PJI after injection. Conclusions: Intra-articular injection is a procedure that may increase the risk of developing periprosthetic infection. This risk is higher if the injection is performed less than 3 months before hip replacement

An unusual suicide by carbon monoxide intoxication: 91% HbCO saturation in a sealed setting

Carbon monoxide (CO) is the most common lethal poison in every community yet studied. Accidental or suicidal CO poisoning has been reported as the most frequent manner of death. In the case we report here, a man was found dead inside his house with a strong smell of burning. The house presented no signs of effraction, and a lot of scotch tape was placed around the windows and doors edges as well as the keyholes to avoid any passage of air. Near the bed, there was an extinguished brazier with combusted carbon. After the external examination of the body a toxicological analysis was performed. The results pointed out 91% HbCO saturation in absence of signs of intermediate intoxication on the body or on the scene. This article aims to outline the importance of performing a multidisciplinary approach that includes an accurate crime scene investigation and a proper toxicological assessment, to evaluate the cause of death in cases of suspected CO inhalation suicide. The crime scene investigation together with the very high levels of HbCO saturation detected, suggest a possible correlation between time of exposure, source of CO, and saturation levels

a narrative review

Funding Information: The authors received medical writing support from Niina Nuottamo of Excerpta Medica. The writing support was funded by Angelini Pharma. Funding Information: Acknowledgments: The authors received medical writing support from Niina Nuottamo of Excerpta Medica. The writing support was funded by Angelini Pharma. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.Low back pain (LBP) is a leading cause of disability. It significantly impacts the patient’s quality of life, limits their daily living activities, and reduces their work productivity. To reduce the burden of LBP, several pharmacological and non-pharmacological treatment options are available. This review summarizes the role of superficial heat therapy in the management of non-specific mild-to-moderate LBP. First, we outline the common causes of LBP, then discuss the general mechanisms of heat therapy on (LBP), and finally review the published evidence regarding the impact of superficial heat therapy in patients with acute or chronic non-specific LBP. This review demonstrates that continuous, low-level heat therapy provides pain relief, improves muscular strength, and increases flexibility. Therefore, this effective, safe, easy-to-use, and cost-effective non-pharmacological pain relief option is relevant for the management of non-specific mild or moderate low back pain in current clinical practice.publishersversionpublishe

Alumina-on-alumina total hip replacement for femoral neck fracture in healthy patients

<p>Abstract</p> <p>Background</p> <p>Total hip replacement is considered the best option for treatment of displaced intracapsular fractures of the femoral neck (FFN). The size of the femoral head is an important factor that influences the outcome of a total hip arthroplasty (THA): implants with a 28 mm femoral head are more prone to dislocate than implants with a 32 mm head. Obviously, a large head coupled to a polyethylene inlay can lead to more wear, osteolysis and failure of the implant. Ceramic induces less friction and minimal wear even with larger heads.</p> <p>Methods</p> <p>A total of 35 THAs were performed for displaced intracapsular FFN, using a 32 mm alumina-alumina coupling.</p> <p>Results</p> <p>At a mean follow-up of 80 months, 33 have been clinically and radiologically reviewed. None of the implants needed revision for any reason, none of the cups were considered to have failed, no dislocations nor breakage of the ceramic components were recorded. One anatomic cementless stem was radiologically loose.</p> <p>Conclusions</p> <p>On the basis of our experience, we suggest that ceramic-on-ceramic coupling offers minimal friction and wear even with large heads.</p