Surgical treatment of displaced acetabular fractures: Report of 13 clinical cases

Background and aim of the work: Displaced acetabular fractures are complex lesions which may cause severe consequences if not appropriately treated. The results are linked to the quality of the articular reduction. Anatomical reduction, through surgical treatment with rigid internal fixation, should be considered to obtain an early mobilization, reduce long term osteoarthritis evolution and make the acetabular cavity suitable to eventually recive a total hip prosthesis. The aim of this study is to evaluate functional and radiographic outcome of patients with displaced acetabular fractures surgically treated. Methods: Between 2005 and 2011, 29 displaced acetabular fracures were treated with open reduction and internal fixation. This study highlight our results in 13 patients with a mean follow-up of 29,5 months (range 5,5-66,3). Clinical evaluation was done according to the Harris hip score, while the radiological criteria were those of Kellgren- Lawrence. The associated injuries and complications were evaluated. Results: At the latest follow-up the radiological results, based on the Kellgren-Lawrence grading scale, showed 3 patients with a I grade of osteoarthritis, 5 with a II grade, 3 with a III grade and 2 with a IV grade. The average Harris hip score was 77 (range 37-100). Postoperative complications included avascular necrosis of the femoral head in 3 patients and heterotopic ossification in 2 patients. Conclusions: This study confirm that open reduction and internal fixation in displaced acetabular fractures represents the best treatment able to lead to a satisfactory functional outcome. Moreover, it posticipates long-term arthrosis and eventually makes easier the implant of total hip prosthesis. © Mattioli 1885

Over the top or endobutton for ACL reconstruction?

There are an estimated 80-100,000 ACL repairs in the US each year: most ACL tears occurs from noncontact injuries. The 3.9% of the knee ligament injuries undergoes surgery: in the 80% of these patients, this means ACL reconstruction. The purpose of this study is to compare two surgical techniques normally used for acl recustruction; the first one is the intra- extra articular technique with single bundle fixed with staples and the second one is the intra-articular technique with double bundle and endobutton post-fixation. We evaluate the clinical outcome of our patients at the time of 4 years follow up. From January 2006 to April 2009 40 patients underwent to ACL reconstruction, all operated by using hamstring tendons: 20 patients with an average age of 28,75 years (12 men and 8 women) underwent surgery using the intra-extra articular technique, whereas the remaining 20 patients with an average age of 34,5 years (11 men and 9 women) benefited the intra-articular technique with double bundle ligament and endobutton post-fixation. Our study shows no substancial difference between these two technique, but clinical outcome measures (I.K.D.C., Lysholm and Tegner) estimated better results for the double bundle technique with Endobutton post-fixation. © Mattioli 1885

Arthroscopic treatment for cuff tear: strength recovery at 12 months of follow-up

The rotator cuff tear is one of the most frequent musculoskeletal disorders, but the real incidence is not clearly known because it’s usually asymptomatic, even if it’s more common in patients with shoulder pain (36 %). The prevalence of the complete tear among general population is estimated approximately around 20.7 % and it is more usual with the increasing of the age. The aim of this study is to evaluate a group of patients with any size of full-thickness cuff tear treated by arthroscopic technique, comparing the clinical and functional recovery (isokinetic, isotonic and isometric strength) with the un-operated side. Between October 2009 and June 2011, 74 patients, mean age 59 (20–72) years old, underwent arthroscopic treatment for rotator cuff tear. Forty-two patients were finally included in the study, 20 men and 22 women, mean age of 55 (20–68) years old. The mean follow-up was 12 months (6–23 months). The strength of each patient’s shoulder, both operated and un-operated, was evaluated using isokinetic, isotonic and isometric tests (BIODEX Medical System). The functional outcome showed no significant differences between operated and un-operated shoulder, confirmed by Constant–Murley score and DASH score. The isokinetic, isotonic and isometric tests are valid support to clinical evaluation in order to obtain an objective data on shoulder recovery

Are percutaneous pinning the best treatment for gartland type iii supracondylar humeral fractures in children?

Background. Supracondylar humeral fractures are the most frequent fractures of the elbow in children. Gartland type III fractures require a surgical treatment. The preferred management is closed reduction and percutaneous pinning with K-wires. Methods. We have treated 15 patients (mean age 6,5 years) with Gartland type III fractures. In 14 patients the percutaneous reduction with K-wires was possible but in 1 case the open reduction was necessary due to the irreducibility of the fracture. In all cases a cycle of rehabilitation was performed. Results. All patients have been evaluated using Flynn's criteria with a mean follow-up of 24 months. All cases resulted excellent except the one that required open reduction, that resulted good. Conclusions. Percutaneous pinning is at our days the gold standard of treatment but open reduction must always be considered mandatory when an anatomical closed reduction is not possible. Rehabilitation is also fundamental though the young age of the patients

Arepercutaneous pinning the best treatment for Gartland type III supracondylar humeral fractures in children?

none5noBackground. Supracondylar humeral fractures are the most frequent fractures of the elbow in children. Gartland type III fractures require a surgical treatment. The preferred management is closed reduction and percutaneous pinning with K-wires. Methods. We have treated 15 patients (mean age 6,5 years) with Gartland type III fractures. In 14 patients the percutaneous reduction with K-wires was possible but in 1 case the open reduction was necessary due to the irreducibility of the fracture. In all cases a cycle of rehabilitation was performed. Results. All patients have been evaluated using Flynn's criteria with a mean follow-up of 24 months. All cases resulted excellent except the one that required open reduction, that resulted good. Conclusions. Percutaneous pinning is at our days the gold standard of treatment but open reduction must always be considered mandatory when an anatomical closed reduction is not possible. Rehabilitation is also fundamental though the young age of the patients.nonePedrazzini, Alessio; Verdano, Michele Arcangelo; De Caro, Francesca; Pellegrini, Andrea; Ceccarelli, FrancescoPedrazzini, Alessio; Verdano, Michele Arcangelo; De Caro, Francesca; Pellegrini, Andrea; Ceccarelli, Francesc

Prevalence of shoulder discomfort in paraplegic subjects

Introduction: The annual incidence of acute spinal cord injury, as reported in the National Spinal Cord Injury Statistical Center, was estimated to be approximately 40 cases per million, or approximately 11.000 new cases in the United States each year (1). In subjects with spinal cord injury, overstress of the upper extremities occurs not only during daily life activities, but also utilizing wheelchair. The aim of this study is to determine the prevalence of shoulder discomfort in subjects affected by paraplegia living in our country area and evaluate the associated risk factors negatively affecting the shoulder function. Material and Method: A computerized database search for paraplegic patients was performed at the Department of Orthopedic Surgery, Trauma Surgery and Rehabilitation Medicine. Among the 54 selected paraplegic patients, 47 accepted to participate at the study. Once the patients were contacted, the medical records were reviewed to obtain information regarding shoulder, elbow and spine region pain and discomfort. Results: The 60% of all the patients who answered to the questionnaire complain shoulder pain, 90% bilaterally, and the 30% referred elbow pain, 20% bilaterally. 77% complains back pain, involving particularly lumbar region. Only 2% of this population undergoes a shoulder surgery treatment for cuff tear and shoulder disability. Discussion and Conclusion: The present study is the first in our country that gives an overview of prevalence of upper limb discomfort in paraplegic patients.We have shown the interplay between shoulder elbow and spine with pain, age of patients and type of wheel chair utilized. The previous factors can be corrected and upper limb discomfort relieved. © Mattioli 1885

Prevalence of shoulder discomfort in paraplegic subjects

The annual incidence of acute spinal cord injury, as reported in the National Spinal Cord Injury Statistical Center, was estimated to be approximately 40 cases per million, or approximately 11.000 new cases in the United States each year (1). In subjects with spinal cord injury, overstress of the upper extremities occurs not only during daily life activities, but also utilizing wheelchair. The aim of this study is to determine the prevalence of shoulder discomfort in subjects affected by paraplegia living in our country area and evaluate the associated risk factors negatively affecting the shoulder function

Prevalence of shoulder discomfort in paraplegic subjects

Introduction: The annual incidence of acute spinal cord injury, as reported in the National Spinal Cord Injury Statistical Center, was estimated to be approximately 40 cases per million, or approximately 11.000 new cases in the United States each year (1). In subjects with spinal cord injury, overstress of the upper extremities occurs not only during daily life activities, but also utilizing wheelchair. The aim of this study is to determine the prevalence of shoulder discomfort in subjects affected by paraplegia living in our country area and evaluate the associated risk factors negatively affecting the shoulder function. Material and Method: A computerized database search for paraplegic patients was performed at the Department of Orthopedic Surgery, Trauma Surgery and Rehabilitation Medicine. Among the 54 selected paraplegic patients, 47 accepted to participate at the study. Once the patients were contacted, the medical records were reviewed to obtain information regarding shoulder, elbow and spine region pain and discomfort. Results: The 60% of all the patients who answered to the questionnaire complain shoulder pain, 90% bilaterally, and the 30% referred elbow pain, 20% bilaterally. 77% complains back pain, involving particularly lumbar region. Only 2% of this population undergoes a shoulder surgery treatment for cuff tear and shoulder disability. Discussion and Conclusion: The present study is the first in our country that gives an overview of prevalence of upper limb discomfort in paraplegic patients.We have shown the interplay between shoulder elbow and spine with pain, age of patients and type of wheel chair utilized. The previous factors can be corrected and upper limb discomfort relieved. © Mattioli 1885

Humeral shaft fractures treated with antegrade intramedullary nailing: What are the consequences for the rotator cuff?

Purpose: The purpose of this study was to investigate the clinical and sonographic impact on the rotator cuff (RC) of the use of the anterolateral approach for nailing. Methods: A retrospective cohort of 48 patients treated for humeral diaphyseal fractures at the University Hospital of Parma between 2007 and 2011 was analysed. Inclusion criteria were (1) acute humeral shaft fractures treated with T2-proximal humeral nail (PHN) and (2) a minimum follow-up of one year. Exclusion criteria were (1) history of proximal and metaphyseal humeral fractures, (2) pathological fractures or open fractures of the humerus, and (3) RC lesions. Clinical assessment using the Constant score, simple shoulder test and through shoulder examination tests was carried out. The sonographic study investigated the integrity of the RC. Results: Mean score on Constant's scale was 78.21 points, with most patients achieving a good result (79 % obtained more than 65 points). One patient had a limited functional outcome (Constant's score of 49 points). The sonographic findings described for supraspinatus tendon were a partial ruptures of less than 30 mm in three patients and a complete tendon rupture in one case. Conclusions: The results of this study suggest that the use of the anterolateral approach for antegrade humeral nailing ensures a good functional result with no significant clinical-sonographic impact on the rotator cuff and a satisfactory long term clinical outcome. © 2013 Springer-Verlag Berlin Heidelberg