A case of bilateral luxatio erecta

Luxatio erecta is an uncommon form of glenohumeral dislocation. Cases of bilateral inferior shoulder dislocation (luxatio erecta) are very rare, and only ten cases have been described in literature. We describe a case of a woman with bilateral luxatio erecta of the shoulders treated with close reduction, immobilization and rehabilitation. The patient had fallen downstairs while clinging to both lateral banisters

Results of isolated posterolateral corner reconstruction

BACKGROUND: Isolated posterolateral corner (PLC) tears are relatively rare events. Various surgical techniques to treat posterolateral knee instability have been described; because surgical results are linked to cruciate reconstructions it has been difficult to date to define whether one surgical procedure has better prognosis than another. The goal of this study is to determine the clinical outcome of PLC reconstruction following fibular-based technique. MATERIALS AND METHODS: We retrospectively evaluated a case series of patients who received isolated PLC reconstruction between March 2005 and January 2007. Ten patients were surgically treated for isolated injuries and were available for follow-up; average patient age was 27.4 years (range 16-47 years). All patients were treated following the fibular-based technique: double femoral tunnel was performed in six patients, while in the remaining four patients, the reconstruction of the PLC was performed with a single femoral tunnel. Six patients had semitendinosus allograft and four had semitendinosus autograft. All patients had the same evaluation and the same rehabilitation protocol. RESULTS: Mean follow-up was 27.5 months (range 18-40 months). Mean range of motion (ROM) was 143.5 degrees for flexion (range 135-150 degrees) and 0.5 degrees for extension (range 0-3 degrees). Three patients showed 1+ on varus stress test, while on Dial test another three patients showed 10 degrees reduction of external rotation compared with contralateral knee. The average Lysholm score was 94 points (range 83-100), and the mean International Knee Documentation Committee (IKDC) subjective result was 88.48 (range 74-96.5). Based on Lysholm score, the results were excellent in eight knees and good in two knees. On IKDC evaluation, two patients were grade A and eight were grade B. No significant difference in clinical results was observed between single and double femoral tunnel. CONCLUSION: Fibular-based technique showed good results in terms of clinical outcome, restoring varus and rotation stability of knees in treatment of chronic isolated PLC injury

Self-inflicted long bone fractures for insurance fraud

Self-inflicted fractures simulating traffic accident represent a new social fraud opportunity for criminality. Recognising scams through an increase of awareness of existence of self-inflicted arm fractures for insurance fraud could help community health workers to report these injuries to the competent authorities. In this article, authors have recognised an unusual but consistent pattern of upper and lower limb fractures whose incidence does not coincide in numerical terms with what is reported in literature. The aim of the present study is to describe fracture patterns observed over the past 2 years. Further, authors describe clinical presentations of these fractures and attempt to define a possible mechanism of these types of injuries

New Light on the Sufferings and the Burial of the Turin Shroud Man

This paper presents news concerning the transportation of the whole cross on the shoulders and the falling mode of the Turin Shroud (TS) Man on the ground that explains the detected traumas. These news base themselves on the hypothesis that the TS Man is Jesus of Nazareth.Based on historical information and on a structural analysis, after a reconstruction of the Roman “Tau” cross, a life-size sample of it has been built in order to study its compatibility with some traumas visible on the TS.Also discussed are the medical implications caused by a violent blunt trauma from behind, to the neck, chest and right shoulder including the etio-pathogenesis of the head posture of Jesus on the cross represented in traditional iconography. Finally, additional news is included regarding bloodstains like the “blood belt”, the “mattress” of spices and the sudarium used as chin bandage.</p

Isolated osteoblastoma of the cuboid bone: A case report and review of the literature

Osteoblastoma is a relatively rare, benign, bone-forming tumor, commonly observed in the second and thirddecades of life. Spine and the long tubular bones are the most common sites of involvement. Osteoblastoma isinfrequently seen in other sites, including the bones of hand and foot. A rare case of a 35-year-old man thatpresented an osteoblastoma of the cuboid bone is reported. The patient was treated with surgical resection andgrafting. After the intervention, the patient recovered with no clinical and radiological evidence of recurrence after one year of follow-up.Several cases of osteoblastoma like variant of osteosarcoma of the cuboid have been previously reported, but ,to our knowledge, this is the first case of conventional and isolated osteoblastoma involving the cuboid bone reported in the literatur

The Causes of Jesus’ Death in the Light of the Holy Bible and the Turin Shroud

Due to the lack of information, the pathogenesis of the death of Jesus of Nazareth is still widely debated. A univocal pathogenesis can be detected by the close comparison between what is reported in the Holy Bible (in particular the four Gospels and the prophetic passages of the Old Testament) and what can be observed on the Turin Shroud (TS). Obviously the authenticity of the latter must be here accepted in the sense that it wrapped the corpse of Jesus of Nazareth. The criteria used to support or ignore many etiological hypotheses regarding the terminal event that caused Jesus’ death must take into account: an acute fact, the perfect lucidity and the cry of Jesus immediately before his death. We conclude that the causes of death are: Terminal cause: myocardial infarction, heart rupture and hemopericardium.Contributing and accelerating causes, in chronological order: 1. severe emotional stress and sweating with hematohydrosis, 2. fl uid loss without drinking, 3. beating and scourging, 4. crown of thorns, 5. blunt trauma to the neck and thorax following the fall with right shoulder dislocation, paralysis of the entire right brachial plexus, pulmonary contusion with hemothorax and cardiac contusion, 6. nailing, 7. probable left ulnar proximal paralysis from stretching during crucifi xion, 8. probable right foot dislocation from stretching during crucifi xion, 9. causalgia, 10. Hypoventilation, 11. Hemorrhagic hypovolemicpolitraumatic and suspension shock.</p

Sopravvivenza delle megaprotesi nel trattamento delle metastasi osee

Introduzione: Il trattamento delle metastasi ossee è sovente palliativo, mirando al controllo del dolore e alla stabilizzazione o prevenzione di fratture patologiche; tuttavia, in casi selezionati può esser eseguita una resezione completa con finalità curative. Obiettivo del nostro lavoro è stato valutare la sopravvivenza delle megaprotesi utilizzate per ricostruzione dopo resezione di metastasi ossea Materiali e Metodi: Tra gennaio 2001 a marzo 2015 abbiamo impiantato 169 Megasystem-C® (Waldemar LINK® GmbH &amp; Co. KG, Amburgo, Germania) dopo resezione di metastasi ossea. I pazienti, 95 femmine e 74 maschi, sono stati operati a un’età media di 61 (12-87) anni per resezione prossimale di femore in 135 (79.9%) casi, distale di femore in 24 (14.2%), prossimale di tibia in 6 (3.6%), totale di femore in 3 (1.8%) e intercalare di femore in 1 (0.6%). Sono state principalmente trattate metastasi da carcinoma mammario (30.8%), renale (17.8%) e polmonare (14.2%). Risultati: A un follow-up medio di 21 (1-150) mesi, abbiamo riscontrato un tasso di salvataggio dell’arto del 99.4%, e un tasso di sopravvivenza libera da fallimento dell’impianto del 96.1% a 1 anno, 92.8% a 2 anni, e 86.8% a 5 e 10 anni. Abbiamo denotato 9 (5.3%) casi di lussazione di megaprotesi di femore prossimale, 3 dei quali necessitanti di riduzione chirurgica; 2 (1.2%) casi di mobilizzazione asettica dello stelo protesico; 2 (1.2%) casi d’infezione periprotesica, uno dei quali necessitante una revisione in 2 tempi. Discussione: A oggi, pochi studi in letteratura hanno valutato la sopravvivenza di megaprotesi nel trattamento di metastasi ossee. I nostri dati evidenziano come in questo specifico contesto il tasso di complicanze è nettamente inferiore a quanto atteso in chirurgia ortopedica oncologica generale. In particolar modo, riteniamo che il basso tasso d’infezione denotato, quasi sovrapponibile a quello atteso in procedure primarie, sia da addebitarsi a puntuali gestioni dei tessuti molli (in particolar modo in ricostruzioni prossimali di tibia) e a una profilassi antibiotica prolungata. Conclusioni: L’utilizzo delle protesi modulari è una valida strategia ricostruttiva dopo resezione di metastasi ossee in pazienti selezionati. Il tasso di complicanze a breve termine è eccezionalmente basso; studi successivi dovranno confermare ciò a più lungo termine

Peri-Implant Distal Radius Fracture: Proposal of a New Classification

A peri-implant fracture near the volar plate of the distal radius represents a rarity and can be associated with a mechanical failure of the devices. A literature review was conducted including all fractures that occurred around a volar wrist plate, which could be associated with an ulna fracture. All articles published until December 2021 were considered according to the guidelines presented in the PRISMA Statement. The search was conducted with the PubMed electronic database, Cochrane Database of Systematic Reviews, Medline, Embase, and Google Scholar. Only nine cases of these fractures were reported in the literature. The causes could be due to delayed union/non-union of the old fracture after low energy traumas, high energy trauma in patients with poor bone quality, or hardware mechanical failure. Furthermore, the literature review of peri-implant radius fracture shows different level of radius fracture and types of implant failure. In accordance with these different cases, a new classification of peri-implant fracture of the distal radius is proposed

L’UTILIZZO DELLE MEGAPROTESI MODULARI DA RESEZIONE PER PATOLOGIE ONCOLOGICHE E NON ONCOLOGICHE DEL GOMITO

Introduzione: La ricostruzione dell’articolazione del gomito dopo ampia resezione ossea è una procedura chirurgica molto impegnativa per complessità biomeccanica, scarsa presenza di tessuti molli per la copertura e la vicinanza delle strutture vascolonervose. Le megaprotesi modulari sono un valido strumento per questo tipo di ricostruzione ma ci sono ancora pochi dati in letteratura. Obiettivo del nostro lavoro è stato valutare la sopravvivenza delle megaprotesi da noi utilizzate per tali ricostruzioni. Materiali e Metodi: Tra Gennaio 1999 e Dicembre 2015 abbiamo impiantato 36 megaprotesi modulari, 24 (66.7%) protesi HMRS (Howmedica International, Limerick, Ireland) e 12 (33.3%) protesi Discovery-SRS (Biomet Orthopedics, Warsaw, Indiana, USA), in pazienti con insufficiente bone stock per l’impianto di una protesi di gomito convenzionale. I pazienti, 14 maschi e 22 femmine, sono stati operati a un’età media di 60.1 (11-84) aa, 31casi (81.6%) in seguito a resezione di tumore osseo e 5 casi (13.9%) in seguito a fallimenti di precedenti ricostruzioni. Sono stati valutati il risultato funzionale, oncologico e le complicanze Risultati: A un follow-up medio di 25 (2-204) mesi, abbiamo riscontrato un Mayo Elbow Performance Score (MEPS) di 77.08 (40-95) punti e un Musculoskeletal Tumor Society Score (MSTS) di 22.9 (8-30) punti. Abbiamo denotato 6 complicanze (16.7%): 2 paralisi del n.radiale, 1 paralisi del n.ulnare, 1 paralisi transitoria del n.ulnare, 1 dissassemblaggio delle componenti protesiche e 1caso di infezione profonda entrambi trattati con revisione chirurgica. Il tasso di sopravvivenza dei pazienti a 5 aa è stato del 25.1% mentre quello di sopravvivenza dell’impianto a 5 aa del 93%. Discussione: Nonostante uno scarso tasso di sopravvivenza dei pazienti per rapida progressione di malattia in particolare nei metastatici abbiamo comunque un tasso di sopravvivenza dell’impianto a 5 aa particolarmente soddisfacente e solo in 1 caso è stata necessaria la sostituzione dell’impianto. I nostri dati evidenziano, con buoni risultati funzionali, come in questo spe-ifico contesto la scelta di utilizzare delle megaprotesi modulari sia valida alla luce del confronto con altre strategie ricostruttive; in particolare, innesti osteoarticolari e protesi composite, gravati da alto tasso di infezioni e dal rischio di instabilità articolare, e l’artrodesi, con forte limitazione funzionale e rischio di ritardato consolidamento osseo nei pazienti oncologici sottoposti a radio e chemioterapia. Conclusioni: Nonostante il limitato numero di pazienti della nostra casistica e l’eterogeneicità di questi, abbiamo evidenziato che l’utilizzo delle protesi modulari è una valida strategia ricostruttiva dopo resezione dell’articolazione del gomito in casi oncologici e non oncologici con buona ripresa funzionale. Studi successivi dovranno confermare ciò a più lungo termine