I.S.Mu.L.T. Achilles Tendon Ruptures Guidelines

This work provides easily accessible guidelines for the diagnosis, treatment and rehabilitation of Achilles tendon ruptures. These guidelines could be considered as recommendations for good clinical practice developed through a process of systematic review of the literature and expert opinion, to improve the quality of care for the individual patient and rationalize the use of resources. This work is divided into two sessions: 1) questions about hot topics; 2) answers to the questions following Evidence Based Medicine principles. Despite the frequency of the pathology andthe high level of satisfaction achieved in treatment of Achilles tendon ruptures, a global consensus is lacking. In fact, there is not a uniform treatment and rehabilitation protocol used for Achilles tendon ruptures

Immediate continuous passive motion after internal fixation of an ankle fracture

Surgical treatment is usually mandatory in displaced bimalleolar and trimalleolar fractures. Some authors have recommended early mobilization of the ankle joint after surgical treatment of these lesions. In this study, we evaluate the effect of immediate postoperative continuous passive motion in the management of displaced bimalleolar and trimalleolar fractures treated surgically

Influence of chronic osteomyelitis on skeletal growth: analysis at maturity of 26 cases affected during childhood

Twenty-six patients who had suffered from chronic osteomyelitis since childhood were followed after skeletal growth. The follow-up ranged from 11 to 41 years, with an average of 23.4 years. At the end of growth, 22 of our 26 patients did not show any deformity of the involved limb. At follow-up, four of 26 patients showed shortening and angular deformity of the affected limb. Irreversible damage of the growth plate, due either to the extreme virulence of the pathogen or to inappropriate surgical treatment, was responsible for the deformities

Surgical treatment of fibrous dysplasia of bone in McCune-Albright syndrome

Seven patients affected by McCune-Albright syndrome with polyostotic fibrous dysplasia were operated on either for fracture fixation or for correction of bone deformity. Ten femurs, three tibiae, and one humerus were stabilized by intramedullary titanium nailing with a modified unreamed femoral nail (UFN) and standard unreamed tibial (UTN) and humeral (UHN) nails. The age of the patients at operation ranged from 8 to 30 years, with an average of 17 years, and the length of follow-up ranged from 8 months to 4 years, with an average of 2 years. Before operation, each patient had suffered from a minimum of three fractures to a maximum of 12, with an average of six fractures. The femur was the most affected skeletal segment. Before surgery, two patients were wheelchair-dependent owing to their severe lower limb bone deformities. At follow-up, all the patients were painless and all were able to walk even though one had to wear a bilateral long leg brace and another had to ambulate with the aid of two crutches. No patient had had additional fractures after surgery. The main intra-operative technical problems of this demanding surgical procedure were: a) reaming of a new medullary canal through the fibrodysplastic bone; b) the amount of blood loss in femoral surgery that ranged from 800 to 2,500 ml

Two-stage surgical treatment of complex femoral deformities with severe coxa vara in polyostotic fibrous dysplasia

In patients with polyostotic fibrous dysplasia with extensive femoral involvement, severe coxa vara may cause complex femoral deformities that are difficult to treat with a single-stage surgical procedure. We evaluated the results of treatment of such patients with a two-stage procedure

A comparison of resultant subtalar joint pathology with functional results in two groups of clubfoot patients treated with two different protocols

Two series of patients with congenital clubfoot treated by different manipulation techniques and by different complementary soft tissue release operations were evaluated at the end of skeletal growth. The severity of the deformity was graded at diagnosis, and the functional results were graded at follow-up with a functional rating system. Computed tomography scans of the subtalar joint were also obtained at follow-up for each patient in order to evaluate the joint morphology. A linear regression model was constructed to study the statistical correlation between the rating score of the treated clubfeet and the shape of the subtalar joint. A statistically significant correlation was found between the clubfeet rating score and the subtalar joint morphology. However, the rating score values of the second series were consistently higher than those of the first series when compared with the same morphological category of the subtalar joint

A simultaneous bilateral asymmetric hip fracture in an elderly patient: A case report and review of the literature

INTRODUCTION: Simultaneous bilateral hip fractures are usually associated with high energy trauma, seizures, metabolic diseases and bisphosphonates use. They are observed rarely in the elderly population after simple trauma and usually have the same fracture pattern (symmetric). We report a rare case of a symmetric fracture and discuss mechanism of injury and treatment, analyzing the literature.PRESENTATION OF CASE: We report a case of an 86-year old woman with a simultaneous bilateral asymmetric hip fracture (trochanteric on the right side and subcapital on the left), occurred after a fall at home. The patient was surgically treated by open reduction and internal fixation with an intramedullary nail on the right and by hemiarthroplasty on the left performed during the same surgical session, with good results.DISCUSSION: Simultaneous bilateral hip fractures in the elderly are rare and usually are symmetric. In the majority of the cases these fractures are intracapsular and are treated by hemiarthroplasties. On the contrary, simultaneous bilateral hip fractures with a different pattern, as the described case, are extremely rare. The possible mechanism of injury is a spontaneous fracture on one side, which causes a fall the contralateral side. The surgical treatment may be performed bilaterally, treating first the trochanteric fracture.CONCLUSION: Simultaneous bilateral asymmetric hip fracture are extremely rare and may occur in elderly patient with a specific mechanism of injury. We believe that the trochanteric fracture should be operated first to avoid possible complications. (c) 2020 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Excision for the treatment of periarticular ossification of the knee in patients who have a traumatic brain injury

Patients who are comatose after a traumatic brain injury often have heterotopic periarticular ossification that can be treated with excision to improve the range of motion of the joint

Aneurysmal bone cyst. Long-term follow-up of 20 cases

Twenty cases of aneurysmal bone cyst were reviewed, with an average follow-up of 10.3 years. Twelve patients still had open growth plates at diagnosis, but all of them were fully grown at follow-up. The treatments performed were: resection of the cyst or of the whole affected bone, curettage, and curettage and bone grafting. Radiation therapy was a complementary treatment in three cases. Two patients relapsed, one that had been treated by curettage alone and one by curettage and bone grafting. Five patients showed skeletal deformities at follow-up. Two had lesions of the growth plate, most likely caused by radiation therapy, whereas in the other three growth had probably been impaired by surgical trauma