Complex Acetabular Prosthetic Revisions. Comparison of modern materials in treatment strategies

The increasing number of total hip arthroplasty (THA) operations has inevitably led to an increase in the number of revisions for aseptic, septic or traumatic mobilization. The surgical treatment of these lesions is a demanding challenge for the surgeon: the primary objective is a stable osterexesis of the fracture that allows an early mobilization of the patient, therefore a careful evaluation of the materials to be implanted is also necessary. The aim of our study is to demonstrate the usefulness and limitations of new revision surgery technologies in cotiprosteal fractures. We enrolled 54 patients who underwent hip acetabular revision. The criteria chosen for the evaluation of outcomes: the visual analogue scale of pain in the traumatized hip (VAS); the subjective score of the Harris HIP Score; quality of life measured with The Short Form (12) Health Survey (SF-12); the average time of cup integration and complications. The evaluation endpoint was set at 24 months. The results, assessed with the aforementioned parameters, were on average good. Complications are the same as those described in the literature. The advantages of the new generation of acetabular components are: excellent integration and ductility of materials during revision of hip arthroplasty

Fake news e polarizzazione: come cambia l'informazione ai tempi di internet

La conferenza si svolge nell'ambito di Trieste Next 2019-Big data e Deep Science: si pensa che Internet possa garantire a tutti un accesso libero ed esaustivo all’informazione. Tuttavia, in un sistema informativo iperconnesso quale quello digitale, le informazioni sono tante, a volte difficilmente verificabili, ma la nostra attenzione è limitata, e alcuni meccanismi cognitivi tendono a prendere il sopravvento, rendendo il dibattito fortemente polarizzato. Ma come funzionano questi meccanismi? Quali strategie possono essere messe in campo per attenuare la polarizzazione? E come possiamo difenderci ed essere dei cittadini digitali consapevoli

Breakage in Two Points of a Short and Undersized “Affixus” Cephalomedullary Nail in a Very Active Elderly Female: A Case Report and Review of the Literature

Introduction. Trochanteric fractures of the femur are common in elderly individuals with osteoporosis. The use of cephalomedullary nails is increasing, and they are now the most commonly used fixation devices, especially for the treatment of unstable trochanteric fractures. The nail breakage is not the most common complication of intramedullary nailing. Many scientific papers report nail breakage in a specific location: through the lag screw hole, the nail shaft, or the distal locking hole. Materials and Methods. We present a case of an 84-year-old patient treated with modular revision hip arthroplasty due to the breakage in two points of a cephalomedullary nail implanted 3 years earlier for a subtrochanteric fracture. Results. After modular revision hip arthroplasty, the functional results and quality of life have been excellent. Conclusions. As far as we could determine, this appears to be the first case of a breakage of a cephalomedullary nail in two points after nonunion in a very active elderly female

Surgical exposure of lateral orbital lesions using a coronal scalp flap and lateral orbitozygomatic approach: clinical experience.

The lateral extraconal compartment is a typical localization of intra-orbital tumours. With the exception of anterior lesions, which can be reached by a transconjuntival route, most of these tumours are currently approached through the classic lateral orbitotomy originally described by Kronlein. We present here our experience in the management of lateral orbital lesions, using a coronal skin flap, followed by subfascial dissection of the temporalis muscle. The procedure was intended to overcome the potential drawbacks associated with the classic transtemporal approach. The approach was used in eleven patients harbouring bone lesions of the lateral orbital wall or intra-orbital lesion of the lateral extra-ocular compartment. The postoperative results were assessed using a simple cosmetic outcome scale, which evalutated the temporalis muscle trophism and the function of the frontotemporal branch of the facial nerve. All lesions were satisfactorily exposed. The subfascial dissection of the temporalis muscle is a key manoeuvre which, at the same time, abolishes the risk of injury to the frontotemporal branch of the facial nerve and provides a wide exposure of the lateral orbital wall. The cosmetic outcome was excellent in 9 patients and good in 2 patients

Endoscopic application of autologous fibrin glue to treat postoperative CSF leak after expanded endonasal approach: report of two cases

Since the introduction of endoscopic surgery for the treatment of skull base lesions, one of the main issues has been the CSF leak. The implementation of efficient reconstructive techniques has reduced the post-operative CSF leak rate. However, none of the techniques for closure has proved to be totally effective in preventing CSF leakage. We propose a possible solution to this problem. Two patients underwent surgery for suprasellar meningioma via an expanded endoscopic endonasal approach and subsequently presented post-operative CSF leakage. They were treated via injections of autologous fibrin glue at the patients ' bedside. The autologous fibrin glue was obtained using the automated Vivostat® system, that prepares 5 ml of autologous fibrin sealant from 120 ml of the patient ' s own blood. In both patients, we obtained the permanent closure of the small defects and the interruption of the leakage. The application of autologous fibrin glue made it possible to successfully treat these two cases of post- operative CSF leak without the need of a second operation. The advantage of using autologous fibrin glue is probably related to the high biological activity of such material in promoting a faster healing, it might be a solution in selected cases

Grafting and fixation after aseptic non-union of the humeral shaft: A case series

Purpose: Non-unions after humeral shaft fractures are seen frequently in clinical practice at about 2–10% after conservative management and 30% after surgical treatment. Non-union, displacement of structures and fixation failure can be hazardous complications. The purpose of our study was to evaluate the outcomes of an on-lay bone graft strut construction with bone chips as grafting augmentation in the management of aseptic non-unions of the humeral shaft. Methods: From 124 eligible patients with a humeral shaft non-union, we included 48 patients. In all cases an anterolateral humeral approach was used, with an on-lay bone graft using an allograft strut construction and with bone substitute augmentation in the non-union gap. To assess the bone healing on radiographs, we used the non-union scoring system according to Whelan. Patients were followed with objective and subjective scores. Results: In all 48 patients we achieved full bone healing without major complications. The average period of union was 124 days. In 40 cases after healing the alignment was neutral, valgus deformation occurred in 6 cases a varus deformation in 2 cases. At twelve months after surgery, all patients recovered with satisfactory range of motion of shoulder and elbow and a good quality of life, without any radial nerve palsies or other major complications. Conclusion: Given the satisfactory results of full bone healing, recovery of the range of motion and the lack of major complications as seen in this study, we find that plating with supporting allograft as a good choice of treatment in the cases of aseptic non-union of the humeral shaft

Effect of trochleocapitellar index on adult patient-reported outcomes after noncomminuted intra-articular distal humeral fractures

Background: Anatomic surgical reduction of intra-articular fractures of the distal humerus is important to achieve the best long-term outcomes and prevent post-traumatic arthritis. In this study we compared the radiographic reduction using the trochleocapitellar index. We also correlated the trochleocapitellar index to the functional outcomes next to the comparison of the triceps brachii lifting approach and olecranon osteotomy approach, 2 common approaches for distal humeral fractures. Methods: From January 2006 to June 2016, patients with elbow fractures were registered in 4 centers. The trochleocapitellar index, a ratio between the angle of the capitellum and the trochlea to the midline of the distal humerus on anterior-posterior radiographs, was calculated for included patients. Functional outcomes were measured using the Oxford Elbow Score and the Mayo Elbow Performance Score. Bone healing was measured using radiographic union scoring. Results: There were 86 patients enrolled: 46 in the olecranon osteotomy group and 40 in the triceps lifting group. Functional outcomes and bone healing did not differ between the approaches. Functional results had a medium correlation with the trochleocapitellar index, which did not differ between the 2 approaches (olecranon osteotomy group, κ = 0.56; triceps lifting group, κ = 0.57; P =.7932). Conclusions: The trochleocapitellar index has a moderate predictive value on the functional results after 12 months after open reduction and internal fixation of intra-articular distal humeral factures. There is no difference in reduction, as measured by trochlear index and functional outcome scores, between the olecranon osteotomy approach and the triceps brachii lifting approach groups

The damage control in tibial pilon open fractures with a new external fixator delta frame

Objective: To evaluate the effectiveness of the damage control, in emergency to treat the open tibial pilon fractures with Dolphix® External Fixator Frame(CITIEFFE®, Calderara di Reno, Bologna, Italy).Methods: From January 2017 to August 2017, at the Department of Orthopedics and Traumatology of Vito Fazzi Hospital Lecce, we treated 23 open tibial pilon fractures with Dolphix® External Fixator Frame(CITIEFFE®, Calderara di Reno, Bologna, Italy). The evaluation criteria of the case series were: the time needed to assemble the external fixator; the time taked to treat the ankle associated lesions; the time of skin healing; the ankle alignment; the subjective/objective Ovadia and Beals score; and complications. The Endpoint assessment was set at the days of the definitive surgery.Results: The results in terms of alignment, biomechanical stability of the frame, healing of soft tissue, complications were as good as the objective and subjective results according Ovadia and Beals score.Conclusion: Pilon fractures are complex and often present complications; the damage control treatment, in emergency, with Dolphix® External Fixator Frame(CITIEFFE®, Calderara di Reno, Bologna, Italy) permits a stable osteotaxis with minimal soft tissue damage and permit the repair of muscles, blood vessels and nerves with a stable bone and the soft tissue healing with vaccum therapy

The Waterfall Fascia Lata Interposition Arthroplasty “Grika Technique” as Treatment of Posttraumatic Osteoarthritis of the Elbow in a High-Demand Adult Patient: Validity and Reliability

Introduction. The elbow interposition arthroplasty is a very common procedure performed mainly on active young patients who need great functionality and for whom total joint replacement is contraindicated and arthrodesis is noncompliant. We are going to demonstrate a case of a 34-year-old male suffering from malunion of the distal humerus, elbow stiffness, and manifest signs of arthrosis of the dominant limb, treated with the IA Grika technique at a 5-year follow-up. Patients and Methods. The chosen criteria to evaluate the injured side and the uninjured side during the clinical and radiological follow-up were the objective function and related quality of life, measured by the Mayo Elbow Performance Score (MEPS), and postoperative complications. To assess flexion and supination forces and elbow muscular strength, a hydraulic dynamometer was used. Results. At a 5-year follow-up, the results were excellent as during the first year. Conclusions. The Grika technique is a valid and feasible option in the treatment of elbow injuries

Challenges in the management of floating knee injuries: Results of treatment and outcomes of 224 consecutive cases in 10 years

Introduction: Floating knee is a flail knee joint resulting from fractures of the shafts or adjacent metaphyses of the femur and the ipsilateral tibia. It is usually associated with several complications and mortality. This study was designed to present our experience with the treatment of this injury. Material and method: This study was performed between January 2004 and December 2014. 224 cases of floating knee injuries gathered from the 34,480 lower extremities trauma files were studied, and the target information recorded. The injuries most frequently occurred in subjects between 16 and 35 years of age (60.71%), and in male subjects (85.71%). The most frequent mechanism of injury was traffic accident (92.85%). External fixation was the common type of treatment (82.14%) in emergency or as a definitive treatment. The treatment was performed within 24 h of the trauma. We performed a 36-month follow up with clinical examination, radiographs, assessing the complications, and using the Modified Cincinnati Rating System Questionnaire (MCRSQ) and the Karlström/Olerud Score (KOS) to evaluate the progression of the outcomes. Results: Early complications included 8 cases of compartment syndrome, 60 open fractures and 24 partially amputated limbs. A total amputation was performed in 3 patients. The most common late complication was heterotopic calcifications of the knee (n = 68, 30.6%). Good scores for MCRSQ and KOS were obtained only after patients were sent to a reference center for knee surgery. Conclusions: Our experience revealed that the complication rate associated with floatingknee injuries remains high, regardless of the performed treatment. Surgeons should focus on reducing complications while treating these severe injuries