A pseudotumoral lesion diagnosed for a hypertrofic fibrosis at the proximal stump in anterior tibialis tendon missed rupture: a case report

The Anterior Tibialis is the most important muscle in ankle dorsiflexion. The anterior tibialis tendon (ATT)'s rupture is an infrequent condition which can be both traumatic and spontaneous. Clinic is poor and it is necessary to confirm the suspect by US or MRI. The reported case refers to a 40 years old man who had a direct trauma at ankle and midfoot which was originally conservatively treated for an ankle sprain. Three months later he returned with pain, swelling and paresthesia. MRI was performed showing a neoformation in the contest of ATT's rupture. The patient underwent open excisional biopsy which was diagnostic for hypertrofic fibrosis. After two weeks, the symptoms were completely decreased and patient didn't want to undergo surgery for tendon reconstruction because he had no limitation in daily activity life

Direct Anterior versus Lateral Approach for Femoral Neck Fracture: Role in COVID-19 Disease

Background: During the COVID-19 emergency, the incidence of fragility fractures in elderly patients remained unchanged. The management of these patients requires a multidisciplinary approach. The study aimed to assess the best surgical approach to treat COVID-19 patients with femoral neck fracture undergoing hemiarthroplasty (HA), comparing direct lateral (DL) versus direct anterior approach (DAA). Methods: A single-center, observational retrospective study including 50 patients affected by COVID-19 infection (30 males, 20 females) who underwent HA between April 2020 to April 2021 was performed. The patients were allocated into two groups according to the surgical approach used: lateral approach and anterior approach. For each patient, the data were recorded: age, sex, BMI, comorbidity, oxygen saturation (SpO2), fraction of the inspired oxygen (FiO2), type of ventilation invasive or non-invasive, HHb, P/F ratio (PaO2/FiO2), hemoglobin level the day of surgery and 1 day post operative, surgical time, Nottingham Hip Fractures Score (NHFS) and American Society of Anesthesiologists Score (ASA). The patients were observed from one hour before surgery until 48 h post-surgery of follow-up. The patients were stratified into five groups according to Alhazzani scores. A non-COVID-19 group of patients, as the control, was finally introduced. Results: A lateral position led to a better level of oxygenation (p < 0.01), compared to the supine anterior approach. We observed a better post-operative P/F ratio and a reduced need for invasive ventilation in patients lying in the lateral position. A statistically significant reduction in the surgical time emerged in patients treated with DAA (p < 0.01). Patients within the DAA group had a significantly lower blood loss compared to direct lateral approach. Conclusions: DL approach with lateral decubitus seems to preserved respiratory function in HA surgery. Thus, the lateral position may be associated with beneficial effects on gas exchange

CT-guided radiofrequency ablation of osteoid osteoma using a multi-tined expandable electrode system

Radiofrequency ablation (RFA) is the gold standard for the treatment of symptomatic osteoid osteoma (OO) as RFA yields both a high success and low complication rate. It has been widely utilized over the years, but recurrences of OO after this treatment have been documented. These recurrences may be the result of various factors, including incomplete tumor ablation, and are significantly higher in lesions greater than 10 mm. Thus, the need to induce thermal ablation in a wider area led us to use a Multi-Tined Expandable Electrode System (MTEES). In this study we examined the efficacy and safety of RFA using a MTEES in symptomatic OO

Hip arthroscopy in osteoarthritis consequent to FAI

Background: Femoral Acetabular Impingement (FAI) means a set of alterations involving the acetabulum, proximal femur, or both of these components that can results in osteoarthritis. Arthroscopy is a choice for the treatment of initial stages of osteoarthritis (OA) in order to reduce evolution of the degenerative processes; advanced degrees of osteoarthritis are absolute contraindications. Materials and Methods: 40 patients affected by osteoarthritis in FAI underwent hip arthroscopy between May 2010 and March 2015. In all 40 cases OA secondary to FAI was diagnosed. All patients were clinically and instrumentally analyzed pre-operatively and then post-operatively after 3, 6, and 12 months. We evaluated the degree of OA using the Tonnis classification; our study included only patients affected by Tonnis grade 0-2 osteoarthritis. Results: The mean modified Harris Hip Score showed an evolution from 54.7 points to an average value of 89,1 points after 12 months. The Lower Extremities Functional Scale evolved by 43 points to an average value of 65,28 points. Conclusions: Based on the data of this study, supported by the concordance with recent literature reviews, in degrees Tonnis 0 and 1 an arthroscopic treatment is recommended. Instead the therapeutic algorithm in Tonnis grade 2 is still being discussed. We detect a significant response to arthroscopic intervention which leads us to suggest that validation of this method needs further confirmatory studies

Chromium-induced diffuse dermatitis with lymph node involvement resulting from Langerhans cell histiocytosis after metal-on-metal hip resurfacing

Total Hip Arthroplasty (THA) is a highly effective surgical treatment for severe jointinvolvement. However, due to the release of metal ions in the blood, the patients undergoinghip replacement with metal-on-metal (MOM) bearings may develop signs of allergic skindisease. We report a case of a 60-year-old man who had received MOM hip resurfacing (HR)five years earlier for osteoarthritis and presented with a 3-year history of diffuse dermatitisnot responding to antihistamines and corticosteroids and elevated serum levels of chromiumand cobalt. A patch test revealed chromium-sulfate hypersensitivity. Skin biopsy showednonspecific perivascular lymphocytic infiltrate associated with histiocytes. Biopsy of aninguinal lymph node demonstrated large aggregates of Langerhans cells, suggesting type IVdelayed-type hypersensitivity. Three months following replacement of the prosthesis usingceramic-on-ceramic bearings the dermatitis resolved. Lymph nodes decreased in volume andserum chromium normalized 24 months after revision surgery. The high levels of serum ionsassociated with the metal debris from MOM-THAs may induce sensitization and type IVhypersensitivity reactions. Only replacement of the prosthesis using alternative couplingsurfaces may definitely solve the symptoms. Physicians who are not familiar with this issuemay misdiagnose systemic symptoms and lack adequate treatment.Total hip arthroplasty (THA) is a standard successful treatment for symptomatic osteoarthritisof the hip joint.1 Metal-on-metal (MOM) hip resurfacing (HR) has been developed as analternative to conventional THA in younger and active patients, with comparable long-termoutcomes.2 However, all MOM bearings implants corrode and cause a release of metal ions inthe blood. The prevalence of metal sensitivity among the general population is approximately10% to 15%, with sensitivity to cobalt and chromium of 3%.3 Many concerns still remainregarding the effects of prolonged exposure to increased metal ion levels: hypersensitivity,carcinogenicity, aseptic lymphocyte-dominated vasculitis-associated lesion and pseudotumorformation.3 Allergic dermatitis and reactive histiocytosis caused by orthopedic implants arewell-known.4 To date, and to the best of our knowledge, diffuse dermatitis and associatedlymph node involvement by Langerhans cell histiocytosis after MOM-HR have not beendescribed