Management of Distal Radius Fractures in the Elderly Patients

Distal radius fractures are one of the most common injuries treated by the orthopedic surgeons representing almost 1/6 of the fractures that are treated in the emergency departments and the 75% of all fractures of the upper limb and are second only to hip fractures in elderly population. The age distribution of this kind of injury is typically bimodal with peaks in the young patients (6-25) and in the elderly patients older than 65. In the first case the mechanism of injury is usually a high energy trauma, such as a car accident, whilst in the second one is usually a low energy trauma like a domestic fall. Various classification systems have been proposed for these fractures. The classic eponymy-based classification, which divides the fractures in “Colles, Smith, Hutchinson, etc” is always useful but we think that the best system could be a combination with the classic eponymy-based classification with the one proposed by the AO Trauma. Distal radius fractures are frequent in elderly active patients and are usually treated with closed reduction and cast immobilization for 5-6 weeks. Decision for surgical treatment in osteoporotic and elderly patients is difficult as there are no significant differences of functional outcome after non surgical and surgical treatment, patient’s comfort, pre- injury activity level, life style requirement, stage of osteoporosis, fracture stability, joint congruency, loss of previous reduction and bilateral fractures should be considered in decision making. Of different kinds of surgical treatment we prefer k-wires fixation, epibloc or ORIF with locking plate

Comparison of the suitability of intra-oral scanning with conventional impression of edentulous maxilla in vivo. A preliminary study

Aim According to recent literature, the accuracy of digital impression can be compared with traditional impressions for most indications. However, little is known about their suitability in digitizing edentulous jaws in view of mobile prosthetic rehabilitation. The aim of this study was to compare in vivo an intra-oral scanner with conventional impression in case of maxillary edentulous jaws. Material and methods Four (1 male, 3 female) subjects who had no previous experience with either conventional or digital impression participated in this study. Digital impression were taken using an intra-oral scanner. After that conventional impressions of maxillary edentulous jaws were taken with an irreversible hydrocolloid impression material. Then all IOSs datasets were loaded in a three-dimensional evaluation software (3DReshaper 2017, Hexagon), where they were superimposed on the model obtained using conventional impression and compared. Results The mean value of difference between the two impression techniques ranged from 219 to 347 μm. The comparison of models obtained with the two techniques showed that the compression given by the impression material on the peripheral areas, such as oral vestibule and soft palate, determined the most important differences recorded. Conclusion Digitizing edentulous jaws with the use of IOS appeared to be feasible in vivo, although peripheral tissue were not effectively reproduced. On the basis of the results of this study, the authors could not recommend the use of IOS for digitization of edentulous jaws in vivo in view of mobile prosthetic rehabilitation, until it will be found a way to give a selective pressure in peripheral areas as occurs during edging of impression tray

EVOLUTION AND HEALING OF FRAGILITY FRACTURES OF THE PROXIMAL FEMUR

After a traumatic fracture a physiological process begins to heal the fracture. The steps of the process are inflammation, granulation, formation of fibrous callus and finally bone. There are many factors that may influence the healing of the fracture: adequate blood supply, good contact between bone fragments, good stability of the fracture, general health, age, smoking, related pathology, use of drugs, etc. In elderly patients the variations in bone structure and healing processes have a negative influence on fracture healing. Fragility fractures require careful placement of the implants to reduce the risk of failure of osteosynthesis. Appropriate surgical devices and facilitation factors must be used to allow bone healing

Acromion Clavicular Joint Reconstruction with LARS Ligament in Acute Dislocation

Background: The acromion clavicular joint dislocations are common injuries of the shoulder. The severity is dependent upon the degree of ligamentous injury. Surgical treatment is typically performed in higher grade acromioclavicular separation with several static and dynamic operative procedures with or without primary ligament replacement. Methods: 47 patients with acute Rockwood type III, IV, and V injuries were treated surgically with LARS reconstruction. The success of technique was evaluated by radiographic outcomes for each patient at every follow-up visit (one,three, 12 months), while to assess pain reduction and clinical evaluation Visual Analogue scale score (VAS) and Constant-Murley score (CMA) was performed, respectively. An One Way Analysis of Variance (Kruskal-Wallis test), a multiple comparison Turket test, or a t-test (Mann-Whitney Rank Sum Test) were used when required. Results: Follow-up radiographs revealed maintenance of anatomical reduction in 41 patients, and no bone erosions has been identified. In short-term joint functional recovery has been observed. Indeed, after 12 months pain on the VAS-scale in all groups decreased significantly (P < 0.05), and the CMS revealed a significant overall improvement (P < 0.05). Conclusion: These data demonstrate that the use of the LARS allows to provide stability to the joint and especially to ensure its natural elasticity, relieving pain and improving joint function already one month post-surgery. Level of evidence: II

Case report: laser Nd:YAG e rieducazione funzionale nella sindrome del piriforme

La sindrome del piriforme \ue8 caratterizzata da una lombalgia con interessamento del gluteo e con possibile irradiazione all'arto inferiore; pu\uf2 essere definita come una patologia dovuta ad intrappolamento, compressione o irritazione del nervo sciatico a livello del muscolo piriforme con o senza deficit neurologici. In questo studio \ue8 stata valutata l'efficacia della sinergia terapeutica tra laser Neodimio:YAG e rieducazione funzionale nella riduzione del dolore e nel miglioramento dell'indipendenza funzionale in una paziente affetta da sindrome del piriforme

Proximal Humerus Reconstruction after Tumor Resection: An Overview of Surgical Management

Proximal humerus is one of the anatomical sites that are most frequently involved by bone and soft tissue malignant tumors. Alone or in association with adjuvant treatments, surgery represents the main therapeutic option to treat and eradicate these diseases. Once the first-line option, in the last decades, amputation lost its role as treatment of choice for the large majority of cases in favor of the modern limb sparing surgery that promises to preserve anatomy and - as much as possible - upper limb functionality. Currently, the main approaches used to replace proximal humerus after a wide resection in oncologic surgery can be summarized in biological reconstructions (allograftsand autografts), prosthetic reconstructions (anatomic endoprostheses, total reverse shoulder prostheses), and graft-prosthetic composite reconstructions. The purpose of this overview is to present nowadays surgical options for proximal humerus reconstruction in oncological patients, with their respective advantages and disadvantages

Oral beclometasone dipropionate in the treatment of active ulcerative colitis: a double-blind placebo-controlled study.

AIM: To evaluate efficacy and safety of oral beclometasone dipropionate (BDP) when added to 5-ASA in the treatment of patients with active ulcerative colitis. METHODS: In a 4-week, placebo-controlled, double-blind study, patients with extensive or left-sided mild to moderate active ulcerative colitis were randomized to receive oral 5-ASA (3.2 g/day) plus BDP (5 mg/day) or placebo. Clinical, endoscopic and histologic features, and haematochemical parameters were recorded at baseline and at the end of the study