Good pain relief in symptomatic hip dysplasia, 32 patients followed for 4 years

Background When surgical treatment of dysplastic hip osteoarthrosis is necessary, osteotomy is preferable to fusion or THR. We evaluated periacetabular osteotomy as a method of choice. Patients and methods We treated 36 symptomatic dysplastic hip joints (32 patients) with the Bernese periacetabular osteotomy (PAO) between 1994 and 2001. We used the ilio-inguinal (I-I) approach in 32 hips and a modified Smith-Petersen (S-P) approach in 4. The patients were followed for mean 4 (1.5-8) years. In 1 patient with coxa valga, a varus femoral osteotomy was performed 1 year after PAO. 2 hips, in which we used the modified S-P approach, necessitated a capsulotomy. Results The median Merle d'Aubigne score increased from 13 points preoperatively to 16 points postoperatively. This improvement in terms of pain, motion and ambulation was accompanied by spatial reorientation and correction. The lateral center edge angle of Wiberg (CE) improved from an average of 7° to 28°. The anterior center edge angle of Lequesne (FP) improved from an average of 18° to 28°. The acetabular index angle (AC) improved from an average of 22° to 10°. Major complications included 1 partial lesion of the sciatic nerve, 1 malunion and 1 combined nonunion of the pubic and ischiatic osteotomy. 2 patients underwent subsequent total hip replacement (THR) for progressive osteoarthrosis with pain. Interpretation We found good radiographic correction of deformities, improvement of hip function and pain relief with an acceptable complication rate. With appropriate patient selection, this procedure is the most physiological treatment of symptomatic hip dysplasia in young adults. In addition to relieving symptoms, it may prevent and postpone the development of secondary osteoarthrosis

Modified Mason type III and IV radial head fractures: results of different surgical treatments

Fractures of the radial head account for 4% of all fractures and 33 % of all elbow fractures. Their treatment is somewhat challenging and diversified, especially in more complex fractures (type III and IV of modified Mason's classification). The aim of this study was to identify the best surgical treatment for patients having sustained these latter lesions and outline possible predictive factors of worse outcomes

Acute radial head replacement with bipolar prostheses: midterm results

In irreparable radial head fractures, especially if primary stabilizers of the elbow are damaged, the prosthetic replacement prevents instability and stiffness. Concerns have arisen over the use of bipolar press-fit prostheses due to the frequent finding of osteolysis and the risk of instability if compared to monopolar implants. Our aim was to assess midterm clinical and radiological outcomes of bipolar implants and the influence of osteolysis on proximal pain. Seventeen patients with irreparable fractures of the radial head, treated in acute with the same prosthetic model (rHEAD recon SBI/Stryker) between January 2015 and December 2018, were enrolled. Clinical assessment was performed using MEPS and DASH scores; a radiographic study was done to identify heterotopic ossifications and periprosthetic osteolysis. Outcomes at the last follow-up, according to MEPS, were excellent in 10 cases, good in 5 and fair in 2; none of the patients had severe pain or instability. In 3 cases, it was necessary to remove the implant, mainly because of early loosening. Radiological findings of osteolysis were detected in 9 cases, but no statistical correlation was found with MEPS and proximal pain. The use of bipolar implants is reliable if an accurate repair of ligament tears is performed and provides a good stability. Nevertheless, the risk of early aseptic loosening in uncemented implants is not negligible, and the follow-up of the patient must be strict. Late osteolysis does not seem to have clinical relevance, but further prospective studies are necessary to clarify this topic

Mid-term results of complex distal humeral fractures.

The aim of this study was to assess outcomes following open reduction and internal fixation in complex fractures of the distal humerus. Between 2000 and 2006, 34 patients were operated for complex fractures of the distal humerus. Bone fixation was obtained with a reverse Y-shaped reconstruction plate in 13 cases and with double plating in 21 cases. At final follow-up, all the patients were assessed with the Mayo Elbow Performance Score. Satisfactory results were observed in 71% of the cases despite a high rate of complications. Age over 65 years is correlated with increased risk for an inferior postoperative result. Complex distal humeral fractures are difficult to treat and are associated with a high incidence of complications. It is therefore mandatory to obtain good anatomical reduction and a stable fixation of lateral and medial columns of the distal humerus. The results observed in older patients suggest that an alternative treatment for these patients may be joint replacement

Delirium risk factors analysis post proximal femur fracture surgery in elderly

Background and aim: The increase in the average-age and in the percentage of elderly people implies an exponential increase in fractures of the proximal femur. A common consequence of hip fracture in elderly patients is delirium, characterized by cognitive confusion or a lethargic-type condition. Predisposing factors have been identified, but risk factors assessment useful for managing clinical intervention, has not received unanimous consent. This work aims to identify the potential risk factors for delirium in the elderly operated for hip fracture. Methods: In this prospective observational study, we included 83 patients aged ≥65 years. Patients undergoing osteosynthesis of the femur and hip replacement for fractures were included. Patients already delusional in the pre-operative period were excluded. At the time, deadlines T0 (pre-operative), and T1,T3,T7 post-operative day, delirium, hematic parameters, blood transfusions, were assessed. Results: Level of delirium was assessed obtaining 80% not delusional and 20% delusional. Glycemia and hemoglobin were not found to be risk factors, although they are known to influence cognitive status; we hypothesize they should be considered predisposing factors. Comorbidities such as atrial fibrillation and Chronic Obstructive Pulmonary Disease were found associated with delirium. The most advanced age, anxiolytic drugs, the use of benzodiazepine as anaesthetic, the time surgical waiting, were found significantly associated with delirium. Conclusions: Taken together, findings of this prospective observational study showed that environmental and metabolic risk factors might contribute to make elderly susceptible to develop postoperative delirium following hip surgery. Thus, these patients should be adequately assessed and monitored. (www.actabiomedica.it)

DELAYED DIAGNOSIS OF ISOLATED CORACOID PROCESS FRACTURES: RESULTS OF 9 CASES TREATED CONSERVATIVELY

Background and aim: Isolated coracoid process fractures are more frequent than what has formerly been believed. Delayed diagnosis or misdiagnosis are not infrequent as it is difficult to notice this injury using routine radiographic projections of the shoulder. In any event, more specific views are prescribed only when a fracture is suspected. The purpose of this study is to assess the outcomes of 9 cases of isolated coracoids fractures treated conservatively after being undiagnosed and discuss the reasons of these delayed diagnoses. Materials and Methods: Between January 1984 and June 2011, 9 out of 19 isolated coracoid fractures received a delayed diagnosis. There were 7 type I fractures and 2 type II. All patients were treated conservatively. Results: All fractures, except one, consolidated. The delay of the diagnosis was greater in type II lesions rather than in type I. Differences in clinical outcomes between affected and healthy side were minimal. Delayed diagnosis was overseen by the physician in 8 cases whereas in 1 case the patient underestimated the trauma and left the injury untreated. Conclusions: An isolated coracoid fracture should always be suspected after receiving a direct blow on the shoulder or after sustaining a forceful traction of the upper arm. In these events, specific radiographic projections should be performed in order to visualise the entire length of the coracoid process and to avoid oversight, delayed diagnosis or misdiagnosis. In isolated type I undisplaced fractures and in the majority of type II fractures, conservative treatment is indicated

Misdiagnosed iuxta-articular osteoid osteoma of the calcaneus following an injury.

The diagnosis of osteoid osteoma, in usual localizations, is generally simple. In iuxta-articular localizations this tumor may be unrecognized and the diagnosis delayed. Injury has been sometimes correlated with the onset of symptoms and this can make the diagnosis even more difficult.We present a case of osteoid osteoma of the calcaneus iuxta-articular to the subtalar joint in a 17-year-old basketball player. He had a history of initial injury, ankle sprain during training, followed by pain and swelling. He was initially treated for lateral ligament lesion of the ankle with unsatisfactory results. After acute trauma the pain changed becoming chronic and mostly nocturnal disappearing when rofecoxib was taken. Standard x-ray didn’t show the lesion.Nuclear Magnetic Resonance (NMR) and scintigraphic results were not well interpreted but these clinical changes and Computed Tomography (CT) images supported the diagnosis of osteoid osteoma. The complete resection of the bone lesion resolved all the symptoms and the histological report confirmed the suspected diagnosis

Surgical treatment of anterior iliac spines fractures: our experience.

Introduction: Iliac spines fractures represent 4% of all pelvic ring fractures and affect more frequently young people with open growth physis. These lesions are usually the consequence of an indirect avulsion trauma due to a sudden and forceful contraction of the muscles that take their origin on these structures. The treatment can be conservative or surgical according to the size and the amount of the dislocation of the fragment. The aim of this study was to evaluate the outcomes of surgical approach of these fractures. Materials and methods: Between 2002 and 2010, 9 patients with fractures of anterior iliac spines were surgically treated. All patients, after an average follow up of 48 months, were evaluated clinically with the Non-arthritic Hip Score (NAHS) and radiographically in order to detect their consolidation. Complications related to the fracture and its treatment were analyzed. Time between trauma and return to sport performance (RSP) was recorded. Results: Mean NAHS was 98 points and RSP averaged 82 days. In 2 cases a transient meralgia paresthetica was observed. In 2 other cases follow-up radiographs showed asymptomatic hyperostosis around the iliac spines. Conclusion: The treatment of iliac spines fractures is mainly conservative. When fragment size is bigger than 2 cm and is dislocated of more than 2 cm surgical treatment is indicated. We recommend a fixation with metallic screws in order to obtain a more stable fixation and an earlier recovery especially in high demanding patients