Anatomically reduced fixation should always be considered when treating B and C proximal epiphyseal humeral fractures

Background Proximal humeral fractures are commonly observed in elderly patients. Management of these injuries is controversial. Literature comparing locking plate fixation, arthroplasty, and conservative treatments show no clear advantages for any of these management strategies. Thus far, no study has considered anatomically reduced fractures obtained after locking plate treatment. To clarify the best surgical procedure in middle-aged patients, we considered outcomes and major complications leading to surgical revision following an anatomically reduced fracture fixed with locking plate and reverse shoulder arthroplasty (RSA) in the treatment of type B/C fractures in patients between 50 and 75 years of age. Methods This is a retrospective study including 59 patients between 50 and 75 years of age with type B/C proximal humeral fracture treated with RSA or with locking plate fixation (resulting in an anatomical reduction) between January 2010 and December 2018. Preoperative radiographs and computed tomography (CT) were evaluated in all patients. Clinical and radiologic follow-up was performed using range of motion (ROM), the Constant-Murley Score (CMS), the Oxford Shoulder Score (OSS), the Simple Shoulder Test (SST), the Subjective Shoulder Value (SSV), and visual analog scale (VAS). Major complications were considered. Results In the plate fixation group, ROM, CMS, SST, and VAS were higher than in the RSA group. Lower complication rates compared with the literature were observed in both groups. Anatomically reduced fracture fixed with plate and screw could outperform RSA in terms of outcome. In second-level centers where traumatology is performed by surgeons with great expertise in upper limb trauma, the choice between plate fixation and reverse arthroplasty should be made during surgery. Conclusion Anatomically reduced fractures showed better outcomes compared with RSA in type B/C fractures. Surgeons should always try to perform a reduction of the fracture in order to understand if a plate fixation could be feasible. If it is impossible to perform an anatomical reduction, we suggest to consider RSA. This is a retrospective observational study

Implant sonication versus intraoperative tissue sample cultures for periprosthetic joint infection (PJI) of shoulder arthroplasty

Introduction: Periprosthetic joint infection (PJI) is the most problematic complications after shoulder arthroplasty. Many diagnostic tools have been identified to find infection, such as hystopatologic examination of tissue sections or cultures of intraoperative tissue. Implant sonication fluid culture showed good results in order to enhance diagnostic accuracy, but literature results are still controversial. Aim of our study is to compare the results of sonication with intraoperative tissue sample cultures. Patients and Methods: From February 2016 to January 2018 we performed 102 revisions of Total Shoulder Arthroplasty (TSA) for suspected PJI. Sixty-five patients respected the criteria for admission to the study and were enrolled. In each case periprostethic specimens were collected and explanted prosthesis were put inside sterile fluid, sonicated and then placed under culture. Results: Among the sixty-five patients, 36 were considered as possible, probable or certain infection. Tissue cultures were positive for infection in thirty-four cases (52,3%) and in nineteen cases was found the positivity for Cutibacterium acnes. Sonication fluid cultures were positive in forty cases (61,5%), with a positivity for Cutibacterium acnes in twenty-seven cases. The sensitivities of sonication and tissue cultures for the diagnosis of shoulder PJI were 83.3% and 88,9% (P = 0,08); the specificities were 65.5% and 93,1% (P < 0.01) respectively. Conclusion: Our results suggest that sonication technique had not shown a clear advantage in postoperative shoulder PJI diagnosis, but it’s a real aid to detect Cutibacterium acnes. In any case, sensitivity and mostly specificity were higher with tissue cultures. (www.actabiomedica.it)

Rotational osteoplasty and bioabsorbable polylactate pin fixation in Pipkin type 2 fracture with acute osteochondral defect: a case report

Pipkin fractures are relative rare high-energy lesions characterized by an intra-articular fracture of the femoral head after posterior hip dislocation. Early anatomic reduction and stable fixation are the main goals of treatment. This case evaluates the outcome of managing Pipkin type 2 fracture with acute osteochondral defect of the femoral head using "rotational osteoplasty" and bioabsorbable polylactate pin fixation. 24-year-old male patient was involved in a motorcycle accident, suffering from a left hip fracture-dislocation, and pelvic Computed Tomography revealed a Pipkin type 2 lesion. An open urgent treatment was performed. After  anatomic reduction of the femoral head fragment a large osteochondral defect in the anterior-superior weight bearing surface was evident. The pattern of the fracture allowed us to perform a "rotational osteoplasty" including rotation of the femoral head fragment, to obtain an osteochondral cartilage congruence of the anterior-superior surface. Stable fixation was obtained by three bioabsorbable polylactate pins. At four-year follow up the patient had an excellent outcome and Magnetic Resonance Imaging (MRI) showed fracture healing, minimal signs of arthritis, excluding osteonecrosis of the femoral head. The reported case confirms that Pipkin fractures are very insidious surgical urgencies. In selected cases, "rotational osteoplasty" may be an alternative to osteochondral transplant for acute osteochondral defect of the femoral head. Bioabsorbable polylactate pin fixation allowed us to have a stable fixation evaluating the bone healing process and vitality of femoral head by MRI

Tibial plateau fractures: compared outcomes between ARIF and ORIF.

The purpose of this study is to compare arthroscopic assisted reduction internal fixation (ARIF) treatment with open reduction internal fixation (ORIF) treatment in patients with tibial plateau fractures. We studied 100 patients with tibial plateau fractures (54 men and 46 women) examined by X-rays and CT scans, divided into 2 groups. Group A with associated meniscus tear was treated by ARIF technique, while in group B ORIF technique was used. The follow-up period ranged from 12 to 116 months. The patients were evaluated both clinically and radiologically according to the Rasmussen and HSS (The Hospital for Special Surgery knee-rating) scores. In group A, the average Rasmussen clinical score is 27.62 ± 2.60 (range, 19–30), while in group B is 26.81 ± 2.65 (range, 21–30). HSS score in group A was 76.36 ± 14.19 (range, 38–91) as the average clinical result, while in group B was 73.12 ± 14.55 (range, 45–91). According to Rasmussen radiological results, the average score for group A was 16.56 ± 2.66 (range, 8–18), while in group B was 15.88 ± 2.71 (range, 10–18). Sixty-nine of 100 patients in our study had associated intra-articular lesions. We had 5 early complications and 36 late complications. The study suggests that there are no differences between ARIF and ORIF treatment in Schatzker type I fractures. ARIF technique may increase the clinical outcome in Schatzker type II–III–IV fractures. In Schatzker type V and VI fractures, ARIF and ORIF techniques have both poor medium- and long-term results but ARIF treatment, when indicated, is the best choice for the lower rate of infections

Cement augmentation of intertrochanteric fractures stabilisedwith intramedullary nail: operative technique.

The incidence of proximal femoral fractures has substantially risen in the elderly. This rise has been attributed to an increase in their life span and the underlying poor bone stock and osteoporosis.One of themain reason for revision surgery, reported to be as high as 19%, is the cut-out of the fixation device at the apex of the femoral head. Augmentation, facilitated by injecting cement (PMMA) around the apex of the proximal screw of the fixation device, is considered as a useful method with regard to the increase purchase between the bone and implant interface.The aim of this study is the description of the cement Augmentation operative technique for unstable osteoporotic intertrochanteric fractures with 1-2 femoral head screws devices. La complicanza del cut-out nel trattamento delle fratture pertrocanteriche nell'anziano con osteoporosi, descritta in letteratura con una incidenza variabile dal 9 al 14%, risulta essere un problema attuale in chirurgia ortopedica. La tecnica operatoria dell’Augmentation, intesa come supporto meccanico della sintesi interna nelle fratture pertrocanteriche, tramite cementazione con pochi millilitri di PMMA all’apice delle viti cervico-cefaliche, è stato dimostrato, in vitro ed in vivo, essere una sicura e valida metodica per scongiurare il fenomeno del cut-out

A complication following ACL reconstruction using bioabsorbable cross-pins

This is a case of a proximal pin migration after ACL reconstruction in medial soft tissue with pain, inflammatory reaction and functional reduction. 33-year-old male presented at our clinic with a complete ACL rupture. Reconstruction with autogenous gracilis and semitendinosus hamstring tendons was performed and graft fixed in the femoral canal with two PLLA bioabsorbable pins (RIGIDFIX\uae Cross Pin System). Two months postoperatively the patient presented swelling and pain on the medial side of the knee, full range of motion and negative results at the Lachman and Pivot shift tests. MRI examination showed the superior femoral tunnel crossing both the lateral and medial cortex lodging the pin in the knee\u2019s medial soft tissue corresponding to the swelling area reported by the patient. The tendon graft was properly positioned. After surgical removal of the pin through a small skin incision, the pain and swelling promptly subsided allowing the patient return to normal activities in few weeks without any pain. In our opinion the painful swelling of the knee was due to a displacement of the pin that had been accidentally lodged in the soft tissues instead of the bone causing a foreign-body reaction resulting in granuloma formation with local inflammation. This dislodgement could have been due to an inappropriately long femoral tunnel

Use of a non-medicated plaster in shoulder tendinopathies

We assessed 20 shoulders with rotator cuff tendinopathy and partial tendon tears treated with FIT\uae plasters (far infrared technology). The criteria for inclusion were pain at night and during active shoulder movement. Patients with restricted passive movement (adhesive capsulitis) and complete tendon tears were excluded. Two different types of FIT\uae plasters were used according to the different power of action. Plasters were replaced after 7 days and dismissed after 15 days. The patients were assessed using the VAS pain scale and the Constant Murley score for function. The use of FIT\uae plasters have shown a certain effectiveness in activation of the endogenous analgesic action, with a role in alleviate painful symptoms and improve function in rotator cuff tendinopathies, without adverse events. On the base of the safety of this technology and promising results of our study, further studies should be encouraged to confirm its effectiveness, increasing the sample number and follow up so as to demonstrate definitely that the use of technologies, on which FIT\uae plasters is based, may be a valid alternative as "non-medicated pain relief"

TikTok content as a source of health education regarding epicondylitis: a content analysis

Purpose This study aimed to assess the validity and informational value of TikTok content about epicondylitis. The hypothesis tested herein was that TikTok video content would not provide adequate and valid information. Methods The term "epicondylitis" was used as a keyword to comprehensively search for TikTok videos, and the first 100 videos that were retrieved were subsequently included for analysis. The duration, number of likes, number of shares and number of views were recorded for each video. Furthermore, the videos were categorized on the basis of their source (medical doctor, physiotherapist, or private user), type of information (physical therapy, anatomy, clinical examination, etiopathogenesis, patient experience, treatment, or other), video content (rehabilitation, education, or patient experience/testimony), and the presence of music or voice. Assessments of video content quality and reliability were conducted using the DISCERN tool, the Journal of the American Medical Association (JAMA) benchmark criteria, and the Global Quality Score (GQS). Results A total of 100 videos were included in the analysis: 78 (78.0%) were published by physiotherapists, 18 were published by medical doctors (18.0%), and 4 were published by private users (4.0%). Most of the information pertained to physical therapy (75; 75.0%) and most of the content was about rehabilitation (75; 75.0%). The mean length of the videos was 42.51 +/- 24.75 seconds; the mean number of views was 193,207.78 +/- 1,300,853.86; and the mean number of comments, likes, and shares were 22.43 +/- 62.54, 1578.52 +/- 8333.11, and 149.87 +/- 577.73, respectively. The mean DISCERN score, JAMA score, and GQS were 18.12 +/- 5.73, 0.80 +/- 0.53, and 1.30 +/- 0.52, respectively. Videos posted by medical doctors/private users had higher scores (p < 0.05) than videos posted by physiotherapists. Videos that focused on education or patient experience had higher scores (p < 0.05) than videos based on rehabilitation. Conclusions TikTok can be an unreliable source of information regarding epicondylitis treatment. It is common to find nonphysicians who share medical advice on the platform, with medical treatments demonstrating the weakest level of supporting evidence. Elbow surgeons should advise their patients that treatment recommendations from TikTok may not align with established guidelines.Level of Evidence: Level IV-Cross-sectional study

A clinical and radiological study of biodegradable subacromial spacer in the treatment of massive irreparable rotator cuff tears

Purpose: The aim of this retrospective study was to report the clinical and radiographic results of the biodegradable subacromial spacer (InSpace Balloon\uae) implantation in patients with massive irreparable rotator cuff tears. Materials and methods: From February 2014 to October 2015, 30 patients affected by massive irreparable rotator cuff tears were treated with the implantation of InSpace Balloon\uae. Clinical evaluation (Constant Score and VAS), X-rays and MR imaging were performed preoperatively in all patients and 3, 6, 12 and 24 months after surgery, dividing patients in different groups according to the time elapsed from surgery. Results: Constant Score increased from 39.89 to 62.33 points (p 0.0002) in the 6 months group and from 41.66 to 65.38 points (p< 0.0001) in the 12 months group. ROM (Range of Movement) and ADL (Activity of Daily Living) significantly improved with the contemporary reduction of VAS and pain at 12 months and, furthermore, an increase of functional performance with reduction of pain was registered at 24 months. Conclusions: Our results supported the surgical procedure of the arthroscopic implantation of biodegradable subacromial InSpace Balloon\uae for irreparable massive cuff tears in worker patients and with recreational activities\u2019 demands in order to recover the shoulder function with a reduction of the pain. (www.actabiomedica.it

The biocompatibility of bone cements: progress in methodological approach

The ideal bone graft substitute should have certain properties and there are many studies dealing with mixture of polymethylmetacrilate (PMMA) and β-tricalciumphospate (β-TCP) presenting the best characteristics of both. Scanning Electron Microscopy (SEM), for ultra-structural data, resulted a very reliable in vivo model to better understand the bioactivity of a cement and to properly evaluate its suitability for a particular purpose. The present study aims to further improve the knowledge on osteointegration development, using both parameters obtained with the Environmental Scanning Electron Microscopy (ESEM) and focused histological examination. Two hybrid bone graft substitute were designed among ceramic and polymer-based bone graft substitutes. Based on β-TCP granules sizes, they were created with theoretical different osteoconductive properties. An acrylic standard cement was chosen as control. Cements were implanted in twelve New Zealand White (NZW) rabbits, which were sacrificed at 1, 2, 3, 6, 9 and 12 months after cement implantation. Histological samples were prepared with an infiltration process of LR white resin and then specimens were studied by X-rays, histology and Environmental Scanning Electron Microscopy (ESEM). Comparing the resulting data, it was possible to follow osteointegration's various developments resulting from different sizes of β-TCP granules. In this paper, we show that this evaluation process, together with ESEM, provides further important information that allows to follow any osteointegration at every stage of develop