BACKGROUND: Distal tibia nonunion often results from open fractures. Its surgical treatment can be challenging due to bone loss and surrounding tissue damage. The study aims to evaluate the long-term surgical and functional outcomes of patients suffering from nonunion, treated with either internal fixation or tibiofibular grafting through the posterolateral approach.METHODS: Between January 2013 and February 2018, we treated 21 patients affected with distal tibial nonunion through the posterolateral approach first described in 1945 by Harmon and modified by Tornetta, in a 2nd level trauma center. The follow-up lasted 41.28 months and evaluated clinical and radiological results retrospectively. The primary outcome evaluated nonunion consolidation and secondary outcomes verified symptoms and ability to function using AOFAS index and VAS. Complications were monitored and reported.RESULTS: Healing rate using the posterolateral approach reached 76.2%, the mean consolidation occurred at 5.6 months. AOFAS Index averaged 74 and VAS scored 30 for pain, 90 for treatment satisfaction and 70 for ability to work.CONCLUSIONS: Our data suggest that non-infected distal tibial nonunion can be successfully treated in a substantial share of patients by internal fixation or tibia-pro-fibula grafting through the posterolateral approach. This treatment allows consolidation, increases the patients’ ability to work and reduces pain leading to a better quality of life on the long-term.

article: A randomized double-blind study comparing local infiltrative analgesia to standard analgesia for total knee arthroplasty - Minerva Orthopedics 2022 October;73(5):451-7 - Minerva Medica - Journals

BACKGROUND: Diagnosis of Marfan Syndrome (MS) in children is difficult because the Ghent Criteria commonly used in adults are unreliable in pediatric populations. The aim of our study was to investigate the role of musculoskeletal aspects in the early diagnosis of MS by analyzing a pediatric cohort of patients.METHODS: We investigated 40 children with MS admitted at the referral center for diagnosis of rare diseases of our hospital. For this study, all children underwent evaluation by an orthopedic, a cardiac surgeon, an ophthalmologist, a geneticist and a pediatrician. A blood test was also performed for genetic assessment to evaluate the presence of FBN1 pathogenic variant.RESULTS: Skeletal abnormalities were observed in all children. The wrist and thumb signs were present in isolated form or in association in 72.5% of cases, pectus carinatum or excavatum, and chest asymmetry in 20%, foot deformities in 27.5%, reduced upper to lower segment ratio in 5%, scoliosis or kyphosis in 7.5% of patients.CONCLUSIONS: Diagnosis of MS remains difficult in the pediatric population because the majority of clinical features are “age-dependent.” Therefore, the Ghent Criteria might be not reliable, especially in younger children. However, the typical musculoskeletal aspects may represent the first alarm bell to guide children towards an early diagnosis.

The prevention of surgical site infections is a priority within the objectives of the National Health System. The negative consequences that postoperative infections entail (morbidity, duration of hospitalization, mortality) represent serious events both for the individual patient and for the community, in consideration of the care resources necessary to treat them. Aim of this paper is to review the scientific evidence derived from accredited and recent guidelines regarding the available methods of infection prevention in hip arthroplasty, in order to establish those that present reliable evidence to support and that deserve to be shared, implemented and that ultimately represent an indicator of the quality of care that we are able to provide to our patients. A review was conducted on the MEDLINE, EMBASE, CINAHL and Cochrane Library databases from January 2010 to May 2021 aimed at finding guidelines of high methodological quality produced by super partes or independent international bodies. The paper analyzes risk factors for infection and provides a summary of best practices that can minimize infectious risk in hip surgery. Adherence to the recommendations expressed by multidisciplinary, evidence-based, up-to-date and authoritative guidelines is the most rigorous way to offer the patient a high standard of care.

INTRODUCTION: Periprosthetic infections of the hip represent a relatively frequent complication, which can lead to implant failure and serious impairment of the patient’s mobility and quality of life. The removal of the infected prosthesis is mandatory for the resolution of the infection. Two treatment strategies are recognized to be reliable and safe: “one-stage” and “two-stage.” The aim of this systematic review was to clarify which of the two treatments is burdened by the highest rate of re-infection when used in peri-prosthetic hip infections.EVIDENCE AQUISITION: Studies were identified by major electronic database (OVID, PubMed). All studies reporting results after one or two stage revisions in periprosthetic hip joint infections were included in the review. The following data were extracted from the full text of each included study: authors, year of publication, study design (prospective or retrospective), LOE, number of patients, patients’ age, surgical approach (one or two stage), pathogen, length of follow-up, re-infection rate after treatment and complications. Descriptive statistics were used to summarize findings across all studies.EVIDENCE SYNTHESIS: Fifty-three studies comprising 4.646 patients were finally included. Patients treated by one-stage revision were 926. The mean rate of infection eradication was 86.41% (95% CI=67% to 100%). Patients treated by two-stage revision were 3433. The mean rate of infection eradication was 91% (95% CI=77% to 100%). The four studies comparing one- and two-stage revision included 99 patients who underwent one-stage method and 188 patients who underwent two-stage revision. In this case, the mean infection eradication rate was 98.75% (95% CI=95% to 100%) for one-stage revision and 96% (95% CI=94% to 98%) for two-stage revision. The most frequently isolated pathogens were S. aureus and S. epidermidis. Aseptic loosening of the components and hip instability were the most common complications for both methods.CONCLUSIONS: One- or two stage hip revision seem to have no different reinfection rates. New studies are needed to confirm the equal effectiveness of both procedures.

article: The role of cytokines in the mechanisms of regulation of reparative processes in modeling fractures of the proximal femur secondary to the correction of concomitant arterial hypertension - Minerva Orthopedics 2022 June;73(3):287-93 - Minerva Medica - Journals

BACKGROUND: Intra-articular distal radius fractures are notorious in progressing to malunion when mismanaged. Despite the availability of extensive research material, a lot of controversies still exist when it comes to narrowing down to one reliable treatment approach in intraarticular distal radius fractures. The aim of this study is to compare the clinical, radiological, and functional outcomes between external fixation and internal fixation in the management of intra-articular distal radius fractures.METHODS: All patients between 18-50 years of age with intra-articular distal end radius fractures were studied from September 2016 to July 2018. Patients were randomly grouped into group 1, closed reduction and external fixation with spanning external fixator (ExFix) and group 2, open reduction and internal fixation with volar locking plate (VLP). Clinical, radiological, and functional outcomes were evaluated preoperatively and postoperatively at 6, 12, 24, and 48 weeks. Statistical evaluation was conducted using R software v. 4.0.1 and Microsoft Excel 2016.RESULTS: A progressive increase of the mean values at subsequent follow-ups was observed in both the groups. The mean values of radiological parameters (radial inclination and radial height) and all clinical parameters were significantly better in the VLP group (P<0.001). Significant differences were found in the functional outcomes (DASH score and Mayo wrist score) at time periods (P<0.001); however, scores were better in VLP compared to the ExFix group.CONCLUSIONS: Internal fixation using volar locking plate provided better outcomes in addition to reduced complications and rehabilitation duration compared to external fixation in the management of distal radius intra-articular fractures.

Proper management of coronoid fractures is mandatory because missed diagnosis or poor treatment may lead to elbow dysfunction. The main portions of the coronoid are the tip, the base, the anteromedial facet, the sublime tubercle, and the lesser sigmoid notch. Coronoid fractures are typically after elbow dislocation or subluxation. Consequently, collateral ligament tears are often associated, ranging from small to high grade tears. There are two possible mechanisms of injury: posterolateral rotatory instability (PLRI) and posteromedial rotatory instability (PMRI). Nowadays, the most widely used classifications - as the one published by Raegan and Morrey - can be misleading and insufficient since it does not give any information about the possible mechanism of injury. The O’Driscoll classification is three-dimensional and CT scan-based and helps distinguish between PLRI and PMRI mechanism of injury. It classifies coronoid fractures as tip, anteromedial, or basal fractures. Treatment can be based on the O’Driscoll classification and on the analysis of other factors, such as the number and size of fracture fragments and associated lesions. Occasionally, nonsurgical management is a treatment option, but must be selected with caution. Surgical management often consists of fracture fixation (with several options, such as cannulated screws, Kirschner wires, sutures, and dedicated plate and screws) and ligament repair. Arthroscopy may be a treatment option, in particular when there is only one coronoid fragment.

This case report discusses the reconstruction after a radical resection of a giant cell tumor in an elderly woman involving the second metacarpal bone. At the presentation the tumor was in stage III with an involvement of the trapezium and trapezoid. The patient underwent en-block resection of the second ray including trapezium and trapezoid bones. Bone fusion in opposition of the first metacarpal and a cutaneous flap was performed. This treatment allowed the patient to achieve optimal functional results with pinch and grasp ability after surgery and adequate safety from recurrency. A literature review of case series describing hand localizations of TGC, and related treatments was performed.