Objective. Proximal humeral fractures are among the most frequent fracture in the adult and their treatment is controversial.The purpose of this paper is to present the most common complications in managing prox- imal humeral fractures, reviewing the literature.The principal complications are mainly caused by biological elements, but are also related to iatrogenic factors.Conclusions. It is very important to provide a correct fracture classification, accurate pa- tient clinical investigation, and to perform all instrumental procedures required to get a correct indication in managing proximal humeral fracture. In case of operative treatment, accurate pre-operatory planning is mandatory. Moreover, the surgeon must consider the feasible intra-operatory complications, such as the possibility to convert an open reduction and internal fixation to a total arthroplasty.In our opinion, the arthroplasty system should be available in every operating theater.
{"title":"Complications of proximal humeral fractures","authors":"A. Maresca, L. Senesi, S. Cerbasi, R. Pascarella","doi":"10.36149/0390-5276-201","DOIUrl":"https://doi.org/10.36149/0390-5276-201","url":null,"abstract":"Objective. Proximal humeral fractures are among the most frequent fracture in the adult and their treatment is controversial.The purpose of this paper is to present the most common complications in managing prox- imal humeral fractures, reviewing the literature.The principal complications are mainly caused by biological elements, but are also related to iatrogenic factors.Conclusions. It is very important to provide a correct fracture classification, accurate pa- tient clinical investigation, and to perform all instrumental procedures required to get a correct indication in managing proximal humeral fracture. In case of operative treatment, accurate pre-operatory planning is mandatory. Moreover, the surgeon must consider the feasible intra-operatory complications, such as the possibility to convert an open reduction and internal fixation to a total arthroplasty.In our opinion, the arthroplasty system should be available in every operating theater.","PeriodicalId":238529,"journal":{"name":"LO SCALPELLO-OTODI Educational","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114227630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Troiano, N. Mondanelli, G. Peri, A. Facchini, N. Nuvoli, S. Giannotti
The use of megaprostheses or custom-made devices is an established treatment for or- thopedic malignancies, but their indication has been expanded to some non-neoplastic conditions such as complex cases of re-revision surgery or failed osteosynthesis. A con- secutive series of 5 patients were treated with megaprostheses as a solution for complex cases of re-revision surgery around the knee joint. Each patient was assessed clinically and radiographically at 1, 3, 6, and 12 months after surgery. One patient died for intestinal infarc- tion after surgery. The 4 remaining patients resumed gait and knee function. We did not observe infections or mobilizations of the implants, and the only complication we described was patellar dislocation of the extensor mechanism when the implant with proximal tibia resection was used. Complex re-revision surgery after TKA represents a major challenge for the orthopedic surgeon due to poor bone stock and the presence of prosthetic revision components. The implant of megaprostheses or custom-made devices can play a crucial role in these rare but complex cases of non-oncological orthopedic surgery ensuring early functional recovery.
{"title":"Megaprostheses and custom-made implants in complex cases of revision surgery after TKA","authors":"E. Troiano, N. Mondanelli, G. Peri, A. Facchini, N. Nuvoli, S. Giannotti","doi":"10.36149/0390-5276-195","DOIUrl":"https://doi.org/10.36149/0390-5276-195","url":null,"abstract":"The use of megaprostheses or custom-made devices is an established treatment for or- thopedic malignancies, but their indication has been expanded to some non-neoplastic conditions such as complex cases of re-revision surgery or failed osteosynthesis. A con- secutive series of 5 patients were treated with megaprostheses as a solution for complex cases of re-revision surgery around the knee joint. Each patient was assessed clinically and radiographically at 1, 3, 6, and 12 months after surgery. One patient died for intestinal infarc- tion after surgery. The 4 remaining patients resumed gait and knee function. We did not observe infections or mobilizations of the implants, and the only complication we described was patellar dislocation of the extensor mechanism when the implant with proximal tibia resection was used. Complex re-revision surgery after TKA represents a major challenge for the orthopedic surgeon due to poor bone stock and the presence of prosthetic revision components. The implant of megaprostheses or custom-made devices can play a crucial role in these rare but complex cases of non-oncological orthopedic surgery ensuring early functional recovery.","PeriodicalId":238529,"journal":{"name":"LO SCALPELLO-OTODI Educational","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132608918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This is an open access article distributed in accordance with the CC-BY-NC-ND (Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International) license. The article can be used by giving appropriate credit and mentioning the license, but only for non-commercial purposes and only in the original version. For further information: https://creativecommons.org/licenses/by-nc-nd/4.0/deed.en The role of reinforced carbon fiber plates in supracondylar femoral fractures
{"title":"The role of reinforced carbon fiber plates in supracondylar femoral fractures","authors":"N. Tartaglia, A. Giorgio, M. Saracino","doi":"10.36149/0390-5276-194","DOIUrl":"https://doi.org/10.36149/0390-5276-194","url":null,"abstract":"This is an open access article distributed in accordance with the CC-BY-NC-ND (Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International) license. The article can be used by giving appropriate credit and mentioning the license, but only for non-commercial purposes and only in the original version. For further information: https://creativecommons.org/licenses/by-nc-nd/4.0/deed.en The role of reinforced carbon fiber plates in supracondylar femoral fractures","PeriodicalId":238529,"journal":{"name":"LO SCALPELLO-OTODI Educational","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129380307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Momoli, Alessio Mulone, Maurizio Ulgelmo, Enrico Lunardelli, C. Ambrosini, Stefano Giaretta
{"title":"The role of dual-mobility in primary total hip arthroplasty","authors":"A. Momoli, Alessio Mulone, Maurizio Ulgelmo, Enrico Lunardelli, C. Ambrosini, Stefano Giaretta","doi":"10.36149/0390-5276-212","DOIUrl":"https://doi.org/10.36149/0390-5276-212","url":null,"abstract":"","PeriodicalId":238529,"journal":{"name":"LO SCALPELLO-OTODI Educational","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125895642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective. The gynecologist often involves the orthopaedic surgeon in the evaluation of pregnant women with previous medical history of pelvic surgery who will give birth. Young women can receive pelvic surgery for proximal femoral fractures, sacro-iliac or pelvic ring fractures, avascular necrosis of the femoral head, hip dysplasia and severe ankylosing spondylitis. The aim of this study is to determine whether such women can accomplish a natural delivery or should have caesarean delivery (C-section). Methods. Pubmed and the Cochrane Database of Reviews were searched for manuscripts including the years 1970 to present. Results. It is important to discriminate between pathological and/or post-surgical conditions affecting the coxo-femoral joint which constitute an absolute contraindication to vaginal delivery from other circumstances that may have a relative contraindication. Orthopaedic relative indications for C-section may include coxo-femoral pathologies where coxo-femoral joint range of motion is limited and women cannot assume a given position that is deemed necessary by the obstetric specialist for natural delivery. Conditions requiring C-section are those producing an insufficient width of the bony birth canal; when the transverse mid-pelvis diameter is <9.5 cm, then the probability of C-section is increased. Conclusions. It is not mandatory to perform a C-section in all women with a past medical history of pelvic surgery; accurate medical history collection, imaging technologies and ultrasound make it possible decide if a C-section is compulsory.
{"title":"Pelvic bone surgery and natural delivery: absolute and relative contraindications","authors":"M. Ometti, G. Bettinelli, M. Candiani, V. Salini","doi":"10.36149/0390-5276-187","DOIUrl":"https://doi.org/10.36149/0390-5276-187","url":null,"abstract":"Objective. The gynecologist often involves the orthopaedic surgeon in the evaluation of pregnant women with previous medical history of pelvic surgery who will give birth. Young women can receive pelvic surgery for proximal femoral fractures, sacro-iliac or pelvic ring fractures, avascular necrosis of the femoral head, hip dysplasia and severe ankylosing spondylitis. The aim of this study is to determine whether such women can accomplish a natural delivery or should have caesarean delivery (C-section). \u0000Methods. Pubmed and the Cochrane Database of Reviews were searched for manuscripts including the years 1970 to present. \u0000Results. It is important to discriminate between pathological and/or post-surgical conditions affecting the coxo-femoral joint which constitute an absolute contraindication to vaginal delivery from other circumstances that may have a relative contraindication. Orthopaedic relative indications for C-section may include coxo-femoral pathologies where coxo-femoral joint range of motion is limited and women cannot assume a given position that is deemed necessary by the obstetric specialist for natural delivery. Conditions requiring C-section are those producing an insufficient width of the bony birth canal; when the transverse mid-pelvis diameter is <9.5 cm, then the probability of C-section is increased. \u0000Conclusions. It is not mandatory to perform a C-section in all women with a past medical history of pelvic surgery; accurate medical history collection, imaging technologies and ultrasound make it possible decide if a C-section is compulsory.","PeriodicalId":238529,"journal":{"name":"LO SCALPELLO-OTODI Educational","volume":"92 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124430675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Raggini, G. Bettinelli, V. Pace, V. Salini, G. Placella
Nonsteroidal anti-inflammatory drugs (NSAIDs) remain the most commonly utilised prophylaxis to reduce arthrofibrosis (AF) related to the inflammatory response which leads to a pathological condition called arthrofibrosis. Several NSAIDs have shown to be effective, although postoperative indomethacin has been the historical gold standard. More recently, credit has been given to the use of COX-2 selective inhibitors, due to concerns over gastrointestinal effects, as peptic ulcers, with non-selective COX. However, to date, few studies have compared the therapeutic effects of the two drugs. The aim of this study is to compare the postoperative administration of indomethacin and celecoxib in patients with diagnosis of AF treated with arthroscopic lysis and evaluate joint recovery. In this prospective study, 42 patients were diagnosed with hip, knee and elbow residual AF. The inclusion criteria were age > 18 years and a diagnosis of residual AF, following exposure to a previous traumatic event or surgical treatment; exclusion criteria were patients with 35 or < 18 kg/m2, affected by peripherical neuropathies and presence of heavy functional limitations, active infection, complex regional pain syndrome diagnoses. All patients underwent to arthroscopy, operated by a single surgeon with the same team in the same clinic and postoperatively were randomly divided into two groups, one treated with indomethacin, and the other with celecoxib. Of the patients examined, the following parameter was considered: joint range of motion (ROM) preintervention and post-intervention at 3 months and after 12 months. ROM was analysed with Student t test. The comparison of the ROM between both the 3 months postoperative groups has been shown to be not statistically significant. On the other hand, after 1 year, t-Student test referred to preoperative condition was significantly in favour of the group treated with celecoxib (p = 0.02). Lastly, neither celecoxib nor indomethacin showed any gastrointestinal side effects.
{"title":"Celecoxib versus indomethacin as prevention of arthrofibrosis. A perspective case-control study","authors":"F. Raggini, G. Bettinelli, V. Pace, V. Salini, G. Placella","doi":"10.36149/0390-5276-162","DOIUrl":"https://doi.org/10.36149/0390-5276-162","url":null,"abstract":"Nonsteroidal anti-inflammatory drugs (NSAIDs) remain the most commonly utilised prophylaxis to reduce arthrofibrosis (AF) related to the inflammatory response which leads to a pathological condition called arthrofibrosis. Several NSAIDs have shown to be effective, although postoperative indomethacin has been the historical gold standard. More recently, credit has been given to the use of COX-2 selective inhibitors, due to concerns over gastrointestinal effects, as peptic ulcers, with non-selective COX. \u0000However, to date, few studies have compared the therapeutic effects of the two drugs. The aim of this study is to compare the postoperative administration of indomethacin and celecoxib in patients with diagnosis of AF treated with arthroscopic lysis and evaluate joint recovery. \u0000In this prospective study, 42 patients were diagnosed with hip, knee and elbow residual AF. The inclusion criteria were age > 18 years and a diagnosis of residual AF, following exposure to a previous traumatic event or surgical treatment; exclusion criteria were patients with 35 or < 18 kg/m2, affected by peripherical neuropathies and presence of heavy functional limitations, active infection, complex regional pain syndrome diagnoses. All patients underwent to arthroscopy, operated by a single surgeon with the same team in the same clinic and postoperatively were randomly divided into two groups, one treated with indomethacin, and the other with celecoxib. Of the patients examined, the following parameter was considered: joint range of motion (ROM) preintervention and post-intervention at 3 months and after 12 months. ROM was analysed with Student t test. The comparison of the ROM between both the 3 months postoperative groups has been shown to be not statistically significant. On the other hand, after 1 year, t-Student test referred to preoperative condition was significantly in favour of the group treated with celecoxib (p = 0.02). Lastly, neither celecoxib nor indomethacin showed any gastrointestinal side effects.","PeriodicalId":238529,"journal":{"name":"LO SCALPELLO-OTODI Educational","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128906238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Conti, Federico Bertolo, M. Boffano, P. Pellegrino, N. Ratto, R. Piana
Objective. Current Italian guidelines recommend surgery within 24 hours from admission for hip fractures of the elderly. In such patients, a pathologic fracture of the proximal femur is not an uncommon event and may be consequent to bone metastases or primary tumours. This paper aims to investigate the current literature and to propose an algorithm to manage patients more securely. Methods. A review of the literature on diagnostic and therapeutic tools in pathologic fractures of the hip was conducted. Evidence from the literature was merged to define a flowchart for a safe clinical-diagnostic pathway. Results. Proper imaging is essential in the management of bone metastases, along with appropriate laboratory tests and within a multi-disciplinary setting. While bone metastases are the expression of a systemic disease, bone sarcomas have an extremely aggressive local course and an incorrect surgical procedure could heavily affect prognosis of the patient. The surgeon should not rush to treat a suspicion of a pathological fracture without having performed all necessary investigations. Conclusions. Orthopaedists must doubt a pathologic fracture. An algorithm could help standardise procedures and provide a tool for safe management of these patients.
{"title":"Pathological hip fracture in the elderly: review and proposal of an algorithm","authors":"A. Conti, Federico Bertolo, M. Boffano, P. Pellegrino, N. Ratto, R. Piana","doi":"10.36149/0390-5276-160","DOIUrl":"https://doi.org/10.36149/0390-5276-160","url":null,"abstract":"Objective. Current Italian guidelines recommend surgery within 24 hours from admission for hip fractures of the elderly. In such patients, a pathologic fracture of the proximal femur is not an uncommon event and may be consequent to bone metastases or primary tumours. This paper aims to investigate the current literature and to propose an algorithm to manage patients more securely. \u0000Methods. A review of the literature on diagnostic and therapeutic tools in pathologic fractures of the hip was conducted. Evidence from the literature was merged to define a flowchart for a safe clinical-diagnostic pathway. \u0000Results. Proper imaging is essential in the management of bone metastases, along with appropriate laboratory tests and within a multi-disciplinary setting. While bone metastases are the expression of a systemic disease, bone sarcomas have an extremely aggressive local course and an incorrect surgical procedure could heavily affect prognosis of the patient. The surgeon should not rush to treat a suspicion of a pathological fracture without having performed all necessary investigations. \u0000Conclusions. Orthopaedists must doubt a pathologic fracture. An algorithm could help standardise procedures and provide a tool for safe management of these patients.","PeriodicalId":238529,"journal":{"name":"LO SCALPELLO-OTODI Educational","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115434275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Giannicola, S. Prigent, Giorgio Iacono Quarantino, C. Villani
Distal humerus fractures (DHF) are rare and complex injuries. Although knowledge of these lesions among surgeons has increased in recent decades, a high rate of complications and unsatisfactory results are still reported. The main complications are ulnar nerve neuropathies, stiffness, heterotopic ossifications, nonunions, malunions, painful hardware and post-traumatic osteoarthritis. Careful pre-operative planning, choosing the correct surgical approach, mini-invasive and tissue-sparing surgery, stable osteosynthesis, correct management of the ulnar nerve and early rehabilitation can improve clinical outcomes by reducing the number of complications. The type of trauma, bone exposure, timing of surgery in polytraumas and varying levels of compliance among patients represent inevitable risk factors for unsatisfactory outcomes. Early and appropriate treatment of complications is associated with better results as it reduces the development of osteoarthritis and avoids a long period of functional disability. The aim of this study is to describe the main complications of DHF and ways of preventing and treating them
{"title":"Sequelae of distal humeral fractures","authors":"G. Giannicola, S. Prigent, Giorgio Iacono Quarantino, C. Villani","doi":"10.36149/0390-5276-003","DOIUrl":"https://doi.org/10.36149/0390-5276-003","url":null,"abstract":"Distal humerus fractures (DHF) are rare and complex injuries. Although knowledge of these lesions among surgeons has increased in recent decades, a high rate of complications and unsatisfactory results are still reported. The main complications are ulnar nerve neuropathies, stiffness, heterotopic ossifications, nonunions, malunions, painful hardware and post-traumatic osteoarthritis. Careful pre-operative planning, choosing the correct surgical approach, mini-invasive and tissue-sparing surgery, stable osteosynthesis, correct management of the ulnar nerve and early rehabilitation can improve clinical outcomes by reducing the number of complications. The type of trauma, bone exposure, timing of surgery in polytraumas and varying levels of compliance among patients represent inevitable risk factors for unsatisfactory outcomes. Early and appropriate treatment of complications is associated with better results as it reduces the development of osteoarthritis and avoids a long period of functional disability. The aim of this study is to describe the main complications of DHF and ways of preventing and treating them","PeriodicalId":238529,"journal":{"name":"LO SCALPELLO-OTODI Educational","volume":"56 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123223528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Complications after surgical treatment of femoral diaphyseal and supracondylar fractures can occur. Adequate planning and knowledge of the principles of osteosynthesis can help to avoid predictable sequelae.
股骨骨干及髁上骨折手术治疗后可出现并发症。充分的计划和对植骨原理的了解有助于避免可预测的后遗症。
{"title":"Sequelae of diaphyseal and supracondylar femoral fractures","authors":"F. Chiodini, Luca Busnelli","doi":"10.36149/0390-5276-009","DOIUrl":"https://doi.org/10.36149/0390-5276-009","url":null,"abstract":"Complications after surgical treatment of femoral diaphyseal and supracondylar fractures can occur. Adequate planning and knowledge of the principles of osteosynthesis can help to avoid predictable sequelae.","PeriodicalId":238529,"journal":{"name":"LO SCALPELLO-OTODI Educational","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130137724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Tripodi, V. Macrì, G. Gigliotti, D. A. Riccelli
The appropriateness of fixation use in orthopedic surgery is a debated and constantly evolving topic, similar to the devices themselves. Devices and materials impossible even to imagine until a few years ago, are now available. Consequently, indications, timing and methods of surgical treatment are constantly changing, along with the expansion of knowledge and technological progress. This also applies to the treatment of tibial plateau fractures which, due to the specific anatomy of the knee joint and the traumatic mechanisms, represents a constant challenge for surgeons. In addition to the fracture typology, several factors must be considered, among which, undoubtedly, the degree of soft tissue injury. Age, functional demands, patient compliance, and comorbidities must be carefully evaluated before choosing suitable osteosynthesis devices, i.e., cannulated screws, synthetic bone substitutes, the assistance of arthroscopy technique (A.R.I.F.) in closed reduction internal fixation (C.R.I.F.) and in minimally invasive percutaneous plate osteosynthesis (M.I.P.P.O), support plates and locking plates in open reduction internal fixation (O.R.I.F.), temporary or permanent external fixators (T.E.F.) and, finally, primary total knee arthroplasty (P.T.K.A.), which in recent times have been proposed for treating complex fractures in the elderly with poor bone quality and severe pre-existing knee arthrosis.
{"title":"Appropriateness of fixation use in tibial plateau fractures","authors":"G. Tripodi, V. Macrì, G. Gigliotti, D. A. Riccelli","doi":"10.36149/0390-5276-015","DOIUrl":"https://doi.org/10.36149/0390-5276-015","url":null,"abstract":"The appropriateness of fixation use in orthopedic surgery is a debated and constantly evolving topic, similar to the devices themselves. Devices and materials impossible even to imagine until a few years ago, are now available. Consequently, indications, timing and methods of surgical treatment are constantly changing, along with the expansion of knowledge and technological progress. This also applies to the treatment of tibial plateau fractures which, due to the specific anatomy of the knee joint and the traumatic mechanisms, represents a constant challenge for surgeons. In addition to the fracture typology, several factors must be considered, among which, undoubtedly, the degree of soft tissue injury. Age, functional demands, patient compliance, and comorbidities must be carefully evaluated before choosing suitable osteosynthesis devices, i.e., cannulated screws, synthetic bone substitutes, the assistance of arthroscopy technique (A.R.I.F.) in closed reduction internal fixation (C.R.I.F.) and in minimally invasive percutaneous plate osteosynthesis (M.I.P.P.O), support plates and locking plates in open reduction internal fixation (O.R.I.F.), temporary or permanent external fixators (T.E.F.) and, finally, primary total knee arthroplasty (P.T.K.A.), which in recent times have been proposed for treating complex fractures in the elderly with poor bone quality and severe pre-existing knee arthrosis.","PeriodicalId":238529,"journal":{"name":"LO SCALPELLO-OTODI Educational","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132396511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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