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Purrpose  Metal-on-metal (MoM) total hip arthroplasty (THA) has been a subject of recent discussion and concern due to the early failures caused by local and systemic adverse reactions related to specific designs. The aim of this study is to analyze the outcomes and survival rates of a single brand of MoM implants implanted in a consecutive series of patients at a single institution. Methods  Between 2007 and 2012, 116 (118 hips) patients were evaluated at a mean follow-up of 6.6 years after primary THA. The diagnosis leading to surgery was osteoarthritis (80 patients) and proximal femoral fracture (36 patients). A single design of THA was implanted. All patients were evaluated before surgery and postoperatively at 1, 3, 6, and 12 months by clinical scores and radiographic studies. The data analysis was made using Student's t -test. Results  The minimum follow-up was of 4 years, with a mean follow-up of 6.6 years. Two aseptic loosenings of the acetabular component were recorded (one per group), which were not associated with local or systemic complications related to metal ion release. Both were revised by an isolated acetabular cup substitution with metal-on-polyethylene couplings. Nonprogressive radiolucency lines < 2 mm in zone 2 were observed in other six patients around the acetabular component without clinical manifestation (four in the arthritis group and two in the fracture group). Postoperative Harris Hip Score and SF-36 (36-Item Short Form Survey) score improved in both groups. Conclusion  Despite several MoM implants showing early complications and failures, a specific MoM design may be associated with good clinical results at a mid- to long-term follow-up. Level of Evidence  This is a therapeutic case series, Level 4 study.

Purpose  The aim of this study was to analyze the results of two different methods of surgical treatment of waist scaphoid nonunions (SNUs). We retrospectively analyzed data from 87 patients referred to our department from January 2010 to December 2017 who were surgically treated for waist SNU. Methods  The mean period of time passed from trauma was 11.2 (±5.6) months. Patients were divided into two groups based on surgical treatment received: volar exposure osteosynthesis with shape memory staple (SMS) (group A) and volar exposure osteosynthesis with SMS and gelled platelet-rich plasma (GPRP) application at the bone defect level (group B). A cast (thumb excluded) was maintained for 4 weeks. Healing was checked clinically (pain, QuickDASH [Disabilities of the Arm, Shoulder, and Hand] score, Mayo Wrist Score) and radiologically (standard X-ray). Results  Union was achieved in 40 patients in group A (95.2%) and in all patients in group B (45 patients; 100%). A statistically significant difference was observed in the improvement of the Mayo Wrist Score, QuickDASH score, and pain (measured through the visual analog scale) after 3 months from surgery ( p  = 0.02). Conclusion  SMS is effective in treating waist SNU at more than 6 months from trauma. GPRP application can improve bone healing and upper limb function. Level of Evidence  This is a retrospective observational Level III study.

Purpose  This study aims to investigate the clinical and functional outcomes of the all-arthroscopic McLaughlin procedure in a clinical series of patients suffering by neglected locked posterior shoulder dislocation. Methods  A retrospective clinical study based on prospectively collected data was conducted in a single center regarding 10 patients with neglected locked posterior shoulder dislocation and concomitant reverse Hill-Sachs lesion, who were treated with the all-arthroscopic Mclaughlin procedure. The average humeral bone defect was 39 ± 7% according to the preoperative computed tomography evaluation. The mean time of follow-up was 77 ± 16 months (range, 63-104 months). Results  No patient had suffered a new dislocation, whereas all of them were satisfied with the surgical outcome and returned to their previous activities of daily living. External rotation was restored to every patient studied from 0 degrees at the baseline. At the last follow-up, the median external rotation beside the body was 90 degrees (range, 50-90 degrees; p  < 0.01) and the respective measurement at 90 degrees of abduction was 90 degrees (range, 80-90 degrees; p  < 0.01). The active forward flexion was increased ( p  < 0.01), from 60 degrees (range, 30-180 degrees) at the baseline to 180 degrees (range, 160-180 degrees) at the last follow-up and the internal rotation was gained ( p  < 0.01) from the level of buttock (range, lateral thigh-T12) at the baseline to the T11 level (range, T7-L3) at the last follow-up. The median UCLA score was increased from 8 (range, 4-22) to 35 (range, 33-35; p  < 0.01) and the Oxford instability score from 5 (range, 3-16) to 46 (range, 43-48; p  < 0.01), respectively. Conclusion  The arthroscopic McLaughlin procedure in substantial reverse Hills-Sachs lesion caused by locked posterior dislocation leads to excellent clinical and functional results in the long-term follow-up. Level of Evidence  This is a therapeutic study, case series with no comparison group, Level IV.

First patellar dislocation is a common injury of the knee, involving often adolescents and the active population. The consequences of the first episode can be various and potentially disabling. Among these, acute patellar dislocation can often result in recurrent patellar instability. Recurrent patellar instability is certainly multifactorial but depends primarily on the injury of the medial patellofemoral ligament (MPFL), the major soft-tissue stabilizer of the patella. Some classifications are extremely useful in establishing the diagnosis and therapy in patellofemoral disease, in particular in terms of instability. Among those, Henri Dejour and WARPS (weak atraumatic risky anatomy pain and subluxation)/STAID (strong traumatic anatomy normal instability and dislocation) classifications are certainly the most frequently used. There is no clear agreement on the management of the first patellar dislocation. A conservative approach seems to be the first choice in most of cases, but the presence of patellar displacement or osteochondral fractures makes surgery mandatory at the beginning. In addition, there is no clear consensus on which surgical strategy should be used to approach first dislocation, in relation to the possible variation in location of the MPFL injury, and to the eventual presence of preexisting predisposing factors for patellar instability. MPFL reconstruction may theoretically be more reliable than repair, while there is no clear evidence available that osseous abnormality should be addressed after the first episode of patellar dislocation. A narrative review was conducted to report the etiology, the diagnosis and all the possible treatment options of the first patellar dislocation. Modern classifications of the patellofemoral instability were also presented.

Patellar instability is a common cause of knee disability in children and adolescent, with a high recurrence rate. When conservative treatment fails, surgical options should be considered. The femoral insertion of the medial patellofemoral ligament (MPFL) is in close proximity to the distal femoral growth plate and precautions should be taken to avoid injuries to the physis. Anatomical features of the MPFL complex, with focus on the relationship between femoral MPFL attachment and femoral physis, are discussed together with surgical tips to avoid injuries to the growth plates. The aim of this article is to review the recent literature regarding MPFL reconstruction and other stabilization techniques for patellofemoral instability in skeletally immature patients, focusing on the different surgical options available. These can be classified as anatomical versus nonanatomical, proximal versus distal realignments, or based on the graft used: free graft and pedicled graft (quadriceps, patellar tendon, hamstring, and adductor magnus).

Adult acquired flatfoot encompasses a wide range of deformities. The goal of surgical treatment of adult acquired flatfoot is to achieve proper alignment of the hindfoot and maintain as much flexibility as possible in the foot and ankle complex; nevertheless, if subtalar arthritis is present, subtalar arthrodesis is usually mandatory. A lateral approach over the sinus tarsi is performed and subtalar joint is prepared removing remaining cartilage, reduced up to 5 degrees of heel valgus, and stabilized with a Kirschner wire. The site of insertion of the corticocancellous bone graft, harvested from the ipsilateral proximal tibia, is prepared carving a vertical groove into the talar and calcaneal edges. Additional autologous cancellous chips, harvested from the proximal tibia, can be positioned and pressed with a beater into the sinus tarsi to enhance fusion. The technique described is a modification of the extra-articular arthrodesis originally proposed by Grice. mini bone block distraction subtalar arthrodesis is a simple and effective technique which permits a subtalar fusion with a restored orientation of the hindfoot and ankle alignment in acquired flatfoot with subtalar arthritis.

Purpose  Piezoelectric and ultrasonic vibrations have been used to cut tissues for three decades, in particular, in periodontics. The increasing use of piezosurgery is based on its clinical advantages such as selective cutting, precision, and low-temperature work rates. The authors applied this concept to a new operative field, the foot and ankle pathology and surgery, such as hallux valgus corrective distal linear osteotomy. Methods  The osteotome equipped was the Surgysonic Moto-II model (Esacrom, Imola, Italy), a system recently developed for cutting bone withmicrovibrations. Tips used in author's case series were a high-efficiency five teeth piezoelectric saw and a high-efficiency flat scalpel shaped on three edges. Operative technique is described. Discussion and Conclusion  Piezoelectric techniques were developed in response to the need for great precision and safety in bone surgery that was availavle with other manual and rmotorised instruments. Piezo-technology allows minimally-invasive and percutaneous surgery, with reduced trauma on periostium, bone, and soft tissues, reduced healing time of the osteotomy due to the absence of bony necrosis and debris formation and major precision.

Purpose  This study aimed to analyze the distance between the superior edge of the pectoralis major and the top of the humeral head and evaluate whether this distance is a consistent measurement. Methods  Twenty-two shoulders in eleven cadavers were dissected and the attachment of the pectoralis major tendon was preserved. Two distances were recorded with the help of digital vernier caliper: the distance between the upper edge of pectoralis major and tangent to the top of humeral head (PM-T) and the distance between the superomedial tip of greater tuberosity (GT) and the upper edge of the pectoralis major tendon (PM-G; ± standard error of the means). Results  The mean PM-T distance was 53.8 mm (±0.8 mm) and the mean PM-G distance was 46.8 mm (±0.9 mm). The distance between the top of humeral head and tip of the GT was 7 mm. The PM-T distance was a significant outlier in three shoulders as it inserted high on the humerus. Conclusion  We can conclude that the PM-T and PM-G distances were a consistent measurement. Clinical Relevance  The distance between the pectoralis major tendon and top of the humeral head was measured in this study as a reliable method that can be used intraoperatively to decide the height of the humerus prosthesis in comminuted fractures of the proximal humerus.

Purpose  Recent advances in total knee arthroplasty (TKA) include an accelerometer portable system designed to improve component position and alignment. The purpose of this study is to evaluate whether accelerometer navigation system can be a valuable option in complex TKAs for extra-articular deformity of the lower limb or in case of retained femoral hardware. Methods  A group of 13 patients underwent TKA with an accelerometer navigation system. Three patients had a tibial extra-articular deformity, six had a femoral extra-articular deformity, and four had an intramedullary nail in the femur. Preoperative and postoperative mechanical axes were measured from full-length lower extremity radiographs to evaluate alignment. The alignment of prosthetic components in the frontal and sagittal planes was determined by postoperative radiographs. Results  At 30-days postoperative radiographic check, the hip knee ankle angle was within 2.0° (0 ± 1) of the neutral mechanical axis. The alignment of the tibial component on the frontal plane was 90.0° (range 89-91) and on the sagittal plane 5.0° (range 3-7). The alignment of the femoral component on the frontal plane was 90.0° (range 89-91) and on the sagittal plane 3.0° (range 0-5). Conclusion  The alignment of the prosthetic components has been accurate and comparable to other navigation systems in literature without any increase in surgical times. The accelerometer-based navigation system is therefore a useful technique that can be used to optimize TKA alignment in patients with extra-articular deformity or with lower limb hardware, where the intramedullary guides cannot be applied. Level of Evidence  This is an observational study without a control group, Level III.