Archivio "Putti" di chirurgia degli organi di movimento最新文献

In the wards of the CTO Hospital in Florence, isolated arthrodeses of the tarsal tibia for ankle fractures, or their effects or complications, have been performed on 29 patients in the past 13 years. Of these 29 patients we were able to personally check up on 23, with a follow-up time ranging from one to thirteen years. The patients we followed-up on had been operated on using the Scaglietti technique or its variations in 15 cases, the Charnley technique in 7 cases, and the fixation according to Ilizarov in one case. We examined the pre-operatory clinical-radiographic conditions and the surgical techniques utilized with all of their advantages, disadvantages, limits, and pre and post-operatory complications. In the follow-up studies, for instance, in addition to the subjectivity of the patient we clinically evaluated the commemorative signs and post-ambulatory adaptation phenomena as a function of the residual degree of equinism and, radiologically, the condition of the arthrodesis and the articulation proximal to the tarsal tibia. Tibio-tarsal arthrodesis, notwithstanding the inconveniences common to all types of arthrodesis, has in essence retained its validity regarding the seriously crippling effects of ankle fractures.

The authors conducted a histologic study on the modalities of ossification of the "diaphyseal osseous ferrule" in embryos between the sixth and eighth week of intrauterine life: the ossification of this "diaphyseal osseous ferrule" presents some peculiarities compared to that of other areas: it occurs with the modalities of periosteal ossification, exploiting, however, a cartilagenous substrate. In addition, the authors compared the ossification of the diaphyseal ferrule to that of the "perichondrial ferrule of the layer of ossification", examining histologic sections of embryos in the 25th week of intrauterine life.

The authors refer on their experience using bone grafting of tibial defects in total knee arthroplasty. The advantages, the technique, the casuistry and the results of this method are illustrated.

The author, after analyzing a series of 7 cases of so-called "equivalents" of malleolar fractures, underlines the opportunity for correct evaluation of articular stability when observing an X-ray of a fracture due to rotation towards the exterior of the fibula. The test, under anesthesia, enables us to confirm the clinical suspicion of injury to the deltoid ligament and suggests surgical treatment for young patients and/or sportsmen.

Congenital hallux varus is a rare deformity. The authors discuss 3 clinical cases observed and define the specific features of the anomaly. The clinical and radiographic pictures are described, emphasising essential aspects and possible variations, including the rare occurrence of congenital varus of a single interphalangeal joint. Differential diagnosis is discussed and surgical indications determined.

In this study the authors find that in the fractures of the forearm in the adults, osteosynthesis with tubular plates and compression, where is possible, is to prefer as the intramedullary nailing. Plates give a better reduction and immobilization of the fractures and allow a quickly healing, but they request a finest surgical technique than the intramedullary nailing. Our review is of 44 bifocal fractures of the forearm in adult over 127 cases that we have treated in the Orthopaedic Department of the University of Florence. Our follow-up ranged between 12 and 1 year. Eleven have been operated with Kirschner pins and 2 with Rush nailing with excellent results in 54%, and 31 with AO plates with good and excellent results in 80%.

The necessity of a surgical approach to the lesser trochanter is fairly rare event that occurs more frequently in the treatment of tumours situated in this anatomical area. The authors described four cases of osteocartilaginous neoplasms situated in proximity of the lesser trochanter. In two cases the mass was removed through a medial surgical approach (Ludloff); in one case through a postcolateral approach (Gibson), in one case through an anterior approach (Smith-Petersen). Each of the used approaches gives a good light on the lesser trochanter, therefore the choice of surgical approach is essentially determined by the prevalent spatial situation of neoplasm. Among the instrumental examinations available the Authors remark the importance of T.A.C. in the spatial visualization of neoformation.

An accurate, rapid response technique for ascertaining the mechanical behavior of the Ilizarov apparatus has been developed. A widely-adopted numerical method (finite elements), is used to achieve simulation of the apparatus configuration, whereby the orthopedic surgeon is able to custom tailor the apparatus to the clinical situation. Experimental activity verifies the validity of the finite element simulation and provides information on the magnitude and type of loads affecting the apparatus during implantation. From this information it is possible to inocuously derive objective parameters characterizing the evolution of patient rehabilitation.

Morphologic classification of fractures, however analytical they may be, is not sufficient to give precise indications as to the most adequate management decision for the various types of fractures of the acetabulum. The authors therefore find it necessary to typify these fractures on the basis of some anatomical and radiographic elements that may cause the prognosis to vary from case to case even in the same type of fracture. Two of the most important typifying factors are: articular congruity and the damage to the weight-bearing dome. The authors point out that such factors are necessary elements in the choice of a logical management decision and consider illogical an aprioristic approach whether surgical or not.

We report one case of osteoid osteoma of olecranon fossa in a female with pain and functional limitation of the elbow. The articular variety of osteoid osteoma is relatively uncommon and its diagnosis is very difficult. Conventional radiology, tomography and scintigraphy are employed for diagnosis, however computed axial tomography is particularly useful for diagnosis and correct treatment of osteoid osteoma of olecranon fossa.