La Chirurgia degli organi di movimento最新文献

Two cases of closed dislocation of the interphalangeal joint of the thumb are presented. It was impossible to achieve manual reduction in either patient. This rare injury required open reduction with anatomical repositioning of the volar plate in both patients. We fixed the IP joint with a steel wire after reduction in both cases because of slight joint instability. At the latest follow-up, both patients do not have any problems with in daily life.

Isolated pure dislocations of the fifth carpo-metacarpal joint are extremely rare injuries. The dorsal form was described in mere 12 cases. The diagnosis can be easily missed. The lesion is also often overlooked in the routine diagnostic X-ray. Lateral and oblique views are important for the recognition of the true extent of the lesion. Treatment of these injures is still controversial and both closed reduction with percutaneous pinning or open reduction with internal fixation are advocated. The goal of treatment is early reduction and fixation of the metacarpal. Early diagnosis is the key to success. The aim of this paper is to review literature and present two new cases.

This paper analyses 80 cases of displaced proximal humerus fractures, with two or three fragments, treated by PHN nailing. The hold of the spiral blade was effective, and is particularly recommended for fractures with two fragments according to Neer's classification. The results, analysed with Constant's score and radiographic checkups, were satisfactory. Nearly all our patients (76 out of 80) had a mean age of 75 years and a total Constant score of 78.48. Only four (mean age 42.5 years) had a Constant score of 86. Shoulder articulation was good and only a few complications occurred.

The purpose of this study is to present midterm results of NexGen LPS (Zimmer, Warsaw) rotating platform total knee arthroplasty. A prospective consecutive series of 50 primary rotating platform total knee replacements in 43 patients were clinically and radiographically evaluated at a mean follow-up of 46.4 (range 30-78) months. There were 12 men (30%) and 31 women (70%) with an average age of 72.3 years (range 55-85). All implants were cruciate-substituting and cemented. Patients were assessed using the Knee Society Clinical Rating System and the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Pre-operatively, the mean knee score was 50.7 points (SD 15.1) and the mean function score was 40.5 points (SD 22.7). Post-operatively the mean knee score was 91.6 (SD 6.5) and the mean function score was 85.9 (SD 17.4). No sign of component loosening or osteolysis could be identified. The NexGen LPS rotating platform total knee replacement design provided excellent mid-term clinical and radiographical results.

A diverse variety of lesions may occasionally occur in the patella. In this case report, we are presenting an interesting case of anterior knee pain in middle aged gentleman. Initial investigations including Magnetic Resonance Imaging not showed any abnormality. Due to prolonged continued pain he had bone scan and MRI, which confirmed the diagnosis of Brodie's abscess. We are presenting this case of Brodie's abscess of the patella causing diagnostic dilemma because of its rarity.

We examined patients affected by a posterior wall fracture of the acetabulum treated with a minimally invasive posterior approach (from 12 to 18 cm). During 2004-2006 19 patients were treated by this approach. 4 patients had a combined surgery by the ileo-inguinal approach. Fracture fixation was performed using reconstruction plates and screws. All the patients were studied with typical X-rays projection for pelvis and iliac oblique view and obturator oblique view (Judet view) and CT scan with 3D reconstruction. After 3 months a CT scan was performed on about 30% of our patients, which demonstrated the perfect healing of the fractures. The most important advantages we observed using this approach were a lesser split of the gluteus maximus and no risk of damage for the superior gluteal nerve. In the early post-operative rehabilitation we examined the trophism of the gluteus maximus, which was found to be better than in patients treated with the typical Kocher-Langenbeck approach. The only absolute contraindication for this technique is in obese patients. The post-operative complications include one case of heterotypic ossification of the gluteus minimus and one case of peroneal-nerve palsy with the spontaneous and complete recovery within 6 months. According to our experience this kind of approach could be used for posterior wall fracture of the pelvis and it can be extended to transverse fractures. In the post-operative period the greatest advantage is the lesser muscle damage and therefore a most effective rehabilitation.

The authors describe their experience in the treatment of the lesions of the distal tendon of the biceps through the anatomic insertion with Mitek mini-anchors using Henry anterior single-incision access. From 1996 to 2007, 12 patients, all male, average age 51.2 years, were treated for a lesion of the distal tendon of the biceps. In all cases, post-operative pain according to the visual analogical scale, the articular motion of the elbow, the occurrence of neurological disorders and the formation of ectopic ossifications appreciated by radiographies were evaluated. Furthermore, the patient's satisfaction and the impact on his quality of life were assessed using the DASH questionnaire. The results that were evaluated at an average follow-up of 65.6 months were satisfactory: in two cases a temporary deficit in the innervation area of the radial nerve occurred; in two cases ossifications formed at the tendon insertion level but with no clinical repercussions. All patients returned to their previous working activity and their level of satisfaction was good in five cases and very good in the other seven cases. In agreement with literature data, this technique, when compared with other treatment methods, proved effective and safe in the treatment of acute lesions of the distal tendon of the biceps brachii.

Fractures of the femoral head are rare. They usually occur in association with a posterior hip dislocation secondary to a high-energy trauma (motor vehicle accident). We report a case of Pipkin II fracture associated with an irreducible hip subluxation. Clinical signs are poor unlike in posterior hip subluxation. CT scan is important to evaluate the traumatism. The Hardinge approach is relevant in this context of irreducible hip subluxation. The clinical, diagnostic, and therapeutic particularities of this lesion type are discussed.

We present a case report of a 14-year-old Caucasian sport woman affected by bilateral and symmetrical knee osteochondritis dissecans (OCD) addressed to surgery, in which extracorporeal shock wave therapy determined complete healing. Shock wave is a longitudinal acoustic wave traveling with the speed of ultrasound through the water of the body tissue. Recently, this therapy has been used in the treatment of a number of musculoskeletal pathologies on the basis of the effects produced by the induction of angiogenesis, recruitment of progenitor cells and downregulation of cartilage damage. This therapy is useful, because it is non-invasive, safe, without complications or adverse effects and repeatable. Thus, it could be suggested as a useful strategy for the treatment of OCD prior starting surgery.

We present a case of irreducible palmar dislocation of the proximal fragment of a scaphoid fracture without carpal dislocation. We observed this lesion 2 days after the injury and we immediately operated the patient with a combined volar and dorsal access: using the Henry access we reduced the fracture and we inserted a cannulated screw to synthesize the scaphoid, using the dorsal access we repaired the complete rupture of the scapho-lunate ligament using a mini anchor. Stabilization among scaphoid, lunate and capitate was performed using Kirschner wires. X-ray showed fracture healing after 90 days. No clinical or radiographic evidence of carpal instability was revealed, on standard X-rays or on dynamic evaluations. No sign of avascular necrosis or degenerative arthritis was observed after 9 months.