Injury最新文献

Introduction: Internal fixation in not-comminuted oblique and transverse olecranon fractures is commonly performed with tension band wiring. However, despite its high healing rate, this technique is associated with a high rate of complications, often requiring the removal of fixation devices in up to 80 % of cases. The aim of our study was to describe a surgical technique using eyelet pins that maintains the effectiveness of the classic tension band wiring while reducing intolerance or displacement of the fixation devices.

Methods: Fifteen patients with surgically treated Mayo type II A or II B olecranon fractures, meeting the inclusion criteria, were enrolled. Clinical and functional assessments were conducted using MEPS and DASH scores at the 12 month follow-up. Additionally, complications and the duration of the operation were documented.

Results: Fifteen patients were enrolled, with eight having type II A and seven having type II B olecranon fractures. The mean patient age was 46.8 years, including ten males and five females. Nine cases involved the right side, while six involved the left. At the 12-month follow-up, the mean MEPS score was 98/100, and the DASH score was 9. Two patients (13.3 %) experienced superficial wound infections, and two (13.3 %) had persistent pain at the triceps tendon insertion site. No cases required removal of fixation devices.

Conclusion: The eyelet pin system was found to be a safe and effective method for reducing and fixing olecranon fractures. Based on a limited series, this new technique exhibits the same reliability and reproducibility as tension band wiring but with a lower rate of complications.

Purpose: Posterior pelvic ring lesions are a common finding in patients with pelvic trauma, representing a challenging condition for trauma surgeons. Surgical options are different and there is not yet evidence about the best option. Aim of the study are: (i) to compare Lumbopelvic fixation (LPF) and ilio-sacral screw fixation (ISS) regarding clinical and radiological outcome in unstable posterior pelvic ring injuries, both as whole population and single similar fracture types according to Tile classification (C1vsC1, C2vsC2, C3vsC3); (ii) to analyze clinical outcomes and complications in lumbopelvic fixation group, comparing open and closed reduction technique.

Methods: A retrospective multicenter study was performed. Data of the patients were collected. Inclusion criteria were: (i) unstable posterior ring lesions Tile C type, (ii) surgically treated either through ISS (Group A) or LPF (Group B), (iii) minimum follow-up 12 months. Radiological evaluation was made through plain radiographs in Antero-posterior (AP), inlet and outlet views. Last clinical evaluation at 12 months was assessed through Majeed Score, and quality of life (QoL) through SF-12.

Results: Group A was represented by 76 patients, and Group B by 42. Group B had better result in Majeed score for non-workers (average 60.1 ± 21.6 vs 65.0 ± 15.6, p = 0.016*). Comparing only C3-type lesions, Group A showed a higher rate of implants breakage (p = 0.032*). Other differences had p > 0.05. Comparing patients underwent open (ORIF) or closed (CRIF) reduction in Group B, CRIF group had shorter hospitalization (47.2 vs 23.4 days, p = 0.020*), an earlier full weight-bearing recovery (4.1 vs 2.6 months, p = 0.035*) and a better Majeed score in workers patients (70.3 vs 82.8, p = 0.019*). Better results for CRIF group were also recorded in quality of life (QoL), both in mental (45.1 vs 55.2, p = 0.040*) and physical outcome (31.9 vs 50.7, p < 0.001*).

Conclusion: ISS and LPF represent both good choices in posterior pelvic ring lesions, however some significant differences were noted. LPF seems to be preferable if the patient did not work before the trauma, due to better clinical outcome. In Tile C3 lesions, LPF have lower breakage rates. If LPF is chosen, CRIF provides better clinical outcomes, QoL and lower hospitalization.

Operative decision-making of tibial pilon fractures is still of great complexity. The AO Trauma Italy has investigated the trend in the management of this fractures among orthopedic surgeons in Italy. A literature-based survey focused on preoperative planning and surgical strategies has been submitted to all the participants and the results were discussed in an online webinar in light of the most recent literature with the aim to outline common treatment recommendations especially useful for young surgeons.

Restoring of leg length and femoral offset in partial hip arthroplasty (PHA) performed by residents (level one of experience surgery) in the neck femoral fractures has a significant role in the clinical outcome. The aim of this study is to show the statistically significant differences in restoring hip geometric parameters using preoperative planning vs intraoperative X-ray. Authors compared the use of pre-operative planning with intra-operative radiography to restore the limb length and femoral offset, focused on the measurement of femoral offset and leg length discrepancy (LLD). Based on the calculation of the sample size, the number of observations required for each test group was 37 patients. For all patients were performed pre- and post-operative measurements, using mediCAD HECTET GmbH Version 5.0 software, calibrated after positioning of a radiographic landmark of 25,4 mm. The median post-operative LLD was substantially overlapping between the two group patients (1 mm vs. 1,5 mm). Statistical analyses did not find a statistically significant difference between the using of preoperative planning and intra-operative x-ray according to postoperative LLD (p = 0,06). Similarly, median change in the offset did not differ between the two groups (-2 mm vs. -1,5 mm; p = 0.69). In our experience, the combined use of pre- and intraoperative techniques appear to be viable and effective in order to restore femoral offset and minimize LLD.

Proximal femoral fractures in elderly women are a major cause of morbidity and mortality worldwide and a public health concern. Although pharmacological therapies have shown potential in improving bone mineral density (BMD) and decreasing fracture risk, the current research effort is focused on developing a procedure that can ensure both immediate and long-term efficacy. A minimally-invasive surgical approach, known as AGN1 local osteo-enhancement procedure (LOEP), has been recently developed to promote bone augmentation. The procedure implies the preparation of an enhancement site, a specific location where new bone is required within a local bony area weakened by osteoporotic bone loss, and the insertion of a triphasic, resorbable, calcium-based implant material. The results of this procedure have shown a significant and sustainable long-term increase in the proximal femur BMD and consequently in bone strength, thereby improving the femoral neck's resistance to compression and distraction forces that may result in fall-related fractures. A preliminary case series of ten women, suffering from intertrochanteric fracture and contralateral proximal femur severe osteoporotic bone loss, who underwent a combined procedure of proximal femoral nailing and AGN1 local osteo-enhancement procedure, has been developed over the course of a year of clinical and radiological data collection.

Proximal femoral fractures are a major public health issue due to an increasing ageing population, with an important impact on patients' quality of life. This study was designed by the Authors through a national survey with the purpuse to investigate the italian experience and practice about management and perioperative/operative trends of intracapsular proximal femoral fractures (PFF). In February-March 2022 a national survey was submitted online to the members of SIOT (Società Italiana Ortopedici e Traumatologi) and SIDA (Società Italiana dell'Anca) societies. Demographic data of the participants such as age, type of workplace and years of working experiences were registered. The questionnarie included 21 multiple choice questions about: demographic data, preoperative management, surgical indications (treatment of non-displaced and displaced fractures), management of the geriatric patient and surgical technique. Resulting data were collected and stored in a database, the results were then processed and compared with the international literature and registries. The Survey was completed by 372 surgeons; answers reported were often in accordance with the literature and national and international guidelines, with, on the other hand, important controversies regarding preoperative management (radiological studies and preoperative planning), some surgical indications and choice of stem fixation. Management of proximal femoral fractures is not always clear and univocal; it is mandatory to produce a diagnostic-therapeutic process supported by scientific evidence. In this context the SIOT Guidelines 2021 offer a real help for the surgeon managing a PPF.

Introduction: Subtalar dislocation is an uncommon orthopaedic pathology, representing 1 % of all traumatic injuries of the foot and 1-2 % of all dislocations, mostly affecting young male adults. While its urgent treatment consisting in reduction and immobilization of the dislocation has been well described, disagreement exists about post-operative management with specific regards to immobilization length and rehabilitation protocols.

Materials and method: A case series of traumatic subtalar dislocations treated with urgent reduction, a mean of 4 weeks immobilization and subsequent rehabilitation is presented, with 1-year minimum clinical and subjective follow up. Also, a systematic review of the literature concerning the post-operative management following a subtalar dislocation, and subsequent results, has been performed.

Results: At 1-year minimum follow up, none of the patients presented with complications such as recurrence of dislocation or talus osteonecrosis. Tibio-talar and subtalar range of motion (ROM) were superimposable to the contralateral joints, with a maximum difference of 5°. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score highlighted a good functionality and a full recovery in all patients but one. Pure subtalar dislocations led to better results than complicated ones. Review of current literature available on the topic demonstrated that an earlier mobilization resulted in better ROM, but the global outcome did not differ among 4 to 6 weeks of immobilization.

Discussion: Conflicting reports are present in the literature regarding the most appropriate post-reduction management of subtalar dislocations. In our case series, successful results have been obtained with a mean of 4 weeks of limb immobilization and an early rehabilitation protocol.

Conclusions: Although some limitations are present, 4 weeks immobilization appears to be the best balance between a good overall outcome and a better recovery of ROM. Further studies are needed to deepen the subject.

Background and purpose: Residual axial and rotational deformities in tibial shaft fracture, after minimally invasive osteosynthesis (MIO) treatment, are widely described in literature. Nevertheless, there is still a lack of evidence about the malunion treatment strategies and results. The aim of our study is to present an innovative technique for tibial shaft malunion: a derotational proximal tibial osteotomy without removing the original plate (Plate-Retaining-Osteotomy: PR-Osteotomy).

Materials and methods: We present the results of two consecutive patients' treatment, affected by tibial shaft fracture malunion, as sequelae of MIO treatment. The two patients, male 60 years old and female 39 years old, underwent previous surgical treatment with an average of 9 months span time before surgical revision. The affected limb showed significant external torsional defect associated with gait impairment, pain and limping. The amount of rotational deformity and the bone healing condition is assessed through a methodical preoperative planning, including weight bearing lower limbs Xray and bilateral computed tomography (CT) scan of the lower limbs. The surgical technique involves a monoplanar tibial osteotomy, in a perpendicular fashion to the tibial axis, at a level that would allow at least 3 proximal screw-holes to become available for subsequent fixation. Proximal to the osteotomy line the screws are removed, while the distal ones, if stable after testing, are left in place. The amount of torsional correction, planned on CT, is reproduced intraoperatively with the assistance of graduated templates. A fibular osteotomy may be performed if required. After temporary stabilization, the correct functional reduction is checked with the aid of fluoroscopy and empirical rod measurement, using the contralateral limb alignment as a reference. Once the desired correction is achieved, absolute stability is applied to the osteotomy site. Postoperative rehabilitation protocol involves partial weight bearing for 6-8 weeks with progression to full weight bearing by 10-12 weeks.

Results: Both patients showed complete osteotomy healing at the 13th and 16th week respectively, with no complications and full recovery of normal gait and daily life activities.

Conclusions: To our knowledge, this is the first description of such surgical technique. Less invasiveness, fast recovery time and cost reductions are the foremost proposed benefits. Further larger case series with longer follow up are needed to assess the advantages of the proposed treatment strategy.

Background: Nowadays, an increasing number of Total Elbow Arthroplasty (TEA) surgeries have been selected as the primary intervention for distal humerus joint fractures. TEA has demonstrated favorable outcomes in elderly osteoporotic patients and has been associated with fewer complications and reduced stiffness when compared to Open Reduction Internal Fixation (ORIF) surgeries. This retrospective cohort study aimed to analyze differences in terms of functional outcomes, complications, and reoperation rates of distal fractures of the humerus treated with ORIF and TEA.

Methods: This is a retrospective cohort study.

Inclusion criteria: Closed intra-articular fractures of the distal humerus (AO/OTA type 13B and 13C); age greater than 50 years; clinical and radiological follow-up of at least 2 years. Patients were divided into two groups according to surgical treatments: ORIF and TEA. The following variables were obtained: age, sex, affected side, AO/OTA classification, follow-up time, approach, surgery duration, Range Of Motions, MEPI (Mayo Elbow Performance Index), QUICK DASH (Disability of the Arm, Shoulder, and Hand), post-operative VAS (Visual Analog Scale), satisfaction rate, complications and reoperation rates. Differences in data averages between the groups were assessed, and a correlation between age and other variables in each group was calculated.

Results: 83 subjects (26 men and 57 women) were eligible and selected for the study. Average age and follow-up time were 74.8 years (+-10.6) and 83.6 months (+-42.6). Group TEA consisted of 41 patients (37 female, 4 male), mean age of 78.8 (+-8.6) with follow-up time of 83,6 months (+-42.6). Group ORIF consisted of 42 subjects (20 female, 22 male), mean age of 71.1 (+-11.6) with follow-up time of 70,6 months (+-40,6) The cohorts didn't differ significantly with any variables calculated (p > 0.05) except for complication and reoperation rates, which were significantly lower in the TEA group. Age didn't have a correlation trend associated with the variables in either group assessed independently (p > 0.05).

Conclusions: The results of the study, may guide in choosing a surgical option for distal humerus fractures in the elderly by considering TEA an alternative that is comparable to ORIF, and in selected cases an alternative that overall provides greater assurance than ORIF.

Introduction: Usually ipsilateral fractures of the femur and tibia are not compatible with good results and require surgery. The unsatisfactory results are more likely due to complex patterns of fractures, compromised soft tissue, associated ligament injuries, and concomitant vital organ injuries. There are many classifications to describe this type of fracture but none of them is a prognostic classification. The aim of this study is to validate our classification according to prognostic terms.

Methods: This retrospective study encloses patients accepted with a diagnosis of floating knee between January 1st 2014 and December 31th 2020. A total of 372 patients met the inclusion criteria, but only 168 patients were selected for the final review. We have reclassified the 168 patients into three classifications: according to our alphanumeric; according to the Fraser classification; according to Letts and Ran. Our classification is divided into 5 macro categories in increasing order of severity, and considering fracture site, and exposure status. The Tau B Kendall and Cohen's Kappa was used to statistically evaluate the prognostic value, reliability and reproducibility of our classification versus Fraser Classification, Letts and Ran Classification in the prognosis of these injuries.

Results: The statistical results showed that classifiying patient into macro category and sub-category it is possible to have a prognostic correlation with functional results. Noteworthy, floating knee is a complex injury with poor results.

Conclusion: The floating knee is not only the bone lesion but is above all the lesion of the soft tissues and the extensor apparatus that allow the correct functionality of the knee. These lesions do not always have favorable outcome, with respect to the nonseverity of the lesion as in Fraser's classification. Furthermore, on average these patients are subjected to an average of 6 surgical interventions; in some cases we have assisted to 23 surgical procedures. This study proved that this new classification system is prognostic, reliable and reproducible.