Rod Link Reducer system in adolescent idiopathic scoliosis: a retrospective observational trial.

PURPOSE: The Rod Link Reducer (RLR) (Globus Medical, PA, USA) allows direct three-dimensional correction of the spine deformity follows the direct vertebral rotation (DVR) theories. The purpose of this retrospective study is to compare RLR with traditional correction technique (TCT) in two cohorts of patients with adolescent idiopathic scoliosis (AIS). METHODS: Fifty-four patients (M:F = 1:8) between 2018 and 2020 were included. The first group (n = 22) was treated by RLR while the second one (n = 32) by TCT. All spines were classified as per the Lenke system. Length of hospitalization, days in intensive care unit (ICU), operative time, and blood loss were recorded. SRS-30 and SF-36 questionnaires were administered pre-operative and post-operative. We collected radiological data: pre-operative and post-operative Cobb angles, coronal and sagittal balance, trunk and thoracic height. RESULTS: RLR and TCT groups are homogeneous in age (p = 0.317), sex ratio (p = 0.347), and Risser stage (p = 0.222). Between both groups there was no significant statistical difference in haemoglobin value, hospitalization length, days in ICU, operative times, SF-36, SRS-30, NRS, and perceived satisfaction. RLR group shows a better improvement of correction of main thoracic (MT) curve (RLR 54.2% ± 15.9%/TCT 38.1% ± 20.4%, p = 0.031). Nevertheless, RLR group shows a worse thoracic kyphosis correction (RLR 16.82° ± 9.13°/27.12° ± 12.13°, p = 0.015). CONCLUSION: RLR system allows a more effective MT curve correction than TCT systems, but it seems to give a hypokyphosis effect.

Direct anterior approach versus direct lateral approach in total hip arthroplasty and bipolar hemiarthroplasty for femoral neck fractures: a retrospective comparative study.

BACKGROUND: In the current literature, there is no consensus on the best surgical approach in hip replacement for femoral neck fractures (FNFs). AIM: The aim of this study is to compare the direct anterior approach (DAA) and the direct lateral approach (DLA) in patients treated with bipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA) for FNFs. MATERIALS AND METHODS: Patients with displaced FNFs (Garden type III and IV) treated operatively using BHA and THA were enrolled. The surgical approach techniques DAA and DLA are compared. The analysed variables are: mean surgery time, number of blood units transfused perioperatively, percentage of patients transfused, perioperative complications, pain and functional outcomes at 1 and 6 months and mortality at 1, 3 and 12 months. RESULTS: Between 2015 and 2017, 37 patients underwent BHA by the DAA and 38 patients underwent BHA by the DLA, 69 patients underwent THA by the DAA and 60 patients underwent THA by the DLA. For THA, the DAA compared to the DLA had a higher mean surgery time (100.8 min vs. 97.7 min), a lower mean number of blood units transfused perioperatively (1.4 U vs. 1.9 U), a significantly lower percentage of patients transfused (53.6% vs. 71.7%), a higher rate of perioperative complications (10.1% vs. 1.6%), a lower pain referred and better functional outcomes in the first 6 postoperative months and a significantly lower mortality rate at 12 months (2.9% vs. 16.7%). For BHA, the advantages of the DAA over DLA are not as significant. CONCLUSIONS: The direct anterior approach in THA for FNFs provides significant benefits in the early post-operative period compared to the direct lateral approach in terms of functional recovery, residual pain, blood loss and mortality rate in the elderly active population. LEVEL OF EVIDENCE: Level IV, retrospective cohort study.

External fixation can be an option for proximal humerus fractures Neer 3-4.

BACKGROUND: Proximal humeral fractures (PHF) account for 4-6% of all fractures and 25% of humeral fractures. While conservative treatment is the gold standard for simple fractures, there is no consensus about the best treatment choice for complex PHF in the elderly. Recently a new external fixator was introduced in clinical practice for treatment of complex PHF.  Aim of the study was to evaluate the functional results of this therapeutic approach. METHODS: Data were retrospectively analyzed. Inclusion criteria were: three- and four- parts PHF according to Neer, treatment with closed reduction and external fixation, normal Abbreviated Mini Mental Test score, independence in the daily living, non-pathological fracture, glenohumeral joint with moderate osteoarthritic changes and availability of clinical and radiological follow-up. For each patient demographic data, comorbidities, surgery time and estimated blood loss were recorded. Clinical and radiological evaluation were performed at 1, 2, 6, 12 months. RESULTS: 17 patients were enrolled. Mean age was 69.7 years. Fractures were classified according to Neer as type III in 10 cases and type IV in 7 cases. The mean operating time was 22 minutes. Mean Constant score value at follow up was 74 ±11,52 at 2 months, 82 ± 11,16 at 6 months and 85 ± 9,86 at 12 months. CONCLUSION: These preliminary results show that the studied system is easy to use, minimally invasive, effective in reducing surgical and hospitalization time. The results in terms of functional recovery are encouraging, showing a reduced number of complications.

Triradiate cartilage fracture of the acetabulum treated surgically.

Fractures of the acetabulum are rare in the pediatric age and may be complicated by the premature closure of the triradiate cartilage. We report a case of triradiate cartilage displaced fracture treated surgically. A 14 years old boy, following a high-energy road trauma, presented an hematoma in the right gluteal region with severe pain. According to radiographic Judet's projections was highlighted a diastasis of the right acetabular triradiate cartilage.  CT scan study with 2D-3D reconstructions confirmed as type 1 Salter-Harris epiphyseal fracture. Due to the huge diastasis of the triradiate cartilage, the patient was operated after 72 hours through a plating osteosynthesis. We decided during the preoperative study that the plates should not be removed. Two years after surgery, the patient is clinically asymptomatic; the radiographic evaluation shows a complete cartilage's fusion and the right acetabulum is perfectly symmetrical to the contralateral. For the treatment of acetabular fractures in pediatric age should be carefully evaluated fracture's pattern, patient's age, skeletal maturity's grade, acetabulum's volume and diameter.