Reverdin-Isham osteotomy versus Endolog system for correction of moderate hallux valgus deformity: a Randomized Controlled Trial.

OBJECTIVES: Several procedures have been described for the management of hallux valgus deformity. In this paper we would like to compare our experiences with two techniques (Endolog system and Reverdin-Isham osteotomy) with a randomized study. To our knowledge, this is the first study to be reported in the literature, that provides a detailed comparison of these two techniques to treat moderate hallux valgus. MATERIALS AND METHODS: A total of 40 consecutive patients (40 feet) with moderate symptomatic hallux valgus were randomly assigned into two groups, to compare the results of Reverdin-Isham osteotomy (group A,20 feet) and Endolog system (group B, 20 feet). RESULTS: The average follow-up was of 23.7 ±7.7months . The average correction of HVA and IMA achieved in group A was 17.1° ±6.2° and 5.2° ±2.6° respectively, while in group B, it was 14°±6.2° and 7.7°±2.6° respectively. The mean AOFAS score improved from a pre-operative of 40.5 ±15.5 points to 90.3 ±5.3 points in group A, and from 32.4 ±16.8 points to 89.2 ±10.5 in group B. CONCLUSIONS: No statistically significant differences were detected between the two groups with respect to the AOFAS score, HVA, and IMA. Both groups showed good to excellent results.

[Surgical treatment of osteochondromas: indication in "Strategic Exostosis"]. / Indicazioni al trattamento chirurgico degli osteocondromi: "Esostosi strategica".

OBJECTIVE: The osteochondromas represents is the most frequent benign lesion interesting the bone tissue. This lesion, often asymptomatic, can arise through mechanical, irritative or painful syndromes: "strategic exostosis". MATERIALS AND METHODS: In our present study we retrospectively evaluated 65 Caucasian patients, which have been treated surgically for symptomatic solitary exostosis from March 2004 to Jan 2011. The most frequent symptom referred by patient has been represented by pain. The others complains were related to nervous compression, esthetic injury and a reduction of range of motion. By using the VAS score we evaluated the post-operative bone pain at 3, 12 and 24 months. At the end of follow up we evaluated by a validated questionnaire the grade of patient satisfaction. RESULTS: No major surgical complication were found. The rate of disease recidivism was null. Only a small group of patient referred a persisting pain in the lesion area during the two years follow up. In this subgroup the rate of satisfaction was obviously reduced. CONCLUSIONS: In our opinion the surgical treatment of strategic exostosis, is safe and it should be recommended, since it allows to eliminate the noise with a low incidence of complications. The large majority of out patients were satisfied of the clinical improvement they experienced.

[The management of post-surgical pain in the patient treated for hallux valgus with percutaneous and minimally invasive technique]. / La gestione del dolore postchirurgico nel paziente trattato per alluce valgo con tecnica mini invasiva e percutanea.

OBJECTIVE: In today's literature there are no defined guidelines for the treatment of postoperative pain in corrective surgery of hallux valgus. In this study we evaluated the use of a new treatment protocol designed to minimize the postoperative pain related to the surgical treatment of hallux valgus. MATERIALS AND METHODS: The study involved 20 female patients (20 feet) treated for moderate to severe hallux valgus between September 2011 and December of 2012 with a percutaneous technique (10 feet) and minimally invasive surgery (Endolog System) (10 feet). All patients received postoperative as analgesic therapy 1 cp etoricoxib 120 mg/ day for 5 days + oxycodone hydrochloride/naloxone 5mg 1cp × 2/day for 15 days. The evaluation forms of pain VAS/VRS have been used for the evaluation of pre and postoperative pain at 15 and 30 days. RESULTS: In both groups we found a significant reduction of pain in the days following surgery. At 30 days the VAS score was similar in between the two groups. Few and mild side effects were reported (1 case). CONCLUSIONS: The co-administration of an anti-cox2 and an opioid in the first postoperative hours is useful to reduce soft tissue swelling and to control pain without causing significant side effects. The therapeutic protocol adopted, along with an adequate anesthesiological approach, has proved to be very effective for pain management in peri-and post-operative treatment of hallux valgus.

[Prosthetic hip revision: relationship between bone stock and quality of life in aseptic loosening of the femoral component]. / Revisione protesica dell'anca: rapporto tra bone stock equalità della vita nelle mobilizzazioni asettiche dellacomponente femorale.

OBJECTIVES: We evaluated the clinical and radiographic results in the medium and long term in patients undergoing revision surgery for aseptic loosening with different bone quality at the time of the operation. We investigated how different bone quality shapes for a good clinical result. MATERIALS AND METHODS: A total of 33 patients who underwent revision surgery of the hip (for aseptic loosening of the stem) evaluated radiographically and clinically at 1,6,12 and 18 months. The evaluation of clinical status preoperatively and at the end of follow-up was be made as questionnaires SF-36, Harris Hip Score and WOMAC; radiographic assessment was made using the scale of Paprosky. The data thus obtained have been related to complications arising and the status of femoral bone-loss before the surgery time. RESULTS: The groups PI and PII (Paprosky) showed a high level of satisfaction with an average value of reference for the postoperative rated as excellent, the absence of complications and good functional recovery at the end of follow-up. The groups PIII and PIV showed increased incidence of complications and difficulties with rehabilitation clinics and SF-36 scores and HHS inferior to other classes. CONCLUSIONS: Our dates confirm that bone quality at the time of surgery affects the therapeutic target. All patients with good bone quality at the time of the revision surgery (groups PI and PII) showed a distinct advantage from surgical treatment. Revision surgery had not much effect in patients with high bone loss. Preservation of bone stock should be considered a good foundation for the success of a prosthetic reimplantation with better functional and radiographic out-come associated with greater satisfaction for the patient.

[Proximal femur fractures in elderly patients: the influence of comorbidity on prognosis in the short, medium and long term]. / Fratture del femore prossimale nel paziente anziano: influenza delle comorbilità sulla prognosi a breve, medio e lungo termine.

INTRODUCTION: Our study aims to assess post-intervention and pre-operative mortality in patients admitted to our institute diagnosed with a fractured proximal femur. The influence of comorbidity on prognosis in the short (1 month), medium (3 month) and long term (6 month) was assessed between July 2006 and July 2009. MATERIALS AND METHODS: The 238 patients (85 men and 153 women), between 65- and 99-year-old, were followed-up as outpatients and by telephone for 1 year to monitor the state of persistence in life or eventually the date of death. The comorbidity parameters considered were: sex, age, ASA class of anesthetic risk, fracture location and type of surgical treatment used, the number of previous associated diseases and the presence/absence of cognitive impairment on admission. RESULTS: The data obtained, in comparison with that of the general population in the Lazio region (ISTAT table), showed. Higher mortality rate in men than women, high mortality rate for patients with cognitive impairment at admission (50%), mortality over twice as high in patients belonging to ASA classes III and IV than in patients belonging to the lower categories. By observing the time between surgery and death it was also evident that the first 6-month period was the most critical; furthermore, 45.45% of deaths occurred within the first 60 days. CONCLUSIONS: Identifying the causes that influence the mortality of our patients and being able to quantify the relevance in subsequent death enables us to improve the care for the risk, strengthen the therapeutic choices based on new evidence, and especially lay the groundwork for the development of new treatment protocols, useful for clinical and forensing decision-making.

Rehabitation of allograft with bone dehydrated with solvents in reconstruction after removal of bone tumors: MRI evaluation.

It was the purpose of this study to analyze the behavior of Tutoplast bone allograf to fill cavities produced by the removal of benigning bone tumors of those with local malignancy. X-ray and MR images obtained during follow-up demonstrated an increase in the signal in all of the sequences within the graft, indicating complete rehabitation of the grafted area.

The conservative treatment of xanthoma of the Achilles tendon in patients affected with type IIA hypercholesterolemia.

Treatment of xanthoma of the Achilles tendon has up until the present been based on partial or total surgical resection of the affected tendon. Because of the different results of surgical treatment our study was aimed at using clinical and ultrasound data to reveal the effectiveness of hypocholesteremic medical therapy in 39 cases of tendinous xanthoma.