Fractures and dislocations of the lisfranc tarso-metatarsal articulation: outcome related to timing and choice of treatment.

A Lisfranc injury is when one or more of the metatarsals are displaced from the tarsus. The term is more commonly used to describe an injury to the midfoot, centred on the 2nd tarso-metatarsal joint. These fractures are sometimes easily overlooked, especially if they are part of a polytrauma. They are often difficult to diagnose and treat, but if they go undetected and are not properly treated, they can cause long-term or chronic disability. Our team reviewed a group of 71 patients with a Lisfranc fracture dislocation. The lesions were classified according to Meyerson classification. All the patients were re-evaluated 3 years after their surgeries by clinical examination, Ankle-Hindfoot Scale AOFAS questionnaire, X-rays and baropodometric analysis. This review outlines the treatment outcome of this injury, taking into consideration the timing of diagnosis.

Choice of three different intramedullary nails in the treatment of trochanteric fractures: Outcome, analysis and consideration in midterm.

The purpose of this study is to compare the results obtained using three different systems of osteosynthesis, developed for the surgical treatment of fractures of the trochanteric region of the femur, based on the principle intramedullary nailing: the Gamma nail, the Affixus nail and the ZNN nail. This is a retrospective study: 72 trochanteric fractures treated with the Gamma nail, 68 treated with the Affixus nail and 69 treated with the ZNN nail, between the years 2012 and 2014, with the prerequisite of a minimum follow-up of 18 months. The fractures were classified according to the AO system; the most commonly reported subtype was the A2 fracture. Clinical and radiographic examinations were performed, both at hospital admission and post-operatively, at 1, 3, 6, 12 and 18 months. Of the 209 patients, 171 were women and 38 were men. The average age was 83.12 years old. All three systems guaranteed an early mobilization and ambulation in most of the patients. There were no significant differences in the use of the three nails in terms of recovery of previous functional capacity, or in terms of the time required for the fracture to heal. There were no advantages encountered with the use of one intramedullary nail over another and, in particular, when observing the complications and patient outcome, there were no statistically significant differences detected.

Bilateral posterior fracture-dislocation of the shoulder after epileptic seizure.

We present a case of a 61 year-old woman who suffered a bilateral posterior fracture-dislocation of the shoulder after an isolated episode of epileptic seizure. The patient was diagnosed at our Emergency department with x-rays and CT scans after being found unconscious. An indication for bilateral shoulder hemiprosthesis implant was initially given. However, given the peculiar pattern of the fracture, the hemiprosthesis was implanted on one side only, while the other side was treated with ORIF with four cannulated screws. After the one year, the patient had resumed her previous activities and had no complaints. We performed a review of similar cases in literature and provided a rationale for our choice of treatment and the reasons for its success.

Achilles Tendon Open Surgical Treatment With Platelet-Rich Fibrin Matrix Augmentation: Biomechanical Evaluation.

The relationship between surgical technique and ankle biomechanical properties after surgery for acute rupture of the Achilles tendon (ATR) has not yet been fully investigated. Platelet-rich fibrin (PRF) matrices seem to play a central role in the complex processes of tendon healing. Our aim was to analyze the biomechanical characteristics, stiffness, and mechanical work of the ankle during walking in patients who had undergone surgery after ATR with and without PRF augmentation. We performed a retrospective review of all consecutive patients who had been treated with surgical repair after ATR. Of the 20 male subjects enrolled, 9 (45%) had undergone conventional open repair of the Achilles tendon using the Krackow technique (no-PRF) and 11 (55%) had undergone surgery with PRF augmentation. An additional 8 healthy subjects were included as a control group. A gait analysis evaluation was performed at 6 months after surgery. The percentage of the stance time of the operated leg, double-support time of the healthy leg, and net work of the ankle during the gait cycle showed statistically significant differences between the no-PRF and the healthy group (p < .005). No differences were found between the PRF and healthy groups. Treatment with suture and PRF augmentation could result in significant functional improvements in term of efficiency of motion.

Lateral wedge osteotomy for pediatric post-traumatic cubitus varus: Kirschner-wires or locking angular plate?

This study aimed to evaluate and compare two types of internal fixation, locking angular plate (group 1) and Kirschner-wires (group 2), for post-traumatic cubitus varus. The parameters used were Laupattarakasem's criteria (for range of motion in extension/flexion, correction of carrying angle, and the 'lazy S' deformity) and the Barrett's questionnaire (for patient satisfaction). In group I (plate+screws), we had three excellent results and five good. In group II (Kirschner-wires), we had two good results, three fair, and two poor. Statistical analysis showed a better outcome for group I (plate+screws) considering the correction of the humeral-elbow-wrist angle (P<0.003), the postoperative lateral prominence index (P<0.048), and the patient satisfaction (P<0.011). We recommend the locking angular plate, because it can rigidly stabilize the osteotomy, ensuring an excellent functional and cosmetic outcome.

Stage-related results in treatment of hip osteonecrosis with core-decompression and autologous mesenchymal stem cells.

Our aim is to analyse the clinical outcome of a series of patients affected by avascular necrosis of the femoral head and treated with core-decompression technique and autologous stromal cells of the bone marrow.We enrolled in our study 29 patients with 31 hips in total affected by avascular necrosis of the femoral head. The clinical and radiological outcome has been assessed through self-administered questionnaires (HHS, VAS and SF12) X-ray and Magnetic Resonance.Of all the examined hips, 25 showed a relief of the symptoms and a resolution of the osteonecrosis, 11 of these were at Stage I and 14 at Stage II. The progression of the disease occurred in 6 hips (2 Stage II, 2 Stage III and 2 Stage IV). Our results show a significant decrease in joint pain level and a success in avoiding or delaying the need of hip replacement in early stages of osteonecrosis.

Italian version of University of California at Los Angeles (UCLA) Activity Score: cross-cultural adaptation.

Over the last 10 years, patient-oriented evaluations using questionnaires have become an important aspect of clinical outcome studies. Any questionnaire must be translated and culturally adapted in order to be used with different language groups, and the translated version must then be evaluated for reliability, validity and responsiveness which are fundamental attributes of any measurement tool. The aim of this study is the validation, translation and cross-cultural adaptation of the Italian version of UCLA activity Score, following the Guillemin criteria. The results show that our Italian version of the UCLA score has the following: reproducibility expressed as ICC=0.994, an internal consistency calculated as Spearman-Brown coefficient=0.754 and finally the construct validity has demonstrated a significant Pearson's correlation coefficient with other validated hip questionnaires.

Risk analysis in tibial plateau fractures: association between severity, treatment and clinical outcome.

Our retrospective study analyzes efficacy of treatment techniques we used for the reduction of tibial plateau fracture. A sample of 67 individuals is evaluated, 50 males and 17 females, and treated for a tibial plateau fracture from December 2003 to June 2008. The mean age is 46 (range 22-72). 35 patients were treated with cannulated screws alone, 21 were treated with plates alone, and 11 were treated with both plates and bone substitutes. All patients were clinically and radiographically followed up for an average time of 36.4 months (SD = 17.4; range 24-72). Data about patients sourced from the analysis of SF36, WOMAC and the Rasmussen score. Patients were divided into 4 groups and 2 subgroups, according to the synthesis method used and the severity of the fracture. The control group includes the patients diagnosed with a low-energy fracture treated with screws alone. The median of the total score of Rasmussen functional grading system resulted to be equal to 26; compared with the control group, there is strong relationship between the use of plates alone and the risk of obtaining a clinically less effective result (O.R. = 5.48; p = 0.003) even more when comparing Schatzker type IV, V, and VI (O.R. = 13; p = 0.0073). Radiographic evaluation shows less efficacy of bone substitute to reduce articular step-off. With regard to the SF36, patients treated with plate alone have been awarded the lowest score. The treatment of the most severe fractures of tibial plateau by means of internal fixation with plates can be improved with the use of bone substitutes.

Adequacy of treatment, bone remodeling, and clinical outcome in pediatric supracondylar humeral fractures.

The aim of this study was to evaluate and compare, both clinically and roentgenographically, 62 extension-type supracondylar fractures on the basis of the synthesis method and severity of the fracture, with a mean follow-up of 4 years and 3 months. Range of motion, axial alignment of the elbow, muscle strength, and joint stability were estimated and the Mayo Elbow Performance Index and the Pediatric Orthopaedic Society of North America Pediatric Outcomes Data Collection Instrument questionnaire were used. Furthermore, we took radiographic measurements (Baumann's angle, humero-capitellar angle, and lateral rotational percentage). According to Flynn criteria, the clinical outcome of all our patients was satisfactory. According to the results of the questionnaires, no patients has reported any disabling limitation of the elbow function. Radiographic study proved a greater capacity of remodeling in the sagittal plane compared with the frontal one, irrespective of severity of fracture assessed by the Gartland classification. Statistical analysis stressed the validity of postoperative Baumann's angle as a predictor of final carrying angle. With regard to the synthesis method, the best way to approach Gartland II fractures proved to be by closed reduction and percutaneous pinning; the use of a third Kirschner wire in the treatment of Gartland III fractures did not lead to a better result. To conclude, remodeling positively influenced the clinical outcome, however, irrespective of synthesis method and severity of the fracture, we should pay more attention to the adequacy of reduction in frontal plane than in the sagittal one, for which a greater capacity of remodeling was proved.