Mini-invasive anterior approach in total hip arthroplasty: short-term follow-up.

PURPOSE: To evaluate short-term follow-up of patients treated with total hip arthroplasty through minimally invasive anterior approach. METHODS: Twenty-four patients, surgically treated with this approach from January 2010 to December 2010. We measured the blood loss, the number of transfusions, the time of surgery, the length of hospital stay and intra and postoperative complications. All patients were clinically evaluated by Womac and Harris Hip Score 12 months after surgery. Radiographic views were performed postoperatively and at 1, 3 and 12 months after surgery in order to evaluate component positioning. RESULTS: The mean value of total blood loss was 1050 ml, the number of transfusions after surgery was on average 0.85. The mean time of surgery was 111 minutes. The mean hospital stay was 6.5 days. The radiographic views showed a correct component placement. We didn't encounter any complication and the mean score of Womac and Harris Hip Score was satisfactory in all cases. CONCLUSIONS: Minimally invasive anterior approach provides good short-term results. However, long-term studies are needed to confirm this evaluation.

Can the osteosynthesis with locking plates be a better treatment for unstable fractures of the proximal humerus?

PURPOSE: The purpose of this study is to review our experience with proximal humeral locking plates, including complications, functional outcomes, strength recovery and predictors of successful treatment. METHODS: Seventy unstable proximal humeral fractures were treated with open reduction internal fixation (ORIF) with the use of locking proximal humerus plate. At an average follow-up of 31 months, the clinical and subjective outcomes were evaluated, and complication was analysed. RESULTS: The average Constant score was 72. The mean disabilities of the arm, shoulder and hand score was 23. The average range of motion was as follows: mean range of anterior elevation and abduction 120°-150°; external rotation in abduction 64° and in adduction 44°; and internal rotation T12. CONCLUSION: On the basis of the overall functional and clinical outcome obtained, it is possible to suggest that the ORIF of the proximal humerus fractures using locking plate represents a helpful option that can lead to a good clinical and functional outcome even in the most complex fractures.

Seidel locked nailing for the treatment of unstable fractures and nonunion of the humerus.

The results of treatment by Seidel locked nailing in 13 recent fractures and 4 nonunions of the humerus are reported. The feature common to all of the fractures was instability consequent to comminution or in the site of the fracture center. The 4 nonunions were originally fractures synthesized by Rush intramedullary nailing. The surgical method used an entry approximately 1 cm from the greater tuberosity through a well-vascularized area of the rotator cuff. All of the cases achieved consolidation and in 70% of the patients results were excellent with complete recovery of range of movement of the shoulder. Thus, the Seidel nail appears to be an intramedullary means of synthesis particularly suited to the treatment of unstable fractures and nonunion of the humerus because it guarantees stability, especially in rotation, superior to any other intramedullary means of synthesis.

The Wagner prosthesis for femoral reconstruction by transfemoral approach.

The authors report their experience at the Orthopaedic Clinic of the University of Parma regarding 20 cases of revision surgery by transfemoral approach using the Wagner long-stem cementless prosthesis for the treatment of prosthetic failure. The authors observed that in 19 cases out of 20 after at least 2 years there was stability of the implant and progressive skeletal reconstruction of the femoral metadiaphysis.

Multifocal fractures of the femur.

Multifocal fractures of the femur in modern traumatology are becoming more and more frequent and often pose difficult problems of treatment. In view of the sparse contributions on this subject in the literature, we analysed our series of 33 cases with a view to formulating our conclusions as to the best type of treatment. Because of the varied associations of different types of fracture in a single skeletal segment, there is no single method of synthesis applicable to all cases. The various means of synthesis at our disposal (Küntscher nail, Grosse Kempf blocked nail, Ender nail, AO plates and screws, external fixators) should be selected depending on the individual case, respecting the concept of closed surgery as much as possible. This requires imagination as well as experience.

The treatment of tibial fractures by elastic nailing and functional plaster cast.

From June 1984 to December 1985, 32 fractures of the tibia were treated by elastic nailing by the Ender method with functional plaster casts according to the Sarmiento method. They represented 28% of all tibial fractures treated during the same period by the traditional conservative method or by external fixators. Elastic nailing was reserved for unstable fractures produced by high velocity trauma. Union occurred in all cases after an average of 13 weeks. Complications were insignificant: shortening by 1.2 cm (1 case); recurvatum (1 case); varus (1 case); valgus (1 case), both less than 8 degrees, and thus within functionally insignificant limits for axial deviation. In one case, a 15 degree internal rotation deformity was corrected after 5 weeks by osteoclasis and fresh elastic nailing which also healed. The advantages of this type of treatment are rapid union and no pseudarthrosis or infection.

Plate and screw fixation by autogenous corticocancellous grafts in comminuted fractures of the femur.

The authors present the results of 25 recent cases of comminuted fractures of the femoral shaft treated by internal plate fixation supplemented by autogenous cortico-cancellous grafts. These were cases in which intramedullary nailing was not practicable and simple plate fixation was deemed to carry a high risk of failure. The results were excellent in all cases, with no complications such as failure of the fixation or pseudoarthrosis. This study confirms the validity in such cases of supplementing rigid internal fixation with autogenous cortico-cancellous grafts as a primary procedure in such high risk cases.

Osteosynthesis with valgus osteotomy in the primary treatment of subcapital fractures of the neck of the femur.

The authors report 25 consecutive cases of subcapital fracture of the neck of the femur treated by osteosynthesis and valgus osteotomy. The results at 3 to 5 years showed bony union in all cases with only 2 cases of ischaemic necrosis (8%). Since this complication is due to vascular damage inflicted at the time of fracture the authors suggest that valgus osteotomy, which is usually only done in cases of pseudarthrosis, is also applicable to recent fractures which have a high risk of non-union.

[Continuous closed aspiration lavage in the prevention and treatment of bone infections]. / Ii lavaggio aspirazione continua chiuso nella profilassi e nel trattamento delle infezioni ossee.

The Authors report their experience on bone infection treatment by means of closed circulation and suction. After a brief history of the informing and applying principles of the method, they expose the results obtained in 41 cases of septic lesions of the skeletal system. Since the patients were treated about 6 years ago, it is therefore possible state the reliability and effectiveness of this therapy. thirty-one (31) exposed fractures, six (6) osteomyelitis and four (4) infected pseudoarthrosis are considered, with a positive result respectively in 87%, 84% and 75% of cases. Considering the initial gravity and the reasons of failure, the Authors conclude that the method, always associated to other surgical acts, is efficacious and finds a precise and precious collocation in the therapeutic outfit.

[Juvenile kyphosis]. / Le cifosi giovanili.

The Authors discuss the juvenile kyphosis, a relatively frequent but neglected pathology. They consider the two significant clinical pictures: postural kyphosis and Scheuermann disease with their clinical, radiographic and therapeutic aspects. In the first entity repeated controls, a correct bearing, physical training and sport are necessary. In the second the treatment is based on physiokinesitherapy and a modified Milwaukee brace for an average time of 21 months. Are considered in this paper 64 cases of Scheuermann disease treated between 1977 and 1982 by the Orthopedic Clinic of the University of Parma, with relative results, classified as positive.

Chronic lumbar pain due to a localised posterior osteophytic bar.

The authors present 6 cases of chronic lumbar pain with sciatic radiation in young subjects caused by an osteophytic bar at a single level, and associated with disc degeneration at that level. The differentiation of this special syndrome demands special methods of radiological investigation, which are discussed. All the cases were in males engaged in heavy work. Surgical treatment, which necessitates removal of the bar as well as the degenerated disc material, gave excellent results.

[The Guyon's tunnel syndrome (author's transl)]. / La sindrome del canale di Guyon

The Authors present two cases of compression of the ulnar nerve at the level of the Guyon's tunnel with a peculiar etiology. In fact, in the first patient the compression was caused by dilatation of veins accompaning the nerve and in the second case by the hypertrophic "piso hamata" ligament. The Authors also take the opportunity of making some pathogenetic and someiotic considerations this syndrome.

[The physiotherapic aspect of omeral epicondilitis (author's transl)]. / La terapia fisica nell'epicondilite omerale

The Authors describe history, etiopatogenesis, clinic, therapy of omeral epicondilitis, very frequent affection. Physiotherapic aspects are studied by different methods. The indications are different compared to clinical aspect, pain modality, relapse eventuality. They conclude with personal considerations based on what observed in Orthopedic Clinica of Parma University.

[Isolated fracture of the transverse apophysis of the 1st dorsal vertebra]. / Frattura isolata dell'apofisi trasversa della prima vertebra dorsale

The Authors describe a case of isolated fracture of first dorsal left transvers apophysis observed in Orthopaedic Clinic of Parma University. It's an exceptional lesion: infact till now only six cases of this type of lesion are been presented in orthopaedic literature.

[Surgical leg lengthening]. / Sull'allungamento chirurgico di gamba

The operative lengthening of tibia and fibula. After a brief bibliographical survey of the principal method adopted in the operative lengthening of tibia and fibula, the Authors consider the risk and complications involved in this operation. They then examine the case histories of patients operated during the period 1969 1973 and discuss the data, the limitations of the operation and the results obtained.

[Fibrous dysplasia of bone]. / Osteodisplasia fibrosa

At hand of 5 clinical and pathological observations, the Authors report on the main features of fibrous Bone Dysplasia. Roentgenological and histological appearances are illustred. In some polyostotic and roentgenologically atypical forms the diagnosis must be histologically confirmed. As for the surgical treatment the Authors state that the result depends considerably on the patient's age.