RESUMO
Osteoporosis and fragility fractures (FFs) are considered critical health problems by the World Health Organization (WHO) because of high morbidity, mortality, and healthcare costs. The occurrence of a FF raises the risk of a subsequent fracture (refracture). The hip is the most common site of fragility refracture, and its onset is associated with a further increase in patient's morbidity, mortality, and socioeconomic burden. Therefore, the prevention of refracture is essential. In this context, fracture liaison service (FLS) demonstrated to be able to reduce FF risk and also improve patients' adherence to anti-osteoporotic treatments, particularly for bisphosphonates (BPs). However, long-term and high adherence to BPs may lead to atypical femoral fractures (AFFs). These latter are tensile side stress fractures of the femur, with high rates of complications, including delayed and non-healing. An effective FLS should be able to prevent both FF and AFF. A comprehensive and interdisciplinary approach, through the involvement and education of a dedicated team of healthcare professionals (i.e. orthopedic, geriatrician, primary care physician, rehabilitation team, and bone nurse) for evaluating both FF and AFF risks might be useful to improve the standard of care.
RESUMO
BACKGROUND: Metallosis is the result of metallic wear debris in the soft tissues and is associated to both local and systemic inflammatory response. Metallosis has been reported after total hip and total knee arthroplasty (TKA), but rarely after a unicompartimental knee arthroplasty (UKA). In the context of UKA metallosis, surgeons often opt for revision using a TKA. However, in this paper, the authors successfully treated UKA revising the metal back only. CASE SUMMARY: Prior to treat our patient we conducted a literature research through which we identified eleven cases of metallosis after UKA, ten (90.9%) were treated revising using though a TKA. Only one case was managed through a uni-on-uni revision, reporting high knee function. Our patient complained worsening pain and function after a snap occurred at 16 mo after UKA implantation. At 18 mo following surgical debridment and uni-on-uni revision surgery, our patient exhibited a relevant improvement in Oxford Knee Score and a reduction of metal ion levels in the blood. CONCLUSION: Our study highlights that in case of metallosis after UKA, the treatment may be based on surgical debridement and just revising the mobilized components.
RESUMO
Background: IM nails are the gold standard of subtrochanteric fractures management. Indications to use a short rather than a long nail remain unclear. Operative complications of subtrochanteric fractures reach up to 25%. Objective: Retrospectively compare clinical and radiographic outcome of subtrochanteric fractures treated by long and short intramedullary nailing, analysing rates of complications. Methods: 390 patients were chosen from the archives. 194 patients were available: 70 treated with a short intramedullary nail (Group A), while 124 with long one (Group B). Radiographic evaluation at 6 and 12 months assess failure of the osteosynthesis. Clinical outcomes were the return to normal activities prior trauma and VAS scale. Group A mean age was 81.37 years, group B mean age was 78.9 years (29-99, SD: 15.38). Results: Radiografic Healing was found in 66 patients (94.28%) in group A, while in 116 patients (94.54%) in group B. Pseudarthrosis was found in 4 cases (5.71%) in group A, while in 8 cases (6.45%) in group B. Implant failure occurred in 5 cases: one required revision of fixation, while 4 require hip replacement. 59 patients of group A (84.29%) returned to social life, while 102 patients (81.94%) in group B. Group A mean VAS was 1.55, Group B mean VAS was 1.49. Conclusion: Comparison of the two group showed no differences. Complication percentages are in line with literature. Optimal reduction and fixation allow high percentage of healing and return to social life.
