Outcomes of surgical treatment of the tibial tuberosity fractures in skeletally immature patients: an update.

Tibial tubercle fractures in adolescents are uncommon injuries which typically occur in 12-16 year-old males involved in athletic activities. We hereby present our experience in the surgical treatment of such lesion. By reviewing all the tibial tuberosity fractures treated surgically at our institution between January 2012 and January 2016, we were able to identify 12 patients (14 fractures), of which 11 males and 1 female, whose average age at the time of the trauma was of 14.05. According to the Ogden classification, we identified two Type IIA fractures, one Type IIB fracture, one Type IIIB fracture, four Type IIIC fractures, four Type IVA fractures, one Type IVB fracture and one Type IVC fracture. All patients underwent surgical treatment-9 fractures ORIF (64.3%), 5 CRIF (35.7%)-and postsurgical immobilization in plaster cast for 15 days, with a non-weight bearing period of approximately 4.7 weeks. They all had a complete ROM recovery and returned to preinjury activities within 4.1 months on average. The successful union of the fracture was observed in all patients, and no cases of meniscal lesions, compartment syndrome, infections, lower limb length discrepancy or axial deviations emerged at the minimum follow-up of 24 months. After an average period of 11 months and 2 weeks (range 6.1-16.3), all patients underwent surgical implant removal. Our experience matches the outcomes described in the literature, therefore confirming the safety and effectiveness of this treatment.

Treatment of complete ankylosed elbow with total arthroplasty.

We reported the case of a 38-year-old patient who in 2017 presented to our institution after post-traumatic complete ankylosis of the elbow. He complained of stiffness and pain, and the radiographs revealed complete fusion of the humeroulnar joint. The Mayo Elbow Performance Score (MEPS) on admission was 31, and the elbow was fused at 90° flexed position. The patient underwent semiconstrained total elbow arthroplasty with Bryan-Morrey approach; after a 2.1 years follow-up, active arc of movement was 120°. The MEPS was excellent with a 100 points score, the patient was able to complete all activities of daily living. We did not report any complications. Total elbow arthroplasty has shown to be a good therapeutic option that make it possible to restore adequate functional range of motion and relieve pain in young patients with post-traumatic stiffness/arthritis of the elbow.