Infiltrative Therapy of Morton's Neuroma.

The aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone infiltrative therapy for treatment of Morton's neuroma. As many kinds of substances are injected, the main outcome defines which treatment provides the best results in term of patient's satisfaction and pain relief, so that it would be possible to choose the best option. Many electronic databases were searched on July 2021; we have included prospective and retrospective case series, and randomized controlled trials of infiltrative treatments in patients with primary diagnosis of Morton's neuroma. The search returned 25 studies which met the inclusion criteria, with a total of 2243 cases. The incidence of outcomes was extracted and analyzed. Although many studies demonstrated favorable results in terms of pain relief and patient's satisfaction employing different substances for infiltration, alcohol injection appears results on long run.

Periprosthetic fractures of the proximal femur within first year of the index hip prosthesis.

INTRODUCTION: Periprosthetic fractures are a serious complication of implants prosthetic. The aim of this review is to analyze incidence and predisposing factors of periprosthetic fractures of the proximal femur within first year of the index hip prosthesis. MATERIALS AND METHODS: Between 1998 and 2017 we have performed 4240 hip replacements (F 2661, M 1579): 2877 total hip arthroplasties (67,9%) and 1363 hemiartrhoplasties (32,1%). Hip replacements with cemented stem were 2173 (51,2%), while cementless ones were 2067 (48,8%). In the same period we admitted 121 hip periprosthetic fractures, 26 of which (0,6%) within the first year of the index surgery. We examined the medical and radiographic records of this last cohort of patients (F 19, M 7) following the Vancouver System, Dorr Classification and Stem Size Index. RESULTS: The cause was a low-energy trauma in 25 cases (96.1%); the primary diagnosis was hip fracture in 20 patients (76.9%); 8 patients were taking chronic osteoporosis medication (30.7%); 14 patients were affected by neuropsychiatric disease (53.8%); cementless stems were found in 18 cases, 12 of which were oversized (SSI < 0,8). According to Vancouver System, fractures were classified as follows: 10 type B1, 14 type B2 and 2 type C. As far as the proximal femoral shape, 2 cases were Dorr type A, 7 Dorr type B and 17 Dorr type C. CONCLUSIONS: The incidence of periprosthetic fractures in the aftermath of stem implant is twice as high with uncemented stems. The Vancouver type B1/B2 is the most common. Predisposing factors are: female sex, hip fracture, chronic osteoporosis medication, neuropsychiatric disease and oversized uncemented stem (SSI < 0.8).The evidence level is IV.

The Painful Hip in Young Adults Between Impingement and Mild Dysplasia: Clinical and Instrumental Diagnostical Criteria.

Femoroacetabular impingement and developmental dysplasia of the hip are among the main causes of hip arthritis. In absence of degenerative alterations of the hip, there is the chance of a surgical conservative treatment. This study aims to show the clinical and imaging criteria to a correct and prompt diagnosis.

Incomplete, stable-like, peri-prosthetic Vancouver B fracture around an ha-coated stem. Is there a case for strategic thoughtful neglect?

The Periprosthetic fracture of the proximal femur is usually treated by internal fixation of the fracture or revision of the femoral stem depending on the characteristics of the fracture and stability of the implant. This case report shows an early periprosthetic fracture around an uncemented straight stem which is treated conservatively with an excellent clinical radiographic result and explains the biomechanics related to this non-operative choice. A conservative treatment of periprosthetic fracture is possible but only after a careful analysis of the fracture pattern, the characteristics of the prosthetic stem and the time elapsed from implanting the prosthesis to the fracture.

Vancouver B2 periprosthetic femoral fractures: a comparative study of stem revision versus internal fixation with plate.

INTRODUCTION: The aim is to compare stem revision versus internal fixation with plate in the treatment of Vancouver B2 periprosthetic femoral fractures. MATERIALS AND METHODS: This is a retrospective review of 34 consecutive patients admitted from June 1998 to May 2017. One patient was treated conservatively, 11 with stem revision (group 1), 20 with plate, screws and cerclage (group 2), one patient with cerclage alone and another by Girdlestone procedure. We assessed surgical complications, mortality within 1 year, functional outcome with Harris Hip Score and radiographic outcome with Beals and Tower's criteria. RESULTS: At an average follow-up of 30.1 months in group 1, we had 36.4% of patients with complications, HHS of 66.8, radiographic outcome "excellent-good" in 91% of cases. In group 2 we had 25% of patients with complications, HHS of 71.8, radiographic outcome "excellent-good" in 80% of cases. There were no significant differences in 1-year mortality between the two groups. In group 2, the best outcomes were obtained in uncemented straight stems with Johansson type 1 fracture and in cemented polished stems with stem detachment from the cement-bone complex. Whatever treatment was adopted, there was an overall worsening in quality of life. CONCLUSIONS: Stem revision remains the treatment of choice in Vancouver B2 fractures, but, in selected cases, internal fixation with plate, screws and cerclage can be a viable alternative option.

Causes of failure in periprosthetic fractures of the hip at 1- to 14-year follow-up.

INTRODUCTION: The results and causes of failure for 61 patients undergoing surgery for femoral hip periprosthetic fracture are reported. MATERIALS AND METHODS: Fractures were classified according to the Vancouver System. Osteosynthesis was performed in 88% of cases and prosthetic revision in 12% of cases. Clinical and functional outcomes were assessed according to the Harris Hip Score and radiological results were evaluated using Beals and Tower's criteria. RESULTS: At a mean follow-up of 32 months, the Harris Hip Score was 73.1 and the radiological results were excellent-to-good in 72.2% of patients after the first surgery. At the end of treatment, complete healing of the fracture and stability of the prosthesis was found in 87.3% of patients. The most relevant result was the recovery of walking in 73.8% of patients. Mortality after surgery was 1.6% at 3 months and 3.3% at 12 months. A higher mortality rate occurred when surgery was delayed more than 5 days after trauma. CONCLUSIONS: The analysis of our cases shows that in Vancouver type B1 fractures treated with plating osteosynthesis, there were worse outcomes in total hip arthroplasty with cemented stems compared with uncemented stems. In Vancouver type B2 fractures with cementless straight stems, osteosynthesis with a plate can be a valid option. In Vancouver type C fractures, the stability of the stem must be carefully assessed.