Preliminary experience in the treatment of hip necrosis with BIOS screws associated with growth factors.

ntroduction: In this paper we present the preliminary results obtained in our clinic with the use of BIOS screws associated with injection of growth factors in the treatment of cephalic necrosis of the femoral head. MATERIALS AND METHODS: In the division of Orthopedics and Traumatology at Guglielmo da Saliceto" hospital in Piacenza were treated between 2012 and 2016 with the proposed technique 8 case of necrosis of the femoral head in 6 patients with a mean age of 41.8 years (between 31 and 60 years). All patients before surgery were affected by debilitating pain with VAS greater than 7 and functional limitation of the range of motion of the hip. In all patients was performed a decompression of the femoral head using cannulated screws BIOS and injection through the implants of growth factors. RESULTS: Our results have been extremely positive. All patients treated at two months have reported the resolution of the pain that affected them before surgery and the recovery of the function of the hip. At the last clinical control carried out no patient experienced recurrence of any symptoms related to necrosis. DISCUSSION: Cephalic necrosis due to various possible etiologies is a not so rare condition, often affecting young patients with high functional demands. Only few years ago the gold standard treatment for this kind of pathological condition was hip prosthesis and this fact was associated with long term complications related with the young age of patients. The treatment presented is simple, fast and very effective in allowing the penetration of growth factors through bony trabeculae of the femoral head, due to the fenestratures inside the screws. The results obtained in our experience are certainly promising, though longer follow-up is needed to evaluate the functional outcome long and to evaluate the possible re-emergence of pain. CONCLUSION: Conservative treatment using BIOS screws associated with growth factors in femoral head necrosis in our experience combine a low invasiveness to excellent functional results and should therefore be considered a valid option in treating this pathology in young patients.

Surgical treatment of radial head isolated Mason III fractures.

INTRODUCTION: In this retrospective study we have analyzed a consecutive series of patients affected by isolated radial head Mason III fractures and treated with bone resection or prosthesis. PATIENTS AND METHODS: This study includes 24 patients affected by fractures mentioned above and treated between July 2009 and November 2015. 15 patients (average age 48 y.o.) have been treated with prosthesis. The remaining 9 (average age 573) have been treated with a capitellectomy instead. From a clinical point of view, we have evaluated the patients according to main performance indicators such as range of motion, pain, instability and Mayo Elbow Performance Score as parameters. RESULTS: We have found similar results in both group, with an average MEPS value of 95 in the prosthesis group and 966 in the radial head resection group. The range of motion was similar too: between 1,3° and 1203° in the first group and between 4,4° and 120° in the second one. No significant complication has detected in any patient. DISCUSSION: According to most recent literature, it is not precisely defined how to treat isolated Mason III fractures, contrary to what is defined in more complex pattern, in which prosthesis are now evaluated as the best indication. Due to radial head limited contribution to elbow stability, in absence of other bony or ligamentous lesions both capitellectomy and prosthesis can be good treatment in this kind of fracture. CONCLUSION: According to our experience and to the most recent literature, we recommend prosthesis in patient younger than 50 y.o., high demanding or manual worker, while in other cases we think that radial head resection can be the treatment of choice.

WITHDRAWN: Surgical treatment of radial head isolated Mason III fractures.

The Publisher regrets that this article is an accidental duplication of an article that has already been published in Injury, 50(2) 2019 382­385, https://doi.org/https://doi.org/10.1016/j.injury.2018.11.044. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Preliminary experience in the arthroscopically assisted treatment of tibial plateau fractures.

BACKGROUND AND AIM OF THE STUDY: Fractures involving the tibial plateau make up 1% of all fractures. Treatment can take advantage of various techniques, including arthroscopically assisted surgical reduction. This procedure is certainly viable for Schatzker III fractures and, in some cases, for Schatzker II. The use of the arthroscope makes possible a smooth reduction of the fractured bone, decreasing the risk of post-traumatic osteoarthritis, and also allows to diagnose and, if necessary, also treat the associated intra-articular lesions, which often are not highlighted during the classical preoperative investigations. METHODS: In the last year we have operated with this technique 8 of the 22 cases of fracture of the tibial plate that have come to our emergency Department. Using the Schaztker classification, we performed an arthroscopically assisted reduction to treat type II and III fractures. The surgical operations involved a first arthroscopic phase, to assess intrarticular damage (bone, cartilage, ACL, PCL, menisci), a second phase for possible treatment of intrarticular lesions and reduction of fractures under arthroscope or open osteosinthesis. Finally, a last arthroscopic check was performed. RESULTS: We obtained excellent results, as we were able to always have a fracture reduction of less than 1 mm, while clinically all the patients could have an early and almost complete functional recovery after only 2 months. CONCLUSION: The arthroscopically assisted technique could be an effective way to adress the anatomical reduction of tibial plate fractures, but must only be used in the indicated cases.