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To retrospectively review the results at minimum ten years after surgery of a consecutive series of total knee arthroplasties (TKAs) performed using a constrained condylar implant in patients with severe coronal plane instability. The series comprised of 44 patients (45 knees) who received primary (19 knees) or revision (26 knees) TKA with a constrained condylar implant between 2001 and 2003 at a single institution. There were no revisions or any other surgery related complications at a mean implantation time of 11.0 years. In 38 patients (15 knees in the primary group and 24 knees in the revision group) who were available for clinicoradiographic follow-up at a minimum of ten years, there was no sign of radiographic loosening. Two patients showed cortical hypertrophy at the extension stem tip but none complained of pain around the stem tip. According to the TLKSS score grading, 73% of the patients in the primary group had results categorized as good or excellent, while 54% of the patients in the revision group had fair results. Four patients (one (7%) in the primary group and three (13%) in the revision group) had poor results. The median WOMAC Index was 80.2% (interquartile range: 74.0%–81.2%) and 74.0% (interquartile range: 72.1%–75.8%) in the primary and in the revision groups, respectively ( $p=0.010$ ). This study showed satisfactory clinical outcomes with no re-operations at minimum ten years after implantation in patients who had undergone primary or revision TKA with a condylar constrained implant.

Total knee arthroplasty is nowdays a safe and reliable procedure in order to pain relief and restore function. Despite the good outcomes in long-term follow-up, the changing in demographics and the growing of surgical procedures, will increase the number of revisions. During the approach to total knee revision, the exposure is often the first issue, which must be addressed step by step. Skin incision must be decided according to previous scars or to varus/valgus deformity. Knee joint can be exposed firstly from a standard medial/lateral parapatellar approach. After scar tissue removal, if the exposure is not sufficient, or the risk of patellar tendon rupture is serious, an extensile approach is necessary. Quadriceps snip is usually the first approach performed, because of the possibility of safe patellar eversion without extensor mechanism interruption or vascular damage. Quadriceps turndown provides to a wide joint exposure, using a “V-Y” plasty of the quadriceps tendon. Tibial tubercle osteotomy (TTO) consists in the osteotomy of a bone fragment containing anterior tibial tubercle and patellar tendon, and subsequent eversion. Both quadriceps turndown both TTO are challenging procedures, and the choice of this kind of exposure must be weighed according to proper indications and potential pitfalls.

Fractures of the calcaneum are frequent lesions, regarding about 60% of all tarsal injuries and occurring, usually, after a fall from a height: this means that most of the affected patients are young and active, which results in long non-working periods and, often, in compensation claims for permanent inability to return to their previous occupation. These lesions are either intra-articular, involving the posterior facet, or extra-articular, located in the body or tuberosities: around 70% are intra-articular, resulting from axial loading during falls from a height or motor vehicle crashes, where the talus acts as a wedge to create a shearing force, dividing the sustentaculum from the great tuberosity. The optimal treatment is still under debate because poor results can be expected despite conservative or surgical treatment, owing to complications related to poor reduction, immobilization, algodystrophy and secondary osteopenia, late arthritis, skin healing and infection. New surgical techniques and technologies (CT scan for preoperative planning, pre-contoured low profile plates and supportive osteointegrative materials), however, have improved the outcomes of operative treatment, but still problems arise from high energy fractures because of soft tissues damage, and of predisposing factors such diabetes, vasculopathy, neurologic disease and immuno-compromission. Looking at these aspects, and at other previous experiences with minimally invasive techniques for fracture treatment, we developed a technique combining percutaneous reduction and stabilization using the kyphoplasty tool (Kyphon) for vertebral fractures. This article presents this new MIPO technique in the treatment of intra-articular fractures of the calcaneum.

Anticoagulant prophylaxis for preventing VTE is a world wide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures. Different guidelines are available in literature with quite different recommendations. None of them is a multidisciplinary effort as the one presented. In 2010 the Italian Society on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the Association of Orthopaedics and Traumatologists of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI), have set down practical suggestions for VTE prophylaxis in hip and knee surgery as well as in femoral neck fracture treatment. This Intersociety Consensus Statement aimed at simplifying the grading system reported in the literature, and its goal was to favour its clinical application. Special focuses addressed fragile patients and those patients at high risk of bleeding or receiving chronic antiplatelet and vitamin K antagonists treatment, and a special chapter was dedicated to regional anaesthesia and VTE prophylaxis. The registration of three novel oral anticoagulants (dabigatran, rivaroxaban and apixaban) for VTE prophylaxis in major orthopedic surgery and the ongoing introduction of these drugs for the prevention of embolism in atrial fibrillation make it necessary an update of the Intersociety Consensus Statement.

Piriformis syndrome (PS) is a frequently misdiagnosed but not so rare neuromuscular disorder that involves buttock pain referred to the leg. Piriformis syndrome occurs when the piriformis muscle or a local pathological process compresses or irritates the sciatic nerve. Diagnosis is often difficult, and it is of exclusion, due to few validated and standardized diagnostic tests. Treatment for PS has historically been focused on stretching and physical therapy modalities, with refractory patients also receiving anesthetic and corticosteroid injections into the piriformis muscle origin, belly, muscle sheath, or sciatic nerve sheath. Recently, the use of botulinum toxin to treat PS has gained popularity. Surgical treatment is indicated in selected cases not responding to conservative therapy.

Polytrauma and multifractured patients are the most critical in the Emergency System, and measures should be systematically taken to avoid time loss in identifying lesions, and wrong choices in terms of hospitals capable of treating them. The concept of “golden hour” is widely known and accepted, as well as the concept of Trauma Team, a true multidisciplinary unit that gathers together all the necessary skills. Our country is working on a project of emergency network, and the SIOT is producing documents to support the Age.na.s. commission in codifying the role of orthopaedic and trauma surgeons.

Anticoagulant prophylaxis for preventing VTE is a world wide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures.Different guidelines are available in literature with quite different recommendations.None of them is a multydisciplinary effort as the one presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the association of Orthopaedic Traumatology of Italian Hospitals (OTODI) together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) have set down easy and quick suggestions for TEV prophylaxis in hip and knee surgery as well as in femoral neck fracture treatment. This intersociety consensus statement aims at simplifying the grading system reported in the literature, and its goal is to favour its clinical application. Special focuses have been also pointed toward fragile patients and on those patients at high risk of bleeding or receiving chronic antiplatelet and Vitamin K antagonists treatment. A special chapter have been dedicated to regional anaesthesia and TEV prophylaxis.

The increase in injury to bone secondary to vehicular accidents or work-related trauma, as well as different sport activities, with subsequent infection, and increase in major reconstructive surgical procedures, have contributed to a definite rise in the incidence of infections and nonhematogenous osteomyelitis. The most effective treatment remains their prevention by meticulous wound care and debridement after open fractures. Appropriate antibiotic treatment and early soft tissue coverage should lower further the incidence of this complication, but the emergence of resistant bacterial strains has complicated treatment with consequences in terms of medical care and cost.

Successful treatment of displaced humeral fracture can be difficult to achieve because of osteopenia of proximal humerus. One of the new options for humeral internal fixation is the minimally invasive intramedullary nail.

There are many biomechanical advantages in using an intramedullary implant to fix a long bone fracture: placing a nail in the medullary canal provides a strong fixation with the lowest “shield effect” on the bone. From a mechanical point of view, this is explained by the nail being within the neutral bone’s axis, acting like a central tutor which allows an optimal share of the load along the bone, preserving the obtained reduction and allowing early function. With the new developments in closed tecniques, it’s no necessary to open the fracture site, thus respecting the biology of fracture healing.

Surgical indications for the treatment of distal radial fractures are evolving and becoming more common among surgeons, but, as shown in many studies, these fractures can be successfully managed by a range of methods and techniques, including conservative treatment based on closed reduction by manipulation and cast.

Anticoagulant prophylaxis for preventing VTE is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, but few data exist in other fields of orthopaedics and traumatology. Thus no guidelines or recommendations are available in the literature except for a limited number of weak statements about knee arthroscopy and lower limb fractures. In any case, none of them is a multidisciplinary effort as the one here presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the association of Orthopaedic Traumatology of Italian Hospitals (OTODI) together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and the Italian Society of General Medicine (SIMG) have set down easy and quick suggestions for VTE prophylaxis in a number of surgical conditions for which only scarce evidence is available. This inter-society consensus statement aims at simplifying the approach to VTE prophylaxis in the single patient with the goal to foster its clinical application. This statement is therefore addressed to the Italian scientific community and institutions with the aim of attaining good clinical practice in the profession. The present statement will be published in the “Journal of Orthopaedics and Traumatology”,” Lo Scalpello” and in the websites of the Societies participating this consensus (OTODI, SIAARTI, SIMG, SIOT, SISET). It will be submitted to Minerva Anestesiologica.