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Introduction: Proximal femoral fractures (PFF) are a significant health concern among the elderly, often leading to complications and high mortality rates. Intramedullary nailing is widely considered the most effective treatment for lateral proximal femoral fractures (LPFF), with the Tip Apex Distance (TAD) being a crucial predictor of surgical success. This study aimed to compare outcomes between patients treated with and without the ADAPT (ADAptive Positioning Technology) system, which aids in the precise placement of the cephalic screw., Materials and Methods: A retrospective analysis was conducted on 97 patients with intertrochanteric fractures treated in 2022. Patients were divided into two groups: those treated with the ADAPT system (group I, n=34) and those treated without it (group II, n=63). Fractures were classified according to AO/OTA classification. The primary outcomes measured were operative time, cephalic screw angle, TAD, and incidence of lag screw cut-out. Statistical analyses included chi-square tests and t-tests, with significance set at P < 0.05., Results: The ADAPT system did not significantly reduce TAD (18.21 mm in the ADAPT group vs. 19.94 mm in the control group, p=0.149). Operative times were similar between the groups. The incidence of lag screw cut-out was low in both groups, with no significant differences. The study confirmed a strong correlation between higher TAD and increased risk of screw cut-out, underscoring the importance of precise screw placement., Discussion: Computer-assisted surgery, such as the ADAPT system, aims to enhance the accuracy of cephalic screw placement. In this study, the ADAPT system didn't demonstrate a statistically significant advantage in reducing TAD or preventing screw cut-out. Nevertheless, the critical role of TAD in preventing fixation failure was reaffirmed, emphasising the need for precise surgical techniques., Conclusion: While the ADAPT system did not show a significant advantage in reducing TAD or preventing screw cut-out in this study, the importance of achieving optimal TAD in cephalomedullary nailing was reinforced. Future research should continue to explore the role of computer-assisted systems in enhancing surgical accuracy and improving outcomes for patients with LPFF., Competing Interests: Each author declares that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article.

This study aimed to evaluate and compare two types of internal fixation, locking angular plate (group 1) and Kirschner-wires (group 2), for post-traumatic cubitus varus. The parameters used were Laupattarakasem's criteria (for range of motion in extension/flexion, correction of carrying angle, and the 'lazy S' deformity) and the Barrett's questionnaire (for patient satisfaction). In group I (plate+screws), we had three excellent results and five good. In group II (Kirschner-wires), we had two good results, three fair, and two poor. Statistical analysis showed a better outcome for group I (plate+screws) considering the correction of the humeral-elbow-wrist angle (P<0.003), the postoperative lateral prominence index (P<0.048), and the patient satisfaction (P<0.011). We recommend the locking angular plate, because it can rigidly stabilize the osteotomy, ensuring an excellent functional and cosmetic outcome.

Our aim is to analyse the clinical outcome of a series of patients affected by avascular necrosis of the femoral head and treated with core-decompression technique and autologous stromal cells of the bone marrow.We enrolled in our study 29 patients with 31 hips in total affected by avascular necrosis of the femoral head. The clinical and radiological outcome has been assessed through self-administered questionnaires (HHS, VAS and SF12) X-ray and Magnetic Resonance.Of all the examined hips, 25 showed a relief of the symptoms and a resolution of the osteonecrosis, 11 of these were at Stage I and 14 at Stage II. The progression of the disease occurred in 6 hips (2 Stage II, 2 Stage III and 2 Stage IV). Our results show a significant decrease in joint pain level and a success in avoiding or delaying the need of hip replacement in early stages of osteonecrosis.