Search

Introduction: In this retrospective case-series study we discuss the clinical and radiographic outcomes obtained following the “tibia-first concept” in the treatment of distal tibia fractures, both in patients with fibular comminution and in cases with a simple fibula fracture. Materials and methods: We analysed a consecutive series of 64 patients who presented at our emergency department with a distal articular tibial and fibular fracture from January 2015 to September 2020. A total of 22 patients met the inclusion and exclusion criteria and were included in the study. Clinical and radiographic examination were performed at each follow-up. To quantify pain and functional disability, the Foot and Ankle Outcome Score (FAOS) and the American Orthopaedic Foot and Ankle Society’s ankle- hindfoot scale (AOFAS) were applied. Results: The overall mean age was 52.8 years, and the mean follow-up was 13.18 months. Multiple scales data from the FAOS were as follows: pain score 80.70; symptoms score 81.69; activities of daily living score 87.22; quality of life 76.05. The mean AOFAS ankle-hindfoot score was 74.36. Conclusions: Even though the principles of Rüedi and Allgöwer are still valid, in specific circumstances, the tibia- first concept could be considered as a valid option for the treatment of these demanding fractures. If a good reduction is obtained intra-operatively by ligamentotaxis, we recommend fixing the tibia first, avoiding surgical stress on tissues derived from a previous fibular fixation.

Purpose: The aim of our prospective randomised trial was to demonstrate the efficacy and improvement in surgical skills of inexperienced surgeons in the balloon kyphoplasty procedures trained with virtual reality (VR) compared to untrained inexperienced surgeons. Methods: Six orthopaedic residents were randomized to group VR1 (trained) and group VR0 (untrained, control group). At the beginning, all participants, after a theoretical lesson, performed a virtual kyphoplasty. Each resident of the Group VR1 did four training sessions in 1 month (2 h per week) and at the end of training was re-evaluated performing a virtual kyphoplasty. Residents were evaluated with global task completion time and rates subtask ability according to Global Rating Scale of Operative Performance adaptation (both in VR simulation and during the surgery). A percutaneous vertebral augmentation with balloon kyphoplasty was performed by all residents. Intraoperative parameters, complications and cumulative transfer effectiveness ratio (CTER) were analysed. Results: Intraoperative scores revealed an improvement in the group VR1 between the first VR trial and the intraoperative phase (2.85 ± 0.65 vs. 4.09 ± 0.62, P < 0.05), which was not seen in the group VR0 (2.71 ± 0.71 vs. 2.85 ± 0.75). Statistical analyses indicated significant differences in intraoperative scores between the two groups. The CTER was 0.85 and suggests that 10 training sessions could reduce the procedure time by approximately 8 min in a 15 min of surgery. Conclusion: Our study about the balloon kyphoplasy reaffirms the potential of VR as an effective and cost-efficient training tool, bridging the gap between theoretical knowledge and practical execution. [ABSTRACT FROM AUTHOR]

Helical plating for humeral shaft fractures has gained popularity in recent years as it avoids iatrogenic nerve damage. A total of 16 patients with humeral shaft fracture involving the metaphyseal proximal part were treated between Dicembrer 2016 and January 2023. Complications such as pseudarthrosis, infections and nerve lesions were investigated during the postoperative period. Functional outcome was quantified using the Italian version of the DASH 30 quality of life assessment item. Healing of the fracture was achieved at the last follow-up with good clinical recovery and no pain. The self-contoured Philos-Helix plate for humeral shaft fractures with proximal extension in combination with an anterior window approach is a safe procedure with good functional results at a follow-up of at least one year. Clin Ter 2024; 175 (5):318-322 doi: 10.7417/ CT.2024.5136 [ABSTRACT FROM AUTHOR]

Traumatic rupture of the long head of biceps tendon (LHBT) in the young is rare and it is often related to sports. We describe a technical note of a mini open supra-pectoral tenodesis fixed by the "ToggleLoc™" (Zimmer Biomet, Warsaw, IN, USA) and performed by a two-window approach. The proposed technique guarantees an optimal visualization with low risk of complications and without arthroscopic assistance. [ABSTRACT FROM AUTHOR]

Background. Distal metaphyseal-diaphyseal fractures of the humerus can be challenging. The success lies in achieving a stable fixation that could allow early functional recovery. Our aim is to combine different approaches already reported, to obtain an ideal surgical strategy for treating these fracture patterns. Methods. In this retrospective study, we present the clinical outcome of a 12-patient cohort in which we used a combined paratricipital and triceps-splitting approach to the distal humerus. The mean age of the group was 50 years (range 17 - 88). Clinical and radiographic evaluation was performed at 1, 3, 6, and 12 months after surgery and thereafter, depending on the necessity of a further control. Patients' range of motion (ROM) of the elbow was reported, and functional outcome was assessed using the Mayo Elbow Performance Index (MEPI).The minimum follow-up was fixed at 12 months. Results. Union was achieved in all fractures. After a median follow-up of 15.7 months (range 12-21), none of the patients complained of any limitation in daily activities. The ROM at the last follow-up was complete in eight patients. Instead, three patients had ROM limitations, but none of them mentioned Limitations in the activities of daily living. We observed a single iatrogenic radial nerve palsy undergoing a full functional recovery at the final follow-up. No further complications occurred. Conclusion. We believe that the here presented modified approach could represent a solution that meets the modern demands for both robust fixation and early mobilization, with minimal soft tissues damage around distal humeral fractures. [ABSTRACT FROM AUTHOR]

Background. Tibial plateau fractures pose multiple challenges to the surgeon given their frequent intra-articular involvement and the tendency to displace under axial load. The aim of this study is to describe the clinical outcomes of a retrospective case series in which tibial plateau fractures were not treated with PL fragment osteosynthesis. Methods. In the present retrospective study, we included patients treated for tibial plateau fracture with PL fragment in our department from January 2016 to January 2020. All patients were seen at the outpatient clinic 2 and 5 weeks after surgery, and at 3, 6 and 12 months, and thereafter at regular intervals, depending on the overall clinical status. Every patient included in this study was then contacted by phone to assess self-reported clinical outcomes. The Oxford Knee Score (OKS) questionnaire was used to assess functional outcomes. Patients were divided in six groups depending on the three-column classification by Lou (groups A1-A6). Patients were also divided in four groups based on the whole area of the PL column and on the depression of the PL fragment (group B1-B4). One-way ANOVA was used to compare groups of patients. Results. OKS scores, extension and step-off of the PL fragment were analyzed in groups A1 - A6. No significant differences between OKS scores and step-off were found, while statistical difference was found between surfaces of PL fragment. No significant difference was found between OKS scores in groups B1-B4. Conclusion. Our findings suggest that the treatment outcome is influenced not only by the superficial involvement or collapse of PL fragments, but also by other variables, including BMI, pre-injury physical health, and age. [ABSTRACT FROM AUTHOR]