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In recent years, there has been an increasing interest in the development of arthroplasty registries, therefore, in our country, the Italian Arthroplasty Registry (RIAP), was issued by the National Law No. 221/2012. In the last decade, however, some European countries -namely Sweden, Denmark, Norway, and Germany (in development)- have introduced another nationwide orthopaedic registry than arthroplasty registers: the fracture registry. The development of this new tool aims to improve quality and safety in fracture management, thus trying to provide a better postoperative quality of life in trauma patients. Based on these findings, the AO-Trauma Italy Council encouraged the development of a national fracture registry in Italy. The present study aims to (1) provide an overview of the fracture registries in Europe and (2) to develop, for the first time, a pilot Italian Fracture Registry (RIFra). Thirteen AO-Trauma Italy members, chairmen of Level-I orthopaedic and trauma centres, diffused throughout Italy, were involved in the RIFra project. The RIFra form, developed between November 2019 and March 2020, consists of 5 main sections, namely: epidemiologic data, previous surgical procedure (if any), patient and fracture features, surgical procedure, surgical implant details. This study constitutes the first step to start, in future years, the bureaucratic procedure leading to the final establishment of a RIAP-like fracture registry in Italy.

The number of hip replacements is constantly and progressively increasing, resulting in an increase in periprosthetic fractures. The main aim of this study is to analyze costs and outcomes of surgical treatment for those fractures. A retrospective study was performed on periprosthetic proximal femur fracture presented a single-level I trauma center. Medical records were reviewed in terms of demographic data, diagnosis (according to Vancouver classification), type of surgical treatment, hospitalization length and follow-up. Patients were interviewed about number of consultations after discharge, medications and physiotherapy sessions. Clinical outcome was evaluated with WOMAC score at the last follow-up, and patient health status was evaluated with the EQ5D5L score pre-trauma and at the last follow-up. Patients were divided into two groups according to surgical treatment: reduction and internal fixation alone and revision plus fixation. A further group was also considered: patients underwent a Girdlestone procedure. Global costs for each group were calculated. We initially recruited 117 patients, 17 of them were lost at follow-up. Furthermore, 19 patients (19%) died during the follow-up, and 81 of them were therefore included in the study. Mean follow-up was 26.5 months. Mean postoperative WOMAC score was 39.44, and EQ5D5L score was 9.12 for the preoperative period and 12.35 at the last follow-up. A significant worsening of clinical conditions was found comparing the period before fracture to the last follow-up (p

Background Resorbable osteosynthesis has been used in orthopaedic surgery for many years. However, indications for the use of these implants in the surgery of traumatic lesions of the foot have not yet been clearly defined. The aim of this study is to analyse reported experiences with the bioabsorbable devices and to suggest guidelines for their use in foot trauma surgery Methods We conducted a literature review to identify known indications for the use of absorbable devices in traumatic lesions of the foot. We also conducted a retrospective analysis of our registry, reviewing patients with traumatic lesions of the foot who were treated surgically with absorbable devices from November 2005 to January 2017. To this end, we analysed for each case the indication for the use of resorbable devices and the incidence of related complications. Results Only 14 relevant studies were found. In the selected period, 76 patients were treated using bioabsorbable devices for a traumatic lesion of the foot. Nine patients were lost to follow-up or did not satisfy the inclusion criteria. Therefore, the final size of the registry was 67 patients. The average follow-up was 20.5 months (range 6–66). All the bioabsorbable devices used were screws and bars of poly-L-lactic acid (PLLA). The indications identified in the literature review and in our registry were osteosynthesis of small periarticular fragments in talus and calcaneus fractures, preliminary stabilisation of articular fragments in Sanders III calcaneal fractures and fracture-dislocations of the Lisfranc or Chopart joints. No foreign-body reactions occurred. However, in one case we registered a late mobilisation of a PLLA bar in a healed calcaneal fracture, probably as a consequence of surgical malpositioning of the device. All the operated lesions demonstrated a normal healing time, and the complication rate was comparable with those of other types of osteosynthesis. Conclusion In foot trauma surgery the use of absorbable devices can give advantages. The most clearly defined indications are osteosynthesis of peri-articular or articular fragments in talus and calcaneus fractures, Sanders III calcaneal fractures and fracture-dislocations of Lisfranc's or Chopart's joints. Foreign-body reactions are rare and seem not to present a problem.

Introduction Tendon healing is a complicated process that results in inferior structural and functional properties when compared with healthy tendon; the purpose of this study was to assess the effects of the adjunct of microfragmented adipose tissue (M-FATS) after the suture of a series of Achilles tendons. Methods After complete Achilles tendon tear, 8 patients underwent open suture repair in conjunction with perilesional application of a preparation of M-FATS rich in mesenchymal stem cells. Results were compared with a similar group of patients treated with conventional open suture. Outcomes were evaluated based on range of motion, functional recovery, and complications according to the American Orthopedic Foot and Ankle Society (AOFAS) score and Foot and Ankle Disability Index (FADI). Achilles tendons were examined by ultrasound (US) at 3 months. Results The AOFAS and FADI scores showed no differences between the 2 groups. US evaluation showed quicker tendon remodeling in the M-FATS group. Adverse events were not documented for both procedures. Conclusions The combined application of derived M-FATS for tendon rupture is safe and presents new possibilities for enhanced healing. Levels of Evidence Level IIIb: Case control study

PURPOSE: to evaluate the results of Delta ceramic-on-ceramic (CoC) for total-hip-arthroplasty (THA). METHODS: 261 THA using Delta-CoC, retrospectively analyzed. A 36 mm head was used in 189 cases and a 32/40 mm in the others. The series have been compared to a group of 89 THA with Forte-CoC. RESULTS: The Harris-Hip-Score improved from 49.1 ± 14.3 to 92.0 ± 8.9 (P

Background Surgical management of Achilles tendon rupture is still controversial: open techniques have a higher rate of soft tissue complications but a lower incidence of re-rupture than percutaneous tenorrhaphies. The aim of our retrospective study was to analyze and compare clinical and functional results in patients treated with either the conventional open or minimally invasive suture treatment with the Achillon ® system. Methods A retrospective review of 140 patients was performed; 72 were treated with open tenorrhaphy, 68 with the minimally invasive Achillon ® suture system. Results With a comparable re-rupture rate, there was a statistically significant reduction in surgical time, incidence of minor complications, time required to return to sport activities and return to work in the minimally invasive group. Conclusions Achillon ® mini-invasive suture system is a reliable tool for the Achilles tendon ruptures, able to reduce the incidence of soft tissues complications if compared to the classic open tenorrhaphy, while maintaining strength of the suture and leading to superimposed functional outcomes.

Background:The tibial pilon fractures represent a complex therapeutic problem for the orthopedic surgeon, given the frequent complications and outcomes disabling. The recent medical literature indicates that the best strategy to reduce amount of complications in tibial pilon fractures is two-stages procedure. We describe our experience in the primary stabilization of these fractures.Methods:We treated 36 cases with temporary external fixation in a simple configuration, called "tripolar": this is an essential structure (only three screws and three rods), that is possible to perform even without the availability of X-rays and with simple anesthesia or sedation.Results:We found a sufficient mechanical stability for the nursing post-operative, in absence of intraoperative and postoperative problems. The time between trauma and temporary stabilization ranged between 3 and 144 hours; surgical average time was 8.4 minutes. Definitive treatment was carried out with a delay of a minimum of 4 and a maximum of 15 days from the temporary stabilization, always without problems, both in case of ORIF (open reduction, internal fixation) or circular external fixationConclusion:Temporary stabilization with external fixator in ‘tripolar’ configuration seems to be the most effective strategy in two steps treatment of tibial pilon fractures. These preliminary encouraging results must be confirmed by further studies with more cases.

Severe traumatic losses of soft tissues and bone at foot and ankle level are often treated by means of amputation, but this may involve important psychological and anatomic consequences for the patient. If there are good vascular conditions, reconstruction by means of composite free flaps is often the only alternative to this demolitive treatment. The transfer of composite free flaps that include vascularized bone from various donor sites may provide anatomical reconstruction and recovery of function of the foot and ankle. If plantar skin and its sensation are present, these techniques may represent a good choice in the treatment of complex injuries of the foot, and by means of skeletal morphological reconstruction, they may give good functional results. With these premises, we report a case in which was used a groin flap to fill and solve a complex defect of bone and soft tissues of midfoot in a gunshot injury.

The fractures of phalanx and metatarsal bones are one of the most frequent in the foot and more generally in the human body. Even if they present with a high incidence, in consideration of the frequent loss of diagnosis, the anatomical segment and the low disability generated, the surgical treatment is performed in the minority of cases.

The injuries of the midfoot are extremely infrequent and insidious; for this reason, it’s very important to perform all diagnostic examination in helping decision-making and performing surgery and even to determine the preoperative planning and all instrumentation that may be helpful in the operating room.

The fracture of the calcaneus is a relative frequent injury, including about 2% of all fractures. Classification, type of treatment and indications must be considered, and they orient the surgical planning. The goals of the surgery, the surgical technique and the postoperative care are the main topics that need a careful consideration in the several types of surgeries feasible for these fractures: percutaneous techniques, external fixation or open reduction and internal fixation (ORIF).

Subcutaneous rupture of the Achilles tendon is an extremely frequent injury. Injury areas determine the indications. The goals of the surgery and the surgical technique for the three main categories of surgery, open, percutaneous and minimally invasive, are the main topics that need a careful consideration.

Tibial plafond fractures affect the distal meta-epiphyseal tibia associated with an important cartilage involvement. Classification, treatment and indications and surgical timing are milestones in the two-step treatment that is the gold standard for these lesions. The goals of the surgery and the surgical technique for both temporary fixation and definitive treatment techniques are the main topics that need a careful consideration.

Talus fractures are injuries relatively infrequent that represent less than the 1% of all the fractures and only the 3–5% of the fractures of the foot.

Background: In middle-aged patients, treatment of femoral neck fractures is still debated between osteosynthesis and replacement. Describing predictive factors is essential to choose the appropriate treatment for each patient. The aim of this study was to describe risk factors for avascular necrosis (AVN) of the femur head in patients with femoral neck fractures treated with three cannulated screws. Methods: We conducted a retrospective study of 91 patients between January of 2011 and February of 2017. Fractures were classified according to Garden and Pauwels classifications, fracture displacement was measured in millimetres (mm), quality of reduction was classified as anatomical or not anatomical; all post-operative radiographs were classified with Garden Alignment Index (GAI). Demographic data were recorded and analyzed. Results: AVN was found in six cases (6.6%). The Garden Classification ([Formula: see text]), GAI classification ([Formula: see text]), fracture displacement in mm ([Formula: see text]) and anatomical reduction ([Formula: see text]) were significantly associated with AVN. The most important risk factor for AVN was suboptimal reduction in axial view evaluated with GAI ([Formula: see text]). One case of AVN occurred in patients with GAI considered excellent (71.42%); no AVN occurred in patients with anatomical reduction (47.2%). Conclusions: Anatomical reduction in patients with femoral neck fractures treated with cannulated screws is mandatory. The degree of displacement before surgery influences the outcome but post-operative anatomical reduction, especially in the lateral view, is the most important predictive factor for the outcome: decreasing the Lateral Garden Angle (LGA) from 180∘increases significantly the risk for AVN.

This review focuses on the various techniques of conservative treatment of plantar fasciitis and posterior heel pain. Being the optimal therapy controversial, the intent is to drive surgeons and rehabilitation specialists in the choice of the strategies. The Data sources were MEDLINE, PubMed, CINAHL, EMBASE, and Psych INFO databases using the selected key words. Studies have been selected for review using as criteria English, adults, clinical population and intervention. Among several published studies about rehabilitation and fasciitis, only a few showed bases on scientific evidence. Moreover, many studies were heterogeneous and included different outcomes and evaluations. There is consensus that a specific rehabilitation program is necessary to avoid chronicity. However, the real efficacy of every specific treatment (orthoses, stretching, radiotherapy, botulin toxin, shock waves, corticosteroid therapy, and platelet rich plasma) is still questionable, and often related to the experience of the authors. In conclusion, patients undergoing physiotherapy obtain a better and faster outcome achievement than non-treated patients; however, evidence-based treatments, protocols and clinical trials are recommended.

Purpose. The aim was to evaluate and compare patient's health-related quality of life after THA for osteoarthritis and femoral neck fracture. The postoperative outcome was retrospectively evaluated in patients who underwent THA with an intracapsular femoral neck fracture (Group A) or with an hip osteoarthritis (Group B). Methods. Length discrepancy was measured on postoperative X-rays. Study groups were compared as to age, results of WOMAC and SF-36 tests, limb length discrepancy (LLD) by independent group t-test. Correlations between LLD and results obtained atWOMAC test were performed. 117 patients were enrolled. The 2 groups were similar as to age, type of implanted stem and sex. Mean follow up was 2,4 years for group A and 2,3 years for group B. Results. WOMAC score was found higher in group A in all items examinated. Correlation tests did not indicate a statistically significant linear relationship between LLD and WOMAC score in both groups. Conclusions. Patients who received THA for arthritis have better perception of quality of life than traumatologic patients. Although LLD should always be strongly considered by the surgeons performing a THA, LLD alone can't be considered as an indicator of patient dissatisfaction or clinical bad result after a 2-year followup.

Severe injuries at foot and ankle level with loss of soft tissues and bone are often treated by means of amputation. The transfer of composite free flaps from various donor sites may provide anatomical reconstruction of the foot and ankle and function. Ten patients who sustained severe combined tissue injuries of the foot requiring reconstruction with composite free flaps were studied with a mean follow-up of 3.4 years. A thorough clinical examination was performed, and gait analysis was carried out with kinetic and kinematic parameters. Bone integration and healing was observed with satisfactory foot morphology. All the patients returned to normal activities, although biomechanical gait analysis showed some functional disorders mainly in joint angular kinematics. Our results showed that microvascular flaps afford successful combined tissue reconstruction of the foot. V C 2011 Wiley-Liss, Inc. Microsurgery 31:212–217, 2011. In severe losses of substances of the lower extremity, reconstruction by means of free flaps is often the only alternate to amputation. When considering this decision, reconstructive surgeons must evaluate several elements. The aim, in lower limb traumas, is not only restoration of physical integrity, but also good functionality. Weight bearing areas, joint stability, and motion have to be evaluated and restored in the best possible way.

Fractures of the talar body can have devastating results despite treatment. While talar body fractures are uncommon, they have worse outcomes than do other fractures of the talus, including more osteonecrosis and posttraumatic arthritis1,2. Crush injuries are the most difficult to treat as a result of a very constrained anatomy, the comminution of the fracture fragments, and articular cartilage damage. These fractures are challenging to reconstruct and stabilize and often have poor outcomes3. Conservative treatment does not appear to be better than operative treatment for talar body fractures4. For crush injuries, very aggressive techniques such as primary fusion of the talocrural joint, primary tibiotalar arthrodesis and subtalar arthrodesis, and salvage ankle fusion techniques with structural bone blocks are usually used3,5,6. There have been isolated reports of surgical treatment for crush injuries of the talar body with open reduction and internal fixation; however, these procedures either have had unsatisfactory outcomes2 or were used when there was comminution of only part of the talar dome7. It is generally accepted that severe crush fractures cannot be treated satisfactorily with open reduction and fixation5,8. We describe a case of a severely comminuted talar body and neck fracture treated effectively with surgical reconstruction with a satisfactory result. The patient gave permission for this information to be submitted for publication. A twenty-three-year-old man injured the right ankle in a high-speed motorcycle accident. At the time of admission, the patient had local swelling and varus deformity of the ankle, severe pain, and an inability to actively and passively move the ankle and subtalar joints. He had no neurovascular deficit, tension of the surrounding soft tissue was noted, and there was no open skin lesion. Anteroposterior and …

This article is a retrospective study comparing the efficacy of Regnauld arthroplasty to first ray osteotomies for the treatment of hallux valgus. One hundred consecutive cases of Regnauld arthroplasties were compared with 100 consecutive first ray osteotomies. One hundred fourty-one patients were available for follow-up, and based on clinical/radiographic examinations, 72 were treated with the osteotomy protocol (group A) and 69 with Regnauld arthroplasty (group B). Age at surgery, clinical symptoms, and preoperative radiologic findings were similar for the 2 groups; there was a preponderance of female patients (90%). The average follow-up was 49 months in group A and 51 months in group B. Clinical evaluation showed in the osteotomy group a more stable correction (79% v 49%), greater pain reduction (measured in a visual analog scale from 0 = pain free to 10 = deep intolerable pain), increased residual articular excursion of the first metatarsophalangeal joint (27 degrees of active dorsiflexion from neutral position v 8 degrees ), and less presence of central metatarsalgia (15% v 34%) (P.05). The radiographic evaluation expressed more stable correction values in group A for the following parameters: joint preservation, sesamoid position, intermetatarsal angle (7 degrees v 12 degrees ), abduction angle of the hallux (14 degrees v 20 degrees ), and proximal articular set angle (8 degrees v 18 degrees ) (P.05).