Treatment of Scaphoid Non-Unions with Custom-Made 3D-Printed Titanium Partial and Total Scaphoid Prostheses and Scaphoid Interosseous Ligament Reconstruction.

PURPOSE: Treatment of scaphoid fracture sequelae is still an unsolved problem in hand surgery. Custom-made 3D-printed titanium partial and total scaphoid prosthesis and scaphoid interosseous ligament reconstruction (SLIL) are performed in cases of non-union and isolated aseptic necrosis of the proximal scaphoid pole and when it is impossible to save the scaphoid bone, respectively. This study aims to evaluate the clinical, functional and radiographic results after these two prosthesis implantations. METHODS: Between January 2019 and July 2020, nine partial and ten total scaphoid prostheses were implanted using custom-made 3D-printed titanium implants. Evaluation criteria included carpal height ratio (CHR), radioscaphoid angle, wrist extension and flexion, radial deviation and ulnar deviation of the wrist, grip strength and pinch strength, Visual Analogue Scale (VAS), the Disabilities of Arm, Shoulder, and Hand (DASH) score, and the Patient-Rated Wrist Evaluation (PRWE). RESULTS: Clinical, functional, and radiographic improvements were found in all outcomes analyzed for both patient groups. The VAS pain scale obtained the most remarkable improvement at the one-year follow-up. The results of the DASH scores and the PRWE were good, with a great rate of patient satisfaction at the end of the follow-up. SLIL reconstruction also provided excellent stability and prevented a mid-carpal bone collapse in the short- and medium-term follow-up. CONCLUSIONS: A custom-made 3D-printed titanium partial or total scaphoid prosthesis is a viable solution for patients with scaphoid non-union and necrosis or complete scaphoid destruction in whom previous conservative or surgical treatment has failed.

Hamstring Graft Preparation for ACL Reconstruction.

Anterior cruciate ligament (ACL) reconstruction represents one of the most common procedures in orthopedic surgery. It usually involves the harvest of both gracilis and semitendinosus tendons from the ipsilateral knee. Different methods of hamstring graft preparation have been proposed in recent years, to create an adequate graft diameter reducing morbidity linked to gracilis tendon harvesting procedure. More recently, the use of only 1 of the tendons (semitendinosus) in a tripled or quadrupled arrangement has been described, especially in an all-inside type of reconstruction. Having a thicker tendon with a quadrupled semitendinosus (ST), instead of double gracilis and ST enables to have a graft with enough diameter to resemble more closely the native ACL and decreases the risk of graft re-rupture. The present study aims to describe different options of hamstring graft preparing, listing and analyzing each configuration to help surgeons to choose the most suitable graft type for their patients.

Is There a Relationship between Idiopathic Scoliosis and Body Mass? A Scoping Review.

The etiopathogenesis of idiopathic scoliosis remains unknown, although genetic or hereditary factors, neurological disorders, hormonal and metabolic dysfunctions, biomechanical factors, and environmental factors seem to be involved. Several studies have found that patients with scoliosis have common characteristics of taller stature, lower body mass index (BMI), and low systemic bone mass. We conducted a scoping review to analyze the association between idiopathic scoliosis and BMI. The search for articles was performed on PubMed and Cochrane, including the English language, full-text and free-full-text articles published from 31 December 2011 to 31 December 2021. Most of the results analyzed are in favor of a relationship between low BMI and scoliosis. Having a low BMI could be associated with the presence of scoliosis, although the reason for which is still doubtful. However, further large-scale epidemiological studies on different ethnicities and a comparison of BMI with the healthy population will be needed to better define the correlation between BMI and scoliosis.

Peri-Implant Distal Radius Fracture: Proposal of a New Classification.

A peri-implant fracture near the volar plate of the distal radius represents a rarity and can be associated with a mechanical failure of the devices. A literature review was conducted including all fractures that occurred around a volar wrist plate, which could be associated with an ulna fracture. All articles published until December 2021 were considered according to the guidelines presented in the PRISMA Statement. The search was conducted with the PubMed electronic database, Cochrane Database of Systematic Reviews, Medline, Embase, and Google Scholar. Only nine cases of these fractures were reported in the literature. The causes could be due to delayed union/non-union of the old fracture after low energy traumas, high energy trauma in patients with poor bone quality, or hardware mechanical failure. Furthermore, the literature review of peri-implant radius fracture shows different level of radius fracture and types of implant failure. In accordance with these different cases, a new classification of peri-implant fracture of the distal radius is proposed.

Cement augmentation for trochanteric fracture in elderly: A systematic review.

BACKGROUND: Cement augmentation of internal fixation of hip fracture has reported to improve fracture stability in osteoporotic hip fractures, reducing the risk of cut-out of the sliding screw through the femoral head. The purpose of present study was to perform a systematic literature review on the effects of augmentation technique in patients with osteoporotic hip fractures. MATERIAL AND METHODS: A comprehensive literature search was systematically performed to evaluate all papers published in English language included in the literature between January 2010 and July 2020, according to the PRISMA 2009 guidelines. In vivo and in vitro studies, case reports, review articles, cadaveric studies, biomechanical studies, histological studies, oncological studies, technical notes, studies dealing with radiological classifications and studies on revision surgery were excluded. RESULTS: A total of 5 studies involving 301 patients were included. Patients had a mean age of 84.6 years and were followed up for a mean period of 11 months. The proximal femoral fractures were stabilized with implantation of the PFNA or Gamma nail and augmentation was performed with two different cements: polymethylmethacrylate (PMMA) in 4 studies and calcium phosphate (CP) in one study. Overall, 57.5% of patients reached the same or greater preoperative mobility, and postoperative Parker Mobility Score and Harris Hip Score were acceptable. No significantly complications were observed, and no additional surgery related to the implant was required. CONCLUSION: The results of this systematic review show that cement augmentation is a safe and effectiveness method of fixation to treat trochanteric fractures.

Single use instruments for total knee arthroplasty.

Aim Total knee arthroplasty represents a procedure that is successfully performed to relieve functional limitation and pain in advanced stages of osteoarthritis. In the next 20 years the number of these procedures will be increased about four times. Patient specific instrumentation (PSI) has been introduced in the past years. The aim of this study was to evaluate whether SUI are more useful in clinical, organizational and economic terms. Methods A database search about single use instrumentation (SUI) was conducted on PubMed and Google Scholar for the period 2010-2020 using the following key "total knee replacement", "total knee arthroplasty", "single use instruments", and "disposable instruments". The results of the selected studies were classified according to clinical, economic and organizational criteria. Results The main advantage of SUI has been reported to reduce costs, timely turnover of operating rooms, maximizing the operating room utilization and patient throughput, improving the number of outpatient total joint replacements. No difference has been found other than with regard to conventional instruments in terms of clinical outcome such as hip-knee-ankle angle and other radiographic parameters, Oxford Knee Score, while a decreased infection rate has been demonstrated. Regarding the economic aspect, a reduction of direct and indirect reduction of costs has been shown for the cost of instruments reprocessing, tray sterilization, 90-day infection rate. Conclusion The SUI can be an alternative to conventional instruments, but there are still few studies in the literature regarding clinical outcomes.

A rare case of peri-implant distal radius fracture.

A peri-implant fracture near the volar plate of distal radius represent a very rare injury. The main factor of this lesion is high energy trauma on the wrist. We report a case of a 61-year-old woman with a peri-implant fracture located just proximally to the plate and a fracture of the ulnar head that occurred after a simple fall. The patient was surgically treated by plate and screws removal. The fracture was fixed using a longer volar plate for the radial fracture and a plate for the head ulnar fracture. Different factors such as osteoporosis, BMI and screw position could influence the fracture pattern. However, considering growing use of plates for distal radius fracture fixation, the frequency of these kind of fracture will probably increase.

Isolated osteoblastoma of the cuboid bone: A case report and review of the literature.

Osteoblastoma is a relatively rare, benign, bone-forming tumor, commonly observed in the second and third decades of life. Spine and the long tubular bones are the most common sites of involvement. Osteoblastoma is infrequently seen in other sites, including the bones of hand and foot. A rare case of a 35-year-old man that presented an osteoblastoma of the cuboid bone is reported. The patient was treated with surgical resection and grafting. After the intervention, the patient recovered with no clinical and radiological evidence of recurrence after one year of follow-up. Several cases of osteoblastoma-like variant of osteosarcoma of the cuboid have been previously reported, but, to our knowledge, this is the first case of conventional and isolated osteoblastoma involving the cuboid bone reported in the literature.

Continuous Femoral Catheter for Postoperative Analgesia After Total Knee Arthroplasty.

INTRODUCTION: Postoperative pain management in the total knee replacement (TKR) represent a fundamental step for a positive outcome, allowing rapid mobilization, already on the first day. Further, continuous peripheral nerve block techniques have been reported to allow effective and safe control of acute postoperative pain, ensuring the implementation and completion of an accurate and intensive joint rehabilitation program. AIM: The aim of this study was to assess early mobility and compliance of patients that underwent TKR surgery using the femoral block. METHODS: For the study, all patients that underwent TKR from 2015 to 2018 with ASA score between II-III was evaluated. Patients underwent vital parameters monitoring and were treated initially with midazolam (0.05mg / kg) e.v. combined sciatic block + femoral perineural catheter positioning using a peripheral nerve stimulation-assisted technique. RESULTS: Intraoperatively, satisfactory analgesia was guaranteed in all patients, associated with a complete muscle relaxation of the affected limb. High patient compliance, associated with good control of acute postoperative pain was obtained in the first 24 hours after surgery (VAS 0- 1). The ROM outcomes were good in all rehabilitation stages, managing to reach 90 degrees bending on the seventh day with an average KSS score of 88-90. Patient satisfaction and impact on quality of life were assessed with the SF-36 showing average scores of 78. CONCLUSION: Continuous femoral nerve blocking ensures good postoperative analgesia in TKR allowing an early joint mobilization, a rapid functional recovery of the knee and increasing patient compliance during the post-operative rehabilitation program.

What's the resolutive surgery for pseudo-ainhum in Vohwinkel syndrome? A case report and review of the literature.

Vohwinkel Syndrome, also known as Keratoderma Hereditarium Mutilans, is an extremely rare dominant autosomal keratosis. It typically presents with "starfish" keratoses on the knuckles, palmoplantar keratoderma (PPK), hearing impairment and mutilating digital constriction bands (pseudoainhum) that cause strangulation, often leading to autoamputation of the affected digit. Both medical and surgical treatment haven't shown to date consistent results, in the treatment of pseudoainhum. In this study we present the case of a woman with Vohwinkel syndrome who showed constriction bands causing ischemic changes of the 5th digit of the right hand for which she was treated with surgery. We also present a review of the literature for the management of this disease.