Isolated, displaced, talar body fracture: a case report and literature review.

Talar body fractures are uncommon fractures of the foot and its management results to be very hard due to retrograde vascularization and wide articular cartilage coverage of talar surface, which could easily lead to poor functional outcomes, avascular osteonecrosis and early post traumatic arthritis. We describe a case of displaced, vertical, talar body fracture in a 41-year-old patient treated with reduction and fixation by talar anteromedial approach coupled to medial malleolar osteotomy to better expose the fracture. Our literature review has found few studies, in addition with a low level of statistical evidence. We advocate for more studies with a bigger sample and with a design of randomized control trials.

Total hip arthroplasty and Paget's disease: case report and literature review.

Paget's disease (PDB) is a chronic osteopathy more common in male, Caucasic, European population, after the age of 50 years, that can lead to bone deformities. A challenging surgical solution for affected hip with severe hip osteoarthritis is total hip replacement (THA). We describe a case of THA in a 71-year-old patient with PDB and we present a literature review. In particular we find out that more studies comparing cementless THA with cemented one are necessary, in order to understand if one implant is better than the other.

Traumatic acute stem rupture in stress shielding bone resorption of a bipolar radial head arthroplasty: case report and literature review.

Bone resorption around the proximal portion of the stem of a radial head prosthesis is a frequent phenomenon. In the vast majority of cases it is not correlated with to be without clinical manifestations.  This radiographic sign, refers to the stress shielding effect has been more described in total hip replacement surgery. Few authors have noticed this phenomenon in radial head replacement. however, given the increasing number of these procedures, a careful surveillance is required in patients presenting this sign. We report a literature review and a case presentation of proximal stem rupture following a trauma in association to radiological periprosthetic bone resorption due to stress shielding and treated with revision surgery.

The Charcot Knee Arthropaty: The Diagnostic and Surgical Challenge. A Case of Syphilis Arthropaty and a Review of Literature.

The Charcot knee is a progressive, degenerative disease of the joint that may represent a diagnostic challenge; at the moment, poorly controlled diabetes mellitus is the main cause of this condition. We describe here a case of a man presenting with an end stage joint arthropathy who was diagnosed with neurosyphilis. Tabetic arthropathy is currently a very rare disease, but in the past represented the main cause of joint arthropathy. Finally, we discussed the different surgical options of Charcot arthropathy, our choice of megaprosthesis implant and the failure of such procedure mainly due to patient's unreliability to care leading to infective complications and peri-prosthesis fracture.

Lisfranc injuries in adolescents: A case report and literature review.

Lisfranc injuries result if bones or ligaments that support the midfoot are torn. In children and adolescents these injuries are not only rare, but are also similar to adult Lisfranc injuries, in that they are often mistaken especially if the injury is a result of a straightforward twist and fall. The goal of surgical treatment is to realign the joints. However, few studies related to Lisfranc injuries in pediatric patients exist. A case of 15 years old patient treated using an Arthrex mini tight rope is described.

Intertrochanteric hip fracture in an arthrodesed hip treated by a LCP condylar plate.

We report the case of an intertrochanteric hip fracture in a 73 years-old woman with a long-standing arthrodesis. The proper surgical treatment is controversial but we decided to treat the fracture with a single LCP condylar plate turned upside-down. After one year the patient achieved her preinjury levels of activities. This kind of fracture could be satisfactorily treated with locking plate.

Efficacy of a single intra-articular injection of ultra-high molecular weight hyaluronic acid for hip osteoarthritis: a randomized controlled study.

BACKGROUND: Viscosupplementation with hyaluronic acid (HA) is increasingly used for the treatment of hip osteoarthritis (OA). The purpose of this study was to compare the efficacy of intra-articular injections of an ultra-high molecular weight viscosupplement (UHMW-HA, Fermathron S) with a medium molecular weight hyaluronan (MMW-HA, Hyalubrix 60) in hip OA. METHODS: Fifty-four patients with hip OA grade 3 on the Kellgren/Lawrence scale were randomized. All infiltrations were performed under ultrasound guidance. Evaluation was performed preoperatively and at 1, 3, 6 and 12 months after infiltration. Patients were clinically evaluated using Lequesne index, VAS and WOMAC score. RESULTS: Fifty patients, including 27 in the MMW-HA group and 23 in the UHMW-HA group, completed the follow-up. No significant difference was found between the two groups in terms of VAS, WOMAC or Lequesne index preoperatively or at 1, 3, 6 and 12 months after viscosupplementation. A stratified analysis was performed to study the development over time of Lequesne index of patients aged ≤ 55 years, > 55 and, ≤ 70 years and > 70 years and Lequesne index was different between the three age-stratified subgroups only in the MMW-HA group. The subgroup of older patients showed a higher Lequesne index than the subgroups of younger patients (p < 0.05). CONCLUSIONS: UHMW-HA is a safe and effective treatment for hip osteoarthritis. A single dose of UHMW-HA was as effective as two doses of MMW-HA resulting in similar reductions of pain and disability. STUDY DESIGN: Multicenter, independent, prospective, randomized controlled trial with level of evidence 1.

Early results for treatment of two- and three-part fractures of the proximal humerus using Contours PHP (proximal humeral plate).

BACKGROUND AND AIM OF THE WORK: The management of displaced 2- and 3-part fractures of the proximal humerus is controversial, both in younger and in elderly patients. The purpose of this paper is to evaluate the functional results of the Contours Proximal Humerus Plate (OrthofixR, Bussolengo,Verona, Italy), for the treatment of displaced 2- and 3-part fractures of the proximal humerus. METHODS: We retrospectively reviewed 55 patients with proximal humerus fractures, who underwent osteosynthesis with Contours Proximal Humerus Plate from December 2011 to March 2015. We had 21 patients with 2-part fractures and with an average age of 67.1 years and 34 patients with 3-part fractures, with average age of 63.6 years. RESULTS: The average union time was 3 months. The mean Constant score was 67 for 2-part fracture group and 64.9 for 3-part fracture group. The difference was not statistically significant (p = 0.18). The overall complication rate was 14.5 %. Six patients underwent additional surgery (10.9%). CONCLUSIONS: The most frequent major complication was secondary loss of reduction following varus collapse of the fracture (2 cases). In these patients, there was loss of medial hinge integrity due to impaction and osteoporosis. The placement of the main locking screw in the calcar area to provide inferomedial support is the rational of the Contours Proximal Humerus Plate. Osteosynthesis with Contours Proximal Humerus Plate is a safe system for treating displaced 2- and 3-part fractures of the proximal humerus, with good functional results and complication rates comparable to those reported in the literature.