The Incidence of Screw Failure in Fenestrated Polyaxial Pedicle Screws vs. Conventional Pedicle Screws in the Treatment of Adolescent Idiopathic Scoliosis (AIS).

Background: Adolescent idiopathic scoliosis (AIS) is a spinal pathology affecting 0.47-5.2% of the population, often requiring surgical intervention to control deformity progression. Posterior spinal instrumentation and fusion with pedicle screw fixation are standard procedures for AIS curve correction; however, implant failure remains a significant complication, especially in multi-level fusions. This retrospective cohort study aims to compare the failure rates between conventional pedicle screws (CPSs) and fenestrated pedicle screws (FPSs) in AIS treatment, with a focus on investigating potential causes of these failures. Methods: This study, conducted from January 2016 to December 2020, involves a two-center retrospective analysis of AIS patients undergoing posterior instrumented fusion. Results: Data from a total of 162 patients (122 females and 40 males) revealed a mean age of 14.95 years (range: 11-18). The CPS group consisted of 80 patients (56 females and 24 males), whereas the FPS group consisted of 82 patients (66 females and 16 males) stratified by Risser grade and Lenke Classification. Radiological assessments, clinical outcomes, and SRS-22 scores were evaluated pre-operatively, at 6 months, and post-operatively (minimum follow-up of 2 years). Conclusions: Fenestrated pedicle screws (FPSs) pose concerns due to their lower mechanical strength compared to solid screws. Understanding their limitations and optimizing their application in AIS treatment is essential.

Tibiotalocalcaneal arthrodesis in a rare case of tuberculosis of the talus.

Aim To assess our personal experience of a case of tuberculosis of the talus, and to provide an overview of the literature about the tuberculosis manifestations, including all its aspects: epidemiology, clinical and imaging presentation, and all the treatments available to the current state of knowledge. Methods We present our experience in a case of a 34-year-old patient, who came to our attention with difficulty in walking and pain due to a talar tuberculosis, with consequent bone disruption and reabsorption, and foot deformities. Results A tibiotalocalcaneal arthrodesis with retrograde nail and bone graft was performed after antibiotic therapy. Today, almost two years after the treatment, the patient can walk independently with no major limitations in everyday life. Conclusion Tibiotalocalcaneal arthrodesis with bone graft showed good functional results in this case study, with complete graft fusion and good functional and radiological outcomes.

Retro-Malleolar Z-Plasty of Flexor Hallucis Longus Tendon in Post-Traumatic Checkrein Deformity: A Case Series and Literature Review.

Checkrein deformity (CD) is a dynamic deformity of the hallux characterized by flexion contracture of the interphalangeal (IF) joint and extension contracture of the metatarsophalangeal (MTP) joint, worsened by ankle dorsiflexion. It is due to post-traumatic or ischemic retraction of the long hallux flexor tendon (FHL) following soft tissue trauma, leg fractures, ankle fractures and, more rarely, calcaneal or talar fractures. Diagnosis is essentially clinical, associated with imaging, to rule out unrecognized causes and evaluate fracture healing process. Few cases are reported in literature without univocal treatment. Background and Objectives: To analyze clinical and functional outcomes in patients with CD treated with release and retro-malleolar Z-plasty lengthening of FHL tendon. Materials and Methods: Patients diagnosed with CD treated with retro-malleolar (at tarsal tunnel) Z-plasty lengthening of the FHL tendon between January 2016 and August 2020 were included. Clinical and functional outcomes were collected on admission and post-surgery and analysed retrospectively. Patients with a minimum follow-up of 18 months were included. Results: A total of 14 patients, with mean age of 37.4 years old, with CD diagnosis were included in the study. All patients were suffering from post-traumatic CD and the mean time from trauma to onset of deformity was of 7 months (range 1−12). At a mean follow-up of 31.8 months (range 18−48) we found a significant improvement (p < 0.05) in terms of pain relief (VAS), function (AOFAS score) and ROM of the IP and MTP hallux joints. No recurrence, loss of strength, nerve injury or tarsal tunnel syndrome were observed. No patient required revision surgery. Conclusions: In this case series the retro-malleolar FHL tendon Z-plasty proved to be a suitable option for CD correction, allowing a good clinical and functional recovery.

Antibiotic-Coated Nail in Open Tibial Fracture: A Retrospective Case Series.

Implant-associated infections still represent one of the main problems in treatment of open fracture. The role of systemic antibiotic prophylaxis is now agreed and accepted; however, recent literature seems to underline the importance of local antibiotic therapy at the fracture site, and antibiotic nails have been shown to play a role in the treatment of open fractures in terms of fracture healing and lower risk of infection. We retrospectively analyzed our results, from January 2016 to March 2020, with the use of coated nails in the treatment of open tibial fractures, evaluating the rates of infection and fracture healing as primary outcomes and the rate of reoperations, time from trauma to nailing and hospital stay as secondary outcomes. Thirty-eight patients treated with coated nail (ETN ProtectTM, Synthes) were included in the study. Minimum follow-up was of 18 months. Thirty-four of 38 patients achieved bone union and 2 patients underwent septic non-union. In our series, no systemic toxicity or local hypersensitivity to antibiotics were recorded. From this study, use of antibiotic-coated nails appears to be a valid and safe option for treatment of open tibial fractures and prevention of implant-related infections, particularly in tibial fractures with severe soft tissue exposure and impairment.

Uncoated vs. Antibiotic-Coated Tibia Nail in Open Diaphyseal Tibial Fracture (42 according to AO Classification): A Single Center Experience.

Implant-associated infections remain one of the main problems in the treatment of open tibia fractures. The role of systemic antibiotic prophylaxis is now agreed and accepted; nevertheless, recent literature also seems to emphasize the importance of local antibiotic therapy at the fracture site. Several therapeutic strategies have been proposed to overcome this new need. Antibiotic-coated nails play crucial role in this, allowing both infection prevention and favoring the fracture stabilization. We describe the outcome of patients with open diaphyseal tibia fracture treated either with a standard uncoated nail or a gentamicin-coated nail from January 2016 to December 2018 at our second level emergency-urgency department. Primary outcomes were infection rate and bone union rate. Other outcomes reported are reoperation rate, time between injury and nailing, and safety of antibiotic nail. Numerical variables were tabulated using mean, standard deviation, minimum, maximum, and number of observations. Categorical variables were tabulated using number of observations. 23 patients treated with uncoated nail and 23 patients treated with antibiotic-coated tibia nail were included in the study and were evaluated for a minimum follow-up of 18 months. Among the 46 patients, 9 were Gustilo-Anderson type I, 21 type II, and 16 type III open fracture. Regarding the bone healing rate at 12 months, 16 fractures in the first group and 18 in the second were completely healed. 4 infections were found in the first group (3 superficial surgical site infection and 1 osteomyelitis) and 3 superficial infections in the second one. No adverse events have been recorded with antibiotic-coated nails. In this unicentric retrospective study observed no deep wound infections and good fracture healing in the use of antibiotic-coated nails. Antibiotic nails have been shown to play a role in the treatment of fractures in critically ill patients with severe soft tissue damage.