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BACKGROUND: Proximal humeral fractures (PHFs) are still controversial with regards to treatment and are difficult to classify. The study's objective is to show that preoperative planning performed while handling a three-dimensional (3D) printed anatomical model of the fracture can ensure a better understanding of trauma for both surgeons and patients. MATERIALS AND METHODS: Twenty patients (group A, cases) with complex PHF were evaluated preoperatively by reproducing life-size, full-touch 3D anatomical models. Intraoperative blood loss, radiographic controls, duration of surgery, and clinical outcomes of patients in group A were compared with 20 patients (group B, controls) who underwent standard preoperative evaluation. Additionally, senior surgeons and residents, as well as group A patients, answered a questionnaire to evaluate innovative preoperative planning and patient compliance. Cost analysis was evaluated. RESULTS: Intraoperative radiography controls and length of operation were significantly shorter in group A. There were no differences in clinical outcomes or blood loss. Patients claim a better understanding of the trauma suffered and the proposed treatment. Surgeons assert that the planning of the definitive operation with 3D models has had a good impact. The development of this tool has been well received by the residents. The surgery was reduced in length by 15%, resulting in savings of about EUR 400 for each intervention. CONCLUSIONS: Fewer intraoperative radiography checks, shorter surgeries, and better patient compliance reduce radiation exposure for patients and healthcare staff, enhance surgical outcomes while reducing expenses, and lower the risk of medicolegal claims. LEVEL OF EVIDENCE: Level I, prospective randomized case-control study.
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Satisfação do Paciente , Fraturas do Ombro , Humanos , Estudos de Casos e Controles , Duração da Cirurgia , Estudos Prospectivos , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Fixação Interna de Fraturas/métodos , Custos e Análise de CustoRESUMO
INTRODUCTION: Acetabular revision surgery is the most challenging aspect in hip prosthetic. There is lack of consensus on the optimal method of reconstructing the acetabular defects. The aim of this systematic review is to take stock of the state of the art on the options available and highlight which type of construct is the most reliable in usual clinical practice. MATERIAL AND METHODS: The reporting of this systematic review was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 Statement.Electronic search of MEDLINE was performed from 1991 up to April 2021 to identify relevant studies for this review. Discussion: various surgical techniques have been adopted and proposed to treat acetabular bone defects: cemented cups, large-sized non-cemented acetabular cups, higher positioned cups, reinforcement rings, cage, oblong cups, custom triflange implants, high porous metal cups and augments. Bone defect defines the type of components to be implanted and among those, outcomes are various depending on the study taken into account, the component used and the degree of initial bone defect. CONCLUSIONS: In acetabular revision surgerythe use of TM cups and augment is a valid option in presence of major bone loss and pelvic discontinuities. In clinical practice the use of TM components replaced rings, while the cup-cage implant replaced conventional cages. TM augments and cups can be considered as the most promising technique in the reconstruction of wide acetabular defects, while the use of cages can be considered as a valid option in the elderly population.
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The anterior hip approach is a procedure with increasing popularity in hip replacement surgery due to its many benefits and the number of surgeons using it is steadily increasing around the world. Less pain, better results in the first few weeks, reduced dislocation rate are the prerogatives of this approach. We analyzed in a group of 26 patients the use of a soft tissue retractor, Alexis Orthopedic Protector, the CPK values in the first third and fifth postoperative day. The results obtained, normalized, demonstrate a slight reduction in tissue damage using the device compared to a control group. In addition to blood values, improved exposure, distribution of leverage, cleanliness of the field and a potential reduction in infectious risk are advantages for the use of an orthopedic surgery retractor. We believe that the adoption of the Alexis Orthopedic Protector provides numerous improvements during the hip arthroplasty surgical procedure, especially when adopting the direct anterior approach, because it distributes the traction forces around the surgical path resulting in greater visibility. However, the small number of patients is not sufficient to perform an accurate statistical analysis and further studies on larger samples will be required.
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The implantation of short femoral stems has significantly increased over the past decade, thanks to their preservation of bone stock, allowing for easier potential revision of components and physiological joint reconstruction. Their main features are metaphyseal fixation and partial retention of the femoral neck which lead to biomechanical advantages and high stability. They also guarantee the preservation of bone stock and insertion through minimally invasive approaches. Fifty-one non-consecutive patients with osteoarthritis or avascular necrosis were treated by two senior surgeons with total hip arthroplasty (THA) with anterior or anterolateral approach between April 2013 and October 2016. Cementless short femoral stem monobloc (Minihip, Corin, Cirencester, UK) was implanted in all patients who were studied retrospectively. Radiographic outcome was analyzed and clinical outcomes were assessed with Harris Hip Score (HHS), Hip handicap and Osteaorthritis Outcome Score (HOOS) and Oxford Hip Score (OHS). Based on radiological results we did not find periprosthetic osteolysis while bone resorption was evaluated in 5 implants which were classified according to Gruen. The MiniHip stem demonstrates adequate metaphyseal grip, excellent implant stability to ensure implant survival.
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Artroplastia de Quadril , Prótese de Quadril , Artroplastia de Quadril/efeitos adversos , Seguimentos , Articulação do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Humanos , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Vascular injuries during hip revision surgery can be life-threatening complications for patients. There are many aspects to consider when approaching this type of surgery for an optimal diagnostic and therapeutic strategy, as a careful planning with extensive preoperative investigations, a full attention during the surgical procedure and the use of suitable material for a proper treatment. This kind of surgery can require a dedicated and trained multidisciplinary team. We report a case of an acute intraoperative vascular lesion during an acetabular revision performed in a 55-years-old patient.
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Artroplastia de Quadril , Prótese de Quadril , Acetábulo/cirurgia , Artroplastia de Quadril/efeitos adversos , Humanos , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. AIM: To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF. METHODS: A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra- and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. RESULTS: A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics). CONCLUSION: These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.
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Serviços de Saúde para Idosos , Fraturas do Quadril , Idoso , Consenso , Geriatras , Fraturas do Quadril/cirurgia , Humanos , ItáliaRESUMO
Cigarette smoking has a negative impact on the skeletal system, as it reduces bone mass and increases fracture risk through its direct or indirect effects on bone remodeling. Recent evidence demonstrates that smoking causes an imbalance in bone turnover, making bone vulnerable to osteoporosis and fragility fractures. Moreover, cigarette smoking is known to have deleterious effects on fracture healing, as a positive correlation between the daily number of cigarettes smoked and years of exposure has been shown, even though the underlying mechanisms are not fully understood. It is also well known that smoking causes several medical/surgical complications responsible for longer hospital stays and a consequent increase in the consumption of resources. Smoking cessation is, therefore, highly advisable to prevent the onset of bone metabolic disease. However, even with cessation, some of the consequences appear to continue for decades afterwards. Based on this evidence, the aim of our review was to evaluate the impact of smoking on the skeletal system, especially on bone fractures, and to identify the pathophysiological mechanisms responsible for the impairment of fracture healing. Since smoking is a major public health concern, understanding the association between cigarette smoking and the occurrence of bone disease is necessary in order to identify potential new targets for intervention.
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Osso e Ossos/efeitos dos fármacos , Fumar/efeitos adversos , Animais , Consolidação da Fratura/efeitos dos fármacos , Fraturas Ósseas/etiologia , Humanos , Nicotina/efeitos adversos , Agonistas Nicotínicos/efeitos adversos , Abandono do Hábito de FumarRESUMO
Background: From 10 March up until 3 May 2020 in Northern Italy, the SARS-CoV-2 spread was not contained; disaster triage was adopted. The aim of the present study is to assess the impact of the COVID-19-pandemic on the Orthopedic and Trauma departments, focusing on: hospital reorganization (flexibility, workload, prevalence of COVID-19/SARS-CoV-2, standards of care); effects on staff; subjective orthopedic perception of the pandemic. Material and Methods: Data regarding 1390 patients and 323 surgeons were retrieved from a retrospective multicentric database, involving 14 major hospitals. The subjective directors' viewpoints regarding the economic consequences, communication with the government, hospital administration and other departments were collected. Results: Surgical procedures dropped by 73%, compared to 2019, elective surgery was interrupted. Forty percent of patients were screened for SARS-CoV-2: 7% with positive results. Seven percent of the patients received medical therapy for COVID-19, and only 48% of these treated patients had positive swab tests. Eleven percent of surgeons developed COVID-19 and 6% were contaminated. Fourteen percent of the staff were redirected daily to COVID units. Communication with the Government was perceived as adequate, whilst communication with medical Authorities was considered barely sufficient. Conclusions: Activity reduction was mandatory; the screening of carriers did not seem to be reliable and urgent activities were performed with a shortage of workers and a slower workflow. A trauma network and dedicated in-hospital paths for COVID-19-patients were created. This experience provided evidence for coordinated responses in order to avoid the propagation of errors.
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COVID-19 , Procedimentos Ortopédicos , Cirurgiões , Humanos , Itália/epidemiologia , Pandemias , Estudos Retrospectivos , SARS-CoV-2RESUMO
BACKGROUND: Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. MATERIALS AND METHODS: Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type of operation and anaesthesia, in-hospital and early complications (Clavien-Dindo Classification, CDC), and length of stay (LOS). Data were analysed by means of descriptive statistics. Out of 1390 patients treated for any reason, 38 PPFs were included. RESULTS: Median age was 81 years (range 70-96 years). Twenty-three patients (60.5%) were swabbed on admission, and two of them (5.3%) tested positive; in three patients (7.9%), the diagnosis of COVID-19 was established on a clinical and radiological basis. Two more patients tested positive post-operatively, and one of them died due to COVID-19. Thirty-three patients (86.8%) presented a proximal femoral PPF. Median ASA Score was 3 (range, 1-4), median VAS score on admission was 3 (range, 0-6), median CFS was 4 (range, 1-8), median EQ-5D-5L Score was 3 in each one of the categories (range, 1-5). Twenty-three patients (60.5%) developed post-operative complications, and median CDC grade was 3 (range, 1-5). The median LOS was 12.8 days (range 2-36 days), and 21 patients (55.3%) were discharged home. CONCLUSIONS: The incidence of PPFs did not seem to change during the lockdown. Patients were mainly elderly with comorbidities, and complications were frequently recorded post-operatively. Despite the difficult period for the healthcare system, hospitals were able to provide effective conventional surgical treatments for PPFs, which were not negatively influenced by the reorganisation. Continued efforts are required to optimise the treatment of these frail patients in the period of the pandemic, minimising the risk of contamination, and to limit the incidence of PPFs in the future. LEVEL OF EVIDENCE: IV.
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COVID-19 , Reestruturação Hospitalar , Controle de Infecções , Pandemias , Fraturas Periprotéticas , Padrão de Cuidado , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/normas , Controle de Doenças Transmissíveis/estatística & dados numéricos , Comorbidade , Feminino , Fragilidade/epidemiologia , Reestruturação Hospitalar/organização & administração , Reestruturação Hospitalar/normas , Reestruturação Hospitalar/estatística & dados numéricos , Humanos , Incidência , Controle de Infecções/métodos , Controle de Infecções/normas , Controle de Infecções/estatística & dados numéricos , Itália/epidemiologia , Masculino , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/normas , Procedimentos Ortopédicos/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Fraturas Periprotéticas/complicações , Fraturas Periprotéticas/epidemiologia , Fraturas Periprotéticas/cirurgia , Fraturas Periprotéticas/terapia , Estudos Retrospectivos , SARS-CoV-2 , Padrão de Cuidado/normas , Padrão de Cuidado/estatística & dados numéricosRESUMO
BACKGROUND: Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1 month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1 month on the basis of type of fracture and type of surgical treatment. MATERIALS AND METHODS: For this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+ group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C- group) were asymptomatic and tested negative for SARS-CoV-2. The two groups were compared for differences in time to surgery, survival rate and complications rate. The follow-up period was 1 month. RESULTS: Of the 1390 patients admitted for acute care for any reason, 477 had a proximal femur fracture; 53 were C+ but only 12/53 were diagnosed as such at admission. The mean age was > 80 years, and the mean American Society of Anesthesiologists (ASA) score was 3 in both groups. There was no substantial difference in time to surgery (on average, 2.3 days for the C+ group and 2.8 for the C- group). As expected, a higher mortality rate was recorded for the C+ group but not associated with the type of hip fracture or treatment. No correlation was found between early treatment (< 48 h to surgery) and better outcome in the C+ group. CONCLUSIONS: Hip fracture in COVID-19-positive patients accounted for 11% of the total. On average, the time to surgery was > 48 h, which reflects the difficulty of maintaining normal workflow during a medical emergency such as the present pandemic and notwithstanding the suspension of non-urgent procedures. Hip fracture was associated with a higher 30-day mortality rate in COVID-19-positive patients than in COVID-19-negative patients. This fact should be considered when communicating with patients and/or their family. Our data suggest no substantial difference in hip fracture management between patients with or without COVID-19 infection. In this sample, the COVID-19-positive patients were generally asymptomatic at admission; therefore, routine screening is recommended. LEVEL OF EVIDENCE: Therapeutic study, level 4.
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COVID-19/epidemiologia , Fraturas do Quadril/mortalidade , Pandemias , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Hospitalização/tendências , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , SARS-CoV-2 , Taxa de Sobrevida/tendências , Fatores de TempoRESUMO
BACKGROUND: Hip fracture (HF) is a burdening health problem in older people. The orthogeriatric approach has been shown to favour functional recovery and reduce mortality, but its implementation in clinical practice cannot rely upon shared management protocols and greatly varies among different healthcare systems. Here, we present the rationale and design of the Italian consensus document on the management of HF in older people. METHODS: A panel of multidisciplinary experts from ten Italian scientific societies involved in the care of HF and including geriatricians, orthopaedics, anaesthesiologists, physiatrists and general practitioners, will join to establish the content validity of a list of statements. A Delphi consensus methodology will be applied to obtain the opinions of the panel and to provide the final recommendations. OBJECTIVES: The document will include indications on the following relevant topics: (1) optimal care path of older subjects with HF; (2) management of comorbidities and pre-operative alteration of physiological parameters; (3) management of selected categories of patients at expected increased risk of adverse outcomes; (4) continuity of care out of hospital; (5) screening and correction of risk factors for HF in older subjects; (6) information and divulgation of shared management strategies. The objective of the consensus will be to inform clinicians, patients, researchers, and health policy makers about the best management strategies for HF in older people and their inherent limitations, thus facilitating communication between stakeholders and promoting the most cost/effective models of care.
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Fraturas do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Consenso , Atenção à Saúde , Fraturas do Quadril/epidemiologia , Humanos , Itália/epidemiologia , Procedimentos Ortopédicos , Recuperação de Função FisiológicaRESUMO
The treatment of chonic large and partial rotator cuff tears represents a common challenge for orthopedic surgeons. Numerous treatments were suggested but the best is still controversial. Into this field the use of an augment for rotator cuff repair aims to protect the tension of the suture in the postoperative phase and to facilitate the biological healing process. In our institution we treated 4 patients (3 males and 1 female) with rotator cuff tear with bio-inductive implant. All patients presented with a postero-superior rotator cuff tear: 3 patients with a type C-III tear according to Snyder classification and 1 patient with partial articular tear with significant degeneration and poor tendon quality (type A-III tear according to Snyder classification). The final outcome is highly satisfying intraoperatively and the postoperative protocol reflects our normal postoperative protocol following to rotator cuff repair. No complications occurred at 6 months follow-up. The use of the bio-inductive implant in the arthroscopic rotator cuff repair resulted easy, rapid and reproducible. Although no current scientific evidences regarding such implants exist, in selected cases and with the correct indications, the use of bio-inductive implant could represent an effective aid and an option in case of complex rotator cuff tears.
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Lesões do Manguito Rotador , Manguito Rotador , Artroscopia , Feminino , Humanos , Masculino , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Ruptura , Resultado do TratamentoRESUMO
BACKGROUND: Modern TKA implants promise to improve functional outcomes, stability, patient satisfaction and operating room efficiency. The purpose of this retrospective study is to evaluate our short-term clinical and radiological results and survival using the ATTUNE Total Knee Replacement System. METHODS: The authors reviewed 228 primary cemented TKAs using ATTUNE Total Knee Replacement System which were implanted between 2014 and 2018 concerning short-term clinical and radiographical outcomes and survival. Clinical evaluation was performed using the Knee injury Osteoarthritis Outcome Score (KOOS), the Oxford Score and a Numeric Rating Scale (NRS) for pain. Radiographic analysis was performed using the Modern Knee Society Score Evaluation System. RESULTS: The means of the clinical results as measured with KOOS score were Pain 82,7, Symptoms 79, ADL 78,3, Sport and recreation 51,8 and QOL 78,6. The mean Oxford score was 35 and NRS 2. The mean ROM was 113,4 (SD 9,4 range 90-130). Radiographically mean mechanical axis was 1,97° of Varus and radiolucent lines were detected in 43 knees (22,4%). The survival rate is 98.4% at 2 years and 97.4% at 5 years. CONCLUSION: At short-term follow-up the ATTUNE Knee Replacement System provide excellent clinical and radiographical outcomes and good results regarding revision rate. Due to high incidence of radiolucent lines, those patients should be closely monitored even though they show no clinical evidence for loosening.
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Artroplastia do Joelho/instrumentação , Prótese do Joelho , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias , Radiografia , Amplitude de Movimento Articular , Estudos RetrospectivosRESUMO
Posterior shoulder fracture-dislocations are rare. A combination of this injury with ipsilateral humeral shaft fracture is an extremely rare event. We report two cases of posterior shoulder fracture-dislocation with ipsilateral fracture shaft of humerus treated in our department. We highlight the rarity of the condition and the potential risk of recognize only the shaft fracture. We emphasize the importance of complete physical and radiological examination (x-rays and CT scan) in such cases to ensure early detection and its subsequent surgical treatment.
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Fratura-Luxação/complicações , Fraturas Múltiplas/complicações , Fraturas do Úmero/complicações , Luxação do Ombro/complicações , Adulto , Fratura-Luxação/cirurgia , Fraturas Múltiplas/cirurgia , Humanos , Fraturas do Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Luxação do Ombro/cirurgiaRESUMO
INTRODUCTION: Periprosthetic femoral fracture represent a severe complication, at present the third cause of revision surgery, with an estimated incidence from 0,1 to 2,1%. The number of these fracture can be expect to increase in line with the aging of population and amount of THA implants also in younger high demanding patients. MATERIALS AND METHODS: The aim of this study is analyze the diagnostic and therapeutic decision making processes performed in 64 patients with periprosthetic fractures treated surgically from January 2012 and October 2016 in our center. We analysed instrumental exams and surgical reports focusing on type of procedure, surgical access, operative time and type of fixation. RESULTS: Average age was 809 years and a mean follow-up 231 months. According to Vancouver system and after X-rays, CT scan and intraoperative evaluation, 26 fractures were classified as type B1, 31 as type B2, 3 type B3 and 4 type C. Follow up results were divided on the basis of the surgical treatment: in ORIF group (23 type B1 fractures and 4 type C fracture) fracture union was obtained in 16 cases (593%) and the final HHS mean value was 6161; in Revision group (3 type B1, 31 type B2 and 3 type B3) bone healing was reported in 26 cases (703%) with mean HHS score of 7194. CONCLUSIONS: In this surgery the objectives are provide an adequate bone healing and return to previous functional status as soon as possible. Many reasons make these goals challenging, in particular advanced age, osteoporosis, co-morbidity and weakness that lead to low energy trauma, the most frequent cause of these injuries. In our opinion a crucial aspect is the evaluation of stem stability, considering an implant mobilized until the opposite is clearly evident. Reduction of surgical time and early mobilization are goals of this surgery, often associated with several complications and high mortality rate.
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Artroplastia de Quadril , Fraturas do Fêmur/diagnóstico , Consolidação da Fratura/fisiologia , Fraturas Periprotéticas/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Reoperação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Placas Ósseas , Feminino , Fraturas do Fêmur/cirurgia , Humanos , Masculino , Fraturas Periprotéticas/classificação , Fraturas Periprotéticas/fisiopatologia , Fraturas Periprotéticas/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Radiografia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Reverse shoulder arthroplasty (rTSA) is a largely used procedure with a wide variety of indications. The incidence of this surgery is increased in recent years and the literature expects similar trend for them future. Metaphyseal stem rTSA seems to be a promising solution considering major objectives the preservation of humeral bone stock and ease of revision. In our study we analyzed 19 patients treated with cementless metaphyseal stem rTSA for osteoarthritis (group A) and acute fractures (group B). In group A (7 patients) the average Constant score improved from 21,57 (16-29) to 56,85 (38-72), the average SST improved from 2,29 (1-4) to 9,43 (8-12) and the mean VAS score improved from 14,29 to 4,86. In group B (12 patients) the mean Constant-Murlay score at last follow up was 42,17; the average SST was 7 and average pain score was 8,92. Overall active range-of-motion (ROM) improved significantly. Surgical considerations, clinical (analyzing Constant score and Simple Shoulder Test) and radiological short-term outcomes are encouraging, with low rate of complications. Long term follow-up studies are necessary to confirm our findings and the potential benefits related to these implants.
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Artroplastia do Ombro/instrumentação , Osteoartrite/cirurgia , Reoperação , Fraturas do Ombro/cirurgia , Prótese de Ombro , Idoso , Cimentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Desenho de Prótese , Amplitude de Movimento Articular , Estudos Retrospectivos , Fraturas do Ombro/diagnóstico por imagem , Resultado do TratamentoRESUMO
Bilateral hip dislocation is a rare event, asymmetric dislocation is even rarer. Due to the intrinsic stability of the hip joint this lesions usually follow a high energy trauma. Because of the common associated lesions, the initial clinical assessment should be performed thoroughly. CT scan rather than x-rays offers a complete survey of these possible associated injuries such as thoracic or abdominal bleedings, neurologic lesions or fractures directly associated with the hips dislocations. The first goal should be reduction of the dislocation to prevent avascular necrosis (AVN) of the femoral head and arthritis. We report a case of a young man with right anterior hip dislocation and left posterior hip dislocation with associated fracture of the posterior wall.
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Fixação Interna de Fraturas , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/cirurgia , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Luxação do Quadril/etiologia , Fraturas do Quadril/etiologia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
BACKGROUND: Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. METHODS: The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. RESULTS: 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r = 0.63 (p < 0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. CONCLUSIONS: This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings.
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Consolidação da Fratura/fisiologia , Tíbia/fisiopatologia , Tíbia/cirurgia , Fraturas da Tíbia/fisiopatologia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteogênese/fisiologia , Estudos Prospectivos , Reprodutibilidade dos Testes , Resultado do Tratamento , Adulto JovemRESUMO
Total knee arthroplasty (TKA) is the treatment of choice for end-stage osteoarthritis of the knee. The aging of population and the need to maintain high quality of life have increased the demand for TKA. Although considered a successful procedure, 15-30% of patients presenting persistent pain. The management of these patients requires a clinical, laboratory and radiological assessment in order to address the underlying aetiology. There are several causes of pain, divided in joint and non-joint related, which should be diagnosed and treated promptly. Patients with unexplained pain should be treated conservatively since a plausible reason has been identified.
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Artroplastia do Joelho/efeitos adversos , Osteoartrite do Joelho/cirurgia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/terapia , Humanos , Osteoartrite do Joelho/complicações , Dor Pós-Operatória/etiologiaRESUMO
Patellar instability is one of the most common conditions treated in the field of orthopedics. A diagnosis based on clinical and instrumental tests allows proper treatment planning. The techniques at the disposal of the surgeon - arthroscopic, arthroscopically-assisted and open - are numerous, and extensor mechanism realignment procedures are among the ones most frequently used. The choice of the most appropriate technique must be made case by case, considering the peculiarities of the individual patient.