Periprosthetic acetabular fractures: A New classification proposal.

INTRODUCTION: Acetabulum periprosthetic fractures are rare, but are increasing, due to increase in high-energy trauma and a decrease in mortality index. Reconstruction of an acetabular fracture, in the presence of hip arthroplasty can be very complex and represents a real challenge for orthopedic surgeon. Aim of this multicentric study is to classify periprosthetic acetabulum fractures and to propose a treatment algorithm. MATERIALS AND METHODS: 24 cases of acetabular periprosthetic fracture were treated surgically from 01.01.2010 to 31.04.2017 in three different hospitals; 4 males and 20 females, average age 76 years (range 56-90 years). TREATMENT: 4 cases treated conservatively, 8 cases ORIF, 2 cases treated with acetabular ring and screws, 9 cases ORIF and acetabular cup revision, 1 implant removal without revision. RESULTS: All cases were reviewed at minimum 12 months follow-up. In 22 cases, there was no need for new surgical procedures and radiographically all implants appeared stable and with good bone integration. In a case of a type 1b fracture, a dislocation of prosthetic implant was observed after 3 months. In a case prosthesis was explanted and it was not possible to perform a revision. DISCUSSION AND CONCLUSIONS: Fracture classification systems must facilitate communication between surgeons and encourage documentation and research. However, they should also have prognostic value, so from them should come directly a treatment algorithm. In our experience, most important factors as prognostic and therapeutic predictors were: implant stability and timing of fracture: intraoperative or postoperative. In postoperative fractures CT is mandatory to evaluate cup mobilization and fracture patterns. Our classification proposal is simple and easy to remember for daily use. From it is derived a simple treatment plan.

[Granular cell myoblastoma (apropos of a case with bilateral localization in the thigh)]. / Mioblastoma granulo-cellulare (A proposito di un caso con localizzazione bilaterale alla coscia.

Granulo-cellular myoblastoma (MGC) is a rare disease, the nature of which is still discussed and uncertain. The authors describe a particular case with bilateral location at thigh in a patient suffering also from pigmental villonodular tenosynovitis (TSVNP) at the right thumb. This observation confirms the absolute benignancy, and supports the theory of the non-neoplastic histogenesis of MGC.

[The treatment of medical fractures of the femoral neck]. / Il trattamento delle fratture mediali del collo del femore.

It is first stressed that medial fractures of the femur neck pose therapeutic and prognostic problems linked above all to biological factors. After reference to the criteria of classification adopted by Linton and Pauwels, the need to adopt fixed parameters in establishing the surgical indication is then asserted. These parameters are the patient's age, understood not only as number of years but also as general and psychic state, and the obliquity of the fracture line or its degree of decomposition. The Authors conclude by establishing four theorectical groups of patients and indicating the treatment they adopted for each group.

[Limits of prosthetic restoration of the hip joint and possibilities of recovery in failures]. / Limiti della protesizzazione dell'anca e possibilita' di recupero negli insuccessi.

The Authors report on treatment of patients with total prosthesis of the hip, in whom mobilisation of the prosthesis or one or both its components has occurred. In particular, stress is put on the results of the operation of removal of the prosthesis, which finds its major indications in cases of acute or remote, deep sepsis, and in case of aseptic mobilisation when the theoretical presuppositions allowing its substitution do not exist.

[Treatment of supracondyloid fractures of the femur with Judet's bone plate and screws]. / Il trattamento delle fratture sovracondiloidee del femore con la vite-placca di Judet.

Severe fractures of the distal end of the femur, which have become increasingly numerous as a result of the multiplication of road accidents, frequently require surgical treatment. The Authors, updating to 1979 the cases of the "G. Pini" Orthopedic Institute in the field of Judet's screw-plate, document the validity of this means of synthesis as confirmed by the quality of the results.