II Italian intersociety consensus statement on antithrombotic prophylaxis in orthopaedics and traumatology: arthroscopy, traumatology, leg immobilization, minor orthopaedic procedures and spine surgery.

Pharmacological prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, but few data exist in other fields of orthopaedics and traumatology. Thus, no guidelines or recommendations are available in the literature except for a limited number of weak statements about knee arthroscopy and lower limb fractures. In any case, none of them are a multidisciplinary effort as the one here presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the Association of Orthopaedic Traumatology of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and the Italian Society of General Medicine (SIMG) have set down easy and quick suggestions for VTE prophylaxis in a number of surgical conditions for which only scarce evidence is available. This inter-society consensus statement aims at simplifying the approach to VTE prophylaxis in the single patient with the goal to improve its clinical application.

[Release of metals from metal-on-metal hip prostheses]. / Rilascio di metalli da protesi d'anca metallo-su-metallo.

The present study examined blood and urinary concentrations of Cr and Co in 30 patients with metal-on-metal hip prostheses without signs of wear and 6 patients with prosthetic bearing and clear signs of wear and metallosis. The determination in biological fluids showed in patients with not signs of wear the geometric mean concentration of metals only modestly increased (CoS 0.5 microg/l, CoU 5.7 microg/l, CrS 0.8 microg/l, CrU 3.4 microg/l) compared to the reference values, while the wear caused a significant increase in the concentration of both Co (CoS 94.6 microg/l, CoU 334.5 microg/l) and Cr (CrS 57.7 microg/l, CrU 89.4 microg/I). As the results, the not functioning implants are a risks to the patients and are associated with high levels of metals in biological fluids. Currently, the patients with metallosis had not signs and symptoms associated with metal toxicity, but high concentrations could to cause kidney, peripheral nervous system, heart, and thyroid damage.

Italian intersociety consensus statement on antithrombotic prophylaxis in hip and knee replacement and in femoral neck fracture surgery.

Anticoagulant prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures (FNF). Different guidelines are available in the literature, with quite different recommendations. None of them is a multidisciplinary effort as the one presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the association of Orthopaedists and Traumatologists of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) have set down easy and quick suggestions for VTE prophylaxis in hip and knee surgery as well as in FNF treatment. This inter-society consensus statement aims at simplifying the grading system reported in the literature, and its goal is to benefit its clinical application. Special focus is given to fragile patients, those with high bleeding risk, and those receiving chronic antiplatelet (APT) and vitamin K antagonists treatment. A special chapter is dedicated to regional anaesthesia and VTE prophylaxis.

[Diagnostic support of arthrographic study in recent sprains of the ankle]. / Apporto diagnostico dell'indagine artrografica nelle distorsioni recenti di tibio-tarsica.

The Authors assert, through the valuation of forty recent cases of ankle injury, submitted to the arthrographic research, the validity of such method for the valuation of ligament injuries and for the topographic orientation of the same injuries.

II Italian intersociety consensus statement on antithrombotic prophylaxis in orthopedics and traumatology.

Pharmacological prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, but few data exist to its regard in other fields of orthopedics and traumatology. Indeed, no guidelines or recommendations are available in the literature, except for a limited number of weak statements about knee arthroscopy and lower limb fractures. The present paper represents the first multidisciplinary effort to provide suggestions on the prophylaxis of VTE in the remaining fields of orthopedic surgery (minor orthopedic surgery and orthopedic trauma). The Italian Society for Studies on Hemostasis and Thrombosis (SISET), the Italian Society of Orthopedics and Traumatology (SIOT) and the association of Orthopedic Traumatology of Italian Hospitals (OTODI) together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and the Italian Society of General Medicine (SIMG) have set down quick and easy suggestions for VTE prophylaxis in a number of surgical conditions for which only scarce evidence is available. This inter-society consensus statement aims at simplifying the approach to VTE prophylaxis in the single patient with the goal of improving its clinical application.

Italian intersociety consensus statement on antithrombotic prophylaxis in hip and knee replacement and in femoral neck fracture surgery.

Anticoagulant prophylaxis for preventing venous thrombembolism (VTE) is a worldwide established procedure in hip (HR) and knee replacement (KR) surgery, as well as in the treatment of femoral neck fractures (FNF). Different guidelines are available in the literature, with quite different recommendations. None of them is a multidisciplinary effort as the one presented. The Italian Society for Studies on Hemostasis and Thrombosis, the Italian Society of Orthopedics and Traumatology, the association of Orthopedic Traumatology of Italian Hospitals, together with the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care have set down easy and quick suggestions for VTE prophylaxis in HR and KR surgery as well as in FNF treatment. This inter-society consensus statement aims at simplifying the grading system reported in the literature, and thus at improving its proper application. Special focus is given to fragile patients, those with high bleeding risk, and on those receiving chronic antiplatelet and vitamin K antagonists treatment. A special chapter is dedicated to regional anesthesia and VTE prophylaxis.

Tibial plateau fractures: internal fixation with locking plates and the MIPO technique.

Proximal tibial fractures are difficult lesions to treat because of the involvement of the articular surface, the often occurring comminution, and the precarious condition of the soft tissues, especially following high-energy trauma. Aim of the treatment is to restore the congruence of the articular surface supporting the tibial plateau cartilage which is usually depressed; to fix the fracture with a stable device; to allow early rehabilitation. We present our treatment strategy, utilising closed or open reduction and internal fixation, angle-stable polyaxial plates, immediate osteointegration, when necessary, with autologous bone graft or other osteoconductive material augmented with autologous platelet gel. Surgery is soft-tissue dependent in terms of timing, and it is usually performed directly or under supervision of an experienced surgeon utilising, whenever possible, a tissue sparing technique. A cohort of 58 proximal tibial fractures, surgically treated, from January 2004 to June 2007, was retrospectively reviewed. Fractures were classified according the OTA/AO classification. The assessment of the functional outcome with the use of the Rasmussen score identified good to excellent results in 78% of the cohort 12 months post-surgery. Internal fixation with locking plates, following the principles of MIPO (Minimally Invasive Percutaneous Osteosynthesis), provides satisfactory fracture reduction with good results regarding the mid-term clinical outcome.

Growth disturbances following fractures of the femur and tibia in children.

The authors reviewed 477 diaphyseal fractures of the long bones in the lower limbs of children between the ages of one to 11 years treated at our Institute between 1976 and 1982. The objective was to evaluate the incidence and extent of post fracture lengthening and its possible relationship to the method of treatment. The amount of lengthening observed never exceeded 2 cms. and this always occurred in the early months after injury and then ceased. There was no statistical relationship with the method of treatment or with the type of fracture. For any valid assessment of such statistics, however, it would be necessary first to know the incidence of lower limb dysmetria in a similar group of normal children who had not sustained fractures.

The functional method of treatment in nonunion of fractures of the lower limb in which other methods have failed.

In the light of experience in the treatment of lower limb fractures with the functional method (plaster and orthoses), the authors applied this method in cases of nonunion which had failed to respond to other types of treatment. The excellent results obtained showed that the functional method may succeed in such cases.

Static-dynamic intramedullary nailing (SDIN) in diaphyseal and metaphyseal lower limb fractures.

The authors report their experience with the Grosse-Kempf nail in treatment of diaphyseal and metaphyseal fractures of the femur and tibia. The biological and biomechanical preconditions of the method as well as several details of the surgical technique are discussed, and the results of 70 procedures performed from 1986 to 1989 are evaluated. The outcomes are quite positive and confirm other reports in the literature.