Degenerative lesion of the extensor tendon V finger: Ultrasound imaging in diagnosis and therapeutic possibilities.

Traumatic injuries of the extensor tendons of the hand are common and are more frequent predisposed to tendon injuries due to the presence of chronic tendon damage. We present the case of a 61-year-old woman, tailor by profession, who showed acute rupture (80 %) with degenerative etiology of the extensor tendon of the V finger of the fifth level according to Kleinert and Verdan classification.

Radiographic and functional outcome of complex acetabular fractures: implications of open reduction in spinopelvic balance, gait and quality of life.

Aim To investigate the effects of surgical reduction of complex acetabular fractures on spine balance, postural stability and quality of life. Methods Twenty-six patients with acetabular fractures surgically treated by open reduction and internal fixation were divided into two groups according to the amount of reduction. Group A consisted of 18 patients with satisfactory reduction (≤2 mm), and group B of eight patients with incomplete reduction (>2 mm). Functional outcome was measured with Harris Hip Score (HHS), Oswestry Disability Index (ODI), and Short Form (12) Health Survey (SF12). Radiological parameters were assessed with standing whole spine, pelvis and hip X-rays, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and sagittal vertical axis (SVA). Follow-up intervals were 1, 3, 6 and 12 months and annually thereafter. Gait analysis and baropodometry were performed after 24 months of operation. Results Mean HHS, ODI, and SF-12 was improved during the first postoperative year in both groups. After two years average scores kept improving for group A, but worsened for group B. Mean PI, PT, and SS increased in both groups during the first postoperative year, with further increase after two years only in group B. After two years, 16 (89%) patients in group A and four (50%) in group B had a balanced spine (SVA <50 mm). Gait analysis and baropodometry showed greater imbalance and overload for group B compared to group A. Conclusion In the long term, incomplete reduction of associated acetabular fractures may lead to poor outcome because of secondary spinopelvic imbalance, with posture and gait impairment.

Effectiveness of teriparatide combined with the Ilizarov technique in septic tibial non-union.

Aim The septic non-union is a common compliance in bone healing due to bone infection. Bone resection, associated with Ilizarov osteo-distraction technique, is commonly used in these cases. The aim of this study was to analyse clinical and radiological results of teriparatide in combination with the Ilizarov technique and to compare this treatment with the standard treatment. Methods Forty adult patients underwent surgery because of type C of the Association for the Study and Application of Methods of Ilizarov (ASAMI) classification non-union were enrolled. The patients were divided in two groups: those treated with Ilizarov technique (Norm group) and those treated with Ilizarov technique combined with teriparatide injection (Teri group). Surgical duration, complication rate, bone healing status, clinical and functional outcomes were assessed according to the A.S.A.M.I. classification in the mean follow-up of 12 months. The subjective quality of life was assessed by the Short Form Survey (SF)-12. Results Teri group showed less time wearing Ilizarov's frame (p <0.05) than the Norm group and a statistical significance in the inter-rater reliability Cohen's k (p>0.05) respect to Norm according the score between the bone healing and clinical outcome results. There was no statistically significant difference between the two groups in other parameters that were assessed. Conclusion A benefit of teriparatide was found as adjuvant in the treatment of septic non-union.

Iliopsoas bursitis: The role of diagnostic imaging in detection, differential diagnosis and treatment.

Iliopsoas bursitis is characterized by distension of the iliopsoas muscle bursa due to synovial fluid and/or hypertrophic synovium. Hip disease is usually associated with it, however, isolated bursitis is also present. Clinically Diagnosing iliopsoas bursitis can be difficult, and imaging is usually required to differentiate iliopsoas bursitis from other inguinal masses such as lymphadenopathy, hernias, and tumors. We present the case of a 45-year-old athletic patient who underwent diagnostic examination for recurrent right hip pain and a recent development (last 3 months) of a bulky right inguinal mass.

Tibial diaphyseal fractures in children: indications and limitations of the treatment with monolateral and hybrid external fixator.

Aim To report our indications and limitations about the use of external fixation in children. Methods It was retrospectively reviewed all tibial fractures treated with monolateral and hybrid external fixator, at our three Centres. It was included 32 fractures which did not show an acceptable reduction after an attempt under anaesthesia. The exclusion criteria were: open fractures, children with previous fractures of the lower limbs, with skeletal congenital diseases, fractures involving the physis and with neurovascular involvement. All fractures were classified according to the AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification. An outcome was evaluated according to the time needed to obtain radiographic bone healing, the range of motion (ROM) of the ankle, the asymmetry of the lower limbs, the malunion, and complications. Results The average time of consolidation was 10.66 weeks (6-17 weeks). There were no cases of deep infection, but only seven cases of superficial pin infections. No patients reported loss of ROM of the knee or ankle. We had zero cases of residual angle greater than 5°, and in all cases the difference in length between the limbs was <1 cm. Conclusion The external fixation is a viable technique in the treatment of tibial fractures in children. Therefore, the external fixation, both monolateral and hybrid, should be considered a viable treatment for this type of fracture.

Surgical treatment of multifragmentary segmental femur shaft fractures with ORIF and bone graft versus MIPO: a prospective control-group study.

Aim Multifragmentary segmental femoral shaft fracture is a high energy injury frequently associated with life-threatening conditions. The aim of this study was to compare the use of bio metallic open reduction internal fixation (ORIF) (plate with allograft bone strut) with minimally invasive plate osteosynthesis (MIPO) fixation for the treatment of multi-segmental femoral shaft fracture in terms of outcomes, bone healing and complications. Methods Forty patients with segmental femoral shaft fractures were included and divided into two groups: 20 patients treated with ORIF+, 20 with MIPO. All fractures were classified according to AO (Arbeitsgemeinschaft für Osteosynthesefragen) and Winquist and Hansen Classification. Evaluation criteria were: duration of follow up and surgery, Non-Union Scoring System, Pain Visual Analogic Scale (VAS), objective quality of life and hip function, subjective quality of life and knee function, quality of life the Short Form-12 Survey Questionnaires (SF-12), bone healing and femoral alignment (radiographs), Radiographic Union Score for Hip (RUSH). Results Better results of ORIF in terms of complication rate, RUSH, VAS, regression between RUSH and VAS, average correlation clinical-radiographic results and patients' outcomes (Cohen k) were obtained, and similar results for the length of follow up, surgery duration, perioperative blood transfusion, wound healing. No statistical difference for Harris Hip Score (HHS), Knee Society Score (KSS), quality of life (SF-12). Conclusions The ORIF and bone strut allograft technique had better results compared to the MIPO technique with regards to complication rate, RUSH, VAS, regression between RUSH and VAS, and average correlation clinical-radiographic results and patients' outcomes (Cohen k) in the surgical treatment of multifragmentary segmental femoral shaft fractures.

Feasibility and value of non-locking retrograde nail vs. locking retrograde nail in fixation of distal third femoral shaft fractures: radiographic, bone densitometry and clinical outcome assessments.

Aim Distal femoral shaft fractures are characterized by increasing incidence and complexity and are still considered a challenging problem. No consensus on best surgical option has been achieved. The aim of this study is to investigate mineral bone densitometry, radiographic and clinical outcomes of locking retrograde intramedullary nailing (LRN) and non-locking retrograde intramedullary nailing (NLRN) regarding surgical treatment of distal femoral shaft fractures in adults based on the hypothesis that there is no statistical difference among the results of both surgical options. Methods Retrospective study: 30 patients divided into 2 groups (Group 1 LRN, Group 2 NLRN). Average age was 42.67±18.32 for Group 1 and 44.27±15.11 for Group 2 (range of age 18-65 for both groups). Gender ratio (male:female) was 2.75 (11:4) for both groups. AO Classification, Non Union Scoring System (NUSS) and Radiographic Union Score Hip (RUSH), Visual Analogic Score (VAS), Dexa scans, plain radiographs were used. Evaluation endpoint: 12 months after surgery. Results No statistical difference was obtained in terms of surgery time, transfusions or wound healing. There were similar results regarding average time of bone healing, RUSH scores, VAS, regression between RUSH and VAS, average correlation clinical-radiographic results and patients outcomes. Only one patient of LRN group had reduction of mineral bone densitometry values. Conclusion No statistical difference in terms of radiographic, bone densitometry and clinical outcomes among LNR and NLNR for the treatment of distal femur fractures was found. The presence of no statistical difference regarding radiological findings is the main factor supporting our hypothesis given their strong objectivity.

A new plate design to treat displaced 3-4 parts proximal humeral fractures in comparison to the most tested and used plate: clinical and radiographic study.

Aim Proximal humeral fractures are common and most complex patterns currently represent a challenge for surgeons. Difficulties in obtaining good anatomical reduction (particularly of great tuberosity) often lead to unsatisfactory results; choices often fall onto prosthesis implantation against fixation options. The aim of this study was to compare a new design of proximal humeral plate with the most used plates in the treatment of these injures by analysing outcomes and complications. Methods Two hundred patients with proximal 3 or 4 parts humeral fracture were enrolled (Neer 3-4). First group treated with PGR Plate composed of 98 patients. Second group treated with Philos Plate composed of 102 patients. Evaluation criteria were Non-Union Scoring System, duration of surgery, complications, objective quality of life and elbow function (Constant Shoulder Score), subjective quality of life and elbow function (Oxford Shoulder Score), post-op radiographs, centrum collum diaphyseal angle. Evaluation endpoint was 12 months. Results There was no statistically significant difference between the groups with regard to the selected evaluation parameters. Achievement of good shoulder range of motion and ability to perform normal daily living activities was obtained in both groups. The PGR had a positive impact on treatment results of varuspattern of proximal humeral fractures. Conclusions The PGR allowed good clinical and radiographic results in the treatment of proximal humeral fractures, comparable to those obtained with Philos. Also, PGR had the advantage to aid and keep the anatomical reduction of patterns of fracture involving the greater tuberosity.