Exploring the difficulties to improve minimally invasive application with long PHILOS plate in multifocal metadiaphyseal fractures of the proximal humerus: analysis of intraoperative procedure and clinical outcomes.

The MIPO (Minimally Invasive Plate Osteosynthesis) technique for treating metadiaphyseal fractures of the proximal humerus has gained great attention during the past years. The purpose of this retrospective study was to underline all the important difficulties when the MIPO technique is applied, to propose practical solutions and to evaluate the overall clinical outcome of our patients treated with this technique. A total of 14 patients had been operated in two different surgical units, at San Carlo Borromeo Hospital (Milan, Italy - 11 patients) and in Policlinico Umberto I Hospital (Rome, Italy - 3 patients), between June 2013 and November 2016. The humeral fractures were divided according to the Maresca et al. classification system. A lateral deltoid-split or an anterolateral deltopectoral approach was performed in the proximal humerus. In distal approach, an anterior or a lateral window was performed for plate fixation. After a follow-up of 17,4 (range 3-31) months all patients showed fracture healing and there were no non-unions or infected cases. MIPO of the humerus is a tissue sparing technique and in expert hands can improve healing rates and can also reduce complications like nerve damages and infections. In conclusion, we would like to highlight the importance of the MIPO technique as a possible alternative option to the traditional ORIF technique.

Bilateral posterior fracture-dislocation of the shoulder after epileptic seizure.

We present a case of a 61 year-old woman who suffered a bilateral posterior fracture-dislocation of the shoulder after an isolated episode of epileptic seizure. The patient was diagnosed at our Emergency department with x-rays and CT scans after being found unconscious. An indication for bilateral shoulder hemiprosthesis implant was initially given. However, given the peculiar pattern of the fracture, the hemiprosthesis was implanted on one side only, while the other side was treated with ORIF with four cannulated screws. After the one year, the patient had resumed her previous activities and had no complaints. We performed a review of similar cases in literature and provided a rationale for our choice of treatment and the reasons for its success.

A two-choice strategy through a medial tibial approach for the treatment of pilon fractures with posterior or anterior fragmentation.

OBJECTIVE: The anterolateral approach to the tibia has been popularized for the management of tibial pilon fractures. For complex fracture patterns a combined anterolateral/anteromedial approach is suitable but a high rate of complication has been reported. In our retrospective study a two-choice strategy adopting a medial tibial approach was proposed for the treatment of pilon fractures with anterior or posterior fragmentation. METHODS: Based on an anatomic study of tibial pilon fractures, we retrospectively analyzed the fractures with primary posterior, posterior-lateral or anterior, anterior-lateral (Tillaux-Chaput) involvement of the distal tibia. This retrospective study consisted of 18 patients with a closed tibial plafond fracture. The inclusion criteria were: (1) pre- sence of an anterior/anterolateral type fragment or a posterior (Volkmann) type fragment involving larger than 25% of the articular surface, (2) a minimum follow-up of 12 months, (3) a fibula fracture associated with a medial column fracture of the distal tibia, and (4) soft tissue conditions at the time of operation that did not compromise the choice of surgical access (Tscherne classification for closed fractures: grade 0 and grade 1). Tibial plafond fractures were classified into two groups: one presenting anterior and the other with posterior rim (Volkmann) fragments. RESULTS: Most patients achieved a good clinical recovery in terms of range of motion and Olerud-Molander scale scores. Only three patients presented a grade 2 osteoarthritis at the 12 month follow-up. CONCLUSION: Our two-choice strategy highlights concepts which have been previously debated and described in the literature. But a new extended protocol for surgical approach to the distal tibia, including more fracture patterns and their association should be further investigated.

The Endolog system for moderate-to-severe hallux valgus.

PURPOSE: To report the midterm outcome of the Endolog system for correction of moderate-to-severe hallux valgus. METHODS: 23 women and 2 men (33 feet) aged 35 to 80 (mean, 52) years underwent minimally invasive surgery for moderate (n=25) and severe (n=8) hallux valgus using the Endolog system. The hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the proximal articular set angle (PASA) were measured on radiographs. The feet were also assessed based on the American Orthopaedic Foot and Ankle Society (AOFAS) scale. RESULTS: The mean follow-up duration was 18.2 (range, 12-36) months. The mean HVA, IMA, PASA, and the mean AOFAS score improved significantly after surgery (all p<0.0001). Periosteal reaction was noted by week 4, and callus formation after 3 months. There were no delayed or non-union or other complications. CONCLUSION: The Endolog system achieved good outcome for moderate-to-severe hallux valgus.

Intralesional curettage, with phenol and cement as adjuvants, for low-grade intramedullary chondrosarcoma of the long bones.

The authors conducted a retrospective study on 23 patients (12 females and 11 males) with low-grade intramedullary chondrosarcoma of a long bone, treated with intralesional curettage, phenolization and cementation. The use of phenol was supported by an in vitro study, the use of bone cement by clinical studies. A consensus has been growing that this type of tumours should be treated less aggressively. The average age of the patients was 445 years (range: 29 to 71). The mean follow-up period was 6.2 years (range: 2.5 to 11 years). After 6 months the average Musculoskeletal Tumor Society (MSTS) score was 76.8% of 30, the best possible score (range: 61% to 87%). After 12 months this score increased to 89.8% (range: 63% to 100%). Complications were: one recurrence (43%), treated with a tumour prosthesis, and 3 fractures (13%). The authors strongly support this new technique, all the more as it still allows for a more radical approach, if necessary. They stress the importance of a strict follow-up by a multidisciplinary team, in order to treat local recurrences and (rarely) metastases.

Chondromyxoid fibroma of the lateral malleolus: a case report.

Chondromyxoid fibromas account for <1% of primary bone neoplasms. We report one such case occurring in the distal fibula of a 27-year-old woman. The patient underwent curettage, followed by phenolisation, insertion of a Steinmann pin, and cementation. This treatment reduced morbidity, restored stability, and enabled rapid functional recovery. There was no recurrence after 2 years.

Surface-based haemangioma of the tibia: a case report.

We present in this paper a case of surface-based haemangioma of the tibia in a 34-year-old patient which had been misdiagnosed as periostitis. X-ray examination demonstrated a periosteal reaction, confirmed by a MRI showing a soft tissue mass adjacent to bone. We performed an incisional biopsy and made a diagnosis of haemangioma only after examining the histological results. An angiographic study was performed in order to have embolisation of the vessels, but this was not possible because of the excessive number and calibre of afferent arteries. No further symptoms arose after biopsy and therefore an en bloc or radical excision was not performed. Indications for making a correct diagnosis and performing a suitable treatment are presented below.