Coracoid tunnels in open and arthroscopic treatment of acromioclavicular dislocation: an experimental cadaveric study.

PURPOSE: Treatment of acromioclavicular joint (ACJ) dislocation is not encoded uniquely. Type I and II injuries are usually treated conservatively, while types IV, V and VI surgically. Controversy still exists over the treatment of type III injuries. In the operative approach, there is no agreement on the best surgical technique. Our purpose is to compare the mini-open and arthroscopic approach focusing on the evaluation of the anatomical precision of the coracoid drilling. METHODS: This is a controlled laboratory study. Ten fresh-frozen cadaveric shoulders were randomly assigned to the two techniques in order to compare them. We performed essential surgical gestures to drill the tunnel using MINAR® System (mini-open) and Dog-Bone® (ARTHREX, arthroscopic). The anatomical specimens were then subjected to CT-scan investigation. We statistically evaluated the precision of these two techniques analyzing DICOM files using two parameters. Parameter 1 evaluates the tunnel entry area on the superior side of the coracoid. Parameter 2 describes the orientation of the tunnel. RESULTS: There are no statistically significant differences (95% confidence level) between arthroscopic and mini-open approach about the precision in the location of the coracoid hole, regarding the entry area (p = 1.00) and the orientation (p = 0.196). CONCLUSION: The evidences collected enable the orthopedic surgeon to choose equally between the two techniques in the treatment of AC joint dislocation toward precision.

Fall from heights: possible factors influencing the onset of complications.

PURPOSE: Fall from a height is high energy trauma. The causes include both accidental falls and suicide attempts. The literature and also our previous study demonstrated that this kind of patients, during their recovery time, need a high multidisciplinary workload with significant costs. The present study is the first researching the patterns of the non-acute orthopedic complications after a trauma precipitation that required a new hospitalization and surgical procedure. METHODS: Retrospective study and analysis of orthopedic complication characteristics of patients fallen from height. We researched the possible relation between the complication pattern (soft tissue or bone involvement) and the case character (psychiatric or non-psychiatric patients, type of fracture and kind of fixation). RESULTS: The 18.83% of all patients (154 cases included) needed a new admission to perform further surgical procedures (9.74% of psychiatric patients and 9.09% of unvoluntary victims). Our data showed that patients with psychiatric disorder were associated with a statistically significant (p < 0.05) increase in soft tissue complications (46.67%) and onset of non-union after internal osteosynthesis and external fixation (72.72%), respectively. CONCLUSION: According to the results obtained, we can conclude that osteosynthesis in psychiatric patients is related to well-defined and predictable complications.

Comparison of Anterior and Lateral Approach in Hip Hemiarthroplasty for Femur Neck Fractures in the Elderly: Clinical and Radiographic Outcomes.

Introduction: Many surgical approaches have been described for hip hemiarthroplasty (HHA) treating femur neck fractures (FNFs). Direct lateral approach (DLA) is one of the most used. Today, the direct anterior approach (DAA) has become very attractive, but it seems to involve more intra-operative fractures. Our main endpoint was to demonstrate that the DAA may be a valid alternative comparing to the DLA. Materials and methods: Patients affected by FNFs and treated with HHA between the years 2016 and 2020 were studied. We divided the treatment of the fractures according to the surgical approach. The analysis was focused on perioperative complications and radiological outcomes. Results: There were a total of 166 patients. The DLA group included patients with an average age of 83.5 years and the DAA group of 83 years. We found similar surgical times (DLA 67 min vs DAA 61 min; p = 0,55), number of transfusions (DLA 3/person vs DAA 4/person; p = 0,91), perioperative complications (fractures: DLA 0 vs DAA 0 - dislocations: DLA 2,50% vs DAA 0) and functional outcomes (HHS: DLA 83 points vs DAA 87 points; p = 0,71). There were no statistical differences comparing diaphyseal filling (Canal Fill Index at the proximal third: DLA 0,79 vs DAA 0,78; p= 0,24), bone loss (Paprosky I: DLA 96,25% vs DAA 91,86%; p = 0,47) and prevalence of heterotopic ossification (Broker low degree: DLA 93,75% vs 95, 34%; p = 0,87). Conclusion: Analysing perioperative complications and studying post-operative radiographic evolution, our results suggest that the DAA is a valid alternative to the DLA in HHA treating FNFs.

Comparison of Anterior and Lateral Approach in Hip Hemiarthroplasty for Femur Neck Fractures in the Elderly: Clinical and Radiographic Outcomes

@#Introduction: Many surgical approaches have been described for hip hemiarthroplasty (HHA) treating femur neck fractures (FNFs). Direct lateral approach (DLA) is one of the most used. Today, the direct anterior approach (DAA) has become very attractive, but it seems to involve more intra-operative fractures. Our main endpoint was to demonstrate that the DAA may be a valid alternative comparing to the DLA. Materials and methods: Patients affected by FNFs and treated with HHA between the years 2016 and 2020 were studied. We divided the treatment of the fractures according to the surgical approach. The analysis was focused on perioperative complications and radiological outcomes. Results: There were a total of 166 patients. The DLA group included patients with an average age of 83.5 years and the DAA group of 83 years. We found similar surgical times (DLA 67 min vs DAA 61 min; p = 0,55), number of transfusions (DLA 3/person vs DAA 4/person; p = 0,91), perioperative complications (fractures: DLA 0 vs DAA 0 – dislocations: DLA 2,50% vs DAA 0) and functional outcomes (HHS: DLA 83 points vs DAA 87 points; p = 0,71). There were no statistical differences comparing diaphyseal filling (Canal Fill Index at the proximal third: DLA 0,79 vs DAA 0,78; p= 0,24), bone loss (Paprosky I: DLA 96,25% vs DAA 91,86%; p = 0,47) and prevalence of heterotopic ossification (Broker low degree: DLA 93,75% vs 95, 34%; p = 0,87). Conclusion: Analysing perioperative complications and studying post-operative radiographic evolution, our results suggest that the DAA is a valid alternative to the DLA in HHA treating FNFs.

Comparing mini-open and arthroscopic acromioclavicular joint repair: functional results and return to sport.

INTRODUCTION: Acromioclavicular joint (ACJ) dislocation is a common injury that can result from sports activities. The surgical technique for the treatment of Type III and Type IV injuries, according to the Rockwood classification, remains controversial. The purpose of the study was to determine the functional outcome after minimally invasive and arthroscopic surgery. The mini-open surgery was done with MINAR® system, whereas the arthroscopic technique was done with Dog BoneTM Button. STUDY DESIGN: Retrospective Cohort study. METHODS: We reviewed 31 who were surgically treated for acute acromioclavicular dislocation Type III and Type IV (2012-2015). We excluded subjects with chronic dislocation or other injury. We selected 16 patients (average age 37).  Half of the sample patients were treated with mini-open surgery with the MINAR® system, and the other half of the patients were treated with the Dog Bone arthroscopic technique. The Constant Shoulder Score, the Oxford Shoulder Score, the Simple Shoulder Test and the Subjective Patient Outcome for Return to Sports (SPORTS) score were used to assess functional outcome of the treated shoulder. RESULTS: Mean follow-up was 13 months (range 6-27 months). The mean Constant Shoulder Score was 91.10 (range 82.76-96.66), Oxford Shoulder Score was 46.19 (range 42.00-48.00), the Simple Shoulder Test was 10.50 (range 9.00-12.00), and the SPORTS score was 7.88 (range 3-10). There is a statistically significant difference between the sample operated with the mini-open surgery and the group operated with arthroscopic technique. The probability of return to their sport, according to the results of the SPORTS score, was significantly higher for patients treated with the MINAR® system (p < 0.001). However, the objective parameter of Constant scale is statistically better in patients operated by arthroscopic technique (p < 0.05; p < 0.001). CONCLUSION: Restoration of ACJ anatomy is the key to a successful therapy. The surgical technique should be personalized. The miny-open surgery and also the arthroscopic surgery are adequate with good clinical results. However, according to the SPORTS score, the patients treated with mini-open surgery returned to their sport with less pain and better performance than those belonging to the other group.