CT-scan Evaluation of Osteointegration and Osteolysis in Different Graft Types and Surgical Techniques for the Treatment of Shoulder Instability.

Background: Bone graft is often needed in treating anterior shoulder instability in glenoid bone loss and graft integration is crucial in achieving good results. This study aimed to evaluate bone graft remodeling in different techniques for shoulder anterior-inferior instability. Methods: Graft osteointegration and osteolysis were retrospectively evaluated with CT-scan imaging performed 6 to 12 months after surgery to compare the outcome of three procedures: Latarjet, bone block with allograft, and bone block with xenograft. Screw fixation and double endobuttons fixation were also compared. Results: CT scans of 130 patients were analyzed. Of these, 30 (23%) were performed after the bone block procedure with xenograft and endobuttons fixation, 55 (42%) after the bone block procedure with allograft and endobuttons fixation, 13 (10%) Latarjet with screw fixation and 32 (25%) Latarjet with endobuttons fixation. The prevalence of osteolysis was significantly inferior (P<.01) in the bone block procedure compared to the Latarjet procedure (11.7 % vs. 28.8 %). Bone integration was higher in bone block procedures (90.5%) than in Latarjet (84.4%), but the difference was not statistically significant. Among the Latarjet procedures, endobuttons fixation resulted in a higher integration rate (87.5% vs. 73.6%) and lower osteolysis rate than screw fixation (24.6% vs. 38.5%), despite these differences did not reach a statistical significance. Among the bone block procedures, using a xenograft resulted in a lower osteolysis rate (6.7%) than an allograft (14.5%), but the result was not statistically significant. Conclusion: This study shows a significantly lower rate of graft osteolysis after bone block procedures compared to Latarjet procedure between 6 and 12 months postoperatively. Moreover, our findings suggest good results in osteolysis and graft integration with xenograft compared to allograft and double endobuttons fixation compared to screw fixation, despite these differences being not-significant. Further studies on this topic are needed to confirm our results at a longer follow-up and thoroughly investigate the clinical relevance of these findings.

Septic arthritis following joint injections: a 17 years retrospective study in an Academic General Hospital.

BACKGROUND: Septic arthritis following intra-articular infiltrations is an uncommon devastating complication correlated  to high costs for the health service and often to poor outcomes. The purpose of this study is to assess a 17-years experience in a single academic multispecialist hospital managing this uncommon complication in Orthopaedic practice. METHODS: Patients with diagnosis of septic arthritis following joint injections treated in our hospital from January 2002 to December 2019 were included in the study. Clinical and demographic data, pathogens, injected agent, conservative/surgical treatments were reviewed. Patient were classified according to the ore operative Charlson Comorbidity Index (CCI) and the Cierny-Mader Classification(CMC). Furthermore follow-up outcome and time occurred to infection eradication were registered. RESULTS: We included in the study 11 patients with a median age of 74 years old (IQR= 61.5 - 79). The median CCI was 3  (IQR= 2 - 5) and the majority of patients belong to CMC = B class. Septic arthritis occurred mainly following corticosteroids injections and more frequently involving knees. The pathogen more often isolated was Staphylococcus aureus. Five (45%) patients referred an history of multiple intrarticular injections. 7 patients (64%) had a complete resolution following an arthroscopic debridement, 4 (36%) patients underwent to a 2-stage replacement and one of them hesitated in an arthrodesis because of a recurrent periprothesic joint infection and extensor apparatus insufficiency. CONCLUSION: The authors observed a potential increased risk of septic arthritis following joint injection in patients with history of multiple injections and poor health/immunological conditions. They recommend an early arthroscopic debridement as the treatment of choice especially in septic knees  performed in a multispecialist dedicated center.

Case series of traumatic neglected Extensor Hallucis Longus lacerations: choice of surgical treatment based on injury type.

BACKGROUND AND AIM: Extensor Hallucis Longus (EHL) tendon rupture is a rare injury of the foot, representing only 1% of overall tendon rupture. Early diagnosis and surgical repair are recommended but there is still no consensus regarding the ideal treatment. The purpose of this study was to evaluate a case series of patients with neglected extensor hallucis longus (EHL) tendon rupture. METHODS: We report a case series of 3 patients affected by traumatic neglected EHL lacerations treated with reconstructive surgery using tissue scaffolds, between November 2019 and May 2020. Demographics data, mechanism of injury, zone of injury, tendon gap, time to surgery, type of surgical repair, preoperative and postoperative functional score were collected with a minimum follow-up of 8 months. RESULTS: The zone of injury (according to Al-Qattan classification) involved was in 1 case zone 2, in 1 case zone 4 and in the last case zone 5. The mean value of intraoperative tendon gap was of 3,4 cm. The elapsed time from injury to surgery was an average of 3,3 months. One tendon transfer surgery and two primary repairs with Krakow fashion were performed, all augmented with tissue scaffolds. The mean preoperative and postoperative American Orthopedic Foot and Ankle Society (AOFAS) scores were, respectively, 43 and 97. CONCLUSIONS: Our results highlight good functional result and satisfaction with active extension of the hallux restored in all patients. According to our experience, we recommend choosing reconstruction technique basing on the topographic zone of lesion and intraoperative tendon gap.

Clinical outcome before and after COVID-19 quarantine in patients affect of knee and hip osteoarthritis.

BACKGROUND: The emergency caused by COVID-19 Pandemia has resulted in a complete suspension and consequent delay of common planned surgery such total hip replacement in patients affect by osteoarthritis. At the same time, the issue of the quarantine imposed changes to the normal lifestyle of these patients. The purpose of our study is to evaluate how the presence of these two factors affect the quality of live of patients living in the Italian red zone. METHODS: From outpatient pre-operative assessment we collect data about: demographic data, WOMAC score, NRS (Numeric rating scale 0-10), PCS SF12 and MCS SF12 score. Selected patients were therefore contacted by telephone call and re-assess using the same score. In addition, patients were asked if they intended to undergo the planned surgery again despite the current emergency Results:  14 patient have been recruited for the study. Male/female ration was 10/4, mean age was 70 years. Pre operative outpatient assessment mean WOMAC score was 44,86 (SD ± 8,52) , mean NRS was 8,07 (SD ± 1,33), PCS SF12 was  30,33 (SD ± 5,0) and MCS SF12 was 40,95 (SD ± 3,51).  At re-evalutation the mean WOMAC score was 32,86 (SD ± 17,88) , mean NRS was 5,79 (SD ± 3,66), PCS SF12 was  39,9 (SD ± 3,70) and MCS SF12 was 50,14 (SD ± 6,86) Conclusion:  The exceptionale pandemic from Covid-19 has profoundly changed our lifestyle, impacting normal daily activities but also on regular surgical activity in patients affected by osteoarthritis. Our study suggested that the lifestyle changes imposed by the situation led to an improvement of clinical score. This shows how an exceptional event can affect many aspects of daily life.