Evaluation of Outcome after Total Hip Arthroplasty for Femoral Neck Fracture: Which Factors Are Relevant for Better Results?

Background: Femoral neck fractures (FNFs) are frequent orthopedic injuries in elderly patients. Despite improvements in clinical monitoring and advances in surgical procedures, 1-year mortality remains between 15% and 30%. The aim of this study is to identify variables that lead to better outcomes in patients treated with total hip arthroplasty (THA) for FNFs. Methods: All patients who underwent cementless THA for FNF from January 2018 to December 2022 were identified. Patients aged more than 80 years old and with other post-traumatic lesions were excluded. Patient data and demographic characteristics were collected. The following data were also registered: time trauma/surgery, surgical approach, operative time, intraoperative complications, surgeon arthroplasty-trained or not, and anesthesia type. In order to search for any predictive factors of better short- and long-term outcomes, we performed different logistic regression analyses. Results: A total of 92 patients were included. From multivariable logistic regression models, we derived that a direct anterior surgical approach and an American Society of Anesthesiologists (ASA) classification < 3 can predict improved short-term outcomes. Moreover, THAs performed by surgeons with specific training in arthroplasty have a lower probability of revision at 1 year. Mortality at 1 year was ultimately influenced by the ASA classification. Conclusions: A direct anterior approach and specific arthroplasty training of the surgeon appear to be able to improve the short- and long-term follow-up of THA after FNF.

Proximal fibular stress fracture in adolecent soccer player. A case report.

Fibular fractures are the third most common stress fractures in children and adolescents. Proximal fibular location is a very rare finding, with few reports in the literature and, frequently, careful investigations before a definitive diagnosis could be necessary. The authors report a case of an adolescent 13 years old soccer player with a proximal fibular fracture that was initially underestimated and misdiagnosed and ultimately confirmed as a stress lesion by MRI.

Metacarpophalangeal joint hyperextension in rhizartrosis: is surgical correction necessary?

BACKGROUND AND AIM: Rhizarthrosis represents 10% of all arthritic manifestations and its prevalence increases with age and in women. The hyperextension of the metacarpophalangeal joint (MCPj) is consequent to a progressive dorsoradial subluxation of the trapeziometacarpal joint (TMj) in advanced osteoarthritis. The aim of this retrospective study is to evaluate the clinical and functional results of 32 patients affected by advanced rhizarthrosis who underwent to modified Burton-Pellegrini's trapeziectomy in absence of surgical correction of MCPj hyperextension in order to understand when this last step is really necessary. METHODS: Patients were assessed trough DASH and PRWHE questionnaires; the functionality of the hand was assessed by carrying out specific test (grip strength, key-pinch, kapandji test, reduction of wrist flexion strength) and the degree of MCP joint hyperextension was recorded. RESULTS: Clinical evaluation and individual satisfactory were positive in most cases (mean DASH 19 and mean PRWHE 21.8, with a reduction of 77% of VAS pain score). Kapandji test was excellent in 26 patients and grip strength and key pinch were stackable in operated and non-operated hands. Twenty-five out 32 patients presented a MCP joint hyperextension between 0° and 5°, 5 of 10° and other 2 of 15°. CONCLUSION: Modified Burton-Pellegrini's trapeziectomy is a valid option to treat patient with TMj osteoarthritis. The absence of surgical correction of the MCPj does not affect clinical and functional results in deformities <15°.

Dair approach in 7 infected total hip arthroplasties: our experience and current concepts of the literature.

INTRODUCTION: Periprosthetic joint infection (PJI) is one of the most challenging complications following total hip arthroplasty. In early infection, within four to twelve weeks from surgery, debridement, antibiotics and implant retention (DAIR) can be the initial treatment. The aim of this study is to report our case series and review current concepts reported in the literature about this topic. MATERIALS AND METHODS: This was an observational cohort study that included 7 patients managed with DAIR for PJI following primary total hip replacement (THR) between 2014 and 2020. Inclusion criteria were a primary THR, direct anterior or lateral approach, DAIR procedure, and PJI. Exclusion criteria were a PJI following a revision total hip replacement or hemiarthroplasty, posterolateral approach, 1-stage revision, 2-stage revision, and Girdlestone procedure without prior DAIR. For each patient demographic characteristics, laboratory values, microorganisms involved, antibiotic therapy and outcome at one-year follow-up were registered. RESULTS: The mean duration between THR and DAIR was 19 days. In all cases only one DAIR procedure was performed. Most infections were caused by Staphylococcus aureus (4 cases) [one methicillin resistant (MRSA)]. The other infections were caused by Streptococcus agalactiae, Staphylococcus coagulase negative and Escherichia coli. At the final follow-up, the procedure was considered as successful in 6 out of 7 patients (85%). The one with unsuccessful outcome underwent to a two-stage revision. DISCUSSION: Our results were comparable with those of a recent systematic review of the literature. Factors that have been postulated to influence the outcome of DAIR in the management of PJIs include the timing and numbers of debridement, the exchange of components, the responsible microorganism and the duration of antibiotic treatment. In conclusion, the outcomes following DAIR are better as the indications are refined and risk factors identified. PJI prevention remains the key but the current literature still lacks well documented and effective PJI prevention protocols. (www.actabiomedica.it).

Involvement of the medial and lateral epicondyles in distal humeral coronal shear fractures: Case series and literature review.

PURPOSE: Epicondyle involvement in capitellar and trochlear fractures is often considered a simple associated lesion that does not substantially change treatment or prognosis. Although theoretically predicted in reviews, case series almost never report elbow prosthesis use in comminuted coronal shear injuries associated with epicondylar fracture in the elderly. The purpose of this study is to focus on this underestimated injury pattern that can be a negative risk factor for treatment and prognosis. METHODS: We retrospectively reviewed all cases with coronal shear fracture of the distal humerus treated from 2016 to 2019. Fractures were classified according to Dubberley. Open reduction and internal fixation (ORIF) were performed when possible. Partial or total elbow replacement was used in severely comminuted fractures with epicondylar involvement in four elderly patients. RESULTS: Nineteen consecutive patients were selected (mean age: 62.4 years), of which 10 had type 3A/3B fractures, and seven had both medial and lateral epicondylar involvement. The mean follow-up duration was 31.78 months. The average Mayo Elbow Performance Index (MEPI) score was 81.05 points, with 7 excellent, 8 good, 1 fair, and 3 poor results. The average MEPI score of Dubberley's type 1 and type 2 was better than that of type 3 (mean: 92 vs. 72, p = 0.02). Further, the results of average range of motion were better in patients who had sustained Dubberley types 1 and 2 lesions than those with Dubberley type 3 lesion (mean: 133° vs. 85°, p = 0.002). Two patients out of three who required intra-operative conversion to total elbow arthroplasty had poor outcomes. CONCLUSIONS: The simultaneous presence of fracture of one or both epicondyles are usually associated with severe joint comminutions and makes ORIF more challenging, especially among elderly women. In these cases, primary total elbow prosthesis implantation could be a valid treatment option.

Hip arthroscopy and T-shaped capsular plication for the treatment of borderline dysplasia: a minimum 2-year follow-up.

PURPOSE: The aim of the study was to evaluate the clinical outcomes of patients treated arthroscopically for symptomatic borderline dysplasia of the hip (BHD) with a T-shaped capsular plication, with a minimum follow-up of 24 months. METHODS: Twenty-seven patients who had undergone hip arthroscopy and T-shaped capsular plication for symptomatic BHD were included in the study. All patients were clinically evaluated prior to surgery (T0) and at two consecutive follow-ups (T1: 12 ± 1.2 months; T2: 52.0 ± 23.2 months) using the visual analogue scale (VAS) pain score, the Hip Outcome Score in activities of daily living (HOS-ADL) and sport-specific subscale (HOS-SSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form-12 in its physical (PCS) and mental component scores (MCS). We also evaluated the presence of correlations and analysed the possible differences between subgroups. RESULTS: We found a significant difference for HOS-ADL, HOS-SSS, VAS and WOMAC with the Friedman test for repeated measures through time points (p < 0.0001), but not for MCS. All clinical scores reported a significant improvement compared to the previous time point (p < 0.05), with the exception of HOS-SSS, for which p = 0.2570 between T1 and T2. The body mass index was positively correlated with preoperative VAS (R = 0.42857; p = 0.0257) and negatively correlated with PCS at T0 (R = - 0.40999; p = 0.0337) and with PCS (R = - 0.40491; p = 0.0362), MCS (R = - 0.45939; p = 0.0159) and WOMAC (R = - 0.40573; p = 0.0216) at T2. No complications were reported in our cohort. CONCLUSIONS: The results of the current study confirm that patients with intra-articular hip pathology and concomitant BHD (LCEA 20°-25°) can benefit from arthroscopic treatment and that T-shaped capsular plication is one of the available options. Orthopaedic surgeons specialising in hip arthroscopy should consider arthroscopy for the treatment of symptomatic BHD for stabilising and strengthening the joint. Future studies should focus on finding out which type of patients can benefit most from this procedure. LEVEL OF EVIDENCE IV: Prospective Case Series.

Distal tibial fractures treated with intramedullary nailing: management of associated posterior and medial malleolar injuries.

INTRODUCTION: Articular tibial ankle injuries may occur in association with distal tibial fractures, especially in those characterized by spiral or oblique shape. These lesions are often misdiagnosed and overlooked with significant biomechanical and clinical consequences. The purpose of this study was to evaluate the outcomes of patients affected by posterior and medial malleolar ankle fractures associated with distal tibial fracture who underwent intramedullary nailing at a follow-up of 3 years. Furthermore authors wanted to highlight the correct sequence of diagnosis and fixation in these associated fracture patterns. MATERIALS AND METHODS: All treated patients between 2006 and 2016 (Group 1) were compared with a control group (Group 2) without ankle lesions. Demographic variables and data related to surgical procedure and hospitalization were documented and analyzed. X-rays and computed tomography before operation were reviewed to identify type of fracture; radiographs after surgery and at follow-up were respectively analyzed to study the quality of joint reduction and the development of osteoarthritis. Clinical outcomes were evaluated using OMAS and DRI scores. RESULTS: Thirty-six patients were in group 1 and 36 in group 2. In group 1 longer operating time and hospitalization were documented. Quality of reduction in group 1 was always satisfactory. No signs of osteoartritis were detected at 3 years follow-up. The mean union time was 23.6 weeks for group 1 and 20,4 for group 2 (p=0.111). No differences in clinical scores were documented after 6 months. The full weight-bearing time was longer in group 1 (p=0.017). CONCLUSIONS: Clinical results appeared similar. No osteoarthritis was documented in group 1 as consequence of good articular reduction that is better and more easily executable if malleolar ankle fractures are fixed before intramedullary nailing. In distal tibial fractures CT has always to be performed to recognize associated ankle lesions as it may modify the surgical plan, postoperative management and outcomes.

Long-term results after modified Burton-Pellegrini's technique in 24 cases affected by advanced rhizarthrosis.

BACKGROUND AND AIM: Rhizarthrosis common in elderly and represents 10% of all artrhitic manifestations. Trapeziectomy with ligament reconstruction and tendon interposition remains the gold standard for stages II to IV according to Eaton and Littler. This retrospective study aimed to evaluate the results of 24 patients affected by advanced rhizarthrosis who underwent to modified Burton-Pellegrini's trapeziectomy with ligamentoplasty using the entire flexor carpi radialis tendon. METHODS: Patients were assessed through DASH and PRWHE questionnaires; the examination focused also on pain symptoms (VAS score) and the results obtained in carrying out specific tests to evaluate the trapezius-metacarpal functionality (key-pinch, grip strength, Kapandji test, reduction of wrist flexion). Furthermore, postoperative complications were evaluated. RESULTS: Clinical evaluation and individual satisfaction were positive in most cases (mean DASH 18,8 and mean PRWHE 21,7). VAS pain score reduced of 76.7%, grip strength and key pinch were similar to those of the non-operated hand and Kapandji test was excellent in 20 patients.  One superficial wound infection was encountered which resolved by specific antibiotic therapy. CONCLUSIONS: The choice of the most appropriate treatment depends on clinical conditions and socio-occupational factors of the patient (age, sex and functional needs), the degree of osteoarthritis and the presence of deformaties of the first metacarpophalangeal joint. Surgery aims to relief pain and to improve joint function and strength. According to the results observed this surgical technique has to be considered a valid option for the treatment of advanced rhizarthrosis as it provides pain relief, stability and mobility of the thumb.

Survival and outcome of total elbow arthroplasty for distal humeral fracture at long term follow-up.

Background Total elbow arthroplasty is an accepted procedure for the treatment of acute comminuted distal humeral fractures in elderly. Few long-term outcomes are available. The purpose of this study was to examine long-term clinical and radiological outcomes of prosthesis performed (January 2002-June 2015) for complex intra- fractures of the distal humerus (AO/C) in patients older than 65 years with low functional demands. Materials and Methods Further inclusion criteria were: the availability of a clinical and radiological follow-up of minimum 5 years and pattern of closed fracture. Demographic data and characteristics of patients were collected. All patients were clinically and radiographically assessed after 2 and 5 years from surgery. Results Twelve patients were included with complete available data. The mean follow-up was 7.6 years. Five patients reported a worsening of the elbow functionality through the follow-ups. Five subjects had complications. There were no cases of revision surgery. The quality of fixation showed a progressive worsening with increase of radiolucency both on humeral and ulnar side. The recorded MEPS showed no correlation with the grade of periprosthetic osteolysis. Polyethylene bushing wear was scored of grade 2 in one subject who had showed type 4 Morrey radiolucency. Discussion and Conclusions Total elbow arthroplasty is an effective and reliable procedure for comminuted fractures of the distal humerus in elderly, although the incidence of complications can not be considered as negligible. For the majority of these patients, a well-performed implant will give them a well-functioning elbow for their remaining life.

Efficacy and safety of viscosupplementation with hyaluronic acid for hip osteoarthritis: results from a cross-sectional study with a minimum follow-up of 4 years.

BACKGROUND AND AIM OF THE WORK: Osteoarthritis is the most common cause of disability in elderly. Hip osteoarthritis is the second most frequent form affecting a large joint and the social and economic impact on society of its related disability is expected to increase. The purpose of this study was to verify the efficacy and safety of ultrasound-guided viscosupplementation with high weight hyaluronic acid in hip osteoarthritis. METHODS: 183 patients with painful hip OA (Kellgren-Lawrence 1-2-3) were treated from January 2014 to December 2016 with viscosupplementation. Patients were evaluated before injection (T0) and after 1,2,3,4 years through the VAS scale and Harris Hip Score (HHS). Patients who underwent to subsequent injections were followed and assessed. Subjects who underwent prosthesis were analyzed for a minimum of 6 months in order to detect any early postoperative complication. RESULTS: The mean improvement of HHS and VAS between T0 and T1 was statistically significant. Patients who underwent subsequent injections showed a higher improvement even if statistical significance was not observed. Results showed that patients with grade 2 of osteoarthritis had the higher change in the scores. No adverse effects were registered. No early complications were reported in those patients who needed prosthesis. DISCUSSION AND CONCLUSIONS: Results observed confirm that ultrasound-guided viscosupplementation with high weight hyaluronic acid could be a possibility in the treatment of hip osteoarthritis, especially in patients with Kellgren-Lawrence grade 2 of disease. Subsequent injections are not characterized by similar positive effects. Outcomes of prosthetic surgery are not influenced by viscosupplementation.

Is there a relation between clinical scores and serum ion levels after MoM-THA? One year results in 383 implants.

BACKGROUND AND AIM OF THE WORK: Adverse reaction to metal debris is the major cause of the high revision rates of metal on metal hip implants with femoral head size ≥ 36mm. Health authorities recommend regular surveillance even for asymptomatic individuals. The main investigations used are Co+ and Cr+ serum levels, x-rays and, eventually, ultrasound and MARS-MRI. Clinic is also assessed. The aim of this study is to identify if there is a relation between  ion levels and the clinical scores  in order to evaluate the outcome and  plan the correct management after this type of implant. METHODS: 383 subjects were included and divided in 3 groups (serum ion levels >, <  and >60 µg/L). Co+, Cr+, HHS and OHS results of 1 2017 were analysed in order to show a correlation between ion levels and clinical scores . RESULTS: Clinical scores were similar in group 1 and 2. Differences were observed comparing the group 1 and 2 with group 3 for both variables. DISCUSSION AND CONCLUSIONS: Surveillance algorithms have been introduced by health  authorities. Nevertheless, the indication to revision surgery is not simple especially in those cases in which a discrepancy between clinic and investigations is present. In this study clinical scores seem to be less important than ion levels in the evaluation of outcomes and in order to plan the correct management in the majority of cases. Larger studies are needed to highlight the real importance of clinical scores in the decision making after these type of implants.

Mini-Open Surgical Fasciotomy for Chronic Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Adolescents.

OBJECTIVE: Evaluate treatment and outcome of mini-open fasciotomy (MOF) in a population of adolescent motorcycling racers affected by forearm chronic exertional compartment syndrome (CECS). DESIGN: Prospective case series. SETTING: University hospital/private practice. PATIENTS: Nine professional motorcycling adolescents were diagnosed with forearm CECS. All were treated with MOF between 2007 and 2012 and followed for a minimum of 5 years (range 5-10 years). Age, sex, body mass index, laterality, and profession were recorded. INTERVENTIONS: A MOF to obtain decompression of all compartments was performed in all patients. MAIN OUTCOME MEASURES: Visual analog scale; a subjective scale to measure strength; and Quick-DASH functional scores. Time to resume full riding capacities as the short-term evaluation. RESULTS: A significant decrease in visual analog scale (P < 0.001) and Quick-DASH (P < 0.001) scores was observed in the first 3 months, stabilizing during follow-up (P = 0.521; P = 0.217). Average time to return to sport was 2.8 ± 1 week. No symptom recurrence was reported, but one patient suffered a minor complication. There were no cases of infection, hematoma, or peripheral nerve injury. CONCLUSIONS: We assess that MOF can be a valid alternative for the treatment of forearm CECS in adolescent competitive motorcycling racers, as demonstrated by the good success rate and minimal incidence of complications during follow-up. LEVEL OF EVIDENCE: IV, case series.

Outcome of short versus conventional stem for total hip arthroplasty in the femur with a high cortical index: a five year follow-up prospective multicentre comparative study.

BACKGROUND: The uncemented total hip arthroplasty (THA) has become the choice for many hip surgeons. Although conventional uncemented femoral components have a proven track record, there remain concerns about the rate of thigh pain, proximal stress shielding, and consequent loss of bone stock at revision surgery. METHODS: Inclusion criteria were the following: patients between 50 and 85 years old undergoing primary THA with implant of short (group 1) or conventional (group 2) femoral stem and with femoral shape type A, according to Dorr classification. Clinical follow-up was registered using OHS, HHS, and Womac scores. The radiographic scans were evaluated in order to compare component positioning and bone remodeling at five year follow-up. RESULTS: We included in the analysis 60 subjects in group 1 and 67 in group 2. No differences were registered between the groups comparing demographic and operative data. One case in group 1 (1.7%) and three cases in group 2 (4.5%) reported an intra-operative fracture. There was a significant improvement in the functional scores in both groups with no significant difference at final follow-up. The incidence of reported thigh pain at follow-up was 14.9% in group 2 and 3.3% in group 1 (p = 0.033). Radiographic analysis documented a difference in terms of stress shielding and thinning of medial and lateral cortex in favour of group 1. Moreover, patients of group 1 showed a higher varus angle at six month follow-up. CONCLUSION: In patients with high cortical index, a short stem shows better clinical and radiological outcomes at five year follow-up.

Surgical or conservative treatment in ARGP syndrome? A systematic review.

BACKGROUND AND AIM OF THE WORK: The rectus-adductor syndrome is a common cause of groin pain. In literature the adductor longus is reported as the most frequent site of injury so that the syndrome can be fitted into the adductor related groin pain (ARGP) group. The aim of this study was to define what is the best treatment between surgical and conservative in athletes affected by ARGP in terms of healing and return to play (RTP) time. METHODS: A systematic review was performed searching for articles describing studies on RTP time for surgical or conservative interventions for ARGP. A qualitative synthesis was performed. Only 10 out 7607 articles were included in this systematic review. An exploratory meta-analysis was carried out. Due to high heterogeneity of the included studies, raw means of surgery and conservative treatment groups were pooled separately. A random effects model was used. RESULTS: The results showed quicker RTP time for surgery when pooled raw means were compared to conservative treatments: 11,23 weeks (CI 95%, 8.18,14.28, p<0.0001, I^2=99%) vs 14,9 weeks (CI 95%, 13.05,16.76, p<0.0001, I^2 = 77%). The pooled results showed high statistical heterogeneity (I^2), especially in the surgical group. CONCLUSIONS: Surgical interventions are associated with quicker RTP time in athletes affected by ARGP, but due to the high heterogeneity of the available studies and the lack of dedicated RCTs this topic needs to be investigated with dedicated high quality RCT studies.

Long-Term Outcome of Mini-Open Surgical Decompression for Chronic Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Riders.

OBJECTIVE: To evaluate results of mini-open fasciotomy (MOF) in high-level motorcycling or motocross riders with chronic exertional compartment syndrome (CECS) at long-term follow-up (minimum 5 years). DESIGN: Case series. LEVEL OF EVIDENCE: IV. SETTING: University Hospital/Private Practice. PATIENTS: Fifty-four professional motorcycling riders treated with MOF for a CECS of the forearm from January 2006 to June 2011. Inclusion criteria comprised: high-level motorcycling or motocross riders, clinical symptoms of CECS for at least 6 months, diagnosis confirmed using preoperative compartment hydrostatic pressure measurement and/or magnetic resonance imaging of the forearm, minimum follow-up of 5 years. INTERVENTIONS: A MOF to obtain decompression of all compartments was performed in all patients. MAIN OUTCOME MEASURES: Visual analog scale; a subjective scale to measure strength; QuickDash functional scores. Time to resume full riding capacities as short-term evaluation. RESULTS: A total of 54 patients who underwent 77 MOF procedures overall (23 bilateral) were included. The mean age was 23.6 ± 5.2 years. Mean Visual Analog Scale decreased from a preoperative value of 68.2 to a 3-month postoperative value of 26 (P < 0.001). Mean QuickDash scale was 84 at preoperative registration, falling to 20, 3 months after surgery (P < 0.001) and down to 12 at 1-year follow-up (P = 0.017). The average time to return to full riding capacities was 3.5 ± 1 week. CONCLUSIONS: Mini-open fasciotomy resulted safe and effective for the treatment of chronic exertional compartment syndrome in high-level motorcycling or motocross riders. The good outcome at follow-up resulted stable at 5 years and the incidence of complications remained low. Our data demonstrate that the resolution of symptoms is reliable and durable. Pain recovery was immediate after surgery, instead functional scores showed a more gradual recovery throughout the 12 months after surgery. CLINICAL RELEVANCE: Mini-open fasciotomy is a reliable treatment for CECS of the forearm in professional motorcycling riders. This treatment should also be considered in young riders due to the absence of tardive relapse reported in this study.

Acetabular erosion following bipolar hemiarthroplasty: A Role for the size of femoral head?

INTRODUCTION: Femoral neck fractures are the most frequent fractures in the elderly and hemiarthroplasty is the treatment of choice. The objective of this study is to identify predictive factors of acetabular erosion after bipolar hemiarthroplasty in a mobile independent population during a follow-up of ten years. MATERIALS AND METHODS: This multicenter study started in 1997 ending in 2007. Data were prospectively collected and retrospectively analyzed. Inclusion criteria were: age > 60 and < 85 years, BMI < 35, normal Abbreviated MiniMental Test score, ability to walk 0.8 km and live independently, non-pathological fracture, hip with no or minimal osteoarthritic changes, and availability of clinical and radiological follow-up. For each Patient were recorded: demographic data, comorbidities, time from fracture to surgery, characteristics of the implant, duration of surgery. Patients included underwent clinical and radiological follow-up at a minimum of ten years. RESULTS: Overall, 209 Patients met inclusion criteria. A press-fit implant was performed in 172 subjects; in contrast a cemented prosthesis was implanted in 37 patients. Nineteen patients underwent implant revision to total hip arthroplasty for acetabular erosion and pain. Classification of X-ray using Baker criteria showed a grade 0 in 54.5%, a grade 1 in 19.6%, a grade 2 in 18.1% and a grade 3 in 7.6%. Multivariate analysis revealed that the size of the femoral head (FH) was the only predictive factor of a higher risk of acetabular erosion. The Kaplan-Meier survival curve verified the risk of implant revision in Group 1 (FH sized > 48 mm) and Group 2 (FH sized < 48 mm). The probability of implant revision for acetabular erosion at ten years from surgery were 5.5% in Group 1 and 15.6% in Group 2. CONCLUSION: In bipolar hemiarthroplasty smaller head size lead to a polar wear implying a higher risk of acetabular erosion and migration; in our population this risk was consistent with the use of implant head < 48 mm diameter. Considering the absolute risk of a smaller FH size, the surgeon must evaluate the accuracy of measurement of the caliber, since as reported in previous studies, it can significantly underestimate the size.

When is indicated fibular fixation in extra-articular fractures of the distal tibia?

BACKGROUND AND AIM OF THE WORK: There is no consensus about indications for fibular osteosynthesis in extra-articular fractures of the distal tibia (DTF). This study analyses patients affected by DTF associated to fibular fracture and has the aim to define whether the level of fibular fracture has an influence on bone healing and consequently when its fixation is indicated. METHODS: Eighty-seven patients were operated from January 2005 to December 2016. Inclusion criteria were: the presence of skeletal maturity, the absence of physical limitations before trauma and a type 43-A AO closed fracture. Clinical outcomes were evaluated using Olerud-Molander Ankle Score (OMAS) and the Disability Rating Index (DRI). Malrotation was also assessed as well as incidence of nonunion and malalignment through x-rays. RESULTS: No differences in clinical scores were reported at follow-up between patients in which fibular fixation was performed (Group 1) in comparison with those in which this procedure was not executed (Group 2).  Nonunions were registered in 8 cases: four in Group 1 and four in Group 2. A statistically significant difference in incidence of external malrotation and valgus malalignment between the groups was documented, with a higher risk in patients of the second group. CONCLUSIONS: The level of fibular fracture is important to determine when the fixation of this bone is indicated. In supra-syndesmotic fractures osteosynthesis leads to a higher incidence of nonunions. Fibular osteosynthesis could prevent malrotation and malalignment and is advisable in distal metaphyseal fracture of this bone (trans- or infrasyndesmotic lesion) with syndesmotic injury.

Treatment of distal tibial fractures: prospective comparative study evaluating two surgical procedures with investigation for predictive factors of unfavourable outcome.

PURPOSE: The aim of this study is to compare clinical and radiological outcome of intramedullary nailing (IMN) and locked plate (LP) in patients affected by fracture of the distal tibia (DTF). We performed also an analysis to identify predictive factors of unfavourable outcome. METHODS: Data about patients with DTF treated at our first level trauma centre between 2008 and 2017 were collected. Patients were divided in group 1 (IMN) and group 2 (LP). The inclusion criteria were age at least 18 years at the time of diagnosis and unilateral DTF (closed or Gustilo 1). Demographic variables and data related to surgical procedure and hospitalization were registered. X-ray at follow-up was reviewed to identify malunions and nonunions. Clinical outcome was evaluated using scores and registering any complication. RESULTS: One hundred two patients were included in group 1 and 81 in group 2. In group 2 were documented higher operating time and hospitalization. The mean union time was 20.2 weeks for IMN and 24.8 weeks for LP group (p = 0.271). The rate of infections and wound complications was higher in group 2 while malunion and anterior knee pain were more frequent in group 1. No difference in scores for clinical outcome was documented after six months. The full-weight bearing time was significantly longer in the LP group (p = 0.019). At multivariate analysis, no variables showed a predictive power for unfavourable outcome. CONCLUSIONS: Clinical and radiological results of LP and IMN appear similar. No predictive factors of unfavourable outcome were identified.

WITHDRAWN: Acetabular erosion following bipolar hemiarthroplasty: A role for the size of femoral head?

The Publisher regrets that this article is an accidental duplication of an article that has already been published in Injury, 50(2) (2019) 420­423, https://doi.org/https://doi.org/10.1016/j.injury.2018.11.041. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Modified SERI technique in the treatment of hallux valgus combined with arthritis.

INTRODUCTION: Few reports encompass the treatment of first metatarsophalangeal joint (MTPJ) arthritis complicating hallux valgus. Indeed, in the literature, there is a lack of guidance concerning the management of patients affected by mild to moderate first MTPJ arthritis complicating hallux valgus. The aim of this study is to present the mid-term results of an original joint-preserving surgical technique. MATERIALS AND METHODS: A group of 50 patients (60 feet) affected by mild to moderate first MTPJ arthritis complicating hallux valgus who underwent modified Giannini's SERI (simple, effective, rapid, inexpensive) surgical procedure were prospectively reviewed. They were clinically and radiographically evaluated preoperatively and after surgery and were also assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score and Coughlin and Shurnas classification. The average follow-up was 38 months. A multivariate analysis was performed to evaluate the existing relationship between postoperative AOFAS results and radiological preoperative measured angles and sesamoid grade of dislocation. RESULTS: The average AOFAS score significantly improved at last follow-up to an average of 90.5 ± 14.5, while preoperatively it was 45.6 ± 15.3 ( p < 0.001). On multivariate analysis, a statistically significant correlation resulted among all the radiographic preoperative registered parameters and clinical postoperative results. However, it was shown that any radiological parameter alone could not predict a better clinical recovery. CONCLUSIONS: The surgical technique proposed here could extend the indications of the SERI procedure to those patients affected by mild to moderate hallux valgus combined with mild to moderate osteoarthritis.