Correlation between Ankle Imaging Findings and Self-Reported Outcomes: A Longitudinal Assessment in Patients with Tibiofibular Diastasis.

BACKGROUND AND OBJECTIVES: This longitudinal study investigated the correlation between imaging findings and self-reported questionnaire outcomes in patients with tibiofibular diastasis, exploring the effects of surgical screw removal versus conservative treatment. This study was conducted at "Victor Babes" University of Medicine and Pharmacy in Timisoara between 2018 and 2023. MATERIALS AND METHODS: The study involved 85 patients in the screw removal group and 44 in the conservative group, assessed at 2 and 6 months post-surgery, answering the SF-36, HADS, and WHOQOL questionnaires. RESULTS: Significant differences were observed at 2 months post-surgery, with the screw removal group showing lower shear wave velocities in ankle dorsiflexion (8.9 ± 1.4) and anterior talofibular ligament (2.8 ± 0.9), indicating better mobility compared to the conservative group (ankle dorsiflexion: 10.1 ± 1.8, ATFL: 3.2 ± 1.1). Radiographically, lower tibiofibular overlap (8.1 ± 2.1) in the screw removal group suggested improved joint fixation quality. These physical improvements were mirrored in the quality-of-life assessments, where the screw removal group reported higher physical health scores on the SF-36 survey at 2 months, a trend that continued at 6 months. At 2 months, ankle dorsiflexion demonstrated a strong negative correlation with the SF-36 Physical score (r = -0.417) and WHOQOL Physical domain (r = -0.394), and a positive correlation with HADS Anxiety (r = 0.312). Similarly, ATFL and CFL velocities negatively correlated with the SF-36 Physical score (ATFL: r = -0.251; CFL: r = -0.237). Radiographic tibiofibular overlap and clear space positively correlated with WHOQOL Physical domain (TOL: r = 0.291; TCS: r = 0.276), with TCS also negatively correlating with HADS Anxiety (r = -0.228). At 6 months, these correlations persisted, with notable negative correlations between ultrasound ankle dorsiflexion and both SF-36 Physical score and WHOQOL Physical domain. CONCLUSIONS: These findings underscore the advantages of screw removal in enhancing physical recovery and reducing anxiety in the short term, while indicating similar long-term mental health outcomes between treatment approaches.

Impact of Syndesmotic Screw Removal on Quality of Life, Mobility, and Daily Living Activities in Patients Post Distal Tibiofibular Diastasis Repair.

Background and Objectives: While numerous studies have been conducted on syndesmotic screw management following distal tibiofibular diastasis repair, a clear consensus remains unclear. This research aims to evaluate whether the postoperative removal of syndesmotic screws leads to improved patient outcomes, specifically in quality of life, mobility, and daily living activities, and whether it offers a cost-effective solution. Materials and Methods: Patients with a history of unimalleolar or bimalleolar ankle fractures, classified according to the Danis-Weber and Lauge-Hansen systems, were included. Comprehensive evaluations were made via standardized questionnaires like the SF-36 Health Survey, HADS, and WHOQOL-BREF, distributed approximately 2 months post surgery. A total of 93 patients underwent syndesmotic screw removal while 51 retained the screws (conservative approach). Results: Patients who underwent screw removal reported superior satisfaction in mobility, with a score of 7.8, compared to 6.7 in the conservative approach (p = 0.018). Similarly, their ability to perform daily activities scored 8.1, higher than the 6.5 from the conservative cohort (p < 0.001). Pain levels were also more favorable in the screw removal group, with a score of 5.3 against 6.8 in the conservative group (p = 0.003). On the SF-36 physical domain, the screw removal group achieved a mean score of 55.9 versus 53.3 for the conservative group (p = 0.027). Notably, the HADS anxiety subscale highlighted reduced anxiety levels in the screw removal cohort with a mean score of 5.8 against 7.3 in the conservative group (p = 0.006). However, overall quality of life and recommendations to others showed no significant difference between the groups. Conclusions: Syndesmotic screw removal postoperatively leads to marked improvements in patients' mobility, daily activity abilities, and reduced postoperative pain and anxiety levels. However, overall quality of life was similar between the two approaches. The findings offer valuable insights for orthopedic decision making and patient-centered care concerning the management of syndesmotic screws after distal tibiofibular diastasis repair.

Acetabular cup placement and offset control in robotic total hip arthroplasty performed through the modified anterolateral approach.

PURPOSE: The modified anterolateral approach (Röttinger) for total hip arthroplasty (THA) offers great advantages over conventional approaches, especially concerning early postoperative symptoms, which are mild and well tolerated by patients. Robotic-assisted implantation might facilitate rapid adoption of the modified anterolateral approach without exposing surgeons to risks encountered during the learning curve. This study posits that the use of robotic assistance in conjunction with the modified anterolateral approach for total hip arthroplasty (THA) can provide a substantial enhancement in the accuracy of cup placement in comparison to manual surgery. METHODS: Thirty-two robotic-assisted THAs met the inclusion criteria and were matched to 32 conventional cases. Acetabular cup inclination, anteversion, limb-length discrepancy, and acetabular offset were assessed using certified planning software by two independent observers using pre- and postoperative anterior-posterior radiographs. Data was analyzed for normal distribution. Chi2 test was used to determine whether implanted acetabular cups that were within Lewinnek's safe zones were influenced by type of implantation. Effect size estimates and statistical power analysis were also performed to appreciate the appropriateness of the chosen sample size. RESULTS: Robotic-assisted implantation was found to significantly improve acetabular cup placement in terms of inclination (p < 0.001) but not anteversion (p = 0.783). Although mean postoperative limb-length discrepancy and mean acetabular offset did not differ between groups, a significantly smaller variance was found in the robotic-assisted group (p < 0.001) and (p = 0.04), respectively. There were no significant differences between the two groups in terms of consistently implanting the acetabular cup within the Lewinnek safe zones p = 0.641 for anteversion and p = 0.230 for inclination, respectively. CONCLUSIONS: Our results show that although robotic-assisted acetabular cup implantation performed through the modified anterolateral approach did not significantly differ from conventional implantation, it did offer increased accuracy in cup positioning, acetabular bone preservation, and limb-length restoration.

Early experience using patient-specific instrumentation in opening wedge high tibial osteotomy.

PURPOSE: Patient-specific instruments (PSI) have been designed to improve the accuracy of performing opening-wedge high-tibial osteotomies (OW-HTO). This study aims to evaluate the lower limb alignment, by comparing pre-operative desired correction to post-operative achieved correction, the difference in surgical time and number of radiological exposures in OW-HTO using patient-specific instruments (PSI) versus conventional osteotomies and the specific and non-specific complications that occurred. METHODS: We performed a single-centre, retrospective, observational study, including 25 consecutive patients undergoing OW-HTO using PSI, from January 2019 to October 2020. RESULTS: Pre-operatively, the mean hip-knee angle (HKA) was 167°, the mean tibial slope was 7.9° and the mean medial proximal tibial angle (MPTA) was 82.5°. Post-operatively, the mean HKA was 182.2° (180.1-184.7°), the tibial slope was 6.5° (4.2-12.9°) and the MPTA was 92.8° (90.6-93°). In both coronal and sagittal plane, all knees were within 2° from the planned value. The mean tourniquet time, by which the surgical time was measured, was 40 minutes and the average number of intra-operative fluoroscopic images was 10 (range: 7-14), significantly less than when using conventional techniques. CONCLUSIONS: The use of PSI in OW-HTO allows accurate achievement of the desired correction, while shortening the OR time. The number of radiological exposures is also decreased, in comparison with the conventional osteotomies.

Large giant cell tumor of the posterior iliac bone - an atypical location. A case report and literature review.

Giant cell tumor (GCT) is a locally aggressive tumor but with benignity features, representing approximately 18% of non-malignant bone tumors in European countries, with slight female predominance. Malignancy in GCT is rare, about <2% of cases and is more common at older ages. Is known that usually occurs at the epiphyses of long bones, but extremely rare may have another location, such as the pelvic bone. An atypical location - the posterior iliac bone, found at a 34-year-old male -, is the case report we studied and described. Starting from the patient's complains, like a mass in the left buttock region described as "recently appeared", firm, not-mobile, with no distinctive borders and no tenderness at palpation, and a recent history trauma, multiple investigations have been performed, which have highlighted an osteolytic lesion, close to the sacroiliac joint, only with infiltration of the gluteal, iliac and paravertebral muscles. The treatment of choice was hemipelvectomy, with wide tumoral resection, and selective embolization of the nutrient vessels 24 hours prior to the surgical procedure. At two years postoperative, we found a good functional result and the computed tomography (CT) scan revealed no signs of recurrence.

Morphometric characteristics of fibrocartilaginous tissue in the herniated intervertebral disc.

The purpose of this research was to identify a possible correlation between the morphometric characteristics of fibrocartilaginous tissue in the intervertebral herniated disc fragment and the clinical and imagistic characteristics of patients with back pain. Sixty-two samples were included in this study. Intervertebral herniated disc fragments obtained during surgery (microdiscectomy) were analyzed histologically and morphologically. The analyzed fragment tissues from herniated lumbar discs were from L3-L4, L4-L5 or L5-S1 levels. The average number of chondrons encountered in a visual field was 35 (ranging from 8 to 51). The minimum chondrons surface area - 493.4 pixels² (from 188 to 925 pixels²) and the average peak area of chondrons - 5250.9 pixels² (ranging from 1171 to 11811 pixels²) and the median was 785.4 pixels² (values between 247.5 and 1621 pixels²). With age control, a correlation between the average chondron area and the Pfirrmann classification (r=0.413; p=0.014) was found but the correlation coefficient was small. The results of this study demonstrate that there is a correlation between the area of the chondrons and the clinical and imagistic characteristics. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) correlated with the chondrocyte area in the presence of a lumbar disc herniation with surgical indication. It should be taken into account that the variables considered only correspond to certain patients with degenerative lumbar discopathy.

Haematology panel biomarkers for humeral, femoral, and tibial diaphyseal fractures.

PURPOSE: The neutrophil to lymphocyte ratio (NLR) is a simple predictor used in oncology and cardiology. We aimed to analyze the NLR profile of patients with diaphyseal fractures of the humerus, femur, and tibia. METHODS: We performed a cross-sectional, consecutive-case population-based study including 148 patients (41.9% men respectively 58.1% women) with humeral (23.0%), femoral (30.4%), and tibial (46.6%) diaphyseal fractures, admitted for surgical treatment in our level 1 trauma centre over two years. RESULTS: The differences in NLR between the studied subgroups were not significant (p = 0.067), the highest value being observed in patients with femoral fracture (5.6) in contrast to patients with humeral fracture (4). In the global cohort, there was a significantly positive correlation between NLR and PLR (platelet to lymphocyte ratio; Spearman's r = 0.595; p < 0.001). The stratified subgroup analysis found significant association between NLR and duration of admission only for patients with femoral fracture (Spearman's r = - 0.308; p < 0.001). When compared with controls, all three fracture types had significantly higher neutrophil numbers and NLR and lower thrombocyte numbers. CONCLUSIONS: NLR are elevated in femur diaphyseal fractures compared with tibia and humerus, up to cut-off values with negative prediction of outcome in malignancy and cardiovascular patients. Increased NLR are predictive of longer hospital admissions for femur fractures.

Cross-cultural adaptation and validation of the Romanian Hip disability and Osteoarthritis Outcome Score for Joint Replacement.

OBJECTIVE: Perform translation, cultural adaptation and psychometric testing of the Romanian translation of the Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS_JR). DESIGN: Assess construct validity, reliability, internal consistency and reproducibility. SETTING: Adults with chronic hip disability prior or at a minimum of 3 months after surgery. PARTICIPANTS: Ninety-six patients (22 bilateral) with hip osteoarthritis or who had previous hip replacement or osteosynthesis for a fracture of the trochanteric region. INTERVENTION: Complete the HOOS_JR together with the Oxford Hip Score (OHS_RO), Harris Hip Score (HHS) and Euroqol EQ-5D. 57 patients repeated the HOOS_JR after 2 days. MAIN OUTCOME MEASURE: Convergent validity using Spearmans's correlation coefficient; Cronbach's alpha coefficient, intraclass correlation coefficient (ICC, two-way mixed effects model) and inter-item correlation matrix and test-retest assessment after 2 days. RESULTS: The questionnaire had a high degree of reliability with a Cronbach's α of 0.923 at the initial completion and 0.924 at the second testing. The ICC was 0.923 for average measures for the first form and 0.910 for the second form. The two results were strongly, positively and significantly correlated (rs = 0.859; P < 0.001). The Romanian HOOS_JR strongly, significantly and positively correlated with the OHS_RO (rs = -0.880 initial and rs = -0.803 s; P < 0.001) and HHS (rs = -0.731 initial and rs = -0.654 s; P < 0.001) and moderately, significantly and positively correlated with the EQ-5D Index (rs = -0.580 initial and rs = -0.542 s; P < 0.001) and VAS (rs = -0.500 initial and rs = -0.690 s; P < 0.001). CONCLUSIONS: The translated HOOS_JR is a reliable, reproducible and valid measure of function in patients with chronic hip disability.

The role of immunohistochemistry in the diagnosis and management of synovial sarcoma.

Synovial sarcoma (SS) is a malignant soft tissue tumor representing 5-10% of all soft tissue sarcomas. Most synovial sarcomas are found at the extremities, especially in the lower limbs. A 28-year-old female presented at the Department of Plastic and Reconstructive Surgery, "Dr. Pius Brînzeu" Clinical Hospital, Timisoara, Romania, for evaluation of a mass located in the anterior region of the elbow. Imagistic, histological and immunohistochemically evaluations established the diagnosis of monophasic spindle cell SS G2. Block excision of the tumor with oncological safety margins was performed followed by total elbow arthroplasty. The patient then received radio- and chemotherapy. The case was followed-up at regular intervals for local recurrence and metastases and was free of symptoms at two years. Early diagnosis of SS, multimodal therapies and performing an arthroplasty of the elbow allowed the patient to resume daily activities. The unpredictable evolution requires regular follow-up for a long period of time.

Deep vein thrombosis following the treatment of lower limb pathologic bone fractures - a comparative study.

BACKGROUND: Deep vein thrombosis is a well-known complication of fracture occurrence, lower limb surgery and periods of prolonged immobilisation. Its incidence can be increased even more in specific cases with metastatic bone disease and adjuvant treatment. There is a small amount of literature that addresses the incidence of DVT by comparing osteosynthesis and arthroplasty as surgical treatments. Current recommended anticoagulation protocols might be inadequate for specific groups of cancer patients undergoing osteosynthesis or arthroplasty. METHODS: The study was designed and performed in a retrospective manner and carried out on patients that presented at our Emergency Clinical County Hospital between 01.01.2008-31.12.2016. The patients' evolution was followed for a standard of 2 months. All our deep vein thrombosis events were diagnosed via venous duplex imaging. The studied lot (n = 85) was paired with a control group (n = 170) with similar baseline characteristics. RESULTS: Our lot was comprised of 85 patients that underwent 85 surgeries, on both of our hospital's Orthopaedic and Traumatology wards. When performing the student t-test and calculating OR (odds ratio) and RR (risk ratio) we encountered 11 cases of DVT in our studied group and 12 cases of DVT in our control group (p < 0.04). We found statistical significance when correlating DVT with type of implant (prosthesis), the presence of metastases over primary tumour and the choice of implant (prosthesis over intramedullary nail). There was no statistical significance found when correlating DVT events with the type of anticoagulation and the amount of blood transfusion units required. CONCLUSION: Patients who undergo surgical treatment for lower limb pathological fracture due to malignancy are at increased risk of DVT or death due to PE under current general thromboprophylaxis regimens. The risk is higher for the immediate postoperative period (10 days). The risk is increased by metastasis, arthroplasty and adjuvant therapy (radiotherapy, chemotherapy), and we think that a more aggressive prophylactic protocol should be used.

Cross-cultural adaptation and validation of a patient-reported hip outcome score.

PURPOSE: We aimed to perform psychometric testing for the translated Oxford Hip Score (OHS) for use as a recommended tool to measure treatment outcomes. METHODS: The original English questionnaire was translated and culturally validated using the instrument developer's guidelines and the ISPOR principles of good practice. One hundred patients completed the form together with the Harris Hip Score (HHS) and EQ-5D-5 L. Fifty patients repeated the form after two days. They were suffering from hip osteoarthritis, had had hip replacement or underwent osteosynthesis for a fracture of the trochanteric region. RESULTS: The questionnaire had a high degree of reliability with a Cronbach α of 0.917 at the initial completion and 0.917 at the second testing, respectively. The two results were strongly positive and significantly correlated (Pearson's r = 0.947; p < 0.001). The OHS was strongly and significantly correlated with the HHS (Pearson's r = 0.880 initial and r = 0.840 s; p < 0.001) and strongly, positive and significantly correlated with the EQ-5D-5 L VAS (Pearson's r = 0.614 initial and r = 0.704 s; p < 0.001). CONCLUSIONS: Our study showed that the translation of the OHS is a reliable, reproducible and valid measure of function in patients who undergo treatment for hip pathology.

Extra-articular distal tibia fractures-controversies regarding treatment options. A single-centre prospective comparative study.

Distal tibia fractures are reported to have a high complication rate pre-operatively as well as post-operatively, which can include open fractures, soft tissue damage, infection, malalignment, pseudarthrosis and ankle arthrosis. The operative treatment for the extra-articular distal tibia fractures is a controversial topic in the orthopaedic literature. Some of these fractures are proximal enough to be treated with an intramedullary nail while others are too distal for that. The aim of our study was to compare the results we have had with intramedullary nail (IMN) and minimally invasive plate osteosynthesis (MIPO) in distal metaphyseal (extra-articular) tibia fractures. The study was designed prospectively between January 2013 and March 2016 and took place on the Orthopaedics and Traumatology ward of a Clinical Emergency County Hospital in western Romania. The follow-up visits were scheduled one month, three months and six months post-operatively. For evaluating the ankle function, we used the Olerud-Molander ankle score (OMAS) and union was evaluated at six months on ankle X-rays. At the six-month follow-up visit the average scores were 75.55 (20-100) for the IMN lot and 74.23 (20-90) for the MIPO lot, without finding any statistical difference between the two groups (p >0.1). At the six-month follow-up, X-ray union was objected in 48 (90.5%) of our patients, the IMN lot having worse results (85.18%) than the MIPO lot (96.15%). The results we encountered showed little to no statistical difference when it comes to the functional score we used (OMAS score), leading us to believe that you can achieve comparable results with both implants.

Trochanteric fracture following hip arthrodesis: case presentation.

Even if the intertrochanteric fracture under an arthrodesis hip is rare and the optimal surgical treatment is controversial, we consider that treating this kind of fracture with a locked plate was a success.

Alveolar rhabdomyosarcoma in an adolescent male patient - case report and current perspectives.

Alveolar rhabdomyosarcoma (RMS) is a common pediatric malignant mesenchymal tumor, representing half of soft tissue sarcomas and approximately 5% of all cancers. We present the case of an adolescent male patient treated in our Department for a tumoral mass located in the middle third of the forearm. Magnetic resonance imaging (MRI) and angiography-computed tomography (angio-CT) showed a large mass located in the muscles of the anterior compartment of the forearm. Surgical treatment consisted of tumor ablation including segmental resection of the radial and ulnar arteries and of the median nerve, followed by saphenous autograft vascular bypass. The treatment plan was based on tumor type, histological grading (high), age, tumor size greater than 5 cm, unfavorable location, postoperative tumor, node, metastasis (TNM) stage II, presence of microscopic tumoral tissue in the margins of the resected piece, lymph node metastases (N1) and bone metastases (M1) found on positron-emission tomography (PET)-CT according to the German soft tissue sarcoma study (CWS)-IV 2002 protocol. The chemotherapy used Carboplatin and Topotecan. Survival was less than two years after the initial presentation. Adolescent extremity masses should raise suspicion to exclude serious malignancy. Despite early diagnosis and use of multimodal therapies, alveolar RMS prognostic remains unpredictable.

Patient specific instrumentation versus conventional knee arthroplasty: comparative study.

BACKGROUND: The key to a successful knee replacement is restoring normal kinematics with a neutral alignment, thus a hip-knee-ankle (HKA) angle of 180° (within 3° limits). Conventional TKR is proven to have excellent results but relies in extensive visual referencing of bony landmarks. Customised cutting blocks provide accurate bone cuts, also lowering the risk of fat embolism, blood loss and operating time. METHOD: We share our experience comparing two different TKA techniques using patient specific instrumentation (PSI) with the Visionaire knee and conventional instrumentation (CVI) from the same system (Genesis II Smith&Nephew). A total number of 80 knees were divided into two equal groups, 40 PSI and 40 CVI respectively, operated between April 2013 and August 2014. One female patient had bilateral TKR during this period, at six months interval, both with the PSI. RESULTS: All operated knees had varus deformity, with a mean HKA of 168° (PSI) vs 163° (CVI). We used tranexamic acid (double-dose scheme) and suction drains for 48 hours, with a mean blood drainage in the PSI group of 185 ml and Hb levels of 11.2 g/dl at three days post, compared to 260 ml and 10.7 g/dl in the CVI. Mean blood loss was 3.5 g/dl in PSI, and 4.2 g/dl in the CVI. On the long leg standing radiograph at six weeks, all knees were aligned in frontal plane, with simillar HKA values (178.9° PSI vs 178.6° CVI). Bone cuts measured intraoperatively proved to be accurate within a 1 mm limit. CONCLUSIONS: We cannot recommend PSI-TKR for a better outcome. It is an alternative to conventional and computer-assisted TKR, but further studies are needed to evaluate weather surgical or economic benefits may be achieved by choosing customised instruments.

Avascular necrosis of the femoral head at 2 years after pertrochanteric fracture surgery: Case report.

INTRODUCTION: The avascular necrosis of the femoral head represents the death of bone tissue due to the lack of blood supply. The disease has a progressive evolution and left untreated leads to femoral head collapse and severe arthritis. CASE PRESENTATION: We present a case of a pertrochanteric fracture which has been successfully operated with a dynamic interlocking trochanteric gamma nail on the right hip. At 2 years after surgery the patient developed an incipient avascular necrosis of the femoral head. Despite the good positioning of the implant, we considered that the source of the pain was an intolerance of the implant, and thus we removed it. After implant removal, the patient was kept under observation and conservative treatment, to prevent further damage to the right hip and allow the healing to occur. At 6 months after the gamma nail was removed the X-rays revealed advanced avascular necrosis of the femoral head and secondary osteoarthritis on the right hip. The patient underwent surgery with an uncemented total hip arthroplasty. DISCUSSION: There are a few discussions regarding the avascular necrosis of the femoral head. These discussions may include the predisposing risk factors, the treatment of choice and the postoperative complications. CONCLUSION: The avascular necrosis of the femoral head is a complication of pertrochanteric fractures that can not be foreseen or avoided. The optimal treatment in these cases is uncemented total hip arthroplasty.

Occult fractures of the proximal femur: imaging diagnosis and management of 82 cases in a regional trauma center.

BACKGROUND: Occult hip fractures are often difficult to identify in busy trauma units. We aimed to present our institutions experience in the diagnosis and treatment of occult fractures around the hip and to help define a clinical and radiological management algorithm. METHOD: We conducted a seven-year retrospective hospital medical record analysis. The electronic database was searched for ICD-10 CM codes S72.0 and S72.1 used for proximal femoral fractures upon patient discharge. We identified 34 (4.83 %) femoral neck fractures and 48 (4.42 %) trochanteric fractures labeled as occult. RESULTS: The majority of the cases were diagnosed by primary MRI scan (57.4 %) and 12 were diagnosed by emergency CT scan (14.6 %). For the remaining cases the final diagnosis was confirmed by 72 h CT scan in 9 patients (representing 39 % of the false negative cases) or by MRI in the rest of 14 patients. MRI was best at detecting incomplete pertrochanteric fracture patterns (13.45 % of total) and incomplete fractures of the greater trochanter (3.65 % of total) respectively. It also detected the majority of Garden I femoral neck fractures (20.7 % of total). CT scanning accurately detected 100 % of Garden 2 fractures (2.44 %) and 25 % (3.65 %) of the complete pertrochanteric fractures (false negative 25 %). CONCLUSION: Occult fractures should be suspected in all patients with traumatic onset of hip pain that is inconsistent with normal radiographic findings. MRI is the golden standard but not as readily available not as cheap and not quite as quick to perform as as a CT scan. The latter which in turn can provide falsely negative results in the first 24 h. Improved imaging protocols could expedite management and improve treatment.

Gait characteristics before hardware removal in patients operated upon for tibial plateau fractures.

PURPOSE: The reporting of gait analysis data on operated fractures of the tibial plateau, while extensive for studies of knee osteoarthritis of mostly undisclosed aetiology and ACL deficient knees, is rather limited in literature. METHODS: In the present study we investigated 25 tibial plateau fractures classified as Schatzker II, IV, V and VI that underwent operative reduction and lateral plate osteosynthesis. Apart from routine radiographic exploration and patient completed (KOOS) scores at three (mean of 3.2 months), six (mean of 5.6 months) and 12 months (mean of 11.3 months) postoperatively, gait analysis was performed at these intervals as well. Cadence, step time and knee flexion were the gait parameters that were selected for the comparison at six and 12 months postoperatively. RESULTS: The analysed gait parameters were significantly improved between the six and the 12-month session and statistically significant differences were found between the two groups of values. Cadence had a mean value of 41 steps/minute at six months and 45 steps/minute at 12 months (p = 0.99). Step time was a mean of 0.74 seconds at six months while at 12 months the median value was 0.66 seconds (p = 0.94). Knee flexion angles evolved in a similar manner with mean values of 58° at six months and 69° at 12 months (p = 0.95). The mean KOOS scores were 42.4, 56.3 and 67.99 at three, six and 12 months postoperatively, respectively. CONCLUSION: Complex intra-articular fractures, classified as Schatzker IV, V and VI, had a higher impact on joint function than Schatzker II fractures treated with similar techniques and implants. There were statistically significant improvements in the recovery status at 12 months postoperatively compared to six months with extended chances for improvement.

Combined bilateral femoral head necrosis and pertrochanteric fracture: a case report.

INTRODUCTION: Modular femoral implants have become a regular feature of revision hip surgery. However, for a primary hip arthroplasty, such as a femoral neck fracture case, the implant of choice is a standard femoral component, while compelling literature evidence have made osteosynthesis the standard procedure for the vast majority of trochanteric fractures. CASE PRESENTATION: We present the case of a 66-year-old Caucasian woman presenting with two trochanteric fractures associated with primary and secondary hip osteoarthritis that were treated with an uncemented total hip replacement with a modular femoral component. CONCLUSIONS: We found that a modular femoral component can address the issues of stability and, in our case, proved to be a viable solution for treating cases that are complicated by concomitant acetabular or femoral head and neck pathology.

Reamed versus unreamed intramedullary locked nailing in tibial fractures.

The purpose of this prospective observational study is to identify whether or not reaming of tibial shaft fractures has benefits over unreamed intramedullary locked nailing. Eighty-four adult patients with recent open and closed tibial shaft fractures were treated with reamed or unreamed intramedullary locked nail fixation. We followed up for 12 months 39 of 43 patients in the unreamed and 38 of 41 patients in the reamed group, respectively. There were no significant differences between the two groups regarding the average time to healing for both clinical (3.2 vs 3.4 months, p = 0.65) and radiological (4.1 vs 4.5 months, p = 0.43) evaluations. The mean duration of surgery was shorter (p = 0.025) for the unreamed group 43 min (SD 18) compared to 55 (SD 27), but the main determinants were the fracture type and the surgeon's experience. We conclude that reamed nailing proved beneficial, but the impact on overall outcome is not superior to unreamed nailing.