Pseudoarthrosis of second metatarsal fracture.

Metatarsal fractures make up the greatest portion of foot fractures in children. Most of them are treated with closed reduction and non-weightbearing cast immobilization.Usually, these fractures heal uneventfully and delay union and pseudoarthrosis are rare. We report a case of a 10-year-old child with non-union of the second metatarsal following a traumatic fracture, caused by an accident 10 months before, and treated successfully by osteosynthesis with plate and screws. Good clinical outcome was achieved at 2 years follow-up.

Evaluation of the Effectiveness of Neuromuscular Electrical Stimulation After Total Knee Arthroplasty: A Meta-Analysis.

OBJECTIVE: The aim of the study was to evaluate the efficacy of the use of the neuromuscular electrical stimulation after total knee arthroplasty. DESIGN: The study used a systematic review of randomized controlled trials (MEDLINE, PubMed, Cochrane Library, and PEDro) using Patient Population or Problem, Intervention, Comparison, Outcomes, Setting approach to formulate the research question, controlled terms, and Boolean operators. Inclusion and exclusion criteria were defined in advance. "Neuromuscular electrical stimulation" and "total knee arthroplasty" were used as keywords. The overall risk of bias was determined according to the following: random sequence generation, concealment, blinding mass of participants and staff, commissioning blind assessment results, incomplete data, and loans received. RESULTS: Of the 36 identified studies, six were included in the review (496 participants). In these studies, one group of patients followed a rehabilitation protocol (control group) and the other followed a rehabilitation program plus a session of neuromuscular electrical stimulation (neuromuscular electrical stimulation group). Patients of neuromuscular electrical stimulation groups got the best scores (timed up and go test, stair climbing test, and walk test). Neuromuscular electrical stimulation benefits were strong in the first postoperative weeks/months and gradually diminished. CONCLUSIONS: Neuromuscular electrical stimulation allows a slightly better functional recovery after total knee arthroplasty, especially in the first period, with more evident benefits in patients with a severe lack of muscular activation. Nevertheless, there is no difference at medium-long term.

Combined Intra- and Extra-Articular Technique in Revision Anterior Cruciate Ligament Reconstruction.

Purpose The aim of the study was to evaluate the "over the top" (OTT) nonanatomical technique for revision of anterior cruciate ligament (ACL) reconstruction. Methods Twenty-four patients with a mean age of 31.9 ± 11.2 years underwent revision of ACL reconstruction using OTT technique. International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, Tegner score, Subjective Patient Outcome for Return to Sport (SPORTS) score, Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale, and KT-1000 evaluation were recorded at a mean follow-up of 30.7 ± 18.9 months. Results Postoperatively, the IKDC objective total score significantly improved ( p = 0.0046). The KOOS, Lysholm, and Tegner scores also improved, but the results were not statistically significant (62.4 vs. 72.6, 6.5 vs. 75.8, and 4.1 vs. 6.0, respectively). The subjective IKDC evaluation score improved from an average of 51.1 points to 63.7 points at the last follow-up ( p = 0.0027). The RTP prevalence was 81.8%, with 44.4% of the patients returning to the same preinjury level. According to the SPORTS score, 16.6% of patients played sport without limitations in activity and performance. The average ACL-RSI score was 52.1 ± 27.0. No major complications were reported. A total of 21.5% of patients underwent surgical removal of staples. The failure prevalence was 14.3% and the cumulative survivorship, calculated using the Kaplan-Meier method, was equal to 70% at 60 months of follow-up. Conclusion The OTT technique in the revision ACL reconstruction provided improvement in objective and subjective scores, good RTP prevalence, and acceptable rate of complication and failure. One of the advantages was the possibility to avoid the femoral tunnel. Level of Evidence Level IV, therapeutic case series.