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Background: Intramedullary nailing (IN) seems to be the best primary surgical treatment for patients with either polyostotic fibrous dysplasia or McCune–Albright syndrome (PFD/MAS) when the femur and tibia are totally affected by fibrous dysplasia (FD) and pain, fracture and deformity are likely to occur. However, other management protocols have been applied in these cases, often leading to disabling sequelae. This study sought to evaluate if IN could also have been effective as a salvage procedure to provide patients with satisfactory results, regardless of the poor results due to the improper treatment previously performed. Materials and methods: Twenty-four retrospectively registered PFD/MAS patients with 34 femurs and 14 tibias totally affected by fibrous dysplasia had received various treatments with unsatisfactory results in other institutions. Before the IN performed in our hospital, 3 patients were wheelchair bound; 4 were fractured; 17 limped; and many used an aid for walking. Salvage IN was performed in our hospital at a mean patient age of 23.66 ± 6.06 years (range, 15–37 years). The patients were evaluated before—except for the four fractured ones—and after IN using the validated Jung scoring system, and the data were statistically analyzed. Results: The mean length of follow-up after IN was 9.12 ± 3.68 years (range, 4–17 years). The patients' mean Jung score significantly improved from 2.52 ± 1.74 points before IN to 6.78 ± 2.23 at follow-up (p < 0.05). Ambulation was improved in ambulatory patients and restored in wheelchair users. The complication rate was 21%. Conclusions: Regardless of the high rate of complications, IN may be considered a reliable surgical procedure to salvage a failed treatment in PFD/MAS, with long-lasting satisfactory results achieved in most patients. Trial registration statement: Not applicable. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We compared two series of patients treated at our Hospital for periprosthetic hip and knee infections (PHI; PKI), in order to evaluate etiology, perioperative management (duration of spacer, antibiotic therapy, quality of life during the treatment), length of hospital stay, and costs. PATIENTS AND METHODS: We included in the study 32 patients with PHI and 30 patients with PKI. The average age of the patients was 74.8 in PHI and 71.2 in PKI. Treatment consisted of a two-stage revision associated with antibiotic therapy. All patients were followed up for at least two years after surgery. We analyzed the causative microorganism responsible for the infection, duration of the spacer and antibiotic therapy, quality of life during this time, length of hospital stay, and total hospital cost of treatment. RESULTS: The gram-negative microorganisms were more common in PHI, without any statistically significant difference compared to PKI. Duration of the spacer for PHI was 7.4 months and 5.5 months for PKI (p=0.005). Length of antibiotic therapy was 6.2 months for PHI and 4.1 months for PKI (p<0.001). Most patients in the two series had an acceptable quality of life during treatment. The mean length of hospitalization was 54 days in PHI and 26 days in PKI (p<0.001). The cost averaged 38,300 euros for PHI and 22,100 euros for PKI (p<0.001). CONCLUSIONS: Our study showed statistically significant differences between periprosthetic hip and knee infections as regards etiology, duration of treatment and global costs. Periprosthetic hip infections are caused by more virulent microorganisms that are harder to eradicate, require a longer length of treatment and have a greater economic impact on the healthcare system. [ABSTRACT FROM AUTHOR]

BACKGROUND: Distal chevron osteotomy is a procedure widely performed for the surgical treatment of painful hallux valgus. The risks and benefits of a lateral capsular release and adductor tenotomy combined with chevron osteotomy are still debated. The aim of our study was to report the clinical and radiographic outcomes of this combined procedure in mild and moderate incongruent bunion deformities, with a hallux valgus angle (HVA) up to 40 degrees and an intermetatarsal angle (IMA) up to 20 degrees. MATERIALS AND METHODS: Forty-two patients (52 feet) who consecutively underwent chevron osteotomy combined with lateral release and adductor tenotomy were reviewed 24-36 months after surgery. The mean age of the patients was 53.5 (range, 43 to 64) years. All the deformities were mild to moderate, with a mean preoperative value of 28 degrees in the HVA (range, 16 degrees to 40 degrees) and of 13 degrees in the IMA (range, 9 degrees to 20 degrees). RESULTS: At followup, the AOFAS hallux score improved from an average of 46 to an average of 88. The HVA and IMA had an average postoperative decrease respectively of 12 degrees and 6 degrees; lateral sesamoid displacement decreased by a mean of 15%. In no case did we observe infection or nonunion of the osteotomy. In one case, painless avascular necrosis of the first metatarsal head developed. CONCLUSION: Our short-term results show that distal chevron osteotomy combined with lateral release and adductor tenotomy is a feasible surgical option to address mild to moderate hallux valgus deformity, even with an IM angle between 15 and 20 degrees. Clinical and radiographic outcomes are generally good and patient satisfaction is generally high. [ABSTRACT FROM AUTHOR]

The authors describe a case of idiopathic Charcot's joint in a 67-year-old lady. The diagnosis was made after a careful screening that ruled out all the common causes, known so far, of Charcot's joint. [ABSTRACT FROM AUTHOR]