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The aim of this prospective study was to assess the clinical and functional results of radial head reconstruction with an autologous bone graft from distal humerus in 12 patients, with a follow-up for a period of 24 months. From March 2017 to June 2018, we surgically treated 12 patients using an autologous bone graft from the lateral distal metaphysis of the homolateral humerus. Patients were divided into two groups: -Group A consisted of patients with previous failed ORIF for radial head fracture. Patients underwent revision surgery at an average time of 7 months (between 6 to 8 months) from the first surgery. All the patients reported pain during the elbow range of motion with no gross clinical signs or instability of the joint. They all presented standard X-ray and CT-scan of the elbow suggestive of non-union fracture. None of them presented osteoarthritic modification at the time of surgery. -Group B consisted of patients reporting acute irreparable radial head fractures. Patients were evaluated clinically at 6-, 12-, and 24-months duration according to Disabilities of the Arm. Shoulder and Hand (DASH), Mayo Elbow Performance Score (MEPS), and Visual analogue score for pain (VAS);, range of motion (ROM) was evaluated at 6 and 24 months after surgery. Plain radiographs on anteroposterior and lateral views of the elbow were evaluated at final follow-up. In both, groups (A and B) patients showed a significant improvement with regards to VAS, MEPS, and DASH at each follow-up (p

Background Femoroacetabular impingement is characterised by an abnormal contact between the acetabulum and the femoral head-neck junction. Femoroacetabular impingement shows three main clinical frameworks: Pincer-FAI, Cam-FAI and Cam-Pincer mixed form. The aim of the study was to investigate the correlation between femoroacetabular impingement, imaging, activity and chondral damages. Methods Forty-one patients, undergoing arthroscopic chondroartroplasty for Cam and Cam-Pincer mixed form were considered. All patients underwent an X-ray hip evaluation (G1 group), while 15 patients also underwent a pelvis MRI evaluation (G2 subgroup). For G1 patients, the superior-inferior offset ratio and alpha angle were calculated from the X-ray examinations. For G2 patients, the antero-posterior offset ratio was also calculated from pelvis MRI. Chondral damage was classified according to the Outerbridge classification. Results The superior-inferior offset ratio and the antero-posterior offset ratio were respectively 0.50 ± 0.23 and 0.33 ± 0.19. The α angle predictive for a chondral damage of IV degree was 81.5°.The chondral damage of the patients suffering from Cam-FAI and Cam-Pincer mixed form were respectively 3.53±0.80 and 3.00±1.41. Conclusions From the results was possible to: - Elaborate two tables providing a reliable indirect calculation of the alpha angle. - Establish an alpha angle cut-off value indicative for a IV degree chondral damage. - Show that Pincer-FAI does not represent an aggravating factor for chondral damage - Show that the level of sports activity was related to the severity of chondral damage. - Show that a physically demanding occupation was not an aggravating factor for chondral damage.

Background:From February 20 to April 2020, the coronavirus SARS (severe acute respiratory syndrome)-CoV-2 spread in northern Italy, drastically challenging the care capacities of the national health care system. Unprepared for this emergency, hospitals have quickly reformulated paths of assistance in an effort to guarantee treatment for infected patients. Orthopaedic departments have been focused on elderly traumatology, especially the treatment of femoral neck fractures in patients with coronavirus disease-2019 (COVID-19). The purpose of the present study was to evaluate the orthopaedic management strategy for femoral fragility fractures in COVID-19-positive patients with the hypothesis that operative treatment may contribute to the overall stability of the patient. Methods:Sixteen patients affected by proximal femoral fracture and a recent history of fever, shortness of breath, and desaturation were admitted to the emergency room. Thoracic computed tomography (CT) and oropharyngeal swabs confirmed that they were positive for COVID-19, requiring hospitalization and prophylaxis with low-molecular-weight heparin. Results:Three patients died before surgery because of severe respiratory insufficiency and multiple-organ-failure syndrome. Ten patients underwent surgery on the day after admission, whereas 3 patients had suspended their use of direct thrombin inhibitors and needed surgery to be delayed until the third day after admission. In all patients except 1, we noted an improvement in terms of O2 saturation and assisted respiration. In 9 patients, hemodynamic and respiratory stability was observed at an average of 7 days postoperatively. Four patients who underwent surgical treatment died of respiratory failure on the first day after surgery (1 patient), the third day after surgery (2 patients), or the seventh day after surgery (1 patient). Conclusions:We noted a stabilization of respiratory parameters in 12 COVID-19-positive patients who underwent surgery treatment of proximal femoral fractures. We believe that in elderly patients with COVID-19 who have proximal femoral fractures, surgery may contribute to the overall stability of the patient, seated mobilization, improvement in physiological ventilation, and general patient comfort in bed. Level of evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Ventilators, masks, and tests are in short supply Background: From February 20 to April 2020, the coronavirus SARS (severe acute respiratory syndrome)-CoV-2 spread in northern Italy, drastically challenging the care capacities of the national health care system Unprepared for this emergency, hospitals have quickly reformulated paths of assistance in an effort to guarantee treatment for infected patients Orthopaedic departments have been focused on elderly traumatology, especially the treatment of femoral neck fractures in patients with coronavirus disease-2019 (COVID-19) The purpose of the present study was to evaluate the orthopaedic management strategy for femoral fragility fractures in COVID-19-positive patients with the hypothesis that operative treatment may contribute to the overall stability of the patient Methods: Sixteen patients affected by proximal femoral fracture and a recent history of fever, shortness of breath, and desaturation were admitted to the emergency room Thoracic computed tomography (CT) and oropharyngeal swabs confirmed that they were positive for COVID-19, requiring hospitalization and prophylaxis with low-molecular-weight heparin Results: Three patients died before surgery because of severe respiratory insufficiency and multiple-organ-failure syndrome Ten patients underwent surgery on the day after admission, whereas 3 patients had suspended their use of direct thrombin inhibitors and needed surgery to be delayed until the third day after admission In all patients except 1, we noted an improvement in terms of O2 saturation and assisted respiration In 9 patients, hemodynamic and respiratory stability was observed at an average of 7 days postoperatively Four patients who underwent surgical treatment died of respiratory failure on the first day after surgery (1 patient), the third day after surgery (2 patients), or the seventh day after surgery (1 patient) Conclusions: We noted a stabilization of respiratory parameters in 12 COVID-19-positive patients who underwent surgery treatment of proximal femoral fractures We believe that in elderly patients with COVID-19 who have proximal femoral fractures, surgery may contribute to the overall stability of the patient, seated mobilization, improvement in physiological ventilation, and general patient comfort in bed Level of Evidence: Prognostic Level IV See Instructions for Authors for a complete description of levels of evidence Email address for F Catellani: francesco catellani@gavazzeni it Email address for A Coscione: andrea coscione@gavazzeni it Email address for R D’Ambrosi: riccardo dambrosi@hotmail it Email address for L Usai: luca usai@gavazzeni it Email address for C Roscitano: claudio roscitano@gavazzeni it Email address for G Fiorentino: gennaro fiorentino@gavazzeni it Investigation performed at Humanitas Gavazzeni, Bergamo, Italy Disclosure: The authors indicated that no external funding was received for any aspect of this work The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links lww com/JBJS/F867) Copyright 2020 by The Journal of Bone and Joint Surgery, Incorporated

Unrepairable comminuted fractures of the radial head Mason type III or type IV have poor outcomes when treated by open reduction and internal fixation. Radial head resection has been proposed as good option for surgical treatment, while in the last decades, the development of technology and design in radial head prosthesis has increased efficacy in prosthetic replacement. The present review was conducted to determine the best surgical treatment for comminuted radial head when ORIF is not possible. Better outcomes are reported for radial head arthroplasty in terms of elbow stability, range of motion, pain, and fewer complications compared to radial head excision. Nevertheless, radial head resection still can be considered an option of treatment in isolated radial head fractures with no associated ligament injuries lesion of ligaments or in case of older patients with low demanding function.

Purpose: To build a post-arthroscopy outcome-predictive score (POPS) associated with the likelihood of lasting benefit after arthroscopic treatment of femoroacetabular impingement (FAI) and based solely on unambiguous preoperative information. Methods: A population of 220 FAI patients, operated on with standard techniques by orthopaedic surgeons trained in hip arthroscopy in 6 different centres, was evaluated physically or by telephone interview 2 to 5 years after surgery. The criteria of successful mid-term outcome (SMO) were agreed upon by all authors. A multivariate logistic regression, adjusted for patient’s age and centre, was applied to predict SMO. In the model, the variables associated with the outcome were included and the relative ORs (odds ratios) were used to compute the FAI-POPS (FAI - post-arthroscopy outcome-predictive score). A ROC (receiver operating characteristic) curve was plotted and the optimum cut-off was calculated. Results: 155 patients out of 220 showed a successful mid-term outcome. The optimum cut-off of FAI-POPS was calculated to be 6.3 and with this threshold it proved a sensitivity of 0.66 and a specificity of 0.69, a positive predictive value of 0.84 and a negative predictive value of 0.46. Conclusions: The standard arthroscopic treatment of FAI resulted in satisfactory persistent symptom relief for about 70% of patients. No or minimal osteoarthritis, short time elapsed from the appearance of symptoms and high preoperative modified Harris Hip Score are independent predictive factors of SMO. The FAI-POPS is obtained as sum of 3 odds ratios corresponding to the above prognostic factors and is a useful predictor of mid-term outcome after conventional arthroscopic FAI treatment.

About 4% of glenohumeral dislocations are posterior and only 1% is associated with fracture of the humeral head. Most frequent causes are high energy traumas, seizures and electrocution. The fracture and the posterior dislocation, associated with the trauma and capsular lesion can cause an important vascular damage of the humeral head.We describe 5 cases of posterior fracture-dislocation of the shoulder that required open reduction and internal fixation treated using double approach: posterior approach for reduction humeral head and eventually bone and capsular posterior repair and anterior approach for osteosynthesis. A Clinical examination was performed at one year and follow-up was at two years.This combined approach is less invasive, easier for dislocation reduction of the humeral head, with minimal biological damage that may occur during the reduction maneuvers. Our thought is that the posterior approach reduce vascular and bone damages during humeral head reduction and permit to suture and retention posterior capsula that is often damaged by the trauma.

The importance of the lateral meniscus in weight bearing, distribution of force, shock absorption, articular cartilage protection, proprioception, stabilization of the joint, and joint lubrication is well known. Surgeons currently agree on the importance of preserving the menisci. Different suture techniques have been standardized. These include outside-in, inside-out, and all-inside techniques. The all-inside technique can be used to repair lesions of the posterior horn of the lateral meniscus. However, this technique presents important disadvantages, such as the necessity for an accessory portal and a high risk of neurovascular damage. For these reasons, we have developed a technique in which a suture hook and a shuttle relay are used to pass the suture wire through the meniscal lesion of the posterior horn of the lateral meniscus with an all-inside technique, without the use of accessory portals and cannulas, with a standard 30° arthroscopic camera. © 2013 Arthroscopy Association of North America.