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Surgical site infections (SSIs) represent a potential complication in any type of surgery and can occur up to one year after the procedure in the case of implant placement. In the field of orthopedic and hand surgery, the rate of SSIs is a relevant issue, considering the need for the placement of synthesis devices and the type of some interventions (e.g., exposed fractures). This work aims to provide guidance on the management of peri-operative antibiotic prophylaxis for the pediatric and neonatal population undergoing orthopedic and hand surgery in order to standardize the management of patients and to reduce, on the one hand, the risk of SSI and, on the other, the development of antimicrobial resistance. The following scenarios were considered: (1) bloodless fracture reduction; (2) reduction of unexposed fracture and grade I and II exposed fracture; (3) reduction of grade III exposed fracture or traumatic amputation; (4) cruel fracture reduction with percutaneous synthesis; (5) non-traumatic amputation; (6) emergency intact skin trauma surgery and elective surgery without synthetic media placement; (7) elective orthopedic surgery with prosthetic and/or synthetic media placement and spinal surgery; (8) clean elective hand surgery with and without bone involvement, without use of synthetic means; (9) surgery of the hand on an elective basis with bone involvement and/or with use of synthetic means. This manuscript has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies and represents, in our opinion, the most complete and up-to-date collection of recommendations regarding the behavior to be adopted in the peri-operative setting in neonatal and pediatric orthopedic and hand surgery. The specific scenarios developed are aimed at guiding the healthcare professional in practice to ensure the better and standardized management of neonatal and pediatric patients, together with an easy consultation.

(1) Background: Congenital pseudoarthrosis of the clavicle is a rare condition due to the failure of the union process of the ossification nuclei of the clavicle. The aim of this study was to conduct a systematic review of relevant case series about the argument to find an up-to-date base of evidence for treatment choice. (2) Methods: an electronic literature research of Ovid, MEDLINE and the Cochrane Library databases was conducted, and articles were selected based on inclusion criteria. Demographic data, clinical features, treatment options, outcomes and complications were analyzed. (3) Results: 21 articles met the inclusion criteria, showing a poor overall study quality; 231 pediatric patients (240 clavicles) were analyzed. The condition was typically right sided, showed no sex predominance and no clear predisposing factors. 156 patients underwent surgical treatment, mainly open debridement and refresh of bony ends, fixation with pin or plate and bone graft, with a successful union rate of 87.4%. The nonunion rate was significantly higher in the allograft group (44.4%, p = 0.019). (4) Conclusions: this paper presents an updated systematic review about treatment of congenital pseudoarthrosis of the clavicle. We confirm the generally satisfactory results of surgery, demonstrating that successful union is achievable in 87.4% of cases with a prevalence of 15.7% of major complications. Nonetheless our results should be interpreted with caution due to several limitations.

The modality of progression of the correction along casting sessions of Ponseti method has been poorly investigated and information regarding evolution of muscular abnormalities is missing. The aim of the study was to investigate dynamics of correction of the different components of clubfoot deformity in a clinical setting. In a prospective study, 124 clubfeet consecutively treated by a single orthopaedic surgeon were evaluated with the Dimeglio system at each casting session and score progression was determined. For each component a typical pattern was recorded. Cavus and medial crease showed a rapid correction. Rotation, adduction and varus corrected gradually and simultaneously. The posterior crease usually persisted until final cast was discontinued. Equinus improved progressively after each cast and then to a larger extent with Achilles tenotomy. The parameter describing poor muscular condition, reported at presentation in 39 feet (31.5%), was the only item showing extremely different dynamics of correction (from rapid and complete resolution to persistence at last cast removal), which could be explained by the large diversity of entities included (hypertonia, imbalance, fatty infiltration, fibrosis, aplasia). This study confirmed that dynamics of correction in clinical setting correspond essentially to theoretical principles of Ponseti method. Muscle abnormalities are not uncommon in clubfeet and have great influence on the progression of correction. If abnormalities are recorded, their evolution along the treatment should be monitored. A more objective evaluation would be required.

The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention. The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase. Electronic supplementary material The online version of this article (10.1186/s13052-018-0525-6) contains supplementary material, which is available to authorized users.

Hip deformities during early childhood following Perthes' disease, congenital dislocation or septic arthritis are not rare, causing limitation of motion and limping. A number of proximal femoral osteotomies to address residual deformities have been described, but the outcome has been variable. We describe a proximal femoral osteotomy aimed at restoring a more anatomic insertion of the gluteus medius. The clinical and radiographic results thus far are promising. We believe that the technique improves both the anatomy and biomechanics of the hip.

Osteoarthritis of the hip joint secondary to femoral head collapse may develop after curettage of lesions in the femoral head. We report the case of a patient with chondroblastoma of the femoral head who was treated with wide curettage of the lesion and implantation of an osteochondral allograft to prevent femoral head collapse.

We report on two cases of simultaneous asymmetrical bilateral hip dislocation. Both patients were involved in car accidents. The first case is a 23-year-old man who had a bilateral hip dislocation, anterior on the right side and posterior on the left associated with bilateral femoral head fracture. The second case presented the same dislocations of the hips associated with acetabular fracture on the right side. Closed reduction of the hips was performed in both cases. In the first case the femoral head fragments was subsequently removed. In the second case internal fixation of the acetabular fracture was postponed.

The growth plate is responsible for the longitudinal growth of the long bones. In the trauma of physis, the proliferative layers are involved and growth disturbance may occur. Salter and Harris physeal injury descriptive classification is very simple and repeatable. Five main types of fracture were identified. Salter–Harris types I and II injuries are usually managed by closed manipulation and plaster cast and have lower potential risk of growth damage. Salter and Harris types III and IV injuries are intra-articular and need an anatomical reduction, often requiring open reduction and internal fixation. The occurrence of a growth disturbance depends more on the age at the time of injury than on the anatomical region involved.

The aim of the study was to investigate the use of a hyaluronic acid/polycaprolactone material for meniscal tissue engineering and to evaluate the tissue regeneration after the augmentation of the implant with expanded autologous chondrocytes. Eighteen skeletally mature sheep were treated. The animals were divided into three groups: cell-free scaffold, scaffold seeded with autologous chondrocytes, and meniscectomy alone. The implant was sutured to the capsule and to the meniscal ligament. At a 12-month gross assessment, histology and histomorphometry were used to assess the meniscus implant, knee joint, and osteoarthritis development. All implants showed excellent capsular ingrowth at the periphery. The implant gross assessment showed significant differences between cell-seeded and cell-free groups (p = 0.011). The histological analysis indicated a cellular colonization throughout the implanted constructs. Avascular cartilaginous tissue formation was significantly more frequent in the cell-seeded constructs. Joint gross assessment showed that sheep treated with scaffold implantation achieved a significant higher score than those underwent meniscectomy (p < 0.0005), and the Osteoarthritis Research Society International score showed that osteoarthritic changes were significantly less in the cell-seeded group than in the meniscectomy group (p = 0.047), even though results were not significantly superior to those of the cell-free scaffold. Seeding of the scaffold with autologous chondrocytes increases its tissue regeneration capacity, providing a better fibrocartilaginous tissue formation. The study suggests the potential of the novel hyaluronic acid/polycaprolactone scaffold for total meniscal substitution, although this approach has to be further improved before being applied into clinical practice.

The purpose of this study was to review the operative long-term results of a large cohort of children treated arthroscopically for a symptomatic discoid lateral meniscus. We retrospectively reviewed the arthroscopic procedures performed on 104 knees (97 patients) between 1990 and 2006 to treat symptomatic discoid lateral meniscus in children. The median age at the time of surgery was 8 years (range 2.5–13.9 years). The follow-up was 8.5 ± 2.5 (mean ± SD) years (median 9, range 2–18.5 years). In this series, young children (2–7 years) usually presented complete discoid menisci with deficit in extension and little pain. The meniscal tissue was almost degenerated, and subtotal meniscectomy was performed. Children aged from 8 to 14 years referred to our institute typically presented a symptomatic tear (pain and swelling joint with snap) of a complete or incomplete discoid lateral meniscus, usually pursuant to a trauma. The treatment performed in this group was a partial meniscectomy. Clinical results at long-term follow-up show better results for subtotal meniscectomies than for partial ones. The results showed the long-term efficacy of arthroscopic treatment of a symptomatic discoid lateral meniscus. On the basis of this study, subtotal meniscectomies in younger patients are preferable when meniscal tissue is degenerated. In older children, we recommend to preserve meniscal tissue as much as possible. In younger patients submitted to subtotal meniscectomies, some adaptation of the knee to stress activity may occur. Therapeutic case series, Level IV.

Acetabular fractures are often associated with dislocation of the femoral head. When the dislocation is reduced,or = 1 fragments may remain inside the joint, especially in posterior dislocation. In this kind of dislocation, the fracture of the posterior wall of the acetabulum may be comminuted. The fragments attached to the joint capsule or free may remain between the femoral head and the acetabulum. During reduction, these fragments are dragged inside the joint. The presence of the fragments in the hip joint may prevent complete reduction of the dislocation. Surgery should be performed early to reduce the risk of aseptic necrosis of the femoral head. Sometimes the fragments derive from a fracture of the femoral head without involving the posterior wall. Fragments are difficult to detect by conventional radiography; therefore, computed tomography scans are always indicated in fracture-dislocations pre- and postoperatively to check that all intra-articular fragments have been removed and the fracture has been reduced. We observed 373 cases of acetabular fracture between January 1, 1997 and December 31, 2007. One hundred twenty-seven cases presented a dislocation: 5 anterior, 13 central, and 109 posterior. In 45 cases, after reduction of the dislocation, 2 anterior and 43 posterior intra-articular fragments were observed. Removing a loose body inside the joint is always necessary because movement causes damage of the cartilage and therefore an early arthritis. The strategy to remove and the approach differs according to the kind of dislocation observed.

Acetabular fractures are often associated with dislocation of the femoral head. When the dislocation is reduced, > or = 1 fragments may remain inside the joint, especially in posterior dislocation. In this kind of dislocation, the fracture of the posterior wall of the acetabulum may be comminuted. The fragments attached to the joint capsule or free may remain between the femoral head and the acetabulum. During reduction, these fragments are dragged inside the joint. The presence of the fragments in the hip joint may prevent complete reduction of the dislocation. Surgery should be performed early to reduce the risk of aseptic necrosis of the femoral head. Sometimes the fragments derive from a fracture of the femoral head without involving the posterior wall. Fragments are difficult to detect by conventional radiography; therefore, computed tomography scans are always indicated in fracture-dislocations pre- and postoperatively to check that all intra-articular fragments have been removed and the fracture has been reduced. We observed 373 cases of acetabular fracture between January 1, 1997 and December 31, 2007. One hundred twenty-seven cases presented a dislocation: 5 anterior, 13 central, and 109 posterior. In 45 cases, after reduction of the dislocation, 2 anterior and 43 posterior intra-articular fragments were observed. Removing a loose body inside the joint is always necessary because movement causes damage of the cartilage and therefore an early arthritis. The strategy to remove and the approach differs according to the kind of dislocation observed.

The purpose of the present study was to make a histological analysis of the remodelling process of hamstring tendon graft used as Anterior Cruciate Ligament (ACL). The hamstring graft of eight patients was biopsied at different follow-up times from 1 to 10 years. The specimens were analysed with transmission electron microscopy (TEM) at ultrastructural level comparing them with a native ACL and a native hamstring graft. The hamstring graft was found to undergo ultrastructural changes in terms of number and diameter of fibrils with the major changes occurring in the first 2 years. At longer times after surgery (48 and 120 months) no important further changes were evident and the ultrastructure did not vary substantially from 2 to 10 years. In conclusion, the hamstring tendon used as ACL graft undergoes a transformation process but does not match the ultrastructure pattern of a normal ACL up to 10 years.

Autologous chondrocyte implantation (ACI) is an effective means of treating symptomatic articular cartilage defects. This two-stage cartilage repair strategy relies on the cultured expansion of harvested chondrocytes; these cells are subsequently reimplanted into the host defect and covered (periosteum, collagen patch). The ACI technique has been shown by many authors to result in improved clinical outcomes by facilitating the creation of a hyaline-like cartilage repair tissue. However, it has been demonstrated that defect fill can be variable, and that the procedure itself is technically demanding. Over the past few years, so called “second generation” ACI techniques have been available for clinical use in many parts of the world. These second generation techniques rely on the combination of autologous chondrocytes with absorbable scaffolds. It is believed that the addition of a stable matrix scaffold facilitates the creation of a more hyaline-like cartilage repair tissue. We describe, herein, such a technique. The Hyalograft C implant has been used to treat symptomatic cartilage defects at our institution for many years. This implant consists of autologous chondrocytes that are seeded on a hyaluronan-based scaffold. Implantation of the Hyalograft C scaffold simplifies the method by which autologous chondrocytes may be used to repair a cartilage defect. Moreover, we believe this is the first method by which autologous chondrocytes may be implanted using minimally invasive arthroscopic techniques. The Hyalograft C implant effectively treats symptomatic cartilage defects in a manner that is less morbid, simpler, and more predictable than first-generation ACI methods.

The Du Toit open capsuloplasty for the treatment of anterior shoulder instability is based on the concept of restoring joint stability by recreating the integrity of the anterior glenoid labrum and inferior gleno-humeral ligament using staples. The long-term validity of this procedure for the treatment of anterior shoulder instability was retrospectively assessed by a clinical or telephone interview and radiographic evaluation in 58 patients with an average 35-year follow-up between 1948 and 1974. The range of motion was evaluated by comparing the treated side with the contralateral one; subjective and objective evaluation was performed according to the ASES, Rowe scales and Constant rating system; A-P and axillary X-rays were performed to evaluate glenohumeral arthrosis by the Samilson criteria. Despite the need for a second operation due to staple loosening (5 of 58 patients in our series), this open procedure for shoulder instability gave a high rate of satisfactory results, thus holding the ground for the current concept of the modern arthroscopic Bankart repair.