No abstract

AMIC combined with the CLP-MB membrane, and Cartifill seems to be a promising approach to treat knee chondral defects.

The ideal treatment for displaced intraarticular calcaneal fractures is still under debate. Open reduction and internal fixation is the most popular surgical procedure; however, wound complications, hardware failure and infection remain a major concern. The aim of this study was to evaluate the results of a new minimally-invasive surgical procedure: closed reduction technique combined with balloon-assisted fracture augmentation with cement or calcium phosphate (minimally-invasive percutaneous calcaneoplasty). We retrospectively reviewed 11 patients that sustained Sander’s type II and III calcaneal fractures treated in our institution from January 2008 to June 2010. The same approach and technique was utilized in all cases. Conventional X-rays and CT scan have been performed pre- and post-operatively. The average follow-up was 24 months. The American Orthopaedic Foot and Ankle Society ankle/hindfoot score has been utilized for clinical evaluation and Bohler’s angle to assess bone reduction. All cases obtained bony union in 2/3 months, with average Bohler’s angle of 22.97° (from 14.21° to 32.83°). No skin complications or adverse reactions were observed, with only one patient complaining of residual pain in the hindfoot. Minimally-invasive percutaneous calcaneoplasty can represent an alternative to open reduction internal fixation in the treatment of calcaneal fractures, allowing stable reduction without plating, early function recovery and short hospital stay.

No abstract

IntroduzioneLe fratture dell'estremo prossimale dell'omero rappresentano circa il 5% di tutte le fratture [1], con una maggiore incidenza nella popolazione anziana. Le cause più frequenti, nei pazienti con età inferiore a 50 anni, sono i traumi ad alta energia, di solito in seguito a incidenti stradali, cadute dall'alto o sport di contatto. Nella popolazione con età superiore a 50 anni, invece, l'evento fratturativo può verificarsi in seguito anche a traumi di modesta entità per la ridotta resistenza dell'osso a causa dell'osteoporosi. Infatti circa il 75% delle fratture dell'estremo prossimale dell'omero si verifica in soggetti con oltre 65 anni di età [1]. Per inquadrare da un punto di vista diagnostico queste fratture è sufficiente eseguire le tre proiezioni della serie traumatica della spalla: antero-posteriore sul piano scapolare (Fig. 1), ascellare (Fig. 2) e defilè del sovraspinato o "Y" (Fig. 3). Tali radiogrammi permettono di classificare le fratture dell'estremo prossimale dell'omero secondo lo schema di Neer [2], ovvero della AO [3], in base al numero di frammenti principali coinvolti (trochite, trochine, collo chirurgico o collo anatomico e metadiafisi) e ai loro rapporti reciproci. L'esame TC (Fig. 4) è di solito limitato ai casi che presentano grave scomposizione e comminuzione dei frammenti, con sospetto di lus-LO SCALPELLO ( ABSTRACT -THE TREATMENT OF DISPLACED HUMERAL FRACTURES WITH INTRAMEDULLARY NAIL Successful treatment of displaced humeral fracture can be difficult to achieve because of osteopenia of proximal humerus. One of the new options for humeral internal fixation is the minimally invasive intramedullary nail.We retrospectively reviewed 31 consecutive proximal humeral fractures treated with Sirus and T2 antegrade intramedullary nail (20 Sirus; 11 T2 Proximal) from January 2005 to December 2007. Time to union, level of pain, recovery of shoulder function according to Neer score, level of patients satisfaction and complications were recorded. All of the fractures proceeded to union in an average time of 3 months. An unsatisfactory result was obtained in two patients. Mobilization of proximal screws was seen in 3 patients (Sirus nail) and subacromial impingement of nail in 2. Antegrade intramedullary nail is an acceptable alternative for the treatment of proximal humeral fractures, especially in osteoporotic bone, allowing satisfactory functional recovery. Aggiornamenti Fig. 1 -Radiografia della spalla sul piano scapolare, proiezione antero-posteriore Fig.2 -Proiezione ascellare