Purpose Intra-articular injection is a well-established and increasingly used treatment for the patient with mild-to-moderate hip osteoarthritis. The objectives of this literature review and meta-analysis are to evaluate the effect of prior intra-articular injections on the risk of periprosthetic joint infection (PJI) in patients undergoing total hip arthroplasty (THA) and to try to identify which is the minimum waiting time between hip injection and replacement in order to reduce the risk of infection. Methods The database of PubMed, Embase, Google Scholar and Cochrane Library was systematically and independently searched, according to Preferred Reporting Items for Systematic Reviews and Meta–Analyses (PRISMA) guidelines. To assess the potential risk of bias and the applicability of the evidence found in the primary studies to the review, the Newcastle–Ottawa scale (NOS) was used. The statistical analysis was performed by using the software ’R’ version 4.2.2. Results The pooling of data revealed an increased risk of PJI in the injection group that was statistically significative (P = 0.0427). In the attempt to identify a ’safe time interval’ between the injection and the elective surgery, we conducted a further subgroup analysis: in the subgroup 0–3 months, we noted an increased risk of PJI after injection. Conclusions Intra-articular injection is a procedure that may increase the risk of developing periprosthetic infection. This risk is higher if the injection is performed less than 3 months before hip replacement.
Background: Three-dimensional (3D) printing is a technology capable of creating solid objects based on the reproduction of computerised images. This technology offers revolutionary impacts on surgical practice, especially in prosthetic and traumatological surgery. Methods: 20 patients with proximal humeral fractures were divided into two groups, one of which involved the processing of a 3D model. The model made it possible to plan the positioning and dimensions of the implants. The results were then compared with those obtained according to the usual procedures. We also reported the irreparable case of a custom revision implants acetabular bone loss treated with a 3D-printed, custom-made implant. Results: In the processed 3D proximal humeral fracture series, in the face of time and costs expenses, surgical and X-ray times were shorter than in the control group. On the other hand, there were no differences in terms of blood loss. The patient who underwent acetabular re-prosthetic surgery in a 3B Paprosky bone loss was managed and solved with a 3D-printed, custom-made implant and reported excellent outcomes at a 1 year follow-up. Conclusion: Three-dimensional printing made it possible to create better pre-operative planning in traumatology in order to optimise surgical procedures and outcomes. It also made it possible to deal with large losses of bone stock in prosthetic revision surgery, even when reconstruction may have appeared impossible with traditional implants.
Humeral fractures have an incidence of 3-5% and a bimodal age distribution. They may occur in young patients after highenergy traumas or in elderly osteoporotic patients after low-energy injuries. In nondisplaced fractures or in elderly patients, humeral fractures are treated by conservative methods. Open reduction and internal fixation (ORIF) should be the treatment of choice in case of multi-fragmentary fractures associated with radial nerve palsy or not. ORIF is usually regarded as the gold standard treatment, but, depending on the different types of fracture, the surgical approach can change. In this review, we compare results and complication rates between lateral and posterior surgical approaches in the management of extraarticular distal humeral shaft fractures. An internet-based literature research was performed on Pubmed, Google Scholars and Cochrane Library. 265 patients were enrolled: 148 were treated by lateral or antero-lateral approach, while 117 by posterior or postero-lateral approach. The literature shows that no differences between the posterior and lateral approach exist. Certainly, the posterior approach offers undoubted advantages in terms of exposure of the fracture and visualization of the radial nerve. In our opinion, the posterior approach may also allow better management of complex and multi-fragmentary fractures.
The entrapment of the ulnar nerve in Guyon’s canal (GC) is a well-known wrist canalicular syndrome which is usually followed by a gradual combination of both sensitive and motor symptomatology. However, GC nerve compression could also cause a pure hand motor dysfunction. This condition, less frequent than the classic Guyon’s syndrome, can be difficult to diagnose. Authors report a case series of eight patients affected by isolated compression of the ulnar nerve motor branch, due to piso-triquetrum or triquetro-hamate joint ganglia. Surgical technique and postoperative outcomes are discussed in this paper. The isolated compression of the ulnar nerve motor branch is a very rare clinical condition which is often linked to several causes. The rarity of the pathology is probably due to lack of knowledge and therefore to the difficulty in formulating a correct diagnosis. Surgical treatment appears to be decisive in most cases, although late diagnosis often leads to incomplete functional recovery.
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