Surgical treatment of extra-articular metacarpal and phalangeal fractures should be considered when there is instability or in patients with high demand. To overcome the issues related to the use of Kirschner wires, external fixators, and open reduction and internal fixation procedures, intramedullary headless screw fixation (IHSF) is an alternative technique to achieve primary fracture stability and early return to daily activities. We report the data of the Italian Multicentric Intra-Medullary Experience, which includes 173 cases of extra-articular unstable fractures (38 phalanges and 135 metacarpals) treated with the IHSF. After surgery, patients underwent early mobilization without splinting. The results confirm the reliability of IHSF in cases with non-articular involvement, showing a good recovery rate in terms of bone healing and range of motion. Level of evidence: IV
The best treatment of bile duct lithiasis in the era of the laparoscopic cholecystectomy has not
yet been defined, as we can choose between different kinds of therapies which range from the
traditional laparotomic treatment to the more modern endoscopic and laparoscopic
techniques. Although in some centres a wholly laparoscopic access to the bile duct is used,
we believe that the fastest, safest and most reliable method is still the sequential treatment,
endoscopic and laparoscopic. In our experience the endoscopic cleaning of the choledochus
was performed in 87.1% of the cases, with no mortality and 4.2% morbidity.
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