Enrico Bonicoli

Acromio-clavicular repair using two different techniques.

Acromio-clavicular joint (ACJ) injuries represent nearly half of all athletic shoulder injuries. Stability of this joint depends on the integrity of the acromio-clavicular and coracoclavicular ligaments. Although the traumatic acromioclavicular joint separation is a well-known topic, there are different classifications, diagnostic procedures, concepts of intervention, and a great variety of implants. In this paper, we present an overview of the recent literature about this issue and the results of a retrospective non-randomized study with 2 different techniques. At the first Orthopedic Department of University of Pisa, a retrospective study was performed starting from January 2007 to February 2011 in our electronic database. We selected patient treated with two different techniques (tight-rope® system and hook plate) by the same senior surgeon with experience in shoulder surgery. The mean Costant score was 90 for the tight-rope® system group and 75 for the hook plate group. At the final follow-up, most of the patients had returned to their preinjury level of activity. Two patients had a breakage of the fixating system. The above-mentioned techniques provided satisfactory results with no loss of reduction except in two cases. The use of the hook plate is useful in fracture-dislocation of ACJ, but this requires another surgery to remove it. On the contrary, the use of the tight-rope® system does not require a new surgery or use of expensive synthetic graft or a graft harvested from a distant donor site.

Comparison of the POSSUM score and P-POSSUM score in patients with femoral neck fracture.

AbstractPurposeThe ageing of the population in developed countries has led to an increased number of patients with hip fractures all over the world. POSSUM and P-POSSUM scores predict morbidity and mortality of patients who will be undergoing a surgical treatment. The aim of this study was to evaluate accuracy of these two scores in hip-fractured patients.Materials and methodsBetween January and December 2012, in our department 144 patients were hospitalised for femoral neck fractures according to the grade III or IV of Garden’s classification treated with total hip arthroplasty or endoprosthesis. POSSUM scores and P-POSSUM scores were calculated for each patient with complete clinical data. We then calculated the observed and the expected ratio.Results134 patients were eligible: 110 females and 24 males. The mean age for women was 79 years, and the mean age for men was 84 years. We observed 13 deaths and 66 complications. The POSSUM scores predicted 16 deaths and 60 complications, while P-POSSUM scores predicted 6 deaths. The O/E ratio for POSSUM mortality was 0.81 and for P-POSSUM was 2.17, while POSSUM morbidity was 1.1.ConclusionIn our study, we have shown that on the one hand, the POSSUM score predicted accurately both the mortality and morbidity in patients undergoing surgery for the femoral neck fracture, while on the other hand, the P-POSSUM score underestimated them. For this reason, we believe that the POSSUM is indeed a good audit tool, which can accurately predict both mortality and morbidity in a cohort of patients.

Clinical and Radiological Results over the Medium Term of Isolated Acetabular Revision

Acetabular cup loosening is associated with pain, reduced function, and instability of the implant. If such event happens while the femoral implant is in a satisfactory position and is well fixed to the bone, isolated acetabular revision surgery is indicated. The aim of this single-center retrospective study was to evaluate the clinical and radiological results over the medium term (12-month follow-up mean 36, max 60) of isolated acetabular revisions surgery using a porous hemispheric revision shell matched with a cemented all-poly cup and large diameter femoral head (>32). 33 patients were enrolled. We collect any relevant data from the clinical board. Routine clinical and radiographic examinations were performed preoperatively; the postoperative follow-up was made at 1, 3, and 6 months and yearly thereafter. At the last available follow-up, we report satisfactory improvement of functional scores in all the patients; 2 patients (6.1%) showed thigh pain and only 4 hips (12.11%) presented mild groin pain; all the femoral components are well fixed and there were no potential or pending rerevisions. With bias due to the follow-up and to the retrospective design of the study, we report clinical, functional, and radiological satisfactory results.

The difference in activity of daily living (ADL) and mortality in patients aged over 80 years with femoral neck fracture treated with hemiarthroplasty or osteosynthesis at 2 years of follow-up

INTRODUCTION Hip fractures are one of the major causes of morbidity and mortality in the elderly and outcomes following hip fracture have been the focus of several studies over recent decades. Among all types of fall-related injuries, hip fractures cause the greatest number of deaths, lead to severe health problems and reduce quality of life. Improving the outcome of hip fracture surgery has thus become one of the main areas of interest for orthopaedic surgeons. The aim of this study was to compare the difference in activity of daily living (ADL) and mortality between patients aged over 80 years with hip fracture treated with osteosynthesis versus prosthesis at 2 years of follow-up. MATERIALS AND METHODS The data were collected on admission and during in-hospital stay. Information recorded on admission included: age, sex, type and mechanism of fracture, functional and cognitive status, comorbidity, and severity of illness. Prefracture functional status was measured. The follow-up was clinical and radiographical, or was by telephone for patients who were not able to come to the clinic. Patients aged over 80 years who underwent a single surgical procedure treated with intramedullary nail or hemiarthroplasty were included in the study. RESULTS A total of 174 patients (45 male and 129 female) were included in the study. The two treatment groups were comparable for all preoperative parameters except for preoperative haemoglobin, which was an average of 1g/dl higher in the patients given hemiarthroplasty compared with those treated with intramedullary nail (t-test: p<0.05). The average observation period was 594.99days; the number of deaths was 62 of 164 contacted patients, and the survival rate at 2 years was 62.2%. There was increased mortality in patients who underwent hemiarthroplasty (Log-rank Mantel-Cox, p: 0,048). The difference in ADL between preoperative and follow-up is not statistically significant between the two groups. DISCUSSION In the literature, there are few specific studies that consider these parameters in this population. However, these findings are consistent with the findings from other studies. CONCLUSION Patients who received hemiarthroplasty have a higher mortality risk than those treated with intramedullary nail; there are no differences in ADL at follow-up.

Intrapelvic tension wire in treatment of transtectal acetabular T-fractures

Our study emphasizes the difficulty of reducing and fixing some transtectal T acetabular fractures by means of the classic surgical techniques and shows the possibility of obtaining, in these cases, good immediate and medium-term results, using the intrapelvic tension wire techinque and a simultaneous double approach. In our cases, the lesion was transtectal with associated posterior wall and roof fractures and the procedure was performed within three weeks after the trauma. The remarkable difficulties to reduce and to fix the three main acetabular fragments by classic techniques are well known. The difficulty of reducing is due to the anatomical divergence of the columns and to the characteristic of these fractures, in which the transverse split of one column carries on with a longitudinal split beside the other column, going away from the first. This means that a minimally defective reduction of one column can have negative repercussions on the other, whose displacements increase. In this situation, the sequence of classic surgical acts can increase the risk of not reducing, of penetrating lag screws into the articular space or not stabilizing the fracture.

A single-stage posterior approach in the treatment of spinal tuberculosis: case report

We describe a case of dorsal vertebral tuberculosis that was initially treated non-surgically. Despite apparent clinical improvement, the patient suffered sudden partial paralysis of the legs and surgery was required. Spinal decompression, transpeduncular abscess drainage and posterior vertebral stabilisation were carried out.

1989–1999. Ten years of low-invasive techniques for the treatment of lumbar disk herniation: a critical review of 80 monitored cases

Abstract Low invasive techniques for the treatment of lumbar disk herniation are still a subject of debate and interest in the field of vertebral surgery. We present a critical review of 80 cases of percutaneous nucleotomy performed from 1989 to 1999 at the First Orthopaedic Clinic in Pisa. The analysis of the results confirms the usefulness of this method for lumbar disk hernias in young patients who precisely meet the indications for surgery. Furthermore, automised percutaneous nucleotomy did not provoke collapses in the intervertebral space or instability in the functional units following the emptying of the nucleus. Post-operative magnetic resonance imaging revealed, in all cases, the creation of a discal scar.