Filippo Calderazzi

Does hip osteoarthritis have a protective effect against proximal femoral fractures? A retrospective study

The inverse relationship between proximal femoral fracture incidence and hip osteoarthritis remains controversial. However, femoral neck fractures rarely occur in patients with hip osteoarthritis, suggesting a protective effect of osteoarthritis. We sought to determine if the severity of osteoarthritis influenced fracture type. We examined the radiographs of 190 consecutive patients treated at our institution after hip trauma. They were divided into three groups according to the outcome of the trauma: femoral neck fracture; trochanteric fracture; and no fracture. We then analysed the severity of osteoarthritis within these groups. No relationship between the grade of hip osteoarthritis and the presence of a proximal femoral fracture was found. However, the grade of osteoarthritis was related both to the outcome of the trauma (p<0.0001) and to the location of the fracture (p<0.0001). Patients with osteoarthritis of the hip had a three-fold increased likelihood of trochanteric fracture compared to femoral neck fracture. Osteoarthritis does not protect against proximal femoral fractures, but strongly affects the location of the fracture in the proximal femur, increasing the possibility of a trochanteric location.

Modified SERI technique in the treatment of hallux valgus combined with arthritis

Introduction: Few reports encompass the treatment of first metatarsophalangeal joint (MTPJ) arthritis complicating hallux valgus. Indeed, in the literature, there is a lack of guidance concerning the management of patients affected by mild to moderate first MTPJ arthritis complicating hallux valgus. The aim of this study is to present the mid-term results of an original joint-preserving surgical technique. Materials and Methods: A group of 50 patients (60 feet) affected by mild to moderate first MTPJ arthritis complicating hallux valgus who underwent modified Giannini’s SERI (simple, effective, rapid, inexpensive) surgical procedure were prospectively reviewed. They were clinically and radiographically evaluated preoperatively and after surgery and were also assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score and Coughlin and Shurnas classification. The average follow-up was 38 months. A multivariate analysis was performed to evaluate the existing relationship between postoperative AOFAS results and radiological preoperative measured angles and sesamoid grade of dislocation. Results: The average AOFAS score significantly improved at last follow-up to an average of 90.5 ± 14.5, while preoperatively it was 45.6 ± 15.3 (p < 0.001). On multivariate analysis, a statistically significant correlation resulted among all the radiographic preoperative registered parameters and clinical postoperative results. However, it was shown that any radiological parameter alone could not predict a better clinical recovery. Conclusions: The surgical technique proposed here could extend the indications of the SERI procedure to those patients affected by mild to moderate hallux valgus combined with mild to moderate osteoarthritis.

How to approach Monteggia-like lesions in adults: A review

Monteggia-like lesions encompass a wide spectrum of fractures of the forearm and elbow associated with dislocations, subluxations and ligamentous lesions. Many attempts have been made to classify these injuries, not only to understand their pathology but also to develop optimal treatments. Unfortunately, although some of these classifications are complete, they are either complex, not immediately usable, or not exhaustive. An orthopedic surgeon who aims to rapidly treat this kind of injury needs a visual classification, and knowledge of the best surgical approach. Monteggia like lesions do not allow for mistakes during surgery, as even a minor error could be prove detrimental to performing and completing all surgical steps. In this paper, based on our extensive experience in treating these rare lesions, we suggest a practical guide to the best surgical approach for various types of Monteggia like lesions. Some technical tips and pitfalls are also described.

Tecnica outside-in nelle lesioni meniscali isolate e con ricostruzione del LCA

We have investigated the outcome of the outside-in suture technique in a 28 patients. Seventeen patients had isolated meniscal tears (Group A), and 11 had meniscal tears with anterior cruciate ligament rupture (Group B). All patients were clinically evaluated, before surgery and postoperatively. By statistical comparison of clinical outcomes of the two groups, we found better results in Group B than in Group A, showing a significant difference. We believe the critical factor leading to a better outcome of the suture can be attributed to the haemarthrosis generated during the ACL repair.

Semitendinosus Tendon Transfer Associated With Distal Alignment for Patella Alta in a Patient With Recurrent Dislocations

Patellofemoral instability is characterized by pain during normal daily activities and frequent dislocation events. In the reported case, an adolescent girl, aged 15 years, affected by left patellofemoral instability, underwent surgery with a double technique comprising tibial tubercle distalization and medial patellofemoral ligament reconstruction. In case of patella alta associated with patellofemoral instability, surgical treatment should focus on medial patellofemoral ligament repair and on recurrent instability prevention.