Francesco Zambianchi

Volar plate fixation for the treatment of distal radius fractures: analysis of adverse events.

Objectives: Determining the rate of specific adverse events after volar plating performed for distal radius fractures. Design: Retrospective. Setting: University level I trauma center. Patients: We searched the electronic database of all surgical procedures performed in our department using the following keywords: distal radius fracture, wrist fracture, and plate fixation. We identified 315 patients, 12 of whom were lost at follow-up. Intervention: Volar plate fixation for the treatment of distal radius fractures. Main Outcome Measurements: At an average follow-up of 5 years, 303 patients were evaluated through medical records and clinical and radiographic assessment for specific adverse events after volar plate fixation. Results: Adverse events were observed in 18 patients (5.9%). Implant-related adverse events, including tendon impairments, intra-articular screws, and screw loosening, were observed in 15 patients (5.0%). Extensor tendon impairments were represented by 5 cases of extensor tenosynovitis and 3 cases of rupture of the extensor pollicis longus due to screws protruding dorsally. Flexor impairments were represented by 2 cases of tenosynovitis and 2 cases of flexor pollicis longus rupture. Screw penetration into the radioulnar joint was observed in 1 case. Loss of reduction was identified in 3 cases. One patient had a deep postoperative infection treated with operative debridement. One patient experienced injury to the median nerve during routine implant removal unrelated to tendon issues. Conclusions: The majority of adverse events after volar plate fixation were due to technical errors in implant placement. In our cohort, tendon impairments were the most frequently observed; among these, extensor tendon impairments were the most represented (50% of all adverse events). All 12 tendon-related adverse events were due to technical shortcomings with implant placement. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Fresh osteochondral allograft is a suitable alternative for wide cartilage defect in the knee

INTRODUCTION There are several surgical options to restore a wide osteochondral defect in the knee. Fresh osteochondral allografts are usually considered a poor alternative due to their difficulties in surgical application. The aim of this work is first to present our experience including the surgical technique and the functional results of patients receiving fresh osteochondral allograft to restore major knee lesions, then, to compare our results with other results presented in literature. METHODS Between 2006 and 2011, we treated 11 patients with osteochondral lesion of the knee (Outerbridge IV°). The average lesion size was 10.3 cm(2) (range 3-20 cm(2)). The average age was 34 years (range 18-66). Patients were followed from 12 to 55 months (average of 26.5) through clinical examination, X-ray film and MRI every 3 months for the first year, then every 6 months. RESULTS The treatment was successful in 10 patients showing pain regression and mean IKDC subjective score improvements from 27.3 to 58.7. The IKDC objective score also improved of at least one class for each patient except the who failed. The radiographs show good osteointegration in all cases but one. CONCLUSIONS Fresh allograft is an effective therapy for osteochondral defects repair because it allows functional recovery in a considerable number of patients. This technique obtains better results in lesion smaller than 8 cm(2). However larger lesion show good results. LEVEL OF EVIDENCE Therapeutic study, Level IV.

Distal triceps tendon repair using Krakow whipstitches, K wires, tension band and double drilling technique: a case report

IntroductionThe management of distal triceps tears must address each patient’s medical and functional status: in general, the literature has described satisfactory nonsurgical treatment in tears less than 50%. Tears greater than 50% are treated nonsurgically in a sedentary person and surgically in active patients. Complete tears are generally managed surgically: most reported repair techniques describe the use of Bunnell or Krakow whipstitch techniques, passing the sutures through transosseous drill holes in the ulna. Other described techniques include the use of suture anchors and direct tendon repair to a periosteal flap raised from the olecranon.Case presentationIn the presented report we describe the surgical technique used to treat a complete traumatic distal triceps tendon rupture associated with olecranon fracture in a 40-year-old Caucasian man with underlying poor tendon quality and postoperative assessment. To the best of our knowledge no studies describing the performed surgical technique, utilizing Krakow whipstitches, olecranon fixation with K wires and Zuggurtung tension band through transosseous drill holes have been previously described in the literature.At 30 days postoperatively the patient had regained full elbow flexion/extension and pronation/supination.ConclusionsThe described methodology, using a double ulnar tunnel to obtain fixation of the fragment, associated with a whipstitch locking-type suture for the triceps tendon, allowed proper fixation of the fracture and optimal reinsertion of the detached tendon on its footprint with sufficient strength.

The Impact of Bone Deformity on Osteoarthritic Varus Knee Correctability

BACKGROUND Bone deformities in the varus osteoarthritic knee may influence soft-tissue balancing and therefore knee correctability. The hypothesis of the present study was that the grade of coronal plane knee deformity may influence directly knee correctability along the entire range of motion from 0° to 90°. Tibial and femoral epiphyseal bone deformities were also analyzed to determine which kind had the greater impact on knee correctability. METHODS A coronal plane deformity radiographic assessment and an intraoperative correctability assessment using computer-assisted surgery were performed on 118 varus osteoarthritic knees undergoing total knee arthroplasty. Knees were divided into groups taking into account the kind of bone deformity (tibial, femoral, and combined). RESULTS A significant inverse correlation was found between coronal plane deformity and knee correctability at every 10 degrees of flexion. Correlation was strong at 0° and progressively got weaker at further flexion angles. According to literature, knees with a varus deformity >10° were rarely correctable in full extension, but often correctable in flexion, whereas knees with varus deformity >15° showed to be almost never correctable. Combined deformity group had a significantly lower rate of correctability along the entire range of motion. CONCLUSION The severity of varus knee malalignment always influenced knee correctability with the knee in full extension, in further flexion (20°-60°), correctability was mildly affected. Isolated tibial epiphyseal deformity and combined epiphyseal deformity have the greatest impact on knee correctability.

Distal biceps tendon rupture reconstruction using muscle- splitting double-incision approach

AIM To evaluate the clinical and functional results after repair of distal biceps tendon tears, following the Morreys modified double-incision approach. METHODS We retrospectively reviewed 47 patients with distal rupture of biceps brachii treated between 2003 and 2012 in our Orthopedic Department with muscle-splitting double-incision technique. Outcome measures included the Mayo elbow performance, the DASH questionnaire, patients satisfaction, elbow and forearm motion, grip strength and complications occurrence. RESULTS At an average 18 mo follow-up (range, 7 mo-10 years) the average Mayo elbow performance and DASH score were respectively 97.2 and 4.8. The elbow flexion range was 94%, extension was -2°, supination was 93% and pronation 96% compared with the uninjured limb. The mean grip strength, expressed as percentage of respective contralateral limb, was 83%. The average patient satisfaction rating on a Likert scale (from 0 to 10) was 9.4. The following complications were observed: 3 cases of heterotopic ossification (6.4%), one (2.1%) re-rupture of the tendon at the site of reattachment and 2 cases (4.3%) of posterior interosseous nerve palsy. No complication required further surgical treatment. CONCLUSION This technique allows an anatomic reattachment of distal biceps tendon at the radial tuberosity providing full functional recovery with low complication rate.

Robotic-arm assisted partial knee arthroplasty: a single centre experience

Background and aim of the work : The international literature and analysis of the prosthetic registers highlight a significant relationship between the alignment of the components and the survival of prosthetic implants of the knee. The patient specific instrumentation (PSI) technology exploits the data obtained with the MRN for the production of cutting blocks (CB) useful to a TKA. Revisiting the recent international literature, comparing the results of the conventional method and PSI, numerous studies confirm a statistically significant difference of inliers (± 3 degrees) for HKA. The purpose of this retrospective study was to investigate whether these statistically significant difference is also present in our group. Methods : Postoperative radiographic measures of alignment based on a mechanical limb axis (hip-knee-ankle angle, HKA) of 180° were sought. A range of 180° ± 3° varus/valgus was defined as optimal for mechanical axis. Results: The percentage of knees that had a HKA within ±3° of the desired value was 92.2. Conclusion: the CB did accurately produce the desired HKA. The PS system is an effective and reproducible, whose organizational effort is fully justified.

Il trattamento del ginocchio rigido protesizzato

Stiffness is a disabling complication following total knee arthroplasty (TKA), leading to important limitation in the range of movement and affecting patient ability to perform daily activities. In this study, 25 records were considered to describe the most common treatment for prosthetic knee stiffness.Manipulation under anaesthesia is the first option in early arthrofibrosis, arthroscopic arthrolysis is usually performed 3 to 6 months after TKA, while arthrotomic arthrolysis has to be considered a second-line treatment. Revision arthroplasty should only be used in selected cases.