Luca Fabbri

The role of external fixation in the treatment of humeral shaft fractures: A retrospective case study review on 85 humeral fractures

There is no consensus among surgeons on the treatment for humeral fractures: the best it is still a matter of some debate. The aim of our work was to demonstrate that external fixation may be considered a valid method not only in emergencies but also for the definitive treatment of such fractures. We perform a retrospective case study review on 85 humeral fractures, 62 shaft fractures, and 23 extrarticular distal third fractures treated with external fixation. Clinical (Disabilities of the Arm, Shoulder and Hand (DASH) score and SF-36) and radiographic follow-up lasted on average 30 months (minimum 12 to maximum 36). Complete healing of fractures was achieved in 97.6% of cases (83 patients), with an average consolidation time of about 12 weeks (83.2 days). One case of delayed union and one case of refracture were encountered. Eighty-one patients demonstrated SF-36 scores at or above the national average and an average DASH score of 8.9. External fixation of humeral shaft fractures is considered a valid treatment method as it provides good results in terms of stability of reduction, tolerability, healing times, and functional recovery.

Osteoid osteoma mimicking monoarticular juvenile idiopathic arthritis in a girl

Osteoid osteoma (OO) is a benign osteogenic neoplasm, usually affecting children and young adults, that is typically characterized by nocturnal pain and response to non‐steroidal anti‐inflammatory drugs. OO is frequently misdiagnosed because it mimics juvenile idiopathic arthritis (JIA), bone infection or malignancy. Herein we report the case of a girl who presented with chronic monoarthritis of the knee mimicking JIA. After 1 year, OO of the femoral distal metaphysis was diagnosed. OO was treated with computed tomography‐guided radiofrequency ablation with disappearance of the symptoms and resolution of the neoplasm. No recurrences have been observed 3 years after the treatment. This case highlights that intra‐articular or juxta‐articular OO should be suspected in the case of misleading symptoms and signs, such as swelling, lack of typical pain and synovial thickening on ultrasound; needle biopsy of the lesion is necessary in the case of confusing imaging.

Hip replacement in femoral head osteonecrosis: current concepts.

Osteonecrosis of the femoral head is a destructive disease that usually affects young adults with high functional demands and can have devastating effects on hip joint. The treatment depends on extent and location of the necrosis lesion and on patients factors, that suggest disease progression, collapse probability and also implants survival. Non-idiopathic osteonecrosis patients had the worst outcome. There is not a gold standard treatment and frequently it is necessary a multidisciplinary approach. Preservation procedures of the femoral head are the first choice and can be attempted in younger patients without head collapse. Replacement procedure remains the main treatment after failure of preserving procedures and in the late-stage ONFH, involving collapse of the femoral head and degenerative changes to the acetabulum. Resurfacing procedure still has good results but the patient selection is a critical factor. Total hip arthroplasties had historically poor results in patients with osteonecrosis. More recently, reports have shown excellent results, but implant longevity and following revisions are still outstanding problems.