Purpose : This study aims to compare the effectiveness and clinical value of ultrasound-assisted and arthrography-assisted treatment for acute Monteggia fractures in young children. Methods : We conducted a retrospective analysis of 40 cases of acute Monteggia fractures in children treated with Kirschner wire or elastic intramedullary nail fixation between April 2020 and April 2025. Among these cases, 19 were treated under arthrography assistance (Group A), and 21 were treated under ultrasound guidance (Group B). We recorded baseline data for both groups, including gender, age, fracture side and type, associated injuries, time from injury to surgery, internal fixation device, fluoroscopy time, surgical duration, follow-up duration, and internal fixation removal time. Postoperative X-ray examination was performed to assess the quality of fracture reduction. Results : Fluoroscopy time and surgical duration in Group B were significantly lower than in Group A ( P < 0.05). Based on the evaluation criteria for assessing reduction quality, 17 cases were graded excellent, and 2 were considered good in Group A, while in Group B, 20 cases were deemed excellent and 1 was considered good. At the final follow-up, there was no significant difference in the range of elbow flexion, extension, pronation, and supination between the affected limbs of Group A and Group B ( P > 0.05). Conclusion : Ultrasound not only saves surgical time and reduces intraoperative radiation exposure for the patients but also enables the exploration of peripheral nerves, vessels, and soft tissue compressions.
Total hip arthroplasty remains one of the most successful orthopedic procedures for the treatment of hip osteoarthritis. Among contemporary surgical approaches, the direct anterior approach has gained increasing popularity due to its intermuscular and internervous plane, which aims to minimize soft-tissue trauma and potentially reduce instability. This article provides a step-by-step pictorial overview of the Anatomic–Atraumatic–Anterior Reconstructive Technique (A-A-ART) performed without a traction table and combined with dual-mobility articulation. Key technical steps are described, including patient positioning, capsular management, acetabular preparation using anatomical landmarks, controlled femoral exposure, and implant positioning. Particular emphasis is placed on progressive capsular release, protection of the anterior acetabular horn, and prevention of varus stem alignment. When performed in a standardized and reproducible manner, the A-A-ART technique allows reliable limb length control, stable component orientation, and preservation of periarticular structures, offering a safe and effective strategy for the surgical management of hip osteoarthritis.
Introduction : Coronal alignment following total knee arthroplasty (TKA) is commonly assessed using radiographs, but postoperative radiographic protocols are not standardised. This study evaluated agreement between coronal alignment measured on short-leg and standing long-leg radiographs. We hypothesised that, in knees demonstrating varus alignment on standing long-leg radiographs, short-leg radiographs would demonstrate greater apparent varus. Methods : This retrospective cross-sectional study included 62 sequentially selected patients following primary TKA. All included patients had both postoperative short-leg and standing long-leg radiographic examinations available for analysis. Coronal alignment was assessed using the β angle. Agreement was evaluated using paired differences and Bland–Altman analysis. Interobserver reliability was assessed across six observers (two primary observers and four additional colleagues) using ICC(2,6). Intraobserver reliability was assessed using ICC(3,1). Results : The mean paired difference (short-leg minus standing long-leg) was −1.13° (95% confidence interval [CI]: −1.40° to −0.85°), indicating a systematic shift towards a more varus measurement on short-leg radiographs. The 95% limits of agreement were −4.08° to –1.82°, and 29% of measurements differed by more than 2°. In the 47 varus knees, the mean difference was −0.79° (95% CI: −1.18° to −0.40°; p < 0.001). In the valgus subgroup ( n = 14; one neutral knee excluded), the mean difference was −2.31° (95% CI: −3.22° to −1.40°; p < 0.001). Discussion : Short-leg and standing long-leg radiographs demonstrate systematic differences in postoperative coronal-alignment measurement. Although the overall mean difference was modest, the relatively wide limits of agreement indicate that larger discrepancies can occur in individual patients. Short-leg radiographs should not be considered interchangeable with standing long-leg radiographs when accurate assessment of the lower-limb mechanical axis is required.
Ballistic femoral neck fractures are complex, high-energy injuries that require a management approach distinct from conventional blunt trauma. These current concepts review examines the evolving landscape of evaluation and treatment for these rare injuries based on contemporary literature. Initial management emphasizes the Advanced Trauma Life Support (ATLS) protocol, with a critical focus on identifying associated neurovascular and skeletal injuries, which are present in approximately one-third of cases. Diagnostic evaluation relies on plain radiography and thin-slice CT to delineate fracture morphology and bullet trajectory, with CT angiography recommended if vascular compromise is suspected. Surgical decision-making balances the goals of head preservation through open reduction and internal fixation (ORIF) against the definitive stability provided by total hip arthroplasty (THA). While ORIF remains the standard for young, active patients, clinicians must account for the historically high incidence of nonunion and infection associated with ballistic mechanisms. In cases of failed osteosynthesis or catastrophic articular comminution, conversion to THA offers a reliable salvage option with favorable functional outcomes. This review highlights the need for individualized treatment plans and meticulous clinical follow-up to manage the inherent risks of this challenging injury pattern.
Introduction: Staphylococcus aureus is the most frequently implicated pathogen in periprosthetic joint infections (PJIs) and surgical site infections (SSIs), with nasal colonization being a well-established risk factor for their onset. Despite this association, the role of routine preoperative screening and decolonization in reducing postoperative infection rates remains debated. Methods: This retrospective study analyzed 2,507 elective joint arthroplasty procedures performed between January 2022 and December 2024 at a single center in Italy. Starting in 2024, patients underwent nasal swab screening for methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA). Positive carriers received a decolonization protocol consisting of mupirocin nasal ointment and chlorhexidine showers in the days preceding surgery. The incidence of PJIs in this group was compared to that observed in a control cohort from 2022–2023, during which no screening or decolonization was implemented. Results: Among the 988 patients screened in 2024, 231 (25.2%) tested positive for MSSA and 18 (1.8%) for MRSA. Notably, no PJIs caused by MSSA or MRSA were reported that year, compared to three such cases recorded in the preceding 2 years. Overall, 11 PJIs (0.44%) were documented across the study period. All infections in 2024 occurred in patients who had tested negative for S. aureus colonization. However, the reduction in infection rates did not reach statistical significance (p = 1.00). Conclusions: Although the observed decrease in S. aureus-related periprosthetic joint infections was not statistically significant, the trend suggests that preoperative screening and targeted decolonization may contribute to a lower incidence of these infections. These findings support further investigation into standardized preventive strategies to enhance outcomes in joint replacement surgery.
