The Pipkin fracture, a complex injury involving femoral head fractures often accompanied by hip dislocation, presents significant challenges in surgical management. Despite various proposed approaches, the optimal treatment, especially in polytraumatized patients, remains debated. This case report presents a Pipkin type IV fracture treated using a combination of damage control surgery, intramedullary nailing for femoral shaft fractures, and arthroscopic reduction and fixation for the femoral head fracture. A 22-year-old male was admitted following a high-energy car accident, presenting with bilateral femoral shaft fractures, a right Pipkin type IV femoral head fracture with an associated posterior acetabular fragment, and an exposed left patellar fracture. Initial damage control involved external fixation of femoral fractures and irrigation of the patellar wound. Definitive treatment was staged: first, intramedullary nailing of the left femoral shaft and patellar cerclage; second, right femoral shaft intramedullary nailing followed by arthroscopic reduction and fixation of the femoral head fracture. Arthroscopy facilitated minimally invasive removal of intra-articular fragments and secure fixation with a headless cannulated screw. Post-surgical rehabilitation focused on early mobilization and gradual weight-bearing. Using advanced arthroscopic techniques for the fixation of femoral head fracture dislocations resulted in excellent functional outcomes and minimal complications. This case underscores the effectiveness and benefits of arthroscopy in achieving precise reduction and accelerated recovery.

Background:Total hip arthroplasty (THA) is one of the most frequently performed orthopedic procedures. Developmental dysplasia of the hip (DDH) presents specific anatomical challenges that require tailored implant designs. Wagner™ conical stems were developed to address the morphological alterations of dysplastic femur, offering potential advantages in stability and functional restoration. This study assesses the long-term survival and clinical outcomes of Wagner™ conical stems in patients with Crowe non-IV DDH. Materials and methods:This retrospective study included primary THAs performed between 2003 and 2015 using Wagner™ conical stems exclusively in patients with DDH. Only cases with complete clinical and radiographic follow-up were analyzed, excluding those lost to follow-up or revised. The evaluated outcomes were prosthetic survival rate, clinical performance assessed with the Modified Harris Hip Score (mHHS), and radiographic findings at final follow-up. Results:Forty-five patients (57 hips) met the inclusion criteria. The mean age at surgery was 56.5 years (range, 33-76), with a mean follow-up of 15 years (range, 8-20). Kaplan-Meier analysis showed a survival rate of 95.7% at 10 years and approximately 80.5% at 20 years, with an overall survival rate of 89.5% at the final follow-up. The main cause of failure was aseptic loosening, followed by infection, recurrent dislocation, and metallosis. Among hips with retained implants, 86.3% (44/51) achieved an mHHS > 70, indicating satisfactory functional recovery. The mean mHHS was 88.6 ± 14.3 (Range, 62-100), with a median of 92 and a mode of 100. Conclusion:Wagner™ conical stems provide durable fixation and favorable long-term functional outcomes in Crowe non-IV DDH, with high survival rates and low complication incidence over extended follow-up.

BACKGROUND Childhood obesity has emerged in the last decades as an important public health problem worldwide. Although relationships between obesity and flatfoot have been shown, no studies have investigated the influence of obesity on arthroereisis outcomes. AIM To evaluate correlations between childhood overweight/obesity and clinical and radiographic outcomes after subtalar arthroereisis with self-locking implants. METHODS This retrospective study included one hundred and sixty-nine pediatric patients (10-14 years old) who underwent subtalar arthroereisis (PEEK PitStop® device) for severe flexible flatfoot. Exclusion criteria were additional procedures, revision of previous corrective surgeries, rigid flatfoot with severe deformity, and neurological or post-traumatic flatfoot. Preoperative/postoperative European Foot and Ankle Society (EFAS) and visual analogue scale (VAS) scores were determined; radiographic assessment was conducted on weight-bearing foot X-rays: Kite angle, first metatarsal-talus angle, Meary angle, calcaneal pitch angle and lateral talo-calcaneal angle were analyzed. RESULTS EFAS and VAS scores improved post-operatively in the whole population. Only seven cases with complications were reported. Radiographic assessment revealed an improvement in all angles. Statistical analysis demonstrated that the impact of obesity was significant on arthroereisis outcomes: Relationships were reported between BMI and postoperative EFAS/VAS scores, postoperative calcaneal pitch angle, Kite angle, Meary angle and talo-first metatarsal angle. CONCLUSION Although arthroereisis represents a very effective and valid treatment for flatfoot both in normal weight and obese children, obesity significantly influences clinical and radiographic outcomes of arthroereisis, and obese children tend to perceive more pain and discomfort.

Treatment of bacterial septic arthritis in the native adult hip joint can be challenging. Prompt diagnosis and treatment decisions can reduce the associated morbidity and mortality.For this systematic review of the literature, we asked: (1) What are the treatment options? (2) What are the success rates and the outcomes after treatment? (3) Which antibiotic and duration of therapy are optimal?We searched the electronic databases PubMed, Scopus, and Embase using the search terms "hip" or "native hip" and "septic arthritis" or "coxitis". Studies were included if they reported on: (1) bacterial infection of the hip, (2) treatment, (3) success rate/outcomes, (4) follow-up. The final review included 19 studies. The quality of study reporting was evaluated with the Methodological Index for Non-randomized Studies (MINORS) questionnaire.Three treatment options are: arthroscopy, single open surgery, and two-stage total hip arthroplasty (THA). A high success rate in infection eradication was reported for all three. Intravenous antibiotic therapy should be promptly initiated to eradicate septic arthritis and minimize potential sequelae and complications.Arthroscopy, single open or two-stage THA were reported to be effective in treating bacterial septic arthritis of the native hip. The key to optimal outcome is early diagnosis and timely treatment. Cite this article: EFORT Open Rev 2021;6:164-172. DOI: 10.1302/2058-5241.6.200082.

Background:Unstable ankle fractures are very frequent. Given the instability, they often require surgical treatment, but literature scarcely reports on the outcomes of their management.Questions/purposes:For this systematic review we asked: (1) What are the outcomes in treatment of unstable ankle fractures? (2) What about complications of treatment in unstable fractures? (3) What factors influence the outcomes? (4) What about the role of the posterior malleolus?Methods:The electronic databases PubMed, Scopus, and Embase were interrogated using the search terms "bimalleolar" or "trimalleolar" and "fracture". Studies were included if they reported on: (1) bimalleolar or trimalleolar fracture in adults; (2) treatment; (3) outcomes reported by scales; (4) follow-up. The final review included 33 studies. The quality of the studies was evaluated with the Methodological Index for Non-randomized Studies (MINORS) questionnaire.Results:All the outcomes of the thirty-three selected studies were analyzed.Discussion:Surgical fixation of unstable ankle fractures should always be performed within the first 48 hours from the trauma, preventing instability and post-traumatic osteoarthritis. Surgeon should consider factor may influence functional outcomes. Posterior malleolar fractures should be fixed regardless the size, considering some individual factors.

A successful and minimally invasive treatment for adolescent flexible flatfoot is subtalar arthroeresis. This study examines the short-term results of subtalar arthroereisis with a new PEEK device (Pit’Stop®); additional research will be required to determine the device’s true potential, but the preliminary findings are very encouraging, with a high success rate and a low complication rate (0.08).

Rare shear-type fracture of the talar head in a thirteen-year-old child — Is this a transitional fracture: A case report and review of the literature

BACKGROUNDTalar fractures are exceedingly rare in childhood. There are very few studies on the clinical aspects, the long-term outcomes and the appropriate treatment of these fractures in pediatric patients. The mechanism of trauma consists of the application of a sudden dorsiflexion force on a fully plantar-flexed foot. Traumatic mechanism, symptoms and imaging of injuries of the talar head are similar to transitional fractures that are normally described at the distal epiphysis of the tibia: the so-called transitional fracture is defined as an epiphyseal injury when the growth plate has already started to close.CASE SUMMARYA thirteen-year-old girl reported a high-energy trauma to her right foot, due to falling from her horse. X-rays at the Emergency Department were negative. Because of persistent pain, the patient was assessed by an orthopedic surgeon after two weeks and computed tomography scans revealed a misdiagnosed displaced shear-type fracture of the talar head. Hence, surgical open reduction and fixation with two headless screws was performed. The girl was assessed regularly, and plain films at follow-up revealed complete healing of the fracture. Within six months after surgery, the patient returned to pre-injury sport activities reporting no complications.CONCLUSIONInjuries of the talar head in childhood should be considered as transitional fractures. Open reduction with internal fixation aims to reduce malalignment and osteoarthritis. Computed tomography scans are recommended in these cases.

BACKGROUND Müller-Weiss disease（MWD） is an idiopathic foot condition characterized by spontaneous tarsal "scaphoiditis" in adults. Frequently bilateral and affecting females during the 4 th -6 th decades of life,the pathogenesis of MWD remains unclear: It has been traditionally considered a spontaneous osteonecrosis of the navicular. The typical presentation of MWD is a long period of subtle discomfort followed by prolonged standing,atraumatic,disabling pain. Currently,there is no gold standard for the treatment of patients with MWD. Most support initial conservative therapy. Operative treatment should be considered for failure of conservative therapies longer than 6 months. The indication for surgery is severity of symptoms rather than severity of deformities. Operative treatment options include core decompression,internal fixation of the tarsal navicular,open or arthroscopic triple fusion,talo-navicular or talo-navicular-cuneiform arthrodesis,and navicular excision with reconstruction of the medial column.CASE SUMMARY In this study,we report four patients affected by MWD. Clinical and radiographic assessment,follow-up and treatment are reported.CONCLUSION As it is frequently misdiagnosed,MWD is challenging for orthopedic surgeons. Early diagnosis and effective treatment are mandatory to avoid sequelae.

Background As a result of the uncontrolled spread of the COVID-19 virus infection, a health reorganization according to the "hub and spoke" model was necessary. The purpose of the article was to document the adopted corporate protocol and describe the management of the traumatized patient in a Hub center. Methods Our hospital has been identified as one of the three regional Hubs for polytrauma and major traumas, requiring suitable pathways to receive confirmed or suspected COVID-19-positive patients, from the emergency room entrance to the operating room, and finally to the inpatient ward or ICU. From February 23th to April 30th 2020 we analyzed the total number of trauma patients hospitalized and the number of femoral neck fractures surgically treated within 48 h; the data were then compared with the corresponding period of the previous year. Results There has been a reduction in the overall number of traumas as a result of government restraint measures. Total occupancy time in the operating theater has increased, but not drastically considering dressing procedures and anesthesia (carried out inside the operating room). The number of patients with femoral neck fractures surgically treated within 48 h (none of the COVID-19-positive patients) decreased from 83.33 to 58.70%, but only slightly lower than the Italian pre-COVID average of 64.70%. Conclusions The correct management of the hospital and the meticulous organization of the traumatized patient have made it possible to contain the potential negative effects on the medical care quality during this unexpected and severe health emergency.

Anterior knee pain (AKP) is one of the most common musculoskeletal disorders and may cause severe disability and discomfort in children and in adolescents. Its etiology is heterogeneous and includes all causes of pain in the anterior aspect of the knee. Amongst rare causes, there are patellar tumors; in this paper we reported a unique case of patellar osteoma osteoid. In literature, nature and treatment of iuxta-articular osteoma osteoid remain controversial: some authors believe that iuxta-articular osteomas could lead to permanent deformity and advocate an early surgical treatment. Other authors report spontaneous regressions, good response to nonsteroidal anti-inflammatory drugs (NSAIDs) e risk of iatrogenic damages. In this paper, we reviewed current treatment concepts in view of our therapeutic choices.

BACKGROUND Primary synovial chondromatosis（PSC） is a rare arthropathy of the synovial joints characterized by the formation of cartilaginous nodules, which may detach and become loose bodies within the joint and may undergo secondary proliferation. PSC of the foot and ankle is exceedingly rare, with only a few cases reported in the literature. The diagnosis may be difficult and delayed until operative treatment, when it is confirmed by histological assessment. PSC may degenerate into chondrosarcoma. Operative treatment is the gold standard aiming to minimize pain, improve function, prevent or limit progression of arthritis. Surgical treatment consists in debridement by arthrotomic or arthroscopic management, but there is no consensus in the literature about timing of surgery and surgical technique. Thus, the aim of this study is to report the outcomes of the surgical treatment of two cases, together with a literature review.CASE SUMMARY We report two cases of patients affected by PSC of the foot in stage III, according to the Milgram classification: the former PSC localized in the ankle that underwent open surgery consisted of loose bodies removal; the latter in the subtalar joint, and the choice of treatment was the arthrotomy and debridement from loose bodies, in addition to the subtalar arthrodesis. Both patients returned to complete daily and working life after surgery.CONCLUSION Synovial chondromatosis is a rare benign pathology, even rarer in the ankle joint and especially in the foot. Surgery should be minimal in patients with ankle PSC,choosing the correct timing, waiting if possible until stage III. More aggressive and early surgery should be performed in patients with PSC of the foot,particularly the subtalar joint, due to the high risk of arthritic evolution.

BACKGROUNDEarly dislocation is a foremost complication of total hip arthroplasty through a postero-lateral approach. The extra-articular impingement of the anterior part of the great trochanter with ileum bone, with or without soft tissue interposition is a well recognized but underestimated etiopathogenetic cause reported in literature. In this retrospective study through the assessment of clinical and radiographic follow-up at a minimum of six months, the effectiveness of an antero- longitudinal osteotomy of the great trochanter for early dislocation prevention is evaluated.MATERIALS AND METHODS209 patients (48.3% males and 51,7% females) underwent a total hip arthroplasty from June 2011 to September 2015, with surgery being performed by the same surgeon. A modified posterolateral approach was used according to the tissue-sparing criteria, in all the cases an anterior longitudinal osteotomy of the great trochanter has been performed at 90° to the antiversion angle of the implant and aligned posteriorly ...

AbstractObesity is one of the most problematic issues for health organizations worldwide because of its relationship with several chronic diseases. It is also demonstrated to increase early onset of hip arthritis, consequently leading to early failure of implants of total hip arthroplasty (THA). The aim of the study was to assess the influence of obesity on the positioning of prosthetic components and potential complications. A total of 312 patients underwent THA from 2006 to 2015 at our institute. All procedures were performed by a single surgeon (M.F.S.). As indicated by the World Health Organization (WHO), our population was stratified on the basis of body mass index (BMI): Four underweight, 112 nonobese, 131 overweight, 51 grade-1 obese, 10 grade-2 obese, and 4 grade-3 obese patients were included. No superobese patients were reported. The population was assessed clinically (implant survival, surgery time, blood loss, and complications) as well as radiologically (femoral offset, cup abduction and anteversion, and periacetabular osteolysis). Higher cup inclination (48.70 vs. 45.94 degrees), surgical time (86 vs. 80 min), and total blood losses (1,026 vs. 761 mL) were reported in overweight/obese patients (p < 0.01). Statistical analysis documented a significant relationship between obesity and cup inclination, surgical time, intraoperative and total blood losses, as well as BMI and age at surgery (p < 0.05). The overall correct positioning of prosthetic components is not significantly related to obesity. Although maintained in the “safe zone,” cup abduction, blood loss, and operative time tend to significantly increase with BMI.

Polyethylene wear is the main factor leading to periprosthetic osteolysis, aseptic loosening and long-term failure of the implant in total hip arthroplasty (THA). The present study compares the clinical and radiographic outcomes of 88 patients who underwent primary THA with either conventional polyethylene or cross-linked polyethylene (XLPE) from the same manufacturer (Zimmer®, Warsaw, IN, USA). There were no significant differences between the two sub-populations in average age, gender, side affected and prosthetic stem and cup size. The average follow-up was 104 months, ranging from 55 to 131 months: to our knowledge this is the longest follow-up for this particular insert. Clinical and x-ray evaluation was obtained at 1, 3, 6 and 12 months and yearly thereafter. Our results showed that cross-linked polyethylene has a significantly greater wear reduction than that of standard polyethylene.

BACKGROUND:Dislocation of primary THA (total hip arthroplasty) is one of the most undesirable complications with an incidence ranging from 2% to 5%. Several risk factors are described, related to the patient, surgery, or prosthetic design. The aim of the study was to assess risk factors and their potential influence on dislocation.MATERIALS AND METHODS:387 primary THA were performed between September 2005 to December 2008 at our institute (Varese, Italy) through a modified posterior-lateral approach. Clinical evaluation was based on range of motion (ROM) and Harris Hip Score; femoral offset, acetabular inclination, and anteversion were measured on plain radiograms. Data were analyzed by SPSS software (SPSS, Inc., Chicago, Illinois).RESULTS:Excellent ROM and Harris Hip Scores were achieved in more than 95% of patients (p<0.05). The offset was restored in all patients. Most of the cases had their cup positioned in the "safe zone" (both inclination and anteversion). Six dislocations (1.87%) occurred: significant correlation was found between dislocation and preoperative diagnosis of femoral neck fracture.CONCLUSIONS:THA dislocation rate appears not to be related to patient biometric parameters and prosthesis design. Femoral neck fracture is reported as the major risk factor for this complication, probably caused by higher preoperative activity and lesser compliance of the patient.

The extra-articular impingement of the greater trochanter against the ileum is an underrated cause of early dislocation in total hip arthroplasty. In this preliminary study, the authors assess the effectiveness of an anterior longitudinal osteotomy of the greater trochanter for preventing dislocation. A total of 115 patients underwent a total hip arthroplasty through a posterolateral approach. All patients underwent clinical and radiological follow-up at 1, 3, and 6 months. No dislocation was reported. All patients demonstrated fast recovery of range of motion and walking. No trochanter fractures were observed. The osteotomy of the greater trochanter is an effective surgical technique that decreases anterior impingement and consequently lowers the dislocation rate in primary total hip arthroplasty. [Orthopedics. 2015; 38(8):490-493.].

The clinical and radiographic outcomes of 88 patients who underwent primary total hip arthroplasty with either conventional polyethylene or cross-linked polyethylene (XLPE) from the same manufacturer were compared. There were no significant differences between the 2 subpopulations regarding average age, gender, side affected, or prosthetic stem and cup size. The average follow-up was 104 months (range, 55 to 131 months). To the authors' knowledge, this is the longest follow-up for this particular insert. Clinical and radiographic evaluations were performed at 1, 3, 6, and 12 months and then annually. Results showed that XLPE has a significantly greater wear reduction than that of standard polyethylene in primary total hip arthroplasty. At the longest available follow-up for these specific inserts, XLPE proved to be effective in reducing wear.