Neurovascular injuries during shoulder surgery occur infrequently but they produce severe morbidity and may require surgical management. The purpose of this paper is to review the literature and present the most common neurovascular injuries occurring during specific orthopaedics procedures.

Per le fratture della diafisi tibiale il trattamento chirurgico è considerato essenziale, ma è dibattuto quale sia la migliore tecnica. Scopo del lavoro è confrontare, analizzando la letteratura, l’efficacia dell’inchiodamento endomidollare rispetto alla fissazione con placche nel trattamento delle fratture extraarticolari di tibia. Negli articoli selezionati, 318 pazienti erano affetti da frattura prossimale (234 chiodo, 84 placca), 226 da frattura distale (135 chiodo, 93 placca). Sono stati considerati esiti specifici differenti per le fratture prossimali e distali. Nelle fratture prossimali la placca garantisce minore insorgenza di sindrome compartimentale (p = 0,0488) e di fallimento dell’impianto (p = 0,0176), il chiodo comporta meno infezioni (p = 0,0019). Nelle fratture metafisarie distali, la placca assicura minor difetto di allineamento (p = 0,01), il chiodo comporta meno infezioni (p = 0,02) e maggior angolo di dorsiflessione (p = 0,001). La letteratura esaminata mostra variabilità degli outcome nei gruppi a confronto. La scelta di chiodo o placca deve essere effettuata in base alle caratteristiche cliniche e radiologiche.

Aim. The treatment of proximal humeral fractures continues to be a matter of debate among orthopaedists, especially when dealing with complex fractures in elderly people. The aim of this study was to compare percutaneous osteosynthesis with hemiarthroplasty as regards functional results and complications. Methods. Forty patients, twenty in the osteosynthesis group and twenty in the hemiarthroplasty group, with a 3/4-fragment fracture, type B-C according to AO classification, were included in the study. Results. The average age was 71.1 +/- 8.94 (50-84) in the hemiarthroplasty group and 55.9 +/- 13.78 (32-77) in the osteosynthesis one. After a mean follow-up of three years, the Constant Score (CS) and the Modified Constant Score (MCS) were significantly better (P=0.01) in the osteosynthesis group (hemiarthroplasty group: CS: 48.1 +/- 16.26 range 18-79; MCS: 64 +/- 22% range 28-96%; osteosynthesis group: CS: 72.35 +/- 13.26 range 49-98; MCS 83 +/- 11% range 56-100). The Oxford Score showed similar results in the osteosynthesis group (41.1 +/- 6.27 range 30-48) versus the hemiarthroplasty group (32.85 +/- 11.23 range 13-48) (P < 0.01). Patients' stratification according to age, fracture type and days elapsed between the trauma and the surgical operation confirmed the best results in the osteosynthesis group. Seven complications occurred in the hemiarthroplasty group, among which superficial infection and algodistrophy were the most frequent, while six complications occurred in the osteosynthesis group, mainly represented by necrosis (P=1). Conclusion. Percutaneous osteosynthesis seems to be an effective alternative treatment in cases of proximal humeral fractures. Compared to hemiarthroplasty it showed better functional results and a similar incidence of complications.

Aim. Proximal tibial osteotomy, with Puddu's plate fixation, has become, in Europe, one of the most popular surgical procedures utilized to treat arthrosis of medial compartment in varus knee. A standard X-ray in front-backside and lateral-sideward projections is usually used to evaluate post surgical results. That could be inadequate to evaluate with precision the evolution of osteotomy recovery. That is the reason why it is important to find other techniques of evaluation of bone osteointegration. Methods. Twenty patients enrolled for the study underwent proximal tibial osteotomy with Puddu's plate fixation. Two months after surgery patients were evaluated using two alternative techniques to complement conventional radiology: the first technique is CT with 3d evaluation of bone density that enables the acquisition of multiple points measurements, expressed in HU The second one is DEXA expressed in BMD, that permits to obtain useful data of bone quality. Results. CT measurements: the relationship between the mean HU density measures of proximal bone and the native one are: 1 HU with a SD of 0.47, whereas HU measures in the distal site are: 1.4 HU with a SD of 0.61. DEXA measurements: the relationship be-tween the mean BMD density measures expressed in g/cm of proximal bone and the native one are 0.99 g/cm(2) with a SD of 0.36, whereas BMD density measures in the distal site are: 1.1 g/cm with a SD of 0.53. Conclusions. The results obtained in this study suggest that both TC and DEXA techniques are adequate to evaluate osteointegration of a scaffold, like HatriC at bone interface, without being invasive as biopsy can be.

Aim. The analysis of results in the medium and long term of a series of more than 100 ABGII (Stryker Howmedica) hip arthroplasties allowed us to assess the prosthesis' validity and the residual pain possible presence. Methods. Between October 1999 and December 2004 113 ABGII cementless consecutive total hip replacements at the Mauriziano "Umberto I" hospital in Turin have been performed; 100 replacements (88 patients) were reviewed clinically and radiographically; the mean duration of the follow-up was 7.72 years. Results. Chronic pain was found in 41% of cases; in most of them it was located in the trochanteric zone, largely unrelated with charge and it was defined "mild" and not disabling; 19% of the examined patients referred thigh pain. It was also found a high failure rate of the prosthetic implant (6%). Conclusion. In conclusion, this implant is successful in a medium and long term analysis, however it is still present an excessive incidence of residual pain, probably related to the anatomical design of the stem, without showing significant radiographic correlations.