Le fratture della mano in età pediatrica

LO SCALPELLO-OTODI Educational - Phalangeal fractures are the most common hand fractures in children and the distal phalanx is the most injured. Minor fingertip injuries are very common; sometimes...     

Le fratture del femore prossimale in età pediatrica

Proximal femoral fractures are rare in children; however, they are associated with a high rate of complications. They are the consequence of high energy trauma following motor vehicle accidents and falls from greater heights. The ideal treatment for displaced fractures should include anatomical reduction and stable fixation, if possible within 24 hours from the trauma in order to reduce the incidence of sequelae. Adequate fixation may be obtained using Kirschner wires, cannulated screws, plates and screws or external fixators, depending on the type of fracture. Complications include avascular necrosis of the femoral head, coxa vara, nonunion, premature physaeal closure and limb discrepancy.

     

Le fratture del capitello radiale in età infantile

Fractures of the radial neck are rare and account for approximately one percent of all bone fractures in childhood, while severe displaced fractures account for only 1/3 of those. According to the literature, the main complications of surgical treatment include loss of function and avascular necrosis. The aim of the study was to describe our mini-invasive technique and to compare it to eighteen minimally-invasive techniques found after a literature review. Between 1990 and 2017 twelve patients (7 males and 5 females) aged between one and thirteen years (average age 8.3 years) with severe displaced radial neck fractures (6 type III, 4 type IVa and 2 type IVb according to Judet’s classification) were treated with a minimally-invasive technique combining percutaneous Kirschner wire reduction and intramedullary fixation according to Métaizeau. The Metaizeau radiological and functional score evaluation and the functional score of Tibone and Stoltz were considered. The postoperative x-ray evaluation according to Metaizeau showed eleven excellent results and one good result. After an average follow-up of 28 months (range 8–110 months) the scores according to Tibone and Stoltz showed 10 excellent results and two good results; the functional evaluation according to Métaizeau showed 11 excellent results and one good result. Percutaneous reduction of the displaced radial head in radial neck fracture using a Kirschner wire combined with an intramedullary fixation according to Metaizeau has proven to be simple, effective and without complications.

     

Le fratture di gamba in età pediatrica

Diaphyseal fractures of tibia and fibula are common in children and adolescents. Radiographic evaluation should be accompanied by meticulous neurovascular status monitoring. Closed reduction and casting are still a good option in undisplaced fractures affecting young children, although flexible intramedullary nailing has become increasingly popular for fractures that require surgical fixation.

     

Le fratture diafisarie di omero in età pediatrica

LO SCALPELLO-OTODI Educational - Humeral shaft fractures are uncommon in children. They occur with bimodal distribution, presenting peaks in the first and third childhood. The treatment differs...     

Le lussazioni dell’arto superiore in età evolutiva

Children have a high propensity to injure their upper limbs. Younger children use their hands to discover and get to know the world around them, while older ones and the teenagers are increasingly dealing with recreational physical activities and agonistic sports events. Upper extremity lesions may occur from the shoulder to the fingers. As regards the biomechanical features in the developing skeleton, bones and physes are usually involved while, on the other hand, dislocations and subluxations of the upper extremities are uncommon in children, because of the relative weakness of the epiphyseal plates. Correct diagnostic procedures and consequent therapeutic treatments are fundamental to achieve the best possible outcome.     

Le fratture sovracondiloidee dell’omero in età pediatrica

LO SCALPELLO-OTODI Educational - Supracondylar humeral fracture is the most common elbow injury in pediatric population. According to the mechanism of injury, these fractures can be divided in two...     

Le fratture dell’omero prossimale in età pediatrica

In the paediatric population, sports, falls and car accidents can result in proximal humerus fractures. Since the proximal humeral growth plate is responsible for up to 80% of the growth of the humerus, remodelling of these fractures in children is enormous: the younger the patient, the higher the potential for remodelling. Most proximal paediatric humeral fractures can be treated successfully by closed means. However, some patient factors or fracture characteristics may prompt for surgical treatment.

     

Classificazione,inquadramento diagnostico e trattamento della lesione di Monteggia in età pediatrica

LO SCALPELLO-OTODI Educational - Monteggia fractures represent the association of a fracture of the proximal ulna and luxation of the radial head. This type of lesion is infrequent and may be...     

Trattamento delle lesioni del rachide nel polifratturato in età pediatrica

Spine injuries involve 1 to 5% of children admitted to trauma centers and a high index of suspicion is warranted owing to the potential severe consequences of unstable lesions. Evaluation of cervical and lumbar trauma in children requires an understanding of developmental anatomy to differentiate trauma from age-appropriate findings. Generally speaking, young children more often have ligamentous injuries, whereas older children and adolescents have bone injuries as the spine takes on adult features. The aim of this review is to provide a concise overview of the major aspects involved in spine injuries detection and management in children. Epidemiology is discussed first, and then appropriate precautions and paediatric spine immobilization protocols are presented. Details of paediatric spine radiological anatomy are included and our institutional spine clearance protocol is discussed. Lastly, a short paragraph is devoted to analyze treatment of spinal cord injuries in children and halo immobilization.     

Le fratture complesse dell’omero

Complex humeral fractures represent an exciting challenge in traumatology. Recently, the use of MIPO techniques has been gaining success in traumatology as well. Concerning our experience, we do not recommend the use of these techniques in all fracture types and kinds of patients.     

Le fratture esposte d’avambraccio

Open fractures of the forearm represent an urgent/emergency orthopaedic condition. They are not free of complications, which can lead to upper limb disabling outcomes or amputation. The traumatologist’s goal is to carry out a correct and anatomic osteosynthesis bearing in mind the type of lesion, the instruments used for the synthesis and the consequences of his therapeutic choices. The authors of this articles describe the state of the art of open forearm fractures.     

Consenso intersocietario sulla profilassi antitrombotica in chirurgia protesica dell’anca e del ginocchio e nelle fratture del collo femorale: aggiornamento 2013

Anticoagulant prophylaxis for preventing VTE is a world wide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures. Different guidelines are available in literature with quite different recommendations. None of them is a multidisciplinary effort as the one presented. In 2010 the Italian Society on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the Association of Orthopaedics and Traumatologists of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI), have set down practical suggestions for VTE prophylaxis in hip and knee surgery as well as in femoral neck fracture treatment. This Intersociety Consensus Statement aimed at simplifying the grading system reported in the literature, and its goal was to favour its clinical application. Special focuses addressed fragile patients and those patients at high risk of bleeding or receiving chronic antiplatelet and vitamin K antagonists treatment, and a special chapter was dedicated to regional anaesthesia and VTE prophylaxis. The registration of three novel oral anticoagulants (dabigatran, rivaroxaban and apixaban) for VTE prophylaxis in major orthopedic surgery and the ongoing introduction of these drugs for the prevention of embolism in atrial fibrillation make it necessary an update of the Intersociety Consensus Statement.     

Come affrontare e prevenire le complicanze e gli insuccessi nelle fratture laterali del collo del femore trattate con l’inchiodamento endomidollare

Complications of treatment with intramedullary nail of lateral femoral fractures can be divided in intraoperative and postoperative. Intraoperative complications are usually related to poor fracture reduction, to the target device, to inadequate X-ray control and to incorrect nail introduction. Postoperative complications are usually related to synthesis malpositioning, to poor fracture reduction, to lateral fractures engaging the femoral neck and generating an unstable fracture, to bone stock loss in low proximal femoral fractures and to fracture non-union.     

Le fratture dell’omero: la fissazione esterna

External fixation is not the first choice in the treatment of humeral fractures. In most cases ORIF is the best option. EF can be considered as a MIPO technique representing a good option in many cases: in open fractures, as damage control or definitive surgery in politrauma, in fractures with bone loss, in comminuted and unstable fractures and sometimes even in elderly patients with HA coated pins. Good results are only obtained if the frame is very stable with pins in a multiplanar configuration and with an adequate number of pins. EF versatility could help surgeons to stabilize the fracture and is the first step to obtain fracture healing. This article reports the rules for good synthesis and for preserving the radial nerve in the management of humeral shaft fractures. The authors report 37 humeral shaft fractures treated with external fixation, during a period of 30 years. Stability of the frame is the key to a favourable outcome.     

Le fratture dell’omero prossimale: la fissazione interna

Most proximal humeral fractures occur in elderly patients, and can be treated non-operatively with good functional outcomes. Percutaneous, intramedullary, and locked-plate fixation can be successful fixation strategies for proximal humeral fractures, with the correct indications and careful patient selection, based on the anatomy and biomechanics of the injury. Each method has its advantages and disadvantages. A variety of underlying factors have to be considered, related to the patient (e.g., comorbidity, functional demand), the fracture (e.g., osteoporosis), and the surgeon (e.g., experience). Low local bone mineral density, humeral head ischaemia, residual varus displacement, insufficient restoration of the medial column, and non-anatomic reduction promote failure of fixation and impair functional outcome. Regardless of the technique selected, meticulous surgical technique and anatomic reduction, MIPO and respect of soft tissues are essential.     

Percorso di trattamento delle fratture del femore prossimale. L’utilizzo del cotile a doppia articolarità: nuove prospettive e risultati

Displaced fractures of the proximal medial femur in elderly patients with high functional demands are treated with the implantation of a hip replacement. The double articulation cup was used in prosthetic instability, regardless of the causes of instability, with good results. We have treated 539 consecutive patients from 2006 to 2012. The double articulation cup has proven effective in reducing the incidence of dislocations.     

Riparazione percutanea del tendine d’Achille. Descrizione della tecnica secondo Maffulli

Minimally invasive surgery on the Achilles tendon is growing up. The aim is to minimize the risk of injury to the sural nerve, one of the commonest complications following percutaneous repair of the Achilles tendon. We describe the last personal percutaneous repair technique of the Achilles tendon that allows accurate opposition of the tendon ends, with low risk of injury to the sural nerve.