Reduction and fixation with a paracortical sliding screw or an intramedullary nail are the most used treatments for intertrochenteric fractures. In cases of complications the attempt to perform further internal fixation may lead to failure because of the poor quality of bone and cartilage. Conversion to a hip replacement seems a better choice and the use of long stems with a distal, diaphyseal fit appears to be a good option, allowing to by-pass the intertrochanteric region. Authors report their experience in hip replacement for failed treatment of hip fractures that allow to restore immediately the function of the hip.
The main problem in revision hip surgery is the loss of bone, expression of the reactive phenomena to the granulation tissues secondary to debris production. The choice of surgical system and strategy is related to the bony loss. The tantalum, due to its elevated porosity and microarchitecture and elasticities similar to trabecular bone, facilitates the periprosthetic osteointegration, so to be considered particularly indicated in acetabular revisions. The Authors present clinical and radiological results of a two years experience with tantalum hemispheric cup, emphasizing its versatily, with possible choice between a model with reinforce net-like function with a cemented polyethylenic component and other with standard modular inlay. In case of serious bone-loss bone banking graft has been used (except in septic mobilization, although a two-stage proedure with the use of temporary antibiotic-impregnated spacer) and two or more screws for additional fixator.
Different revision stems are described in literature: from the primary systems, with or without cementation, used for minor defects of the proximal femoral region, to special revision stems employs in order to by-pass meta-epiphyseal zones with high loss of bone-stock and to search a distal fit. The Authors describe their experience with modular system ZMR (Zimmer, Warsaw, IN, USA), in Titanium alloy, available in two “configurations”: porous, in three distinct porous body styles with variable inclination neck to pair with straight or porous bowed spline stems available in different lengths and diameters optimising axial and rotational stability, and Taper, designed to provide a better distal fixation transmitting axial, torsional and bending loads to the adjacent bone through a splined taper stem, a more physiological cervical-diaphyseal angle and a neck planned in order to save the calcar zone. The mid-stem junction uses a Morse-type taper connection with a dynamometric system to assure locking of the body and stem components.. The Authors underline the benefit to use a versatile system able to allow the intraoperatory choice of antiversion, diameter and length more adapted diminishing the risks of a post-operative sinking and avoiding the corrosion phenomena of splice sites.
Pronatus syndromes of the hindfoot often represent a deformity in patients of developing age. They are characterised by internal valgus rotation and adduction of astragalus, calcaneous pronation and valgus tibial-calcaneous axis. During the walking phase, the astragalic leaning phase is increased with a consequence of wider pronation of the forefoot. This often creates a functional compensation of the joint and of the myotendinous structures of IMF and progressive valgus deviation of the hallux. In the last few years, many different techniques to correct and to stabilise the altered alstagalus-calcaneous relation have been introduced. This altered relation represents the ‘primum movens’ of this deformity through the stimulation of the endotarsal proprioreceptors; this evokes some inputs that allows the capsular ligaments a retraction structure during the development. In the period between April 2001 and December 2003, in the 1st Clinica Ortopedica of the Bari University, 30 patients (16 males and 14 females; age range between 7–12 years, median age 9.6 years) with pronatus syndrome were treated with surgical astragalus-calcaneous arthrorisis according to Pisani; 27 patients were operated bilaterally. All patients (57 feet) were evaluated at a median follow-up of 15.3 months (range 2–32 months). Clinical and radiological results have shown alignment of the hind-foot and normal plantar part of the foot. These data confirms that the astragalus-calcaneous arthrorisis represents a valid technique in the pronatus syndrome.
In the correction of hallux valgus, there are many different treatments with the aim to resume angular values I MF (metatarsal-phalangeal), I IM (intermetatarsal), PASA (proximal articular set angle), sesamoid position, to improve transferring metatarsal pain and the aesthetics of the forefoot. From November 2001 to November 2003, in the 1st Clinica Ortopedica at Bari University, 40 patients were treated for hallux valgus (nine males and 31 females). The age ranges from 17 to 82 years of age (median age: 50 years). The correction technique is based on a distal metatarsal osteotomy (modified Chevron techniques) and fixation with ‘hallux splint’ interfragmentation dynamic and compression device (Waldemar Link GmbH &
Co Hamburg, Germany). This technique give intra-operative stability of the osteotomy, giving free weight-bearing from the beginning in the post-operative phase and the complete resumption of daily activities in a short period of time. At a median follow-up of 2 months, a significant improvement in the angular values is shown by radiological evaluation. Therefore, the result shows that this surgical technique is valid in the correcting hallux valgus.
