Lateral unstable fractures of the femoral neck represent a controversial problem for the surgical treatment, due to the difficulty in achieving an adequate mechanically stable bone-devices system. Compression hip screw alone has proven to be inadequate, while in association with the trochanteric stabilizing plate (TSP) it offers better results. The authors analyse functional results and complications of a series of 87 lateral unstable fractures of the femoral neck (type A2 and A3 of the AO classification). Weight bearing was allowed 48 hours after surgery. The most important complications reported were: persistent trochanteric pain (12 cases) shaft medialization and device mobilization (2 cases) shortening of more than 2cm (3 cases). All complications were reported in A3 type fractures. Our data confirm the efficacy of the TSP the treatment of lateral unstable fractures of the femoral neck (type A2) because it stabilizes the lateral cortex. In A3 type fractures, intramedullary devices offers better results than compression hip screw and TSP in terms of complications rate and stability.
Patella resurfacing in revision total knee arthroplasty is a controversial issue. While performing revision TKA we must consider some different situations: previously resurfaced patella or not, in case of resurfaced patella, if it is fix or loosened, in case of loosened patella is there a bone loss or not. If patella wasn’t previously resurfaced, we can preserve natural patella performing at least a regularization of its osteophytes, or we can realize a primary resurfacing. If patella was previously resurfaced and still well fixed, we preserve domed component if not grossly damaged. Its revision is performed if it is damaged or not congruent. If patella was previously resurfaced and loosened the two possibilities are the revision or the retention of the bony patella. In case of previously resurfaced and loosened patella, with severe bone loss, we can preserve the bony shell, or we can realize revision with the use of cortical grafting or we can performa patelloplasty, or complete patellectomy. Finally, in these cases it’s possible the revision with tantalum patella. Outcomes of patella resurfacing in revision total knee arthroplasty are usually fair: low functional and pain scores, quadricipite leverage loss, worse patellar tracking, anterior pain, patellar fractures, knee stiffness.
Six patients presented a structural derangement localized to the forefoot (Pattern I according to Sanders and Frykberg Classification), one to the ankle (Pattern IV) and 18 to the mid-foot region (Pattern II and III). At first clinical evaluation, 13 patients presented a plantar monolateral ulcer. Their treatment was multifactorial. An offloading regimen was adopted, with the use of a total contact cast and crutches, in order to avoid weight-bearing on the affected foot for the first two months. Patients responsive to the treatment were successively treated with a pneumatic cast (Air cast) and partial weight-bearing for another four months. Four unresponsive patients underwent surgical treatment. 10 patients were also treated with alendronate (70 mg per os once a week). Three patients died during treatment and one during the follow-up, three of them for cardiovascular disease, one for bronchopneumopathy.
