Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology
-
Comparative Study
Bedside fasciotomy under local anesthesia for acute compartment syndrome: a feasible and reliable procedure in selected cases.
Fasciotomy for compartment syndrome is an emergent procedure that is usually done in the operating theater under general anesthesia. Delay in performing the procedure can lead to worse outcome. Various reasons can cause delay in performing the surgery. Bedside fasciotomy under local anesthesia can be done in these cases to avoid delay in compartment release. ⋯ Bedside fasciotomy under local anesthesia is a feasible, safe, and effective choice for treating compartment syndrome in patients with delayed presentation or those with anticipated delay to undergo surgery in the operating theater under general or regional anesthesia. The results of this study are encouraging, as all wounds healed satisfactory and there were no cases of deep infections. The formal release of compartments in the operating room under general anesthesia continues to be the standard of care. This is the first description in the literature for bedside fasciotomy under local anesthesia with a relatively large number of patients.
-
The fingernail has an important role in hand function, facilitating the pinch and increasing the sensitivity of the fingertip. Therefore, immediate and proper strategy in treating fingernail injuries is essential to avoid aesthetic and functional impairment. ⋯ All these injuries require careful initial evaluation and adequate treatment, which is often performed under magnification. Delayed and secondary procedures of fingernail sequelae are possible, but final results are often unpredictable.
-
Multicenter Study Comparative Study
Adherence to routine use of pharmacological prophylaxis of heterotopic ossification after total hip arthroplasty: results from an Italian multicenter, prospective, observational survey.
In spite of the proven efficacy of pharmacological prophylaxis of heterotopic ossification following total hip arthroplasty, its routine use is still debated, and no data are available regarding the adherence to its administration in clinical practice. ⋯ This study confirms the efficacy and tolerability of celecoxib for the prophylaxis of heterotopic ossification after total hip arthroplasty, and shows how the surgeon's belief that routine prevention is not required still plays an important role in the determination of this complication, together with the fear of possible unwanted side effects.
-
Anatomic reduction of intra-articular fractures of the tibial plateau and distal radius can be difficult to achieve. Treatment goals are centered on restoring the native anatomy and articular congruency. Several surgeons in the USA have begun using an inflatable bone tamp to reduce these fracture patterns. The concept is built on the success of the tamp in kyphoplasty of the spine, but it has yet to be tested in the lab for use in the extremities. We performed an investigation into the safety and efficacy of using an inflatable bone tamp for intra-articular fracture reduction of the tibial plateau and distal radius. ⋯ Anatomic reduction of impacted articular fractures should be the goal of any treating surgeon. In our cadaveric models, we have shown the inflatable bone tamp to be safe and effective in reducing depressed articular fractures around the tibial plateau and distal radius. The balloon offers the advantage of being minimally invasive and creating a symmetric, contained defect to hold bone filler for subchondral support.
-
Comparative Study
Distally based sural fasciomusculocutaneous flap for treatment of wounds of the distal third of the leg and ankle with exposed internal hardware.
Soft tissue reconstruction of the distal third of the lower limb with exposure of the internal hardware is a challenging problem with several potential complications, such as exposure of the fracture line, fracture instability and bacterial contamination. The treatment of these lesions usually consists of substitution of the internal hardware with external fixation devices and further flap coverage. We propose a different reconstructive approach, characterized by harvesting a sural fasciomusculocutaneous flap on the exposed internal hardware once a sterile ground has been obtained. ⋯ The sural fasciomusculocutaneous flap is a safe alternative to other pedicled and free flaps. Moreover, it allows direct coverage of internal fixators, thus completing the reconstruction in less time. This flap fits best to the morphology of the wound and internal hardware, leaving the main vascular trunk of the leg intact and at the same time providing a reliable vascular supply.