Lo Scalpello - Journal

Endopelvic cup migration in the presence of concomitant infection and pseudoaneurysm of the external iliac artery

Alessandra Radaelli — 2025-01-24

Endopelvic migration of the acetabular prosthetic component is an uncommon but serious complication in hip replacement. When the medial acetabular wall is perforated, intrapelvic injuries may occur. In such cases, the external iliac artery and bladder are the most commonly involved structures. In this case three main sources of potential problems that emerge from preoperative assessment must be taken into account: presence of infection with periprosthetic collection, significant lymphedema in the lower extremities complicated by the presence of ulcerative lesions in both legs, and vascular involvement with the presence of a pseudoaneurysm of the external iliac artery. In order to minimize the surgical risks presented by explanation of the prosthesis, interventional angiography should be conducted, which can reveal the previously undiagnosed pseudoaneurysm and allow positioning of a covered stent to protect the vessel. Placement of a vascular covered stent before explanation of the acetabular component offers a two-fold advantage: i.e. to secure this important blood vessel before surgery and allow a less invasive approach, which is of particular relevance when taking into account the precarious situation of soft tissues.

Use of highly porous shell and variable-angle locking screws for acetabular revision surgery: our experience and medium term results

Jacopo Ambrosini — 2025-01-24

This article presents the clinical outcomes and experiences of our hospital in utilizing highly porous shells with variable-angle locking screws in acetabular revision surgery in patients with total hip arthroplasty (THA). A retrospective analysis was conducted on 16 acetabular revision cases, and patients were followed for an average of 22 months. The postoperative functional outcomes were evaluated with the Harris Hip Score (HHS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Complications and radiographic findings were also analyzed. The results demonstrate promising outcomes with improved hip function, pain relief, minimal complications and implant stability. Our findings contribute to the growing evidence supporting the efficacy and safety of high porosity cotyles in revision surgery of THA.

Double plate osteosynthesis in a C1-C2 tibial pilon fracture: two case reports

Mario Paracuollo — 2024-12-18

Tibial pilon fractures, despite their infrequency, while accounting for 4-10% of all tibial fractures and less than 1% of all fractures of the lower extremity, still represent a challenge for orthopedic surgeons due to their poor prognosis. We present two case reports of C1-C2 tibial pilon fractures, through which we try to demonstrate that double plate fixation offers a superior stability to the osteosynthesis both in case of articular rim multi-fragmentarity, wherein primary key-fragments can be fixed by anatomically shaped plates, to better restore the articular surface and joint stability, and in the scenario of long spiroid or extended oblique fractures, whereby a buttressing and a supporting plate best domain the vertically directed shear forces that tend to diastase the three pilon columns.

Pedrada syndrome and massive degeneration of the Achilles tendon: a case report

Alessandro Bartoli — 2024-12-18

This case report explores “Pedrada syndrome,” a rare vascular condition characterized by spontaneous intramuscular venous hemorrhage of the calf, often mistaken for muscular injuries like tennis leg. The study presents the case of a 65-year-old male with comorbidities, including diabetic polyneuropathy, who developed a massive degeneration of the Achilles tendon (AT) due to complications from Pedrada syndrome. Following an initial unnoticed heel ulcer, the patient experienced sudden pain in the calf, misattributed to muscle strain. Persistent symptoms led to imaging studies revealing a 5 cm AT lesion and soft tissue infection. A two-stage surgical intervention was performed, including debridement and subsequent AT reconstruction with a cadaveric allograft. The patient achieved satisfactory functional recovery after six months. This report highlights the diagnostic challenges of Pedrada syndrome and emphasizes the need for a multidisciplinary approach, especially in patients with peripheral neuropathies, to prevent severe complications.

Distal interosseous oblique bundle reconstruction with a brachioradialis tendon strip according to Aita-Mantovani technique: description of a case of misdiagnosed volar DRUJ dislocation and review of the literature

Mario Paracuollo — 2024-12-18

Volar distal radioulnar joint (DRUJ) dislocation is a very rare condition, and up to 50% of cases are misdiagnosed at the emergency room, because of subtle clinical findings and inadequate evaluation of radiographs in emergency settings. Treatment options vary from closed reduction with immobilization in a pronated position, to open reduction and repair of DRUJ stabilizers in case of locked irreducible or chronic dislocation, as well as in case of unstable DRUJ after an attempt at closed reduction. Among surgical procedures, the Aita-Mantovani technique of distal oblique bundle repair with a brachioradialis tendon strip can fully restore the multiplanar stability of the distal radio-ulnar joint. We present a case of an inveterate volar DRUJ dislocation, where the ulnar head was stuck out of the sigmoid notch, which was managed with open reduction and distal oblique bundle restoration according to the Aita-Mantovani technique.

Managing native shoulder septic arthritis in dialyzed patients is not so easy: report of two cases

Ilaria Morelli — 2025-01-24

Native joint septic arthritis is frequent in dialyzed patients, because of comorbidities and immune system impairment. Nevertheless, its diagnosis and treatment can be challenging due to different clinical presentations, difficult pathogen isolation and risk of infection despite surgical irrigation and debridement procedures. We report herein two cases of native glenohumeral joint septic arthritis, discussing in depth the difficulties met during the diagnostic and therapeutic process.