Background Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. Methods The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. Results 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r = 0.63 (p < 0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. Conclusions This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings.

The anterior cruciate ligament reconstruction is a common procedure that improves stability and function of the knee. The surgical technique continues to evolve and many issues are still under debate. These mainly include: (1) graft selection (patellar tendon, hamstring, quadriceps tendon, or allografts), (2) surgical technique (double versus single bundle), and (3) femoral tunnel drilling. Currently, the most controversial one is the femoral tunnel drilling (transtibial vs. anteromedial portal drilling). Common opinion is that drilling the femoral tunnel through the anteromedial (AM) allows a more anatomic placement of the graft and a better rotational stability; therefore, this technique is gaining in popularity compared with the transtibial drilling despite a greater difficulty and the risk of medial condyle damage, tunnel back wall blowout, and inadequate socket length. The aim of this article is to describe the surgical technique of the anterior cruciate ligament reconstruction (single and double bundle), drilling the femoral tunnel through the AM portal.

Primary total knee arthroplasty is the treatment for end-stage arthritis of the knee; in the last years, it is becoming more common and reliable, due to technical and implant improvement. With larger implant rates, the overall complications will increase and pain is the most common sign of implant failure. Pain can be related to a lot of different clinical findings, and the surgeon has to be aware of the various etiologies that can lead to failure. Pain does not always mean revision, and the patient has to be fully evaluated to have a correct diagnosis; if surgery is performed for the wrong reason, this will surely lead to a failure. In this paper, the authors revised the more common causes of failure that can have a painful onset proposing an approach for diagnosis and treatment.

Background This study aims to evaluate the clinical and radiological outcomes of a modiied technique of Kinematically Aligned Total Knee Arthroplasty (KA TKA) using a cruciate sacriicing (CS) medially stabilised prosthesis at a minimum 24-months follow-up. Methods 59 patients with a varus HKA angle who underwent a TKA from May, 2016 to April, 2017 were retrospectively enrolled. Radiological and clinical evaluations were assessed after 40 days, 6 months and at a minimum follow-up of 24 months. Long leg standing X-rays were performed pre-operatively and the Hip-Knee-Ankle (HKA) angle, the mechanical Lateral Distal Femoral Angle (mLDFA), the mechanical Medial Proximal Tibial Angle (mMPTA) and the Knee Joint Line Obliquity Angle (KJLOA) were analysed. At a minimum follow-up of 24 months, the patients were evaluated subjectively based on the Western Ontario and McMaster Universities Osteoarthritis Index Score (WOMAC) and the Oxford Knee Score (OKS). The post-operative range of motion (ROM) was measured. To reduce lexion instability, an original technique was used, with more posterior positioning of the femoral component, called the "virtuous mistake". Results were compared to the data reported in the literature in patients treated with standard kinematic alignment (KA) technique. ResultsNo difference was found between the mean pre-operative and post-operative angles regarding mLDFA (p value = 0.410) and mMTPA (p value = 0.242). A diference of 0.8° in HKA angle between males and females was found, with more varus results in males. At a minimum follow-up of 24 months, the WOMAC was 87 (SD 4.3), the OKS was 41 (SD 2.4), and the lexion was 124°, which was similar to the data reported in literature with standard KA. There were not any cases of aseptic failures. Conclusions The modiied KA TKA surgical technique proposed in this study can achieve good clinical results at minimum 24 months of follow-up, reproducing accurately native mLDFA and mMPTA. Level of evidence Level III, therapeutic study.

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