ObjectiveTo evaluate mid‐term radiographic and functional outcomes of tibial plateau fracture (TPF) patients treated with the open reduction internal fixation (ORIF) technique and to find predictive factors of clinical outcomes.MethodsA retrospective, single‐center study was performed enrolling a consecutive series of patients with diagnosis of TPF. All subjects were treated by ORIF between January 2010 and December 2015 at our level‐1 healthcare trauma center. The inclusion criteria were: age between 18 and 75 years; ORIF technique used for articular TPF, type 41‐B and 41‐C, isolated or with associated injuries. The patients were divided in two groups, according to fracture patterns and compared. Their characteristics, radiographic and clinical outcomes were recorded. Radiographs 12 months after surgery were evaluated for reduction and alignment, and radiographs at 24 months to describe post‐traumatic osteoarthritis (PTOA). Functional outcomes were assessed using the visual analog scale (VAS), the Short Form 36 (SF‐36), the knee injury and osteoarthritis outcome score (KOOS), and the American Knee Society score (AKSS) questionnaires. Return to work and sport activities were also investigated. Univariate and multivariate analysis were performed, and the statistical significance was defined as two‐tailed P < 0.05.ResultsForty‐five patients were included, 29 males and 16 females; the mean age was 54.5 years. The mean follow‐up was 57.18 months (range, 26–94). There were AO 41‐B fractures (partial articular fractures) in more than half of the patients (66.67%), while the remaining 15 had AO 41‐C fractures (complete articular fractures). The sub‐type AO 41‐B3 was the most common, reported in 62.22% of patients. The mean KOOS score was 69.0. Mean AKSS and SF‐36 PCS scores were 79.0 and 41.4, respectively. There were significant relationships between age and functional results (KOOS ADL, Sport, QoL, and SF‐36 PCS) and between BMI and KOOS Pain, ADL, Sport, and QoL. No differences were found between the two types of fractures regarding quality of reduction and alignment. AO 41‐C TPF tend to develop PTOA more frequently with respect to 41‐B fractures, while type AO 41‐C TPF had the worst clinical outcomes. We found that the presence of an articular step‐off and the malalignment of the tibial axis after surgery were predictive of daily pain felt by patients. PTOA was predictive of a worse AKSS. The overall complication rate was 13.33%: 1 superficial wound infection, 1 deep vein thrombosis, and 4 cases of transitory deficit of the common peroneal nerve.ConclusionThe present study demonstrates that early radiographic features may be predictive for pain perceived by patients at mid‐term follow‐up.

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We report our clinical experience of a 1 year and 10 month child with traumatic anterior shoulder dislocation who underwent non-operative reduction and Desault's bandage immobilization for 10 days. No associated fractures were found and after bandage removal, full ROM of the shoulder was immediately assessed. Further research is needed to unified guideline of treatment and the time of immobilization for this type of injury in pediatric population.

The case reported concerns a 5-years-old child affected by Hereditary Multiple Exostoses (HME), a genetic disorder with autosomal dominant inheritance, that cause multiple skeletal exostosis. Usually those masses are asymptomatic, but in some cases, they can cause a huge spectrum of problems due to their size and site localization interfering with surrounding structures such as nerves, vessels, or organs. In order to reduce patient distress and hospital stay we resected in the same surgical session, an exostosis on the left knee (that was interfering with the correct bone growth) and, with video-assisted-thoracoscopy (VATS), three rib exostosis (one of them misdiagnosed at the MRI examination).. Temporary femoral hemiepiphysiodesis was performed too in order to correct the knee valgus malalignment. In case of exostosis localized at the internal side of the ribs, the collaboration of a skilled pediatric surgeon is recommended to perform VATS resection. common in the setting of multiple hereditary osteochondromato-