Publications by authors named "Aprato A"

Introduction: Sacroiliac joint (SIJ) dislocations, particularly pure SIJ dislocations without associated fractures, represent a rare and complex subset of pelvic ring injuries. Given the intricate pelvic anatomy and the need to achieve both stability and functional recovery, the optimal surgical management for these injuries remains a topic of debate. This systematic review aims to evaluate the various surgical techniques employed in treating this rare and challenging injury and assess associated clinical outcomes and complications.

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  • The study aimed to assess gender equality in orthopedic surgery by analyzing operative times, mortality rates, and the gender distribution of surgeons involved in hip fracture surgeries.
  • A total of 172 surgeons (82% male, 18% female) performed 1,916 procedures, with female surgeons conducting 14.7% of the surgeries, but no significant gender disparities were found in operative times or mortality rates.
  • The results indicated a lack of significant gender differences in the performance of Closed Reduction Internal Fixation and Hemiarthroplasty, as well as in the gender distribution among attending and resident surgeons.
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Background: Patient-reported outcome (PRO) measures are essential for evaluating disease-related quality of life. The International Hip Outcome Tool 12 (iHOT12) assesses various aspects of hip-related symptoms, function, sports participation, and social limitations. This study aimed to adapt and validate an Italian version of the iHOT12 according to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.

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Purpose: Posterior pelvic ring lesions are a common finding in patients with pelvic trauma, representing a challenging condition for trauma surgeons. Surgical options are different and there is not yet evidence about the best option. Aim of the study are: (i) to compare Lumbopelvic fixation (LPF) and ilio-sacral screw fixation (ISS) regarding clinical and radiological outcome in unstable posterior pelvic ring injuries, both as whole population and single similar fracture types according to Tile classification (C1vsC1, C2vsC2, C3vsC3); (ii) to analyze clinical outcomes and complications in lumbopelvic fixation group, comparing open and closed reduction technique.

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  • Posterior wall acetabular fractures are complex injuries often resulting from high-energy trauma, and they present significant surgical challenges, particularly when the fractures are comminuted and difficult to fix.
  • This study evaluated the effectiveness of using autologous bone grafts for reconstructing these challenging fractures, analyzing clinical and radiological outcomes from a systematic review of 71 patients.
  • Results showed that 78.9% of patients achieved good to excellent clinical outcomes, with 66% rated as excellent radiologically, suggesting that this method can be a viable option for young patients, potentially delaying the need for total hip arthroplasty.
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: Pigmented villonodular synovitis (PVNS) is a benign proliferation of synovial tissue that can cause joint damage. The hip, although less commonly affected than the knee, presents a challenging diagnosis and treatment, with magnetic resonance imaging (MRI) as the gold standard for detection. Surgical excision, arthroscopic or open, is the main treatment approach, but there is no consensus on the best strategy for the hip.

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  • This study investigates the occurrence of heterotopic ossification (HO) in male patients under 70 years who underwent total hip arthroplasty (THA), comparing those who received a prophylactic treatment to those who did not.
  • The prophylactic treatment consisted of taking 50 mg of Indomethacin twice daily for three weeks, with HO severity classified using the Brooker grading system.
  • Results showed that while the overall HO rates were similar in both groups, severe HO was significantly lower in the prophylactic group (7.7%) compared to the non-prophylactic group (22.4%), suggesting that such a protocol should be considered for at-risk patients.
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Femur fractures are a significant worldwide public health concern that affects patients as well as their families because of their high frequency, morbidity, and mortality. When employing computer-aided diagnostic (CAD) technologies, promising results have been shown in the efficiency and accuracy of fracture classification, particularly with the growing use of Deep Learning (DL) approaches. Nevertheless, the complexity is further increased by the need to collect enough input data to train these algorithms and the challenge of interpreting the findings.

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Background: This video article describes the technique for arthroscopic reduction and fixation of Pipkin type-I fractures.

Description: Surgery is performed with the patient in a supine position, with free lower limbs, on a radiolucent table. Arthroscopic superior and anterolateral portals are made similarly to the portals created to evaluate the peripheral compartment during an outside-in (ballooning) technique.

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  • Partial posterior wall fractures are commonly treated using an open reduction-internal fixation method through a posterolateral approach.
  • However, if a fragment can be secured with just screws, hip arthroscopy in the prone position can be used as an alternative fixation method.
  • The article outlines all the surgical steps needed to carry out this hip arthroscopy procedure effectively.
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  • Ganz's studies allowed for better treatment of joint deformities in Perthes' disease via femoral head reduction osteotomy (FHRO) and periacetabular osteotomy (PAO), improving joint structure and function.
  • A study conducted from 2015 to 2021 involved 13 FHRO procedures on 11 patients, using CT and MRI to plan corrections and assess outcomes through various clinical and radiological metrics.
  • Results indicated significant improvements in joint shape and patient-reported outcomes, with no major complications, demonstrating the effectiveness of the combined surgical approach.
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Background: The application of lower limb traction during hip arthroscopy and femur fractures osteosynthesis is commonplace in orthopaedic surgeries. Traditional methods utilize a perineal post on a traction table, leading to soft tissue damage and nerve neuropraxia. A postless technique, using high-friction pads, has been considered as a potential damage-free alternative.

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Avulsion fractures of the anterior inferior iliac spine rarely occur in adolescent athletes during rectus femoris contractions or eccentric muscle lengthening while the growth plate is still open. Currently, there are no official guidelines in the literature on the treatment indications of this type of fracture or the type of surgical technique to be used. Nowadays, young and athletic patients desire a quick return to their previous activities, which makes surgical treatment a reasonable choice.

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Background: Developmental Coxa Vara (DCV) consists on a pathological reduction in head-shaft angle (HSA) and increased femoral retroversion. Several case series reported outcomes on proximal femoral valgus osteotomy (PFVO), but no evidence synthesis had been conducted. This systematic review aimed to (1) analyze success rate and complications, (2) report the degree of correction according to the HSA and the Hilgenreiner Epiphyseal Angle (HEA), compare success rate and degree of correction of subtrochanteric (SVO) vs intertrochanteric (IVO) osteotomy, and (4) difference in success rate and correction between patients in which an internal (IF) or external fixation (EF) technique was used.

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Introduction: Acetabular revision surgery is the most challenging aspect in hip prosthetic. There is lack of consensus on the optimal method of reconstructing the acetabular defects. The aim of this systematic review is to take stock of the state of the art on the options available and highlight which type of construct is the most reliable in usual clinical practice.

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Groin pain syndrome (GPS) is a controversial topic in Sports Medicine. The GPS Italian Consensus Conference on terminology, clinical evaluation and imaging assessment of groin pain in athletes was organized by the Italian Society of Arthroscopy in Milan, on 5 February 2016. In this Consensus Conference (CC) GPS etiology was divided into 11 different categories for a total of 63 pathologies.

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Background: Heterotopic ossification (HO) is a well-known complication of arthroscopic and open surgical treatment of femoroacetabular impingement (FAI). Incidence of heterotopic ossification has been reported in the literature between 0% and 44% after hip arthroscopy and between 18.2% and 25% after anterior mini-open surgery.

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Background: There is no evidence in the current literature about the best treatment option in sacral fracture with or without neurological impairment.

Materials And Methods: The Italian Pelvic Trauma Association (A.I.

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Achieving an anatomical reduction in acetabular fracture is essential but may also be challenging. Most of complex fractures are treated with anterior approaches without direct visualization of the acetabular surface. In this paper, we present the surgical technique for arthroscopic assistance during open reduction and fixation for complex acetabular fractures.

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Introduction: Isolated fractures of the greater trochanter (GT) in adults are rare injuries and traditionally treated without surgery. The present systematic review was designed to examine the treatment protocol for isolated GT fractures and to discover if innovative surgical techniques, such as arthroscopy or suture anchors, can be used to improve outcomes in young active patients.

Methods: A systematic review was conducted including all full-text articles suited our inclusion criteria from January 2000 describing treatment protocols of isolated great trochanter fractures confirmed at MRI in adults.

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Purpose: The anterior inferior iliac spine (AIIS) is a frequent site of avulsion fracture in the pelvis, and these lesions could be observed mainly in teenage athletes. The present study aimed to re-evaluate the appropriate acute surgical treatment of AIIS avulsion fractures considering the three-dimensional anatomy of the supracetabular region.

Methods: This study evaluated current evidence of AIIS avulsion fracture treatments and outcomes.

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Purpose: The main challenges in revision total hip arthroplasty (rTHA) are the treatment of the bone loss and the pre-operative planning. 3D-printed models may enhance pre-operative planning. The aim of the study is to compare the intra- and peri-operative results and costs for Paprosky type 3 rTHAs planned with 3D-printed models to ones accomplished with the conventional imaging techniques (X-rays and CT scan).

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Article Synopsis
  • Extended trochanteric osteotomy (ETO) is effective for removing femoral stems in cases of complicated aseptic loosening and periprosthetic fractures, but its safety in periprosthetic joint infections (PJI) is debated.
  • A systematic review of nine studies involving 382 cases evaluated ETO outcomes in two-stage revisions for PJI, finding a reinfection rate of 8.9% and a union rate of 94.8%.
  • The study concludes that ETO is a safe and effective option for challenging cases in PJI revisions, with results comparable to those in non-infected patients.
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The posterior wall fracture is the most frequent pattern of acetabular fractures. Many techniques of fixation have been described in the literature and involve plates, screws, or a combination of both. This study aims to investigate the clinical and radiological outcomes of spring plates in the treatment of comminuted posterior wall acetabular fractures.

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