Gabriele Colò

Background: Shoulder disorders are the third most common musculoskeletal presentation in primary care. Injuries to the structures surrounding this joint are closely related to oxidative stress and can lead to rotator cuff (RC) disease, including subacromial impingement syndrome, tendinopathy, and partial thickness tears, all characterized by pain, functional impairment, and reduced quality of life. This exploratory pilot investigation evaluates the effects of 2% Adelmidrol (ADM) plus 1% hyaluronic acid (HA) subacromial injections in patients with symptomatic RC disease. Methods: Data from 28 patients who received two ADM+HA injections (one every 7 days) were collected. Assessments included the evaluation of pain intensity with the Numeric Rating Scale (NRS) at baseline (T0), 1 week after the 1st injection (T1) and 1 month after the 2nd injection (T2); shoulder functionality by Constant Score (CS) and Simple Shoulder Test (SST) at T0 and T2; and patients’ subjective health status improvement by Patients’ Global Impression of Change (PGIC) at T2. Results: Pain intensity showed a significant improvement over time ( p < 0.0001), already evident at T1 and further at T2 (T1 vs. T0 p < 0.0001; T2 vs. T1 p < 0.0001). Shoulder functionality significantly improved from baseline to the end of the observational period ( p < 0.0001), when most patients reported an overall improvement in their health status. Conclusion: The use of the innovative ADM and HA association showed encouraging preliminary clinical improvements in pain and function, which warrant further confirmation in controlled settings.

Background/Objectives: Ankylosing Spinal Disorders (ASDs) encompass a heterogeneous group of rheumatic diseases characterized by progressive ankylosis of the axial skeleton, including Ankylosing Spondylitis (AS), Diffuse Idiopathic Skeletal Hyperostosis (DISH), and Non-Radiographic Axial Spondyloarthritis (nr-AxSpA). Spinal ankylosis profoundly alters the biomechanical properties of the vertebral column, transforming it into a rigid long-bone equivalent and dramatically increasing fracture risk even after low-energy trauma. Once a fracture occurs, the long lever arm created by the ankylosed segments generates enormous mechanical stress at the fracture site, making surgical stabilization mandatory in the vast majority of cases. Long posterior instrumentation is the treatment of choice; however, no consensus exists regarding the optimal number of instrumented levels. The aim of this study is to clinically and radiologically evaluate long posterior instrumentation in the 3 + 3 (3 proximal and 3 caudal screws), 3 + 2 (3 proximal and 2 caudal screws), or 2 + 2 (2 proximal and 2 caudal screws) configuration for the treatment of traumatic ASD thoracolumbar vertebral fractures, in terms of implant failure, infection rate, and mortality. Methods: Between 2018 and 2023, 65 consecutive patients with ASD-related thoracolumbar vertebral fractures were treated at our institution. After applying pre-defined inclusion and exclusion criteria, 37 patients were enrolled. Patients were retrospectively divided into three groups according to the posterior arthrodesis configuration (notation indicates number of instrumented vertebral levels proximal + distal to the fracture: 3 + 3, 3 + 2, or 2 + 2). Radiological outcomes were assessed for loosening, screw cut-out, and implant breakage. Infection and mortality rates within 3 months from surgery were evaluated as secondary endpoints. Statistical analysis was performed using the Fisher exact test (significance set at p < 0.05). Results: Thirty-seven patients (28 males and 9 females; mean age 77 ± 7.3 years) were included, with a mean follow-up of 30 ± 5.3 months. Instrumentation configurations were as follows: 23 (3 + 3), 5 (3 + 2), and 9 (2 + 2). Three implant failures (8.1%) and four infections (10.8%) were recorded. Eleven patients died within 3 months of surgery. A statistically significant difference was found between instrumentation length and mechanical complications (p = 0.0468), while no significant difference was observed for infection (p = 1) or mortality rate (p = 0.137). Conclusions: In this exploratory retrospective cohort, the 3 + 3 configuration was associated with the lowest observed rate of implant failure in ASD thoracolumbar fractures, suggesting a potential mechanical advantage over shorter constructs that warrants confirmation in larger prospective studies. No significant correlation was found between instrumentation length and infection rate or early mortality. Prospective, multicentre studies with larger cohorts are warranted to establish definitive guidelines for instrumentation length in this challenging patient population.

Bunionette deformity (BD), also referred to as Tailor's bunion, is characterized by a lateral prominence of the fifth metatarsal head, frequently associated with pain, inflammation, and shoe-related discomfort. This narrative review synthesizes current knowledge on the pathogenesis and clinical presentation of BD, while placing particular emphasis on recent developments in minimally invasive surgery (MIS) techniques compared with traditional open approaches. A narrative review of the literature was conducted using PubMed, Scopus, and Embase databases up to July 2025, focusing on the etiology, clinical presentation, and treatment strategies for BD. Both conservative and surgical approaches, including open and MIS techniques, were critically analyzed. Conservative management, including footwear modification and orthoses, is recommended as first-line treatment. However, no long-term studies have demonstrated sustained symptom relief with non-operative modalities. Surgical options include exostectomy and a range of metatarsal osteotomies (distal, diaphyseal, and proximal), performed via open or MIS techniques. Complication rates in open surgery are reported as highest in proximal (22%) and diaphyseal (21%) osteotomies, followed by distal osteotomies (11%). Revision surgery is more frequent in diaphyseal osteotomies (n = 5; 2%). MIS techniques demonstrate complication rates ranging from 0% to 21.4%, with nonunion rates between 0% and 5.6%. MIS appears to reduce wound-related and hardware complications compared to open techniques; however, direct comparative studies are lacking. While MIS techniques demonstrate favorable complication and recovery profiles in retrospective studies, the lack of high-quality prospective trials prevents definitive conclusions. Future research should prioritize randomized comparative designs to establish clear treatment guidelines.

Background: Total ankle replacement (TAR) has evolved considerably over the past five decades as an alternative to arthrodesis for the management of end-stage ankle osteoarthritis. While early TAR designs suffered from high failure rates and limited functional outcomes, subsequent generations have progressively improved implant survivorship and biomechanics. However, determining the optimal prosthesis design for maximizing long-term outcomes remains a challenge, requiring synthesis of analytical performance data and practical guidance for implant selection. Methods: A targeted analytical review of the literature was conducted by analyzing peer-reviewed publications indexed in PubMed, Scopus, and Web of Science, covering the period from 1970 through July 2025. The search strategy focused on historical development and specifically on design characteristics (fixation, constraint) and their corresponding quantitative outcomes (survivorship, failure rates). Both original studies and systematic reviews were included to assess implant design evolution, materials, fixation techniques, survivorship, and complications. Emphasis was placed on representative implant models from each generation, including dedicated revision systems. Results: First-generation TARs, such as ICLH (Imperial College London Hospital) and Lord models, demonstrated high failure rates, with only 21% of cases rated as clinically satisfactory at 5.5 years due to constrained designs and cement-related issues. Second-generation systems introduced semi-constrained, mobile-bearing implants with cementless fixation, achieving up to 92% survivorship at 12 years. Third-generation designs, including HINTEGRA and BOX, emphasized anatomical congruence, ligament balancing, and soft tissue preservation, with survivorship ranging from 66 to 92% depending on implant model and follow-up. Fourth-generation implants (e.g., INFINITY, CADENCE, QUANTUM and the lateral-approach Trabecular Metal Ankle System) featured minimal bone resection and improved primary stability, reporting 1–2 year survivorship between 92 and 98%; however, complications such as heterotopic ossification (up to 69%) and talar loosening remain concerns. The development of dedicated revision TAR systems like INVISION represents a recent innovation, though long-term data are limited. Conclusions: The historical analysis demonstrates a clear performance shift tied to specific design attributes. Specifically, fourth-generation fixed-bearing, cementless designs (reporting survival rates up to 98%) have effectively addressed the mechanical failure and cement-related issues common in earlier constrained and mobile-bearing systems. While challenges persist (such as heterotopic ossification and talar loosening), the data analytically support specific implant choices. Therefore, based on documented survivorship and failure profiles, fourth-generation fixed-bearing, cementless systems are recommended as the primary choice in appropriately selected patients. Graphical

Background: Greater tuberosity fracture–dislocations (GTFDs) represent a distinct subset of proximal humerus fractures, occurring in up to 57% of anterior glenohumeral dislocations. Malreduction may result in impingement, instability, and functional limitation. Treatment is influenced by the displacement magnitude and direction, bone quality, and patient activity level. Methods: This narrative review was based on a comprehensive search of PubMed, Scopus, and Web of Science for English-language articles published between January 2000 and March 2025. Studies on pathomechanics, classification, diagnosis, treatment, and outcomes of GTFDs in adult and pediatric populations were included. Data were analyzed to summarize the current evidence and identify clinical trends. Results: A displacement ≥ 5 mm is the standard surgical threshold, though superior or posterosuperior displacement ≥ 3 mm—and ≥2 mm in overhead athletes—may justify surgery. Conservative treatment remains appropriate for minimally displaced fractures but is associated with up to 48% subacromial impingement and 11% delayed surgery. Surgical options include arthroscopic repair for small or comminuted fragments and open reduction and internal fixation (ORIF) with screws or plates for larger, split-type fractures. Locking plates and double-row suture constructs demonstrate superior biomechanical performance compared with transosseous sutures. Reverse shoulder arthroplasty (RSA) is reserved for elderly patients with poor bone stock, cuff insufficiency, or severe comminution. Pediatric cases require physeal-sparing strategies. Conclusions: GTFDs management demands an individualized approach based on fragment displacement and direction, patient age and activity level, and bone quality. While 5 mm remains the common threshold, lower cutoffs are increasingly adopted in active patients. A tiered treatment algorithm integrating displacement thresholds, fracture morphology, and patient factors is proposed to support surgical decision making. The incorporation of fracture morphologic classifications further refines fixation strategy. Further prospective and pediatric-specific studies are needed to refine treatment algorithms and validate outcomes.

Background Hallux valgus is a common pathology in the orthopedic daily practice. More than 100 techniques of surgical correction are currently described in the literature, mostly focused on osteotomies. Procedures based on soft tissues balancing are actually less described. Materials and methods Between May and October 2019, 20 patients, 16 females and 4 males, underwent surgery using mini TightRope® system. All were addressed to preoperative radiological and clinical assessment through the AOFAS-hallux scale and radiographs. Follow-up was performed postoperatively with weight-bearing radiographs and AOFAS-hallux score at 5 weeks, 3 months and 6 months. All patients were postoperatively allowed to immediately full weight-bear wearing a stiff sole orthopedic shoe (Donjoy, Podalux™). Results The results showed an improvement in the functional score (average AOFAS from 53.5 to 87 at 6 months) and a decrease in IMA and HVA in the direct postoperative with 9.2° and 28.3°, respectively. The reductions were maintained through 6 months and compared with the preoperative condition a reduction of 6.0° and 7.3°, respectively, were observed. Conclusions Correction of hallux valgus with the modified osteodesis procedure with the mini TightRope system with Full Weight-Bearing can be considered effective, safe and reliable.

The first metatarsal has the greatest inclination of all metatarsals and carries about 40% of body weight during the static stance. The rearfoot and the first ray (FR) are two distinct structures, but they are strongly related to the latest studies in the literature; however, their mutual involvement in the foot biomechanics appears not to be fully explored. Understanding their interdependence is essential to approaching the patient in his totality. This overview aims to analyze the current evidence from the latest studies that examine the correlation between FR insufficiency (FRI) and hindfoot valgus (HV), focusing on their biomechanical interaction, clinical implications, and treatment approaches. All analyzed studies showed that plantarflexion of the first metatarsophalangeal (MTP1) joint in correct alignment increased by 26% compared to a deviated articulation. In FRI, the “windlass” mechanism appears compromised, and FR lacks the necessary stability and plantarflexion; consequently, the medial arch collapses, and the foot moves into excessive pronation. On the other hand, in HV condition, the pulley system is significantly diminished, and peroneus longus contraction cannot stabilize the FR with resultant FRI and dorsal migration. A significant correlation was found between hindfoot alignment and first metatarsal rotation (86% of patients) and between HV and hallux valgus. Foot orthoses, physical therapy, and exercise programs, especially in the initial stages of symptomatic HV, provide satisfactory results in 67% to 90% of cases, improving foot alignment and pain relief in FRI patients. In more severe cases, surgical intervention to realign the hindfoot is indicated with a very low complication rate (1–4%), which can vary from 24% to 55% in stage 4 flatfoot. No study in the literature has been found to address both pathologies simultaneously from a treatment point of view, and, although not all HV patients are affected by FRI, most patients seem to benefit from surgical stabilization of the FR in 80% of individuals with symptomatic HV. However, despite a predominance of FRI among HV individuals, not all clinical studies have confirmed this correlation.

Neonatal brachial plexus palsy (NBPP) is a flaccid paralysis of the upper limbs that occurs in about 0.4 percent of live births. This condition can produce permanent disabilities; to date, there is no consensus on protocols to be applied for the rehabilitation of children with this condition. The aim of this article is to provide a concise overview of conservative treatment beyond traditional physical therapy for the management of the child with NBPP and to offer a number of useful options for creating the most comprehensive and functional rehabilitation treatment possible. We conducted a narrative review after analyzing articles from the past 50 years on PubMed, Cochrane Library, Scopus, and Web of Science with the following search string [(“neonatal brachial plexus palsy” OR “obstetric brachial plexus palsy” OR “birth brachial plexus palsy”) AND (“rehabilitation” OR “physiotherapy” OR “conservative treatment”)]. We identified a potential of 1275 articles, but only 11 were exclusively about conservative approaches. The most represented rehabilitation approaches in the literature were botulinum toxin, constraint-induced movement therapy (CIMT), virtual reality, neuromuscular electrical stimulation, and kinesiotaping. In conclusion, the various rehabilitation approaches for NBPP are promising, but none can be considered the best option when used alone. In light of the current evidence, a multimodal approach is needed.

Forefoot disorders are prevalent in the general population, with an incidence between 2 and 20%. Among them, lesser toe deformities (hammer, claw, and mallet toes) are frequent disorders, and their conservative management is often not adequately considered but usually attempted before surgical indication. Among conservative treatments, shoe modifications and the application of orthoses may, in most cases, alleviate symptoms. From a careful analysis of the available literature, it emerged that treatment approaches should be individualized, and patient education has to be a central aspect of therapy. Proper footwear includes rocker and cushioned soles shoes, a wide toe box, proper length, and a lowered heel, eventually combined with the placement of a felt pad. Narrowed shoes must be avoided, limiting the impaction of the distal phalanx and toenail into the ground. A custom-made silicone orthosis applied at the second digit metatarsophalangeal (MTP) joint in a hammer or claw toe seems to reduce mean peak plantar pressure in the rigid stage of deformity but not the flexible one. A metatarsal pad placed 6.5 mm proximal to the second metatarsal head was demonstrated to diminish peak pressures by 33%, and a 12.5-mm insole further reduced peak metatarsal head pressures by 23% compared with a 2.5-mm insole. The best comfort of orthoses seems to be given by treating metatarsalgia resulting from deformities such as MTP joint instability, mallet, and claw toe. Little orthotic relevance is given to deformities such as hammer toes. Although the most significant obstacle appears to be the psychological aspect of patients, who must accept the placement of compensatory orthoses, some studies show that all these management appear to be often beneficial for the treatment of these disorders. However, none of them are permanent solutions to the deformity and they can be treatment of choice just in advanced stages, in elderly and low functional demand patients.