Chiara Suardi

Background: The Orbay approach to volar distal radius described a volar zig-zag incision across the wrist crease, allowing a more distal exposure than traditional approaches. This adaptation enhances mobilization of the proximal radial fragment and improves visualization of both the articular surface and dorsally displaced distal radius fractures. Methods: In the present paper, we propose a further modification of the volar zig-zag approach, positioning the apex of the incision at the level of the radial styloid. Results: This modification aims to improve visualization of the radial styloid, the articular comminution, and the dorsal aspect of the distal radius, thereby optimizing fracture exposure and reduction. Conclusions: The principal advantage lies in the reduced need for traction along the radial margin of the incision to achieve adequate visualization and the avoidance of crossing the wrist crease, thereby preventing the formation of unsightly or adherent scars.

Background/Objectives: The external hinged elbow fixator is a surgical choice both in the case of simple dislocations and elbow dislocation fractures. The correct positioning with respect to the elbow’s center of rotation is demanding. Authors developed a self-centering external fixator that does not require a pin in the elbow’s center of rotation. The aim of this study was to analyze the margin of error in its positioning. Methods: We subjected 16 patients to a CT-3D study reconstruction using 3D motion software to analyze the divergence angle and offset between the elbow’s center of rotation and that of the external fixator. The results were compared to those published on traditional implants. Results: All elbows were correctly reduced without re-dislocation. The average distance was 2° in relation to the center of rotation in the antero-posterior view, 3° in the cranio-caudal, and 2° in the medio-lateral. The divergence angle was 3.5° (min 0.4°; max 9.3°) and the offset 6.8 mm (min 0.06; max 17.5). The average range of motion was 10–145 (range 0–155). Discussion: The traditional hinged elbow external fixator creates severe complexity for surgeons in the necessary positioning of the elbow axial rod to correctly align the implant. The self-centering device avoids this step, making the procedure faster and easier. Although the alignment is still not perfect, the results are still comparable with traditional devices. Conclusions: The self-centering external fixator allows for correct alignment with the elbow’s center of rotation. It is less invasive and simpler, with a shorter learning curve, faster operating time, and less radiographic exposure.

Background: Knee varus alignment represents a notorious cause of knee osteoarthritis. It can be caused by tibial deformity, combined tibial–femoral deformity and/or ligament imbalance. Understanding malalignment is crucial in total knee arthroplasty to restore frontal plane neutral mechanical axis. The aim of this study was to determine which factor contributes the most to varus osteoarthritic knee and its related surgical implications in performing a total knee arthroplasty. Methods: We retrospectively evaluated 140 patients operated for total knee arthroplasty due to a varus knee. Full-leg hip to ankle preoperative X-rays were taken. Radiological parameters recorded were: mechanical axis deviation, hip–knee–ankle, anatomical–mechanical angle, medial neck shaft angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), lateral proximal femoral angle, lateral distal tibial angle (LDTA), femoral bowing, and length of tibia and femur. We also determined ideals tibial and femoral cuts in mm according to mechanical alignment technique. A R2 was calculated based on the linear regression between the predicted values and the observed data. Results: The greatest contributor to arthritic varus (R = 0.444) was MPTA. Minor contributors were mLDFA (R = 0.076), JLCA (R = 0.1554), LDTA (R = 0.065), and femoral bowing (R = 0.049). We recorded an average of 7.6 mm in lateral tibial cut thickness to restore neutral alignment. Conclusions: The radiological major contributor to osteoarthritic varus knee alignment is related to proximal tibia deformity. As a surgical consequence, during performing total knee arthroplasty, the majority of the correction should therefore be made on tibial cut.