Articles in Musculoskeletal & Trauma (14)

Grave lesione traumatica del ginocchio caratterizzata dal distacco osseo a livello dell'inserzione fibulare, frequentemente associata a instabilità dell'angolo postero-laterale (posterolateral corner - PLC) e a deficit neurologici del nervo peroneo.

Septic arthritis is a rheumatologic and orthopedic emergency characterized by purulent invasion of the joint space, requiring urgent arthrocentesis and targeted parenteral antibiotics to prevent irreversible cartilage destruction and joint destruction.

Fat embolism syndrome is a serious multisystem disorder characterized by respiratory distress, neurological impairment, and a petechial rash, typically occurring 24 to 72 hours after long-bone fractures or orthopedic procedures. Diagnosis relies on clinical scoring systems such as Gurd criteria, and treatment is fundamentally supportive, focusing on early fracture stabilization and oxygenation.

The Mason classification system categorizes radial head fractures into three distinct types based on comminution and displacement to guide conservative versus surgical intervention. The gold-standard diagnostic modality is plain radiography of the elbow with dedicated radial head-capitellum views, supplemented by computed tomography (CT) for complex fracture patterns. First-line management ranges from early mobilization and joint aspiration for undisplaced Type I fractures to open reduction and internal fixation (ORIF) or radial head arthroplasty for displaced or comminuted Type II and III fractures.

Neer classification system categorizes proximal humerus fractures based on the displacement of four anatomical segments by >1 cm or >45 degrees of angulation, guiding surgical versus nonoperative management. Gold-standard diagnostic testing is a dedicated shoulder trauma series radiographs supplemented by 3D multiplanar CT scan, while first-line treatment for minimally displaced stable fractures is nonoperative sling immobilization with early pendulum exercises and multi-modal oral analgesia.

The Schatzker classification categorizes tibial plateau fractures into six distinct morphological types based on fracture geometry and energy transfer, guiding surgical stabilization and articular reconstruction. Gold-standard diagnosis relies on multi-detector computed tomography (CT) with 3D reconstructions to evaluate articular depression and split displacement. First-line definitive therapy involves open or arthroscopic-assisted reduction and internal fixation (ORIF) with buttress plating and structural bone grafting.

The Lauge-Hansen classification system categorizes ankle fractures based on the mechanism of injury, defined by the position of the foot at the time of trauma and the direction of the deforming force. The gold-standard diagnostic investigation is standard radiographic series (anteroposterior, mortise, and lateral views), supplemented by computed tomography (CT) for complex articular assessment, with first-line management ranging from closed reduction and below-knee casting for stable patterns to open reduction and internal fixation (ORIF) for unstable, displaced injuries.

The Danis-Weber classification categorizes ankle fractures into types A, B, and C based on the level of the fibular fracture relative to the tibiotalar joint and the tibiofibular syndesmosis. Standard diagnostic evaluation relies on weight-bearing or standard ankle radiographs (anteroposterior, lateral, and mortise views), while first-line management ranges from conservative closed reduction and immobilization for stable Weber A injuries to open reduction and internal fixation (ORIF) for unstable Weber B and C fractures.

The Garden classification system categorizes femoral neck fractures into four distinct types based on the degree of displacement observed on anteroposterior radiographs, guiding surgical decision-making between internal fixation and arthroplasty. The gold-standard diagnostic imaging modality is bilateral plain radiography of the pelvis and a dedicated view of the affected hip, often supplemented by CT when nondisplaced patterns require evaluation for posterior tilt. First-line management involves prompt surgical intervention using closed or open reduction and internal fixation for nondisplaced fractures, and arthroplasty for displaced fractures in elderly patients.

Odontoid peg (dens) fractures are upper cervical spine injuries classified by the Anderson and D'Alonzo system based on the anatomical level of the break. Diagnosis is established via thin-slice computed tomography (CT) with multiplanar reconstructions, while first-line management ranges from rigid cervical immobilization for stable configurations to surgical posterior C1-C2 fusion or anterior screw fixation for unstable or displaced lesions.

Traumatic spondylolisthesis of the axis (Hangman fracture) is a bilateral fracture of the C2 pars interarticularis resulting from hyperextension and axial loading or distraction. The gold-standard diagnostic tool is fine-cut cervical computed tomography (CT) with sagittal and coronal reconstructions, while first-line treatment ranges from rigid cervical orthosis (e.g., Halo-vest or Miami J collar) for stable injuries to surgical anterior or posterior C2-C3 fusion for unstable, displaced configurations.

Coronoid process of the mandible fracture is an uncommon maxillofacial injury resulting from direct blunt trauma or violent temporalis muscle contraction, accounting for approximately 1% of all mandibular fractures. Diagnosis is definitively established via high-resolution maxillofacial computed tomography (CT), while management ranges from conservative observation with soft diet and physical therapy for non-displaced fragments to open reduction and internal fixation or coronoidectomy for cases presenting with severe mechanical trismus.

Acromial avulsion fracture is a rare scapular injury typically caused by direct trauma or forceful deltoid and trapezius muscle contraction, resulting in bony fragment separation from the acromion process. Gold-standard diagnosis is achieved via targeted shoulder radiography (Zanca and axillary views) and high-resolution computed tomography (CT), while first-line management for minimally displaced fractures involves conservative immobilization and multimodal analgesia.

Gastrocnemius avulsion fracture is a rare skeletal injury characterized by the detachment of a bone fragment at the proximal or distal origin/insertion of the gastrocnemius muscle, diagnosed via high-resolution musculoskeletal ultrasound and definitive plain radiography or MRI, and managed via functional bracing or open reduction internal fixation depending on displacement.