Lo Scalpello - Journal

The use of custom-made bone struts in giant cell tumor management

Elio Caiaffa — 2025-04-30

Objective. Giant cell tumor (GCT) is a benign but locally aggressive neoplasm that typically affects the epiphyses of long bones. Surgical resection with curettage remains the standard treatment; however, managing lesions in critical anatomical sites poses unique challenges.
Methods. This study reports the case of a 20-year-old male diagnosed with GCT located in the femoral neck and head. The patient underwent lesion curettage, application of local adjuvants, and bone grafting, including the placement of a custom-made cephalic screw derived from a bone bank to reinforce Ward’s triangle. The cephalic screw, aligned with force transmission lines, was used to prevent head collapse and iatrogenic fractures due to overload. The patient demonstrated satisfactory postoperative recovery, and long-term follow-up (3 months) revealed excellent bone integration of the screw (already evident at 6 months) and no recurrence of tumor. This bone reconstruction approach represents a valuable option to treat bone tumors.
Conclusions. Our experience confirms the efficacy and safety of bone screw implantation using banked bone material in treating GCT of the femur. This approach improves long-term outcomes and enhances patients’ quality of life.

Clinical and radiological results of 3.5 mm locking compression plate fixation for humeral shaft fractures

Alexander Di Francesco — 2025-04-30

Objective. This study aims to evaluate the clinical and radiological outcomes of treating 21 humeral shaft fractures using a single 3.5 mm locking compression plate (LCP). In cases where the humeral size is limited, this construct may offer a viable alternative. However, there is a scarcity of data in the literature regarding the outcomes of this technique. Traditionally, surgeons prefer using a 4.5 mm LCP or two orthogonal 3.5 mm LCPs for such fractures.
Methods. A total of 21 patients, comprising 14 men and 7 women aged 18 to 68 years (mean age: 34; median age: 29), underwent open reduction and internal fixation with a 3.5 mm LCP. The fractures were classified as 12-A, 12-B, or 12-C according to the AO classification. Patients were monitored monthly until radiological union was confirmed in at least three out of four cortices. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score.
Results. The mean follow-up period was 12 months (range: 7–17 months). The mean DASH score was 35.1 at 3 months and improved significantly to 8.9 by 10 months. All fractures achieved union after an average of 14 weeks, with one patient experiencing delayed union in the case of a transverse fracture. No instances of metal failure or plate breakage were observed. Radial nerve deficits were present in 5 patients due to trauma, but the structural integrity of the nerve was maintained in all cases. Full recovery of nerve function, including complete muscle strength restoration, occurred within 6 months.
Conclusions. A single 3.5 mm LCP is a viable treatment option for diaphyseal humeral fractures. This approach demonstrated a satisfactory union rate, range of motion, and a low rate of complications.

Traumatic peroneal tendon dislocation: a case report and surgical treatment options

Antonello Barbati — 2025-04-30

Traumatic peroneal tendon dislocation is a rare but significant injury that predominantly affects athletes. The condition involves the displacement of the peroneal tendons from within the superior peroneal retinaculum around the posterolateral aspect of the fibula. Various surgical options are available to stabilize the peroneal tendons and restore their normal function. We present the clinical case of a 19-year-old male who, after sustaining an eversion sprain during a soccer match, experienced acute pain and difficulty moving his ankle. The availability of different surgical techniques offers the flexibility to choose the most appropriate solution for each specific case.

Practical steps for Freehand Technique insertion of locking screws in intramedullary nails

Massimo "Max" Morandi — 2025-04-30

Freehand Technique for drilling and insertion of locking screws in intramedullary nails can be technically demanding and prone to handling issues. It requires the precise placement of a screw through the holes in the nail under fluoroscopic guidance and can result in a time consuming procedure associated with exposure to radiation. Dedicated training as a result of experience can help overcome these problems. The Freehand Technique of interlocking screw placement is the current standard teaching in most orthopedic residency programs in United States.

Surgical treatment of nutcracker cuboid fracture: a case report

Alessio Carlisi — 2025-04-30

The nutcracker fracture is a rather unusual type of cuboid bone fracture caused by a compressive force which determines a multi-fragmentation of the fracture with consequent loss of the length of the lateral column of the foot and of the anatomy, which if not treated can cause instability and chronic pain. We present this case of a nutcracker fracture that was treated with only a bridge plate and relative screws, resulting in the restoration of length and anatomy with excellent clinical results.

The challenging missing talus, surgical treatment and clinical outcomes: a review

Davide Calabrò — 2025-04-30

Total talus extrusion, a rare and debilitating ankle injury, leads to severe pain, instability, and functional impairment. Its rarity complicates treatment and established guidelines are lacking. This review, adhering to PRISMA criteria, analyzed 113 cases from 53 articles (PubMed, Cochrane, CINAHL) which were retrieved using the keywords: “missing talus”, “total talar extrusion”, “talar extrusion”, “open talar dislocation”, and “open talus dislocation”. The text was submitted to PROSPERO with registration number CRD42023385242. Primary talus reimplantation occurred in 86 cases, talectomy and tibio-calcaneal arthrodesis were alternatives. Avascular necrosis, arthritis, infections, and second surgical revision are the most frequent complications in both cases. The management debate centers on reimplantation versus removal. The evidence suggests immediate reimplantation, coupled with thorough debridement, antibiotics, and tetanus prophylaxis, mitigates complications and restores ankle anatomy. This review aims to establish comprehensive surgical guidelines for missing talus, optimizing recovery and function while minimizing long-term sequelae.