Introduction: Video assisted thoracoscopic surgery (VATS) is associated with good correction ability for spinal deformity and allow the reconstruction of the anterior column of the spine in tumors, deformity and trauma cases. Stand alone and instrumented procedures are possible. VATS has shown to be safe and can reduce the morbidities of traditional open anterior surgery but is a technically demanding procedure with a steep learning curve. The potential technique-related complication rate is low in experienced hands.

Material and Methods: From 2006 till today, 22 thoracic vertebral fractures have been treated with thoracoscopic approach. The mean patients age was 32 years (24–58) and the levels treated between T6 and L1.

Five fractures required only anterior approach, with corpectomy, implantation of an expandable cage (Obelisk, Ulrich, Germany) with autologous bone graft and an anterior Macs TL plate (Aesculap, Germany). The others seventeen fractures were treated by combined anterior – posterior approach in the same operating session or, the second, previously performed immediately after the admission.

The endoscopic splitting of the diaphragm was performed in 9 cases to expose the L1/L2 levels.

Seven patients received decompressive laminectomy during the first posterior approach performed in emergency settings. Endoscopic anterior decompression was required in 5 cases. One thoracic drainage was inserted and removed on third day in most cases.

Results: The thoracoscopic approach allowed a reduction of blood loss, better pulmonary function, an earlier mobilization of the patients and a shorter hospital stay. With the experience the duration of surgical time decreased of one third. The mean duration of the procedure was 190 minutes and the blood loss of 220 ml.

There were no major complications. In the first group of 8 cases a delayed removal of the thoracic drain and three conversion in open thoracotomy occurred. The patients were radiologically evaluated for bony fusion, sagittal alignement and by VAS and Oswestry scale for the overall satisfaction about the treatment.

The mean follow-up time was 10 months (4–32). We didn’t found any loss of correction more than 5 degree.

Conclusion: VATS permits a better visualization of the anatomic structures and allows the same reconstruction capabilities of the open technique with a faster recovery, a shorter hospitalization and a better cosmetic results.

We observed a significant reduction in postoperative pain and drugs delivered for it.

The clinical results have been encouraging. We believe that this technique can be a valuable tool in the management of the thoracolumbar fractures with acceptable morbidity and a little impact of pulmonary function. A careful selection of the patients scheduled for anterior stand alone procedure is required to avoid the risk of failure of the instrumentation.

Introduction: This paper presents the short term results of 56 (28 males and 28 females) consecutive Unicompartimental Knee Arthroplasties (UKAs) and 54 (29 males and 25 females) High Tibial Opening Wedge Osteotomies (HTOs), performed in two centres (Toronto-Canada and Torino-Italy), between 2001 and 2004.

The aim of this prospective study was to compare UKAs to HTOs, in terms of clinical and functional Results: Materials and Methods:

In all UKAs we implanted an Accuris prosthesis (Smith& Nephew, Memphis TN), in all HTOs we performed a medial opening wedge osteotomy, according to the surgical technique and syntesized with a Puddu Plate (Arthrex, Naples FL).

We evaluated all patients preoperatively and at 6 months postoperatively, at 1 year, 2 years and at the last follow-up visit (mean 3,5 years for UKAs and 2,5 years for HTOs), using the Knee Society Score (KSS) and the WOMAC (Western Ontario and McMaster Universities) Score.

Results: The mean age at operation was 55 years for the HTO group and 65 years for the UKA group.

Postoperative program for the HTO group was: 4 weeks of CPM (continuous passive movement), partial weight-bearing al 4 weeks (30–50% of body weight) and then full weight-bearing at 8 weeks postoperatively.

In the UKA group, full weight bearing was allowed immediately after operation.

We observed only one significant complication postoperatively: an early infection in an HTO patient. We thought this complication was not related to the treatment chosen, but to external factors, so we decided to exclude this patient from our study.

In the HTOs group, the KSS knee score (KS) and function score (FS) improved from respectively 38 and 55 preopertively to 76 and 91 at the final follow-up evaluation, while in the UKA group KS increased from 43 to 93 and FS increased from 50 to 84.

The WOMAC Score improved from respectively 48 (HTO Group) and 45 (UKA Group) preoperatively to 15 (HTO Group) and 14 (UKA Group) at the final follow-up evaluation.

Discussion and conclusion: According to both scores (Womac and KSS), the two groups did not differ significantly at 1 year, 2 year and last followup evaluation, considering the different ages of the patients (55 years of the HTO Group versus 64 years of the UKA group).

Comparison of study groups shows good outcome at early and mid-term follow-up. All patients had scores rated good to excellent (both KSS and WOMAC).

However, we found a little difference in KSS between the two groups: UKAs have a higher Knee Score (better knee assessment), while HTOs have a significantly higher Functional Score (better performances, maybe due to a more “anatomic saving” procedure).

This data suggests that the UKAs have better knee assessment, meanwhile the HTOs have better function. Given that, both treatments lead to a good to excellent outcome at early followup.

The failure rate of peritrochanteric fracture implants ranges from 5 to 20 % The aim of the present preliminary study is to evaluate the relationship between Singh index (SI), and failure of internal fixation (cut-out), examining bone mechanical properties from ex-vivo human femoral heads.

The failure rate of peritrochanteric fracture implants ranges from 5 to 20 % The aim of the present preliminary study is to evaluate the relationship between Singh index (SI), and failure of internal fixation (cut-out), examining bone mechanical properties from ex-vivo human femoral heads.

From a methodological point of view we decided to use SI on the basis of previous literature,, our data seems not to be influenced by the use of this methodological approach. > Three load speeds were set: 3, 10, 500 mm/min resulting values of BW/s were compared with Davy and Bergmann ones (obtained with instrumented prosthesis), and test validity was confirmed. In conclusion our data demonstrated that: cut out phenomenon occurs for lower mechanical load in femoral heads of patients with lower SI.

Aims: evaluate the relationship between Singh index (SI), bone mineral density (BMD) examining bone mechanical properties from ex-vivo human femoral heads.

Methods: we collected the femoral heads of 22 patients that underwent arthroplastic for fracture of femoral head under low energy trauma. 5 patients were male while 17 were female. In each patient a pelvis X-ray was performed to estimate Singh Index. From 2 to 3 bone cylinders of cancellous bone were obtained from each femoral head. 52 bone cylinders (7x10mm) were obtained. In each specimen densitometric scans were performed by means of a Hologic QDR 4500 X-ray densitometer, using a small animal software. The coefficient of variation (CV) was calculated by repositioning a sample for 5 scans by different operators. The data obtained were expressed as bone mineral content (BMC) and bone mineral density (BMD). Compression tests with a JJ Instruments T5K machine were conducted on 52 spongy bone cylinders. Each specimen was loaded in movement control; maximum failure load and Young modulus were recorded.

Results The CV for the precision was 1.8% for BMC and 2.7% for BMD. There are no differences between males and females in age, BMC, BMD and Young modulus, while there is a significant difference in maximum load and SI. As regards SI values, there are significant differences among different categories of SI for age, sex, BMC, BMD, Young modulus and maximum failure load. Considering each sample position, namely 1, 2 or 3, there was no significant difference in densitometric parameters and in mechanical properties Statistical analyses of correlations by Pearson’s coefficient showed significant inverse correlations between age and mechanical bone properties (Young modulus and maximum failure load), while the correlations between BMC, BMD and biomechanical bone behaviour were strictly direct Linear regression model demonstrated only maximum load predictors are Young modulus and BMD

Conclusions The maximum failure load is lower in females than in males with similar BMD but lower SI for different SI categories there are significant differences both in biomechanical behaviour both in densitometric parameters.The age is inversely correlated with bone densitometric features and bone biomechanical behaviour, while bone density is directly correlated with bone strength and elastic modulus.The bone strength is predicted with 93% accuracy by Young modulus and BMD.