Background: Literature has shown a significant correlation between early treatment and mortality in femur fractures, but the influence of time to ambulation on mortality has not been studied. The purpose of the present study is to evaluate whether time to ambulation is correlated to femur fracture mortality independently from time to surgery. Patients and methods: All patients older than 65 years admitted at a level I trauma center with proximal femoral fracture during a 1-year period were included. The following data were collected: age, gender, date and time of admission to emergency department, height, weight, body mass index, type and side of fracture, ASA score, date and time of surgery, surgical time, time to ambulation, length of hospitalization, death during hospitalization, and mortality at 6 and 12 months. Results: The study sample comprises 516 patients. The mean age was 83.6 years; ASA score was 3–5 in 53% of patients; 42.7% presented with medial fracture; mean time between admission and surgery was 48.4 h; 22.7% of patients were not able to walk during the first 10 days after fracture; mean duration of hospitalization was 13 days; and mortality was 17% at 6 months and 25% at 1 year. Early surgery and walking ability at 10 days after trauma were independently and significantly associated with mortality at 6 months (p = 0.014 and 0.002, respectively) and at 1 year (0.027 and 0.009, respectively). Conclusions: Early surgery in femur fracture became a priority in health systems, but early postoperative physiotherapy also plays a major role in prevention of mortality: independently from surgical timing, patients who did not walk again within 10 days from surgery showed mortality rates higher than those of patients who did. Level of evidence: IV.

In the last 10 years, the rate of femur fractures treated within 48 h from trauma has been introduced as a performance index for hospital management in Italy. Literature showed a significant indirect correlation between early treatment and mortality/comorbidity. The aims of early treatment are pain management and reduction of time to ambulation. The purpose of this study is to evaluate whether early treatment has reduced time to ambulation in femur fracture. All patients admitted to two level I trauma centers with proximal femoral fracture between 1/1/2017 and 31/12/2017 were included in this study. Exclusion criteria were patient age younger than 65 years, death before surgery, and nonsurgical treatment. The following data were collected: age, gender, date and time of admission to emergency department, height, weight, body mass index (BMI), type and side of fracture, American Society of Anesthesiologists (ASA) score, date and time of surgery, surgical time, length of hospitalization, death during hospitalization, time from surgery to physiotherapy start, and time from surgery to first walking day. The study sample resulted in 660 patients. Mean age was 82 years, 64 % were female, mean BMI was 24 kg/m2, mean ASA score was 2.7, and 42 % were medial fractures. Mean time from admission to surgery was 95 h; 49.8 % were treated within the first 48 h. Mean time from surgery to physiotherapy start was 2 days, 21 % were not able to walk during hospitalization, time from surgery to first walking day was 5 days, and mean hospitalization time was 15 days. Early surgery was significantly (p = 0.008) associated with the probability of ambulation recovery during hospitalization. No association (p = 0.513) was found between early surgery and time in bed without walking. Early surgery in femur fracture became a priority in the health system. However, according to our data, although 51 % of patients were treated within the first 48 h, time from surgery to physiotherapy start (2 days) was still too long. Furthermore, time from surgery to first walking day was 6 days, longer than in most published papers. These data suggest that the performance index (rate of femur fractures treated within 48 h) may be improved by changing it to rate of femur fractures surgically treated with return to walking in 96 h. Level 4 (retrospective study).

Background: The lateral extra-articular tenodesis (LET) procedure associated with anterior cruciate ligament (ACL) reconstruction can be considered in selected patients to diminish the risk of persistent rotatory instability and achieve a protective effect on the graft. Several techniques have been described in the literature to treat rotatory instability. Usually, a strip of the iliotibial band (ITB) is harvested from its middle while leaving the distal insertion, then passed underneath the lateral collateral ligament and fixed on the lateral aspect of the distal femur with various fixation methods such as staples, screws, anchors or extracortical suspensory devices. Despite their effectiveness, these fixation methods may be associated with complications such as lateral pain, over-constraint and tunnel convergence. Methods: This study presents a detailed surgical description of a new technique to perform an LET during ACL reconstruction with any type of graft fixing the ITB strip with the sutures of the ACL femoral button, comparing its pros and cons in relation to similar techniques found in the literature. Conclusions: This technique represents a reproducible, easy to learn and inexpensive solution to perform a lateral extra-articular tenodesis associated with an ACL reconstruction using the high-resistance sutures of the femoral button.

Introduction: Knee osteotomies are effective procedures to treat different deformities and to redistribute the load at the joint level, reducing the risk of wear and, consequently, the need for invasive procedures. Particularly, knee osteotomies are effective in treating early arthritis related to knee deformities in young and active patients with high functional demands, with excellent long-term results. Precise mathematical calculations are imperative during the preoperative phase to achieve tailored and accurate corrections for each patient and avoid complications, but sometimes those formulas are challenging to comprehend and apply. Methods: Four specific questions regarding controversial topics (planning methods, patellar height, tibial slope, and limb length variation) were formulated. An electronic search was performed on PubMed and Cochrane Library to find articles containing detailed mathematical or trigonometrical explanations. A team of orthopedic surgeons and an engineer summarized the available Literature and mathematical rules, with a final clear mathematical explanation given by the engineer. Wherever the explanation was not available in Literature, it was postulated by the same engineer. Results: After the exclusion process, five studies were analyzed. For three questions, no studies were found that provided mathematical analyses or explanations. Through independent calculations, it was demonstrated why Dugdale's method underestimates the correction angle compared to Miniaci's method, and it was shown that the variation in patellar height after osteotomy can be predicted using simple formulas. The five included studies examine postoperative variations in limb length and tibial slope, providing formulas applicable in preoperative planning. New formulas were independently computed, using the planned correction angle and preoperatively obtained measurements to predict the studied variations. Conclusions: There is a strict connection among surgery, planning, and mathematics formulas in knee osteotomies. The aim of this study was to analyze the current literature and provide mathematical and trigonometric explanations to important controversial topics in knee osteotomies. Simple and easy applicable formulas are provided to enhance the accuracy and outcomes of this surgical procedure.

Purpose: Quantifying femoral neck anteversion (FNA) is essential in lower limb torsional deformities. Because of proximal femur anatomy and computed tomography (CT) acquisition, the femoral head and neck are often visualized on different slices, making identification of the femoral‐head–neck axis (FHNA) challenging. This study introduces a new method based on the maximum intensity projection (MIP) function available in most DICOM (Digital Imaging and Communications in Medicine) viewers. By increasing the thickness of the bone segment displayed on a single two‐dimensional image, MIP allows simultaneous visualization of the femoral head and neck, simplifying FHNA identification. To evaluate intra‐ and interobserver reliability of the MIP method and compare it with established techniques. The hypothesis was that MIP would provide superior repeatability and reproducibility than other techniques. Methods: Between 2019 and 2023, 135 consecutive bilateral lower limb CT angiographies were retrospectively screened. A calculated sample size of 50 patients meeting the inclusion criteria was chronologically enroled. Radiographic measurements were performed at Time 0 and after 30 days by two independent observers following a calibrated training phase. FNA was measured using five methods: Murphy, Hernandez, Waidelich, Yoshioka and MIP. Intraobserver and interobserver reliability were evaluated using a two‐way random‐effects, single‐measures, absolute‐agreement intraclass correlation coefficient [ICC (2,1)] model, alongside standard error of measurement (SEM). For pairwise comparisons of estimated marginal means derived from the linear mixed‐effects model, Tukey's honestly significant difference adjustment was applied. For pairwise comparisons of bootstrap‐derived ICC differences, p values were adjusted using the Holm step‐down procedure. Results: Fifty CT angiographies were analysed. Mean FNA values were significantly different among most methods (Murphy: 18.4° ± 7.2; Waidelich: 24.6° ± 7.4; Yoshioka: 11.5° ± 7.8; Hernandez: 10.7° ± 7.1; MIP: 13.7° ± 6.2) The proposed MIP method demonstrated high intraobserver repeatability (Observer 1: ICC = 0.97; Observer 2: ICC = 0.95) and interobserver reproducibility (ICC = 0.84 for single‐measure absolute agreement). Bland–Altman analysis revealed method‐dependent non‐interchangeability, with systematic differences between techniques. Conclusions: The MIP technique simplifies identification of the FHNA and demonstrated the highest overall reproducibility among the evaluated CT‐based methods. It could therefore represent a practical approach for improving the standardization of FNA assessment. Level of Evidence: Level III, diagnostic study.