The coronoid process (CP) is important for stabilizing the elbow joint. The elbow's joint fracture is considered the most common factor in several cases of complex elbow dislocations. The surgical indications for recommending the CP in fractures are prolonged instabilities of the elbow. The open fixation of the CP is a demanding procedure, owing to many complications after the surgeries. Arthroscopic reduction and internal fixation have been proposed to overcome the limitations of open approaches. The aim of our study is to describe, step by step, a new surgical procedure for arthroscopically assisted fracture reduction and insertion of an antegrade guidewire for internal fixation of coronoid fractures. To perform this surgery, the knowledge of the portals in elbow arthroscopy is essential. The final stabilization is achieved by accurate positioning of the Kirschner-wire under arthroscopic control and stabilizing by the cannulated screw. The proposed technique is a safe and appealing procedure in the treatment of coronoid fractures.

Background: Syndesmotic fixation is a standard treatment for tibiofibular syndesmosis injury, especially in ankle fractures, but the necessity of routine screw removal remains debated. This study evaluates the impact of routine removal on functional outcomes, complication rates, and recovery, aiming to clarify its clinical relevance. Methods: This retrospective observational study included 330 patients treated surgically for tibiofibular syndesmosis injuries at a single institution from 2016 to 2024. Patients were categorized into three groups: no removal, routine removal, and removal for clinical indications. Functional outcomes were assessed using the Olerud–Molander Ankle Score (OMAS), and complications, including infections and prolonged pain, were recorded. Statistical analyses evaluated differences between groups. Results: Of the 170 patients who completed follow-up, no significant differences in OMASs were found between the groups (p = 0.646). Complications were more frequent in reoperated patients (9% vs. 2% for non-reoperated), but routine removal did not improve functional outcomes. Younger patients showed better OMASs, highlighting age as a key factor in recovery. Fixation and fracture types had no significant impact on outcomes. Conclusions: Routine syndesmosis screw removal offers no significant functional benefits, as demonstrated by comparable OMASs across groups (median OMAS: 85 for non-reoperated, 80 for routinely reoperated, and 80 for indication-based reoperated patients). However, routine removal is associated with a higher complication rate. A selective approach focusing on clinical indications is recommended to minimize unnecessary surgeries and optimize patient outcomes. Future research should focus on redefining evidence-based management strategies for syndesmotic fixation.

Introduction: The aim of this systematic review is to examine the recent evidence comparing the removal and non-removal of syndesmotic screws in tibiofibular syndesmosis injuries in terms of functional, clinical, and radiographic outcomes. Methods: A comprehensive literature review was conducted to identify clinical studies on syndesmotic screw removal and its outcomes, searching the Cochrane Library and PubMed Medline for publications from 1 January 2004 to 12 February 2024. Studies were included if they involved tibiofibular syndesmotic screw fixation, assessed screw removal or retention, described clinical outcomes, and were original research with at least fifteen patients per group. Results: Most reviewed articles (18 out of 27; 67%) found no significant differences between the routine removal and retention of syndesmotic screws post-fixation. Four retrospective studies (15%) suggested that retaining screws might result in worse outcomes compared to removal. Two studies (7%) indicated that removing screws could introduce additional risks. One study (4%) observed that post-removal, there is some fibula–tibia separation without affecting the medial clear space. Another study (4%) noted that intraosseous screw breakage might increase the need for implant removal due to pain. Additionally, no significant differences in ankle function were found among groups with varying intervals of screw removal. Conclusions: The current literature does not definitively support routine removal of syndesmotic screws. Given the potential complications and financial costs, routine removal should not be performed unless specifically indicated.

The stability of the medial elbow compartment is not only important for everyday life but also plays a key role in throwing gestures. Valgus stress is a fundamental part of popular sport activities (baseball, squash, tennis, and volleyball). Even the isolated medial collateral ligament (MCL) lesion might develop symptomatic medial instability, which interrupts everyday life. This instability may be symptomatic and patients may refer medial elbow pain. Several techniques for MCL treatment have been described. Most of them are reconstructions in which there are tunnels and free cylindrical grafts. The aim of our study is to describe step-by-step a new surgical procedure for minimally invasive plication of aMCL arthroscopically assisted. This procedure should be performed after 6 months of conservative treatment failure. After arthroscopic MCL laxity diagnosis, the standard bioabsorbable double-loaded anchor with high resistance sutures was inserted into the anteroinferior surface of the medial epicondyle. After adequate restraint and preparation of proximal aMCL, 2 bioresorbable sutures were passed through the ligament considering 1 to 1.5 cm of tissue to be plicated. The procedure is considered less invasive and safe in comparison with graft reconstructions of MCL.