Sternoclavicular joint dislocation (SCJD) is a rare injury, generally classified in anterior and posterior. The posterior SCJD is very infrequent yet potentially associated with life-threatening complications. In patients with unfused medial clavicle physis, SCJD can be associated with fracture-dislocation (Salter type I or II). We hereby present the case of a 12-year-old basketball player with severe pain in sternoclavicular region and arising dysphagia after a fall and tackle by another player. A SCJ injury was hypothesised and the CT scan detected the presence of a true posterior SCJD with no associated fracture, which was also confirmed during open reduction. As the patient complained dysphagia, it was also necessary to study other possible mediastinal compressions by a contrast medium CT scan of the great vessels. The CT scanned brachiocephalic vein compression without additional clinical evidence or signs. Twenty hours after the trauma the patient underwent an unsuccessful closed reduction; for this reason, surgical treatment with open reduction and fixation was mandatory. After 12 weeks of therapy she returned to her previous sport activity. (www.actabiomedica)

Objective. Periprosthetic tibial fractures are rare injuries with few studies in the literature. With an increasing number of total knee arthroplasties performed, these injuries are expected to become more common. These fractures are difficult to treat due to complex fracture morphology, high proportions of injuries associated, and the variability of injury patterns. The aim of this work is to report our experience and results in the fixation of Felix type IIIA periprosthetic tibial fractures. Methods. We treated by osteosynthesis three patients who sustained a Felix type IIIA periprosthetic tibial fracture using three different devices. Patients were clinically and radiographically followed up at 1, 3, 6, and 12 months from the surgery. Results. All patients had a good clinical and radiographic outcome with almost complete recovery of joint function. Complete bone healing was radiographically seen on average 6 months after surgery. No signs of infection were observed. Conclusions. Although the incidence of periprosthetic tibial fractures is growing, evidence- based guidelines for their treatment are still lacking. We report our experience in the treatment of these complex fractures, but larger studies in this area are needed to better guide our knowledge and choices of treatment.

Introduction: Various classifications of radial head fractures have been reported in the literature, most of them are based solely on conventional radiographic criteria. The Mason–Johnston classification, currently the most widely used system worldwide, is affected by the limitations of conventional radiographs. The aim of our study is to confirm or refute the low reliability and reproducibility of the Mason–Johnston classification. Materials and Methods: The study collected elbow X-rays showing radial head fractures from 2011 to 2021. Images were evaluated by eight orthopedic surgeons and one radiologist consultant from different hospitals for classification. The first phase assessed inter-observer agreement, comparing classifications among participants. After four months, the same images were randomly reordered and then reclassified to evaluate intra-observer agreement. A total of 90 elbow X-rays from 50 women and 40 men were analyzed. Inter- and intra-observer agreement was assessed using Fleiss’ kappa, Krippendorff alpha, and Cohen’s kappa. Results: Overall inter-observer agreement by unweighted Fleiss’ κ was moderate in both sessions (κ = 0.49 and κ = 0.50), with overall pairwise percent agreement 63% and prevalence- and bias-adjusted κ (PABAK, k = 4) ≈ 0.50. As an ordinal sensitivity analysis, Krippendorff’s α (ordinal) was 0.726 and 0.744, indicating substantial agreement. Type-specific reliability was moderate for Types II–III and higher for Type IV. Unweighted Cohen’s kappa coefficients were calculated to assess intra-observer agreement, demonstrating moderate to substantial levels of concordance. Conclusions: The Mason–Johnston classification shows moderate inter-observer reliability, especially for Types II–III, and moderate to substantial intra-observer agreement.

Adult acquired flatfoot deformity (AAFD) is a common pathology and an important cause of pain and disability. This deformity causes a progressive flattening of the foot arch which has traditionally been associated with posterior tibialis tendon (PTT) dysfunction. Operative treatment is indicated after the failure of conservative management aiming to achieve proper alignment of the hindfoot and to maintain as much flexibility as possible. If subtalar osteoarthritis is present, subtalar arthrodesis is usually the best therapeutic option. Grice-Green subtalar arthrodesis is a widely used procedure. This report describes a case of bilateral painful AAFD in a 39-years old female professional dancer treated with Grice-Green subtalar arthrodesis with an autologous corticocancellous graft harvested from the ipsilateral proximal tibia. Surgeries were performed 3 years apart from each other. The patient had good clinical and radiological outcomes. She returned to dance 4 months after surgery with no referred pain or limitations. Due to its versatility and capability to restore the shape and thickness of the hindfoot Grice-Green procedure is a simple and effective technique for the treatment of AAFD with subtalar osteoarthritis and a valid option to solve professional disabilities as it happened in this case with a professional dancer. (www.actabiomedica.it)