Michele Lisanti | University of Pisa (original) (raw)
Papers by Michele Lisanti
We describe a case report of a 28-year-old man left handed Jehovah's Witness laborer assessed 12 ... more We describe a case report of a 28-year-old man left handed Jehovah's Witness laborer assessed 12 weeks
after bilateral anterior shoulder dislocation. The patient was evaluated with clinical examination, and it was observed an
asymptomatic intrarotation of both shoulders with a mild left circumflex nerve deficit. He was able to perform flexion and
abduction of both arms up to 60° and 10° of extrarotation. Pre-operative constant scores were 49 in left and 55 in right
shoulder, pre-operative disabilities of the arm, shoulder, and hand (DASH) scores were 57 in left and 53 in right shoulder,
and visual analogue scales (VAS) was 2. Radiological examination were bilateral anteroposterior shoulder X-rays and
computer tomography scan. The surgeon treated both shoulder (not simultaneously) by open reduction and Bristow-
Latarjet coracoids transfer procedure. A 1 year after operations, left flexion was 180° while right was 160, bilateral
abduction was 180. He was able to return to his pre-injury activities, the constant score was 89 left and 83 right, DASH
score was 17 left and 13 right and VAS was 0.
Italian journal of orthopaedics and traumatology
ABSTRACT
Acta orthopaedica Belgica
... Arrived: novembre 2001 Accepted: aprile 2002 Corrispondence: Dr. Domenico Sergio Poggi, Via L... more ... Arrived: novembre 2001 Accepted: aprile 2002 Corrispondence: Dr. Domenico Sergio Poggi, Via Livornese, 427 56010 Pisa - Telefax 050/961023 - E-mail ... 8. Castagnaro A, Curini Galletti F. Epicondilalgia omerale esterna: confronto tra le tecniche di Froimson e di Hoh-mann. ...
La Chirurgia degli Organi di Movimento
La Chirurgia degli Organi di Movimento
The authors report their experience in the treatment of traumatic injuries of Lisfranc's ... more The authors report their experience in the treatment of traumatic injuries of Lisfranc's joint based on 30 cases treated by surgery between 1984 and 1999. All of the patients were re-evaluated clinically and radiographically. What emerges from the study is the need for surgical stabilization with percutaneous Kirschner wires or by open procedure in cases where there are doubts or where reduction is impossible. The prognosis is worse in injuries of the medial column and in exposed fractures or when mortification of the soft tissues is present.
Riv Chir Mano - Vol. 38 (3) 2001 A review about surgical treatment applied for 68 cases of radial... more Riv Chir Mano - Vol. 38 (3) 2001 A review about surgical treatment applied for 68 cases of radial head fractures SUMMARY. The authors report their experience about surgical treatment of radial head fractures, as a result performed on 68 pa- tients. We obtained good results with osteosynthesis in fracture type IIa and IIb (according to Mason-Radin), and with excision
Zentralblatt für allgemeine Pathologie und pathologische Anatomie
RIASSUNTO I moderni principi di chirurgia protesica di anca iniziano negli anni 60 ad opera di Si... more RIASSUNTO I moderni principi di chirurgia protesica di anca iniziano negli anni 60 ad opera di Sir Charnley, tuttavia da allora notevoli sono stati i miglioramenti nel disegno degli impianti e nella scelta dei materiali, creando un variegato universo di possibili accoppia-menti protesici. Scopo di questo lavoro è fornire dei solidi principi morfometrici per operare la scelta del tipo di impianto da eseguire. Tuttavia poiché scegliere la protesi giusta può non voler dire eseguire un buon impianto vengono analizzate i sistemi variegati sistemi di navigazione che possono essere utilizzati al ripristino della morfometria. Parole chiave: navigazione, planning, protesi, anca, morfometria SUMMARY The modern principles of total hip replacement began in years sixty thank to Sir Charnley, however since then remarkable improve-ments have been performed, in terms of design of the systems and materials, creating a complicated universe of possible pros-thetic complexes. Aim of the work is to supp...
Even if the skeleton is the third preferential metastatic site after the liver and the lung, digi... more Even if the skeleton is the third preferential metastatic site after the liver and the lung, digital metastases are rare, even more as initial sign of lung adenocarcinoma. Usually finger metastases present with swelling, warmth and dull pain that becomes throbbing whit time. Because of the rarity of acrometastases, especially as the presenting lesion, they are often misdiagnosed as a benigncondition. Amputation of the involved finger is by far the most frequent surgical methodology. Unfortunately, at this time, the primary tumor has invariably spread to diffusely involve other organs and usually patients' survival is only few months. Management should be targeted to patient’s comfort, prevention of infections, and maintenance of function. In this report we present a case of a 66-years old caucasian male in which initial sign of a lung ade nocarcinoma was metastasis to the fourth toe. The patient was affected by non-insulin dependent diabe tes and had a 3-months history of “infec...
Introduction Total knee replacement (TKR) is one of the most common orthopaedic procedures perfor... more Introduction Total knee replacement (TKR) is one of the most common orthopaedic procedures performed in Italy with an increase practice of 11 % from 2001 to 2009. The current need is therefore to reduce hospital length of stay in order to meet the increased demand and lower the costs of hospitalization. Materials and methodsPost-operative outcomes of patients who underwent TKR at the 1st Orthopaedic Division of Pisa University between April 2008 and September 2009 were evaluated retrospectively. The sample consisted of 100 patients with a mean age of 70 years. All patients diagnosed with knee osteoarthritis undertaking a primary TKR were included in the study. Referring to fast-track protocols we have considered: age, sex, BMI, co-morbidities and ASA score, number of blood units transfused, post-operative analgesia protocol, physiotherapy protocol, day of the week when surgical procedure was performed, surgical access route. Each parameter was correlated with length of stay in order...
Introduction Titanium has been used in clinical practice for 35 years and it has proven to be ext... more Introduction Titanium has been used in clinical practice for 35 years and it has proven to be extremely biocompatible. The further development of porous titanium has made it an excellent material for prosthesis implant. The aim of this paper is to present the first experiences with Vitae Adler Ortho Stem neck retaining modular stem built with Ti-Por_ titanium. Materials and methods We will report the preliminary experiences with Vitae Stem in the 1st Orthopaedic Department of Pisa. The preoperative evaluation included X-rays of the hip, clinical evaluation, Harris Hip Score and Western Ontario and McMaster Universities Arthritis Index. The surgical approach was postero-lateral in all patients. We collected clinical and radiological data. Results The intraoperative results using this stem showed an excellent primary stability due to triplanar stability of such kind of stem and to titanium Ti-Por_ roughness. The modularity (27 different neck combinations) allowed an easier implant tec...
Acute compartment syndrome (ACS) is a terrible complication that can occur in tibial fractures, e... more Acute compartment syndrome (ACS) is a terrible complication that can occur in tibial fractures, especially following high energy trauma, and if it is misdiagnosed it could bring to severe consequences. In this report we present a case of a 19-year-old caucasian male rugby player with a medial tibial plateau fracture atypically occurred after a low energy non-contact injury during sports. The diagnosis is generally clinic, based on physical examination, characterized by classic symptoms like severe pain, pallor or pulselessness and on accurated patient history taking. Unfortunately, in rare cases, clinical details are not enough and even further investigations can not predict wether the chosen surgical treatment will be completely decisive or another procedure will be necessary.
La Chirurgia degli Organi di Movimento
Ganglion cysts responsible for compression syndrome of the lower branch of the suprascapular nerv... more Ganglion cysts responsible for compression syndrome of the lower branch of the suprascapular nerve are described, but they are rare. The authors describe a well-documented case that was treated in a traditional manner by exeresis conducted through posterior access. Pain was relieved immediately, while force in external rotation and electromyographic findings improved as early as two months after surgery. One year after surgery the patient does not complain of the recurrence of symptoms. The literature is analyzed and therapeutic options available are discussed.
La Chirurgia degli Organi di Movimento
When a chondroma is localized in the superficial region of the bone it is defined periosteal or j... more When a chondroma is localized in the superficial region of the bone it is defined periosteal or juxtacortical chondroma. This is a rare and benign cartilaginous lesion that more frequently affects males, and is generally observed in the tubular bones of the hand; it may, however, affect the other major bones, particularly the proximal end of the humerus. Age of onset is the second or third decade of life. Symptoms include moderate local pain. The clinical case presented here has two special features: the first is the site; based on an analysis of the international literature it seems that an analogous lesion at the level of the radial neck has not as yet been described; the second is the symptomatology that brought the patient to our attention.
Clinical cases in mineral and bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases, 2012
The hip fractures appear to be a real epidemic problem, especially in the western world, due prim... more The hip fractures appear to be a real epidemic problem, especially in the western world, due primarily to higher average age. The social and economical impact is considerable with a continue social and health costs up-rising. The female-male ratio is approximately 8:1. The purpose of this report is to present a system of osteosynthesis for fractures of the lateral femoral neck. This system is a plate developed by INTRAUMA O'nil(®), 3-hole plate with an 130° angle of valgus and 7° of anteversion. At the I Orthopedic Department at the University of Pisa from January 2009 to February 2012 were treated 52 fractures of the femur neck side with this system. All patients undergone to a clinical and X-ray evaluation according to the AO classification: 14 31-A1, 7 31-A2, 4 31-A3. The mean follow-up was 10 months, in all cases we did not have cut-outs with a TAD average of 23 mm. This system offers the possibility to perform surgery quickly with low risk of cut-out thanks to 7° of antever...
Journal of Wrist Surgery, 2015
Background Screw fixation and bone grafting are the gold standard for scaphoid waist nonunion wit... more Background Screw fixation and bone grafting are the gold standard for scaphoid waist nonunion without avascular necrosis. Question/Purpose Assesses the scaphoid waist nonunion healing rate with use of an uncommon cancellous bone graft (olecranon) and an unusual fixation system (Asnis Micro Cannulated Screw System; Stryker Inc., Kalamazoo, MI, USA). Material and Methods A series of 102 consecutive patients were treated for scaphoid waist nonunion (without deformity). Of these, 80 patients subjected to clinical (Modified Mayo Wrist Score (MMWS), Jamar hydraulic dynamometer) and radiographic examination before and after surgery were evaluated. Ipsilateral olecranon cancellous bone graft and the ASNIS Micro 3.0-mm diameter screw, were used. The average follow up was 6 years (min 3; max 10). Results Radiographic consolidation was achieved in 90% of patients; dorsal intercalated segment instability (DISI) deformities were corrected in 71.4% of cases. Ninety percent improved the range of motion of the wrist and grip strength. All patients showed a significant reduction of peak force in the operated hand. In 6.25% we observed clinical and radiographic screw head-trapezium impingement. Twenty-six patients developed a degenerative wrist sign. The MMWS yielded 68 optimal, 8 good, and 4 bad results. Conclusions To treat scaphoid waist nonunions without misalignment, low-profile headed screw and olecranon bone graft allowed a high consolidation rate with positive results to long-term follow-up. The Asnis Micro 3.0 mm diameter screw may be a suitable option for treating scaphoid waist nonunion. Level of Evidence IV.
The International journal of artificial organs
The purpose of this study was the design and preliminary feasibility study of an advanced tempora... more The purpose of this study was the design and preliminary feasibility study of an advanced temporary hip prosthesis acting as an in-site drug dispensing system. An interactive device was designed to improve the recovery of bone infections compared to the mechanical spacers currently used in septic mobilizations. A commercial device was chosen and modified specifically for the purpose. First of all, the device was provided with a hydraulic multi-channel system connected via catheter to a subcutaneous valve, refillable with a drug aqueous solution from the outside. Moreover, since it allows samples of biological fluids for analyses to be drawn directly from the implantation site, this chemical dispensing system was designed to allow the course of infections to be monitored and customized therapies to be dosed. The insertion of biocompatible membranes inside the channel ends was considered essential to prevent their occlusion by fibrous tissue growth, thereby preserving the device funct...
La Chirurgia degli organi di movimento
The authors evaluate the results of a series of cases treated by surgery for fractures of the ast... more The authors evaluate the results of a series of cases treated by surgery for fractures of the astragalus at the IInd Orthopaedic Division of the University of Pisa between 1978 and 1998. Treatment consisted in reduction and stabilization of the fractures by percutaneous route or by anterolateral approach. Prognosis for fractures of the neck worsens as the Hawkins radiographic classification of degrees increases. Based on the Hawkins clinical evaluation form, excellent and good results were obtained in 56% of cases. Radiographic evaluation confirmed the effectiveness of the Hawkins sign for the prediction of necrosis of the body; this necrosis occurred in 37.5% of cases; arthrosis of the astragalus developed in about half of the patients, which was, however, not always associated with stiffness of this joint. A stiff astragalus was the most fastidious complication, after necrosis of the astragalar body.
We describe a case report of a 28-year-old man left handed Jehovah's Witness laborer assessed 12 ... more We describe a case report of a 28-year-old man left handed Jehovah's Witness laborer assessed 12 weeks
after bilateral anterior shoulder dislocation. The patient was evaluated with clinical examination, and it was observed an
asymptomatic intrarotation of both shoulders with a mild left circumflex nerve deficit. He was able to perform flexion and
abduction of both arms up to 60° and 10° of extrarotation. Pre-operative constant scores were 49 in left and 55 in right
shoulder, pre-operative disabilities of the arm, shoulder, and hand (DASH) scores were 57 in left and 53 in right shoulder,
and visual analogue scales (VAS) was 2. Radiological examination were bilateral anteroposterior shoulder X-rays and
computer tomography scan. The surgeon treated both shoulder (not simultaneously) by open reduction and Bristow-
Latarjet coracoids transfer procedure. A 1 year after operations, left flexion was 180° while right was 160, bilateral
abduction was 180. He was able to return to his pre-injury activities, the constant score was 89 left and 83 right, DASH
score was 17 left and 13 right and VAS was 0.
Italian journal of orthopaedics and traumatology
ABSTRACT
Acta orthopaedica Belgica
... Arrived: novembre 2001 Accepted: aprile 2002 Corrispondence: Dr. Domenico Sergio Poggi, Via L... more ... Arrived: novembre 2001 Accepted: aprile 2002 Corrispondence: Dr. Domenico Sergio Poggi, Via Livornese, 427 56010 Pisa - Telefax 050/961023 - E-mail ... 8. Castagnaro A, Curini Galletti F. Epicondilalgia omerale esterna: confronto tra le tecniche di Froimson e di Hoh-mann. ...
La Chirurgia degli Organi di Movimento
La Chirurgia degli Organi di Movimento
The authors report their experience in the treatment of traumatic injuries of Lisfranc's ... more The authors report their experience in the treatment of traumatic injuries of Lisfranc's joint based on 30 cases treated by surgery between 1984 and 1999. All of the patients were re-evaluated clinically and radiographically. What emerges from the study is the need for surgical stabilization with percutaneous Kirschner wires or by open procedure in cases where there are doubts or where reduction is impossible. The prognosis is worse in injuries of the medial column and in exposed fractures or when mortification of the soft tissues is present.
Riv Chir Mano - Vol. 38 (3) 2001 A review about surgical treatment applied for 68 cases of radial... more Riv Chir Mano - Vol. 38 (3) 2001 A review about surgical treatment applied for 68 cases of radial head fractures SUMMARY. The authors report their experience about surgical treatment of radial head fractures, as a result performed on 68 pa- tients. We obtained good results with osteosynthesis in fracture type IIa and IIb (according to Mason-Radin), and with excision
Zentralblatt für allgemeine Pathologie und pathologische Anatomie
RIASSUNTO I moderni principi di chirurgia protesica di anca iniziano negli anni 60 ad opera di Si... more RIASSUNTO I moderni principi di chirurgia protesica di anca iniziano negli anni 60 ad opera di Sir Charnley, tuttavia da allora notevoli sono stati i miglioramenti nel disegno degli impianti e nella scelta dei materiali, creando un variegato universo di possibili accoppia-menti protesici. Scopo di questo lavoro è fornire dei solidi principi morfometrici per operare la scelta del tipo di impianto da eseguire. Tuttavia poiché scegliere la protesi giusta può non voler dire eseguire un buon impianto vengono analizzate i sistemi variegati sistemi di navigazione che possono essere utilizzati al ripristino della morfometria. Parole chiave: navigazione, planning, protesi, anca, morfometria SUMMARY The modern principles of total hip replacement began in years sixty thank to Sir Charnley, however since then remarkable improve-ments have been performed, in terms of design of the systems and materials, creating a complicated universe of possible pros-thetic complexes. Aim of the work is to supp...
Even if the skeleton is the third preferential metastatic site after the liver and the lung, digi... more Even if the skeleton is the third preferential metastatic site after the liver and the lung, digital metastases are rare, even more as initial sign of lung adenocarcinoma. Usually finger metastases present with swelling, warmth and dull pain that becomes throbbing whit time. Because of the rarity of acrometastases, especially as the presenting lesion, they are often misdiagnosed as a benigncondition. Amputation of the involved finger is by far the most frequent surgical methodology. Unfortunately, at this time, the primary tumor has invariably spread to diffusely involve other organs and usually patients' survival is only few months. Management should be targeted to patient’s comfort, prevention of infections, and maintenance of function. In this report we present a case of a 66-years old caucasian male in which initial sign of a lung ade nocarcinoma was metastasis to the fourth toe. The patient was affected by non-insulin dependent diabe tes and had a 3-months history of “infec...
Introduction Total knee replacement (TKR) is one of the most common orthopaedic procedures perfor... more Introduction Total knee replacement (TKR) is one of the most common orthopaedic procedures performed in Italy with an increase practice of 11 % from 2001 to 2009. The current need is therefore to reduce hospital length of stay in order to meet the increased demand and lower the costs of hospitalization. Materials and methodsPost-operative outcomes of patients who underwent TKR at the 1st Orthopaedic Division of Pisa University between April 2008 and September 2009 were evaluated retrospectively. The sample consisted of 100 patients with a mean age of 70 years. All patients diagnosed with knee osteoarthritis undertaking a primary TKR were included in the study. Referring to fast-track protocols we have considered: age, sex, BMI, co-morbidities and ASA score, number of blood units transfused, post-operative analgesia protocol, physiotherapy protocol, day of the week when surgical procedure was performed, surgical access route. Each parameter was correlated with length of stay in order...
Introduction Titanium has been used in clinical practice for 35 years and it has proven to be ext... more Introduction Titanium has been used in clinical practice for 35 years and it has proven to be extremely biocompatible. The further development of porous titanium has made it an excellent material for prosthesis implant. The aim of this paper is to present the first experiences with Vitae Adler Ortho Stem neck retaining modular stem built with Ti-Por_ titanium. Materials and methods We will report the preliminary experiences with Vitae Stem in the 1st Orthopaedic Department of Pisa. The preoperative evaluation included X-rays of the hip, clinical evaluation, Harris Hip Score and Western Ontario and McMaster Universities Arthritis Index. The surgical approach was postero-lateral in all patients. We collected clinical and radiological data. Results The intraoperative results using this stem showed an excellent primary stability due to triplanar stability of such kind of stem and to titanium Ti-Por_ roughness. The modularity (27 different neck combinations) allowed an easier implant tec...
Acute compartment syndrome (ACS) is a terrible complication that can occur in tibial fractures, e... more Acute compartment syndrome (ACS) is a terrible complication that can occur in tibial fractures, especially following high energy trauma, and if it is misdiagnosed it could bring to severe consequences. In this report we present a case of a 19-year-old caucasian male rugby player with a medial tibial plateau fracture atypically occurred after a low energy non-contact injury during sports. The diagnosis is generally clinic, based on physical examination, characterized by classic symptoms like severe pain, pallor or pulselessness and on accurated patient history taking. Unfortunately, in rare cases, clinical details are not enough and even further investigations can not predict wether the chosen surgical treatment will be completely decisive or another procedure will be necessary.
La Chirurgia degli Organi di Movimento
Ganglion cysts responsible for compression syndrome of the lower branch of the suprascapular nerv... more Ganglion cysts responsible for compression syndrome of the lower branch of the suprascapular nerve are described, but they are rare. The authors describe a well-documented case that was treated in a traditional manner by exeresis conducted through posterior access. Pain was relieved immediately, while force in external rotation and electromyographic findings improved as early as two months after surgery. One year after surgery the patient does not complain of the recurrence of symptoms. The literature is analyzed and therapeutic options available are discussed.
La Chirurgia degli Organi di Movimento
When a chondroma is localized in the superficial region of the bone it is defined periosteal or j... more When a chondroma is localized in the superficial region of the bone it is defined periosteal or juxtacortical chondroma. This is a rare and benign cartilaginous lesion that more frequently affects males, and is generally observed in the tubular bones of the hand; it may, however, affect the other major bones, particularly the proximal end of the humerus. Age of onset is the second or third decade of life. Symptoms include moderate local pain. The clinical case presented here has two special features: the first is the site; based on an analysis of the international literature it seems that an analogous lesion at the level of the radial neck has not as yet been described; the second is the symptomatology that brought the patient to our attention.
Clinical cases in mineral and bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases, 2012
The hip fractures appear to be a real epidemic problem, especially in the western world, due prim... more The hip fractures appear to be a real epidemic problem, especially in the western world, due primarily to higher average age. The social and economical impact is considerable with a continue social and health costs up-rising. The female-male ratio is approximately 8:1. The purpose of this report is to present a system of osteosynthesis for fractures of the lateral femoral neck. This system is a plate developed by INTRAUMA O'nil(®), 3-hole plate with an 130° angle of valgus and 7° of anteversion. At the I Orthopedic Department at the University of Pisa from January 2009 to February 2012 were treated 52 fractures of the femur neck side with this system. All patients undergone to a clinical and X-ray evaluation according to the AO classification: 14 31-A1, 7 31-A2, 4 31-A3. The mean follow-up was 10 months, in all cases we did not have cut-outs with a TAD average of 23 mm. This system offers the possibility to perform surgery quickly with low risk of cut-out thanks to 7° of antever...
Journal of Wrist Surgery, 2015
Background Screw fixation and bone grafting are the gold standard for scaphoid waist nonunion wit... more Background Screw fixation and bone grafting are the gold standard for scaphoid waist nonunion without avascular necrosis. Question/Purpose Assesses the scaphoid waist nonunion healing rate with use of an uncommon cancellous bone graft (olecranon) and an unusual fixation system (Asnis Micro Cannulated Screw System; Stryker Inc., Kalamazoo, MI, USA). Material and Methods A series of 102 consecutive patients were treated for scaphoid waist nonunion (without deformity). Of these, 80 patients subjected to clinical (Modified Mayo Wrist Score (MMWS), Jamar hydraulic dynamometer) and radiographic examination before and after surgery were evaluated. Ipsilateral olecranon cancellous bone graft and the ASNIS Micro 3.0-mm diameter screw, were used. The average follow up was 6 years (min 3; max 10). Results Radiographic consolidation was achieved in 90% of patients; dorsal intercalated segment instability (DISI) deformities were corrected in 71.4% of cases. Ninety percent improved the range of motion of the wrist and grip strength. All patients showed a significant reduction of peak force in the operated hand. In 6.25% we observed clinical and radiographic screw head-trapezium impingement. Twenty-six patients developed a degenerative wrist sign. The MMWS yielded 68 optimal, 8 good, and 4 bad results. Conclusions To treat scaphoid waist nonunions without misalignment, low-profile headed screw and olecranon bone graft allowed a high consolidation rate with positive results to long-term follow-up. The Asnis Micro 3.0 mm diameter screw may be a suitable option for treating scaphoid waist nonunion. Level of Evidence IV.
The International journal of artificial organs
The purpose of this study was the design and preliminary feasibility study of an advanced tempora... more The purpose of this study was the design and preliminary feasibility study of an advanced temporary hip prosthesis acting as an in-site drug dispensing system. An interactive device was designed to improve the recovery of bone infections compared to the mechanical spacers currently used in septic mobilizations. A commercial device was chosen and modified specifically for the purpose. First of all, the device was provided with a hydraulic multi-channel system connected via catheter to a subcutaneous valve, refillable with a drug aqueous solution from the outside. Moreover, since it allows samples of biological fluids for analyses to be drawn directly from the implantation site, this chemical dispensing system was designed to allow the course of infections to be monitored and customized therapies to be dosed. The insertion of biocompatible membranes inside the channel ends was considered essential to prevent their occlusion by fibrous tissue growth, thereby preserving the device funct...
La Chirurgia degli organi di movimento
The authors evaluate the results of a series of cases treated by surgery for fractures of the ast... more The authors evaluate the results of a series of cases treated by surgery for fractures of the astragalus at the IInd Orthopaedic Division of the University of Pisa between 1978 and 1998. Treatment consisted in reduction and stabilization of the fractures by percutaneous route or by anterolateral approach. Prognosis for fractures of the neck worsens as the Hawkins radiographic classification of degrees increases. Based on the Hawkins clinical evaluation form, excellent and good results were obtained in 56% of cases. Radiographic evaluation confirmed the effectiveness of the Hawkins sign for the prediction of necrosis of the body; this necrosis occurred in 37.5% of cases; arthrosis of the astragalus developed in about half of the patients, which was, however, not always associated with stiffness of this joint. A stiff astragalus was the most fastidious complication, after necrosis of the astragalar body.