The management of pilon fractures: An expert survey of AO trauma Italy members and evidence-based treatment recommendations.

Operative decision-making of tibial pilon fractures is still of great complexity. The AO Trauma Italy has investigated the trend in the management of this fractures among orthopedic surgeons in Italy. A literature-based survey focused on preoperative planning and surgical strategies has been submitted to all the participants and the results were discussed in an online webinar in light of the most recent literature with the aim to outline common treatment recommendations especially useful for young surgeons.

Effect of mechanical stability of osteosynthesis on infection rates: Timing of temporary and definitive fixation.

Fracture related infection (FRI) remains one of the most challenging complications of orthopaedic trauma surgery. Several factors contribute to FRI development but, among those, particularly interesting from the orthopaedic surgeon's perspective is the contribution of mechanical stability and timing of fracture fixation. These are indeed crucial factors both in prevention and treatment of FRI and are directly influenced by the surgeon's work.

Assessing environmental sustainability of substitute feeding formulas for gilthead seabream (Sparus aurata) using Life Cycle Assessment.

The rise in fish and seafood consumption driven by aquaculture comes with its share of challenges and controversies, notably the need for expanded feed production. The use of fishmeal and fish oil to raise carnivorous fish has caused environmental problems, including ecosystem imbalance and habitat destruction, as well as ethical issues like fishing forage fish for feed instead of human consumption. Thus, the industry has been actively pursuing alternative feed ingredients to reduce reliance on fish-derived components.

The outcomes of the management of complex distal tibia and ankle fractures in elderly with tibiotalocalcaneal nail in a minimum 12-month follow-up period.

Purpose: To evaluate the clinical outcomes of the use of tibiotalocalcaneal nail for the treatment of complex distal tibia and ankle fractures in elderly people, in a major trauma centre.

Methods: Elderly patients (age > 65) with distal tibia or ankle fractures that underwent stabilization with a tibiotalocalcaneal nail were eligible to participate. Exclusion criteria were patients that died or were lost to follow-up and cases in which the nail was used in a chronic setting, such as malunion and non-union.

Unstable pelvic fractures in women: implications on obstetric outcome.

Purpose: Obstetric outcomes in women following pelvic injuries requiring surgical fixation is not thoroughly known. We aimed to evaluate if radiographic measurements (RMs) can be used to provide information on delivery methods outcome after these injuries, and to evaluate if metal work removal is required prior to delivery.

Method: A retrospective study in a level 1 trauma centre of female patients with pelvic fractures treated operatively, aged 16-45 at the time of injury.

Choice of treatments of the coronal shear fractures of the humerus. A national survey of Italian AO members.

Introduction: Coronal shear fractures of the distal humerus are uncommon injuries representing 6% of distal humeral fractures. There is no univocal consensus about the correct management of this type of fracture. A national survey was conducted to gain more insight into the current classification, diagnosis and treatment of coronal shear fractures in Italy.

Assessing the environmental performance of plastic-based and felt-based green wall systems in a life-cycle perspective.

With the remarkable growth of cities and the increase of built-up areas, mitigation of urban heat island effects has become one of the most crucial challenges in social and environmental sustainability with significant impacts on public health. This has led to an increasing development of urban green infrastructure. Among those nature-based solutions, green wall systems have been receiving a growing attention, being a passive technology with their ability to reduce greenhouse gas emissions, adapt to climate change, improve air quality and reduce the heat island effect in urban environments.

Forearm segmental bone defect: Successful management using the Masquelet Technique with the aid of 3D printing technology.

The management of forearm nonunion is challenging for orthopaedic surgeons because the forearm is a unique anatomical segment in which all the bones and structures involved embody a complex functional unit. Therefore, when treating such a complex condition, the surgeon must focus not only on bone healing but also on the restoration of the native anatomy in order to replicate the normal relationship between the bones and all the surrounding structures and thus the full function of the forearm, the elbow and the wrist. Here we report the case of a 53-year-old patient with a left forearm deformity due to an atrophic nonunion of the ulna and a malunion of the radius, which was successfully managed with the use of the Masquelet technique associated with a corrective osteotomy of the radius, performed with the aid of a 3D model.

Behavior and Welfare of Undocked Heavy Pigs Raised in Buildings with Different Ventilation Systems.

The present study aimed to evaluate animal welfare of pigs from the same farm, raised with two ventilation systems. The study involved 60 pens of fattening pigs, raised in two buildings: one naturally ventilated (NV) and the other mechanically ventilated (MV). Pigs were assessed on three observation days: at 40 kg (T1), 100 kg (T2), and 160 kg (T3) of live weight.

Adhesives for treatment of bone fractures: A review of the state-of-the art.

Treatment of fractures remains challenging and carries a high economical burden to both patients and society. In order to prevent some of the complications, the use of bone adhesives has been proposed, but up to date, bone adhesives are not part of the current clinical practice. Early results of use of bone cements and bone glues are promising, focusing in the areas of highly fragmented fractures, fixation of long bone fractures, filling bone voids and defects, promoting osseointegration, preventing non-union while maintaining the reduction of fracture fixation.

Prevalence of transthyretin amyloid cardiomyopathy in male patients who underwent bilateral carpal tunnel surgery: The ACTUAL study.

Introduction: Bilateral carpal tunnel syndrome (CTS), particularly in male individuals with left ventricular hypertrophy (LVH), has been recognized as a red flag for transthyretin cardiac amyloidosis (TTR-CA). Nonetheless, the opportunity of screening CTS patients for TTR has yet to be determined.

Methods: Medical records of 1689 CTS surgeries performed at our institution between 2008 and 2018 were reviewed.

Plate osteosynthesis for mid-shaft clavicle fractures: An update.

Introduction: Over the last few years, treatment of mid-shaft clavicle fractures seems to have shifted from conservative to surgical. Our study reports the results of plate osteosynthesis of mid-shaft clavicle fractures and compares them with literature.

Materials And Methods: A retrospective cohort study was conducted on 32 patients with mid-shaft clavicle fractures treated with plate and screws between January 2009 and December 2014.

Optimum timing of conversion from DCO to definitive fixation in closed fractures of the lower limb: When and how?

Introduction: In damage control orthopaedics (DCO), fractures are initially stabilised with external fixation followed by delayed conversion to definitive internal fixation. The aim of this study is to determine whether the timing of the conversion influences the development of deep infection and fracture healing in a cohort of patients treated by DCO after a closed fracture of the lower limb. Furthermore, we wanted to evaluate whether the one-stage conversion procedure is always safe.

Sacral fractures: issues, challenges, solutions.

Sacral fractures are a heterogeneous group of fractures occurring in young people following road traffic accidents and falls from height, or in the elderly with osteoporosis following trivial trauma.This heterogeneity, combined with the low incidence of sacral fractures, determines a lack of experience amongst physicians, often leading to misdiagnosis, underestimation and inadequate treatment. The diagnosis should be made by assessing specific features during the clinical presentation, while computed tomography (CT) scan continues to be the choice of investigation.

Femoral non-union above a fused knee: Successful treatment with exchange nailing and intramedullary delivery of bone morphogenetic protein.

Bone healing is a complex and well-orchestrated physiological process, in which bone repairs and regenerates regaining its original biomechanical and biochemical properties. It is estimated that 5 to 10% of all fractures are complicated by delayed union or non-union. Progression to non-union is thought to be multifactorial, even though the exact biological sequence remains obscure.

Semiextended Tibial Nail Insertion Using an Extraarticular Lateral Parapatellar Approach: A 24-Month Follow-up Prospective Cohort Study.

Objective: To analyze the outcomes of tibial shaft fractures treated with a lateral parapatellar approach in the semiextended position for intramedullary nail insertion.

Design: Prospective cohort study.

Setting: Level I trauma center.

Leeds-Genoa Non-Union Index: a clinical tool for asessing the need for early intervention after long bone fracture fixation.

Aim Of The Study: The aim of this case-control study was to develop a clinical decision rule to support assessment of the risk of long-bone non-union and plan for appropriate early intervention.

Methods: Two hundred patients (100 cases and 100 controls) were recruited. Risk factors identified to contribute to the development of non-union were recorded and analysed with a multivariable logistic regression model.

Aetiology of trauma-related acute compartment syndrome of the leg: A systematic review.

Background: Acute compartment syndrome (ACS) is characterised by abnormal pressure inside a compartment, resulting in ischemia of muscles and nerves. Most orthopaedic surgeons, especially those who work in major trauma centres, have been or will be facing a case of ACS in their clinical activity. Fortunately, complications related to untreated compartment syndrome have become less frequent thanks to a better understanding of pathogenesis and to early recognition and prompt surgical treatment.

Treatment of distal clavicle nonunion with and without bone grafting.

The management of distal clavicle nonunion represents a challenging task for orthopaedic trauma surgeon. Both the choice of the implant and whether a bone graft is needed are controversial points which must be addressed. Particularly, in the case of a hypertrophic nonunion, grafting may not necessarily be needed, but given a poor underlying biological environment, a bone graft becomes necessary in order to enhance fracture healing.

Masquelet technique to treat a septic nonunion after nailing of a femoral open fracture.

Septic nonunion is one of the most serious complications after an open fracture because both the infection and the bone defect need to be dealt with. Treatment is always protracted and expensive, and the result is uncertain. In the 1980s, Masquelet first described the technique of the induced membrane and autologous bone grafting to manage critical size bone defects.

Risk factors for long bone fracture non-union: a stratification approach based on the level of the existing scientific evidence.

Non-union continues to be the most devastating complication after fracture fixation. Its treatment can be prolonged and often unpredictable. The burden to the patient, surgeon and health care system can be immense.

Late recurrent peripheral upper limb ischemia after non-union of a clavicle fracture.

A 74-year-old woman was referred to our hospital due to recurrent episodes of upper limb ischemia. Her past medical history included a clavicle non-union developed after a clavicle midshaft fracture that had occurred 30 years previously. After a long asymptomatic period, she started showing symptoms of chronic ischemia to the left arm that were misdiagnosed.

Loss of negative regulation by Numb over Notch is relevant to human breast carcinogenesis.

The biological antagonism between Notch and Numb controls the proliferative/differentiative balance in development and homeostasis. Although altered Notch signaling has been linked to human diseases, including cancer, evidence for a substantial involvement of Notch in human tumors has remained elusive. Here, we show that Numb-mediated control on Notch signaling is lost in approximately 50% of human mammary carcinomas, due to specific Numb ubiquitination and proteasomal degradation.