The Padel phenomenon after the COVID-19: an Italian cross-sectional survey of post-lockdown injuries.

The impact of COVID-19 on sport and physical activity has been a subject of considerable interest and concern. Padel satisfies the desire for social interaction and a return to sport after a period of inactivity. The aim of this study is to show a correlation between return to sport and related injuries in a population of Padel players. The study was carried out in a survey mode, consisting of a questionnaire with four sections and fifty questions on the biographical data of the individual, lifestyle before and after the pandemic, knowledge and playing level of Padel and injuries. The self-administered online questionnaire was developed and validated by a panel of physiotherapists, orthopaedic surgeons, and physiatrists with experience in clinical practice and/or musculoskeletal research. The study was conducted in a survey mode from a smartphone or computer via a link to a multiple-choice document. The link to the questionnaire was distributed via mailing lists, social media, and chat applications.

Chemical-Physical Characterization of PET-G-Based Material for Orthodontic Use: Preliminary Evaluation of micro-Raman Analysis.

OBJECTIVES: Orthodontic treatment with clear thermoplastic aligners is in great demand by patients especially for aesthetics. Any alterations in the chemical composition of the thermoplastic material for aligners, subjected to the oral environment and exposure to various commonly used substances, could influence the desired orthodontic movement decreasing the predictability of the treatment. The objective of this study was to determine the chemical-physical characterization by micro-Raman spectroscopy of a thermoplastic material based on polyethylene terephthalate glycol (PET-G) used for the manufacture of Lineo aligners (Micerium Lab, Avegno, Italy) subjected to different staining beverages and cleaning agents. MATERIALS AND METHODS: Twenty-two thermoformed PET-G samples were immersed to various substances of daily use for 10 and 15 days (coffee, tea, Coca-Cola, red wine, colloidal silver disinfectant, nicotine, artificial saliva, cigarette smoke, and different combinations of saliva with some of the previous solutions). Subsequently, the chemical-physical characterization was investigated by micro-Raman spectroscopy. RESULTS: The analysis of the spectra acquired for all the specimens showed no difference in the exposure to the different solvents at 10 and 15 days. Furthermore, having ascertained the heterogeneous surface morphology of the PET-G material due to thermoforming, various deposits were present on all the samples whose consistency and concentration depended on the substance used. CONCLUSION: The spectroscopic investigations have provided a precise and detailed analysis of the qualitative and structural data of the PET-G material under examination. No significant structural modifications of the thermoplastic polymer were found after immersion in different solutions in the exposure times adopted.

Screw Stress Distribution in a Clavicle Fracture with Plate Fixation: A Finite Element Analysis.

Clavicle midshaft fractures are mostly treated surgically by open internal reduction with a superior or anteroinferior plate and screws or by intramedullary nailing. Screw positioning plays a critical role in determining the stress distribution. There is a lack of data on the screw position and the appropriate number of cortices required for plate fixation. The aim of this study is to evaluate the mechanical behavior of an anterior plate implanted in a fractured bone subjected to 120° of lateral elevation compared to a healthy clavicle using numerical simulations. Contact forces and moments used were obtained from literature data and applied to the healthy and fractured finite element models. Stresses of about 9 MPa were found on the healthy clavicle, while values of about 15 MPa were calculated on the plate of the fractured one; these stress peaks were reached at about 30° and 70° of elevation when the stress shielding on the clavicle sums all the three components of the solicitation: compression, flexion, and torsion. The stress distribution in a clavicle fracture stabilized with plates and screws is influenced by several factors, including the plate's position and design, the type of screw, and the biomechanical forces applied during movements.

Physiologic Response Evaluation of Human Foetal Osteoblast Cells within Engineered 3D-Printed Polylactic Acid Scaffolds.

Large bone defect treatments have always been one of the important challenges in clinical practice and created a huge demand for more efficacious regenerative approaches. The bone tissue engineering (BTE) approach offered a new alternative to conventional bone grafts, addressing all clinical needs. Over the past years, BTE research is focused on the study and realisation of new biomaterials, including 3D-printed supports to improve mechanical, structural and biological properties. Among these, polylactic acid (PLA) scaffolds have been considered the most promising biomaterials due to their good biocompatibility, non-toxic biodegradability and bioresorbability. In this work, we evaluated the physiological response of human foetal osteoblast cells (hFOB), in terms of cell proliferation and osteogenic differentiation, within oxygen plasma treated 3D-printed PLA scaffolds, obtained by fused deposition modelling (FDM). A mechanical simulation to predict their behaviour to traction, flexural or torque solicitations was performed. We found that: 1. hFOB cells adhere and grow on scaffold surfaces; 2. hFOB grown on oxygen plasma treated PLA scaffolds (PLA_PT) show an improvement of cell adhesion and proliferation, compared to not-plasma treated scaffolds (PLA_NT); 3. Over time, hFOB penetrate along strands, differentiate, and form a fibrous matrix, tissue-like; 4. 3D-printed PLA scaffolds have good mechanical behaviour in each analysed configuration. These findings suggest that 3D-printed PLA scaffolds could represent promising biomaterials for medical implantable devices in the orthopaedic field.

Finite element analysis of sagittal balance in different morphotype: Forces and resulting strain in pelvis and spine.

In humans, vertical posture acquisition caused several changes in bones and muscles which can be assumed as verticalization. Pelvis, femur, and vertebral column gain an extension position which decreases muscular work by paravertebral muscles in the latter. It's widely known that six different morphological categories exist; each category differs from the others by pelvic parameters and vertebral column curvatures. Both values depend on the Pelvic Incidence, calculated as the angle between the axes passing through the rotation centre of the two femur heads and the vertical axis passing through the superior plate of the sacrum. The aim of this study is to evaluate the distribution of stress and the resulting strain along the axial skeleton using finite element analysis. The use of this computational method allows performing different analyses investigating how different bony geometries and skeletal structures can behavior under specific loading conditions. A computerized tomography (CT) of artificial bones, carried on at 1.5 mm of distance along sagittal, coronal and axial planes with the knee at 0° flexion (accuracy 0.5 mm), was used to obtain geometrical data of the model developed. Lines were imported into a commercial code (Hypermesh by Altair®) in order to interpolate main surfaces and create the solid version of the model. In particular six different models were created according Roussoly's classification, by arranging geometrical position of the skeletal components. Loading conditions were obtained by applying muscular forces components to T1 till to L5, according to a reference model (Daniel M. 2011), and a fixed constrain was imposed on the lower part of the femurs. Materials were assumed as elastic with an Elastic modulus of 15 GPa, a Shear Modulus of 7 GPa for bony parts, and an Elastic modulus of 6 MPa, a Shear Modulus of 3 MPa for cartilaginous parts. Six different simulations have been carried out in order to evaluate the mechanical behavior of the human vertebral column arranged according to the Russoly's classification; results confirm higher solicitations obtained varying configurations from case I to case VI. In particular way, first three cases seem to supply the different loading configurations spreading stresses in almost all the bony parts of the column, while the remaining others three cases produce an higher concentration of stress around the lower part of spine (L3, L4, L5). Results confirm a good agreement with those present in literature (Winkle et al., 1999), an equivalent Von Mises average stress was of 0,55 MPa was found on the intervertebral disks with the higher values reached on the lower part of the column. A comparison of results obtained for Case I with literature (Galbusera et al., and El Rich et al., 2004), shows a good agreement in terms of normal compressive force, while more evident differences with Galbusera's results can be found for shear force and sagittal moment. The results underline a relationship between PI increase, and accordingly of PT and LL, and the distribution of load forces. Load forcesi is exerted mainly on distal vertebrae, especially on L4 and L5.

Stress shielding in the bony chain of leg in presence of varus or valgus knee.

AIMS: The aim was to assess how the stress shielding can influence the integrity and resistance of bones in presence of a misalignment. METHODS: Three finite elements models have been developed: a normal one, and two varus and valgus knee ones. RESULTS: The obtained results reveal interesting consequences deriving by a wrong disposition of parts which compose the skeletal chain of the leg. CONCLUSION: The most dangerous conditions occur in the contact interface between pelvis and hip of the femur, for the valgus knee configuration, and for the varus one, at the contact interface around the knee zone.

The healing stages of an intramedullary implanted tibia: A stress strain comparative analysis of the calcification process.

AIMS: The extended usage of unreamed tibial nailing resulted in reports of an increased rate of complications, especially for the distal portion of the tibia. Unreamed nailing favours biology at the expense of the achievable mechanical stability, it is therefore of interest to define the limits of the clinical indications for this method. Extra-articular fractures of the distal tibial metaphysis, meta-diaphyseal junction, and adjacent diaphysis are distinct in their management from impaction derived ''pilon'' type fractures and mid-diaphyseal fractures. The goals of this work were to gain a thorough understanding of the load-sharing mechanism between unreamed nail and bones in a fractured tibia. With this purpose a complete model of the human leg was realised, simulating a mid-diaphyseal fracture, classified as A2 type 1, according to the AO classification. The analysis of the entire chain allows to have a complete picture of the stress distribution and of the most stressed bones and soft tissues, but, more importantly can overcome problems connected with boundary conditions imposed at single bony components. METHODS: Model consists of six bony structures: pelvis, femur, patella, fibula, tibia, and a simplified lump of the feet, configured in a standing up position. Their articular cartilage layers, were simulated by 3D membranes of opportune stiffness connecting the different segments. Moreover an unreamed intra-medullary nail Expert Tibial Nail (DePuy Synthes(®)) stabilized the fractured tibia. A load of 700 N has been applied at the top of pelvis and a part the feet, at the tip, was rigidly fixed. Five different contact interfaces have been imposed at the different bony surfaces in contact. RESULTS: Three different conditions were analysed: the initially healthy tibia, the A2 type 1 fractured tibia with the Expert tibial nail implanted, and the follow up stage after complete healing of tibia. Non-linear finite element analysis of the models were performed with Abaqus version 5.4 (Hibbitt, Karlsson and Sorensen, Inc., Pawtucket, RI) using the geometric non linearity and automatic time stepping options. CONCLUSION: The obtained results reveal interesting consequences deriving by taking into account how the stress shielding can influence the integrity and resistance of bones, in order to identify the mechanical reasons for the unfavourable clinical results, and to identify borderline indications due to biomechanical factors. The evolution of treatment options for these fractures has been closely linked to developments in implant technology and surgical technique. Further developments in this area, particularly with respect to minimally invasive plating techniques and nail design are ongoing.

FE analysis of stress and displacements occurring in the bony chain of leg.

AIMS: The aim of this study was to assess how the stress shielding can influence the integrity and resistance of bones. METHODS: With this purpose a complete FE model of the human leg was realised. A load of 700 N has been applied at the top of pelvis and the feet, at the tip, was rigidly fixed. RESULTS: Obtained results reveal interesting consequences deriving by taking into account the complete bony chain. CONCLUSION: A comparison among the literature data and our models can furnish a complete vision of the global spreading of the forces along the various bony components.

In vitro biomechanical evaluation of antegrade femoral nailing at early and late postoperative stages.

The present study addresses the question of evaluating, by combining both experimental and numerical methods, the stress/strain distribution within a standardized composite femur implanted with an anterograde intramedullary nail. A transverse diaphyseal fracture has been introduced in order to evaluate the implant response in the early postoperative clinical stage. By comparing these experimental data with those obtained in the fully healed stage, in which the bone continuity had been recovered, it was possible to get information on load sharing between the bone and the intramedullary nail, location of high strain concentrations, bone relative motion at the fracture site, and stiffness reduction caused by bone discontinuity. Experimental data were correlated with those predicted by a validated 3D finite element model of the complete implant/femur assembly to investigate the full field stress distribution either in the cortical bone, in the nail or in the locking screws. The obtained results suggest that full weight bearing in the immediate post-operating stage should not be allowed since high stress levels are generated in the outer shell of the cortical bone either around the proximal screw hole or the upper locking screw hole. Long-term implant reliability should be guaranteed instead, since after fracture consolidation equivalent von Mises stresses never exceed critical levels neither in the bone nor in the implant.

Measurement of local strains induced into the femur by trochanteric Gamma nail implants with one or two distal screws.

This study aims to evaluate experimentally the behaviour after fracture consolidation of two intramedullary Gamma nail implants, having one (G1) or two (G2) distal screws, respectively. Nails have been implanted into standardized synthetic femora, instrumented with strain gauges. Strains measurements, supported by finite element numerical modelling, showed that the G2 implant, although ensuring higher flexional and torsional stiffness, can lead to localized contacts that occur between the tip of the nail and the femoral endosteum. This might be one of the reasons of the complications associated with pain in the mid-portion of the thigh after implantation which has been reported in several clinical studies when Gamma nails with two distal screws are used.