Comparative study of polycyclic aromatic hydrocarbons (PAHs) in salt gland and liver of loggerhead turtle Caretta caretta (Linnaeus, Cheloniidae) stranded along the Mediterranean coast, Southern Italy.

The levels of polycyclic aromatic hydrocarbons, PAHs, were determined in the liver and salt gland of 19 loggerhead turtles (Caretta caretta Linnaeus, Cheloniidae) stranded along the coasts of the south Tyrrhenian Sea, Italy, from 2019 to 2021. The 16 EPA's priority PAHs were determined by gas chromatography coupled with mass spectrometry (GC-MS). The average values of ΣPAHs in liver, 139 ± 55.0, were exceptionally high and up to one hundred times those of literature and appeared even more worrying in salt gland, 320 ± 97.6 ng/g, w.w. Naphthalene was the predominant contributor to PAHs richness and accounted for 90.0% and 93.7% of ΣPAHs in the two matrices, highlighting the petrogenic source of exposure. An overall higher bioaccumulation of NAP, more than two-fold, was detected in salt gland and especially in female and adults. Data of PAHs richness highlighted a potential risk of neoplastic disease development and that anthropogenic activities may seriously impair healthy state conditions of C. caretta. populations in south Tyrrhenian Sea.

Self-inflicted long bone fractures for insurance fraud.

Self-inflicted fractures simulating traffic accident represent a new social fraud opportunity for criminality. Recognising scams through an increase of awareness of existence of self-inflicted arm fractures for insurance fraud could help community health workers to report these injuries to the competent authorities. In this article, authors have recognised an unusual but consistent pattern of upper and lower limb fractures whose incidence does not coincide in numerical terms with what is reported in literature. The aim of the present study is to describe fracture patterns observed over the past 2 years. Further, authors describe clinical presentations of these fractures and attempt to define a possible mechanism of these types of injuries.

Three single loops enhance the biomechanical behavior of the transtibial pull-out technique for posterior meniscal root repair.

PURPOSE: To investigate the effect of applying an additional suture to enhance the biomechanical behavior of the suture-meniscus construct used during the transtibial pull-out repair technique. METHODS: A total of 20 fresh-frozen porcine tibiae with intact medial menisci were used. In one half of all specimens (N = 10), two non-absorbable sutures were passed directly over the meniscal root from the tibia side of the meniscus to the femoral side (2SS). In other ten specimens, three sutures were passed over the meniscal root (3SS). All specimens were subjected to cyclic loading followed by load-to-failure testing. Displacement of the construct was recorded at 100, 500, and 1000 cycles. Further, stiffness (500-1000 cycles) and ultimate load and modes of failure of the suture-meniscus construct were also recorded. RESULTS: There was no statistically significant difference between the Group 2SS and Group 3SS at the 1st (1.6 ± 0.7 vs 1.4 ± 0.4 mm) and the 100th cycle (2 ± 0.7 vs 1.8 ± 0.4 mm). At 500 and 1000 cycles, the 2SS fixation technique resulted in significantly more displacement than the 3SS fixation technique (2.8 ± 0.6 vs 2.3 ± 0.5 mm; 3.1 ± 0.7 vs 2.5 ± 0.5 mm) (p < 0.05). No differences between two groups were noted concerning ultimate load to failure and stiffness (500-1000 cycles). CONCLUSION: Three single sutures technique provided superior biomechanical properties compared with the two single sutures technique during the conducted fatigue tests. CLINICAL RELEVANCE: Applying three simple stitches during meniscal root repair might be beneficial for healing of the posterior meniscal root, potentially reducing the post-operative immobilization time.

How to avoid collision between PCL and MCL femoral tunnels during a simultaneous reconstruction.

PURPOSE: The purpose of the present study was to assess the risk of femoral tunnel collisions between the medial collateral ligament (MCL) and the posterior cruciate ligament (PCL) tunnels during a simultaneous PCL and MCL reconstruction. METHODS: Fourth generation medium and large synthetic femur bones were used. On each femur, a MCL tunnel and a PCL tunnel were reamed. The MCL tunnel was drilled at 0°, 20° and 40° of axial and coronal angulations. The PCL femoral tunnel was reamed to simulate two different tunnel directions that could be obtained through an inside-out and outside-in technique. Tunnels were filled with epoxy resin augmented with BaSO4, and a multidetector CT examination of each specimen was performed. RESULTS: High rate of tunnel collision (62.5 %) was found when the MCL femoral tunnel was reamed with a coronal angulation of 0° and 20°. The rate of tunnel collision significantly decreased (0 %) when the MCL tunnel was reamed proximally with a coronal angulation of 40°. No differences were found between the two PCL tunnel directions in terms of tunnel collision. CONCLUSION: The results of this study can help surgeons to better direct the femoral MCL tunnel in order to avoid a collision between femoral tunnels during a combined MCL and PCL reconstruction. In order to minimize such potential complications, the MCL tunnel should be created limiting the axial angulation and it should be drilled with a proximal angulation from 20° to 40°, depending on the medial condyle width.

Biomechanical comparison between the modified rolling-hitch and the modified finger-trap suture techniques.

PURPOSE: The purpose of this study was to characterize the biomechanical effect of two grasping suture techniques used during ligament reconstruction: the modified rolling-hitch (MRH) and the modified finger-trap (MFT). METHODS: Flexor profundus tendons were harvested from fresh pig hind-leg trotters. Each specimen was mounted on an electro-mechanic universal testing machine (Instron 3367). In half of all tendons (15 specimens), the suture was passed around the tendon following the MRH knot (Group 1). In the remaining half of all tendons (15 specimens), the suture was passed over a distance of 30 mm according to the MFT suture technique (Group 2). As per standard intra-operative technique, a 1 cm residual tendon stub was left free from suture in all samples. All specimens were preconditioned to a load of 50 N for 10 min, followed by three cycles loading between 50 and 120 N. At this point, each sample was cyclically tensioned between 35 and 240 N, at 1 Hz for 200 cycles. Load-to-failure test was then carried out at a rate of 200 mm/min. RESULTS: Rupture of the suture material at the knot was the mode of failure in all specimens during the loaded to failure test. Significant difference was found between Group 1 vs Group 2 for the elongation between the 0th cycle and 10th cycle, the elongation between the 10th cycle and 200th cycle, the mean stiffness at the 10th cycle, and the mean stiffness at the 190th cycle. No significant differences were noted between Group 1 and Group 2 concerning the ultimate load-to-failure. CONCLUSION: This study showed that both suture methods appear to be biomechanically effective in a porcine tendon model. However, the single-knot grasping technique (MRH) provided superior biomechanical properties compared with the MFT technique.

FiberWire tension band for patellar fractures.

BACKGROUND: Symptomatic hardware represents the most frequent complication reported following surgical treatment of patellar fracture. For this reason, some authors suggested using nonabsorbable sutures to fix the fracture with various techniques. The aim of this study was to evaluate clinical and radiological results of patients treated following a modified Pyriford technique using a FiberWire suture (Arthrex, Naples, FL, USA). MATERIALS AND METHODS: We retrospectively evaluated a case series of seventeen patients with displaced patellar fractures treated by open reduction and internal fixation with a modified tension band using FiberWire sutures. Clinical and radiological outcome were evaluated. Union time, complications, and reoperation rate were observed and recorded. RESULTS: All fractures healed (time to union 9.2 ± 2 weeks), and no fixation failure was observed. Slight losses of reduction (<4 mm) were noted in two patients at 4 weeks postoperatively. The average Lysholm and Bostman scores at the final follow-up were 91 ± 5.7 (range 83-100) and 28.3 ± 1.6 (range 26-30), respectively. CONCLUSION: Modified tension band using FiberWire sutures showed satisfactory clinical results, with a low incidence of complications and reoperations. FiberWire tension bands could be used in place of metal-wire tension bands to treat patellar fracture, reducing the rate of symptomatic hardware. LEVEL OF EVIDENCE: 4.

Femoral neck's fracture in Fahr's Syndrome: case report.

Fahr's syndrome, also known as "Bilateral Striopallidodentate Calcinosis" (BSPDC) primitive, is a rare neurological disease characterized by the presence of idiopathic, bilateral, symmetrical and abnormal deposition of calcium in areas of the brain that control movements including the basal ganglia, dentate nuclei of the cerebellum, nuclei of thalamus and semi-oval center. We describe a case of a 76-year-old male patient underwent reduction and fixation of a subtrochanteric fracture with intramedullary nail. During post-operative rehabilitation therapists's patient management was difficult due to obvious extrapyramidal symptoms characterized by dysarthria, rigidity, bradykinesia, postural instability. A CT scan, performed for the onset of stiffness and confusion before the operation, showed: IV ventricle eumorphic and in axis; expansion in atrophic sense of supratentorial ventricular system; bilateral, diffuse and coarse calcifications of the basal ganglia in the cerebellar and occipital cortex, elements compatible with Fahr's syndrome. The patient presented repeated postural instability episodes in the upright position, with loss balance tendency and recurrent falls. Fahr's syndrome patient is a "weak" patient, which requires a multi-disciplinary approach in order to prevent the mobility reduction, to improve the condition of postural instability, thus reducing the risk of fractures using preventive measures in domestic environment.

Augmentation of tibial plateau fractures with an injectable bone substitute: CERAMENT™. Three year follow-up from a prospective study.

BACKGROUND: Reduction of tibial plateau fractures and maintain a level of well aligned congruent joint is key to a satisfactory clinical outcome and is important for the return to pre-trauma level of activity. Stable internal fixation support early mobility and weight bearing. The augmentation with bone graft substitute is often required to support the fixation to mantain reduction. For these reasons there has been development of novel bone graft substitutes for trauma applications and in particular synthetic materials based on calcium phosphates and/or apatite combined with calcium sulfates. Injectable bone substitutes can optimize the filling of irregular bone defects. The purpose of this study was to assess the potential of a novel injectable bone substitute CERAMENT™|BONE VOID FILLER in supporting the initial reduction and preserving alignment of the joint surface until fracture healing. METHODS: From June 2010 through May 2011 adult patients presenting with acute, closed and unstable tibial plateau fractures which required both grafting and internal fixation, were included in a prospective study with percutaneous or open reduction and internal fixation (ORIF) augmented with an injectable ceramic biphasic bone substitute CERAMENT™|BONE VOID FILLER (BONESUPPORT™, Lund, Sweden) to fill residual voids. Clinical follow up was performed at 1, 3, 9 and 12 months and any subsequent year; including radiographic analysis and Rasmussen system for knee functional grading. RESULTS: Twenty four patients, balanced male-to-female, with a mean age of 47 years, were included and followed with an average of 44 months (range 41-52 months). Both Schatzker and Müller classifications were used and was type II or 41-B3 in 7 patients, type III or 41-B2 in 12 patients, type IV or 41-C1 in 2 patients and type VI or 41-C3 in 3 patients, respectively. The joint alignement was satisfactory and manteined within a range of 2 mm, with an average of 1.18 mm. The mean Rasmussen knee function score was 26.5, with 14 patients having an excellent result and the remaining 10 with a good result. CONCLUSION: It can be concluded that radiological and clinical outcome was satisfactory and obtained in all cases without complications. This injectable novel biphasic hydroxyapatite and calcium sulfate ceramic material is a valuable armamentarium in the treatment of trauma where bone graft is required.

Effectiveness of a physical barrier for contaminant control in an unconfined coastal plain aquifer: the case study of the former industrial site of Bagnoli (Naples, southern Italy).

A vertical engineered barrier (VEB) coupled with a water treatment plant was surveyed in the framework of a vast remedial action at the brownfield site of the former ILVA of Bagnoli steel making facility located in western Naples, Italy. The VEB was put in place to minimize contaminant migration from the brownfield site toward the sea at the shorelines sites of Bagnoli and Coroglio. The efficiency of the VEB was monitored through 12 piezometers, 8 at the Bagnoli shoreline and 4 at the Coroglio shoreline. Concentrations of inorganic and organic pollutants were examined in upstream and downstream groundwater relative to the VEB. The mean levels of Al, As, Fe, and Mn largely exceeded the legal limits, 10-15-fold, whereas that of Hg was up to 3-fold the rules. The VEB decreased the outlet concentrations only at certain specific location of the barrier, four times for Al, 6-fold for Hg, and by 20% for Mn with means largely exceeding the rules. At the other sites, the downstream water showed marked increases of the pollutants up to 3-fold. Outstanding levels of the hydrocarbons > 12 were detected in the inlet water with means of some hundred times the limits at both sites. Likewise most of screened inorganic pollutants, the downstream water showed marked increases of the hydrocarbons up to ~113%. The treatment plant was very effective, with removal efficiencies >80% for As, Al, Fe, and Mn. The study evidenced the need to put alternative groundwater remedial actions.

Assessment of the concentrations of polycyclic aromatic hydrocarbons and organochlorine pesticides in soils from the Sarno River basin, Italy, and ecotoxicological survey by Daphnia magna.

We studied the contamination level of the soils of the Sarno River basin in southwestern Italy by combined acute toxicity test with Dapnia magna and chemical extraction of polycyclic aromatic hydrocarbons (PAHs) and organochlorine pesticides (OCPs). For the ecotoxicological assessment, 188 samples were taken and coincided with those of a previous study (2013) where heavy metals were surveyed. For the organics assessment, 21 samples were selected nearby representative areas of elevated anthropic pressure. About 10.1 % of the samples showed noticeable sign of D. magna mortality, 61-100 %, and fall along the potentially floatable areas of Sarno and Solofrana basins with high degree of contamination by Cr, As, Zn, and Hg. High levels of ecotoxicity, 61-100 %, were determined in the lower Sarno River basin in areas of moderate or low degree of contamination by Cd, Cu Hg, Pb, Sb, Sn, and Zn. Benzo(a)pyrene, indenopyrene, and benzo(g,h,i)perylene were present at concentrations of 0.32, 0.23, and 0.18 mg kg(-1), respectively, 2- to 3-fold the law limits with most of the samples falling nearby the points where the ecotoxicity output was close to 100 %. Among OCPs, pp'-DDT had a mean of 0.225 mg kg(-1) and hence about more than 200- and 2-fold the residential, 0.01 mg kg(-1), and commercial/industrial limits, 0.1 mg kg(-1) and determined mainly in the central Sarno valley in an area where elevated concentrations of benzopyrene and D. magna mortality were also observed. The study evidenced the high rate of contamination by PAHs and OCPs of the soils and the need of urgent remediation actions.

Effect of suturing the femoral portion of a four-strand graft during an ACL reconstruction.

PURPOSE: A suture passed along the part of the graft that will be inserted into the femoral tunnel is widely used by surgeons, because it could prevent the graft sliding on the femoral fixation device during pulling from the tibial side. The aim of this study was to evaluate the biomechanical effects of suturing the intratunnel femoral part of the graft during an anterior cruciate ligament (ACL) reconstruction. METHODS: Bovine digital extensor tendons and tibias were harvested from 20 fresh-frozen mature bovine knees ranging in age from 18 to 24 months. Quadruple-strand bovine tendons were passed through the tibial tunnel and secured distally with a bioabsorbable interference screw. In one half of all grafts (N = 10), the looped-over part of the graft was sutured in a whipstitch technique over a distance of 30 mm (Group 1). In one half of all grafts (N = 10), the looped-over part was left free from any suture (Group 2). The grafts were preconditioned at 50 N for 10 min, followed by cyclic loading at 1 Hz between 50 N and 250 N for 1,000 cycles. Load-to-failure test was then carried out at a rate of 1 mm/s. RESULTS: There was no statistically significant difference between mean stiffness at pullout and yield load between the two groups. In all specimens on Group 1, failure occurred following to partial breaking and then slipping of the tendons between the screw and the tunnel. Concerning Group 2, in six cases failure occurred as described for Group 1 specimens. In the remaining four cases, failure occurred entirely through the ligament mid-substance. CONCLUSIONS: Suturing in a whipstitch fashion the femoral portion of the graft doesn't affect the mechanical proprieties of the ACL graft. When suspension fixation device is used, suturing the looped-over part of the graft could be helpful in order to provide equal tension in all of the strands of the graft at time of tibial fixation.

Olive oil mill wastewater for remediation of slag contaminated soil.

Two olive mill wastewaters (OMW) samples, OMWa and OMWb, containing different polyphenolic loads were used for decontaminating an unauthorized dump site in the Campania region, south Italy. In a bench-scale experiment, OMWa at pH 6.0 (OMWapH6.0) and 4.7 (OMWapH4.7), OMWb at pH 4.7 (OMWbpH4.7) and OMWa free of the polyphenolic moiety polyphenol-free OMWa (PF-OMWa) were added to the soil for a 96 h contact time. At 96 h, OMWapH4.7 was more effective than OMWapH6.0, with Cd, Cu, Pb and Zn removal percentages of 30.7-68.1. Cd and Pb levels were 6.0 and 915 mg kg(-1), respectively, decreasing below the regulatory limits for industrial and commercial areas (15.0 and 1 × 10(3) mg kg(-1), respectively). A threefold decrease in Zn levels was also observed from 13.5 × 10(3) to 4.3 × 10(3) mg kg(-1). The metal removal efficiency of PF-OMWa dropped from 30.7 % to 15.6 % for Cd and from 37.9 % to 1.3 % for Pb. OMWbpH4.7 at 96 h was more efficient than OMWapH4.7, with mean removal percentages of 32.5 versus 7.8, respectively.

Painful prosthesis: approaching the patient with persistent pain following total hip and knee arthroplasty.

BACKGROUND: Symptomatic severe osteoarthritis and hip osteoporotic fractures are the main conditions requiring total hip arthroplasty (THA), whereas total knee arthroplasty (TKA) is mainly performed for pain, disability or deformity due to osteoarthritis. After surgery, some patients suffer from "painful prosthesis", which currently represents a clinical problem. METHODS: A systematic review of scientific literature has been performed. A panel of experts has examined the issue of persistent pain following total hip or knee arthroplasty, in order to characterize etiopathological mechanisms and define how to cope with this condition. RESULTS: Four major categories (non infective, septic, other and idiopathic causes) have been identified as possible origin of persistent pain after total joint arthroplasty (TJA). Time to surgery, pain level and function impairment before surgical intervention, mechanical stress following prosthesis implant, osseointegration deficiency, and post-traumatic or allergic inflammatory response are all factors playing an important role in causing persistent pain after joint arthroplasty. Diagnosis of persistent pain should be made in case of post-operative pain (self-reported as VAS ≥3) persisting for at least 4 months after surgery, or new onset of pain (VAS ≥3) after the first 4 months, lasting ≥2 months. Acute pain reported as VAS score ≥7 in patients who underwent TJA should be always immediately investigated. CONCLUSIONS: The cause of pain needs always to be indentified and removed whenever possible. Implant revision is indicated only when septic or aseptic loosening is diagnosed. Current evidence has shown that peri-and/or post-operative administration of bisphosphonates may have a role in pain management and periprosthetic bone loss prevention.

Long-term variability of metals from fungicides applied in amended young vineyard fields of La Rioja (Spain).

The long-term variability of total Cu content from fungicides applied in a certified wine region of Spain (La Rioja) and of other metals (Cd, Cr, Ni, Pb, and Zn) was evaluated in three young vineyard soils and subsoils unamended and amended with spent mushroom substrates (SMS) over a 3-year period (2006-2008). SMS is a promising agricultural residue as an amendment to increase the soil organic matter content but may modify the behaviour of metals from pesticide utilisation in vineyards. Fresh and composted SMS was applied each year at a rate of 25 t ha(-1) (dry-weight). Copper concentrations in the three unamended soils were 21.2-88.5, 25.5-77.1, and 29.4-78.4 mg kg(-1). They exceeded natural Cu concentrations of the region and reference sub-lethal hazardous concentration for soil organism. The concentrations of Cd, Ni, Pb, and Zn were largely below the sub-lethal limits. Thus, although Cu levels were lower than those of established vineyards, vine performance, and productivity might be affected. The variation in behaviour between different amendments for each soil was high, so a generic conclusion could not be drawn. The amendment practice seemed to have caused temporarily Cu mobilization respect to untreated soils. Total zinc concentrations fall within the range of the natural soil of La Rioja and were significantly affected (p < 0.05) especially by fresh state SMS addition, with increasing up to 75% respect to untreated specimen. The results indicated a build-up of fresh sites for metal retention at both surface and subsurface level, although no accumulation of metals was observed in the short-term period. However, the benefit for soils and the negative effects need to be monitored in the long run.

Spatial distribution of trace elements in surface sediments of Hooghly (Ganges) river estuary in West Bengal, India.

The spatial distribution of trace elements in surface sediments of the Hooghly estuary was studied over the monsoons in 2014-2017. As, Cd, Ni, Pb and U were two- to sixteen-fold the crust means with increasing levels toward the estuary, with Ni peak during the post-monsoon. Pearson's correlation matrix, cluster analysis, enrichment factors and pollution index revealed the anthropic source and association of trace elements with Fe, Mn and Al and of Pb with U. Geoaccumulation index revealed for Ni an extremely contaminated situation at the estuary water during monsoon and for Cd a heavily contaminated situation at freshwater location. The potential contamination index was >6; thus, sediments were very severely contaminated by As, Cd and Ni with worst situation for As and Cd at fresh and brackish water and during post-monsoon. The overall ecological risk was severe, 300≤RI<600 at all sites and seasons, especially after the monsoon, at fluvial and brackish locations.

Levels of non-dioxin-like PCBs (NDL-PCBs) in liver of loggerhead turtles (Caretta caretta) from the Tyrrhenian Sea (Southern Italy).

The levels of six non-dioxin-like polychlorinated biphenyls (PCBs 28, 52, 101, 138, 153, and 180) were determined in the liver of 84 loggerhead turtles (Caretta caretta) stranded along the coasts of the Tyrrhenian Sea in Campania Region (Southern Italy), from 2017 to 2021. The average value of the sum (∑6PCBIND) was 28.0 ± 52.2 ng/g (w.w.). The hexachlorobiphenyls PCB 153 and PCB 138 and the heptachlorobiphenyl PCB 180 were the main contributors to the ∑6PCBIND. A weak positive correlation was found between CCL and highly chlorinated PCBs, with adult females having lower PCB concentrations than juvenile females and adult males. This study provides more comprehensive information on the levels of NDL-PCB in Mediterranean loggerhead turtles and sets the basis for assessing anthropogenic impacts on this species.

Peri-Implant Distal Radius Fracture: Proposal of a New Classification.

A peri-implant fracture near the volar plate of the distal radius represents a rarity and can be associated with a mechanical failure of the devices. A literature review was conducted including all fractures that occurred around a volar wrist plate, which could be associated with an ulna fracture. All articles published until December 2021 were considered according to the guidelines presented in the PRISMA Statement. The search was conducted with the PubMed electronic database, Cochrane Database of Systematic Reviews, Medline, Embase, and Google Scholar. Only nine cases of these fractures were reported in the literature. The causes could be due to delayed union/non-union of the old fracture after low energy traumas, high energy trauma in patients with poor bone quality, or hardware mechanical failure. Furthermore, the literature review of peri-implant radius fracture shows different level of radius fracture and types of implant failure. In accordance with these different cases, a new classification of peri-implant fracture of the distal radius is proposed.

Avoiding tunnel collisions between fibular collateral ligament and ACL posterolateral bundle reconstruction.

PURPOSE: The purpose of this study was to evaluate the risk of tunnel collisions of the fibular collateral ligament (FCL) and posterolateral bundle anterior cruciate ligament (PLB-ACL) tunnels during a combined FCL and double-dundle (DB) ACL reconstruction. METHODS: Thirty-six 4th-generation synthetic femurs (Sawbones, Pacific Research Laboratories, Vashon, WA) were utilized, and two different femur sizes were used. A FCL tunnel and a PLB-ACL tunnel were reamed on each femur. The tunnels of synthetic specimens that did not have a collision were filled with an epoxy resin augmented with BaSO(4) and radiographic evaluation, and Multidetector CT exams of the specimens were performed. RESULTS: The rate of tunnel collision when the FCL tunnel was reamed to a depth of 30 mm was 75 and 69.4% for the 25 mm depth. There was a significantly increased risk of tunnel collision when the FCL tunnel was reamed proximally with coronal angulations of 20° and 40°. No collisions were noted when the FCL tunnel was reamed parallel to the distal condylar line and with axial angulations of 20° and 40°. CONCLUSION: This study provides new insight into tunnel positioning during a combined FCL and DB-ACL reconstruction. The results show that a concomitant FCL injury do not represent a contraindication to perform a DB-ACL reconstruction as long as the FCL tunnel is reamed with no proximal angulation and is directed anteriorly with an axial angulation between 20° and 40°.

A rare case of peri-implant distal radius fracture.

A peri-implant fracture near the volar plate of distal radius represent a very rare injury. The main factor of this lesion is high energy trauma on the wrist. We report a case of a 61-year-old woman with a peri-implant fracture located just proximally to the plate and a fracture of the ulnar head that occurred after a simple fall. The patient was surgically treated by plate and screws removal. The fracture was fixed using a longer volar plate for the radial fracture and a plate for the head ulnar fracture. Different factors such as osteoporosis, BMI and screw position could influence the fracture pattern. However, considering growing use of plates for distal radius fracture fixation, the frequency of these kind of fracture will probably increase.

Bleeding in orthopaedic surgery: the role of blood transfusion and erythropoietin alpha.

High energy trauma is often responsible for acute bleeding. Long bone and pelvis fractures are correlated with increased blood loss. Hypovolaemia could become a life threatening complication especially in elderly patients because of the reduced physiological response. Furthermore it could compromise the course of associated morbidities. Haemorrage is also associated in both comminuted fractures and osteoporosis. An increased intraoperative bleeding often occurs when a prolonged surgical time is required to obtain an appropriate ostheosynthesis. The final consequence of a mayor bleeding is hypovolaemic shock. The reduced oxygen tension of the tissue may be responsible for heart attack, arrhythmia, stroke, multi organ deficiency. For these reasons, it is important to immediately recognize and correct all potential bleeding in order to avoid complications.