Infection after Anterior Cruciate Ligament Reconstruction: A Narrative Review of the Literature.

Infection is an uncommon side effect of arthroscopic surgery, and this percentage is higher in anterior cruciate ligament reconstruction (ACLR) surgery, where graft and fixation devices are used. Infections can not only lead to high re-admission rates and poor functional recovery of the knee but can also have a significant negative impact on the patient's psychological and economic health, especially in athletes, as it can affect their sports career. It is important to be aware of the many risk factors, especially the manifestation of symptoms. These may sometimes be non-specific to the infectious pathology and common to other situations, such as the presence of a significant intra-articular hematoma. Septic arthritis after ACLR can occur at any time after surgery but typically presents acutely, while late manifestation is relatively rare. Diagnosis of infection is based on patient history, physical examination, laboratory parameters, and analysis of synovial fluid after joint aspiration, which is the gold standard for diagnosing post-operative infection. Once symptoms appear and the diagnosis seems certain, it is necessary to intervene quickly with arthroscopic debridement and long-term antibiotic treatment to try to save the graft and resolve the infectious situation to avoid graft failure and arthrofibrotic sequelae. The aim of this paper is to provide an overview of the epidemiology, pathogenesis, risk factors, clinical presentation, diagnostic evaluation, and current treatment guidelines of septic arthritis after ACLR surgery by analyzing recent literature, in particular meta-analyses and systematic reviews.

Pulsed Electromagnetic Fields Induce Skeletal Muscle Cell Repair by Sustaining the Expression of Proteins Involved in the Response to Cellular Damage and Oxidative Stress.

Pulsed electromagnetic fields (PEMF) are employed as a non-invasive medicinal therapy, especially in the orthopedic field to stimulate bone regeneration. However, the effect of PEMF on skeletal muscle cells (SkMC) has been understudied. Here, we studied the potentiality of 1.5 mT PEMF to stimulate early regeneration of human SkMC. We showed that human SkMC stimulated with 1.5 mT PEMF for four hours repeated for two days can stimulate cell proliferation without inducing cell apoptosis or significant impairment of the metabolic activity. Interestingly, when we simulated physical damage of the muscle tissue by a scratch, we found that the same PEMF treatment can speed up the regenerative process, inducing a more complete cell migration to close the scratch and wound healing. Moreover, we investigated the molecular pattern induced by PEMF among 26 stress-related cell proteins. We found that the expression of 10 proteins increased after two consecutive days of PEMF stimulation for 4 h, and most of them were involved in response processes to oxidative stress. Among these proteins, we found that heat shock protein 70 (HSP70), which can promote muscle recovery, inhibits apoptosis and decreases inflammation in skeletal muscle, together with thioredoxin, paraoxonase, and superoxide dismutase (SOD2), which can also promote skeletal muscle regeneration following injury. Altogether, these data support the possibility of using PEMF to increase SkMC regeneration and, for the first time, suggest a possible molecular mechanism, which consists of sustaining the expression of antioxidant enzymes to control the important inflammatory and oxidative process occurring following muscle damage.

Shock Waves and Therapeutic Exercise in Greater Trochanteric Pain Syndrome: A Prospective Randomized Clinical Trial with Cross-Over.

This study aimed to verify the comparative effectiveness of shock wave therapy versus therapeutic exercise, including the possibility of combining both therapies, in patients who did not respond to the first treatment. A prospective randomized clinical trial was carried out, predicting the possibility of a cross-over between the two treatment options, with patients who did not respond to either treatment. Treatments were, respectively, eccentric therapeutic exercise consisting of 30 min sessions of stretching and strengthening exercises, 5 days a week for 4 weeks (Groups A and D) and Extracorporeal Shock Waves Therapy (ESWT) according to a protocol of three sessions, one per week, each of 2000 pulses at a 4 Hz frequency and administering an energy flux density (EFD) varying between 0.03 mJ/mm2 and 0.17 mJ/mm2 (Groups B and C). Patients were evaluated at baseline (T0), 2 (T1), 4 (T2) and 6 months (T3) after the last session, using the Numeric Rating Scale (NRS), Low Extremity Functional Scale (LEFS) and Roles and Maudsley Scale (RMS). The whole study population demonstrated a progressive clinical reduction in pain according to NRS, a recovery from disability according to LEFS and a perception of recovery according to RMS within 6 months, with no significant differences between the four protocols (exercise; ESWT; exercise + ESWT; and ESWT + exercise). Both therapies are therefore valid options in patients with trochanteritis; the combination of the two therapies could be evaluated for those patients who do not respond to the single treatment.

The Efficacy of Temperature-Controlled High-Energy Polymodal Laser Therapy in Tendinopathy of the Shoulder.

BACKGROUND: Rotator cuff tendinopathy is a common diagnosis among patients with shoulder pain and dysfunction. Laser therapy is recommended for the treatment of this tendon disease due to the possibility of increasing tissue biostimulation. The aim of this study was to investigate the effects of HELT (high-energy laser therapy) in relation to the wavelengths of 650 nm, 810 nm, 980 nm, and 1064 nm administered. METHODS: The study design was prospective and observational. Thirty patients with shoulder tendinopathy were recruited and treated in one of two high-energy laser therapy groups (5 Watt/cm2, 450 Joule, super-pulsed mode). Group A received a high-energy laser therapy protocol with a single wavelength (1064 nm); group B received a high-energy laser therapy program with four wavelengths (650 nm, 810 nm, 980 nm, and 1064 nm). Pain (VAS), function (ASES), and disability (DASH) were monitored at the time of recruitment (T0), 1 month later (T1), and 6 months later (T2). Roles and Maudsley scores were also evaluated at T1 and T2. RESULTS: Both protocols resulted in improvement of pain and in functional and disability recovery at the two times of assessment, without statistically significant differences. In group B, treated with the four wavelengths, a trend emerged, bordering on statistical significance, for a greater reduction in pain. CONCLUSIONS: The high-energy laser proved to be an effective therapy for the treatment of rotator cuff tendinopathy. The possibility of modulating the choice of wavelengths could allow the customization of the protocol in relation to the patient's clinical condition.

Promoting physical activity for children: an audit among Italian family pediatricians.

BACKGROUND: This survey aimed to investigate the perception of Italian Pediatricians regarding the promotion of physical activity. METHODS: From January to May 2015, a survey was conducted among family pediatricians working in Puglia, interviewed by a standardized questionnaire, that investigated demographic information, participation in sporting activity by the pediatrician, opinion on obesity and the promotion of physical activity, and attitude towards enquiring about the physical activity of patients with and without chronic diseases. RESULTS: We collected 200 questionnaires (35.7% of target population): 51.5% of enrolled pediatricians stated that they were participating in sporting activities at the time of the survey. The average opinion regarding the relevance of the obesity was 9±1.4/10 and about the promotion of physical activity 9.6±0.8. All enrolled pediatricians asked for their patients' physical activity and encouraged inactive children to begin an appropriate activity. Pediatricians who took part in sport had a high probability of encouraging physical activity, among patients affected by chronic diseases. CONCLUSIONS: Family pediatricians declared a good attitude regarding the promotion of physical activity for their patients according to national and international recommendations. The main concern emerging from our results is the risk of an "inappropriate interdiction" of physical activity in children affected by chronic diseases, in particular physicians that have never participated in a sport.

Plate vs reverse shoulder arthroplasty for proximal humeral fractures: The psychological health influence the choice of device?

BACKGROUND: Proximal humeral fractures represent the third most common observed osteoporotic fracture; the treatment in three and four-part proximal humeral fractures in patients over 65 years is still controversial. Among the treatments described in literature, open reduction and internal fixation (O.R.I.F) and reverse shoulder arthroplasty (RSA) are gaining an increasing popularity. AIM: To investigate the correct treatment for three and four-part proximal humeral fractures according to psychological aspects. METHODS: It was conducted a prospective study with a series of 63 patients treated with O.R.I.F. (group A) and with RSA (group B) for three and four-part proximal humeral fractures according to Neer classification system. A conservative treatment group, as control, was finally introduced. One independent observer performed clinical and a psychological evaluation at one (T0), six (T1) and twelve months (T2) postoperatively. The Constant's score and The Disabilities of the Arm, Shoulder and Hand (DASH score) were used for clinical evaluation, while General Anxiety Disorder-7 (GAD-7) and Caregiver Strain Scale (CSS) were used for psychological evaluation. RESULTS: At one month follow up in group A the mean values were DASH score 50.8, Constant score 36.1, GAD-7 score 5.4, CSS 5.0. For the group B, the average values at T0 were: DASH score 54.6, Constant score 32.0; GAD-7 score 6.4, CSS 6.2. At six months in group A the average values were DASH score 42.1, Constant score 47.3, GAD-7 score 4.3, CSS 3.9. For the group B, the average values at T1 were: DASH score 39.1, Constant score 43.2, GAD-7 score 5.7, CSS 5.5. At twelve months in the group A, the mean values were DASH score 32.8, Constant score 60.0, GAD-7 score 3.2, CSS 3.1. For the group B shown these mean values: DASH score 33.6, Constant score 52.9, GAD-7 score 4.3, CSS 4.5. We demonstrated a better clinical and psychological outcome at T2 in the group treated with osteosynthesis compared to the group treated with arthroplasty (Constant P = 0.049, GAD-7 P = 0.012 and CSS P = 0.005). A better clinical and psychological outcome emerged in control group at T2 comparing with surgical group (DASH score P = 0.014, Constant score P < 0.001, GAD-7 P = 0.002 and CSS P = 0.001). CONCLUSION: Both open osteosynthesis and reverse shoulder arthroplasty are valid treatments for proximal humeral fractures. According to the best osteosynthesis results the authors suggested to perform a psychological analysis for each patient in order to choose the appropriate treatment.

Musculoskeletal pain related to surfing practice: Which role for sports rehabilitation strategies? A cross-sectional study.

BACKGROUND: Surf practice contributes to overuse injuries and musculoskeletal pain. Relationship between the type of surfing practiced and the onset of pain is not fully understood as well as the potential role of rehabilitation in preventing it. OBJECTIVE: To investigate musculoskeletal pain and to deepen whether the age and the anatomical region involved influenced the pain appearance in relation to four surfing disciplines. METHODS: A cross-sectional study was carried out. An online survey was addressed to a group of Italian surfers (practicing surf, kitesurf, windsurf and stand up paddle since at least 1 year), collecting demographic data, discipline practiced, location of musculoskeletal pain. RESULTS: One hundred and twenty-six surfers were involved in the study. Spine and upper limbs pain was more frequent compared to lower limbs one in the surf (p< 0.001) and in the windsurf groups (p= 0.007). In the kitesurf group a greater prevalence of pain was observed in spine and lower limbs compared to upper limbs (p= 0.017). Low back pain is the most represented among the spine pain subgroups (p< 0.001). Pain was lower in younger athletes (p= 0.007). CONCLUSIONS: Understanding risk factors and biomechanics of musculoskeletal pain is essential to realize prevention training strategies. Rehabilitation in sinergy with specific training allows pain-free activity, optimizing its overall health benefits.

Epidemiology of injuries in water board sports: trauma versus overuse injury.

BACKGROUND: Surfing is an increasingly popular sport in the world, but it is not sufficiently investigated in terms of epidemiology of injuries and possible prevention strategies. Moreover, there are different surfing disciplines, with specific characteristics and therefore different potential risks of injury. The aim of this study was to look at the injuries of recreational surfers in an Italian cohort, distinguishing between trauma and overuse lesions and putting in evidence any difference between specific water board sports. METHODS: The design is that of a retrospective observational study. An online survey was distributed to a group of Italian surfers that are members of a surfing association. The survey comprised: demographic data, surfing information such as number of sessions per year and years of experience, and surfing injuries story. The sample size consisted of 126 recreational surfers who practiced four different types of surfing: surf, kitesurf, windsurf and stand-up paddle. RESULTS: The incidence of trauma was significantly higher than the incidence of overuse lesions in all four water board sports evaluated (e.g. in surf, 81% for trauma vs. 27% for overuse, with a difference of 55% , P<0.0001). There was a statistically significant effect of the number of surfing sessions per year both for trauma (W=6.36, P=0.0117) and for total injuries (trauma + overuse; W=4.30, P=0.0381), with a 12-times increased risk for the surfers who performed more than 80 sessions per year. The risk of overuse injuries was higher for those who practice surf for more than seven years (P=0.0193). CONCLUSIONS: Traumas are more frequent than overuse injuries for all the investigated surfing disciplines. The risk of injury increases as the number of annual sessions and the years of practice increase, demonstrating that experience is not a protective factor, whereas higher exposure is certainly a risk factor. New injury prevention strategies should be based on athletic training and preparation programs, traditionally lacking among recreational surfers.

Total hip arthroplasty for dysplastic coxarthrosis using a cementless Wagner Cone stem.

BACKGROUND: Total hip arthroplasty (THA) is currently the best surgical option for hip osteoarthritis secondary to developmental hip dysplasia (DDH); it may be extremely challenging, because of the hypoplasic proximal metaphysis, pathological anteversion, and excessive cervico-diaphyseal angle of the neck at the femoral side. The purpose of this retrospective study was to evaluate the long-term survival and clinical and radiological results of Conus uncemented stems, implanted in patients affected by hip osteoarthritis with Crowe not-type IV secondary to DDH. MATERIAL AND METHODS: We identified 100 consecutive THAs performed for DDH in 63 women and 24 men, with an average age of 53 years in a single center. Thirteen patients underwent bilateral hip replacement. The patients' mean body mass index was 29.8 kg/m2 (range 27.1-35.6 kg/m2). The main indications for surgery were severe hip pain and considerable functional impairment: the preoperative Harris Hip Score was 29.5 on average (range 22-61). Radiologically, 8 hips were classified as Crowe I, 43 hips as Crowe II, and 49 hips as Crowe III. In all cases, we implanted the Wagner femoral cone prosthesis using the direct lateral approach; in the attempt to reestablish native hip biomechanics, 66 stems were 135° and 34 were 125°. RESULTS: The mean follow-up of the study was 11.7 years (range 2.2-21.8 years). Harris Hip Score increased to a mean value of 71.5 points (range 52-93 points). Radiographic evaluation demonstrated osteointegration of the implant with stable bone growth observed at the stem-endosteum interface; signs of bone readaptation and thinning of the femoral calcar were present in nine hips. None of the patients underwent revision for septic or aseptic loosening of the stem; none sustained a periprosthetic fracture. CONCLUSIONS: This study confirms the theoretical advantages that suggest the choice of the Wagner cone when technical difficulties during prosthetic surgery are expected owing to abnormal proximal femoral anatomy. LEVEL OF EVIDENCE: Level IV, retrospective case study.

Irisin Correlates Positively With BMD in a Cohort of Older Adult Patients and Downregulates the Senescent Marker p21 in Osteoblasts.

Irisin is a myokine produced by skeletal muscle during exercise in both mice and humans. We previously showed that irisin treatment ameliorates immobility-induced osteoporosis and muscular atrophy in mice. Data in humans showed a positive association between irisin and bone mineral density (BMD) in athletes and a population of healthy children. However, the role of this myokine regarding the state of muscle and bone in the same population remained to be determined. For this purpose, 62 patients (age 68.71 ± 12.31 years) undergoing total hip or knee replacement were recruited. Our results showed that irisin serum levels negatively correlated with age (R = -0.515; p = .000018) and positively correlated with femoral BMD (R = 0.619; p = .001) and vertebral BMD (R = 0.201; p = .0001). Irisin was also positively associated with Fndc5 mRNA in muscle biopsies (R = 0.248; p = .016), as well as with Osteocalcin (Ocn) mRNA in bone biopsies (R = 0.708; p = .006). In skeletal muscle, FNDC5 positive fibers positively correlate with BMD of total femur (R = 0.765; p = .0014) and BMD of femoral neck (R = 0.575; p = .031), Interestingly, by analyzing patients divided by their T-score, we found lower irisin levels (p = .0011) in patients with osteopenia/osteoporosis (OP) compared to healthy controls matched for age and sex. By analyzing the senescence marker p21, we found a significant increase of its mRNA expression in the bone biopsies of OP patients compared to control ones. Therefore, we investigated in vitro whether rec-irisin had a direct effect on this senescence marker, showing that p21 mRNA expression was significantly downregulated in osteoblasts by the treatment with irisin. Overall, these results indicate that higher irisin levels are associated with a lower rate of age-related osteoporosis and that irisin could be effective in delaying the osteoblast aging process, suggesting a potential senolytic action of this myokine. © 2020 American Society for Bone and Mineral Research (ASBMR).

Internal fixation of acetabular quadrilateral plate fractures in elderly patients: Could the fracture reduction quality affect their functional recovery?

BACKGROUND: Osteoporotic acetabular fractures frequently involve the quadrilateral plate (QP), a flat and thin bone constituting the medial wall of the acetabulum. This study aims to assess the impact of the quality of osteoporotic QP fractures reduction on the patients' functional recovery, at 24 months follow-up. METHODS: Patients referring with osteoporotic QP fractures to our Level I trauma centre were prospectively recruited. INCLUSION CRITERIA: patients aged 60 years old or older; osteoporosis, defined as Dual-energy X-ray Absorptiometry (DXA) T-score ≤ - 2.5; acute acetabular fracture; anatomic or good fracture reduction according to Matta on postoperative CT. EXCLUSION CRITERIA: moderate cognitive impairment (defined as Mini-Mental State Examination < 19); a history of malignant neoplasm; concomitant fractures in other sites; traumatic head injury; lower limb joint prostheses; patient not able to walk independently before trauma; poor fracture reduction, according to Matta, on postoperative CT. All the QP fractures were surgically managed. After surgery, the reduction of each QP fracture was classified as anatomical (displacement 0-1 mm), good (displacement 2-3 mm) and poor (displacement > 3 mm) on postoperative CT. Based on this classification: patients with a poor fracture reduction were excluded from this study, patients with an anatomical reduction were recruited in Group-A and patients with a good reduction in Group-B. All the patients underwent a clinical and radiographic 24-months follow-up. RESULTS: 68 patients (males 38; females 30; mean age 68.6 years old; range 60-79) were finally included in in the study. No cases of open fractures or concomitant pelvic ring fractures were observed. Based on the post-operative CT, 39 patients showed an anatomic fracture reduction (Group-A) while the remaining 29 patients revealed a good fracture reduction (Group-B). Complication rates and mean clinical scores showed no significant differences between groups, at 24-months follow-up. CONCLUSIONS: In this study, the functional recovery at 24 months follow-up showed no significant differences in elderly patients with QP fracture undergoing anatomical reconstruction (displacement 0-1 mm) compared to patients receiving a good QP fracture reconstruction (displacement ≤ 3 mm).

The authorship in nursing literature: an against trend?

BACKGROUND AND AIM OF THE WORK: Women graduated and engaged in the scientific world are in increasing numbers. The present study aimed to analyze the gender difference in nursing scientific publication and to understand the trend in nursing science is the same or different to that reported in other scientific disciplines. METHODS: We considered the first name in the authorship of the highest impacted factor journals related of year 2019 in the Web of Science database for the period 2015-2019, as: the International Journal of Nursing Studies (IJNS) and the Nursing Outlook (NO). Considering the proposed economic classification of the "World bank", weassessed the gender of the first authors searched with the relative degree of wealth of their countries thanks to the chi square test. RESULTS: From 1st January 2015 to 31st December 2019 a total of 1171 first authors were identified. Of these, 776 (66.27%) belonged to the IJNS and 395 (33.73%) to the NO. The female gender was most representative than the male gender into two journals. In fact, 982 (83.9%) citations belong to female researchers while 189 (16.1%) citations belong to male researchers. However, the same trend is not evaluated in the Italian scenario where the male gender predominates over the female one in scientific production. CONCLUSIONS: Nursing scientific production shows a counter trend compared to other scientific disciplines, highlighting a predominance of the female sex over the male one. This difference is more pronounced in the more economically developed countries.

Pseudomonas aeruginosa infection of shoulder joint after latissimus dorsi tendon transfer: A case report.

Infection rates of arthroscopic procedures have been consistently reported at approximately 1% and are even less common in shoulder arthroscopy (0.3%). We are unaware of any prior reports of infection associated with an arthroscopic-assisted latissimus dorsi transfer and report on a 60-year-old male who experienced this event. At the 2-month follow-up, he reported an infection of the shoulder joint, characterized by a fistula on the portal scar. Laboratory tests revealed a Pseudomonas aeruginosa infection which was treated with arthroscopic irrigation and debridement of the shoulder joint followed by oral antibiotics for 6 weeks. At 1-year follow-up no findings of infection were presented. To our knowledge, this is the first case of P. aeruginosa infection of the shoulder after an arthroscopic-assisted latissimus dorsi tendon transfer. Because the empirical pharmacological therapy initially adopted did not produce a clinically important improvement, a more organism-specific antibiotic was used. In conclusion, the key points of positive results were surgical approach with careful washout, debridement of surgical accesses, and targeted antibiotic therapy.

Epidemiology of injuries among amateur athletes who attended fitness activities: the role of the qualification of the trainer.

BACKGROUND: The fitness trainer could have an important role in the prevention of injuries among fitness attendants. In several Countries, including Italy, there is not a formal regulation about the qualification of fitness trainers. The aim of our study is to estimate the incidence of injuries in a sample of amateur fitness athletes training in Apulia (southern Italy) and evaluate if being the presence of a trainer graduated in Sports and Movement Science could be a protective factor for injuries. METHODS: This is a retrospective, cross-sectional study, carried out in a convenience sample of amateur athletes enrolled in 16 Apulian fitness centers. The survey was carried out by an anonymous self-administered questionnaire distributed and compiled in the gym. RESULTS: We enrolled 205 amateur athletes, of which 105/205 (51.2%) cared by a trainer graduated in Sports and Movement Science and 100/205 (48.8%) trained by a person with a qualification from Olympic Committee or Sport Federation. The incidence rate of injury ×1000 person-months of training is 6.1 (95%CI=4.4-8.1), 5.5 (95%CI=3.1-9.2) among athletes trained by graduated and 6.3 (95%CI=4.2-9.2) in ones trained by a person with a different qualification (IRR=1.1; 95%CI=0.6-2.3; P=0.348). CONCLUSIONS: Our study showed a mild lifetime prevalence of injury among subjects attending fitness activities (21%), higher among athletes trained by an instructor not graduated in Sports Science. This is a topic poorly investigated previously but very important in the future, in particular in the view of the diffusion of fitness worldwide.

Epidemiology of injuries among Italian footballers: the role of the playing field.

BACKGROUND: Football has a higher injury rate compared with other team sports such as rugby, in terms of two main categories: intrinsic (individual) and extrinsic (environmental) factors. The playing field is an extrinsic risk factor which has been poorly investigated in the literature. PURPOSE: The aim of our study was to define the incidence and risk factors of injuries in a cohort of footballers comparing the role of three different types of playing field (hard court, natural grass or synthetic grass). STUDY DESIGN: This was a cross sectional prevalence study. METHODS: The population comprised footballers recruited by a convenience sample; the instrument used for the survey was an anonymous self-administered questionnaire. RESULTS: 267 football players were enrolled (average age 23.4±4.8 years), of whom 33.7% (n=90/267) played on hard court, 33.0% (n=88/267) on natural grass and 33.3% (n=89/267) on synthetic grass. The overall incidence of injury was 40.1 (95% CI 34.1 to 46.8) ×1000 person-years of training, with higher values for ankle and knee injuries. Ankle injuries (aOR 0.4; P=0.021) were associated with playing on natural grass as a protective factor, while playing on natural grass seemed to be a risk factor for muscular injuries (aOR 2.3; P=0.026). CONCLUSION: Our study showed a high lifetime prevalence of injury among footballers (57%), in particular among athletes who play and train on a hard court. We have studied a topic poorly investigated previously and provide the opportunity to understand interventions to increase the capacity of stakeholders in preventing injuries.

The risk of injuries among CrossFit athletes: an Italian observational retrospective survey.

BACKGROUND: CrossFit is a strength and conditioning training program, that begin very popular in the last ten years. One of the most concerned characteristics of model is the high intensity activity performed under fatigue conditions that was proposed as potential risk of injuries; current literature on this topic was not conclusive. The purpose of this research was to examine injury epidemiology and risk factors for injury in CrossFit. METHODS: This is a retrospective observational study carried out by an anonymous, self-administered questionnaire in a convenience sample of CrossFit athletes. RESULTS: The questionnaire was completed and returned by 454 subjects, of which 325 (71.6%) were male with an average age of 28.8±7.9. 39.9% reported skeletal or muscles injury after to start training CrossFit. Lifetime Prevalence is 0.23 events per year of training/person. The average number of muscles and skeletal injuries reported was of 1.96±1.36. A percentage of 16.7% reported tendinitis. Time of CrossFit training is a determinant of tendinitis (aOR=1.02; P=0.021). Attending the On-Ramp program seemed to protect against the occurrence of injuries. CONCLUSIONS: According our results the risk of injury in the CrossFit practice is acceptable and, as discussed in a recent published review, CrossFit is comparable to other exercise programs with similar injury rates and health outcomes.

An intravascular papillary endothelial hyperplasia of the hand radiologically mimicking a hemangiopericytoma: A case report and literature review.

Intravascular papillary endothelial hyperplasia is a rare benign vascular lesion of the skin and subcutaneous tissues, characterized by a reactive proliferation of endothelial cells that can present de novo in normal blood vessels (primary intravascular papillary endothelial hyperplasia), but it can also develop from a pre-existing vascular process (type II intravascular papillary endothelial hyperplasia), or it can arise in an extravascular location from a post-traumatic haematoma. The differential diagnosis between intravascular papillary endothelial hyperplasia and malignant vascular tumours can be challenging, due to the lacking of a specific radiologic description. We present a case of intravascular papillary endothelial hyperplasia of the hand radiologically mimicking a hemangiopericytoma.

Extra-articular chondromatosis of flexor and extensor compartments of the hand: Case report and review of literature.

OBJECTIVES: Tenosynovial chondromatosis is an uncommon type of chondro-dysplasia of synovial and connective tissue. We report a case of a patient with a primary right wrist extra-articular chondromatosis extending to the flexor and the extensor compartments. METHODS: Until now, there has been no study describing double surgical access for such a case. RESULTS: Due to the extension, two surgical accesses are required to completely remove the neoformation. CONCLUSIONS: At 2 years of follow-up, the good functional-clinical results and absence of recurrence confirm the validity of our surgical strategy.