Augmented versus non-augmented locking-plate fixation in proximal humeral fractures.

Aims: Proximal humeral fractures are the third most common fracture among the elderly. Complications associated with fixation include screw perforation, varus collapse, and avascular necrosis of the humeral head. To address these challenges, various augmentation techniques to increase medial column support have been developed. There are currently no recent studies that definitively establish the superiority of augmented fixation over non-augmented implants in the surgical treatment of proximal humeral fractures. The aim of this systematic review and meta-analysis was to compare the outcomes of patients who underwent locking-plate fixation with cement augmentation or bone-graft augmentation versus those who underwent locking-plate fixation without augmentation for proximal humeral fractures. Methods: The search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Articles involving patients with complex proximal humeral fractures treated using open reduction with locking-plate fixation, with or without augmentation, were considered. A meta-analysis of comparative studies comparing locking-plate fixation with cement augmentation or with bone-graft augmentation versus locking-plate fixation without augmentation was performed. Results: A total of 19 studies were included in the qualitative synthesis, and six comparative studies were included in the meta-analysis. Overall, 120 patients received locking-plate fixation with bone-graft augmentation, 179 patients received locking-plate fixation with cement augmentation, and 336 patients received locking-plate fixation without augmentation. No statistically relevant differences between the augmented and non-augmented cohorts were found in terms of the Disabilities of the Arm, Shoulder and Hand questionnaire score and Constant-Murley Score. The cement-augmented group had a significantly lower rate of complications compared to the non-augmented group. Conclusion: While locking-plate fixation with cement augmentation appears to produce a lower complication rate compared to locking-plate fixation alone, functional outcomes seem comparable between augmented and non-augmented techniques.

Autologous Chondrocyte Implantation and Mesenchymal Stem Cells for the Treatments of Chondral Defects of the Knee- A Systematic Review.

BACKGROUND: There is still a lack of consensus about the best treatment of chondral defects of the knee. We conducted a systematic PRISMA review to evaluate clinical outcomes of Autologous Chondrocyte Implantation (ACI) and Mesenchymal Stem Cell (MSC) injections for the treatment of focal chondral defects of the knee. METHODS: A systematic review of literature was performed according to the PRISMA guidelines. All the articles reporting data on ACI and MSC treatments for chondral defects of the knee were considered for inclusion. The main databases were accessed: PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar. The statistical analysis was performed using the Review Manager Software. RESULTS: In the p-ACI group (987 knees), the Cincinnati Score improved by 18.94% (p=0.1), VAS by 38% (p=0.01), Tegner score by 19.11% (p=0.03), Lysholm score by 22.40% (p=0.01), IKCD by 27.36% (p=0.003). In the c-ACI group (444 knees), the Cincinnati Score improved by 23.80% (p=0.08), KOOS by 23.48% (p=0.03), VAS by 33.2% (p=0.005), IKDC by 33.30% (p=0.005). In the m-ACI group (599 knees), the Cincinnati Score improved by 26.80% (p=0.08), KOOS by 31.59% (p=0.1), VAS by 30.43% (p=0.4), Tegner score by 23.1% (p=0.002), Lysholm score by 31.14% (p=0.004), IKCD by 30.57% (p<0.001). In the MSCs group (291 knees), the KOOS improved by 29.7% (p=0.003), VAS by 41.89% (p<0.001), Tegner score by 25.81% (p=0.003), Lysholm score by 36.96% (p<0.001), IKCD by 30.57% (p=0.001). CONCLUSION: Both ACI and MSC therapies can be considered as a concrete solution to treat focal chondral defects of the knee.

A Multi-Parametric Wearable System to Monitor Neck Movements and Respiratory Frequency of Computer Workers.

Musculoskeletal disorders are the most common form of occupational ill-health. Neck pain is one of the most prevalent musculoskeletal disorders experienced by computer workers. Wrong postural habits and non-compliance of the workstation to ergonomics guidelines are the leading causes of neck pain. These factors may also alter respiratory functions. Health and safety interventions can reduce neck pain and, more generally, the symptoms of musculoskeletal disorders and reduce the consequent economic burden. In this work, a multi-parametric wearable system based on two fiber Bragg grating sensors is proposed for monitoring neck movements and breathing activity of computer workers. The sensing elements were positioned on the neck, in the frontal and sagittal planes, to monitor: (i) flexion-extension and axial rotation repetitions, and (ii) respiratory frequency. In this pilot study, five volunteers were enrolled and performed five repetitions of both flexion-extension and axial rotation, and ten breaths of both quite breathing and tachypnea. Results showed the good performances of the proposed system in monitoring the aforementioned parameters when compared to optical reference systems. The wearable system is able to well-match the trend in time of the neck movements (both flexion-extension and axial rotation) and to estimate mean and breath-by-breath respiratory frequency values with percentage errors ≤6.09% and ≤1.90%, during quiet breathing and tachypnea, respectively.

Alpine junior world ski championship: nutritional habits and performance in elite skiers.

BACKGROUND: Young athletes need to consume an appropriate diet in order to maintain health and optimize growth and athletic performance. We evaluated nutritional habits of junior elite skiers. METHODS: Alpine junior elite skiers (N.=68; 42 males and 26 females; age range 16-20 years) coming from 20 countries were recruited during the Alpine Junior World Ski Championship, Roccaraso, Italy. Nutritional habits were assessed using a 3-day food record and the NHANES Food Frequency Questionnaire. Data were compared with nutritional recommendations and Recommended Dietary Allowances (RDAs) for athletes. RESULTS: During the training period, the energy intake in both males and females was significantly lower with respect to estimated energy needs. Carbohydrate intake expressed in terms of grams per kilogram of body weight did not meet the RDAs in both groups (4.19 and 5.15 g/kg in males and females, respectively). Protein and fat consumption exceeded the RDAs with a protein intake of 2.34 g/kg in males and 2.10 g/kg in females, and a fat intake >35% of total daily calories. During competition days, both males and females increased carbohydrate intake to 6.23 and 8.11 g/kg respectively, reaching the RDAs. Protein intake increased to 2.56 and 3.14 g/kg in males and females, respectively, and fat intake slightly decreased, still exceeding the RDAs. CONCLUSIONS: Junior elite skiers reported a low intake of carbohydrates and a high intake of protein and fat. Nutritional counselling should be given to athletes to maintain their health and improve their physical performance.

Functional performance, anthropometric parameters and contribution to team success among Italian "Serie A" elite goalkeepers during season 2016-2017.

BACKGROUND: Soccer is the world's game, played by more than 120 million people. Different physical abilities, morphological and physiological characteristics are required for different playing positions. The purpose of this study is to describe anthropometric parameters and functional performances of goalkeepers, and these relationship with team success. METHODS: The study population consisted of 92 professional goalkeepers from the Italian soccer "Serie A" league. Anthropometric measurements and indicators of performance of matches were obtained from the Italian soccer league. Goalkeepers were divided into first-choice and substitutes. RESULTS: Goalkeepers who played at least one match were significantly older and heavier than those who did not play any game (P<0.0001). Minutes on the pitch, goals conceded, total saves and saves from both play sets and free kicks were significantly higher in the first-choice goalkeepers as compared to substitutes. However, by comparing first-choice with substitutes no significant differences for the ratio between goals against and saves by minutes played were observed. A significant positive correlation between points obtained by the team and ratio of goals conceded by minutes played (R=0.55; P<0.0001) as well as ranking position of the team achieved at the end of the season and the ratio of total saves by minutes played (R=0.51; P=0.001) was observed. A significant but inverse correlation between points obtained by the team and goal conceded was reported (R=-0.80; P<0.0001), as well as point obtained and ratio of total saves by minutes played (R=0.51; P=0.001). A lower ratio of goals conceded by minutes played was a significant predictor of total points achieved by the team (ß=0.712, SE=0.15; P<0.0001). Finally, a higher ratio of goal conceded by minutes played was also associated with a higher probability of success for the team at the end of the season. Goalkeepers who completed the season with a ratio of goal against by minutes played greater than 57.5 minutes had an increased probability of leading their team to the first 6 positions of the final ranking (OR=24.7, 95% CI: 2.1-297.3; P=0.01). CONCLUSIONS: Performance activities of the goalkeepers included in the rosters of the Italian soccer league significantly influenced the success of their team. A lower ratio of goals conceded by minutes played resulted to be the most significant predictor of overall team success. The present research extended previous research underlining the central role of goalkeeper for team success.

Patellar Resurfacing in Total Knee Arthroplasty: Systematic Review and Meta-Analysis.

BACKGROUND: Patellar resurfacing in total knee arthroplasty remains controversial. The aim of this study is to evaluate this technique through an analysis of comparative studies in the current literature. METHODS: We performed a comprehensive search of PubMed, MEDLINE, Cochrane, CINAHL, and EMBASE databases using various combinations of the keywords "Knee," "Replacement," "Prosthesis," "Patella," "Resurfacing," and "Arthroplasty." All articles relevant to the subject were retrieved, and their bibliographies were hand searched for further references relevant to primary patellar resurfacing in total knee arthroplasty. Only articles published in peer-reviewed journals were included in this systematic review. RESULTS: The percentage for a reoperation was 1% for the patellar resurfacing group (17/1636) and 6.9% for the non-resurfacing group (118/1699) (odds ratio [OR] 0.18, 95% confidence interval [CI] 0.11-0.29, P < .00001). The patellar resurfacing group showed a significantly higher postop Knee Society Score (KSS) pain (OR 1.52, 95% CI 0.68-2.35, P = .004) and postop Hospital for Special Surgery score (OR 4.35, 95% CI 3.21-5.49, P < .00001), over the non-resurfacing group. CONCLUSION: Based on the outcome scores of KSS (pain), KSS (function), and Hospital for Special Surgery postop, patellar resurfacing TKAs have performed better than non-resurfaced TKAs. The lower secondary operation and revision rates for patellar resurfaced TKAs also demonstrate that this technique is the more effective option. However, the full impact of patellar resurfacing still needs to be critically evaluated by larger randomized controlled trials with long-term follow-up.

Advanced trauma life support radiographic trauma series: part 2--the chest radiograph.

The chest radiograph is used as a screening test to exclude significant thoracic injuries in cases of major trauma. A systematic approach to reviewing chest radiographs is necessary for accurate interpretation. Radiographic findings should be considered together with clinical assessment.