Structured request form in musculoskeletal radiology examinations (CONCERTO): results of an expert Delphi consensus-structured radiology request form for correct classification of patients to undergo radiological examinations of the Italian Society of Medical and Interventional Radiology (SIRM), the Italian Society of Rheumatology (SIR) and the Italian Society of Orthopedics and Traumatology (SIOT).

PURPOSE: To describe a Delphi consensus for the realization of a structured radiology request form for patients undergoing musculoskeletal imaging. METHODS: A steering committee (four radiologists, a rheumatologist and an orthopedic surgeon) proposed a form to an expert panel (30 members, ten radiologists, ten rheumatologists and ten orthopedic surgeons). Through an online survey, the panelists voted on their level of agreement with the statements of the form using a 10-point Likert scale (1: no agreement; 10: total agreement) in a three-round process. A combination of two distinct criteria, a mean agreement level ≥ 8 and a percentage of at least 75% of responses with a value ≥ 8, was deemed as acceptable. RESULTS: The form achieved high median ratings in all the assessed key features. During the first round, all items met the threshold to be advanced as unmodified in the next round. Additional proposed items were considered and introduced in the next round (six items in Section 1, five items in Section 2, ten items in Section 3, 11 items in Section 4, six items in Section 5, eight items in Section 6, ten items in Section 7 and eight items in Section 8). Of these items, in round 3, only six reached the threshold to be integrated into the final form. CONCLUSIONS: Implementation of a structured radiology request form can improve appropriateness and collaboration between clinicians and radiologists in musculoskeletal imaging.

Gaps and alternative surgical and non-surgical approaches in the bone fragility management: an updated review.

Osteoporotic fractures are one of the major problems facing healthcare systems worldwide. Undoubtedly, fragility fractures of the hip represent a far greater burden in terms of morbidity, mortality, and healthcare costs than other fracture sites. However, despite the significant impact on the health and quality of life of older adults, there is a general lack of awareness of osteoporosis, which results in suboptimal care. In fact, most high-risk individuals are never identified and do not receive adequate treatment, leading to further fragility fractures and worsening health status. Furthermore, considering the substantial treatment gap and the proven cost-effectiveness of fracture prevention programs such as Fracture Liaison Services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are adequately assessed and treated. Based on this evidence, the aim of our review was to (i) provide an overview and comparison of the burden and management of fragility fractures, highlighting the main gaps, and (ii) highlight the importance of using alternative approaches, both surgical and non-surgical, with the aim of implementing early prevention of osteoporotic fractures and improving the management of osteoporotic patients at imminent and/or very high risk of fracture.

Pleomorphic clinical spectrum of metallosis in total hip arthroplasty.

PURPOSE: To summarize the biological effects of metal debris from hip arthroplasties which characterize a polymorphic clinical spectrum of local and remote manifestation. METHODS: Retrospective study. Patient, implant, and surgical characteristics were collected, including implant survival, clinical manifestations, cause of arthroplasty revision or implant failure, and peri- and intra-operative complications. The primary endpoint was implant survivorship. Hip revision arthroplasty was decided considering clinical signs and symptoms, abnormal imaging (XR, MR, TC, echotomography, scintigraphy), and blood metal ion level. An ad hoc electronic form was used to collect demographic, epidemiological, and clinical variables. In-between group comparisons of quantitative variables were performed with the Student t test and the Mann-Whitney for parametric and non-parametric variables, respectively. Logistic regression analyses were carried out to assess the relationship between clinical and radiographic characteristics and stem and cup revision. Radiographic measurements of implant positioning validity and reliability were assessed using Krippendorff's alpha reliability coefficient. The statistical software STATA version 15 (StatsCorp, TX) was used to perform statistical computations. RESULTS: In this MoM THA series, the most incident cause of implant failure was ARMD in 11 out of 14 (78.6%) patients. All clinical failure manifestations, revision surgery highlights, and intra-operative findings are reported. CONCLUSIONS: The local adverse reactions include lesions of different clinical relevance from small asymptomatic soft tissue lesions to dramatic osteolysis, necrosis, effusion, and growing masses which can cause secondary pathological effects. Symptoms of systemic toxicity are rarely described but may have been largely unreported in literature. Despite the extensive literature on the topic, the patient's management is still uncertain and challenging. Every metallic implant (e.g., screws, plates, spinal instrumentations) has a potential local or systemic adverse effect. Organizing a national registry of arthroplasty should be mandatory, in order to collect data about the patients, the surgery, the implanted device (with a careful post-marketing tracking), and the follow-up for all the procedures performed at a national level. The data collected in the registry will allow to analyze the implant survival and to better recognize the undesirable and sometimes unexpected effects of different biomaterials on the whole body.

Back surface measurements by rasterstereography for adolescent idiopathic scoliosis: from reproducibility to data reduction analyses.

PURPOSE: Aim of this cross-sectional study was to evaluate the reproducibility of back surface measurements obtained by rasterstereography (RS) in adolescents with idiopathic scoliosis (AIS), and to identify the most informative RS parameters through a multi-step reduction analysis approach. METHODS: Sixty-six AIS were assessed with a RS scanner. The assessment was repeated in the same day 15 min after the first scan and after 1 week. Intraclass-correlation analyses were conducted to verify the consistency of the measurements. A multi-step reduction technique including correlation, principal component analysis (PCA) and regression was employed to extract a core-set of key RS parameters. RESULTS: Back surface measures were obtained from 66 AIS aged 10-17 years (median 13), with a mild Scoliosis angle < 25 (median 20). The reliability over the 3 sessions proved high to very high, with all the intraclass correlation coefficients ≥ 0.8 and 32 out of 48 coefficients ≥ 0.9. Only 8 of the 12 parameters provided by the RS device showed significant inter-item correlations and were therefore considered for further analyses. PCA extracted 4 of them, which entered the final regression analysis. High beta coefficients were found for 2 predictors: "Surface rotation-rms" and "Side deviation-rms," which were found to be significantly associated with the dependent variable "Scoliosis angle." CONCLUSIONS: Data showed that RS measurements are reliable in AIS with mild severity of scoliosis. "Surface rotation" and "Side deviation" were the best descriptors of the Scoliosis angle and should be considered as key parameters when surveilling AIS with mild curves by RS surface topography. These slides can be retrieved under Electronic Supplementary Material.

Biomaterials and bone.

The healing process of bone is influenced by several biochemical, biomechanics, cellular, hormonal and pathological mechanisms. The ideal biomaterials should therefore guarantee the same mechanisms and be able to "heal". At present we do not have such materials at our disposal. We can anyway select among several biomaterials with different characteristics to best suit our need. In this paper we will overview some of the biomaterials used today in bone surgery with regard to their main biological properties as well as their compatibility.

Bone fragility: current reviews and clinical features.

Bone strength is determined by a number of important factors, including bone mass and bone shape. A reduction in bone strength is clearly related to fracture. Bone fragility results from a reduction in bone mass and density. If there is a reduction in the connectivity of bone and impact from a mechanical load occurs, bone will fracture. Rather than considering bone fragility as being the result of a reduced amount of bone, we recognize that bone fragility is the result of changes in the material and structural properties of bone. A better understanding of the contribution of each component of the material composition and structure, and how these interact to maintain whole bone strength is obtained by the study of metabolic bone diseases. Disorders of collagen, of mineral content composition and distribution, disorders of remodelling and other diseases produce abnormalities in the material composition and structure that lead to bone fragility.