A modified Frosch approach for posterior tibial plateau fractures: Technical note and case series.

Achieving the best possible articular congruity following a tibial plateau (TP) fracture is associated with better long-term functional outcomes; TP has an essential role in the movements of the knee joint and is well established that a not optimal reduction leads to articular instability and early osteoarthritis. In recent times, 3D reconstruction from CT scan has greatly contributed to improve the surgical treatment of these fractures since an accurate preoperative plan gives the possibility to decide the best interventional strategy before the surgical incision. Reduction of the posterior part of tibial plateau is not easily achievable with standard surgical access. Several posterolateral approaches, proposed by authors such as Frosch and Lobenhoffer, have been described over the years; these approaches can be divided into 2 groups: with or without osteotomy of the fibula. Main disadvantages of these techniques are the large skin incision, the difficulty of exposing the lateral part of the tibia, the high frequency of damages of the posterolateral TP corner, and in some cases the necessity of performing fibular head osteotomy. The surgical approach presented in this paper is a simple innovation of the well-known Frosch approach: skin incision is about 12 centimeters in length and runs in a "S" shape with the center positioned over the head of the fibula. It starts 2 centimeters laterally to the tibial crest 6 centimeters below the tibial tuberosity and is directed proximally, curving posteriorly at the level of fibular head and returning straight in the most proximal part; it terminates 4 centimeters posteriorly the lateral femoral condyle. This innovative approach allows the trauma surgeon to achieve an optimal exposure and control of posterior tibial plateau fractures, with the great advantage of being able to treat the lateral tibial plateau with the same surgical incision.

RADIAL head arthroplasty: does ligaments repair influence outcomes? A minimum two years follow-up radiographic multi-center study.

PURPOSE: The current indication for comminuted radial head fractures is radial head arthroplasty (RHA). The main purpose of this study was to investigate any statistical differences in terms of prosthesis revision or removal and radiographic degenerative changes by comparing patients who underwent RHA and ligaments repair to those who underwent only RHA implant at minimum two years follow-up. The secondary aim was to delineate a trend profile of RHA implants. METHODS: All patients who underwent RHA surgery for traumatic pathology between January 2012 and December 2017 were eligible. Two researchers independently and retrospectively reviewed the patients' charts and collected the following data: type of prosthesis, associated surgical procedures and revision surgery. They also looked for any radiographic sign of prosthesis loosening, overstuffing, capitellar osteopenia, heterotopic ossification and degenerative changes. No clinical evaluation was performed. RESULTS: In 6 years, 124 RHA were implanted (74 female, 50 male, mean age 56). The main diagnoses were: terrible triad, trans-olecranon fracture and isolated radial head fracture. It was found no significant statistical difference between the 2 groups; nevertheless, the cohort of patients that underwent ligaments repair had a lower revision rate in comparison with the other. Suture of the annular ligament seems to be critical. The overall revision rate was 10.5%. CONCLUSION: This multi-center study found no evidence that ligaments repair, as an associated surgical procedure, improves RHA longevity, except for annular ligament. Nevertheless, it seems to prevent degenerative changes at midterm follow-up.

Novel directions in the study of osteoporosis: focus on gut microbiota as a potential therapeutic target.

Osteoporosis is a significant social health problem, not only in terms of pain and disability but also in terms of mortality rate. In recent years, there is an increasing interest in studying the relationship between gut dysmicrobiosis, immune system and bone health, therefore the term "osteomicrobiology" has been recently coined. This review aims to summarize the current knowledge about the link between gut dysbiosis and osteoporosis, in order to define a potential preventive and therapeutic strategy. Gut microbiota (GM) plays a major role in maintaining body homeostasis, since it is involved in several physiological processes; in recent years, the gut microbiota has shown to modulate not only local processes but also systemic responses including bone metabolism. Several potential mechanisms may explain how gut microorganisms could affect bone metabolism, i.e. influencing the host metabolism, immune system and hormone secretion. The relationship between gut dysbiosis, immunological dysfunction and bone loss could be explained by mainly focusing on T cells. Moreover, it should be noted that the relationship between GM and the endocrine system could also explicate how the microbiome influences bone status. In this context, Insulin-Like Growth Factor-1 (IGF-1), vitamin D, serotonin and leptin might play a central role. GM could have a significant impact on bone metabolism, therefore future clinical studies are necessary to develop a new multidisciplinary approach for osteoporosis treatment and prevention.

The limits and potentials of presepsin in orthopaedic surgery: state of the art and future directions.

Presepsin, i.e. the soluble cluster of differentiation 14-SubType (sCD14-ST), is an emerging biomarker for the diagnosis and evaluation of sepsis and infection. In 2004, Yaegashi et al. originally described presepsin as a potential biomarker; since then, several studies have investigated the role of presepsin in different infectious conditions, including neonatal sepsis, severe acute pancreatitis, infections in patients with haematological malignancies, severe community-acquired pneumonia, pacemaker and implantable cardioverter-defibrillator (ICD) pocket infections, surgical site infections (SSIs) and periprosthetic joint infects (PJIs). Moreover, presepsin has been also studied in the risk stratification in cardiac surgery patients, and as a biomarker in the perioperative management of patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). This review aims to summarize the current knowledge about presepsin, focusing on the limits and potentials that the use of this biomarker could have in daily clinical practice. Presepsin is could be useful in daily clinical practice in orthopaedic surgery in the diagnosis and prevention of SSIs and PJIs. It is a cost-effective biomarker, but to improve its accuracy, it is important to carefully recalculate presepsin circulating values in patients with chronic kidney disease. However, further studies with larger patients' samples are needed to better validate the use of this biomarker in orthopaedics. In the future, synovial fluid presepsin might be a useful biomarker in the diagnosis of septic arthritis and PJIs.

Bridging the gap between serum biomarkers and biomechanical tests in musculoskeletal ageing.

Musculoskeletal ageing is a major public health interesting and strain due to the significant demographic modifications in the population, and it is linked to high risk of falls, loss of autonomy in elderly individuals and institutionalization with small health outcomes. Thus, this pathological status is related to high morbidity and health care rates. Bone mass and muscle mass and strength increase during late adolescence and early adulthood but start to reduce noticeably from the fifth decade of life and are closely linked. Preclinical and clinical data strongly support the muscle-bone cross-talk showing the presence of many tissue-specific factors released by the muscle that modulate bone, such as insulin-like growth factor-1 (IGF- 1), IL-6, IL-15, myostatin and irisin. Bone and muscle tissues were increasingly recognized as endocrine target organs and endocrine organs themselves, interacting through paracrine and endocrine signals. It is then plausible that laboratory parameters could be involved in sarcopenia and osteoporosis diagnosis and treatment monitoring. This narrative review raises the possibility of whether this poor correlation between different muscle/lean mass assessment methods and muscle function tests could suggest that each parameter evaluates different aspects of "muscle status" or "muscle quality". If this is true, no one test can be used to assess muscle status but rather a battery of tests is necessary for a comprehensive assessment. More research is required to provide information for researchers to optimally design studies by using the muscle assessment method that is best associated with selected specific outcomes.

Assessment of patient-specific instrumentation precision through bone resection measurements.

PURPOSE: In the present study, the precision of two patient-specific instrumentation (PSI) systems for total knee arthroplasty (TKA) was evaluated by comparing bony resection thicknesses of the pre-operative PSI planning and intra-operative measurements by a vernier calliper. It was hypothesized that the data provided by pre-operative planning were accurate within ±2 mm of the bone resection thickness measured intra-operatively. METHODS: Forty-one patient-specific TKAs were examined: 25 performed with Visionaire® technology and 16 with OtisMed® system. PSI accuracy was analysed comparing the resected bone thicknesses in the femoral and tibial cuts with pre-operatively planned resections. To determine pre-operative planning precision, the thickness values reported by the PSI planning were subtracted from the values reported intra-operatively by the calliper. RESULTS: The mean absolute differences between pre-operatively planned resections and corresponding intra-operative thickness measurements ranged from a minimum of 2.6 mm (SD 0.8) to a maximum of 3.6 mm (SD 1.3) in all three anatomical planes in both groups. In every plane, the mean absolute discrepancies between planned resections and measured cuts differed significantly from zero (p < 0.0001). The proportion of differences within ±2 mm between intra-operative measured resections and planned PSI cuts occurred in more than 90 % of the cohort for femoral distal resections. Less precision was reported for the femoral posterior medial cuts (70.7 % within ±2 mm) and the tibial cuts (70.7 % on the medial, 75.6 % on the lateral side). Prosthetic component alignment on the coronal and transverse planes resulted in considerable deviations from the pre-operative planning. CONCLUSION: The two examined PSI technologies were accurate in femoral distal cuts, determining acceptable femoral component placement on the coronal plane. Posterior femoral and tibial cuts were less precise. Deviations from the pre-operative resection planning were reported in every plane. Inaccuracy was explained by ambiguous custom-made jigs placement on the bony surface. LEVEL OF EVIDENCE: III.

Primitive synovial chondromatosis of the hip joint.

Primitive synovial chondromatosis of the hip is quite rare. Through the presentation of four new cases, the authors discuss the pathologic and clinical features of this disease and evaluate the performance of imaging studies, emphasizing the value of CT scan for confirmation of radiographic findings. The indication for surgical treatment is analyzed for each stage of the disease.