Balance assessment after altering stimulation of the neurosensory system.

Aim Posture requires fine integrative elaboration, performed by the central nervous system, of neurosensory information originated from the visual, vestibular and spinal circuit. Many perturbing agents can influence this elaboration and then the postural stability. Several studies have evaluated only the effect of a single agent on the postural control. The study analysed the perturbing effect of several external agents on the different sensorial circuits in terms of postural balance loss in orthostatism. Methods The postural stability of 31 patients was evaluated with a static posturography platform in basal conditions and after exposure to an external agent in the following order: stroboscopic light projecting, mechanical rotations on a swivel chair, feet desensitization through ice, administration of an alcoholic drink at intervals which depended on the participant return to basic posturographic values. Tests were performed with open eyes (OE), closed eyes (CE) and reducing plantar perception through the use of a rubber pillow. Results The stroboscopic light altered the postural control. The swivel chair disturbed only with CE. Ice and alcohol increased the oscillation area. The alcohol test had a significant reduction in postural control with OE compared to CE. The rubber cushion increased the oscillation area in all OE tests and with CE in alcohol and ice tests. Conclusion The different agents did not trigger postural control deficits in the same way. A cold environment with psychedelic lights and the use of alcoholic beverages altered significantly the postural stability by influencing simultaneously all perceptions (visual, vestibular and somatosensory feedback).

Retrospective multi-centre study on head adapters in partial revision hip arthroplasty.

BACKGROUND: Instability and dislocation after total hip arthroplasty (THA) is a common reason for revision surgery. THA head-neck adapters promise the reconstruction of optimal femoral offset and leg length in revision THA (rTHA) while retaining stable implants. The aim of this retrospective multi-centre study is to report on the results achieved with the use of head adapters in partial rTHA, to avoid the instability of the implant. METHODS: 55 cases of partial rTHA performed between February 2015 and April 2017 in 3 different hospitals using the Bioball Head Adapter (BHA) (Bioball Merete, Medical GmbH, Berlin, Germany) were retrospectively recorded. All patients were evaluated from a radiological point of view at an average follow-up of 3.5 years. Failure was defined as re-revision surgery for any cause as well as a subjective feeling of instability of the joint. RESULTS: One failure was registered in an extreme case and radiological findings show no suggestive signs of radiolucencies or loosening and therefore all implants have been considered stable. CONCLUSIONS: Despite some limitations of this retrospective study and according to the relevant literature, our data confirms that BHA is a safe system that allows the flexibility to restore femoral offset and version, to adjust leg length, to minimise instability, to avoid unnecessary removal of otherwise well-fixed components thus improving tribology and reducing the risk of taper junction issues without major complications in partial rTHA.

Management of Traumatology Patients During the Coronavirus (COVID-19) Pandemic: Experience in a Hub Trauma Hospital in Northern Italy.

BACKGROUND: As a result of the uncontrolled spread of the COVID-19 virus infection, a health reorganization according to the "hub and spoke" model was necessary. The purpose of the article was to document the adopted corporate protocol and describe the management of the traumatized patient in a Hub center. METHODS: Our hospital has been identified as one of the three regional Hubs for polytrauma and major traumas, requiring suitable pathways to receive confirmed or suspected COVID-19-positive patients, from the emergency room entrance to the operating room, and finally to the inpatient ward or ICU. From February 23th to April 30th 2020 we analyzed the total number of trauma patients hospitalized and the number of femoral neck fractures surgically treated within 48 h; the data were then compared with the corresponding period of the previous year. RESULTS: There has been a reduction in the overall number of traumas as a result of government restraint measures. Total occupancy time in the operating theater has increased, but not drastically considering dressing procedures and anesthesia (carried out inside the operating room). The number of patients with femoral neck fractures surgically treated within 48 h (none of the COVID-19-positive patients) decreased from 83.33 to 58.70%, but only slightly lower than the Italian pre-COVID average of 64.70%. CONCLUSIONS: The correct management of the hospital and the meticulous organization of the traumatized patient have made it possible to contain the potential negative effects on the medical care quality during this unexpected and severe health emergency.

The orthopaedic and traumatology scenario during Covid-19 outbreak in Italy: chronicles of a silent war.

BACKGROUND: From February 21, the day of hospitalisation in ICU of the first diagnosed case of Covid-19, the social situation and the hospitals' organisation throughout Italy dramatically changed. METHODS: The CIO (Club Italiano dell'Osteosintesi) is an Italian society devoted to the study of traumatology that counts members spread in public and private hospitals throughout the country. Fifteen members of the CIO, Chairmen of 15 Orthopaedic and Trauma Units of level 1 or 2 trauma centres in Italy, have been involved in the study. They were asked to record data about surgical, outpatients clinics and ER activity from the 23rd of February to the 4th of April 2020. The data collected were compared with the data of the same timeframe of the previous year (2019). RESULTS: Comparing with last year, overall outpatient activity reduced up to 75%, overall Emergency Room (ER) trauma consultations up to 71%, elective surgical activity reduced up to 100% within two weeks and trauma surgery excluding femoral neck fractures up to 50%. The surgical treatment of femoral neck fractures showed a stable reduction from 15 to 20% without a significant variation during the timeframe. CONCLUSIONS: Covid-19 outbreak showed a tremendous impact on all orthopaedic trauma activities throughout the country except for the surgical treatment of femoral neck fractures, which, although reduced, did not change in percentage within the analysed timeframe.