Triangular osteosynthesis and lumbopelvic fixation as a valid surgical treatment in posterior pelvic ring lesions: a systematic review.

Objective: Unstable fractures of the sacrum often occur in patients with pelvic fractures and represent a real challenge for the orthopedic surgeon. Triangular osteosynthesis (TOS) and lumbopelvic fixation (LP) may represent a valid management option for the treatment of this condition. We present a systematic literature review about lumbopelvic fixation and triangular fixation as treatment option for unstable sacral fractures, to assess clinical and radiological outcomes after surgery and to evaluate appropriate indications and impact on the natural history of sacral fractures. Methods: The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 50 articles out of 108 titles, were considered eligible for the full-text analysis. Finally, 16 studies that met inclusion criteria were included in this review. Results: Overall, 212 patients (87 males, 58 females) with sacral fractures treated with TOS triangular fixation or LP lumbopelvic fixation were collected. The mean age was 37.6 years. Mean follow-up reported in all studies was 24.14 months. Conclusion: The results presented by the different authors, highlight the effectiveness of TOS triangular fixation and LP lumbopelvic fixation for the treatment of unstable sacral fractures associated with other pelvic fractures, in terms of function, stability, cost-effectiveness, and quality of life postoperatively.

Nonmetallic tension band fixation is a viable and low-complication surgical technique in patellar fractures: a five-year retrospective study.

BACKGROUND: Traditionally, patellar fractures (PFs) have been managed using metallic tension band fixation, a method often associated with a notable rate of complications. Considering these challenges, this study explores the potential of nonmetallic fixation as a treatment option for PFs. This research aims to provide robust evidence supporting the use of the nonmetallic tension band fixation technique as an effective alternative to conventional metallic tension band fixation, thereby advancing the standard of care in treating these fractures. METHODS: This retrospective study analyzed a consecutive patient series presenting with PFs from 2008 to 2021, treated with a nonmetallic tension band fixation technique. Inclusion criteria were strictly defined to include individuals over 18 years of age with isolated PFs requiring surgical intervention. The study focused on evaluating postoperative complications and clinical outcomes, as measured by standardized scoring systems, at the final follow-up point to assess the efficacy and safety of the employed surgical technique. RESULTS: In this study, with a mean follow-up of 64 ± 7 months, a total of 64 patients who received open reduction and internal fixation (ORIF) for PFs were enrolled. Among these, five cases required additional surgical interventions. Specifically, two cases were due to knee stiffness, while the remaining three involved complications such as superficial infection, skin irritation, or delayed wound healing. The mean postoperative values recorded for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Oxford knee score (OKS), and visual analog scale (VAS) were 20.4 ± 2.3, 35.5 ± 5.3, and 1.6 ± 0.4, respectively. There were no complications related to the nonmetallic fixation technique or instances of loss of reduction. CONCLUSION: This study substantiates that nonmetallic tension band fixation is a safe and effective alternative to traditional metallic tension band fixation for patellar fractures. The study's low-complication rate and reoperation frequency underscore the value of nonmetallic implants in mitigating adverse effects and enhancing clinical outcomes. LEVEL OF EVIDENCE: IV.

Combining an Anterolateral Complex Procedure With Anterior Cruciate Ligament Reconstruction Reduces the Graft Reinjury Rate and Improves Clinical Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction (ACLR) is a well-established surgical procedure, but it may not always restore complete rotational knee stability. Interest is increasing in anterolateral complex (ALC) procedures, lateral extra-articular tenodesis (LET) and anterolateral ligament reconstruction (ALLR), in association with ACLR to overcome this problem. The better ALC procedure, LET or ALLR, remains controversial to date. PURPOSE: To analyze the patient-reported outcome measures and ACL reinjury rate after ACLR with an ALC procedure compared with after isolated ACLR, as well as to analyze the clinical results and graft failure rate of the LET group versus the ALLR group. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 2. METHODS: A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart was used to conduct a comprehensive search of 5 databases: Scopus, MEDLINE, Embase, PubMed, and the Cochrane Database of Systematic Reviews. Only randomized controlled trials were included. Eligible articles were classified according to the levels of evidence of the Oxford Centre for Evidence-Based Medicine. A methodological quality assessment of randomized controlled trials was performed using the Risk of Bias 2 tool. The present systematic review and meta-analysis was registered on PROSPERO. RESULTS: A total of 14 clinical trials were included in the final analysis, with 1830 patients. Isolated ACLR or a combined procedure with LET or ALLR was performed, with several characteristics described, including the surgical technique, additional torn knee structures and their management, graft failure, complications, clinical outcomes, clinical and instrumental examinations to assess knee stability, and postoperative protocols. Regarding clinical outcomes, pivot-shift tests and reduced graft failure, a significant difference was found in the superiority of the combined ACLR associated with the ALC procedure compared with an isolated ACLR (P < .05). No statistically significant difference was found between the 2 ALC procedures. CONCLUSION: This systematic review and meta-analysis reported on the importance of combined ACLR and ALC procedures in patients with a high-grade rotational laxity, as both procedures, LET or ALLR, without superiority of one over the other, are associated with improved pivot-shift tests, patient-reported outcome measures, and reduced graft failure rates.

Indications, complications, and clinical outcomes of fixation and acute total hip arthroplasty for the treatment of acetabular fractures: A systematic review.

PURPOSE: Acetabular fracture fixation can be challenging, especially in the elderly. Open reduction and internal fixation (ORIF) alone may not allow for early weight bearing and is associated with a high rate of secondary osteoarthritis; therefore, a combined hip procedure (CHP) or ORIF with acute total hip arthroplasty, may be beneficial in this population. The objective of this study was to perform a systematic review of all reported cases of CHP. METHODS: PubMed, Embase, Scopus, and Cochrane databases were searched for studies analyzing acetabular fractures in the elderly managed with a combined hip procedure (CHP). The research was performed following the PRISMA guidelines. The included studies' methodological quality was evaluated using the MINORS score. The present study was registered on PROSPERO. RESULTS: Eleven clinical studies were included in the final analysis. The mean age was 74.4 (63.2-78) years. Low-energy trauma was the most common mechanism of injury (64%). The most prevalent fracture pattern was the anterior column and posterior hemitransverse (ACPHT) (30.6%). The Kocher-Langenbeck approach was preferred for ORIF of posterior fractures and hip arthroplasty. The ilioinguinal approach and modified Stoppa were generally used for anterior fractures. The overall complication rate was 12.2%, and hip dislocation was the most frequent cause of reoperation (4.4%). The average Harris Hip Score reported postoperatively was 81.6 points, which was considered "good." CONCLUSIONS: CHP is a safe treatment for elderly acetabular fractures with an acceptable complication and reoperation rate that results in good clinical outcomes. LEVEL OF EVIDENCE: Level of evidence IV.

Surgical treatment of popliteomeniscal fascicles tears is associated with better patient-reported outcome measures. A systematic review and meta-analysis.

PURPOSE: Popliteomeniscal fascicles (PMFs) are a component of the popliteal hiatus complex in the knee, and their injury primarily affects young athletes participating in sports activities involving twisting movements. The identification of PMFs tears presents a challenge, often accompanied by lateral pain and a locking sensation. The objective of this systematic review (SR) and meta-analysis is to enhance the suspicion and recognition of PMFs tears, aiming to facilitate the treatment of this condition, particularly in symptomatic young patients. METHODS: A comprehensive search, focused on studies examining PMFs injuries and their treatment, was conducted in four databases, PubMed, Scopus, Embase, and Web of Science. The ROBINS-I tool was used to evaluate the risks of bias. The PRISMA flow diagram was used to conduct the research and select the included studies. A meta-analysis was conducted for the Lysholm score, the Tegner Activity Scale, and the subjective IKDC score. The present SR and meta-analysis was registered on PROSPERO. RESULTS: Five clinical studies were included in the final analysis, comprising 96 patients. All the patients underwent a preoperative MRI assessment and a diagnostic arthroscopy to detect the PMFs tears, with a subsequent surgical procedure either open or arthroscopically performed. Surgery was associated with the resolution of symptoms. A statistically significant improvement in the Lysholm score (p: 0.0005) and the subjective IKDC score (p: 0.003) after the surgical procedure with respect to the preoperative evaluation was found. CONCLUSION: This SR and meta-analysis showed a significant improvement in the Lysholm score and subjective IKDC score following surgery for PMFs tears. However, controversy persists regarding the optimal surgical approach, with current literature favoring arthroscopic procedures. LEVEL OF EVIDENCE: IV.

Irreducible knee dislocation: improved clinical outcomes of open and arthroscopic surgical treatment. A systematic review of the literature.

PURPOSE: Irreducible knee dislocations (IKDs) are a rare rotatory category of knee dislocations (KDs) characterized by medial soft tissue entrapment that requires early surgical treatment. This systematic review underlines the need for prompt surgical reduction of IKDs, either open or arthroscopically. It describes the various surgical options for ligament management following knee reduction, and it investigates their respective functional outcome scores to assist orthopedic surgeons in adequately managing this rare but harmful KD. METHODS: A comprehensive search in four databases, PubMed, Scopus, Embase, and MEDLINE, was performed, and following the PRISMA guidelines, a systematic review was conducted. Strict inclusion and exclusion criteria were applied. Studies with LoE 5 were excluded, and the risk of bias was analyzed according to the ROBINS-I tool system. This systematic review was registered on PROSPERO. Descriptive statistical analysis was performed for all data extracted. RESULTS: Four studies were included in the qualitative analysis for a total of 49 patients enrolled. The dimple sign was present in most cases. The surgical reduction, either open or arthroscopically performed, appeared to be the only way to disengage the entrapped medial structures. After the reduction, torn ligaments were addressed in a single acute or a double-staged procedure with improved functional outcome scores and ROM. CONCLUSIONS: This systematic review underlines the importance of promptly reducing IKDs through a surgical procedure, either open or arthroscopically. Moreover, torn ligaments should be handled with either a single acute or a double-staged procedure, leading to improved outcomes. LEVEL OF EVIDENCE: IV.

Treatment of Scaphoid Non-Unions with Custom-Made 3D-Printed Titanium Partial and Total Scaphoid Prostheses and Scaphoid Interosseous Ligament Reconstruction.

PURPOSE: Treatment of scaphoid fracture sequelae is still an unsolved problem in hand surgery. Custom-made 3D-printed titanium partial and total scaphoid prosthesis and scaphoid interosseous ligament reconstruction (SLIL) are performed in cases of non-union and isolated aseptic necrosis of the proximal scaphoid pole and when it is impossible to save the scaphoid bone, respectively. This study aims to evaluate the clinical, functional and radiographic results after these two prosthesis implantations. METHODS: Between January 2019 and July 2020, nine partial and ten total scaphoid prostheses were implanted using custom-made 3D-printed titanium implants. Evaluation criteria included carpal height ratio (CHR), radioscaphoid angle, wrist extension and flexion, radial deviation and ulnar deviation of the wrist, grip strength and pinch strength, Visual Analogue Scale (VAS), the Disabilities of Arm, Shoulder, and Hand (DASH) score, and the Patient-Rated Wrist Evaluation (PRWE). RESULTS: Clinical, functional, and radiographic improvements were found in all outcomes analyzed for both patient groups. The VAS pain scale obtained the most remarkable improvement at the one-year follow-up. The results of the DASH scores and the PRWE were good, with a great rate of patient satisfaction at the end of the follow-up. SLIL reconstruction also provided excellent stability and prevented a mid-carpal bone collapse in the short- and medium-term follow-up. CONCLUSIONS: A custom-made 3D-printed titanium partial or total scaphoid prosthesis is a viable solution for patients with scaphoid non-union and necrosis or complete scaphoid destruction in whom previous conservative or surgical treatment has failed.

Peripheral Nerve Regeneration at 1 Year: Biodegradable Polybutylene Succinate Artificial Scaffold vs. Conventional Epineurial Sutures.

The utilization of a planar poly(1,4-butylene succinate) (PBS) scaffold has been demonstrated as an effective approach for preserving nerve continuity and facilitating nerve regeneration. In this study, we assessed the characteristics of a microfibrous tubular scaffold specifically designed and fabricated through electrospinning, utilizing PBS as a biocompatible and biodegradable material. These scaffolds were evaluated as nerve guide conduits in a rat model of sciatic nerve neurotmesis, demonstrating both their biodegradability and efficacy in enhancing the reconstruction process over a long-term period (1-year follow-up). Histological assay and electrophysiological evaluation were performed to compare the long-term outcomes following sutureless repair with the microfibrillar wrap to outcomes obtained using traditional suture repair.

Study of a constrained finite element elbow prosthesis: the influence of the implant placement.

BACKGROUND: The functional results of total elbow arthroplasty (TEA) are controversial and the medium- to long-term revision rates are relatively high. The aim of the present study was to analyze the stresses of TEA in its classic configuration, identify the areas of greatest stress in the prosthesis-bone-cement interface, and evaluate the most wearing working conditions. MATERIALS AND METHODS: By means of a reverse engineering process and using a 3D laser scanner, CAD (computer-aided drafting) models of a constrained elbow prosthesis were acquired. These CAD models were developed and their elastic properties, resistance, and stresses were studied through finite element analysis (finite element method-FEM). The obtained 3D elbow-prosthesis model was then evaluated in cyclic flexion-extension movements (> 10 million cycles). We highlighted the configuration of the angle at which the highest stresses and the areas most at risk of implant mobilization develop. Finally, we performed a quantitative study of the stress state after varying the positioning of the stem of the ulnar component in the sagittal plane by ± 3°. RESULTS: The greatest von Mises stress state in the bone component for the 90° working configuration was 3.1635 MPa, which occurred in the most proximal portion of the humeral blade and in the proximal middle third of the shaft. At the ulnar level, peaks of 4.1763 MPa were recorded at the proximal coronoid/metaepiphysis level. The minimum elastic resistance and therefore the greatest stress states were recorded in the bone region at the apex of the ulnar stem (0.001967 MPa). The results of the analysis for the working configurations at 0° and 145° showed significant reductions in the stress states for both prosthetic components; similarly, varying the positioning of the ulnar component at 90° (- 3° in the sagittal plane, 0° in the frontal plane) resulted in better working conditions with a greater resulting developed force and a lower stress peak in the ulnar cement. CONCLUSION: The areas of greatest stress occur in specific regions of the ulnar and humeral components at the bone-cement-prosthesis interface. The heaviest configuration in terms of stresses was when the elbow was flexed at 90°. Variations in the positioning in the sagittal plane can mechanically affect the movement, possibly resulting in longer survival of the implant.

Rehabilitation approach in robot assisted total knee arthroplasty: an observational study.

BACKGROUND: The purpose of this study is to evaluate the impact of total knee arthroplasty (TKA) with the aid of Navio Robot, comparing it with standard prosthetic surgery on the functional outcomes of patients after an intensive rehabilitation program. METHOD: A case-control observational study was conducted on patients undergoing TKA for severe KOA. All patients underwent the same intensive hospital rehabilitation program of 14 daily sessions lasting 3 h. The following rating scales were administered: Numeric Rating Scale (NRS), Knee Society Score (KSS) and 12-Item Short Form Survey scale. Patient assessments were performed 1 week post-surgery (T0), 1 month post-surgery (T2), and 3 months post-surgery (T3). The primary outcomes were active knee extension and flexion and pain severity. The secondary outcomes were functional capacity and quality of life. RESULTS: Using repeated measures ANOVA, we observed at T1 a statistically different difference for the treatment group compared to the control group about KSS (p < 0.05), pain (p < 0.05), and knee flexion (p < 0.05). No statistically significant difference between the two groups was observed for knee extension (p = 0.09) and the SF-12 scale (p = 0.52). At T2 instead, we observed a statistically significant difference for the treatment group compared to the control group as regards KSS (p < 0.05) and knee flexion (p < 0.05), while no statistically significant difference was observed for pain (p = 0.83), knee extension (p = 0.60), and the SF-12 scale (0.44). CONCLUSIONS: Our study has demonstrated that robot-NAVIO assisted knee prosthesis surgery, associated with a specific intensive rehabilitation treatment, in the short and medium term, determines good pain control, better flexion recovery and a improvement of functional capacity.

Bilateral Bennett's fracture: A case report.

Bennet's fracture represents one of the most common injuries of the hand district, involving the base of the thumb, and it is affects children and elderly patients the most. The fracture is caused by direct axial trauma to a partially flexed first metacarpal and it is always intra-articular: the fracture line separates the palmar ulnar aspect of the first metacarpal base from the remaining first metacarpal. The fracture pattern is such that the first metacarpal shaft moves dorsally, proximally, and radially due to the pull of the abductor pollicis longus, extensor pollicis longus, extensor pollicis brevis, and the adductor pollicis brevis, which remain attached to the fracture fragment. The surgical treatment consists of closed reduction with percutaneous pinning or open reduction with either pins or interfragmentary screws. The decision to treat these fractures with either open reduction or closed reduction is still a matter of debate. To the best of our knowledge, there are no cases of bilateral Bennett's fracture reported in literature. The aim of this paper is to present a rare case of bilateral Bennet's fracture, the decision of two different treatments, and the good clinical outcomes.

Tibial tubercle osteotomy: effect of different osteotomy planes on contact surface area and tubercle anteriorization.

In 1983, Fulkerson introduced a technique of tibial tubercle osteotomy performed according to an inclined plane with respect to frontal plane. Due to obliquity of the osteotomy plane, this procedure allows both anterior and medial transfer of the tibial tubercle. The purpose of the study was to investigate the influence of the different degrees of the oblique plane of osteotomy on anterior displacement and the contact surface area of tibial tubercle. Synthetic bones were used for the study. An osteotomy of the tibial tubercle (TT) was performed in each specimen. Specifically, 3 different degrees of osteotomy planes relative to the reference frontal plane were examined: 20°, 30° and 40°. On each sample, tibial tubercle medial transposition of 5 mm, 10 mm and 15 mm was performed. Anterior displacement was measured with a caliper. Further, the bone contact surface was calculated for each sample and each transposition. Finally, the measured data were statistically compared with a geometric model. At 5 mm of medial TT transposition, the anterior displacement (AD) was 0.1 mm when the osteotomy was performed at 20°. It increased of 1.5 mm and 2.7 mm, respectively at 30° and 40°. At 15 mm of TT transposition, the AD was 3.4 mm at 20°, 7.6 mm at 30° and 10.0 mm at 40°. Concerning the amount of medialization, it was observed a decrease in the overall contact surface passing from 5 to 15 mm of TT transposition. In addition, regarding the oblique plane of the osteotomy, it was observed an increase in the contact surface area passing from 20° to 40°. The main result of the present study is that the amount of anteriorization and medialization of the tibial tubercle could be predicted by the degrees of oblique plane of osteotomy. An increase in medialization significantly reduces the contact surface area at low degrees of osteotomy plane, potentially increasing the risk of non-union.

Is intra-articular injection of autologous micro-fragmented adipose tissue effective in hip osteoarthritis? A three year follow-up.

BACKGROUND: Recently, increased attention on regenerative medicine and biological injective treatments have been proposed to restore native cartilage. Micro-fragmented adipose tissue (MFAT) has been studied for its anti-inflammatory, paracrine, and immunomodulatory effects. The long-term effects of MFAT are still poorly understood: the aim of the present study is to demonstrate how hip articular injections with autologous MFAT can have an impact on clinical outcomes. METHODS: Seventy-one consecutive patients affected by early hip osteoarthritis underwent an ultrasound-guided hip injection of autologous MFAT between June 2017 and December 2018. Patients were divided into four groups according to the Oxford Hip Score. All patients received 4 mL of autologous micro-fragmented adipose tissue under an ultrasound guide. A clinical evaluation was done between 29 and 41 months after the initial treatment. During this follow-up period, we recorded any new treatment the patients had done, whether that be injection or arthroplasty surgery. RESULTS: The study included 55 patients. Out of 55 patients, 28 saw benefits and were in no need of further treatment. Moreover, the score between the beginning and control increased by 6.9 points. Ten patients underwent a new articular injection: the mean time between the two injections was 635.7 ± 180 days. Seventeen patients underwent total hip replacement: the mean period between the autologous MFAT injection and the surgery was 495 days. CONCLUSION: This study found that intra-articular injections with autologous MFAT achieve beneficial clinical results in patients affected by early to moderate hip osteoarthritis, with an OHS between 48 and 30. Furthermore, these subjects are the ideal patients for whom this treatment obtains good clinical results.

Hamstring Graft Preparation for ACL Reconstruction.

Anterior cruciate ligament (ACL) reconstruction represents one of the most common procedures in orthopedic surgery. It usually involves the harvest of both gracilis and semitendinosus tendons from the ipsilateral knee. Different methods of hamstring graft preparation have been proposed in recent years, to create an adequate graft diameter reducing morbidity linked to gracilis tendon harvesting procedure. More recently, the use of only 1 of the tendons (semitendinosus) in a tripled or quadrupled arrangement has been described, especially in an all-inside type of reconstruction. Having a thicker tendon with a quadrupled semitendinosus (ST), instead of double gracilis and ST enables to have a graft with enough diameter to resemble more closely the native ACL and decreases the risk of graft re-rupture. The present study aims to describe different options of hamstring graft preparing, listing and analyzing each configuration to help surgeons to choose the most suitable graft type for their patients.

Is There a Relationship between Idiopathic Scoliosis and Body Mass? A Scoping Review.

The etiopathogenesis of idiopathic scoliosis remains unknown, although genetic or hereditary factors, neurological disorders, hormonal and metabolic dysfunctions, biomechanical factors, and environmental factors seem to be involved. Several studies have found that patients with scoliosis have common characteristics of taller stature, lower body mass index (BMI), and low systemic bone mass. We conducted a scoping review to analyze the association between idiopathic scoliosis and BMI. The search for articles was performed on PubMed and Cochrane, including the English language, full-text and free-full-text articles published from 31 December 2011 to 31 December 2021. Most of the results analyzed are in favor of a relationship between low BMI and scoliosis. Having a low BMI could be associated with the presence of scoliosis, although the reason for which is still doubtful. However, further large-scale epidemiological studies on different ethnicities and a comparison of BMI with the healthy population will be needed to better define the correlation between BMI and scoliosis.

Peri-Implant Distal Radius Fracture: Proposal of a New Classification.

A peri-implant fracture near the volar plate of the distal radius represents a rarity and can be associated with a mechanical failure of the devices. A literature review was conducted including all fractures that occurred around a volar wrist plate, which could be associated with an ulna fracture. All articles published until December 2021 were considered according to the guidelines presented in the PRISMA Statement. The search was conducted with the PubMed electronic database, Cochrane Database of Systematic Reviews, Medline, Embase, and Google Scholar. Only nine cases of these fractures were reported in the literature. The causes could be due to delayed union/non-union of the old fracture after low energy traumas, high energy trauma in patients with poor bone quality, or hardware mechanical failure. Furthermore, the literature review of peri-implant radius fracture shows different level of radius fracture and types of implant failure. In accordance with these different cases, a new classification of peri-implant fracture of the distal radius is proposed.

Improved Bone Regeneration Using Biodegradable Polybutylene Succinate Artificial Scaffold in a Rabbit Model.

The treatment of extensive bone loss represents a great challenge for orthopaedic and reconstructive surgery. Most of the time, those treatments consist of multiple-stage surgeries over a prolonged period, pose significant infectious risks and carry the possibility of rejection. In this study, we investigated if the use of a polybutylene succinate (PBS) micro-fibrillar scaffold may improve bone regeneration in these procedures. In an in vivo rabbit model, the healing of two calvarial bone defects was studied. One defect was left to heal spontaneously while the other was treated with a PBS scaffold. Computed tomography (CT) scans, histological and immunohistochemical analyses were performed at 4, 12 and 24 weeks. CT examination showed a significantly larger area of mineralised tissue in the treated defect. Histological examination confirmed a greater presence of active osteoblasts and mineralised tissue in the scaffold-treated defect, with no evidence of inflammatory infiltrates around it. Immunohistochemical analysis was positive for CD56 at the transition point between healthy bone and the fracture zone. This study demonstrates that the use of a PBS microfibrillar scaffold in critical bone defects on a rabbit model is a potentially effective technique to improve bone regeneration.

Similar biomechanical properties of four tripled tendon graft models for ACL reconstruction.

PURPOSE: The present study tested and compared the biomechanical properties of four different triplicate graft tendon techniques. METHODS: 32 tripled tendons from the common extensor muscle of bovine fingers were tested on a material testing machine, passing the end loop over a metal rod of a clevis connected to the load cell on the upper side, and fixing the lower end to a clamp. The samples were divided into four groups: (A) tripled with a free end sutured only to one of the two fixed bundles (B) tripled with a free end positioned between the two fixed strands and sutured to both (C) tripled with an S-shape and all the three strands sutured together at the upper and lower extremities of the graft (D) partially quadrupled with the free end sutured together with the other three bundles at the upper extremity. Each sample was pretensioned at 50 N for 10 min and then subjected to 1000 load control cycles between 50 and 250 N. Finally, each sample was subjected to a load to failure test. Authors also present some preliminary results on the feasibility of a non-contact and full-field Thermoelastic Stress Analysis technique, based on Infrared Thermography, to evaluate the level of stress on the whole graft, and hence on each strand, during fatigue loading. RESULTS: Eighty five percent of the samples failed at the level of the clamp. The cyclical elongation progressively decreased in all the samples and there was a simultaneous increase in stiffness. An increased stiffness was noted between Group 2 vs Group 3 and Group 2 vs Group 4 at the 500th and 1000th cycle. The failure loads were as follows: (a) 569.10 N, (b) 632.28 N, (c) 571.68 N, (d) 616.95 N. None of the parameters showed a statistically significant difference between the four groups. CONCLUSION: This study reported similar biomechanical behavior of four different models of tripled grafts suitable for ACL reconstruction. In addition, the biomechanics of overall tripled tendon grafts seems more affected by the viscoelastic property of the tendon itself rather than the preparation method.

Does the association of therapeutic exercise and supplementation with sucrosomial magnesium improve posture and balance and prevent the risk of new falls?

BACKGROUND: Fracture of the proximal femur is the most feared complication of osteoporosis. Given the numerous physiological functions that magnesium performs in our body, in the literature there is a correlation between osteoporosis and low serum levels of magnesium. AIM: Evaluate the incidence of hypomagnesemia in patients with lateral fragility fracture of the proximal femur, the possible correlation between serum magnesium levels and fractures, and the effectiveness of supplementing Sucrosomial® magnesium associated with therapeutic exercise on the outcome of these patients. METHODS: We divided the study into two parts. In the first part, we assessed the preoperative incidence of hypomagnesemia in patients using a blood test. In the second part, patients with hypomagnesemia were divided, in the post-operative period, into two groups, who received, respectively, only therapeutic exercise or oral supplementation with sucrosomial magnesium associated with therapeutic exercise. RESULTS: Half of the patients with fragility femoral fracture had hypomagnesemia, with a higher incidence of the subclinical form. From the comparison between the two groups, the T1 treatment group showed a significant improvement in blood levels of magnesium (2.11 ± 0.15 vs. 1.94 ± 0.11; p < 0.05), on the NRS scale (5.7 ± 0.81 vs. 6.6 ± 1.18; p < 0.05), the Tinetti scale (17.3 ± 1.15 vs. 15.2 ± 2.98; p < 0.05) and the SarQoL questionnaire (47.3 ± 5.21 vs. 44.9 ± 5.54; p < 0.05). CONCLUSIONS: More attention would be needed in the diagnosis and correction of subclinical hypomagnesemia and not just the simple and clinically evident one, including hypomagnesemia among the modifiable risk factors for osteoporosis.

Cement augmentation for trochanteric fracture in elderly: A systematic review.

BACKGROUND: Cement augmentation of internal fixation of hip fracture has reported to improve fracture stability in osteoporotic hip fractures, reducing the risk of cut-out of the sliding screw through the femoral head. The purpose of present study was to perform a systematic literature review on the effects of augmentation technique in patients with osteoporotic hip fractures. MATERIAL AND METHODS: A comprehensive literature search was systematically performed to evaluate all papers published in English language included in the literature between January 2010 and July 2020, according to the PRISMA 2009 guidelines. In vivo and in vitro studies, case reports, review articles, cadaveric studies, biomechanical studies, histological studies, oncological studies, technical notes, studies dealing with radiological classifications and studies on revision surgery were excluded. RESULTS: A total of 5 studies involving 301 patients were included. Patients had a mean age of 84.6 years and were followed up for a mean period of 11 months. The proximal femoral fractures were stabilized with implantation of the PFNA or Gamma nail and augmentation was performed with two different cements: polymethylmethacrylate (PMMA) in 4 studies and calcium phosphate (CP) in one study. Overall, 57.5% of patients reached the same or greater preoperative mobility, and postoperative Parker Mobility Score and Harris Hip Score were acceptable. No significantly complications were observed, and no additional surgery related to the implant was required. CONCLUSION: The results of this systematic review show that cement augmentation is a safe and effectiveness method of fixation to treat trochanteric fractures.