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Introduction: Acetabular fractures (AFxs) are rare injuries considering their incidence. The gold standard of treatment is open reduction and internal xation (ORIF). Surgical treatment represents a challenge for orthopedic surgeons. Our purpose is to assess the short-to medium-term functional outcomes and complications of surgically treated AFx. We analysed the factors in uencing clinical outcomes, the incidence of complications and the predictors of conversion in total hip arthroplasty (THA).Materials and Methods: We retrospectively analysed 102 patients with AFx treated between December 2017 and September 2020. The inclusion criteria were AFx treated with ORIF and more than 12 months of follow-up (FU). We evaluated the quality of reduction with X-ray measuring residual displacement, classi ed into 3 groups (Matta Radiological Score). Postoperative super cial and deep infections, neurological sequelae and deep vein thrombosis were documented. X-rays were performed to con rm the adequacy of xation and complications. At the nal FU, the radiographs were graded according to Matta's Radiological Outcome Grading, and the clinical outcomes were graded using the Oxford Hip Score (OHS).Results: Of 102 patients, 62 patients were enrolled. The statistical analysis revealed that OHS was in uenced by quality of reduction (P=0.033), injury severity score (ISS) (P=0.005) and age (> 75 years) (P=0.029). A signi cant correlation between the patient's BMI and the OHS was recorded. The late sequelae were heterotopic ossi cation (HO) in 13 patients, osteoarthritis (OA) in 22 and avascular necrosis (AVN) in 4. HO was signi cantly affected by the posterior approach (P=0.031) and by an ISS > 15 (P= 0.0003). The analysis showed a correlation between AVN and posterior hip dislocation (P=0.004).OA had a correlation with postoperative quality of reduction (P=0.014). Eight patients required THA. Comparing patients with and without THA, a signi cant correlation between THA and posterior dislocation (P=0.022), isolated posterior wall fracture (P=0.039) and ISS > 15 (P=0.029) was recorded.Conclusion: Despite the improvement of surgical techniques and perioperative care, a high rate of patients with AFx still develop complications and require THA. Identifying negative predictors to help the management of fractures in elderly individuals is needed. Furthermore, the presence of negative predictors could represent an indication for primary THA.

Fernanda et al.: Longitudinal evaluation of bone mass in adolescents and young adults with juvenile idiopathic arthritis: the role of bone mass determinants in a large cohort of patients.

AimTo evaluate safety and efficacy in young adults with JIA treated by TNF and non anti-TNF inhibitors.Methods 36 patients (F26-M10, median age 18,8 yrs) with JIA treated with anti-TNF (17 etanercept, 4 infliximab, 15 adalimumab) followed at Transition Clinic of Florence from January 2008 to December 2010 were enrolled in a observational, singlecentre, retrospective study. 12 pts (4 etanercept, 4 infliximab, 4 adalimumab) failed to respond or did not tolerate the first therapy and switched to a second one. Moreover, 9 patients has received non anti-TNF drug (5 abatacept, 4 tocilizumab). In all, 53 treatments (19 etanercept, 5 infliximab, 20 adalimumab, 5 abatacept, 4 tocilizumab) were performed. Safety assessments were based on adverse events (AEs) report, divided in moderate AES (if infective events or injection site reactions have been occurred) and severe AES (including infusion reactions). Efficacy was assessed using the PedACR30/50/70 criteria. ResultsOf the 36 patients treated with TNF-blockers, Ped ACR30/50/70 response was reached by 78%/67%/58% after 24 weeks, 72%/68%/60% after 48 weeks and 87%/ 87%/73% after 96 weeks of treatment. Of the 9 patients treated with abatacept or tocilizumab, PedACR30/50/70 response was reached by 89%/78%/67% after 24 weeks, 80%/80%/80% after 48 weeks and 75%/75%/75% after 96 weeks. 108 AEs (both moderate and serious) occurred in 26 patients (59%) treated with anti-TNF. Among non anti-TNF agents, 36 AEs occurred in 7 patients (78%), no one was serious and any patient leaved the biological treatment due to AEs. ConclusionsIn our study, anti-TNF agents were well tolerated and provided clinically significant efficacy in young adults with JIA. In the refractory systemic form of JIA, tocilizumab seemed to be effective and safe.

Introduction: Acetabular fractures (AFxs) are rare injuries considering their incidence. The gold standard of treatment is open reduction and internal fixation (ORIF). Surgical treatment represents a challenge for orthopedic surgeons. Our purpose is to assess the short- to medium-term functional outcomes and complications of surgically treated AFx. We analysed the factors influencing clinical outcomes, the incidence of complications and the predictors of conversion in total hip arthroplasty (THA).Materials and Methods: We retrospectively analysed 102 patients with AFx treated between December 2017 and September 2020. The inclusion criteria were AFx treated with ORIF and more than 12 months of follow-up (FU). We evaluated the quality of reduction with X-ray measuring residual displacement, classified into 3 groups (Matta Radiological Score). Postoperative superficial and deep infections, neurological sequelae and deep vein thrombosis were documented. X-rays were performed to confirm the adequacy of fixation and complications. At the final FU, the radiographs were graded according to Matta’s Radiological Outcome Grading, and the clinical outcomes were graded using the Oxford Hip Score (OHS).Results: Of 102 patients, 62 patients were enrolled. The statistical analysis revealed that OHS was influenced by quality of reduction (P=0.033), injury severity score (ISS) (P=0.005) and age (> 75 years) (P=0.029). A significant correlation between the patient’s BMI and the OHS was recorded. The late sequelae were heterotopic ossification (HO) in 13 patients, osteoarthritis (OA) in 22 and avascular necrosis (AVN) in 4. HO was significantly affected by the posterior approach (P=0.031) and by an ISS > 15 (P= 0.0003). The analysis showed a correlation between AVN and posterior hip dislocation (P=0.004). OA had a correlation with postoperative quality of reduction (P=0.014). Eight patients required THA. Comparing patients with and without THA, a significant correlation between THA and posterior dislocation (P=0.022), isolated posterior wall fracture (P=0.039) and ISS > 15 (P=0.029) was recorded.Conclusion: Despite the improvement of surgical techniques and perioperative care, a high rate of patients with AFx still develop complications and require THA. Identifying negative predictors to help the management of fractures in elderly individuals is needed. Furthermore, the presence of negative predictors could represent an indication for primary THA.

Fernanda et al.: Cross-sectional evaluation of bone mass in young adults with Juvenile Onset Systemic Lupus Erythematosus: the role of bone mass determinants in a large cohort of patients.