The increase in osteoporotic fracture worldwide is urging bone tissue engineering research to find new, improved solutions both for the biomaterials used in designing bone scaffolds and the anti-osteoporotic agents capable of promoting bone regeneration. This review aims to report on the latest advances in biomaterials by discussing the types of biomaterials and their properties, with a special emphasis on polymer-ceramic composites. The use of hydroxyapatite in combination with natural/synthetic polymers can take advantage of each of their components properties and has a great potential in bone tissue engineering, in general. A comparison between the benefits and potential limitations of different scaffold fabrication methods lead to a raised awareness of the challenges research face in dealing with osteoporotic fracture. Advances in 3D printing techniques are providing the ways to manufacture improved, complex, and specialized 3D scaffolds, capable of delivering therapeutic factors directly at the osteoporotic skeletal defect site with predefined rate which is essential in order to optimize the osteointegration/healing rate. Among these factors, strontium has the potential to increase osseointegration, osteogenesis, and healing rate. Strontium ranelate as well as other biological active agents are known to be effective in treating osteoporosis due to both anti-resorptive and anabolic properties but has adverse effects that can be reduced/avoided by local release from biomaterials. In this manner, incorporation of these agents in polymer-ceramic composites bone scaffolds can have significant clinical applications for the recovery of fractured osteoporotic bones limiting or removing the risks associated with systemic administration.

The study aimed to identify the psychological changes that result from the amputation of a limb and the ways in which patients coordinate their daily lives. The study uses an interpretative phenomenological analysis (IPA) aimed at understanding individual experiences in seven patients who have suffered limb amputation. The method used consisted of individual, semi-structured interviews, conducted approximately 4 months after surgery, to patients at home or in hospital, at the time of their regular checkup. The interviews were audio recorded, transcribed and, following the qualitative analysis performed, six common themes were identified: emotional impact, negative affects, tendency toward isolation, role constraints and limitations, phantom limb, and emotional balancing. A specific theme for patients who have suffered amputations is phantom limb pain, which has received special attention from researchers. The last topic relates to the tendency toward emotional balancing and psychological calibration to return to normal life.

Two case reports and an updated critical review on bilateral fractures of the femoral neck are presented. Bilateral fractures of the femoral neck have been investigated for at least 80 years and are treated as rare cases. The primary cause is usually considered an external shock; however, aside from high energy shocks (e.g., falling and impact with hard, rigid surfaces, traffic accidents, etc.) the underlying causes of femoral neck frailty have not yet been fully understood. Although not exhaustive, the review spans cases reported as early as 1944 and compares their conclusions in line with medicine developments at the time of the reports until present. The discussion is perhaps controversial at times; it brings to the fore the energy balance between shock waves and stress waves. The two cases reported here add to the review, one highlighting the biomechanics, and the other supporting more recent findings on metabolic disorders, which ultimately lead to enhanced frailty of the femoral neck. Investigation of the fractures has been performed with X-ray radiographs, MRI, and CT, with a follow up using a Doppler US to check blood flow in the lower zone of the limbs. The second case was investigated both for fractures and metabolic diseases, e.g., type I diabetes and kidney failure (dialysis). In Case 1 the second fracture was not observable at the time of admission, and therefore two surgery operations were performed at seven days interval. Taperloc Complete prostheses (Zimmer Biomet) were applied. Case 2 suffered a second fracture in the right hip in the segment above the knee and required better fixation with cables. Despite this, she returned one month later with a new crack in the femur. Case 1 is a typical case of wear consequences on the biomechanics of the hill pad-tibia-femur-femoral neck system, where tension of the neck occurred due to a stress wave rather than a shock wave. This can be proven by the absence of a second fracture from the images first acquired, the only evidence being pain and walking difficulty. Case 2 shows that metabolic diseases can dramatically enhance the frequency of bilateral femoral neck fractures.

The knee joint is one of the most commonly injured joints, as an isolated injury or as a frequent component in a multiple trauma patient. Injury to the ligaments and menisci affects the stability and normal mechanics of the knee joint, resulting in an impairing unstable knee. Magnetic resonance imaging (MRI) is a useful diagnostic tool in the assessment of injuries to the knee joint, while anterior cruciate reconstruction is a common orthopedic procedure. We set to find in this paper the concordance between MRI and arthroscopic findings. We performed a retrospective analysis of 57 patients who underwent both MRI and arthroscopic intervention, in order to see the accuracy of the imagistic evaluation in anterior cruciate ligament (ACL) lesions. Our findings show that MRI and arthroscopy were in complete agreement in 94.7% of the cases. We also found 2 casesthat had normal ACL on MRI, but intraoperative we found a partial tear of the anterior cruciate ligament. In only one case we found an intact ACL at arthroscopy although it looked ruptured on MRI. For the assessment of ligamentous and meniscal injuries, MRI is accurate and non-invasive modality. It can be used as a first line investigation, but arthroscopy remains the gold standard for definitive and accurate diagnostic for ACL and meniscal injuries.

Considered to be a rare and very disabling condition, bilateral terrible triad of the elbow is a fracture-dislocation, which consists in a fracture of the radial head and also of the coronoid process of the ulna, all of this associated with a posterior displacement of the elbow and high instability. It was named "terrible triad" because of the poor outcome of bone healing and range of motion, both medium and long term. What we present is a special case, first because it was not a unilateral terrible triad injury but bilateral, and because the treatment was different for each elbow, which was interesting for comparing the outcome. Although both radial head fractures were comminuted, with different treatment options, for one of them open reduction and internal fixation was performed, while for the other one our option was replacement of radial head with a prosthesis. For both elbows we obtained good functional outcome at 1-year follow up.

Gout is a metabolic condition, common to animals and humans, issuing from the excessive accumulation of end products of proteins degradation. In this study, histopathological and cytological examinations, combined with Raman spectroscopy, have been performed to investigate tissue samples from reptiles, chickens, and humans, presenting lesions produced by uric acid accumulation. As a result of classic processing and staining techniques commonly used in the anatomopathological diagnosis, uric acid crystals lose their structural characteristics, thus making difficult a precise diagnostic. Therefore, complementary diagnostic methods, such as Raman spectroscopy, are needed. This study compares from several perspectives the above mentioned diagnostic methods, concluding that Raman spectroscopy provides highlights in the diagnosis of gout in humans and animals, also adding useful information to differential diagnosis of lesions.