CoViD-19 and ortho and trauma surgery: The Italian experienceItaly was the first country to report a case of Coronovirus in Europe and since the onset of the novel coronavirus (SARS-CoV-2) pandemic in China at the end of December 2019, it has been the country with the highest number of deaths worldwide to date ( Table 1 ) [1][2] .This might be explained by the high percentage of elderly people living in Italy, who make up the majority of the deaths. Moreover, the late recognition of this novel Coronavirus as a potentially serious type, unlike a seasonal flu, might have contributed to the wide spread of the disease [3] .The first cases of Coronavirus disease (CoViD) in Italy were detected in Rome, on January 20th, when a Chinese couple on holiday there resulted affected, and then in Codogno, a little village in Lombardy, on February 21st. However, an Italian Study confirmed that the virus had been circulating since the beginning of January [3] .On January 30th the Italian Government declared the state of emergency over the spread of Coronavirus disease.Afterwards, on February 22nd, the "Istituto Superiore di Sanità" (the highest Italian authority in the health-care field) ordered that some detected towns in Lombardy and Veneto, the so-called "red zones", be quarantined for 14 days. Nevertheless, given the rapid spread of the virus, northern Italy was initially locked down on March 7th but then the entire country had to be declared on lockdown on March 11th [4] .These restrictions were deemed necessary to stop virus diffusion, but, as they were not immediately applied to the whole nation, people kept on travelling around and with them did the virus.In a few weeks many changes had to be made to face the increasing need for medicine and ICU wards. Orthopaedics and Traumatology units, as well as each single hospital unit, had to help as much as possible in order to handle the epidemic in the best possible way.The Italian epidemic can be divided in two periods: an early phase, when only few CoViD patients were diagnosed in confined areas, and a second later phase: the former lasted from the middle of January to the country lockdown; the latter started with this declaration and is still on-going at the moment, due to the epidemic emergency state.
Background Host inflammation contributes to determine whether SARS-CoV-2 infection causes mild or life-threatening disease. Tools are needed for early risk assessment. Methods We studied in 111 COVID-19 patients prospectively followed at a single reference Hospital fifty-three potential biomarkers including alarmins, cytokines, adipocytokines and growth factors, humoral innate immune and neuroendocrine molecules and regulators of iron metabolism. Biomarkers at hospital admission together with age, degree of hypoxia, neutrophil to lymphocyte ratio (NLR), lactate dehydrogenase (LDH), C-reactive protein (CRP) and creatinine were analysed within a data-driven approach to classify patients with respect to survival and ICU outcomes. Classification and regression tree (CART) models were used to identify prognostic biomarkers. Results Among the fifty-three potential biomarkers, the classification tree analysis selected CXCL10 at hospital admission, in combination with NLR and time from onset, as the best predictor of ICU transfer (AUC [95% CI] = 0.8374 [0.6233–0.8435]), while it was selected alone to predict death (AUC [95% CI] = 0.7334 [0.7547–0.9201]). CXCL10 concentration abated in COVID-19 survivors after healing and discharge from the hospital. Conclusions CXCL10 results from a data-driven analysis, that accounts for presence of confounding factors, as the most robust predictive biomarker of patient outcome in COVID-19. Graphic abstract
Introduction: Revision THA (R-THA) is thought to have a higher complication rate if compared to primary THA. Dual Mobility (DM) implants have been designed aiming for achieving greater stability, with good clinical results. However, scarce material can be found about the real improvements provided by this type of implant compared to traditional implant in Revisions of Total Hip Arthroplasties. Methods: A systematic review and meta-analysis of comparative studies were performed in December 2019. This was in accordance with the guidelines of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Our primary outcome measure was overall survivorship and dislocation rate, either treated with a conservative method or requiring surgery. Results: Regarding the overall implant survival, we found a slight significant risk ratio, with a statistically meaningful difference between the two groups in questions in favour of the DM implant. A statistically significant difference in favour of the DM group turned out considering only the Dislocation rate Risk ratio and the aseptic loosening risk as well. No statistical difference was found between the two groups about the risk ratio of infection. Discussion: A steady increase of evidence is demonstrating the efficacy of using a DM cup system in THA revisions with low dislocation rates, but currently there is no study in the literature that demonstrates with statistically significant evidence. The main finding of the present study is that implant’s Survivor and prevention of dislocation at medium follow-up showed better results with a DM if compared to a fixed-bearing cup, for Revision THA.
CoViD-19 epidemic started in China in late December 2019, and soon spread, turning into a pandemic. All medical specialties have soon been involved in the management of CoViD-19 patients; the daily Orthopaedic activity has been affected profoundly by this dramatic health emergency. The present paper aims to summarize all the measures and changes that had to be made in order to avoid the healthcare system collapse in the most affected areas, and provides an operative flowchart.
The Authors report a case of a 46 years old man affected by severe acute respiratory syndrome caused by Novel Coronavirus 2019 and admitted to our hospital. The patient required continuous positive airway pressure therapy (CPAP) in the hospital ward and subsequently orotracheal intubation while in intensive care unit. The patient laid in lateral decubitus position for several hours every day while receiving CPAP therapy. During the hospitalization, he reported limitation of range of motion of the left upper limb, without any history of acute or previous trauma. The clinical appearance of the arm was suggestive of pseudoparalytic shoulder. This case emphasizes the importance of proper body positioning during invasive and non-invasive mechanical ventilation in order to prevent peripheral nerve compression and further disability.
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