Large bone defects resulting from musculoskeletal tumours, infections, or trauma are often unable to heal spontaneously. The challenge for surgeons is to avoid amputation, and provide the best functional outcomes. Allograft, vascularized fibular or iliac graft, hybrid graft, extracorporeal devitalized autograft, distraction osteogenesis, induced-membrane technique, and segmental prostheses are the most common surgical strategies to manage large bone defects. Given its optimal osteogenesis, osteoinduction, osteoconduction, and histocompatibility properties, along with the lower the risk of immunological rejection, autologous graft represents the most common used strategy for reconstruction of bone defects. However, the choice of the best surgical technique is still debated, and no consensus has been reached. The present study investigated the current reconstructive strategies for large bone defect after trauma, infections, or tumour excision, discussed advantages and disadvantages of each technique, debated available techniques and materials, and evaluated complications and new perspectives.

Purpose: Osteonecrosis of the femoral head (ONFH) is common in skeletally immature patients. The management of ONFH is controversial, with limited evidence and unpredictable results. This study systematically reviewed the current operative modalities and clinical outcomes of surgical management for ONFH in skeletally immature patients. Methods: The present study was conducted according to the PRISMA 2020 guidelines. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in October 2021. All the published clinical studies reporting data concerning the surgical management of ONFH in skeletally immature patients were included. Results: This review included 122 patients (127 hips). 38.2% (46 of 122) were female. The mean age of the patients was 14.2 ± 2.3 years. The mean duration of the follow-up was 55.3 ± 19.6 months. The Harris Hip Score improved from 68.8 ± 11.9 at baseline to 90.5 ± 6.5 at last follow-up (p < 0.0001). Femoral head collapse and secondary hip degeneration were the most common complications. Conclusion: Several surgical techniques are available and effective for the management of ONFH in skeletally immature patients. This study evidenced high heterogeneity of the surgical procedures and eligibility criteria. Further high-quality investigations are required to establish proper indications and surgical modalities.

Purpose: Intense sporting activity and certain types of work increase the risk of early osteoarthritis (OA). OA can be idiopathic or associated to certain predisposing factors: female sex, obesity, history of joint injury, and joint overuse. The role of gender among the active population as a predisposing factor for OA is not well clear. This study investigated whether the risk of OA changes with age in both sexes in physically active individuals.Materials and Methods: This systematic review was conducted according to the PRISMA guidelines 2020. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in April 2021. No time constrains were used for the search. All the published clinical studies reporting data about relationship between physical activity and OA were included.Results: Data from 7 articles were retrieved including 360,053 patients (271,903 males; 88,150 females). The mean age was 48.2 ± 16.7 years. Males, under the age of 60 had a higher risk of developing OA. People undertaking intense physical activity, such as professional athletes or heavy workers, are more prone to develop early OA. Conclusion:Physically active males demonstrated a higher risk of developing OA.

We read with great interest the article by Gjerdrum et al concerning the comparison of refractive predictability between different biometers. 1 Analysis of both group refractive index (GRI) and single refractive indices principles is fascinating. However, we would like to make a few comments regarding some points of the study that need to be clarified.Authors correctly listed some causes of postoperative refractive errors, such as inaccurate prediction of corneal power 2 and axial length (AL). We totally agree, but we ask ourselves why the authors forgot to mention the AL reliability due to lens opacity or the corneal thickness/AL ratio in their work. In fact, as the authors evaluated patients undergoing cataract surgery, lens opacity could affect GRI biometers reliability, as demonstrated by De Bernardo et al. 3 They proposed a correction factor (ALc) to improve the AL measurement reliability which can eliminate any systematic error resulting from the biometer. Since authors analyzed two biometers based on GRI, authors should have taken in consideration ALc for these instruments. Lacking AL correction in GRI biometers could explain the AL differences in extreme values compared to sum-of-segments biometer, especially in long eyes, as noted by the authors in this paper. 1,3 Authors also declared that they used optimized constant for Lenstar and after they reduced the mean arithmetic (ME) refractive prediction error (RPE) to zero for each device, surgeon and IOL. We have some concerns in this regard. Firstly, also ME obtained with Lenstar is different from zero, as reported in Table 1. In addition, authors did not report how many eyes were analyzed for each IOL model. This is crucial missing information, because to perform an acceptable optimization at least 3 cases for each IOL model should be listed. 4 Moreover, we wonder why also toric IOLs were included.This study focused on AL reliability, but different RPE obtained by Argos and Anterion were caused by keratometric readings. In fact, these biometers utilize different technologies and diameters to evaluate keratometry. Anyway, optimization of the process could mute every difference between instruments in refractive predictability. Since this process aims to eliminate the systematic error, including optical biometer, 5 we wonder if it could be considered correct to optimize formulas for each biometer in a study that aims to analyze differences between these devices.We have some concerns also regarding the statistical analysis. No data normality check and statement of statistic test used to compare percentages were presented, so, we are surprised by the analysis of subgroups consisting of only 10 or 11 patients! This is in contrast with a minimum sample size of 22 eyes calculated by the authors. For this reason, the analysis of subgroups that comprehend less than the minimum sample size can be misleading. In this scenario, it could be preferable to analyze data according to quartile ranges to have equal subgroups, as carried out by other recent studies. 2 Results...