Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods:We randomised 2970 patients from 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were ≥45 years of age were eligible. Patients were randomly assigned to accelerated surgery (goal of surgery within 6 hours of diagnosis; 1487 patients) or standard care (1483 patients). The co-primary outcomes were 1.) mortality, and 2.) a composite of major complications (i.e., mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Outcome adjudicators were masked to treatment allocation, and patients were analysed according to the intention-to-treat principle; ClinicalTrials.gov, NCT02027896. Findings:The median time from hip fracture diagnosis to surgery was 6 hours (interquartile range [IQR] 4-9) in the accelerated-surgery group and 24 hours (IQR 10-42) in the standard-care group, p<0.0001. Death occurred in 140 patients (9%) assigned to accelerated surgery and 154 patients (10%) assigned to standard care; hazard ratio (HR) 0.91, 95% CI 0.72-1.14; absolute risk reduction (ARR) 1%, 95% CI -1-3%; p=0.40. The primary composite outcome occurred in 321 patients (22%) randomised to accelerated surgery and 331 patients (22%) randomised to standard care; HR 0.97, 95% CI 0.83-1.13; ARR 1%, 95% CI -2-3%; p=0.71.Interpretation: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared to standard care.

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.

The MPFL is a distinct structure that goes from patella to femur with a sail-like shape; its patellar insertion, that mostly occur via an aponeurosis tissue with VMO and VI, is at the proximal third of the patella but it may extend in some cases to the medial third patella or to the quadriceps tendon, or very rarely to the distal third of the patella. In the femoral side, the MPFL is inserted in its own site, in most cases distinct both from epicondyle and adductor tubercle, located on average at a 9.5 mm distance distally and anteriorly in respect to the adductor tubercle. Its lower margin was difficult to define. Given the importance of this structure, it must be reconstructed as anatomically as possible in its insertion and in its shape. Many attempts have been made to make functional reconstructions with less than excellent results.

Systematic review of anatomical study, Level 1.

No abstract