Background Periprosthetic femoral fractures are challenging complications of hip arthroplasty. They are supposed to be a rare complication, but their incidence is rapidly increasing. Surgical treatment aims to achieve early mobilization and avoid the complications of prolonged bed rest. Aim of this study is to evaluate the clinical outcomes of surgical treatment comparing two surgical approaches: revision arthroplasty (RA) versus open reduction and internal fixation (ORIF). Methods Authors retrospectively reviewed a series of 117 patients with total hip arthroplasty treated for periprosthetic femur fractures in the period between January 2013 and March 2018 at a single tertiary referral center. Of these, 70 patients satisfied strict inclusion criteria. Patients were classified according to the Unified Classification System (UCS) and distributed in two groups according to surgical treatment. Clinical outcomes were assessed using the Oxford Hip recorded preoperatively and post operatively, Barthel Score, CIRS score (Cumulative illness rating scale), type of fracture and post-operative complications with a minimum follow up of 1 year. Results Nominal univariate statistical analysis revealed significant differences between the post and pre-operative Oxford Hip Score (Δ Oxford) and the surgical treatment (p = 0.008) and CIRS score (p = 0.048). Moreover, we observed a significant relationship between type of treatment and type of fracture (p = 0.0001). Multivariate analyses revealed that CIRS score was independently associated with Oxford Score improvement after surgery (p = 0.024). Conclusions Data from this case series confirmed that surgical treatment was correlated to type of fracture, according to UCS classification. Patients treated by RA had a better functional outcome than patients treated with ORIF, but these results are strongly influenced from the patients’ age, Barthel index and CIRS score. Also, authors found a correlation between functional outcome and comorbidities evaluated by CIRS score. Based on these data we suggest a multimodal approach to these patients, like those used for proximal femoral fractures.

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.

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.

Introduction: Displaced ankle fractures require surgery, bone healing generally occurs with satisfactory outcomes. In some cases, poor results are recorded related to posttraumatic arthritis or other complications. Occult lesions (osteochondral lesions, loose bodies, impingement syndrome) may be among the common causes of unsatisfactory outcomes. Most of them may be detected by a computed tomography (CT) scan at the emergency room; however, such evaluation is not routinely performed. The aim of this study was to evaluate the clinical results of patients undergoing open reduction and internal fixation (ORIF) and ankle arthroscopy for fractures associated with intra-articular lesions.Materials and Methods: Among 397 patients evaluated for displaced ankle fracture, we selected 13 patients who also presented with intraarticular alterations at the CT scan performed in the Emergency room. All subjects underwent ORIF and arthroscopy. Patients were evaluated by NRS and AO-FAS score for at least of 1-year of follow-up. Results:The mean follow-up was 2.7 years; all fractures fully healed. The mean age at the time of surgery was 33.5 years. A single complication was recorded (complex regional pain syndrome, healed 6 months after surgery). All subjects reported satisfaction with improvements of the scores and return to their daily life activities.Discussion: Occult injuries associated with ankle fractures should be suspected and ruled out by a CT scan at the emergency room. Probably many occult injuries are underestimated because CT scan is not commonly performed, explaining cases of bone healing but poor functional results. In case of confirmation, these alterations should be treated in association with ORIF; arthroscopy may represent a valid and minimally invasive procedure, with low rates of complications.

Background Periprosthetic fractures are challenging complication of hip arthroplasty and a rare injury, but their incidence is increasing. The surgical treatment is demanding to achieve early mobilization and avoid the complications of prolonged recumbency. The aim of this study is to evaluate the clinical outcomes of surgical treatment in periprosthetic femoral fractures of hip arthroplasty, making a comparison between implant revision and reduction and internal fixation of the fracture.Methods Authors retrospectively reviewed a series of 117 patients with total hip arthroplasty treated for periprosthetic femur fractures in the period between January 2013 and March 2018 at a single tertiary referral center. We collected the data of 70 patients who satisfied inclusion criteria. The fractures were classified according to the Unified Classification System (UCS) and randomized in two groups: reduction and internal fixation (G1) or revision arthroplasty (G2). Clinical outcomes were assessed with Oxford Hip Score post and pre-surgery, Barthel Score in relation to CIRS score (Cumulative illness rating scale), the type of fracture and post-operative complications with a minimum follow up of one year.Results Nominal univariable statistical analysis revealed significantly results concerning the difference between the post and pre-operative Oxford Hip Score (D Oxford) with type of treatment (p=0,008) and with the CIRS score (p=0,048). Moreover, we observed a strong significant relationship between type of treatment and type of fracture (P=0,0001). Multivariable analyses revealed that CIRS score was independently associated with Oxford Score improvement after surgery (P=0,024).Conclusions Authors reported how the surgical revision has a better functional outcome in B2 type of fracture than B1 or C, but the chosen treatment should be related to surgeon’s experience and patient’s comorbidities and a multidisciplinary team.

Regenerative medicine includes the use of technologies aimed at repairing or replacing damaged cells, tissues and organs, in order to restore their structure and function. The clinical indications for the use of regenerative medicine in orthopaedic surgery are degenerative diseases (arthritis, aseptic necrosis, osteochondritis), posttraumatic conditions (non-union) and osteoarticular segmental bone loss. The objective of tissue regeneration in orthopaedic surgery can be achieved with minimally invasive techniques or using open surgery with the application of biological or synthetic scaffolds, autologous mesenchymal stem cells, growth factors or specific surgical techniques and new-generation surgical devices. Three-dimensional bioprinting, the new frontier of tissue engineering, is a promising technology for regenerative medicine in orthopaedic surgery. In the present review, all the different techniques of bone tissue regeneration will be described with the aim of highlighting their evidence-based effectiveness and trying to define their specific role in different indications.

Objective. The aim of this study is to evaluate the relationship between serum and whole blood chromium and cobalt levels in a group of patients with metal-on metal total hip arthroplasty (Depuy ASR™). A conversion formula was developed to allow adequate evaluation of patients and correctly interpret the measured value. Methods. The authors retrospectively reviewed a series of 150 patients and prospectively analysed 64 patients who satisfied inclusion criteria. We collected data by taking simultaneously sample of chromium and cobalt ionemia from blood and serum. Results. Statistical analyses revealed significant differences between chromium and cobalt values in serum and whole blood (p 0.007), but with a strong positive correlation for both chromium (r 0.927) and cobalt (r 0.935). The authors also calculated a conversion formula to convert whole blood ion levels into serum levels, Cr se = -0.32582 + 1.39018*Cr WB for chromium and Co se = 0.239637 + 0.804279* Co WB, for cobalt. Conclusions. The difference between serum and blood values of chromium and cobalt is highlighted in a strong positive correlation. The development of the conversion formula allows to better interpret laboratory data and improve care and monitoring of patients.

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