Osteoporosis is called the ‘silent disease’ because, although it does not give significant symptoms when it is not complicated, can cause fragility fractures, with serious consequences and death. Furthermore, the consequences of osteoporosis have been calculated to weigh heavily on the costs of health systems in all the countries. Osteoporosis is considered a female disease. Actually, the hormonal changes that occur after menopause certainly determine a significant increase in osteoporosis and the risk of fractures in women. However, while there is no doubt that women are more exposed to osteoporosis and fragility fractures, the literature clearly indicates that physicians tend to underestimate the osteoporosis in men. The review of the literature done by the authors shows that osteoporosis and fragility fractures have a high incidence also in men; and, furthermore, the risk of fatal complications in hip fractured men is higher than that for women. The authors report the evidence of the literature on male osteoporosis, dwelling on epidemiology, causes of osteoporosis in men, diagnosis, and treatment. The analysis of the literature shows that male osteoporosis is underscreened, underdiagnosed, and undertreated, both in primary and secondary prevention of fragility fractures.

There is a large literature on the relationship between obesity and bone. What we can conclude from this review is that the increase in body weight causes an increase in BMD, both for a mechanical effect and for the greater amount of estrogens present in the adipose tissue. Nevertheless, despite an apparent strengthening of the bone witnessed by the increased BMD, the risk of fracture is higher. The greater risk of fracture in the obese subject is due to various factors, which are carefully analyzed by the Authors. These factors can be divided into metabolic factors and increased risk of falls. Fractures have an atypical distribution in the obese, with a lower incidence of typical osteoporotic fractures, such as those of hip, spine and wrist, and an increase in fractures of the ankle, upper leg, and humerus. In children, the distribution is different, but it is not the same in obese and normal-weight children. Specifically, the fractures of the lower limb are much more frequent in obese children. Sarcopenic obesity plays an important role. The authors also review the available literature regarding the effects of high-fat diet, weight loss and bariatric surgery.

Introduction Pelvic ring injuries, frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5–33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system. The aim of the present study is to perform a systematic literature review on male and female sexual dysfunctions related to traumatic lesions of the pelvic ring. Methods Scopus, Cochrane Library MEDLINE via PubMed, and Embase were searched using the keywords: “Pelvic fracture,” “Pelvic Ring Fracture,” “Pelvic Ring Trauma,” “Pelvic Ring injury,” “Sexual dysfunction,” “Erectile dysfunction,” “dyspareunia,” and their MeSH terms in any possible combination. The following questions were formulated according to the PICO (population (P), intervention (I), comparison (C), and outcome (O)) scheme: Do patients suffering from pelvic fracture (P) report worse clinical outcomes (C), in terms of sexual function (O), when urological injury occurs (I)? Is the sexual function (O) influenced by the type of fracture (I)? Results After screening 268 articles by title and abstract, 77 were considered eligible for the full-text analysis. Finally 17 studies that met inclusion criteria were included in the review. Overall, 1364 patients (902 males and 462 females, M/F ratio: 1.9) suffering from pelvic fractures were collected. Discussion Pelvic fractures represent challenging entities, often concomitant with systemic injuries and subsequent morbidity. Anatomical consideration, etiology, correlation between sexual dysfunction and genitourinary lesions, or pelvic fracture type were investigated. Conclusion There are evidences in the literature that the gravity and frequency of SD are related with the pelvic ring fracture type. In fact, patients with APC, VS (according Young-Burgess), or C (according Tile) fracture pattern reported higher incidence and gravity of SD. Only a week association could be found between GUI and incidence and gravity of SD, and relationship between surgical treatment and SD. Electrophysiological tests should be routinely used in patient suffering from SD after pelvic ring injuries.

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In tro duc tion. Intramedullary nail is an im por tant com po nent of mod ern treat ment of pertrochanteric fe mur frac tures. Ob jec tive. In el derly pop u la tion, pertrochanteric frac tures treated with unreamed intramedullary nails cause less deep in fec tions when com pared to reamed intramedullary nails. Pa tients and Meth ods. From April, 2010 to May, 2012 at the De part ment of Or tho pe dics and Traumatology, Gaetano Rummo Hos pi tal (Benevento, It aly), 156 pa tients with pertrochanteric frac ture, av er age age 82.7 years (75-102 years), were treated. In the an a lyzed case, there were 90 fe males and 66 males with pertrochanteric fractures. The re spon dents were di vided into two groups. The first group con sisted of 78 re spon dents who were treated with reamed intramedullary nails and the second group of 78 re spon dents treated with unreamed intramedullary nails. Dis cus sion. In fec tions are not the most com mon post op er a tive com pli ca tions. The risk of in fec tion is in creased in pa tients with comorbidity and in cases when there is an empty space be tween the intramedullary nail fix a tion and bone. Prox i mal fem o ral frac tures carry a high mor tality, but its causes are un clear. Con clu sion. Our research has shown that the ap pli ca tion of unreamed intramedullary nails in the treat ment of pertrochanteric fem o ral frac tures re duces a mor tal ity risk and risk of infection.

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