Pyogenic spondylodiscitis (PS) is still burdened by a high rate of orthopedic and neurological complications. Despite the rising incidence, the choice of a proper orthopedic treatment is often delayed by the lack of clinical data. The aim of this study was to propose a clinical-radiological classification of pyogenic spondylodiscitis to define a standard treatment algorithm. MethodsBased on data from 250 patients treated from 2008 to 2015, a clinical-radiological classification of pyogenic spondylodiscitis was developed. According to primary classification criteria (bone destruction or segmental instability, epidural abscesses and neurological impairment), three main classes were identified. Subclasses were defined according to secondary criteria. PS without segmental instability or neurological impairment were treated conservatively. When significant bone loss or neurological impairment occurred, surgical stabilization and/or decompression were performed. All patients underwent clinical and radiological two-year follow-up. ResultsType A PS occurred in 84 patients, while 46 cases were classified as type B and 120 as type C.Average time of hospitalization was 51.94 days and overall healing rate was 92.80%. 140 patients (56.00%) were treated conservatively with average time of immobilization of 218.17±9.89 days.Both VAS and SF-12 scores improved across time points in all classes. Residual chronic back pain occurred in 27 patients (10.80%). Overall observed mortality was 4.80%. ConclusionsStandardized treatment of PS is highly recommended to ensure patients a good quality of life. The proposed scheme includes all available orthopedic treatments and helps spine surgeons to significantly reduce complications and costs and to avoid overtreatment.

The microbiological diagnosis is the main predictive factor for successful treatment. Early diagnosis and multidisciplinary management are also needed to identify underlying aggressive conditions and to avoid neurological complications associated with poorer long-term outcomes. Despite high healing rates, PS may lead to major disabilities still representing a difficult challenge. These slides can be retrieved under Electronic Supplementary material.

Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type II fractures are the most common fracture pattern in elderly patients. Treatment (rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type II odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid non-union successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients.

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Background: Fifth metatarsal base fracture are a common occurrence in the orthopaedic practice. Literature on the epidemiology of such fractures is scarce. The aim of this analysis was to study the relationship between Body Mass Index (BMI) and the zone of the fifth metatarsal base involved by the fracture. Methods: Data on adult patients who have been diagnosed with isolated fifth metatarsal base fracture were gathered at our Institution (blinded for review). Age, sex, height, weight and injury mechanism were collected from electronic medical records. Fractures were classified according to the Lawrence and Botte classification (Zone 1, 2 and 3) by three independent reviewers. Results: From March 2016 to December 2018, 149 patients (109 women and 40 men) have been diagnosed with fifth metatarsal base fracture. Average age and BMI at the time of injury were 51.9 (SD 17.1, range 18-84) and 24.0 (SD 3.8, range 16.4-36.7) respectively. Fracture distribution was 63.8% in zone 1, 23.5% in zone 2, 12.7% in zone 3. 12.1% of patients had a BMI < 20 kg/m 2 , 57.7% between 20 and 24.9 kg/m 2 , 22.2% between 25 and 29.9 kg/m 2 and 8.0% over 30 kg/m 2. No statistically significant differences attributable to sex (p = 0.774) or age (p = 0.379) were found between different zones of fracture. Average BMI was found to be higher in the zone 3 (26.1 ± 4.7 kg/m 2) fracture group than in zone 1 (23.7 ± 2.9 kg/m 2) (p = 0.031). Conclusion: The prevalence of proximal diaphysis (zone 3) fractures rises proportionally with BMI in our sample study. BMI appears to have an impact on fifth metatarsal base fractures pattern.