Mattia Fortina

Serum C-Reactive Protein and Procalcitonin Kinetics in Patients Undergoing Elective Total Hip Arthroplasty

Background. The sensitivity and the specificity of different methods to detect periprosthetic infection have been questioned. The current study aimed to investigate the kinetics of C-reactive protein (CRP) and procalcitonin (PCT) in patients undergoing uncomplicated elective total hip arthroplasty (THA), to provide a better interpretation of their levels in noninfectious inflammatory reaction. Methods. A total of 51 patients were included. Serum CRP and PCT concentrations were obtained before surgery, on the 1st, 3rd, and 7th postoperative days and after discharge on the 14th and 30th days and at 2 years. Results. Both markers were confirmed to increase after surgery. The serum CRP showed a marked increase on the 3rd postoperative day while the peak of serum PCT was earlier, even if much lower, on the first day. Then, they declined slowly approaching the baseline values by the second postoperative week. PCT mean values never exceed concentrations typically related to bacterial infections. Conclusions. CRP is very sensitive to inflammation. It could be the routine screening test in the follow-up of THA orthopaedic patients, but it should be complemented by PCT when there is the clinical suspicion of periprosthetic infection.

Total hip arthroplasty with a ribbed anatomic HA coated stem

In total hip arthroplasty, a straight stem seems to provide better results than an anatomic one. A new generation of anatomic stems is under evaluation, so the follow-up is still short and cannot compare with studies of straight stems. The clinical and radiographic results of 176 patients who underwent 189 primary total hip arthroplasties using an anatomic, collared, proximally hydroxyapatite (HA)-coated femoral component were prospectively determined from 1 to 6 years follow-up. The stem is ribbed in the metaphyseal region, allowing to decrease the elasticity modulus, to augment the surface for bone ingrowth and to preserve the space needed for the circulation of the inner half side of the corticalis. The average postoperative Harris hip score was 96.7 points. All femoral components had radiographic evidence of bone ingrowth fixation at the final follow-up. There were no cases of loosening for any reason. The strength of the study is limited by the short follow-up, but our preliminary excellent clinical results with stable bone ingrowth fixation allow us to continue to use this stem following patients over time.

Management of Displaced Intracapsular Femoral Neck Fracture in Young Adult:hy Complications Are Still So High? Case Report of Posttraumatic Avascular Necrosis in a 30-Year-Old Man and a Brief Review

A careful and anatomic or slightly valgus reduction, followed by stable fixation is mandatory for the correct treatment of displaced femoral neck fracture in young adult.1 Although the management of these fractures has become standard in young patients, the rate of complications continues to be unacceptably high.2 The incidence of nonunion and osteonecrosis after intracapsular femoral neck fracture has been well documented. Although for the former, a decreasing occurrence has been registered by paying particular attention to the accuracy of the reduction,3 the incidence of avascular necrosis (AVN) of the femoral head still remain the same as in the 1930s.4 Complications such as AVN and osteoarthritis can be physically, socially, and economically devastating to these young patients. We report a case of a young man who developed AVN even though every possible indication in the management of his fracture has been followed. We also perform a brief review of the current knowledge on the treatment of this type of fracture.

The orthopedic damage control in pelvic ring fractures: when and why-a multicenter experience of 10 years' treatment

Abstract Objectives To report our experience of regional referral center for the pelvis. Methods We treated 526 pelvic fractures from January 2004 to December 2014 in three regional reference centers for pelvic trauma. Men were 480 and women were 46 and ages ranged from 16 to 93 years old. Car (65%) and farm (20%) crashes were the most frequent causes of pelvis fractures. Injury severity scores ranged from 9.0 to 75.0, with a mean of 37.5. A defined algorithm for fracture management has been in place and employed to assure adequate resuscitation and fracture care. Results There were 24 deaths in total (4.56%). Sixty three (11.98%) patients underwent angio-embolization for control of bleeding (12 deaths). The average amount of blood transfused was 8.3 IU. Hospital lengths of stay ranged between 1-35 days. Among the 502 alive patients, 55.98% were able to be discharged at home while the remaining 44.02% being transferred to various rehabilitation facilities or extended care facilities. Conclusions The goal of initial management is to restore vital indicators, urinary excretion function and protect the patient from infectious complications. An emergency decisional algorithm helps manage hemodynamic instability. Initial bone and ligament procedures should reduce displacement and make it possible for the patient to wait until his condition is stable enough for definitive surgical fixation.

Analysis of Injuries and Risk Factors in Taekwondo during the 2014 Italian University Championship

Purpose  This study aims to analyze the risk factors and type of injuries occurring in Taekwondo athletes participating in a national competition. Methods  Out of the 127 competitors, 18 athletes got injured during a Taekwondo championship who were analyzed for the following parameters: modality of training; age, weight; belt color; and the type of injury. Results  Around 89% of the injuries were due to bruising and were found mainly on the lower limbs (61%) during the elimination rounds and during the first match of the day. The higher probability of injury was in the second round (56%), and during the first match of the day (72%). Nearly all the athletes were able to complete the game in which they were injured (83%). Comparing the average age of the athletes suffering an injury (23.6 ± 2.06 years) with their average years of training (8.4 ± 7.05 years) it can be noted that these athletes began this discipline rather late. The more is the training age and the weekly hours of training, the more are the numbers of matches completed, even as injured. Beginners with a low-level belt suffered more injuries than the experienced subjects did. Conclusion  The following risk factors for injury were found: starting to practice in late age, weekly training sessions with a few number of hours, male sex, low-level belt, elimination rounds, the first match of the day, and second round. Level of Evidence  Level III, observational analytic study without a control group.

The Biological Metallic versus Metallic Solution in Treating Periprosthetic Femoral Fractures: Outcome Assessment.

Introduction. The periprosthetic fracture of the femur is, in order of frequency, the fourth leading cause (5.9%) of surgical revision. Our study aims to demonstrate how the grafting of bone splint betters the outcomes. Materials. We treated 15 periprosthetic femoral fractures divided into two groups: PS composed of 8 patients treated with plates and splints and PSS involving 7 patients treated only with plates. The evaluation criteria for the two groups during the clinical and radiological follow-up were the quality of life measured by the Short Form (36) Health Survey (SF-36), Harris Hip Score (HHS), Modified Cincinnati Rating System Questionnaire (MCRSQ), bone healing measured by the Radiographic Union Score (RUS), postoperative complications, and mortality. The evaluation endpoint was set at 24 months for both groups (p < 0.05). Results. The surgery lasted an average of 124.5 minutes for the PS group and 112.6 minutes for the PSS. At 24 months all clinical and radiographic scores were p < 0.05 for the PS group. During follow-up 4 patients (2 in each group) died of causes not related to surgery. Conclusions. The use of the metal plate as opposed to cortical allogenic splint should be taken into consideration as a noteworthy point for periprosthetic femoral fractures.

Differentiating overlapping symptoms of vulvodynia and pudendal neuralgia

Context: Vulvodynia is defined as a chronic vulvar pain non-associated with infectious, inflammatory, neoplastic or hormonal disorders. Objectives: To present a case demonstrating the difficulty in assessing concomitant disease in vulvodynia. Methods: A 26-year-old woman, presented with persistent vulvodynia. She received oral and topical medications and behavioural interventions to lessen sexual pain and restore sexuality. As sexual pain decreased, the patient reported symptoms previously not mentioned: continuous, intense periclitoral pain and numbness at the perineum when sitting for a long time. These new symptoms suggest the involvement of the peripheral neural system. The physical evaluation confirmed right-side pelvic distortion, and pathological increase in lumbar lordosis, which caused neuralgia radiating to the external genitalia and perineum, and overlapping with sexual pain. After diagnosing pudendal neuralgia according to the Nantes criteria, physical treatment and relaxation exercises to de-contract the spine were added to the vulvodynia regimen. Results: During treatment, vulvodynia was sometimes present but never unbearable, allowing satisfactory sex. With physical therapy, the symptoms of pudendal neuralgia decreased. Conclusion: Differentiating the presence of two conditions with overlapping symptoms is difficult because the vestibular pain had shadowed pudendal neuralgia symptoms at initial assessment. Syndromes of chronic pain tend to associate with each other and one syndrome may shadow symptoms of the concomitant condition affecting adjacent anatomical areas. Only the accurate identification of all the syndromes involved allows adopting the correct treatment.

Can Clinical and Surgical Parameters Be Combined to Predict How Long It Will Take a Tibia Fracture to Heal? A Prospective Multicentre Observational Study: The FRACTING Study

Background Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. Methods The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. Results 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r = 0.63 (p < 0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. Conclusions This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings.

Is the short posterior stabilization by TLIF and cages a good way for a correct spinal alignment in the de novo scoliosis? A case report

De novo scoliosis is becoming one of the most prevalent findings in the aging spine, and this condition is associated not only with severe back or leg symptoms but also with complicated surgical outcomes. The most common surgery is a posterior spinal fusion with metal implants and bone graft (from the pelvis or the bone bank), with or without decompression of the nerve roots. Sometimes the surgery may need to be performed anteriorly (from the front of the spine) for better stability, correction, and healing. After 1 years of follow, up we presented a case report of a 74 year old man treated for De Novo Scoliosis with a spinal short posterior stabilization, TLIF and Cages.

A single and versatile acetabular revision system in any case of failed acetabular component

Implant loosening and osteolysis can be associated with massive bone loss. Since the structural quality of bone is difficult to assess accurately with any type of preoperative study, the surgeon needs to be ready to alter the course of the operation based on the circumstances found during surgery and must be prepared with a variety of implants and techniques. We reviewed the results of 88 acetabular revisions performed with the Sph acetabular revision system (Lima-Lto, Italy). This system allows us to choose, during the operation without changing the instrument set, between a hemispherical porous-coated cup, a winged reconstruction ring with an uncemented inner module and a bilobed cup. We implanted 31 Contact, 39 Bicomponente and 18 Bilobo cup implants. Eighty-four of the 86 cases (97.7%) were considered clinically successful at the short-term follow-up (average, 30 months; maximum, 68 months) with stable fixation and reconstruction of periacetabular bone. These encouraging short-term results confirm the importance of an appropriate technique depending on the type of bone loss.