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Introduction: Periprosthetic femoral fracture around hip arthroplasty are growing in the world, nevertheless management and treatment options for fractures "around the stem" are still debated due to lack of high-level studies. Materials and method: A 85-item survey were fill out by 40 Italian Orthopedic Surgeon member of SIOT (Società Italiana di Ortopedia e Traumatologia) and AIR (Associazione Italiana Riprotesizzazione) to assess their current opinion in the management of type B periprosthetic femoral fractures. Responses were summarized using proportions, and further stratified by practice type, case volume, surgeon age, and fellowship training. Results: Vancouver/UCS fracture classification showed a good interobserver agreement (k value =.76). ORIF were the treatment of choice for UCS type B1 fractures (100%), revision stem for B2 (85%) and B3 (100%). Locked plates were preferred to cable plate and cerclage without a plate for B1 fractures (50% vs 40% vs 10%); revision with modular stem was preferred to monoblock stem for B2 fractures (50% vs 35%) and B3 (75% vs 15%). Responders tended to postpone at 1-month weight-bearing in patients with B1 fractures. Regarding postoperative pharmacological treatment there was absolute lack of consensus. Discussion: The primary finding of our survey confirmed the preference of ORIF for B1 fractures and stem revision for B2 and B3 fractures. However, there is no definitive operative technique for all UCS B fractures. Surgeons tended to favor locked plating over cable plating, although only slightly. This general lack of consensus coincides with the inconclusive evidence that currently exists in the literature, which demonstrates both favorable and unfavorable outcomes for both techniques Conclusions: The absence of complete homogeneity among participants showed the need for prospective randomized studies to set up stronger guidelines for classification, management, surgical treatment, rehabilitation, and pharmacological support of periprosthetic femoral fractures. [ABSTRACT FROM AUTHOR]

Introduction: The reverse shoulder arthroplasty is nowadays a treatment option for a variety of shoulder problems. As its incidence rose, also the number of complications increased, including intraoperative fractures. Significance: We performed a systematic review and critical analysis of the current literature following the PRISMA guidelines. Our purpose was to: 1) determine incidence, causes, and characteristics of intraoperative fractures; 2) evaluate their current treatment options, possible related complications, reoperation rates, and the patients' outcome; and 3) determine the overall incidence of each complication related to reverse shoulder arthroplasty. The articles were selected from PubMed medical database in April 2020 using a comprehensive search strategy. Rayyan software was used to support the selection process of the records. A descriptive and critical analysis of the results was performed. Results: The study group included a total of 13,513 reverse shoulder arthroplasty procedures. The total number of complications was 1647 (rate 12.1%). The most common complication was dislocation (340 cases, rate 2.5%). Forty-six studies reported a total of 188 intraoperative fractures among the complications (rate 1.4%). The intraoperative fracture rate was 2.9% and 13.6% in primary and revision settings, respectively. There were 136 humeral fractures, 60% of them occurred in revision RSAs, during the removal of the previous implant, and involved the shaft in the majority of cases (39%). Glenoid fractures were 51 and occurred mostly during the reaming of the glenoid. We observed 7 further related complications (rate of 4%) and 3 reoperations (rate of 1.5%). The outcome was satisfactory in the majority of cases. Conclusions: A comprehensive review on intraoperative fractures in reverse shoulder arthroplasties is presented. Results suggest favorable outcomes for all treatment methods, with a modest further com- plication rate. This investigation may aid in the treatment decision-making for these complications. [ABSTRACT FROM AUTHOR]

Purpose: The management of severe acetabular bone deficiency and a stable femoral stem can be a challenging problem in revision hip surgery. Replacement of both the acetabular and femoral component in elderly patients can increase perioperative risks without the certainty of a better functional outcome. We report the long-term outcome of reinforcement rings in isolated acetabular revision to determine whether this procedure allows hip function restoration and implant longevity. Methods: A retrospective study was conducted to evaluate the long-term results of isolated acetabular revision in thirty patients with a mean age of 70.6 years. 16 patients (16 hips) received an acetabular reinforcement ring, and 14 patients received a reconstruction cage. Acetabular defects were classified as Paprosky Type II in 16 cases and Type III in 14 cases. The mean follow-up was 11.3 years (range 10–15 years). Results: Radiographic signs of loosening were found in 9 cases (30%). 4 cases (13.3%) with severe osteolysis and implant migration underwent further revision surgery. All 30 unrevised femoral stems were considered stable. 1 (3%) early dislocation, was conservatively treated. Clinical assessment showed a significantly improved mean Harris Hip Score from 45.1 points preoperatively to 85.4 at the latest follow-up (p < 0.05). The 15-year survival rate was 86.7%. Conclusions: Our long-term results showed that in selected patients, isolated acetabular revision with rings or antiprotrusio cages represents a reasonable surgical technique for the management of severe acetabular bone loss. However, concerns about the high radiographic loosening rates are possibly related to low bone ingrowth compared to new porous implants. [ABSTRACT FROM AUTHOR]