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Background and objectives: wear and corrosion can lead to the gross failure of the Morse taper junction with the consequent fracture of the true neck of the prosthetic stem in hip arthroplasty. Materials and Methods: 58-year-old male patient, with a BMI of 38 kg/m2. Because of avascular necrosis, in 2007, a metal-on-metal total hip arthroplasty was implanted in him, with a TMZF stem and a Co-Cr head. In December 2020, he complained of acute left hip pain associated with the deterioration of his left leg and total functional impairment, preceded by the crunching of the hip. X-rays and CT scan showed a fracture of the prosthetic neck that necessitated prosthetic revision surgery. A Scanning Electron Microscope (SEM) analysis of the retrieved prosthetic components was conducted. Results: Macroscopically, the trunnion showed a typical bird beak appearance, due to a massive material loss of about half of its volume. The gross material loss apparently due to abrasion extended beyond the trunnion to the point of failure on the true neck about half a centimeter distal from the taper. SEM analysis demonstrated fatigue rupture modes, and the crack began close to the neck's surface. On the lateral surface, several scratches were found, suggesting an intense wear that could be due to abrasion. Conclusions: The analysis we conducted on the explanted THA showed a ductile rupture, began close to the upper surface of the prosthetic neck where the presence of many scratches had concentrated stresses and led to a fatigue fracture. [ABSTRACT FROM AUTHOR]

Background: The aim of our study is to emphasizes the significance of prompt diagnosis and intervention in younger patients affected by osteochondral detachment after patellar dislocation, where the first objective is to minimize in the shortest possible time complications and ingravescence. The method involves a clinical patient assessment and MRI follow-up in subjects who underwent to an immediate surgical intervention for osteochondral damage. Methods: From January 2020 to December 2022, 22 patellar dislocation cases were assessed; osteochondral lesions were identified in 12 (54%) patients; nine of these patients were treated immediately with knee arthroscopy, while in seven instances the osteochondral fragment was reattached using bioabsorbable pins. Post-operative clinical evaluations were conducted at one-, three-, and six-month intervals; finally, a six-month post-operative MRI was performed for all surgically treated patients. Results: The MRI evaluations, conducted six months post-operation for all seven patients, indicated successful integration of the reattached osteochondral fragment. Every patient returned to their pre-injury activities after surgery. However, two of them reported mild pain in the anterior region of the knee post-surgery. Conclusions: in young patients, swift diagnosis and immediate surgical intervention for osteochondral detachment resulting from patellar dislocation are crucial. This approach has been identified as the best practice, since it substantially minimizes immediate functional restrictions and significantly lowers the long-term risk of femoral-patellar osteoarthritis. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is a known risk factor for complications and adverse outcomes after elective total joint arthroplasty (TJA). The progressive increase in the ageing of world population and in the numbers of TJA, widens the demand for a faster post-operative recovery and function. The aim of this study was to review the literature regarding: post-operative transfusion, infections, wound complications, length of hospital stay (LOS), rate of admission in intensive care unit (ICU), and total patient charges, in malnourished patient undergoing TJA. Methods: The search reviewed all fields of the available peer-reviewed literature, published in the English language during the last seven years 2015–2022. We started from a total of 745 studies and finally we included in the review 16 articles. Results: In 10 studies, an increased surgical site infection was shown, being by far the most common complication, in 8 studies, malnutrition was associate with the increase of the average length of stay (LOS), and in 5 studies, the major founding was the increase in costs. An increase of the morbidity was found in 3 studies, instead a larger number of transfusions was highlighted in 2 studies. Lastly, one study showed a major unplanned ICU admission rate. Conclusions: Although the literature trend indicates that the nutritional status of TJA candidate patients is a parameter that influences the surgical outcome, in particular surgical site infections, length of stay, and costs, there are, to the authors' knowledge, no studies aimed at identifying validated and recognized protocols for the correction of malnutrition. [ABSTRACT FROM AUTHOR]

Bisphosphonates are widely used for the treatment of Complex Regional Pain Syndrome type 1 (CRPS-1). Despite their clinical potential, their indication for this disease remains a subject of debate. The purpose of this manuscript was to evaluate the efficacy and benefits of making use of neridronic acid in CRPS-1. Sixteen patients with CRPS-1 were evaluated before and after treatment with intravenous infusion of neridronic acid. All patients underwent the same treatment schedule and for all of them the VAS pain scale was used, integrated with functional assessment before and after treatment. The diagnosis of CRPS-1 was made using the Budapest Criteria. The onset of symptoms varied from 1 to 90 days, with an average of 50 days. All patients fulfilled the Budapest Criteria with pain present in 100% of cases, edema in 87.50%, hyperthermia in 62.50%, hyperhidrosis in 37.50%, skin redness in 56.25%, hypothermia in 12.50%, soft tissue retraction in 6.25% and joint mobility limitation in 87.50% of cases. The mean healing time was 40 days. Most of these patients (93.75%) had no sequelae. The use of neridronic acid has shown promising results in the treatment of CRPS-1. Results of the study suggested that its application, following a specific and standardized treatment schedule, could reduce pain and improve the quality of patients' life. Certainly, further studies on the real etiopathogenesis of this pathology will help to better establish indications in treatment and clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Morton's neuroma (MN) is a neuropathic metatarsalgia that causes pain in the plantar aspect of the forefoot generally between the third and fourth metatarsal heads. Treatment can be nonoperative or surgical. Among nonoperative procedures, alcohol injections are still commonly used as considered simple, relatively safe and well-tolerated treatment. However, they present transient and minor complications. Methods: Two hundred patients with a diagnosis of MN underwent ultrasound-guided injections with a 47.5% alcohol solution between 2013 and 2020. We reviewed the current literature to highlight the known complications of this treatment, comparing them to the complications developed by our patients. Results: Three patients out of 200 patients, developed necrosis of skin and subcutaneous tissue not described in previous studies about MN. Conclusions: Our study focuses attention on the complications subsequent to the alcohol injection therapy for MN. Patients and surgeons should be aware that in a small number of cases this therapy can be burdened by necrotic complications of the skin. [ABSTRACT FROM AUTHOR]

Congenital Hip Dysplasia (CHD) is characterized by a hip joint dislocation between the femoral head and the acetabulum, with a multifactorial etiology. This disorder can be an isolated condition or the manifestation of a syndromic condition, and it has been estimated with higher rates than registered, with a predominance in female sex and left side; risk factors are now defined. In Italy, the incidence rate is 3-4%, with significant regional differences: higher in Lombardy and lower in Sicily. Because clinical examination alone is insufficient to diagnose CHD, it is supplemented with ultrasonography and X-ray if necessary. Surveillance, static or dynamic splints, or osteotomies are the only treatment options. The goal of this study was to evaluate our experience in terms of management and conservative treatment of all newborns from January 2018 to May 2022: female sex and left hip were major involved, risk factors were not significant in our case, but results from early diagnosis and treatments, in terms of better outcome, were interesting. After a strict 6-month follow-up period, 89.13% of the patients were classified as grade Ia or Ib according to the Graf classification system. Finally, we emphasize the importance of early universal screening and subsequent diagnosis to allow for early treatment of the disorder, at an age when conservative treatments can yield good results. [ABSTRACT FROM AUTHOR]

Fractures of the posteromedial tibial plateau are infrequent, for this reason also their clinical description and their treatment is poorly represented in the literature. Only six cases in the literature describe the avulsion fracture of the posterior medial tibial plateau at the insertion of the semimembranous muscle. The mechanism of injury, described in the various articles, however, does not appear univocal, as well as the type of treatment. The analysis of the literature revealed the need for adequate imaging and stable surgical synthesis, in order to obtain an optimal functional recovery. [ABSTRACT FROM AUTHOR]

The aim of this study was to report the clinical and radiographic outcomes of 21 patients with severe thoracic kyphosis who underwent surgical correction by pedicle subtraction osteotomy. A retrospective multicentric study was conducted among a sample of patients who underwent single-stage correction via a posterior surgical approach. Pedicle subtraction osteotomy (PSO) was performed in all patients who presented a kyphotic deformity exceeding 70°. The cohort included 5 males and 16 females, with an average age of 62.7 years at the time of surgery. The minimum follow-up was 36 months, and the mean follow-up was 39.3 months. Following surgery, kyphosis across the treated segments was reduced by an average of 26.5°. Both back pain and neurological function improved after surgical treatment. There was a 68.2% improvement in VAS scores. Severe thoracic kyphosis can be improved through corrective surgery, and deformity correction can be accompanied by improvement in clinical symptoms. [ABSTRACT FROM AUTHOR]

Many orthopaedic surgical procedures are potentially affected by deep vein thrombosis (DVT) and Pulmonary Embolism (PE). DVT and PE are a clinical expression of the same pathological process called venous thromboembolism (VTE). Low-molecular-weight heparin (LMWH) is approved/ recognized to be a pharmacological solution to prevent VTE. The objective of the current study is twofold: (i) to assess the effect of a therapeutic protocol with LWMH started 24 hours after surgery on systemic bleeding and ii) to assess its effect on thrombosis and pulmonary embolism risk in patients undergoing early prophylaxis after spine surgery. A consecutive cohort of 110 patients undergoing spinal surgery was tested. Fifty six cases were spinal stenosis and 54 were degenerative thoracolumbar kypho-scoliosis. None of the patients withdrew from the study. 2 patients manifested PE signs and a prophylactic protocol therapy with LMWH which was started 24 hours after spine surgery resulted in a very low haemorrhage risk and low rate of PE and DVT. [ABSTRACT FROM AUTHOR]

Purpose To investigate the cross-training effect, induced on ankle dorsiflexors (AD) by unilateral strength-training of the contralateral muscles, as transfer of peak torque (PT) and muscle work (MW) and their relative contributions to muscle performance. Methods Thirty healthy volunteers were randomly assigned to a training or control group. The trained group sustained a 4-week maximal isokinetic training of the stronger AD at 90 and 45°/s. At both angular velocities, PT, MW and MW/PT ratio were measured from both legs at baseline and after intervention (trained group) or no-intervention (controls). The familiarization/learning-effect was calculated and subtracted by PT and MW measures to obtain their net changes. Results Net PT increased in both legs (untrained: +27.5% at 90°/s and +17.9% at 45°/s; trained: +15% at 90°/s and +16.3% at 45°/s). Similarly, net MW increased in both the untrained (90°/s: +29.6%; 45°/s: +37%) and trained (90°/s: +23.4%; 45°/s: +18.3%) legs. PT and MW gains were larger in the untrained than trained AD ( p < 0.0005), with MW improving more than PT at 45°/s ( p = 0.04). The MW/PT ratio increased bilaterally only in the trained group ( p < 0.05), depending on the angular velocity. Conclusions The cross-training effect occurred in AD muscles in terms of both PT and MW, with MW adding valuable information to PT-analysis in describing muscle performance. Moreover, the MW/PT ratio allowed estimating the contributions of these parameters to muscle capability and may represent a novel index in isokinetic testing. The greater improvements in the untrained than trained limb raises interesting clinical implications in asymmetric conditions. [ABSTRACT FROM AUTHOR]

BACKGROUND: To our knowledge, no studies on foot drop (FD) caused by peripheral nerve lesion have investigated whether unilateral training of the unaffected ankle dorsiflexors induced a clinically meaningful strength improvement in the affected-untrained leg, namely a cross-training (CT) effect. METHOD: A 59-year-old man, who suffered since childhood from surgically-induced damage of the common peroneal nerve, performed an 8-week maximal-intensity isokinetic training of the healthy leg. Before and after training, patient underwent: bilateral isokinetic testing; functional and mobility tests including 6-minute walking test, 10-meter walking test, timed-up-and-go test and ankle ROM; neurophysiological recordings including motor thresholds, cortical silent period of the hemisphere innervating the affected tibialis anterior and mean EMG recruitment. RESULTS: After cross-training, the affected-untrained dorsiflexors showed notable increases in all dynamometric parameters. Similarly, all functional tests improved considerably. The cortical silent period was reduced and the maximal EMG recruitment increased.CONCLUSIONS: Improvements in muscle performance and neurophysiological drive in the affected non-trained limb due to training of the unaffected side indicate that cross-training may be a viable rehabilitative approach to foot drop. [ABSTRACT FROM AUTHOR]

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• Deltoid ligament lesion in ankle fracture. • Chronic medial ankle pain and instability. • Surgical reconstruction of the medial ligamentous complex. • Prevention of ankle instability and articular damage. The repair of a deltoid ligament injury, following an ankle fracture with involvement of the syndesmosis, has no univocal consensus. Also the surgical strategies in case of a subsequent chronic instability are still under debate. In this work the result of a double bundle anatomic reconstruction of deltoid ligament with ipsilateral autologous gracilis muscle tendon is presented. A 50 year old active male patient came to our attention with a catastrophic medial ankle instability, a severe pronation of the hindfoot and disabling ankle pain. He reported a Weber type B fracture of the left ankle with a lesion of the syndesmosis treated with anatomic plate and screws and a transyndesmotic screw 8 months before. The imaging showed a complete deltoid ligament lesion. Due to the impossibility of a direct repair of the ligament, we performed the reconstruction of the medial ligamentous complex with an autologous gracilis tendon graft. 10 months after the medial ligamentous complex reconstruction, the patient showed an excellent recovery of walking ability, disappearance of pain under load and resumed an active lifestyle. The deltoid ligament has a key role in ankle joint stability and its integrity promotes the recovery after ankle fractures. However, its lesion is often left untreated in the acute setting. The result of a chronic untreated deltoid ligament injury could be extremely disabling and the ligament reconstruction, when an optimal native deltoid ligament repair is not achievable, is the choice to restore ankle function and stability. In the delayed treatment of a deltoid ligament rupture the described double bundle anatomic reconstruction with autologous tendon graft can be an effective and suitable option. [ABSTRACT FROM AUTHOR]

The concept "cyberethnography" remains undefined in the social sciences while, at the same time, still overlapping too much with the more well-known concept of "virtual ethnography." The aim of our paper is to remedy this situation by underlining new directions in the ethnographic study of computer mediated settings. To do so, we define cyberspace as computer-mediated contexts intrinsically related to supposed-to-be "real" places. From this point of view the ethnography of online groups is not just the ethnography of the groups online (or the online ethnography of groups), but it is both the ethnography of online and related off-line situations, the ethnography of humans and non-human actors in these related fields. It is hybrid, like a cyborg. In a word, it is a cyberethnography. In the first part of the paper, we discuss linkages between classical ethnography and its cyber developments. In the second part, we ground epistemologically the argument in favor of a robust social concept of "cyborg" drawing mainly from the fields called Science, Technology and Society (STS), and Organization Studies (OS). In the third part, we focus our argument on web-based group issues, using field data from our own research to define this kind of group and propose a metaphor, "the Internet as a library-of-people." This metaphor, which is strictly grounded in the cyborg concept, highlights the cyborgic characteristic of society that arises in research practice. [ABSTRACT FROM AUTHOR]

Introduction: Essential oils have been used since ancient times and are known for their anti-inflammatory, anti-depressive, antiseptic, antifungal and antimicrobial properties. Methodology: in this study the antimicrobial activity of two essential oils from Melaleuca alternifolia and Thymus vulgaris-red thyme geraniol was tested against 16 multidrug-resistant P. aeruginosa strains from infected hip implants as well as the "in vitro" cytotoxic activity on normal human Wong-Kilbourne derivative (WKD) cells. Results: Thymus vulgaris-red thyme geraniol showed lower antimicrobial activity when compared to Melaleuca alternifolia. All tested oils were cytotoxic at concentrations lower than 0.12%. Conclusion: Increase in drug resistance and lack of new antibiotics may encourage the development of natural treatments together with higher concern on environmental issues and natural lifestyle. [ABSTRACT FROM AUTHOR]