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Background: this study aimed to evaluate the impact of COVID-19 lockdown on Orthopedic and trauma care in apulia, using as a reference point the orthopedic activity performed in the previous three years in the same bimester;and to assess any relationship between the COVID-19 spreading in apulia and changes in orthopedic and trauma working activity MetHOdS: eight apulian level 1 or level 2 orthopedic and trauma centers took part in the present study in each trauma center, between March 9 and May 3 (eight weeks), the following data were prospectively recorded: the number of patients referring to Orthopedic and trauma emergency room (er) and their cause of injury (i e motor vehicle accident, domestic injury, working injury or sports injury);the number of patients referring to outpatient department and the number and type of surgical interventions performed all trauma centers were also asked to gather the data summarizing surgical, outpatient and er activities during the same period in the previous three years (2017-2019) Furthermore, data about COVID-19 total confirmed cases and total deaths in Apulia were daily recorded reSultS: during COVID-19 lockdown, the mean number of trauma surgeries performed for non-femur fractures, and the mean number of Orthopedic er referrals for motor vehicle accidents, work injuries and sports injuries were significantly reduced, compared with the same period in the previous three years Nonetheless, no significant differences were observed in domestic injuries (p=0 1417) and pFFs (p=0 5462) the mortality rate at discharge in patients with pFFs during COVID-19 lockdown, compared with the same period in the previous three years, was not statistically different (P=0 162) A significantly positive correlation was observed between the COVID-19 total cases number and PFFs patients’ discharge to home (P=0 003), whereas a significant negative correlation was recorded with PFFs patients’ discharge to rehabilitation centers (p=0 001) CONCLUSIONS: Although orthopedic and trauma care significantly changed in Apulia during COVID-19 lockdown, the mean number of patients referring to Orthopedic and Trauma ER for home injuries and PFFs showed no significant differences, compared to the same bimester in the previous three years © 2020 Edizioni Minerva Medica

Conservative treatment of diaphyseal humeral fractures is nowadays an effective option in terms of callogenesis and functional outcome: its selection is based on publications by Sarmiento and Rommers. However, the current trend is to provide a stable synthesis and early mobilization, leading to a quicker functional restore than that granted by conservative treatment. Therefore, endomedullary nailing (either anterograde or retrograde) and ORIF represent the gold standard. External fixation (EF) has absolute indications in case of open fractures, fractures with compromised soft tissue and multiple trauma, and represents an effective surgical option in case of closed fractures as well (both in adults and in children), thanks to its minimal invasiveness associated to good mechanical stability and functional restore. Patients’ quality of life is also very good during the first few weeks after surgery: the external fixator does not cause any trouble with shoulder and elbow mobility, allowing for a good restoration of muscular force. This method is even more indicated in elderly patients in overall poor medical conditions, where open invasive surgery would be contraindicated and conservative treatment would not be tolerated by the patients. Humeral external fixation can be considered a minimally invasive option that provides stable synthesis, with good fracture reduction and axial restoration: this leads to good results in terms of early mobilization, consolidation and low percentage of complications.

Due to an error in production the members of SICE CoDIG (Colon Dx Italian Group) listed in the Acknowledgments were not tagged correctly as authors in the XML of this article. This listing is presented again here:.

Objectives To determine the efficacy of hybrid external fixation in the treatment of tibial pilon fractures. Design Retrospective, multicentre study. Patients/Participants Adult patients with tibial pilon fractures treated with hybrid external fixation. Intervention Fracture reduction with ligamentotaxis and fixation with XCaliber hybrid external fixator. Main outcome measurements Fracture union, complications, functional outcome (Mazur Ankle Score). Results Union was obtained in 159 fractures at an average of 125 days; there were three delayed unions and three non-unions. The most frequent complication was superficial pin‐track infections (48), all of which responded to local wound care and antibiotics. There were no deep infections and no DVT. Only one fracture had loss of reduction that required frame revision. The overall functional scores were 91 (excellent) for AO/OTA type A fractures, 89 (good) for type B fractures, and 75 (satisfactory) for type C fractures. Conclusions Hybrid external fixation is an effective method of stabilising tibial pilon fractures, particularly those with marked comminution. The minimally‐invasive technique and stable fixation enable early mobilisation, with good functional results and minimal complications. Level of evidence Level IV Case series.

Introduction Treatment of displaced heel fractures is controversial; however, ORIF is widely described in the literature to be the gold-standard. Percutaneous reduction and monolateral external fixation is gaining increasing attention because it provides a good and stable reduction, and minimises soft tissue complications due to open surgery, such as deep infections and delays in wound healing. The aim of this study was to show that the new Orthofix Calcaneal Minifixator (six pins) provides a greater stability than the four-pin version to enable a better and more stable reduction, an earlier weight-bearing (30 days) and improved functional outcomes. Methods A series of 69 consecutive closed heel intraarticular displaced fractures treated with the new Orthofix Calcaneal Minifixator were evaluated. Patients were assessed clinically with the Maryland Foot Score and radiologically with standard radiographs. Results The clinical results at follow-up were excellent in 37 cases (53.6%), good in 27 (39.2%), fair in two (2.9%) and poor in three (4.3%). The mean preoperative Bohler's angle was 5.2˚ (range 0–18˚) and the mean postoperative value was 28.5˚ (range 16–38˚). Conclusion The excellent functional outcomes were despite some radiological images of imperfect posterior facet anatomical reduction and seemed to correlate with the use of a good and stable minimally-invasive surgical technique. This technique enabled early weight-bearing, minimised complications, respected the delicate biology of this anatomical site and restored the good heel volume and Bohler angle.

Objective To analyze feasibility and outcomes of laparoscopic partial nephrectomy (LPN) for endophytic hilar tumors in low-intermediate (ASA I-II) risk patients. Methods This is a single centre retrospective study. From May 2009 to September 2011, 208 LPNs were performed at our institution. Overall 11 (5.2%) elective LPNs were for hilar tumors not visible on kidney surface. Hilar tumor was defined as a mass located in the renal hilum and in contact with a major renal vessel on preoperative imaging. Procedures were carried out by a single experienced surgeon (G.G.) via retroperitoneal approach by clamping the only main renal artery. Results Mean (range) age of patients was 45.3 years (38.2–64.1), tumor size 1.6 cm (1.2–2.0), warm ischemia time 24 min (19–32), operative time 140 min (110–200) and estimated blood loss 270 ml (100–750). Two collecting system injuries were observed and repaired intraoperatively. No conversion to open surgery was required. Final pathological examination revealed 10 renal cell carcinomas and 1 oncocytoma. A negative surgical margin was obtained in 10/11 (91%) patients. Renal function and serum hemoglobin were nearly unaltered pre and post-surgery. No tumor recurrence was observed at mean (range) follow-up of 34 months (15–43). Conclusions In experienced hands, LPN represents a feasible, safe and effective treatment for selected patients diagnosed with endophytic hilar masses. A larger number of patients and longer follow-up are required to draw definitive conclusions.

Subtrochanteric fractures have a bimodal age distribution. They usually require open reduction and internal fixation. Closed reduction and intramedullary nail fixation rate are increased for this type of fracture. As a result, the hardware breakage and non-union rate is high among such patients. Our purpose is to evaluate the outcomes of the role of blade plate and bone strut allograft in the management of subtrochanteric non-union by femoral nailing. We reported a group of 22 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail with medial femoral allograft bone and lateral blade plate and wire (PS) s; and a group of 13 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail treated with lateral blade plate and screws (CG). The chosen criteria to evaluate the two group during the clinical and radiological follow-up were the quality of life, measured by The Short Form (12) Health Survey (SF-12), the hip function and quality of life related to it, measured by the Harris Hip Score (HHS), bone healing, measured by Radiographic Union Score (RUS) by XR and CT at 1 year after the surgery, and postoperative complications. The evaluation endpoint was set at 12 months. The Bone healing measured by RUS occurred and also the full recovery before the first trauma measured by SF-12 and HHS are better in PS group. We only had three unimportant complications in PS while four breakage hardware in CG. We conclude that in complicated non-unions, the use of blade plate and bone strut allograft has a definite positive role in the management of such cases.

The treatment for humeral diaphyseal fractures is still controversial. The purpose of this study was to evaluate the clinical and radiographic outcomes of treating humeral distal third diaphyseal fractures by using external fixation technique. We retrospectively review 65 cases of diaphyseal humeral fractures (31 type A, 23 type B and 11 type C of the AO/OTA classification) treated with external fixation (Orthofix FAD small) between 2008 and 2013. The mean follow-up was 48 months (24–72 months). There were 12 open fractures; however, no cases of concomitant vascular injury were described. The transolecranic traction was always applied to promote partial reduction through ligamentotaxis. In case of interposition of soft tissues impeding reduction, a small incision was performed allowing mobilization of bone ends. All fractures resulted healed at a mean of 11 weeks (range 9–13 weeks); the average time of removal of the external fixator was 88 days (range 65–95 days). At the last follow-up, the mean elbow flexion was 132.6° (Min 126°–Max 137°) and the mean elbow extension was 6.4° (Max 0°–Min 13°). The Cassebaum’s index rated as excellent in 47.8 % (31 patients), good in 37 % (24 patients), fair in 9.2 % (6 patients) and poor in 6 % (4 patients). The mean DASH score at the final follow-up was 14.7 (range 0–33); 15 patients had a range score between 10 and 20, 43 had less than 10, and seven had more than 20. We observed three cases of superficial infections and two cases of acute radial nerve palsy recovered within 3 months. According to the excellent clinical results and full rate of consolidation, we state external fixation as a valid option in the treatment of distal third humeral diaphyseal fractures.

Contemporary fixation of the proximal femur is performed utilising a number of implants adopting different concepts and techniques. Cephalomedullary nails in particular represent one of two main options, the other being dynamic hip screw (DHS). The aim of this cohort study is to present the early experience of two large units from different countries of the use of the AFFIXUS nail for stabilisation of proximal femoral fractures. Over a period of almost three years, data from 476 proximal femoral fractures were collected and analysed using a specific research protocol, assessing data relevant to basic demographic details, in-hospital stay, surgical technique and post discharge outcomes with a minimum follow up of 6 months. Both the short and long versions of the nail were used in both centres, however, with some statistically significant differences as far as the type of fractures stabilised with the nail, which also translated to differences in the combination or not of 2 lag screws, and the static or dynamic mode of the proximal fixation construct. Other areas of difference amongst the 2 units, were the length of hospital stay and return of patients to their pre-injury residence, most likely reflecting the different social circumstances between the 2 countries. Overall mortality at a median follow up period of 17 months (range 6 to 35) was limited to 6.3%, nonunion and cut out rates 2.7%, whilst revision surgery occurred in just 2.5%. Over the first 6 months of follow up 63.6% returned to their pre-injury ambulatory status and 90.5% to their pre-injury residence. Further studies and higher level of scientific evidence is needed to verify the findings of this retrospective cohort study as to the effectiveness and safety of this new cephalomedullary nail.

The dynamic locking screw (DLS) in association with minimally invasive plate osteosynthesis (MIPO) in a bridging construct for simple metadiaphyseal long bone fractures enables modulation of the rigidity of the system and facilitates the development of early and triplanar bone callus. Twenty patients affected by distal tibial fracture were treated with MIPO bridging technique and DLS at the proximal side of the fracture. Time of consolidation, quality of the reduction, complications and American Orthopaedic Foot and Ankle Society (AOFAS) score were monitored and the results compared with those from a control group treated with only standard screws on both fracture sides. Student t-test for independent samples was used for the comparison of means between the two groups. Chi-square test was used for the comparison of proportions. A multiple logistic regression model was constructed to assess the possible confounding effects. Performance was considered significant for p0.05. The mean healing time was 17.6 ± 2.8 weeks in the group treated with standard screws and 13.5 ± 1.8 weeks in the group treated with DLS (t=5.5, p0.0001). The DLS was associated with early healing and triplanar bone callus.

Trisomy X syndrome is a sex chromosome aneuploidy condition that affects 1 in 1000 females. Females with trisomy X typically have tall stature and an increased risk for urinary tract abnormalities, seizures, and premature ovarian failure (POF). They have an increased risk for developmental delays including speech–language and motor delays, as well as below-average IQ scores with learning disabilities, and other psychosocial and behavioral findings including anxiety, social withdrawal, and other social difficulties and psychological features.

Objective To test the feasibility and safety of salvage laparoscopic radical prostatectomy (sLRP) for recurrent prostate cancer after high-intensity focused ultrasound (HIFU) treatment. Methods Thirteen men (median age 61.3 years) fulfilled the criteria of recurrent prostate cancer after HIFU undergoing sLRP with HIFU performed using Ablatherm devices (EDAP TMS, Lyon, France). The median interval from primary treatment and biochemical recurrence was 38 months, and the median serum PSA nadir after primary therapy was 1.05 ng\mL. Perioperative data and functional outcome were recorded for each patient. Complications were recorded and graded according to Clavien scale. The prostatectomy specimens were analyzed for Gleason score, extracapsular extension, and surgical margins. Mean follow-up was 14 months. Results There was no perioperative mortality and no conversion to open surgery was necessary. Mean operation time was 220 minutes, mean blood loss was 150 mL, and none of the patients received any transfusion. On histopathologic evaluation, 8 patients had extracapsular extension (pT3a) and 5 patients had intracapsular disease (pT2b). Positive surgical margins (PSMs) were detected in 2 patients in the pT3a group. Gleason score was 7 (3 + 4) in 6 patients and (4 + 3) in 5 patients. Two patients had a Gleason score of 8. The median time to achieve continence was 6 months. Four patients showed mild incontinence and used 2 pads per day. None of the patients in our series were potent after sLRP. Conclusion sLRP is feasible for men in whom HIFU has failed but has a higher morbidity rate than primary surgery.