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Fracture repair has not been fully optimised and there is opportunity to increase the healing rate and reduce the number of complications using pharmacological means. While most anti-osteoporosis drugs have been widely tested for their ability to decrease the risk of osteoporotic fractures, fragility fractures still occur in patients under medical intervention. The primary purpose of this systematic review is to understand these underlying mechanisms between bone and drug therapies in osteoporosis and the overall promotion of fracture healing and callus formation. Databases such as MEDLINE, Google Scholar, EMBASE and CINAHL were searched and nine articles met all inclusion criteria. We report that there is still large controversy and a need for clinical trials to address the deficiencies found in animal models. There is no clear evidence yet as to whether complications during the course of healing are attributable to implant anchorage problems in osteoporotic bone or to possibly delayed healing in the aged.

The aim of our study is to review the most important concepts in the prosthesis technique fixation. The elements for a successful prosthesis implantation are due to the prosthesis design, the pattern of fixation, the articular tribology, and the surgical accuracy. Also other factors like osteonecrosis, toxicity of the implanted materials, the early stability and the time and the bearing of the implanted prosthesis, affect deeply the implant-bone surface and therefore the quality of fixation. The cemented fixation is based on the acrylic cement and is commonly considered the easier, the most effective and the less expensive fixation technique. The uncemented fixation allows a lower surgical time due to the implantation technique. This technique more difficult than the cemented fixation, is based on the osteointegration. The hybrid fixation presents components each with different fixation techniques. On the contrary, the polyurethane prosthesis does not use a real fixation, but fits on the articular surfaces in which they are inserted. However the elements that should always lead to treatment choice are the specific surgical aptitude and knowledge of the literature results based on the scientific evidence.

Il trattamento delle patologie dell’anca in pazienti giovani e attivi rappresenta una difficile scelta, prevalentemente a causa dei risultati non soddisfacenti a lungo termine che si ottengono con le sostituzioni protesiche totali. I risultati dell’artroplastica convenzionale dell’anca sono infatti molto positivi nei pazienti anziani, mentre nei pazienti giovani non sono altrettanto soddisfacenti. Questi scarsi risultati clinici dipendono dall’elevata attività funzionale dei pazienti giovani che determina un’elevata usura dei materiali con conseguente aumento dei fallimenti per mobilizzazione dell’impianto protesico. Per migliorare i risultati funzionali e la durata delle artroprotesi d’anca nei pazienti giovani e/o attivi sono state riproposte, dopo essere state abbandonate negli anni 80 per l’alta percentuale di fallimenti le protesi di rivestimento. La nostra esperienza con l’impiego della protesi di rivestimento BHR consta di 350 casi. La sopravvivenza media dell’impianto ad un follow-up medio di 20 mesi è del 98,8%. Sulla base degli ottimi risultati ottentui con l’impiego di questa metodica e dai dati pubblicati in letteratura, si può oggi affermare che che la protesi di rivestimento dell’anca è un intervento che rappresenta il trattamento di scelta nei pazienti giovani e/o attivi con patologie invalidanti dell'anca.

Introduzione Lo scopo di questo lavoro è valutare comparativamente 2 gruppi di pazienti affetti da frattura di collo di femore Gardner tipo 1 e 2 trattati mediante osteosintesi con viti percutaneeestandard e viti rivestite di idrossiapatite. Metodo Sono stati selezionati 60 pazienti con frrattura di collo di femore Gardner tipo1 e 2, età >65 anni, grado di osteoporosi con DEXA

Bone resorption of the proximal femur is a frequent complication of total hip replacement. As hip resurfacing (HR) may load the bone more physiologically, we measured proximal femur bone mineral density (BMD) in 21 patients with HR. DEXA analysis was performed in the 7 Gruen zones and in the femoral neck pre-operatively and at 3, 9, and 24-months post-operatively. In Gruen zone-2 the BMD ratio decreased to 90±18.8% (p=0.0009) at 3-months and completely restored at 24-months to 100±17.7% (p=0.01). In Gruen zone-7 the BMD ratio decreased to 93±15.3% (p=0.05) by 3 months and surpassed the baseline to 105±14.8% (p=0.01) at 24-months. A positive correlation was observed between valgus positioning of the femoral component and BMD in Gruen zone-2 and 7 respectively. HR preserves the bone-stock of the proximal femur. When the femoral component is implanted in a valgus position BMD is further enhanced, thus potentially reducing the risk of femoral neck fractures.

Bone resorption of the proximal femur is a frequent complication of total hip replacement. As hip resurfacing (HR) may load the bone more physiologically, we measured proximal femur bone mineral density (BMD) in 21 patients with HR. DEXA analysis was performed in the 7 Gruen zones and in the femoral neck pre-operatively and at 3, 9, and 24-months post-operatively. In Gruen zone-2 the BMD ratio decreased to 90±18.8% (p=0.0009) at 3-months and completely restored at 24-months to 100±17.7% (p=0.01). In Gruen zone-7 the BMD ratio decreased to 93±15.3% (p=0.05) by 3 months and surpassed the baseline to 105±14.8% (p=0.01) at 24-months. A positive correlation was observed between valgus positioning of the femoral component and BMD in Gruen zone-2 and 7 respectively. HR preserves the bone-stock of the proximal femur. When the femoral component is implanted in a valgus position BMD is further enhanced, thus potentially reducing the risk of femoral neck fractures.

Instruments that are useful in clinical or research practice will, when the object of measurement is stable, yield similar results when applied at different times, in different situations, or by different users. Studies that measure the relation of differences between patients or subjects and measurement error (reliability studies) are becoming increasingly common in the orthopaedic literature. In this paper, we identify common aspects of reliability studies and suggest features that improve the reader's confidence in the results. One concept serves as the foundation for all further consideration: in order for a reliability study to be relevant, the patients, raters, and test administration in the study must be similar to the clinical or research context in which the instrument will be used. We introduce the statistical measures that readers will most commonly encounter in reliability studies, and we suggest an approach to sample-size estimation. Readers interested in critically appraising reliability studies or in developing their own reliability studies may find this review helpful.