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Background: This study aims to evaluate complications and early postoperative clinical outcomes of direct anterior approach (DAA) in total hip arthroplasty (THA). Methods: Ninety-one consecutive patients who underwent primary elective unilateral THA between January 2013 and December 2019 were identified. Collected data included age of patient, BMI, ASA score, EBL (estimated blood loss), LOS (length of stay), operating time, and intra/postoperative complications. The recorded complications included prolonged wound drainage without infection, superficial and deep infection, dislocation, periprosthetic fracture, aseptic loosening or failure of osteointegration and nervous damage. Any reoperation, with or without prosthetic component revision, was recorded. Results: Fourteen complications (15,4%) and 12 (13,18%) postoperative anemizations were observed in this series. No deep infection was reported. Most common complications were nerve damage (3/91; 3,29%), greater trochanter fracture (3/91; 3,29%), and wound trouble (3/91; 3,29%). Two (2,19%) dislocations were reported. One (1,09%) intraoperative periprosthetic fracture was treated with cerclage wiring. One (1,09%) revision was needed for an acetabular mobilization. One patient (1,09%) had severe periprosthetic ectopic ossifications (Brooker 4), needing reintervention because of severe limitations of the range of motion (ROM). Conclusions: Complications rate in this study with THA by DAA is comparable to those reported in literature. DAA is a safe, efficient procedure but it needs a steep learning curve. (www.actabiomedica.it)

Fourth generation ceramic bearings (BIOLOX delta, CeramTec AG; Phlochingen, Germany) were developed to reduce wear debris and improve fracture resistance. A case of a fourth generation head fracture in ceramic-on-polyethylene (COP) coupling after hip revision surgery is reported. A 58-year-old man was admitted to our department for increasing hip pain following a direct trauma which occurred during skiing activity 4 months before. Six years earlier, he had undergone a right cementless revision surgery with a 36-mm BIOLOX delta femoral head on polyethylene liner for metallosis and foreign body reaction after primary total hip replacement for hip osteoarthritis. At admission, radiological evaluation revealed a fracture of ceramic femoral head requiring a new revision surgery. Extensive synovectomy, lavage and capsulectomy were performed. Both acetabular cup and femoral stem were well fixed with no damage of trunnion, and therefore they were retained. A 36-mm internal diameter polyethylene acetabular liner was inserted along a 36-mm BIOLOX delta head with a BioBall adapter XL. The postoperative course was uncomplicated. At 1-year follow-up, the patient had a complete functional recovery. To our knowledge, BIOLOX delta ceramic femoral head fracture after COP hip revision surgery has not been previously reported. (www.actabiomedica.it)

Objective: To evaluate the effects of a novel experimental protocol to treat patients with Parkinson’s disease (PwP) and freezing of gait (FoG), using functional, and clinical scales, and gait analysis. Background: FoG is a disabling symptom strictly associated to falls. The little or no pharmacological responsiveness of FoG has led to an increasing interest in rehabilitation interventions aimed at functional recovery and autonomy. Currently, standard protocols employed for rehabilitation are based on the use of external sensory cues. However, cued strategies generate an important dependence on the environment. Teaching motor strategies without cues (i.e.action observation) can be an alternative/innovative approach to rehabilitation that matters most on appropriate allocation of attention and lightening cognitive load. Methods: We compared the effects of two different therapeutic pro- tocols on three gait movements: walk, step initiation, and sit-to-step. The experimental protocol was based on action observation plus sonifi- cation; patients re-learned 8 motor gestures watching video-clips showing an actor performing the same gestures, and then tried to repeat the gesture. Each video-clip was composed by images and sounds of the gestures. The sounds of gestures were obtained with the sonification technique, by transforming kinematic data (velocity) recorded during the execution of gesture, into pitch variations (for an example see: bit.ly/ sonif_example). The same 8 motor gestures were re-learned in the stand- ard protocol, with a common sensory stimulation method. We evaluated patients with functional and clinical scales before, immediately after, at 1 month, and 3 months after the treatment. We also compared gait indi- ces with those of a normative sample of PwP and FoG (Mezzarobba et al. 2015). Preliminary data are based on two patients. Results: Overall, data showed that both protocols have positive effects on functional and clinical tests. Larger performance improve- ments were seen with the experimental protocol. In the after treatment evaluations, the number of indices that differed from those of the norma- tive sample, were larger in the experimental protocol than the baseline protocol. Conclusions: These preliminary data suggest that a multisensory approach could help PwP with FoG to re-learn gait movements, to reduce freezing episodes, and that these effects could be prolonged over time.

Freezing of Gait (FoG) is one of the most debilitating symptom of patients with Parkinson Disease (PwP) as it could leads to fall and loss of independence. We evaluated the motor behavior in simple and complex gait movements with three groups of participants: PwP with and without FoG in ON state condition, and participants without neurologic and gait disorders. All participants were required to walk, to begin to walk (Step Initiation), and raise from a chair for walking (Sit-to-Walk). Analysis of variance helped to identify task-specific kinematic and kinetic variables which differentiate among the three groups. Classification accuracy of such variables was obtained by training a Linear Discriminant Analysis – LDA algorithm on reduced sub-samples, and by testing it on the left out subjects.

The injury of the radial nerve is not uncommon in humeral shaft fractures. These lesions may be of different types and levels and their treatment changes depending on traumatic characteristic. The authors present a case report of a patient affected by a closed shaft humeral fracture, consequence of an high energy trauma, associated with motor palsy of the radial nerve in which an open surgical revision was performed. The nerve appeared medially displaced and entrapped within the fracture fragments and the fibrous tissue around the lesion and showed signs of posttraumatic suffering without disruption. The nerve was repositioned in its anatomical site after neurolysis and intramedullary nailing of the humeral fracture. The fracture healed after 4 months with full recovery of motor function of the radial nerve.We believe that, in shaft fractures of the humerus with radial nerve deficits, it is imperative to perform surgical exploration of the conditions of the radial nerve itself, in order to obtain a recovery of its functionality.

The receptor activator of nuclear factor-κB ligand (RANKL), its signaling receptor RANK, and its natural decoy receptor OPG are members of the tumour necrosis factor (TNF) and TNF receptor superfamily and are best known for their essential role in controlling osteoclastogenesis. RANKL in bone has also been shown to serve as a chemoattractant for cancer cells, thus explaining the tropism of certain cancers such as breast and prostate cancer to preferentially metastasize to bone. Here, we will discuss the important role of RANKL and its possible role in the management of bone loss in patients with breast cancer., Italian Journal of Anatomy and Embryology, Vol 119, No 1 (2014)

The hallux rigidus, especially in advanced stage, has always been a challenge as regards the surgical treatment. Over the years there have been various surgical techniques proposed with the aim of relieving pain, correcting deformity and maintain a certain degree of movement. For some years we have addressed the problem with the replacement metatarsophalangeal joint arthroplasty with Reflexion system. As far as our experience we have operated and monitored 25 patients (18 females and 7 males) of mean age 58.1 years, operated with this technique from June 2008 to June 2011. It 'reached an average ROMof 72 ° (extension and flexion 45 ° and 27 °) with a good functional recovery in 8 patients, and this articulation was good (50 ° -40 °) in 12 patients and moderate in 5 with a articular range from 40 ° -30.The clinical results, according to our experience, appear to be favorable, as even patient satisfaction is complete.