Two-stage surgical treatment for septic non-union of the forearm

AIM To investigate the effectiveness of a two-stage surgical procedure for the treatment of septic forearm non-union.METHODS Septic non-unions are rare complications of forearm fractures. When they occur, they modify the relationship between forearm bones leading to a severe functional impairment. Treatment is challenging and surgery and antibiotic therapy are required to achieve infection resolution. It is even harder to obtain non-union healing with good functional results. The aim of this study is to present a two stages surgical treatment for septic forearm non-union with revision and temporary stabilization of the non-union until infection has cleared and subsequently perform a new synthesis with plate, opposite bone graft strut and intercalary graft. We retrospectively reviewed 18 patients with a mean age at the time of primary injury of 34.5 years(19-57 years) and a mean follow-up of 6 years(2-10 years). All patients presented an atrophic nonunion with a mean length of the bone defect of 1.8 cm(1.2-4 cm). Complications and clinical results after surgical treatment were recorded. RESULTS Mean time to resolution of the infectious process was 8.2 wk(range 4-20 wk) after the first surgery and specific antibiotic therapy. All the non-union healed with an average time of 5 mo(range 2-10 mo) after the second step surgery. Cultures on intraoperative samples werepositive in all cases. No major intraoperative complications occurred. Two patients developed minor complications and one needed a second surgical debridement for infection resolution. At the last follow-up functional results were excellent in 5(27.8%) patients, satisfactory in 10(55.5%) and unsatisfactory in 3(16.7%) patients. No activities of daily living(ADLs) limitations were reported by 12(66.6%) patients, slight by 3(16.6%) and severe limitation by 3(16.6%) patients. Mean visual analog scale at the last follow-up was 1(0-3).CONCLUSION The two-step technique has proven to be effective to achieve resolution of the infectious process and union with good functional results and low rate of complications.

Preoperative and postoperative risk factors for periprosthetic joint infection in primary total hip arthroplasty:A 1-year experience

BACKGROUND Periprosthetic joint infection(PJI)in primary total hip replacement(THR)is one of the most important threats in orthopedic surgery,so one important surgeon’s target is to avoid or early diagnose a PJI.Although the incidence of PJI is very low(0.69%)in our department,with an average follow-up of 595 d,this infection poses a serious threat due to the difficulties of treatment and the lower functional outcomes after healing.AIM To study the incidence of PJI in all operations occurring in the year 2016 in our department to look for predictive signs of potential infection.METHODS We counted 583 THR for 578 patients and observed only 4 cases of infection(0.69%)with a mean follow-up of 596 d(min 30,max 1451).We reviewed all medical records to collect the data:duration and time of the surgery,presence,type and duration of the antibiotic therapy,preoperative diagnosis,blood values before and after surgery,transfusions,presence of preoperative drugs(in particularly anticoagulants and antiaggregant,corticosteroids and immunosuppressants),presence of some comorbidities(high body mass index,blood hypertension,chronic obstructive pulmonary disease,cardiac ischemia,diabetes,rheumatological conditions,previous local infections).RESULTS No preoperative,intraoperative,or postoperative analysis showed a higher incidence of PJI.We did not find any class with evident major odds of PJI.In our study,we did not find any border value to predict PJI and all patients had similar values in both groups(non-PJI and PJI).Only some categories,such as female patients,showed more frequency of PJI,but this difference related to sex was not statistically significant.CONCLUSION We did not find any category with a higher risk of PJI in THR,probably due to the lack of few cases of infection.

Off-the-shelf 3D printed titanium cups in primary total hip arthroplasty

Three-dimensional(3D)-printed titanium cups used in primary total hip arthroplasty(THA)were developed to combine the benefits of a low elastic modulus with a highly porous surface.The aim was to improve local vascularization and bony ingrowth,and at the same time to reduce periprosthetic stress shielding.Additive manufacturing,starting with a titanium alloy powder,allows serial production of devices with large interconnected pores(trabecular titanium),overcoming the drawbacks of tantalum and conventional manufacturing techniques.To date,3D-printed cups have achieved dependable clinical and radiological outcomes with results not inferior to conventional sockets and with good rates of osseointegration.No mechanical failures and no abnormal ion release and biocompatibility warnings have been reported.In this review,we focused on the manufacturing technique,cup features,clinical outcomes,open questions and future developments of off-the-shelf 3D-printed titanium shells in THA.

陶瓷杯衬垫断裂的早期诊断——根据12年临床实践所提供的指南

由于磨损碎屑造成的溶骨性损害是构成全髋置换术的主要长期困扰问题。为了避免磨损碎悄，已经有改善磨损特性的耐磨表面全髋假体应用到外科手术中。陶瓷表面假体的长期临床结果非常令人鼓舞，现代的金属背面矾土杯已取得了很好的临床结果。

Au,Pd and maghemite nanofunctionalized hydroxyapatite scaffolds for bone regeneration

Nanotechnology plays a key role in the development of innovative scaffolds for bone tissue engineering(BTE)allowing the incorporation of nanomaterials able to improve cell proliferation and differentiation.In this study,Mg-HA-Coll type I scaffolds(Mg-HA-based scaffolds)were nanofunctionalized with gold nanorods(Au NRs),palladium nanoparticles(Pd NPs)and maghemite nanoparticles(MAG NPs).Nanofunctionalized Mg-HA-based scaffolds(NF-HA-Ss)were tested for their ability to promote both the proliferation and the differentiation of adipose-derived mesenchymal stem cells(hADSCs).Results clearly highlight that MAG nanofunctionalization substantially improves cell proliferation up to 70% compared with the control(Mg-HA-based scaffold),whereas both Au NRs and Pd NPs nanofunctionalization induce a cell growth inhibition of 94% and 89%,respectively.Similar evidences were found for the osteoinductive properties showing relevant calcium deposits(25% higher than the control)for MAG nanofunctionalization,while a decreasing of cell differentiation(20% lower than the control)for both Au NRs and Pd NPs derivatization.These results are in agreement with previous studies that found cytotoxic effects for both Pd NPs and Au NRs.The excellent improvement of both osteoconductivity and osteoinductivity of the MAG NF-HA-S could be attributed to the high intrinsic magnetic field of superparamagnetic MAG NPs.These findings may pave the way for the development of innovative nanostructured scaffolds for BTE.