Background/Objectives: Although MRI with fat-suppression sequences is the gold standard for diagnosis of bone marrow edema (BME), Dual-Layer Spectral CT (DL-SCT) with electron density (ED) provides a viable alternative, particularly in situations where an MRI is not accessible. Using MRI as the reference standard, this study analyzed how DL-SCT with ED reconstructions may be a valid alternative in the detection of BME. Methods: This retrospective study included 28 patients with a suspected diagnosis of BME via MRI conducted between March and September 2024. Patients underwent DL-SCT using ED reconstructions obtained through IntelliSpace software v. 12.1. Images were evaluated by two experienced radiologists and one young radiologist in a blinded way, giving a grade from 0 to 3 to classify BME (0 absence; 1 mild; 2 moderate; 3 severe). To reduce the recall bias effect, the order of image evaluations was set differently for each reader. p-Values were considered significant when <0.05. Fleiss’ Kappa was used to assess inter-rater reliability: agreement was considered poor for k < 0; slight for k 0.01–0.20; fair for 0.21–0.40; moderate for 0.41–0.60; substantial for 0.61–0.80; and almost perfect for 0.81–1.00. Results: All the readers detected the presence or absence of BME using DL-SCT. Inter-rater reliability for grade 0 resulted in 1 (p-value < 0.001); for grade 1: 0.21 (p-value < 0.001); for grade 2: 0.197 (p-value < 0.001); and for grade 3: 0.515 (p-value < 0.001). Conclusions: ED reconstructions allowed the identification of BME presence or absence in all analyzed cases, thus suggesting DL-SCT as a potentially effective method for its detection.

Intramediastinal fracture dislocation of the humeral head due to a blunt trauma is very rare. It may be accompanied by local and systemic injuries associated with high-energy trauma. Only one case has been reported in the literature; therefore, an appropriate treatment modality remains unclear. We present a case of a 71-year-old woman involved in an accidental fall who sustained an intramediastinal humeral head fracture dislocation through the thoracic inlet, without damaging the chest wall, causing the thoracic duct rupture and requiring three consecutive surgical procedures as treatment.

Background/Objectives: Chronic locked posterior shoulder dislocations (PSDs) are rare and often misdiagnosed, leading to delayed treatment and complex management. This study retrospectively evaluates surgical outcomes in patients treated for chronic PSDs and reports our clinical experience. Methods: Ten male patients with chronic PSDs treated between 2016 and 2022 at “Vito Fazzi Hospital” (Lecce) were analyzed. Lesions were classified according to the Randelli system (Type 1: 20–50% bone loss; Type 2: >50%; Type 3: fracture dislocation without bone loss; Type 4: multifragmentary fracture dislocation). Surgical options—subscapularis transposition, bone grafting, osteosynthesis, and reverse shoulder arthroplasty—were selected based on lesion type, age, and functional demand. Follow-ups at 1, 3, 6, and 12 months assessed ROM, SF-36, and SDQ scores. Results: Six patients had Type 1 lesions, two Type 2, and two Type 4. The mean diagnostic delay was 6 weeks (up to 5 months). Early follow-ups showed superior ROM and SDQ in patients with reverse prostheses, while at 12 months, cancellous grafts achieved better functional recovery. Subscapularis transpositions resulted in minor internal rotation loss and increased pain. One Type 4 case developed avascular necrosis. Mean healing time was 2.9 ± 0.5 months. Although SDQ differences at 12 months were not significant, internal rotation was reduced by 10% in patients treated with the McLaughlin technique (p < 0.05). Conclusions: Prompt diagnosis and tailored surgical management are key to favorable outcomes in chronic PSDs. While various techniques provide good results, subscapularis transposition should be limited to unstable cases, and osteosynthesis should be used only when strictly indicated due to necrosis risk.

Background/Objectives: To evaluate dual-energy computed tomography (DECT) in comparison with conventional CT for periprosthetic bone and surrounding soft tissues in total hip arthroplasty (THA). Methods: Two authors independently screened titles and abstracts for eligibility, discussing any disagreements with a third author for final decisions. The articles were categorized into two main groups: those focusing on periprosthetic bone and those on blood vessels or pelvic organs. Results: A total of 37 articles were selected to be included in this systematic review. Conclusions: Our systematic review reveals significant variability in the use of DECT for periprosthetic bone and soft tissue imaging, due to differences in equipment, protocols, and clinical settings. While many studies indicate that virtual monochromatic imaging (VMI), especially when combined with metal artifact reduction (MAR), improves image quality, there is no consensus on optimal energy levels. Future research should focus on large-scale, multicenter studies with standardized protocols to compare reconstruction techniques, energy levels, and combined MAR-VMI use.

The Pipkin fracture, a complex injury involving femoral head fractures often accompanied by hip dislocation, presents significant challenges in surgical management. Despite various proposed approaches, the optimal treatment, especially in polytraumatized patients, remains debated. This case report presents a Pipkin type IV fracture treated using a combination of damage control surgery, intramedullary nailing for femoral shaft fractures, and arthroscopic reduction and fixation for the femoral head fracture. A 22-year-old male was admitted following a high-energy car accident, presenting with bilateral femoral shaft fractures, a right Pipkin type IV femoral head fracture with an associated posterior acetabular fragment, and an exposed left patellar fracture. Initial damage control involved external fixation of femoral fractures and irrigation of the patellar wound. Definitive treatment was staged: first, intramedullary nailing of the left femoral shaft and patellar cerclage; second, right femoral shaft intramedullary nailing followed by arthroscopic reduction and fixation of the femoral head fracture. Arthroscopy facilitated minimally invasive removal of intra-articular fragments and secure fixation with a headless cannulated screw. Post-surgical rehabilitation focused on early mobilization and gradual weight-bearing. Using advanced arthroscopic techniques for the fixation of femoral head fracture dislocations resulted in excellent functional outcomes and minimal complications. This case underscores the effectiveness and benefits of arthroscopy in achieving precise reduction and accelerated recovery.

Background:Total hip arthroplasty (THA) is one of the most frequently performed orthopedic procedures. Developmental dysplasia of the hip (DDH) presents specific anatomical challenges that require tailored implant designs. Wagner™ conical stems were developed to address the morphological alterations of dysplastic femur, offering potential advantages in stability and functional restoration. This study assesses the long-term survival and clinical outcomes of Wagner™ conical stems in patients with Crowe non-IV DDH. Materials and methods:This retrospective study included primary THAs performed between 2003 and 2015 using Wagner™ conical stems exclusively in patients with DDH. Only cases with complete clinical and radiographic follow-up were analyzed, excluding those lost to follow-up or revised. The evaluated outcomes were prosthetic survival rate, clinical performance assessed with the Modified Harris Hip Score (mHHS), and radiographic findings at final follow-up. Results:Forty-five patients (57 hips) met the inclusion criteria. The mean age at surgery was 56.5 years (range, 33-76), with a mean follow-up of 15 years (range, 8-20). Kaplan-Meier analysis showed a survival rate of 95.7% at 10 years and approximately 80.5% at 20 years, with an overall survival rate of 89.5% at the final follow-up. The main cause of failure was aseptic loosening, followed by infection, recurrent dislocation, and metallosis. Among hips with retained implants, 86.3% (44/51) achieved an mHHS > 70, indicating satisfactory functional recovery. The mean mHHS was 88.6 ± 14.3 (Range, 62-100), with a median of 92 and a mode of 100. Conclusion:Wagner™ conical stems provide durable fixation and favorable long-term functional outcomes in Crowe non-IV DDH, with high survival rates and low complication incidence over extended follow-up.

BACKGROUND Childhood obesity has emerged in the last decades as an important public health problem worldwide. Although relationships between obesity and flatfoot have been shown, no studies have investigated the influence of obesity on arthroereisis outcomes. AIM To evaluate correlations between childhood overweight/obesity and clinical and radiographic outcomes after subtalar arthroereisis with self-locking implants. METHODS This retrospective study included one hundred and sixty-nine pediatric patients (10-14 years old) who underwent subtalar arthroereisis (PEEK PitStop® device) for severe flexible flatfoot. Exclusion criteria were additional procedures, revision of previous corrective surgeries, rigid flatfoot with severe deformity, and neurological or post-traumatic flatfoot. Preoperative/postoperative European Foot and Ankle Society (EFAS) and visual analogue scale (VAS) scores were determined; radiographic assessment was conducted on weight-bearing foot X-rays: Kite angle, first metatarsal-talus angle, Meary angle, calcaneal pitch angle and lateral talo-calcaneal angle were analyzed. RESULTS EFAS and VAS scores improved post-operatively in the whole population. Only seven cases with complications were reported. Radiographic assessment revealed an improvement in all angles. Statistical analysis demonstrated that the impact of obesity was significant on arthroereisis outcomes: Relationships were reported between BMI and postoperative EFAS/VAS scores, postoperative calcaneal pitch angle, Kite angle, Meary angle and talo-first metatarsal angle. CONCLUSION Although arthroereisis represents a very effective and valid treatment for flatfoot both in normal weight and obese children, obesity significantly influences clinical and radiographic outcomes of arthroereisis, and obese children tend to perceive more pain and discomfort.

Background/Objectives: conducting fitness tests in educational settings can lead to advantages for both individuals and groups, beyond just enhancing fitness. With the aim of appropriately interpreting performance, this study was conducted to establish sex- and age-specific percentile normative data for a physical fitness (PF) protocol and to define a compound measure of physical performance. Methods: In this cross-sectional study, a short, feasible, and easy-to-administer test battery was performed for 5106 school children, aged 6–10 years. Gender- and age-specific percentiles for the PF tests were constructed, and a Physical Fitness–Motor Competence Performance Index (PF-MC PI) was calculated according to the percentiles. Results: Boys scored higher in all the PF tests when compared to girls (p < 0.001). There was also a trend towards increased PF levels as the age increased in both genders (p < 0.0001). Correlations between scores on individual test items were moderate to high (r from 0.549 to 0.700), and all individual test item scores significantly correlated with the PF-MC PI (p < 0.0001). Conclusions: the provided percentile values will enable the correct interpretation and monitoring of the fitness status of children and the PF-MC PI can be used for easily rating children’s health-related fitness qualities.

Dual-Energy computed tomography (DECT) with its various advanced techniques, including Virtual Non-Contrast (VNC), effective atomic number (Z-eff) calculation, Z-maps, Iodine Density Index (IDI), and so on, holds great promise in the diagnosis and management of urogenital tumours. In this narrative review, we analyze the current status of knowledge of this technology to provide better lesion characterization, improve the staging accuracy, and give more precise treatment response assessments in relation to urological tumours.

The purpose of this bicentric case series was to report the safety, efficacy, and clinical outcome of transcatheter embolization in pulmonary artery pseudoaneurysms (PAPAs). Between January 2016 and June 2021, eight patients with PAPA were subjected to transcatheter embolization. The total number of patients was eight, of which five were female, with a mean age of 62 ± 14 years (average ± standard deviation). Etiology was traumatic in 2/8 cases and iatrogenic in 6/8 cases (after positioning a Swan-Ganz catheter in 5/6 cases and a temporary pacemaker in the latter case). In a single case, the PAPA was incidentally discovered during a routine X-ray, in the remaining 7 cases, the procedure was performed in emergency settings. PAPA embolization was performed using detachable coils alone in 3 cases; coils and glue in 1 case; coils, glue, and vascular plug in 1 case; coils and non-adhesive liquid embolic agents (Onyx and Squid respectively) in 2 cases; and non-adhesive liquid embolic agent alone (Onyx) in 1 case. No peri-procedural or post-procedural complications were recorded. Both the technical and clinical success rates were 100.0%. In conclusion, endovascular embolization is a technically feasible and safe therapeutic option for patients with PAPAs.

Treatment of bacterial septic arthritis in the native adult hip joint can be challenging. Prompt diagnosis and treatment decisions can reduce the associated morbidity and mortality.For this systematic review of the literature, we asked: (1) What are the treatment options? (2) What are the success rates and the outcomes after treatment? (3) Which antibiotic and duration of therapy are optimal?We searched the electronic databases PubMed, Scopus, and Embase using the search terms "hip" or "native hip" and "septic arthritis" or "coxitis". Studies were included if they reported on: (1) bacterial infection of the hip, (2) treatment, (3) success rate/outcomes, (4) follow-up. The final review included 19 studies. The quality of study reporting was evaluated with the Methodological Index for Non-randomized Studies (MINORS) questionnaire.Three treatment options are: arthroscopy, single open surgery, and two-stage total hip arthroplasty (THA). A high success rate in infection eradication was reported for all three. Intravenous antibiotic therapy should be promptly initiated to eradicate septic arthritis and minimize potential sequelae and complications.Arthroscopy, single open or two-stage THA were reported to be effective in treating bacterial septic arthritis of the native hip. The key to optimal outcome is early diagnosis and timely treatment. Cite this article: EFORT Open Rev 2021;6:164-172. DOI: 10.1302/2058-5241.6.200082.

Pancreatic ductal adenocarcinoma (PDAC) is a cancer with one of the highest mortality rates in the world. Several studies have been conductedusing preclinical experiments in mice to find new therapeutic strategies. Experimental ultrasound, in expert hands, is a safe, multifaceted, and relatively not-expensive device that helps researchers in several ways. In this systematic review, we propose a summary of the applications of ultrasonography in a preclinical mouse model of PDAC. Eighty-eight studies met our inclusion criteria. The included studies could be divided into seven main topics: ultrasound in pancreatic cancer diagnosis and progression (n: 21); dynamic contrast-enhanced ultrasound (DCE-US) (n: 5); microbubble ultra-sound-mediated drug delivery; focused ultrasound (n: 23); sonodynamic therapy (SDT) (n: 7); harmonic motion elastography (HME) and shear wave elastography (SWE) (n: 6); ultrasound-guided procedures (n: 9). In six cases, the articles fit into two or more sections. In conclusion, ultrasound can be a really useful, eclectic, and ductile tool in different diagnostic areas, not only regarding diagnosis but also in therapy, pharmacological and interventional treatment, and follow-up. All these multiple possibilities of use certainly represent a good starting point for the effective and wide use of murine ultrasonography in the study and comprehensive evaluation of pancreatic cancer.

Background and Objective Modular neck adapters allow different length and offset changes to reach a stable total hip arthroplasty (THA) and permit a quick partial hip revision procedure without removing the existing components. The literature is poor on this matter and about the long-term related outcomes. This narrative review summarizes the most recent literature about these devices as an option of surgical treatment in partial total hip arthroplasty revision (THAr) focusing on indications, clinical and radiological outcomes, and related complications. Methods The narrative review of the current available literature was conducted in December 2022 through electronic database. The terms used were: “Head neck taper” OR “Merete BioBall” AND “revision Total Hip Arthroplasty (MeSH Terms)”. The timeframe was limited between 01/01/2000 and 01/12/2022. The studies regarding the clinical use of the Merete BioBall® system in hip revision surgery were included, while all the papers concerning modular stem prosthesis were excluded. Key Content and Findings The surgical procedure is safe, quick and allows the surgeon to correct a well-fixed stem version, length and offset, besides retensioning soft tissues. Clinical and radiological outcomes are good with low complications rates. Conclusions The modular neck adapter system seems to be a good surgical procedure for recurrent dislocation of THA, especially in case of a second THAr surgery. However, the main indication of adapter use remains the isolated acetabular cup revision. The related complications are rare: the worst is the re-dislocation due to an insufficient stem version and length correction. Re-dislocation rates reported in literature vary from 5.2% to 15%. Corrosion or fretting of the modular system are not reported in literature.

Purpose:Intra-articular injection is a well-established and increasingly used treatment for the patient with mild-to-moderate hip osteoarthritis. The objectives of this literature review and meta-analysis are to evaluate the effect of prior intra-articular injections on the risk of periprosthetic joint infection (PJI) in patients undergoing total hip arthroplasty (THA) and to try to identify which is the minimum waiting time between hip injection and replacement in order to reduce the risk of infection. Methods:The database of PubMed, Embase, Google Scholar and Cochrane Library was systematically and independently searched, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To assess the potential risk of bias and the applicability of the evidence found in the primary studies to the review, the Newcastle-Ottawa scale (NOS) was used. The statistical analysis was performed by using the software 'R' version 4.2.2. Results:The pooling of data revealed an increased risk of PJI in the injection group that was statistically significative (P = 0.0427). In the attempt to identify a 'safe time interval' between the injection and the elective surgery, we conducted a further subgroup analysis: in the subgroup 0-3 months, we noted an increased risk of PJI after injection. Conclusions:Intra-articular injection is a procedure that may increase the risk of developing periprosthetic infection. This risk is higher if the injection is performed less than 3 months before hip replacement.

Abstract Purpose The aim of this study was to investigate the presence of synovial mast cells (MCs) in hip and knee tissue from osteoarthritis (OA) patients and to correlate them with clinical and radiological data. Methods Synovial tissue was obtained during arthroplasty from 60 patients, 30 with knee OA and 30 with hip OA. Control synovial tissue was obtained from 30 patients without OA, 15 undergoing above-knee amputation and 15 receiving a hip replacement for fracture. Before surgery, the radiographic findings were graded according to the Kellgren-Lawrence system and clinical data including pain (VAS) and functional information (KOOS and HOOS) was collected. The tissue was stained with hematoxylin–eosin and toluidine blue for histochemistry and incubated with CD117 and CD31 antibodies for immunohistochemistry. MC and vessel number and synovitis score were determined in all samples. Results Mean MC number, synovitis score and vessel number were significantly higher in the OA samples (p < 0.05) than in control tissue. MC number correlated with the synovitis score and disease severity in both patient groups. Conclusions The prevalence of MCs in synovium from OA patients and their association with synovial inflammation and pain suggest a role for them in OA pathophysiology.

Two stage revision with antibiotic loaded spacers is the gold standard for the treatment of periprosthetic joint infections, with a high rate of success in avoiding infection recurrence. In literature there is a great variability of data about this procedure, leading surgeons not to have clear reference points about it. We reviewed 28 articles of literatures of last ten years on online databases (PubMed, Scopus, Embase) in order to analyze several outcomes: diagnosis, surgical approach, type of spacer and cement used, timing for second stage revision (interstage duration), rate of success, complications. Diagnosis was performed with a combination of clinical, laboratory and radiological parameters; postero-lateral approach was the most common approach used and a preformed, encased in gentamicin impregnated acrylic cement spacer was used in most cases. We found a mean success rate of 91.4%, 6 of 29 studies reported a 100% effectiveness in eradicate the infection, while in 15 of 28 we found an effectiveness >95% in eradicate the infection (no recurrence). The mean waiting time for second stage revision surgery was 14.5 weeks. Most frequent interstage complications were dislocation of the spacer, followed by infection recurrence -spacer exchange and fracture of the femur. Second stage most frequently reported complication is infection recurrence followed by the need for revision for different reasons and final implant dislocation. Despite the great success rate of this procedure, the surgeon has to be aware of possible complications deriv-ing from that, in particular dislocation, fractures and infection recurrence and their management.

A successful and minimally invasive treatment for adolescent flexible flatfoot is subtalar arthroeresis. This study examines the short-term results of subtalar arthroereisis with a new PEEK device (Pit’Stop®); additional research will be required to determine the device’s true potential, but the preliminary findings are very encouraging, with a high success rate and a low complication rate (0.08).

We present the case of a 60-year-old man with a history of severe tophaceous gout with polyarticular involvement who came to the emergency room due to direct trauma to the right forearm and knee. The knee X-ray and CT scan showed a lateral tibial plateau fracture characterized by the presence of a lytic bone lesion. The presence of a solid neoplasm was ruled out and a CT-guided biopsy was performed. Histological evaluation revealed findings typical for an advanced intraosseous gout. As there was no significant risk of progression of the lytic lesion, the fracture site was treated conservatively. This case is unique in the literature in terms of location and should be considered as an atypical site of intraosseous gout. Proper differentiation of a pathological fracture on an intraosseous gout location from a neoplastic lesion is essential to choose the correct therapy.

Background Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1 month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1 month on the basis of type of fracture and type of surgical treatment. Materials and methods For this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+ group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C− group) were asymptomatic and tested negative for SARS-CoV-2. The two groups were compared for differences in time to surgery, survival rate and complications rate. The follow-up period was 1 month. Results Of the 1390 patients admitted for acute care for any reason, 477 had a proximal femur fracture; 53 were C+ but only 12/53 were diagnosed as such at admission. The mean age was > 80 years, and the mean American Society of Anesthesiologists (ASA) score was 3 in both groups. There was no substantial difference in time to surgery (on average, 2.3 days for the C+ group and 2.8 for the C− group). As expected, a higher mortality rate was recorded for the C+ group but not associated with the type of hip fracture or treatment. No correlation was found between early treatment (< 48 h to surgery) and better outcome in the C+ group. Conclusions Hip fracture in COVID-19-positive patients accounted for 11% of the total. On average, the time to surgery was > 48 h, which reflects the difficulty of maintaining normal workflow during a medical emergency such as the present pandemic and notwithstanding the suspension of non-urgent procedures. Hip fracture was associated with a higher 30-day mortality rate in COVID-19-positive patients than in COVID-19-negative patients. This fact should be considered when communicating with patients and/or their family. Our data suggest no substantial difference in hip fracture management between patients with or without COVID-19 infection. In this sample, the COVID-19-positive patients were generally asymptomatic at admission; therefore, routine screening is recommended. Level of evidence Therapeutic study, level 4.