The management of penetrating skeletal extremity trauma is a clinical challenge even for experienced surgeons. While the treatment of associated vascular injuries should be prioritized, there is still a lack of evidence regarding the management of foreign bodies in case of bone fractures or neurological injuries. Here we present a case of impalement of the right proximal humerus with a construction steel rod. The 54-year-old man was successfully treated without vascular, neurological, and thoracic sequelae. A review of the current literature about the most appropriate extrication sequences and soft tissue reconstruction following massive foreign body injuries was carried out.

BACKGROUND:Infections of the spine and hip joint are not common and, as described in literature, they are occasionally linked by a psoas abscess. In patients suffering back pain with history of spondylodiscitis, the spine as primary source of infection for a secondary psoas abscess should always be included in differential diagnosis. A delay in diagnosis of the psoas abscess could lead to septic femoral head necrosis.CASE REPORT:A case of a 65-year-old woman affected by septic femoral head necrosis due to spondylodiscitis and secondary psoas abscess is reported; the patient needed a specific antibiotic therapy then undergoing a total hip arthroplasty(THA).DISCUSSION AND CONCLUSION:Diagnoses of lumbar spine infection and psoas abscess are difficultand often delayed. Since the symptoms of both are non-specific, high degree of suspicious is necessary. In psoas abscess, an early diagnosis is important, because a delayed treatment could result in septic femoral head necrosis requiring both a prolonged antibiotic therapy and a THA.

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).

Vascular injuries represent an uncommon complication of total hip arthroplasty, with an incidence of 0.1-0.3% as reported in the literature. The aim of the study is the description of a case of late bleeding in a female patient undergoing surgery for total hip arthroplasty in right osteoarthritis through direct anterior approach. The treatment carried out was a selective embolization of the main ascending branch of the lateral circumflex artery. This was performed by placing two spirals following an angiography, which was revealing an active spreading of contrast at the right femoral circumflex ascending artery. The effectiveness of endovascular techniques for the treatment of early and late bleeding after surgery is pointed out.

We report two cases of adjacent segment degeneration in patients with idiopathic scoliosis who underwent surgical treatment with Harrington instrumentation in young age. Both patients developed a symptomatic degeneration of the disk immediately under the last stabilized level and were treated with decompression and stabilization. Clinical and radiological results are satisfactory at the follow-up.

Infection of total knee arthroplasty (TKA) is a challenge in orthopedic surgery. In literature TKA infection is classified according to the time after surgery: acute postoperative; late chronic; acute hematogenous; positive intraoperative microbiological growth. The purpose of this study is to present the results of the use of a preformed antibiotic-loaded spacer in TKA infections, treated by a two-stage revision procedure. A series of 19 consecutive patients (20 knees) with a diagnosis of infected TKA were treated from January 2003 to February 2012. Two-stage reimplantation protocols were completed only in 16 patients and these data were included in the study. We lost three patients at follow-up. An antibiotic-loaded preformed articulating polymethylmethacrylate spacer was applied. Patients were observed 1, 3, and 6 months postoperatively and then yearly for clinical and radiographic examination. The mean American Knee Society Score improved from 68.4 preoperatively (range, from 34 to 108) to 112.7 at final follow-up (range, from 49 to 180). The pain was evaluated as part of clinical score. It improved from an average of 19.3 preoperatively (range, from 10 to 30) to 34.3 at final follow-up (range, from 10 to 50). The average range of motion improved from 40.1 degrees (range, from 6 to 90 degrees) to 79.3 degrees (range, from 45 to 125 degrees). The use of the spacer allows obtaining a reduction of pain, an improvement of quality of life in the period of time between the two surgical stages and an easier reimplantation of TKA.

This study is troubling on several accounts.First, the Disclosure reveals flagrant financial relationships between the authors and LDR Medical.It then clearly states, "LDR contributed to the design and conduct of the study and also provided assistance with analysis of data and manuscript review."The fact that such disclosure is required relates to the truth of inevitable bias when such relationships exist.This bias, even with the best intentions, is simply a function of our human nature and has been well documented psychologically.And it must be understood that the actual revelation of these relationships in a disclosure neither establishes an unbiased publication nor exonerates the authors of conscious or subconscious collusion.The disclosure mandate exists to serve as a warning to the readers, and that warning could not be stronger than in this article.Does not the editorial board of the Journal of Neurosurgery: Spine also review article submissions in this light?Secondly, this article is an extreme representation of how the hardware industry has "driven" the science of spine care.Enrollment in this study is documented simply as "a diagnosis of degenerative disc disease with radiculopathy or myelopathy at 2 contiguous levels from C-3 to C-7."And there were 330 patients in the study.Yet there is no mention that posterior cervical options were considered or discussed with these patients.Hence, the hardware industry, in effect, has dictated surgical care to this group of patients and has done so by providing direct or indirect financial incentives to the surgeon-authors.Does not the Journal of Neurosurgery: Spine editorial board consider the ethical questions of such a study?It should be remembered that the thrust of total disc replacement (TDR) development was for the prevention or moderation of adjacent-segment disease, created by arthrodesis.Yet it is often forgotten that such arthrodesis (anterior cervical discectomy and fusion [ACDF]) is required only as a response to the potential iatrogenic instability and/or deformation in those cases when the 1.