The Challenges of the Femoral Bone Loss in the Management of the Floating Knee IIB According Fraser: A Case Report

Introduction: This case report describes the management and the possible therapeutic solutions for the treatment of femoral bone loss associated with an open fracture IIIB Gustilo Andersonin a polytrauma that includes floating knee (GF) Fraser IIB from damage control orthopedics to final treatment. Case Report: The patient was treated with an external fixator femorotibial bridge after extensive cleaning and debridement of open fractures. After 17-day post-trauma, we substitute the fixator with a less invasive stabilization system plate and screws with contralateral allograft bone strut.3months after the first surgery, the patient underwent surgery for the intramedullary nailing of the tibia. The follow-up was clinical using the knee injury and osteoarthritis outcome score (KOOS), short form 12 health survey (SF-12) for the quality of life, and radiological at 1–3–6–12–18–24–36 months. The patient walked with partial load up until the 6months after injury and then began a progression to a total load. At 24-months post surgery, the patient had both the KOOS and SF-12 at 100 points. Conclusion: Not all Fraser IIB are equal, the timing of treatment should be discussed case by case. The surgical sequence should be respected: First, the fixation of the femur, and then, the stabilization of the tibia, taking into account the condition of the skin, eventual exposure or the eventual level of sub-amputation of the limb. The clinical and radiographic results show how efficient damage can lay the foundations for an excellent definitive treatment

Posterior Tibial Tendon Rupture Associated With Anterolateral Distal Tibial and Medial Malleolar Fracture and a Novel Pattern of Tibiofibular Syndesmotic Injury: A Case Report and Review of the Literature.

A posterior tibial tendon (PTT) rupture associated with ankle fractures is a very rare condition. Ankle pronation and external rotation (PER) movement are the typical traumatic mechanism. This injury is frequently overlooked preoperatively. Early diagnosis and treatment are very important to prevent the serious consequences related to functional PTT insufficiency on biomechanics of the foot. Few cases have been described in the literature that highlight the relationship between PTT rupture and PER type ankle fracture with a medial malleolar fracture. We present a case of a complete PTT rupture in a closed atypical ankle fracture in which a medial malleolar fracture was associated with a very large fragment from the anterolateral distal tibia (Tillaux-Chaput fragment) and a concomitant avulsion fracture from the anteromedial portion of the fibula (Lefort-Wagstaffe fragment), with a novel pattern never described before

Emergenza sismica nel centro Italia 2016-2017. Secondo rapporto del gruppo operativo SISMIKO. Sviluppo e mantenimento della rete sismica mobile a seguito del terremoto di Amatrice Mw 6.0 (24 agosto 2016, Italia centrale)

La rete sismica temporanea installata dal gruppo operativo INGV SISMIKO a seguito del terremoto del 24 agosto 2016 tra i Monti della Laga e la Valnerina, è stata ampliata nel settore settentrionale a seguito dei forti terremoti avvenuti alla fine del mese di ottobre 2016. Successivamente alle due scosse di Mw 5.4 e 5.9 che il 26 ottobre hanno interessato l’area al confine Marche-Umbria tra i Comuni di Castelsantangelo sul Nera (MC), Norcia (PG) e Arquata del Tronto (AP), la geometria della rete è stata estesa di circa 25 km verso nord con l’attivazione di ulteriori tre stazioni temporanee di cui una, da subito, disposta per la trasmissione dei dati in tempo reale e per l’inserimento nel sistema di sorveglianza sismica dell’Istituto Nazionale di Geofisica e Vulcanologia (INGV). Un’ultima stazione è stata inoltre installata nei pressi di Campello del Clitunno in provincia di Perugia ad ovest della sequenza, a seguito del terremoto Mw 6.5 che la mattina del 30 ottobre ha interessato l’intera area già fortemente provata dalla sequenza in corso; questo è stato il più forte terremoto registrato negli ultimi 30 in Italia. A circa 5 mesi dall’inizio dell’emergenza sismica, la rete temporanea conta quindi 23 stazioni che da metà dicembre sono tutte trasmesse in tempo reale ai diversi centri di acquisizione INGV, ovvero Milano, Ancona e Grottaminarda ma soprattutto Roma dove i dati vengono contestualmente archiviati nell’European Integrated Data Archive (EIDA) e integrati nel sistema di monitoraggio e sorveglianza sismica dell’INGV; per la sorveglianza sono incluse solo parte delle stazioni. Nelle ultime settimane, le attività di campagna del gruppo operativo SISMIKO sono state costantemente focalizzate alla cura e alla manutenzione della strumentazione per garantire la continuità della trasmissione e dell’acquisizione dei dati, a volte compromesse da malfunzionamenti legati al maltempo. Alla data di aggiornamento del presente report, non è ancora stata decretata una dismissione o una rimodulazione della geometria della rete sismica temporanea, anche in considerazione della attività sismica in corso a tutt’oggi molto sostenuta. Tutti i dati acquisiti dalle stazioni temporanee SISMIKO, sono distribuiti senza alcun vincolo, al pari dei dati della Rete Sismica Nazionale (RSN, codice di rete IV), ed utilizzati per prodotti scientifici in tempo reale (localizzazioni di sala, calcolo dei Time Domain Moment Tensor -TDMT delle ShakeMaps, ecc) e per l’aggiornamento dei database dell’INGV come l’Italian Seismological Instrumental and Parametric Database (ISIDe) con la revisione del Bollettino Sismico Italiano (BSI), dell’INGV Strong Motion Data (ISMD) e dell’ITalian ACcelerometric Archive (ITACA), dell’European-Mediterranean Regional Centroid Moment Tensors (RCMT) e nei lavori scientifici che utilizzano forme d’onda velocimetriche ed accelerometriche (ri- localizzazioni, studi della sorgente sismica ecc.).Istituto Nazionale di Geofisica e Vulcanologia (INGV)Published1SR. TERREMOTI - Servizi e ricerca per la Societ

Rapporto Preliminare Sulle Attività Svolte Nel Primo Mese Di Emergenza Dal Gruppo Operativo Sismiko A Seguito Del Terremoto Di Amatrice Mw 6.0 (24 Agosto 2016, Italia Centrale)

Sintesi delle attività svolte dal coordinamento delle reti sismiche mobili INGV in emergenza, denominato SISMIKO, nel primo mese della sequenza sismica “Amatrice” seguita al terremoto di Mw 6.0 del 24 agosto 2016 (01:36 UTC). Descrizione della rete sismica implementata e prime analisi dei dati acquisiti. Report on the activities in the first month of emergency by coordination of mobile seismic networks INGV emergency, called SISMIKO, after the Mw 6.0 Amatrice earthquake (August 24th, 2016, central italy). Description of the temporary seismic network implemented and preliminary analysis of the acquired data.INGV DPCPublished1IT. Reti di monitoraggi

SISMIKO:emergency network deployment and data sharing for the 2016 central Italy seismic sequence

At 01:36 UTC (03:36 local time) on August 24th 2016, an earthquake Mw 6.0 struck an extensive sector of the central Apennines (coordinates: latitude 42.70° N, longitude 13.23° E, 8.0 km depth). The earthquake caused about 300 casualties and severe damage to the historical buildings and economic activity in an area located near the borders of the Umbria, Lazio, Abruzzo and Marche regions. The Istituto Nazionale di Geofisica e Vulcanologia (INGV) located in few minutes the hypocenter near Accumoli, a small town in the province of Rieti. In the hours after the quake, dozens of events were recorded by the National Seismic Network (Rete Sismica Nazionale, RSN) of the INGV, many of which had a ML > 3.0. The density and coverage of the RSN in the epicentral area meant the epicenter and magnitude of the main event and subsequent shocks that followed it in the early hours of the seismic sequence were well constrained. However, in order to better constrain the localizations of the aftershock hypocenters, especially the depths, a denser seismic monitoring network was needed. Just after the mainshock, SISMIKO, the coordinating body of the emergency seismic network at INGV, was activated in order to install a temporary seismic network integrated with the existing permanent network in the epicentral area. From August the 24th to the 30th, SISMIKO deployed eighteen seismic stations, generally six components (equipped with both velocimeter and accelerometer), with thirteen of the seismic station transmitting in real-time to the INGV seismic monitoring room in Rome. The design and geometry of the temporary network was decided in consolation with other groups who were deploying seismic stations in the region, namely EMERSITO (a group studying site-effects), and the emergency Italian strong motion network (RAN) managed by the National Civil Protection Department (DPC). Further 25 BB temporary seismic stations were deployed by colleagues of the British Geological Survey (BGS) and the School of Geosciences, University of Edinburgh in collaboration with INGV. All data acquired from SISMIKO stations, are quickly available at the European Integrated Data Archive (EIDA). The data acquired by the SISMIKO stations were included in the preliminary analysis that was performed by the Bollettino Sismico Italiano (BSI), the Centro Nazionale Terremoti (CNT) staff working in Ancona, and the INGV-MI, described below

Le attività del gruppo operativo INGV "SISMIKO" durante la sequenza sismica "Amatrice 2016",

SISMIKO è un gruppo operativo dell’Istituto Nazionale di Geofisica e Vulcanologia (INGV) che coordina tutte le Reti Sismiche Mobili INGVPublishedLecce3T. Sorgente sismica4T. Sismicità dell'Italia8T. Sismologia in tempo reale1SR TERREMOTI - Sorveglianza Sismica e Allerta Tsunami2SR TERREMOTI - Gestione delle emergenze sismiche e da maremoto3SR TERREMOTI - Attività dei Centr

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Jockey injuries during the Siena “Palio”. A 72-year analysis of the oldest horse race in Italy

Introduction: Horse racing is a hazardous sport. We analyzed the incidence and characteristics of jockey injuries in a typical horse race. Methods: We analyzed all injuries sustained by 224 jockeys in the last 72 years. Results: It was found that in 96.1% of the races there was at least one fall and in 28.6% of the races 50% or more of the jockeys fell. In 43.4% of the falls, the jockey was taken to the emergency room. Comparing the Palio with traditional races in other countries, a higher injury incidence rate was observed for every 100 falls (109.884 vs 27–59) and a lower concussion rate/100 falls (0.97 vs 1.8-7.4). Conclusion: The Palio is one of the most threatening races that continues today. Jockeys are at greater risk for a fall than any other race in the world