Management of orthopaedic and traumatology patients during the Coronavirus disease (COVID-19) pandemic in northern Italy

Purpose: This article aims to share northern Italy\u2019s experience in hospital re-organization and management of clinical pathways for traumatic and orthopaedic patients in the early stages of the COVID-19 pandemic. Methods: Authors collected regional recommendations to re-organize the healthcare system during the initial weeks of the COVID-19 pandemic in March, 2020. The specific protocols implemented in an orthopaedic hospital, selected as a regional hub for minor trauma, are analyzed and described in this article. Results: Two referral centres were identified as the hubs for minor trauma to reduce the risk of overload in general hospitals. These two centres have specific features: an emergency room, specialized orthopaedic surgeons for joint diseases and trauma surgeons on-call 24/7. Patients with trauma without the need for a multi-disciplinary approach or needing non-deferrable elective orthopaedic surgery were moved to these hospitals. Authors report the internal protocols of one of these centres. All elective surgery was stopped, outpatient clinics limited to emergencies and specific pathways, ward and operating theatre dedicated to COVID-19-positive patients were implemented. An oropharyngeal swab was performed in the emergency room for all patients needing to be admitted, and patients were moved to a specific ward with single rooms to wait for the results. Specific courses were organized to demonstrate the correct use of personal protection equipment (PPE). Conclusion: The structure of the orthopaedic hubs, and the internal protocols proposed, could help to improve the quality of assistance for patients with musculoskeletal disorders and reduce the risk of overload in general hospitals during the COVID-19 pandemic

Fibromyalgia and Shoulder Surgery : a Systematic Review and a Critical Appraisal of the Literature

Fibromyalgia is a common musculoskeletal syndrome characterized by chronic widespread pain and other systemic manifestations, which has demonstrated a contribution to higher postoperative analgesic consumption to other surgeries such as hysterectomies and knee and hip replacements. The aim of this review is to search current literature for studies considering the impact of fibromyalgia on clinical outcomes of patients undergoing shoulder surgery. A systematic literature review was conducted in PubMed/Medline, Embase, and ClinicalTrials.gov in February 2019. Studies were selected based on the following participants, interventions, comparisons, outcomes, and study design criteria: adult patients undergoing surgery for shoulder pain (P); diagnosis of fibromyalgia (I); patients without fibromyalgia (C); outcome of surgery in terms of pain or analgesic or non-steroidal anti-inflammatory drugs consumption (O); case series, retrospective studies, observational studies, open-label studies, randomized clinical trials, systematic reviews and meta-analyses were included (S). Authors found 678 articles, of which four were found eligible. One retrospective study showed that patients with fibromyalgia had worse clinical postoperative outcomes; two retrospective studies reported a higher opioid prescription in patients with fibromyalgia and one prospective observational study found that a higher fibromyalgia survey score correlated with lower quality of recovery scores two days after surgery. The scarce and low-quality evidence available does not allow confirming that fibromyalgia has an impact on postoperative outcomes in shoulder surgery. Future studies specifically focusing on shoulder surgery outcomes may help improvement and personalization of the management of patients with fibromyalgia syndrome (PROSPERO 2019, CRD42019121180)

Total Joint Arthroplasty in Patients with Inflammatory Rheumatic Diseases

Since its introduction, total joint arthroplasty (TJA) has improved the quality of life of patients with degenerative joint disorders. In the last decades, a number of conventional and biological disease-modifying antirheumatic drugs have become available for the treatment of patients with inflammatory rheumatic diseases (IRD), leading to a reduction in the need to undergo TJA. However, TJA is still frequently performed in IRD patients. Both rheumatologists and orthopedics should be aware that patients with IRD have a peculiar perioperative risk profile due to disease-related, patient-related, and surgery-related risk factors. On the basis of current evidence, TJA is a safe procedure for IRD patients as long as an accurate risk stratification and a multidisciplinary approach are applied. We here describe the current strategies for an appropriate surgical management of osteoarthritis in IRD patients and the fascinating opening perspectives that surgeons and clinicians may expect in the future

Clinical outcome of latissimus dorsi tendon transfer and partial cuff repair in irreparable postero-superior rotator cuff tear

Background and purpose Irreparable rotator cuff tears are a common cause of pain in adult population, requiring in many cases a surgical treatment. Possible alternatives are debridement, partial repair, muscle transfers and joint replacement. We evaluated two groups of patients with irreparable rotator cuff tear treated surgically: one group received an arthroscopic-assisted latissimus dorsi tendon transfer (LDTT), and the other an arthroscopic rotator cuff partial repair. Aim of our study was to compare clinical results and quality of life in two groups of patients with massive irreparable rotator cuff tear: one receiving an arthroscopic LDTT and the other receiving an arthroscopic rotator cuff partial repair. Methods Forty patients were assigned to two groups: 20 patients to group TT treated with LDTT and 20 patients to group PR treated with a partial repair. The average follow-up duration was 2.8 years (1\u20135, SD 3). Pre- and postoperative modified UCLA shoulder score, ROM, measurement of the strength and the rotator cuff quality of life (RC-QOL) were used to asses the outcome. Results LDTT showed significative improvements when compared to partial repair in UCLA score results, strength and RC-QOL questionnaire. No differences were found between the groups in pain relief. Conclusion Both techniques are effective in reducing patients\u2019 symptoms. We believe that in younger, high-demanding patients with no or mild osteoarthritis, the LDTT represents a valid treatment option with better modified UCLA score improvement and strength at our follow-up

Variation in sexual dimorphism in a wind-pollinated plant: The influence of geographical context and life-cycle dynamics

Understanding the mechanisms causing phenotypic differences between females and males has long fascinated evolutionary biologists. An extensive literature exists on animal sexual dimorphism but less information is known about sex differences in plants, particularly the extent of geographical variation in sexual dimorphism and its life‐cycle dynamics. Here, we investigated patterns of genetically based sexual dimorphism in vegetative and reproductive traits of a wind‐pollinated dioecious plant, Rumex hastatulus, across three life‐cycle stages using open‐pollinated families from 30 populations spanning the geographic range and chromosomal variation (XY and XY1Y2) of the species. The direction and degree of sexual dimorphism was highly variable among populations and life‐cycle stages. Sex‐specific differences in reproductive function explained a significant amount of temporal change in sexual dimorphism. For several traits, geographical variation in sexual dimorphism was associated with bioclimatic parameters, likely due to the differential responses of the sexes to climate. We found no systematic differences in sexual dimorphism between chromosome races. Sex‐specific trait differences in dioecious plants largely result from a balance between sexual and natural selection on resource allocation. Our results indicate that abiotic factors associated with geographical context also play a role in modifying sexual dimorphism during the plant life‐cycle

Dynamic contact area ratio in shoulder instability: an innovative diagnostic technique measuring interplay of bony lesions

Purpose: The hypothesis of this study is that Dynamic Contact Area Ratio of the humerus and glenoid, measured with CT scans, is significantly reduced in patients with anterior shoulder instability compared to the Dynamic Contact Area Ratio in a control group of people without shoulder instability. Methods: Preoperative CT scans of patients who underwent surgery for anterior shoulder instability were collected. Additionally, the radiologic database was searched for control subjects. Using a validated software tool (Articulis) the CT scans were converted into 3-dimensional models and the amount the joint contact surface during simulated motion was calculated. Results: CT scans of 18 patients and 21 controls were available. The mean Dynamic Contact Area Ratio of patients was 25.2 \ub1 6.7 compared to 30.1 \ub1 5.1 in healthy subjects (p = 0.014). Conclusion: Dynamic Contact Area Ratio was significantly lower in patients with anterior shoulder instability compared to controls, confirming the hypothesis of the study. The findings of this study indicate that calculating the Dynamic Contact Area Ratio based on CT scan images may help surgeons in diagnosing anterior shoulder instability. Level of evidence: III

Late metamorphic veins with dominant PS-15 polygonal serpentine in the Monte Avic ultramafite

The ultramafic body of Monte Avic (Aosta Valley, Western Alps, Italy) consists of antigorite serpentinite and Ti-clinohumite metadunite. They host late metamorphic veins, up to a couple of centimeters thick, compact, and homogeneous, with a “porcelain” appearance. Vein colors range from yellowish to light greenish, light yellowish fading to white, or rare orange. The veins consist of 15-sector PS-15 polygonal serpentine, with chemical composition Mg2.85 Fe0.08 Si2.05 O7.05 [OH]3.95. Recognition of this unusual phase is supported by diagnostic satellite reflections in the X-ray powder diffraction pattern (e.g., at dobs of 2.502, 2.336, 2.151, and 1.966 Å) TEM images (showing 15-sector polygonal fibers, mostly 200 nm in diameter and a few µm in length, forming a randomly oriented felt) and a µ-Raman wavenumber, matching previous data. This different evidence affords the successful distinction of PS-15 and PS-30, alternatively using TEM images, X-ray powder diffraction, or the low- and high-wavenumber µ-Raman spectra. At Monte Avic, the vein emplacement was accompanied by significant fluid pressure, as suggested by deformation and dismembering of the host rock, with PS-15 grown within isotropic stress microenvironments characterized by fluid-filled voids. Random growth of the mass-fiber polygonal serpentine was favored by low-strain conditions. PS-15 veins formed at the end of the long polyphase Alpine orogenic evolution, with hydrous fluids possibly deriving from serpentinite dehydration in the depth.</p