Representation formulas for pairings between divergence-measure fields and BV functions

The purpose of this paper is to find pointwise representation formulas for the density of the pairing between divergence-measure fields and BV functions, in this way continuing the research started in [17, 20]. In particular, we extend a representation formula from an unpublished paper of Anzellotti [7] involving the limit of cylindrical averages for normal traces, and we exploit a result of [35] in order to derive another representation in terms of limits of averages in half balls

Representation formulas for pairings between divergence-measure fields and BVBV functions

The purpose of this paper is to find pointwise representation formulas for the density of the pairing between divergence-measure fields and BV functions, in this way continuing the research started in [17,20]. In particular, we extend a representation formula from an unpublished paper of Anzellotti [7] involving the limit of cylindrical averages for normal traces, and we exploit a result of [35] in order to derive another representation in terms of limits of averages in half balls.Comment: 24 page

Atypical periprosthetic femoral fractures of the hip: A PRISMA compliant systematic review

Introduction: Long-term use of bisphosphonates (BPs) is associated with Atypical Femoral Fracture (AFF). Theoretically, periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. How-ever, recently several studies reported the occurrence of PPFs around a hip arthroplasty presenting fea-tures of an AFF. The present study describes the characteristics of Atypical Periprosthetic Femoral Fracture (APFF) and evaluates the effectiveness of their management through a PRISMA compliant systematic re-view of the published case reports and series. Materials and methods: A literature search was performed using "periprosthetic fracture" and "atypical femoral fracture" as keywords. Patients demographics, drug use, clinical and imaging characteristics, stem fixation and classification, management strategies for APFF and patients' outcomes, were also collected. Results: The present review included and analysed 17 patients from 12 studies. All APFFs occurred in females with a mean age of 75.9 years of age (range 43-87). In 11 patients, APFFs occurred around an uncemented stem, and in 6 around a cemented stem. Ten fractures were incomplete, and 7 complete. Conservative management was effective in 4 of 10 patients with incomplete fracture, while all patients with complete fractures underwent open reduction and internal fixation. A fracture non-union was ob-served in 5 patients and further surgery was required. Discussions: APFFs share several clinical and imaging characteristics with AFF. An appropriate and early diagnosis may allow to improve the outcome of these fractures, the management of which should be based on the same principles of that of AFFs. Conclusions: Considering the low quality of published articles and the heterogeneity of the treatment used, a clear recommendation of the most appropriate treatment cannot be formulated. (c) 2021 Elsevier Ltd. All rights reserved

Hallux rigidus treated with adipose-derived mesenchymal stem cells: A case report

BACKGROUND First metatarsophalangeal joint arthritis (FMTPA), also known as hallux rigidus, is the most frequent degenerative disease of the foot. Diagnosis is made through both clinical and radiological evaluation. Regenerative medicine showed promising results in the treatment of early osteoarthritis. The aim of the present study was to report the results of a case of FMTPA treated with the injection of autologous adipose-derived mesenchymal stem cells. CASE SUMMARY A gentleman of 50 years of age presented with a painful hallux rigidus grade 2 resistant to any previous conservative treatment (including nonsteroidal anti-inflammatory drugs and hyaluronic acid injections). An injection of autologous adipose-derived mesenchymal stem cells into the first metatarsophalangeal joint was performed. No adverse events were reported, and both function and pain scales improved after 9 mo of follow-up. CONCLUSION The FMTP joint injection of mesenchymal stem cells improved symptoms and function in our patient with FMTPA at 9 mo of follow-up

Fragility Fractures of the Acetabulum: Current Concepts for Improving Patients’ Outcomes

The incidence of fragility fractures of the acetabulum (FFA) is constantly increasing. Generally, these fractures are related to a fall on the greater trochanter involving the anterior column. The management of FFA is extremely difficult considering both patients’ comorbidities and poor bone quality. Both non-operative and several operative treatment protocols are available, and the choice among them is still ambiguous. The proposed surgical techniques for FFA [namely open reduction and internal fixation (ORIF), percutaneous fixation and total hip arthroplasty (THA)] are associated with a high complication rate. The treatment with the higher early mortality is the ORIF + THA, while the one with the lowest is the non-operative. However, at longer follow-up, this difference dreadfully change is becoming the opposite. Frequently ORIF, percutaneous fixation, and non-operative treatment need a subsequent re-operation through a THA. This latter could be extremely difficult, because of poor bone quality, acetabular mal union/non-union, bone gaps and hardware retention. However, the outcomes of each of the proposed treatment are mostly poor and controverted; therefore, a comprehensive patient evaluation and an accurate fracture description are required to appropriately manage acetabular fracture in the elderly

SuperPath approach is a recommendable option in frail patients with femoral neck fractures: a case–control study

INTRODUCTION: The treatment of intracapsular femoral neck fractures (FNFs) in the elderly is usually based on hip replacement, both total hip arthroplasty (THA) and hemiarthroplasty (HA). Recently, several tissue-sparing approaches for hip arthroplasty had been described with promising results in terms of hospitalization length, blood loss and dislocation rate. The aim of the present study was to compare the blood loss and the transfusion rate in a cohort of patients with FNF treated using an HA through both the SuperPath (SP) and the traditional posterolateral (PL) approaches. MATERIALS AND METHODS: We retrospectively collected data from patients affected by FNFs between January 2018 and February 2020. All patients with intracapsular FNF treated with a single HA implant (Profemur L, MicroPort Orthopedics Inc., USA) via PL or SP approaches were included. Exclusion criteria were pathological fractures, polytrauma and preoperatively transfused patients. RESULTS: Thirty-five patients were included and analysed in the present study. 17 patients were classified in the SP group, and 18 in the PL one. The rate of antithrombotic therapy was higher in the SP group compared with the PL group [10 (58, 82%) vs 4 (22, 2%)]. While the two groups did not differ in terms of preoperative haemoglobin (Hb), 48 h postoperative Hb and Hb reduction, a significative difference was observed in terms of blood transfusion rate (1 SP vs 9 PL, p = 0.0072). CONCLUSIONS: The SuperPath approach in patients with FNF under antithrombotic therapy assures lower transfusion rate, potentially reducing complication rates and improving patients' outcomes

Why Use Adipose-Derived Mesenchymal Stem Cells in Tendinopathic Patients: A Systematic Review

The aim of the present systematic review was to provide a clear overview of the clinical current research progress in the use of adipose-derived mesenchymal stem cells (ASCs) as an effective therapeutic option for the management of tendinopathies, pathologies clinically characterized by persistent mechanical pain and structural alteration of the tendons. The review was carried out using three databases (Scopus, ISI Web of Science and PubMed) and analyzed records from 2013 to 2021. Only English-language papers describing the isolation and manipulation of adipose tissue as source of ASCs and presenting ASCs as treatment for clinical tendinopathies were included. Overall, seven clinical studies met the inclusion criteria and met the minimum quality inclusion threshold. Data extraction and quality assessment were performed by groups of three reviewers. The available evidence showed the efficacy and safety of ASCs treatment for tendinopathies, although it lacked a clear description of the biomolecular mechanisms underlying the beneficial properties of ASCs

X-linked hypophosphatemic rickets. What the orthopedic surgeon needs to know

Purpose: X-linked hypophosphatemic rickets (XLH) is a rare genetic disease characterized by an increase in fibroblast growth factor 23 (FGF23) expression. The skeleton is one of the systems most affected and deformities of the lower limbs are one of the first reasons for consulting an orthopedic surgeon. The aim of the present study was to offer practical advice for a comprehensive orthopedic approach to XLH. Materials: A literature search was conducted in PubMed, a freely available and cost-effective database. The articles included in the study were discussed by a research group with specific expertise in bone metabolism and pediatric deformities, in order to answer three fundamental questions and thus provide the orthopedic specialist with guidance on XLH: (1) How should the physician complete the diagnosis of XLH?; (2) When might a surgical procedure be recommended?; (3) What kind of surgical procedure should be performed? Results: Sixty-three articles were included and discussed by the research group. Conclusions: A correct and timely diagnosis of XLH is essential to appropriately manage affected patients. To complete this diagnosis a detailed medical history of the patient, a comprehensive clinical and radiographic evaluation, and specific biochemical tests are needed. Pharmacological treatment is based on supplementation of both phosphate and vitamin D, however, a monoclonal antibody that inactivates FGF23 (burosumab), has recently been introduced with promising results. Orthopedic surgery is needed in cases of moderate or severe deformities, to allow physiological growth and prevent early osteoarthritis and gait alterations. Surgical options are osteotomies and hemiepiphysiodesis, which is preferred whenever possible. Three different devices for temporary hemiepiphysiodesis are available (staples, transphyseal screws and tension band plates). Obviously, surgical procedures need an appropriate medical therapy to be effective. In conclusion, the diagnosis, treatment and follow-up of XLH require a multidisciplinary approach and a comprehensive evaluation of anamnestic, clinical and radiographic data