Outcomes of Vancouver B2- type and B3-type proximal femur periprosthetic fractures after revision surgery using cementless tapered modular stem: a retrospective case series of 39 fractures

Objective. Evaluate outcomes of Vancouver B2-type and B3-type proximal femur periprosthetic fractures (PPFs) in elderly patients treated with a cementless tapered modular femoral stem. Methods. 37 patients with a proximal femur PPF (34 B2-type and 5 B3-type) on primary or revision implants, with a minimum of 2-year follow-up, treated with revision of the failed stem using uncemented MP® reconstruction system stem (Waldemar Link®), were included.Results. At last follow-up, the average Harris Hip Score was 91 ± 9.8, and average Numerical Rating Score was 0.7 ± 0.8, without a significant difference between B2-type and B3-type PPFs. X-rays at last follow-up revealed bone union in all patients. According to Beals and Tower's criteria, we found excellent radiological findings in 89.7% patients. Fourteen local surgery-related complications were reported (35.9%), and 4 patients required revision surgery (10.2%), without significant differences between B2-type and B3-type PPFs. We found involvement of both trochanters in fracture as a possible risk factor for dislocation.Conclusions. Vancouver B2-type and B3-type PPFs can be effectively treated using a cementless modular stem, even without cortical struts graft, although further studies are needed regarding B3-type PPFs

The Use of Iliac Stem Prosthesis for Acetabular Defects following Resections for Periacetabular Tumors

Introduction. The management of pelvic tumors is a challenge for orthopaedic oncologists due to the complex anatomy of the pelvis and the need to have extensive exposure. Various reconstructive techniques have been proposed with poor functional results and a high percentage of complications. Our purpose is to determine the functional results and the rate of complications of iliac stem prosthesis for acetabular defects following resections for periacetabular tumors. Materials and Methods. Between 1999 and 2012, 45 patients underwent pelvic resections for periacetabular bone tumors followed by reconstruction with stem cup prosthesis. The most common diagnosis was CS (chondrosarcoma, 29 cases), followed by OS (osteosarcoma, 9 cases) and metastasis (3 cases). In 33 cases, this implant was associated with massive bone allografts. Minimum follow-up required to evaluate functional outcome was 2 years. We classified pelvic resections according to Enneking and Dunham’s classification and we used MSTS (musculoskeletal tumor system) score to evaluate functional outcomes. Results and Discussion. Sixteen patients died of their disease, three were lost to follow-up, four are alive with disease, and twenty-two are alive with no evidence of disease. Fifteen patients had local recurrence. Sixteen patients had bone or lung metastasis. We have had 6 infections, 2 aseptic loosening, and 2 cases of hip dislocation. Iliac sovracetabular osteotomy was fused in all cases at 10 months from surgery. Functional results were good or excellent in 25 of 31 patients with long-term follow-up (77%), with a percentage similar to that reported in the literature. Conclusion. The use of iliac stem prosthesis is a simple reconstructive technique that reduces operative times and risk of infection. It allows having good results and low rate of complications, but it should be performed in selected cases and centres of reference

Bone and Joint Infections: The Role of Imaging in Tailoring Diagnosis to Improve Patients' Care

Imaging is needed for the diagnosis of bone and joint infections, determining the severity and extent of disease, planning biopsy, and monitoring the response to treatment. Some radiological features are pathognomonic of bone and joint infections for each modality used. However, imaging diagnosis of these infections is challenging because of several overlaps with non-infectious etiologies. Interventional radiology is generally needed to verify the diagnosis and to identify the microorganism involved in the infectious process through imaging-guided biopsy. This narrative review aims to summarize the radiological features of the commonest orthopedic infections, the indications and the limits of different modalities in the diagnostic strategy as well as to outline recent findings that may facilitate diagnosis

Combined Orthoplastic Approach in Fracture-Related Infections of the Distal Tibia

This series reports on the treatment of distal tibia (DT) fracture-related infections (FRI) with a combined orthoplastic approach. Thirteen patients were included. In eight patients with extensive bone involvement and in those with a non-healed fracture, the DT was resected ("staged approach"). In five cases, the DT was preserved ("single-stage approach"). A wide debridement was performed, and the cavity was filled with antibiotic-loaded PerOssal beads. All patients had a soft-tissue defect covered by a free vascularized flap (anterolateral thigh perforator flap in eight cases, latissimus dorsi flap in five). At the final follow-up (mean 25 months, range, 13-37), no infection recurrence was observed. In one patient, the persistence of infection was observed, and the patient underwent a repeated debridement. In two cases, a voluminous hematoma was observed. However, none of these complications impacted the final outcome. The successful treatment of FRI depends on proper debridement and obliteration of dead spaces with a flap. Therefore, when dealing with DT FRI, debridement of infected bone and soft tissues must be as radical as required, with no fear of the need for massive reconstructions

Strongest atomic physics bounds on Non-Commutative Quantum Gravity Models

Investigations of possible violations of the Pauli Exclusion Principle represent critical tests of the microscopic space-time structure and properties. Space-time non-commutativity provides a class of universality for several Quantum Gravity models. In this context the VIP-2 Lead experiment sets the strongest bounds, searching for Pauli Exclusion Principle violating atomic-transitions in lead, excluding the $\theta$-Poincar\'e Non Commutative Quantum Gravity models far above the Planck scale for non-vanishing $\theta_{\mu \nu}$ ``electric-like'' components, and up to $6.9 \cdot 10^{-2}$ Planck scales if $\theta_{0i} = 0$.Comment: 7 pages, 2 figure

Experimental test of Non-Commutative Quantum Gravity by VIP-2 Lead

Pauli Exclusion Principle (PEP) violations induced by space-time non-commutativity, a class of universality for several models of Quantum Gravity, are investigated by the VIP-2 Lead experiment at the Gran Sasso underground National Laboratory of INFN. The VIP-2 Lead experimental bound on the non-commutative space-time scale $\Lambda$ excludes $\theta$-Poincar\'e far above the Planck scale for non vanishing ``electric-like" components of $\theta_{\mu \nu}$, and up to $6.9 \cdot 10^{-2}$ Planck scales if they are null. Therefore, this new bound represents the tightest one so far provided by atomic transitions tests. This result strongly motivates high sensitivity underground X-ray measurements as critical tests of Quantum Gravity and of the very microscopic space-time structure.Comment: 13 pages, 2 figures. arXiv admin note: substantial text overlap with arXiv:2209.0007

VIP-2 —High-Sensitivity Tests on the Pauli Exclusion Principle for Electrons

The VIP collaboration is performing high sensitivity tests of the Pauli Exclusion Principle for electrons in the extremely low cosmic background environment of the underground Gran Sasso National Laboratory INFN (Italy). In particular, the VIP-2 Open Systems experiment was conceived to put strong constraints on those Pauli Exclusion Principle violation models which respect the so-called Messiah–Greenberg superselection rule. The experimental technique consists of introducing a direct current in a copper conductor, and searching for the X-rays emission coming from a forbidden atomic transition from the L shell to the K shell of copper when the K shell is already occupied by two electrons. The analysis of the first three months of collected data (in 2018) is presented. The obtained result represents the best bound on the Pauli Exclusion Principle violation probability which fulfills the Messiah–Greenberg rule

Test of the Pauli Exclusion Principle in the VIP-2 Underground Experiment

The validity of the Pauli exclusion principle\u2014a building block of Quantum Mechanics\u2014is tested for electrons. The VIP (violation of Pauli exclusion principle) and its follow-up VIP-2 experiments at the Laboratori Nazionali del Gran Sasso search for X-rays from copper atomic transitions that are prohibited by the Pauli exclusion principle. The candidate events\u2014if they exist\u2014originate from the transition of a 2p orbit electron to the ground state which is already occupied by two electrons. The present limit on the probability for Pauli exclusion principle violation for electrons set by the VIP experiment is 4.7 710^ 1229. We report a first result from the VIP-2 experiment improving on the VIP limit, which solidifies the final goal of achieving a two orders of magnitude gain in the long run

High Precision Test of the Pauli Exclusion Principle for Electrons

The VIP-2 experiment aims to perform high precision tests of the Pauli Exclusion Principle for electrons. The method consists in circulating a continuous current in a copper strip, searching for the X radiation emission due to a prohibited transition (from the 2p level to the 1s level of copper when this is already occupied by two electrons). VIP already set the best limit on the PEP violation probability for electrons $\frac{1}{2} \beta^2 < 4.7 \times 10^{-29}$, the goal of the upgraded VIP-2 (VIolation of the Pauli Exclusion Principle-2) experiment is to improve this result of two orders of magnitude at least. The experimental apparatus and the results of the analysis of a first set of collected data will be presented

Search for a remnant violation of the Pauli exclusion principle in a Roman lead target

In this paper we report on the results of two analyses of the data taken with a dedicated VIP-Lead experiment at the Gran Sasso National Laboratory of the INFN. We use measurements taken in an environment that is especially well screened from cosmic rays, with a metal target made of “Roman lead” which is characterised by a low level of intrinsic radioactivity. The analyses lead to an improvement, on the upper bounds of the Pauli Exclusion Principle violation for electrons, which is more than one (four) orders of magnitude, when the electron-atom interactions are described in terms of scatterings (or close encounters) respectively