Genetics in orthopaedic practice

DNA holds genetic information in the nucleus of eukaryotic cells; and has three different functions: replication, storage of hereditary information, and regulation of cell division. Most studies described the association of single nucleotide polymorphism (SNP) to common orthopaedics diseases and the susceptibility to develop musculoskeletal injuries. Several mutations are associated with osteoporosis, musculoskeletal ailments and other musculoskeletal deformity and conditions. Several strategies, including gene therapy and tissue engineering with mesenchymal stem cells (MSC), have been proposed to enhance healing of musculoskeletal tissues. Furthermore, a recent technique has revolutionized gene editing: clustered regulatory interspaced short palindromic repeat (CRISPR) technology is characterized by simplicity in target design, affordability, versatility, and high efficiency, but needs more studies to become the preferred platform for genome editing. Predictive genomics DNA profiling allows to understand which genetic advantage, if any, may be exploited, and why a given rehabilitation protocol can be more effective in some individual than others. In conclusion, a better understanding of the genetic influence on the function of the musculoskeletal system and healing of its ailments is needed to plan and develop patient specific management strategies

Lower limb joint repair and replacement: an overview

In the last few years, much has been published concerning total joint arthroplasty, and debates and discussions to new questions and points of view started many years ago. In this commentary, we report the latest evidence of best practice in the field of lower limb arthroplasty; this evidence is based on a literature search conducted by using PubMed and Scopus databases with a time limit of five years. We found novel evidence regarding cemented and not cemented implant, implant design, anticoagulant use, tourniquets, and other aspects of joints replacement surgery that we consider a common part of modern orthopedic practice. We specifically focus on lower limb joint replacement

Defensive antibacterial coating (Dac®) for prevention of infection in acl reconstruction: A feasibility study

Defensive Antibacterial Coating (DAC) is a hydrogel, Conformité Européene (CE)-marked medical device, intended to be used as a disposable, quickly bioresorb-able antibacterial coating for implants. The present feasibility study investigated the application of DAC on the grafts, in addition to IV prophylaxis, during anterior cruciate ligament (ACL) reconstruction

Autograft Reconstruction for Chronic Achilles Tendon Disorders

Surgical management of chronic tendon Achilles ruptures usually requires tendon grafting procedures. Several techniques have been described. We describe the use of 3 different minimally invasive tendon transfer techniques in the management of patients with a chronic rupture of the tendon Achilles, undertaking a free transfer of the semitendinosus tendon, or a transfer of the peroneus brevis or flexor hallucis longus tendons. All 3 techniques produce marked functional improvement, and return to sports is possible in most patients. The advantages of one technique over the others need to be explored. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence

Surgery in Tendinopathies

Tendinopathies are challenging. The term "tendinopathy" refers to clinical condition characterized by pain, swelling, and functional limitations of tendons and nearby structures. Tendinopathies give rise to significant morbidity, and, at present, only limited scientifically proven management modalities exist. Achilles and patellar tendons are among the most vulnerable tendons, and among the most frequent lower extremity overuse injuries. Achilles and patellar tendinopathies can be managed conservatively and surgically. Several surgical procedures have been described for both conditions, and, if performed well, they lead to a relatively higher rate of success with low complication

Prevalence of Hyponatremia in Elderly Patients with Hip Fractures: A Two-Year Study

Objective: This study investigated the prevalence of hyponatremia in elderly patients (≥65 years old) with hip fractures. Subjects and Methods: All records containing clinical and laboratory data on the 334 elderly patients admitted to the San Giovanni di Dio e Ruggi d'Aragona Hospital of Salerno, Italy, with hip fractures during 2014 and 2015, were retrieved from the hospital database. Patients were divided into 4 groups, according to their sex and the type of hip fracture. Sodium serum concentrations were retrieved from the medical records. Hyponatremia was defined as the presence of at least 1 episode of hyponatremia during the hospital stay. Results: Of 334 elderly patients, hyponatremia was found in 64 (19%). The prevalence of hyponatremia was 18% (28/157) for female patients with extracapsular proximal femoral fracture, 22% (17/79) for female patients with intracapsular proximal femoral fracture, 20% (12/60) for male patients with extracapsular proximal femoral fracture, and 18% (7/38) for male patients with intracapsular proximal femoral fracture. Conclusion: There was a high prevalence of hyponatremia in the elderly patients with hip fractures. Hence, serum sodium concentrations should be regularly assessed to prevent occurrence of hyponatremia