Can Clinical and Surgical Parameters Be Combined to Predict How Long It Will Take a Tibia Fracture to Heal? A Prospective Multicentre Observational Study: The FRACTING Study

Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. Methods: The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. Results: 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r = 0.63 (p < 0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. Conclusions: This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings

Platelets and Hepatocellular Cancer: Bridging the Bench to the Clinics

Growing interest is recently being focused on the role played by the platelets in favoring hepatocellular cancer (HCC) growth and dissemination. The present review reports in detail both the experimental and clinical evidence published on this topic. Several growth factors and angiogenic molecules specifically secreted by platelets are directly connected with tumor progression and neo-angiogenesis. Among them, we can list the platelet-derived growth factor, the vascular endothelial growth factor, the endothelial growth factor, and serotonin. Platelets are also involved in tumor spread, favoring endothelium permeabilization and tumor cells' extravasation and survival in the bloodstream. From the bench to the clinics, all of these aspects were also investigated in clinical series, showing an evident correlation between platelet count and size of HCC, tumor biological behavior, metastatic spread, and overall survival rates. Moreover, a better understanding of the mechanisms involved in the platelet-tumor axis represents a paramount aspect for optimizing both current tumor treatment and development of new therapeutic strategies against HCC

Atypical lipomatous tumor: Retrospective analysis, prognostic factors and MRI in differential diagnosis

Background. Authors analyzed retrospectively 98 Atypical Lipomatous Tumor (ALT) treated at a single institution, 96% of which was localized to the extremities and 4% to the trunk, assessing MRI, surgical treatment, local recurrence, follow-up and de-differentiation ability. Methods. Authors used MRI in order to identify ALT size, site, the presence of septa and contrast enhancement. Surgical margins were divided at final histology in wide/radical, marginal and intralesional. Results. The most common localization was the lower limb (84% of cases), 52% of cases showed size larger than 10 cm; 80% of cases were deep-seated. MRI revealed thick septa in 83% and contrast enhancement in 78% of the cases. Eleven local recurrences of the disease (11%) were observed, with only surgical margins representing a significant prognostic factor on local recurrence (p = 0.0007). No de-differentiation was reported nor metastatic spread. Conclusions. The slow growth and the dedifferentiation ability in ALT needs a long follow-up. MRI with contrast is the imaging method of choice. The optimal treatment is wide/radical resectio