Synthetic bone grafting in aseptic loosening of acetabular cup: Good clinical and radiological outcomes in contained bone defects at mediumterm follow up

Restoring bone loss is one of the major challenges when facing hip revision surgery. To eliminate the risk of disease transmission and antigenicity of allografts and donor-morbidity of autografts, the use of synthetic bioceramics has become popular in the last decade. Our study investigated the effectiveness of impaction bone grafting (IBG) of contained acetabular defects (Paprosky 2 and 3a) using a porous ceramic-based hydroxyapatite bone substitute (Engipore, provided by Finceramica Faenza S.p.A., Faenza, Italy) mixed with a low percentage of autologous bone (obtained from reaming when available). We retrospectively assessed 36 patients who underwent acetabular revision using IBG using a porous ceramic-based hydroxyapatite bone substitute with cementless implants with a mean follow-up of 4.4 years. We evaluated, at regular intervals, patients clinically (using the Hip Harris Score and Oxford Score) and radiologically to evaluate the rate of incorporation of the graft, the presence of radiolucent lines or migrations of the cup. Clinical scores significantly improved (WOMAC improved from 49.7–67.30, and the HSS from 56–89). The rate of implants’ survival was 100% at our medium follow-up (4.4 years). We reported five cases of minor migration of the cup, and radiolucent lines were visible in seven patients at the last-follow up. The graft was well-incorporated in all patients. The results presented in this study suggest the HA bone substitute is an effective and safe bone graft when facing hip revision surgery; thus, longer follow-up studies are required

Giovanni Alfonso Borelli: The precursor of medial pivot concept in knee biomechanics

A new philosophy of science and medicine had spread throughout the 17th-century Italy: the "Scientific Revolution." Giovanni Alfonso Borelli (1608-1679) was one of the most charismatic and brilliant scientists of his generation in Europe. He extended to biology the rigorous analytic methods developed by his indirect mentor Galileo in the field of mechanics. In his masterpiece " De Motu Animalium ," Borelli analyzed structure, motion, balance, and forces concerning almost all the principal joints of the human body, in static and dynamic situations. In particular, he accurately studied the anatomy and biomechanics of the knee joint. He sustained that femoral condyles shift backward during flexion, allowing a wider range of movement. Furthermore, he observed that, when the knee flexes, the lateral condyle moves backward more than the medial condyle: this concept is nowadays known as medial pivoting. The aim of this article is to describe the life and work of this important Italian scientist and to present his unrecognized contribution to modern knee biomechanics

Cross-Sectional Imaging of Nontraumatic Peritoneal and Mesenteric Emergencies

Multiple nontraumatic peritoneal and mesenteric emergencies are encountered at imaging of patients in the emergency department. Peritoneal and mesenteric emergencies are usually detected in patients in the emergency department during evaluation of nonspecific abdominal pain. A high index of suspicion is required for the establishment of early diagnosis and aversion of life-threatening complications in cases of peritoneal carcinomatosis, nontraumatic hemoperitoneum, and peritonitis. A correct diagnosis of omental infarction, mesenteric adenitis, and mesenteric panniculitis helps patients primarily by avoiding unnecessary surgery. In this review article, we illustrate the cross-sectional imaging appearance of various nontraumatic peritoneal and mesenteric emergencies by emphasizing the role of the emergency radiologist in detecting and managing these entities

The flight of Arcadia: spatial CO2/SO2 variations in a cross section above the Nord East crater of Etna volcano

The CO2/SO2 ratio in volcanic plumes of open conduit volcanoes can provide useful information about the magma depth inside a conduit and the possible occurrence of an eruptive event. Moreover, the same CO2 measurement when combined with a SO2 flux measurement, commonly carried out at many volcanoes nowadays, is used to contribute to an improved estimate of global volcanic CO2 budget. Today worldwide at 13 volcanoes automated in-situ instruments (known as Multi-GAS stations) are applied to continuously determine CO2/SO2 ratios and to use this signal as additional parameter for volcanic monitoring. Usually these instruments carry out measurements of half an hour 4 – 6 times/day and thus provide continuous CO2/SO2 values and their variability. The stations are located at crater rims in a position that according to the prevailing winds is invested by the plume. Obviously, although the stations are carefully positioned, it is inevitable that other sources than the plume itself, e.g. soil degassing and surrounding fumaroles, contribute and will be measured as well, covering the ‘real’ values. Between July and September 2014 experiments were carried out on the North East crater (NEC) of Mount Etna, installing a self-made cable car that crossed the crater from one side to the other. The basket, called “Arcadia”, was equipped with an automated standard Multi-GAS station and a GPS, which acquired at high frequency (0.5 Hz) the following parameters : CO2, SO2, H2S, Rh, T, P and geo-coordinates. The choice of NEC of the volcano Etna was based on its accessibility, the relative small diameter (about 230 m) and the presence of a relatively constant and rather concentrated plume. Actually, NEC belongs also to the monitoring network EtnaPlume (managed by the INGV of Palermo). The aim of these experiments was to observe variations of each parameter, in particular the fluctuation of the CO2/SO2 ratio within the plume, moving from the edge to the center of the crater. The gained results give a first possibility to understand if common measurements carried out at the edge of a crater are subject to overor underestimation and about the order of derivations caused by other sources than the plume. A preliminary analysis results in a lower CO2/SO2 ratio in the central part of the crater versus the more peripheral one. The deviation between the average CO2/SO2 ratio and the center of the plume ranges from a minimum of 58% up to a maximum of 74%. An increased CO2/SO2 emission could be caused by the influence of soil and/or fumarolic degassing at the crater rim. This interpretation leads us to the conclusion that measurements by fixed installed stations might overestimate the CO2/SO2 ratio compared to values originating from the “pure” plume. Further on, it means that variations of up to 74%(in our experiment) don’t necessarily correlate with volcanic activity changes

Treatment of Vancouver B1 periprosthetic femoral fractures using Intrauma Iron Lady® locking plate: A retrospective study on 32 patients

Introduction: Periprosthetic femoral fractures (PFF) actually represent a serious public health problem. They are reported to occur in 0,1-4.5% of all patients undergoing total hip replacement (THR). PFF are commonly distinguished using the Vancouver classification. This study principal aim is to evaluate results obtained using the Intrauma Iron Lady® Conical Coupling locking plate for the treatment of Vancouver type B1 periprosthetic femoral fractures. Materials and Methods: We enrolled 32 patients affected by Vancouver B1 PFF and treated with the same device. Metal cerclages were additionally used in 12 (38%) patients. A clinical and radiographical post-operative follow-up was then planned at 1, 3 and 6 months after surgery; than the follow-up was annually fixed. Results: Mean age at the moment of trauma was 76,7 years. All involved femoral stem were uncemented and the they were all radiographically and intraoperativelly judged to be stable. Mean post-operative follow-up period was 5,8 years. 29 patients (91%) presented healed fracture at 6 months follow-up. 9% patients developed a superficial surgical site infection. Discussion and Conclusions: Literature highlights that Vancouver B1 PFF should be treated with open reduction and internal fixation (ORIF) using polyaxial locking plates. However, no single technique has gained universal acceptance to be superior that the other. The current reported healing rate ranges from 40 to 100%. Using the Intrauma Iron Lady® Conical Coupling locking plate, we obtained a healing rate of 91%; this data is consistent with recent literature. Moreover, the role of cerclages in addition to femoral plating is actually controversial because they potentially damage the soft callus vascularization. Our results showed no difference in term of healing rate between patients with and without cerclages, according with some of most recent articles. A prospective study with a higher number of patients should be carried out in order to better evaluate the role of cerclages on healing rate but also the complications frequency after PFF surgical treatment

The 50 most cited articles about wrist surgery

The purpose was to establish a ranking of the 50 most cited articles about wrist surgery and analyse their features. Science Citation Index Expanded was used to identify the 50 most frequently cited orthopaedic journal articles written in English, searching for the topic “wrist surgery” in the subject category ‘‘Orthopaedics’’. Then, we analysed the number of citations, citation density, authorship, article institution, the year of publication, the country of origin of the article, name and impact factor of the journal, and publication type of the article. The 50 most cited articles were published in only 6 of the 74 journals included under the category “orthopaedics”. Citation count ranged from 256 for the first one to 67 for the 50th article. Most of them were written by American authors. These articles were published between 1991 and 2011. “Distal Radius Fractures” was the most common issue. This type of bibliographic analysis could be particularly useful for other young Authors who would like to improve their research in wrist and hand surgery and make their publications more citable and appreciated by the scientific communit

Passive degassing at Nyiragongo (D.R. Congo) and Etna (Italy) volcanoes

Volcanoes are well known as an impressive large natural source of trace elements into the troposphere. Etna (Italy) and Nyiragongo (D.R. Congo) are two stratovolcanoes located in different geological settings, both characterized by persistent passive degassing from their summit craters. Here, we present some re-sults on trace element composition in volcanic plume emissions, atmospheric bulk deposition (rainwater) and their uptake by the surrounding vegetation, with the aim to compare and identify differences and sim-ilarities between these two volcanoes. Volcanic emissions were sampled by using active filter-pack for acid gases (sulfur and halogens) and specific teflon filters for particulates (major and trace elements). The im-pact of the volcanogenic deposition in the surrounding of the crater rims was investigated by using differ-ent sampling techniques: bulk rain collectors gauges were used to collect atmospheric bulk deposition, and biomonitoring technique was carried out to collect gases and particulates by using endemic plant species. The estimates of the trace element fluxes confirm that Etna and Nyiragongo are large sources of metals in-to the atmosphere, especially considering their persistent state of passive degassing. The large amount of emitted trace elements has a strong impact on the close surrounding of both volcanoes. This is clearly re-flected by in the chemical composition of rainwater collected at the summit areas both for Etna and Nyira-gongo. Moreover, the biomonitoring results highlight that bioaccumulation of trace elements is extremely high in the proximity of the crater rim and decreases with the distance from the active craters

Passive degassing at Nyiragongo (D.R. Congo) and Etna (Italy) volcanoes

Volcanoes are well known as an impressive large natural source of trace elements into the troposphere. Etna (Italy) and Nyiragongo (D.R. Congo) are two stratovolcanoes located in different geological settings, both characterized by persistent passive degassing from their summit craters. Here, we present some re-sults on trace element composition in volcanic plume emissions, atmospheric bulk deposition (rainwater) and their uptake by the surrounding vegetation, with the aim to compare and identify differences and sim-ilarities between these two volcanoes. Volcanic emissions were sampled by using active filter-pack for acid gases (sulfur and halogens) and specific teflon filters for particulates (major and trace elements). The im-pact of the volcanogenic deposition in the surrounding of the crater rims was investigated by using differ-ent sampling techniques: bulk rain collectors gauges were used to collect atmospheric bulk deposition, and biomonitoring technique was carried out to collect gases and particulates by using endemic plant species. The estimates of the trace element fluxes confirm that Etna and Nyiragongo are large sources of metals in-to the atmosphere, especially considering their persistent state of passive degassing. The large amount of emitted trace elements has a strong impact on the close surrounding of both volcanoes. This is clearly re-flected by in the chemical composition of rainwater collected at the summit areas both for Etna and Nyira-gongo. Moreover, the biomonitoring results highlight that bioaccumulation of trace elements is extremely high in the proximity of the crater rim and decreases with the distance from the active craters