Clinical and Experimental Biomechanical Studies Regarding Innovative Implants in Traumatology

Fracture treatment has experienced a fascinating evolution in the last years. The aim of this chapter is to reveal some clinical and biomechanical studies regarding innovative implants. After a short introduction (1), we intend to present our results regarding (2) dynamic condylar screw versus condylar blade plate in complex supracondylar femoral fractures; (3) biomechanical analysis of four types of implants in humeral fractures; (4) clinical and experimental studies for optimal stabilization of trochanteric fractures: the gliding nail; (5) intramedullary XS nail for pilon and ankle fractures: design, biomechanics, and clinical results; (6) the XS nail for the treatment of patella and olecranon fractures; and (7) plates with polyaxial stability for fractures of distal radius and proximal humerus. In conclusion, the authors highlight the advantages of these innovative implants in difficult trauma cases

DENTAL ANTIBIOTIC PROPHYLAXIS IN TOTAL JOINT REPLACEMENT: AN UPDATED REVIEW OF GUIDELINES AND CLINICAL STUDIES

Aim of the study: This review evaluates the necessity and effectiveness of antibiotic prophylaxis in preventing prosthetic joint infections (PJI) following dental procedures in patients with joint implants.Material and methods: An extensive literature review was conducted, focusing on studies evaluating the link between dental care and PJI. Sources included PubMed and other databases, using terms such as dental care, joint prosthesis, and antibiotic prophylaxis. The review spanned papers from 2003 to 2023, with a focus on hip and knee joint replacements and dental procedure-related prophylaxis guidelines.Results: The review found that the prevalence of dental pathology in patients with total hip arthroplasty (THA) or total knee arthroplasty (TKA) varied significantly. Studies indicated no significant benefit of antibiotic prophylaxis in reducing PJI risk post-dental procedures. Furthermore, the incidence of PJI was not significantly different in patients receiving antibiotic prophylaxis compared to those who did not. It was observed that routine activities, such as chewing and brushing, contribute more to bacteremia and potential joint infection than dental procedures themselves.Conclusions: The evidence suggests that antibiotic prophylaxis for dental procedures in patients with joint prostheses is not universally beneficial and should not be routinely recommended. Emphasis on individual risk assessment, maintenance of good oral hygiene, and adherence to evidence-based guidelines is paramount. The study advocates for personalized approaches to PJI prevention, aligning with the goals of antibiotic stewardship and patient safety

Thromboembolic Disease in Haemophilic Patients Undergoing Major Orthopaedic Surgery: Is Thromboprophylaxis Mandatory?

Haemophilia is a rare genetic disorder, that results from various degrees of deficiency of coagulation factor VIII (haemophilia A), or factor IX (haemophilia B), with an X-linked transmission. The patients affected are in the majority of cases males (who inherit the affected X-chromosome from the maternal side), with rare cases of females with haemophilia (FVIII or FIX < 40 IU/dL), situations in which both X-chromosomes are affected, or one is affected, and the other one is inactive (known as carrier). The hypocoagulable state due to the deficiency of clotting factors, manifests as an excessive, recurrent tendency to bleeding, which positively correlates with plasmatic levels. Severe haemophilia results in hemarthrosis, although recent data have shown that moderate or even mild disease can lead to joint bleeding. Recurrent episodes of haemorrhages, usually affecting large joints such as knees, elbows, or ankles, lead to joint remodelling and subsequent haemophilic arthropathy, which may require arthroplasty as a last therapeutic option. Orthopaedic patients have the highest risk among all for deep vein thrombosis (DVT) and venous thromboembolism (VTE) with morbid and potentially fatal consequences. While for the rest of the population thromboprophylaxis in orthopaedic surgery is efficient, relatively safe, and widely used, for patients with haemophilia who are considered to have a low thromboembolic risk, there is great controversy. The great heterogeneity of this particular population, and the lack of clinical trials, with only case reports or observational studies, makes thromboprophylaxis in major orthopaedic surgery a tool to be used by every clinician based on experience and case particularities. This review aims to briefly summarise the latest clinical data and to offer an insight into the current recommendations that readers would find useful in daily practice