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Introduction: Lateral fractures of proximal femur are the most frequent fractures in elderly people. Internal fixation using medullary nails is the gold standard of treatment (Gamma 3 nail is the most implanted device) due to reduced incidence of complications than other devices. We report our experience in treating this kind of fractures with Gamma 3 nail, between January 2015 and December 2021. Methods: We performed a retrospective cohort study of patients treated in our orthopaedic department; level of clinical care is III: 559 patients (431 females and 128 males, with an average age of 85.3 years) with lateral femoral neck fracture. All patients were surgically treated with Gamma 3 standard nail (SGN). We evaluated preliminary X-rays to classify fractures, according to AO-OTA classification and post-operative X-ray to verify cephalic screw position site, according to areas described by Cleveland in 1959: we measured tip-to-apex distance (TAD) and tip-to-apex calcar referred distance (CalTAD). Finally Chang reduction quality criteria (CRQC) for fracture reduction of trochanteric fractures were determined using preoperative or postoperative Antero-Posterior (AP) and lateral radiographs in a Picture Archiving and Communication System (PACS). Incidence of cut-out was evaluated in relation with these parameters. Patients were divided into 2 groups: first group had cephalic screw in optimal positions (5-8-9), the other group had cephalic screw in other positions. Results: In 328 patients (58.7%) screw was in positions 5-8-9, in 231 patients (41.2%) screw was in not-optimal position. Median TAD was 19.1 ± 7.0 mm (range = 0.0–50.5); in 463 patients (82.8%) TAD was ≤ 25 mm. Median CalTAD was 21.4 ± 4.7 mm (range = 5.7–39.2); in 105 patients (79.4%) CalTAD was ≤ 25 mm. Cut-out was observed in 8 cases (1.43%). Multivariate analysis showed a significant correlation (p 25 mm. Cephalic screw position did not influence incidence of cut-out. Discussion: In order to obtain fracture healing with a low risk of failure, in particular cut-out, it is necessary to obtain good reduction of fracture and optimal lag screw position in order to achieve a TAD inferior to 25 mm.

Background Compression injuries of the thoracolumbar spine without neurological impairment are usually treated with minimally invasive procedures. Intravertebral expandable implants represent an alternative strategy in fractures with low fragments' displacement. Methods Patients with A2, A3 and A4 fractures of the T10--L2 spinal segment without neurological impairment, fracture gap >2 mm, vertebra plana, pedicle rupture, pedicle diameter <6 mm, spinal canal encroachment ≥50%, and vertebral body spread >30% were treated with the SpineJack device. Patients with pathological/ osteoporotic fractures were excluded. Demographic and fracture-related data were assessed together with vertebral kyphosis correction, vertebral height restoration/loss of correction and final kyphosis. The modified Rankin Scale (mRS), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), Smiley--Webster Pain Scale (SWPS) and EuroQol-5D (EQ-5D) were evaluated at 1 (-post), 6 and 12 months (-fup) after surgery. Statistical analysis was performed and p values ≤0.05 were considered significant. Results Fifty-seven patients were included in the study. Patients aged >60 years reported worse kyphosis correction (<4°) with more postoperative complications, while vertebral plasticity in younger patients, fragmentation-related greater remodeling in A3/ A4 fractures, and treatments within 7 days of trauma determined superior wedging corrections, with better EQ-5D-post and mRS-fup. Cement leakages did not affect functional outcome, while female gender and American Society of Anesthesiologists (ASA) score of 3-4 were associated with worse ODI-fup and VAS-fup. Although fracture characteristics and radiological outcome did not negatively influence the clinical outcome, A2 fracture was a risk factor for complications, thus indirectly compromising both the functional and radiological outcome. Conclusion With spread of <30%, the SpineJack is an alternative to minimally invasive fixations for treating A3/ A4 thoracolumbar fractures, being able to preserve healthy motion segments in younger patients and provide an ultraconservative procedure for elderly and fragile patients. [ABSTRACT FROM AUTHOR]

In this work we demonstrate that restoration interventions in arid to semi-arid landscapes can be independently assessed by remote sensing methods throughout all phases. For early verification, we use Sentinel-1 radar imagery that is sensitive to changes in soil roughness and thus able to rapidly detect disturbances due to mechanised ploughing, including identification of the time of occurrence and the surface area prepared for planting. Subsequently, time series of the normalized difference vegetation index (NDVI) derived from high-resolution imagery enabled tracking and verifying of the increase in biomass and the long-term impact of restoration interventions. We assessed 111 plots within the Great Green Wall area in Burkina Faso, Niger, Nigeria and Senegal. For 58 plots, the interventions were successfully verified, corresponding to an area of more than 7000 ha of degraded land. Comparatively, these computerised data were matched with field data and high-resolution imagery, for which the NDVI was used as an indicator of subsequent biomass growth in the plots. The trends were polynomial and presented clear vegetation gains for the monthly aggregates over the last 2 years (2018–2020). The qualitative data on planted species also showed an increase in biodiversity as direct sown seeds of a minimum of 10 native Sahel species (six woody mixed with four fodder herbaceous species) were planted per hectare. This innovative and standardised monitoring method provides an objective and timely assessment of restoration interventions and will likely appeal more actors to confidently invest in restoration as a part of zero-net climate mitigation. [ABSTRACT FROM AUTHOR]

Background: Lateral fractures of proximal femur are the most frequent to treat for the traumatologist surgeon. Intramedullary nailing is the gold standard treatment of this type of fracture. The aim of the study is to analyze the results obtained with the Elos Intrauma nail by the experience of two Departments of Orthopedics and Traumatology ("Guglielmo da Saliceto" Hospital in Piacenza and the Maggiore hospital in Bologna)., Methods: We performed a retrospective cohort study of 400 patients with lateral femoral neck fracture surgically treated with Elos Intrauma standard nail. The examined period is from 1st Jannuary 2018 to 31st Dicember 2020.  In all patients we implanted Elos® - Intrauma nail, a titanium cervical diaphyseal nail, according to the standard technique., Results: We evaluate at a minumum of three months of follow up 286/400 patients. Average follow up was 3.94 months, minimum 3 months and maximum 24 months. We obtain the 96.85 % of fracture healing, recording 33 complications (11.54%). The incidence of surgical revision was 2.8% (8 cases). No mechanical complications was found in stable fractures treated with short nail and without distal locking., Conclusions: With the use of Elos nail we obtained 95% of radiographic healings within three months with a complication rate comparable to literature report. Distal locking is absolutely recommended in complex fractures, it may be superfluous after careful evaluation of the fracture pattern and morphological characteristics of the femur to be treated; future in-depth studies may narrow the criteria to choose distal locking or non locking.

In recent years, the application of fibrin sealant has been shown to be efficacious in the management of intraoperative and postoperative hemostasis. We designed a prospective randomized controlled clinical trial to assess the efficacy of two different dosages of fibrin sealant (5 and 10 ml) in patients undergoing total knee arthroplasty, as compared with the untreated control group. A total of 90 patients entered the study, randomly assigned to one of the three groups: treatment with 5 ml fibrin sealant (30 patients), with 10 ml fibrin sealant (30 patients) or no treatment (30 patients). A statistically significant difference in the mean reduction of hemoglobin concentrations was found on the first postoperative day in the treated groups as compared with the controls: 5 ml fibrin sealant (2.6 mg/dl) and 10 ml fibrin sealant (2.5 mg/dl) vs. controls (3.7 mg/dl) (P = 0.024). The mean number of blood transfusions was significantly lower in the treated groups: 5 ml (0.5) and 10 ml (0.3) of fibrin sealant vs. controls (1) (P = 0.0019). Functional recovery was also better in the treated groups: on the seventh day, the joint ROM (range of motion) was statistically superior in the 5 ml group (96.5°) and 10 ml group (98.8°) as compared with the controls (75.5°) (P < 0.0001). This study supports the efficacy of administering fibrin sealant in the perioperative management of bleeding after total knee arthroplasty and shows that a 5 ml dosage yields a comparable outcome to the 10 ml dosage previously reported in the literature.