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Background Complex proximal humeral fractures (cPHFs) represent an important public health concern, and reverse shoulder arthroplasty (RSA) has emerged as a feasible treatment option in the elderly with high functional demands. Recent studies have shown that tuberosity healing leads to better clinical outcomes and an improved range of motion. However, the best surgical technique for the management of the tuberosities is still a topic of debate. The purpose of this retrospective observational study is to report the radiographic and clinical outcomes of a consecutive series of patients who underwent RSA for cPHFs using a novel “7 sutures and 8 knots” technique. Materials and methods A consecutive series of 32 patients (33 shoulders) were treated with this technique by a single surgeon from January 2017 to September 2021. Results at a minimum follow-up of 12 months and a mean ± SD follow-up of 35.9 ± 16.2 (range 12–64) months are reported. Results The tuberosity union rate was 87.9% (29 out of 33 shoulders), the mean Constant score was 66.7 ± 20.5 (range 29–100) points, and the mean DASH score was 33.4 ± 22.6 (range 2–85) points. Conclusions The “7 sutures and 8 knots” technique, which relies on three sutures around the implant and five bridging sutures between the tuberosities, is a relatively simple procedure which provides a reliable means for anatomic restoration of the tuberosities and allows functional recovery of the shoulder in elderly patients with cPHFs treated with RSA. Level of evidence: IV; retrospective atudy. Trial registration: At our institution, no institutional review board nor ethical committee approval is necessary for retrospective studies.

Background Delayed bone healing and nonunions represent a great challenge for the orthopedic surgeon. In addition to traditional surgical approaches, increasing attention is being given to the use of systemic anabolic therapy with Teriparatide, whose efficacy in preventing osteoporotic fractures is widely validated and whose application as a promoter of bone healing has been described but it is still debated. The aim of the study was to evaluate bone healing in a series of patients with delayed unions or nonunions treated with Teriparatide in conjunction with eventual appropriate surgical procedure. Methods Twenty patients with an unconsolidated fracture that were treated at our Institutions from 2011 to 2020 with Teriparatide were retrospectively included into the study. The pharmacological anabolic support was used off-label with a planned duration of 6 months; radiographic healing was evaluated at 1-, 3- and 6-months follow-up outpatient visits over plain radiographs. Also, eventual side-effects were registered. Results Radiographic signs indicative of favorable evolution of the bone callus were observed as early as at 1 month of therapy in 15% of cases; at 3 months, healing progression was appreciated in 80% of cases and complete healing in 10%; at 6 months, 85% of delayed and nonunions had healed. In all patients, the anabolic therapy was well tolerated. Conclusions In accordance to Literature, this study suggests that Teriparatide plays a potentially important role in the treatment of some forms of delayed unions or nou-nions, even in the presence of failure of hardware. The results suggest a greater effect of the drug when associated with a condition in which the bone is in an active phase of callogenesis, or with a “revitalizing” treatment which represents a local (mechanical and/or biological) stimulus to the healing process. Despite the small sample size and the variety of cases, the efficacy of Teriparatide in treating delayed unions or nonunions emerged, highlighting how this anabolic therapy can represent a useful pharmacological support in the treatment of such a pathology. Although the results obtained are encouraging, further studies, particularly prospective and randomized, are needed to confirm the efficacy of the drug, and define a specific treatment algorithm.

In July 2019, disease outbreaks were observed in two tomato fields in South Sardinia. The first field located in Samassi was established with tomato spotted wilt virus (TSWV)-resistant cultivars Taylor and Docet. The second field located in Serramanna was established with TSWV-resistant cultivars Dask and SV051, and the TSWV-susceptible cultivar Creso. The two fields were about 4.0 km away from each other. Symptoms resembling those elicited by TSWV, consisting in leaf and stem necrosis, and necrotic rings and patches on the fruits, were noticed on most of the plants in the two fields. Preliminary screening of two symptomatic plants of each cultivar with a specific TSWV Lateral Flow (LF) assay (Forsite Diagnostics, UK) showed that none of the samples, with the exception of Creso, reacted positively to TSWV. Then RT-PCR was conducted with total RNA extracted from non-necrotic tissue of the same plants tested in LF using the E.Z.N.A.® Plant RNA kit (Omega Bio-tek, USA) and orthotospovirus universal primers BR60/BR65 and primers PMoVMP1a/PMoVMP2b specific to parietaria mottle virus (PMoV) (Parrella et al. 2016). Amplicons of the expected size (916 bp) for PMoV were obtained from all symptomatic leaf samples tested, whereas TSWV amplicons (453 bp) were obtained only from the Creso samples. No amplicons were obtained from asymptomatic samples or healthy samples used as controls. The PMoV PCR products from three tomato plants were cloned and sequenced. Sequences of the PMoV isolates were identical (GenBank accession number MN782302) and shared 96% nucleotide identity with the Spanish isolate RAMS1 from tomato (AM182748). Further, PMoV was detected in symptomatic leaf samples by dot-blot hybridization assay using a PMoV-specific riboprobe (Parrella 2002). Using this assay, the PMoV incidence was around 80% in both tomato fields (52 of 67 plants were positive in the first field and 41 of 51 plants were positive in the second field). PMoV has been previously reported in protected and open field tomato cultivation in Spain only with low incidence (Soler et al. 2010). This is the first report of a significant outbreak of PMoV in tomato in the Mediterranean basin