International trauma care: initial European approaches during the COVID 19 pandemic.

The world was not prepared for the global of pandemic in early 2020 with the arrival of COVID 19. Europe has some of the most developed health care systems in the world and this article explains the initial response to the pandemic from an orthopaedic and trauma viewpoint from 8 nations. Italy reported the first cluster in February, which then rapidly spread around the continent, requiring a rapid reorganization of services. The reports highlight how elective surgery was universally stopped, surgical services were reconfigured, and new practices, such as the widespread use of telemedicine, may well become permanent. It also emphasizes how the pandemic has re-educated us on the importance of a consistent and central approach to deal with a global health crisis, and how medical services need to remain flexible and responsive to new ways of working.

Comparative prospective randomized study comparing conservative treatment and percutaneous disk decompression for treatment of intervertebral disk herniation.

PURPOSE: To compare short-, intermediate-, and long-term functional results concerning pain reduction and mobility improvement between conservative therapy and percutaneous disk decompression (PDD) in patients with intervertebral disk herniations. MATERIALS AND METHODS: The study received approval from both the university ethics panel and the institutional review board. Patients provided informed consent for the study. Over the past 4 years, two randomized groups of 31 patients with sciatica due to intervertebral disk herniation were prospectively studied and compared with the t test. The control group underwent conservative therapy (administration of analgesics, antiinflammatory drugs, muscle relaxants, and physiotherapy) for 6 weeks. The decompression group underwent fluoroscopically guided PDD. Pain reduction and mobility improvement were recorded at 3-, 12-, and 24-month follow-up on a numeric visual scale (NVS) (range, 0-10). RESULTS: The control group had a mean pain score of 6.9 NVS units ± 1.9 prior to conservative therapy. This was reduced to 0.9 NVS units ± 2.0 3 months after therapy; however, it increased to 4.0 NVS units ± 3.4 at 12-month follow-up and further increased to 4.0 NVS units ± 3.4 at 24-month follow-up. The decompression group had a mean pain score of 7.4 NVS units ± 1.4 prior to PDD. This was reduced to 3.0 NVS units ± 2.4 at 3-month follow-up and further reduced to 1.7 NVS units ± 2.4 at 12-month follow-up and 1.6 NVS units ± 2.5 at 24-month follow-up. No complications were noted. CONCLUSION: When compared with conservative therapy, PDD shows improved amelioration of symptoms at 12- and 24-month follow-up.

Migration of the trabecular metal monoblock acetabular cup system.

Fifty-one primary total hip arthroplasties were performed using Trabecular Metal Monoblock Acetabular Cup System (Zimmer Inc, Warsaw, IN). In a 2-year prospective study, its behavior was closely monitored by clinical, radiologic, and component migration assessment by Ein-Bild-Röntgen-Analyse method. There were no complications. The mean Harris hip score was improved from 41 to 95. A polar gap at the postoperative radiograph was noted at 25% of the arthroplasties, most of which subsequently filled with bone within 6 months. The mean total absolute migration was 0.67 mm. The implant showed excellent early clinical and radiographic behavior. The 2-year migration rate study, as index of long-term survival and success, showed very good early implant stability and, in all cases except one, superior to the available studies for similar design acetabular cups.