Sarcopenia in distal radius fractures: systematic review of the literature and current findings.

INTRODUCTION: Sarcopenia is a clinical syndrome characterized by the reduction in muscle mass, strength and physical ability. Although proximal femur fractures are one of the major burdens affecting the ageing population, distal radius fractures are equally important for frequency, clinical and social consequences. The aim of this study is to evaluate the incidence of sarcopenia in distal radius fractures and clinical implications in functional recovery. MATERIALS AND METHODS: Scopus and PubMed search was performed to find relationship between sarcopenia and distal radius fractures. Literature search was performed between 2009 and 2019 including clinical trials and clinical studies related to "sarcopenia and distal radius fracture" and "sarcopenia and wrist fracture". After identification, studies were screened and analysed through the Oxford Level of Evidence. RESULTS: According to the inclusion and exclusion criteria, five articles were included. Four articles analysed the incidence of sarcopenia and its role as a risk factor in patients with distal radial fractures, while one article focused on sarcopenia and clinical results of surgical treatment of distal radius fractures. Incidence of sarcopenia in patients older than 50 years with distal radius fracture varied between 29.7% and 31.7%. Patients with distal radial fractures did not show a significant inferior muscle mass than control group in examined population. Functional results of surgery were significantly inferior in sarcopenic patients than control group (no sarcopenia). CONCLUSIONS: About 30% of patients older than 50 years with distal radius fracture suffered by sarcopenia; sarcopenic patients surgically treated had worse clinical results than no sarcopenic patients. Further studies with larger samples are needed to confirm these preliminary results.

Megaprostheses in the Revision of Infected Total Hip Arthroplasty. Clinical Series and Literature Review.

PURPOSE: The management of severe femoral bone loss associated with hip infection is a major problem in joint replacement surgery. Femoral megaprostheses have been rarely reported in reconstructive procedure for this complex condition. The aim of the study was to evaluate clinical results observed after such uncommon reconstruction in our case series and in a similar group of patients extracted by literature review. METHODS: We evaluated clinical outcomes and eradication of sepsis in five patients who underwent femoral revision with modular femoral resection stems at our institution, and we reviewed the literature about this topic. In our case series, the femoral bone loss was grade III-B in three cases and grade IV in two cases according to the Paprosky classification. One patient was operated with one-stage revision, and four patients were operated with two-stage revision. The mean age was 72 years (range: 60 to 81 years), and the mean time of follow-up was 62 months (range: 36 to 82 months). RESULTS: We observed sepsis eradication in four out of five patients in our series, and clinical results were satisfactory with a mean Harris Hip Score of 74 points (range: 46 to 95 points). Cumulative results obtained considering our series and data obtained by literature review showed a mean Harris Hip Score of 75 points (range: 42 to 95 points) in patients able to walk and an overall incidence of recurrent infection in 33% of patients. Complications were observed in 8 out of 20 patients (dislocation, 6 cases; greater trochanter displacement 2 cases; and transient sciatic palsy, 1 case). CONCLUSIONS: Revision with megaprostheses in case of infected total hip arthroplasty with severe femoral bone loss have a high risk of complication and should be carefully evaluated and used in selected patients when other surgical procedures are not feasible.

Perforator based propeller flaps in limb reconstructive surgery: clinical application and literature review.

The reconstruction of loss of substance due to trauma or oncological excision may have relevant functional and aesthetic implications. We report our experience in twenty-one cases of propeller flaps for the treatment of loss of substance of the upper and lower limbs. The etiology of defect was tumor excision in nine cases, trauma in seven cases, surgical wound complications in four cases, and chronic osteomyelitis in one case. Clinical results were favorable in most cases and eighteen flaps survived. We observed an overall complication rate of 33% with four cases of superficial epidermolysis that spontaneously healed and three cases of partial flap loss ranging from 10 to 50% that required surgical revision by means of skin graft (two cases) or ALT free flap (one case). Propeller flap harvesting requires great care and experience, and potential complications may occur even in expert hands. When indicated by the characteristic of the defect, these flaps can be a useful surgical option for the treatment of loss of substance of upper and lower limbs.

Multidrug-resistant Acinetobacter baumannii infection following para-articular steroid injection in the knee--a case report.

Acinetobacter baumannii is an emerging gram-negative nosocomial pathogen that rarely causes infections in orthopaedic patients. We report a case of imipenem-resistant Acinetobacter baumannii paraarticular infection of the knee occurring in a healthy patient following one ambulatory steroid injection for the treatment of quadriceps tendinopathy. The infection was reduced by early surgical debridement of infected tissues, abscess drainage, and prolonged antibiotic therapy with colistin. To our knowledge, this is the first case in the literature reporting such an infection following single steroid injection in orthopaedic patients.

Clinical experience in femoral revision with the modular Profemur R stem.

The application of modular femoral stems is constantly increasing in revision hip surgery. From March 2001 to March 2006, we employed the Profemur R modular stem in 35 cases of femoral component revision (31 first revisions and 4 re-revisions). The reasons for revision surgery included aseptic loosening in 17 cases, periprosthetic femoral fracture in 8 cases, stem fracture in 3 cases, septic loosening in 2 cases and recurrent dislocation in 1 case. According to the Merle d'Aubugne-Postel score clinical results were very good in 11 cases, good in 9 cases, medium in 5 cases, fair in 4 cases and poor in 4 cases. The main complications included 2 intraoperative diaphyseal fractures treated with multiple cerclage wires and 2 early infections treated with debridement and prolonged antibiotic therapy. One fracture healed in association with temporary wound discharge, and the other resulted in non-union with a femoral varus deformity. This required revision with internal fixation (LCP plate) at 3 months, with a successful result. In one case of stem subsidence femoral revision with a larger Profemur R implant was required. In our retrospective study the Profemur R modular stem has been an effective prosthetic system for femoral reconstruction in case of loosening with Paprosky grade III bone loss and following periprosthetic femoral fractures.