Lo Scalpello - Journal

Restoring the abductor mechanism after proximal femoral resection in orthopedic oncology: trochanter-sparing versus tendon reinsertion techniques

2026-10-06T16:05:21+02:00

Objectives. Reconstruction of the hip abductor mechanism drives gait and function after proximal femoral resection for bone tumors, yet the strategy is debated. We compare soft-tissue reattachment to a modular megaprosthesis with biological tendon-to-tendon reinsertion using an allograft-/autograft-prosthesis composite.

Methods. An AI-assisted (Consensus) plus manual search with full-text verification appraised comparative and cohort studies; function was assessed by MSTS and gait analysis.

Results. Both techniques give reasonable-to-good function (mean MSTS 75-88%). Biological reinsertion gives more efficient gait and active abduction; modular reconstructions more often cause weakness and Trendelenburg gait. Tumor prostheses fail through soft-tissue insufficiency and dislocation, composites through structural failure and infection, although composites show the lowest dislocation rates; limb-salvage is high (97-99%). Synthetic augmentation and posterolateral approach are protective.

Conclusions. Neither technique is superior: biological reinsertion offers the best abductor recovery but more graft complications; modular reconstruction, versatility and durability if soft-tissue repair is optimized. Selection should be individualized to tumor extent, host biology, life expectancy, and clinical experience.

Patient-specific 3D-printed hemipelvis model for cup re-revision: a case report

2026-10-06T16:04:42+02:00

Early repeated acetabular cup failure after total hip arthroplasty is uncommon and may be a severe reconstructive problem, particularly when cement, graft material, and bone loss make imaging difficult to interpret. We report the case of a 59-year-old woman referred after two early acetabular failures within 1 month of primary total hip arthroplasty. Radiographs and computed tomography showed loosening of the acetabular component-cement construct and a Paprosky type IIIA defect. A life-size patient-specific three-dimensional printed hemipelvis model was obtained from computed tomography data in 4 days and used to analyze bone loss, identify landmarks, estimate cup size, and plan screw trajectories. Acetabular re-revision was performed through a posterolateral approach using impaction bone grafting, a multi-hole press-fit cup with supplemental screws and a structural posterosuperior allograft. At 2-year follow-up, the patient was pain-free, walked unaided, and showed graft osseointegration without radiographic loosening. This case suggests that patient-specific three-dimensional printed models may be a practical adjunct for selected urgent acetabular re-revisions, translating complex imaging into a reproducible surgical plan with standard revision components.

The floating shoulder: classification criteria, treatment indications, and functional outcomes

2026-10-06T16:04:49+02:00

The floating shoulder is a complex injury in which the superior shoulder suspensory complex (SSSC) is disrupted at two or more points, typically through fractures of the clavicle and scapular neck. Its management remains debated, particularly the choice between surgical and conservative treatment. This narrative review summarizes selected recent evidence (2020–2026), supplemented by classic background references, on: (1) classification criteria and radiographic parameters used for severity stratification; (2) indications for surgical versus conservative management; (3) functional outcomes. A non-systematic search of PubMed and Scopus was performed, and five core studies were discussed: two systematic reviews, one prospective case series, one case report and one cadaveric biomechanical study. The radiographic parameters most commonly used to guide treatment are the glenopolar angle (GPA), glenoid medialization and clavicular shortening. The thresholds applied, however, derive largely from earlier studies of scapular and clavicular fractures, and their prognostic value in floating shoulder injuries remains to be established. Satisfactory functional outcomes have been reported after both conservative and surgical management. Injuries with significant scapular neck displacement may benefit from combined fixation, while minimally displaced injuries appear to do well with conservative treatment or clavicle fixation alone. The available evidence is of low level, and prospective multicenter studies are needed to define optimal treatment thresholds.

Distal locking in intramedullary nailing of humeral fractures: a narrative review

2026-10-06T16:04:51+02:00

Objective. This narrative review analyzes distal locking in antegrade intramedullary nailing (IMN) for humeral shaft fractures, a common injury with both conservative and surgical treatment options.

Methods. IMN has gained popularity due to its minimally-invasive nature, preservation of fracture hematoma, and favorable biomechanical properties. However, distal locking remains a debated aspect of the technique. Traditional locking methods provide stability but are associated with risks such as radial nerve injury, increased operative time, and radiation exposure. Alternative systems and nail designs have been developed to reduce these complications, though some compromise rotational stability.

Results. Recent evidence suggests that distal locking may not always be necessary, particularly in non-distal fractures with adequate intrinsic stability, since similar union rates and functional outcomes can be achieved without it while reducing surgical time and complications. The number of distal screws also remains controversial, with single-screw fixation often sufficient except in osteoporotic bone or complex fractures.

Conclusions. Distal locking is still recommended when compression techniques, such as back-slapping, are required or in fractures of the distal third. Overall, IMN is a reliable treatment, but the indication and configuration of distal locking should be individualized based on fracture characteristics and patient factors.

Pre-injury athletic activity and functional recovery after surgical fixation of Schatzker I-II tibial plateau fractures in patients over 65 years: a state-of-the-art review

2026-10-06T16:04:52+02:00

Objective. To evaluate the impact of pre-injury physical and athletic activity on functional recovery following surgical fixation of Schatzker I-II tibial plateau fractures in patients over 65 years of age.

Methods. A comprehensive literature search was performed using the Consensus platform, which indexes more than 170 million scientific articles across major biomedical databases, and was complemented by a targeted manual search. A total of 1,141 records were identified. Following de-duplication, title/abstract screening and full-text eligibility assessment against pre-specified inclusion and exclusion criteria, 50 studies met eligibility and were reviewed; the 22 most relevant and methodologically robust studies (> 2,200 patients with extractable data) form the core evidence base and are tabulated. Study selection is summarized in a PRISMA-style flow diagram, and the strength of each key claim was appraised using an explicit three-tier grading scheme. No formal meta-analysis was performed; a qualitative synthesis was undertaken.

Results. Across the available literature, patients with higher levels of pre-injury physical or athletic activity consistently demonstrated superior early functional recovery, including earlier return to independent ambulation and higher early functional scores. However, these differences tended to diminish over time, with comparable mid- to long-term functional outcomes reported between athletic and non-athletic patients. Complication rates were more strongly associated with fracture morphology, fixation strategy, and comorbidities than with baseline activity level alone.

Conclusions. Pre-injury physical activity appears to be a relevant determinant of early functional recovery following surgical fixation of Schatzker I-II tibial plateau fractures in patients over 65 years. Although long-term outcomes tend to converge, recognition of baseline functional status may improve patient counselling, rehabilitation planning and expectation management in the increasingly active elderly population.

Intramuscular neridronate for the treatment of bone marrow edema of the femoral neck: efficacy and rapid clinical response in an ultratrail runner

2026-10-09T08:47:58+02:00

Bone marrow lesions (BML) appear on magnetic resonance imaging (MRI) as areas of altered signal intensity and are frequently associated with joint pain and significant functional impairment. In the resolution of inflammatory bone marrow edema, neridronate, a second-generation bisphosphonate, has demonstrated high efficacy and a rapid therapeutic effect, promoting early functional recovery, particularly in patients with high functional demands.

We present a clinical case of a femoral neck BML in an ultra-endurance athlete (trail runner). Treatment with intramuscular neridronate resulted in complete resolution of pain symptoms and an early return to daily and sporting activities, as well as resolution of the MRI findings. This outcome highlights the potential role of a timely and targeted therapeutic approach in the management of femoral neck BML.

C. burnetii-associated culture-negative septic arthritis of a native knee in a dialyzed patient

2026-10-06T16:04:57+02:00

Coxiella burnetii is a rare cause of osteoarticular infection and may be overlooked in patients with culture-negative septic arthritis. We report the case of an 82-year-old man affected by diabetes mellitus and end-stage renal disease on chronic hemodialysis who presented with a 2-day history of knee pain and fever. Synovial fluid analysis showed 86,460 white blood cells/µL with 95% polymorphonuclear cells, highly suggestive of septic arthritis. A multiplex molecular panel on synovial fluid was negative, as were routine cultures from arthrocentesis and intraoperative samples obtained during arthroscopic lavage. Empirical postoperative treatment with vancomycin and levofloxacin was started. Because of the culture-negative setting, serological testing for atypical pathogens was performed 10 days later and showed IgG positivity for Coxiella burnetii. The patient lived in a rural environment, making zoonotic exposure plausible. Therapy was switched to doxycycline and moxifloxacin, with complete clinical remission. This case highlights the diagnostic challenge of Coxiella-associated osteoarticular infection and the need to consider atypical zoonotic pathogens in selected cases of culture-negative septic arthritis.

The use of MAÏA™ prothesis in the treatment of trapeziometacarpal arthritis: a single center retrospective study with 6-years follow-up

2026-10-07T12:27:06+02:00

Objective. Trapeziometacarpal (TMC) osteoarthritis is a common condition and several treatments have been described, including first joint arthroplasty. The aim of this study is to report our experience with the MAÏA™ prosthesis evaluating clinical and radiographic outcomes.

Methods. In this retrospective study 60 hands treated with MAÏA™ prothesis have been re-evaluated. Pain on VAS scale, Kapandji score, pinch strength, functional (DASH score) and radiographic parameters were collected at follow-up and compared to pretreatment values.

Results. After a mean follow-up of 28.4±11.8 months significant improvement of pain, Kapandji score, overall hand function was observed. Grip strength increased. Height of thumb column was preserved. Two cases of trigger finger of the thumb and one case of De Quervain disease were reported. Radiographic analysis at follow-up revealed no signs of osteolysis. One event of implant dislocation was observed.

Conclusions. MAÏA™ prothesis can be considered a reasonable option for selected patients with TMC osteoarthritis, offering significant pain relief and a trend towards improved hand function and range of motion.

Pulsed electromagnetic fields in orthopedics: mechanisms, evidence, and clinical use

2026-10-06T16:05:06+02:00

Pulsed electromagnetic fields (PEMFs) are non-invasive biophysical stimuli used in orthopedics, but clinical efficacy varies markedly by indication and device. This critical review integrates mechanistic, preclinical and clinical evidence identified through a structured search updated to 16 July 2026. PEMFs can modulate calcium-dependent signaling, adenosine receptors, nitric oxide, MAPK/ERK and Wnt/β-catenin pathways, with downstream effects on osteogenesis, inflammation and angiogenesis. The most defensible clinical applications are selected mechanically stable, aseptic delayed unions or non-unions and patients at increased risk of spinal pseudarthrosis. Routine use after an uncomplicated acute fracture is unsupported. In osteoarthritis, benefits are heterogeneous, generally modest and time dependent, without convincing evidence of cartilage regeneration or durable structural modification. Evidence for osteoporosis, osteochondral disease, soft-tissue repair, rehabilitation and infection-related applications remains preliminary. PEMF should therefore be used as a selective adjunct after correction of mechanical, infectious, metabolic and rehabilitative factors, with device-specific dosing, adherence monitoring and predefined outcomes.