Several rehabilitation systems based on inertial measurement units (IMU) are entering the market for the control of exercises and to measure performance progression, particularly for recovery after lower limb orthopaedic treatments. IMU are easy to wear also by the patient alone, but the extent to which IMU’s malpositioning in routine use can affect the accuracy of the measurements is not known. A new such system (Riablo™, CoRehab, Trento, Italy), using audio-visual biofeedback based on videogames, was assessed against state-of-the-art gait analysis as the gold standard. The sensitivity of the system to errors in the IMU’s position and orientation was measured in 5 healthy subjects performing two hip joint motion exercises. Root mean square deviation was used to assess differences in the system’s kinematic output between the erroneous and correct IMU position and orientation. In order to estimate the system’s accuracy, thorax and knee joint motion of 17 healthy subjects were tracked during the execution of standard rehabilitation tasks and compared with the corresponding measurements obtained with an established gait protocol using stereophotogrammetry. A maximum mean error of 3.1 ± 1.8 deg and 1.9 ± 0.8 deg from the angle trajectory with correct IMU position was recorded respectively in the medio-lateral malposition and frontal-plane misalignment tests. Across the standard rehabilitation tasks, the mean distance between the IMU and gait analysis systems was on average smaller than 5°. These findings showed that the tested IMU based system has the necessary accuracy to be safely utilized in rehabilitation programs after orthopaedic treatments of the lower limb.

Accurate outcome detection in neuro-rehabilitative settings is crucial for appropriate long-term rehabilitative decisions in patients with disorders of consciousness (DoC). EEG measures derived from high-density EEG can provide helpful information regarding diagnosis and recovery in DoC patients. However, the accuracy rate of EEG biomarkers to predict the clinical outcome in DoC patients is largely unknown. This study investigated the accuracy of psychophysiological biomarkers based on clinical EEG in predicting clinical outcomes in DoC patients. To this aim, we extracted a set of EEG biomarkers in 33 DoC patients with traumatic and nontraumatic etiologies and estimated their accuracy to discriminate patients’ etiologies and predict clinical outcomes 6 months after the injury. Machine learning reached an accuracy of 83.3% (sensitivity = 92.3%, specificity = 60%) with EEG-based functional connectivity predicting clinical outcome in nontraumatic patients. Furthermore, the combination of functional connectivity and dominant frequency in EEG activity best predicted clinical outcomes in traumatic patients with an accuracy of 80% (sensitivity = 85.7%, specificity = 71.4%). These results highlight the importance of functional connectivity in predicting recovery in DoC patients. Moreover, this study shows the high translational value of EEG biomarkers both in terms of feasibility and accuracy for the assessment of DoC.

Objective: To compare the effectiveness in wound healing of negative pressure wound therapy (NPWT) versus a standard dressing in patients who underwent hip or knee revision surgery.Method: Participating patients scheduled for hip and knee prosthetic revision were randomised into two groups: one receiving standard povidone-iodine gauze and patch wound dressing (control group) and the other NPWT over the sutured wound area (NPWT group). Patients were evaluated by means of ASEPSIS score, occurrence of blisters, visual analogue scale (VAS) and dressing changes seven days after surgery. We hypothesised a five-point difference in ASEPSIS scores as clinically relevant.Results: A total of 110 patients were enrolled in the study. Mean ASEPSIS score was 5.1 for the control group and 3.0 for the NPWT group, with a significant difference in the ASEPSIS score between groups (p5 points ASEPSIS score was recorded (p<0.0005). Blister occurrence, VAS score and number of dressing changes were significantly lower in the NPWT group.Conclusion: The results of this study do not support the routine use of NPWT after hip and knee revision. However, it could be beneficial for selected patients once specific risk factors for wound healing complications have been determined.

Background: Locked posterior glenohumeral dislocations with a reverse Hill-Sachs impaction fracture involving less than 30% of the humeral head are most frequently treated with lesser tuberosity transfer into the defect, whereas those involving more than 50% undergo humeral head arthroplasty. Reconstruction of the defect with segmental femoral osteochondral allografts has been proposed to treat patients between these two ranges, but the medium−/long-term outcomes of this joint-preserving procedure are controversial. Methods: Between 2001 and 2018, 12 consecutive patients with a unilateral locked posterior shoulder dislocation and an impaction fracture from 30 to 50% (mean 31% ± 1.32) of the humeral head were treated with segmental reconstruction of the defect with fresh-frozen humeral head osteochondral allografts. Patients were assessed clinically, radiographically and with computed tomography (CT) at a medium follow-up of 66 ± 50.25 months (range, 24–225). Results: All twelve shoulders presented a slight limitation in anterior elevation (average, 166.6° ± 22.76). The mean active external rotation with the shoulder at 90° of abduction was 82.5° ± 6.61, and that with the arm held in stable adduction was 79.16 ± 18.80. The mean abduction was 156.25° ± 25.09. The mean Constant-Murley score (CS) was 82 ± 15.09 points (range, 40–97 points), and the mean ASES was 94 ± 8.49 points. The mean pre- and postoperatively Western Ontario Shoulder Instability index (WOSI) was 236.5 ± 227.9 and 11.20 ± 10.85, respectively. Development of osteoarthrosis (OA) was minimal. The average allograft resorption rate was 4% ± 2.4. There were no cases of failure (reoperation for any reason) in this series. Conclusion: Segmental humeral head reconstruction with humeral head fresh-frozen osteochondral allografts provides good to excellent clinical results with low-grade OA and low allograft resorption in patients with locked posterior shoulder dislocation. Trial registration: ClinicalTrials.gov PRS, ClinicalTrials.gov ID: NCT04823455. Registered 29 March 2021 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AU8P&selectaction=Edit&uid=U0004J36&ts=12&cx=6cykp8 Level of evidence: Level IV, Case Series, Treatment Study.