Coronavirus disease (CoVID-19) is causing millions of deaths worldwide and the crisis of the global healthcare system. Aim Of The Study: evaluate the preliminary impact of CoVID-19 in three Italian Orthopedics and Traumatology Departments in the first 10 weeks of the national lockdown. We focused on proximal humerus fractures, analyzing data and results in comparison with the same period of 2019. From February 22nd to May 3rd 2020, 55 patients were admitted to our departments for promixal humerus fractures. Our cohort of patients is composed by 13 males (23.6%) and 42 females (76.4%), with an average age of 73.8 ± 11.7 years (range 44 - 94). Trauma occurred at home in 43 cases (78.2%), by the roadside in 10 cases (18.2%), in a retirement home in 1 case (1.8%), and at work in 1 case (1.8%). We proposed surgical treatment in 15/55 cases, but 4 patients refused hospitalization, mainly because of the risk of contracting n-CoV19 infection. We noticed a decrease in proximal humerus fractures compared to 2019 (-37.5%). Particularly, we observed a significant drop in traumas occurred on the road and at work respectively 23.9% and 3.4%% in 2019, and 18.2% and 1.8% in 2020, probably due to the consequences of the national lockdown. Sports traumas had a reset during the pandemic (6 cases in 2019, 0 in 2020). As consequence, surgical treatment had a decrease due to the reduction in number of fractures, indications and patient's consent. The incidence of proximal humerus fractures had a significant reduction during CoVID-19 spread. We assume that the reasons of this reduction are to be found in the national lockdown (since March 10th, 2020) and Ministerial Decrees that limited the access to the E.R. only in case of severe traumas in order to avoid CoVID-19 spread.

Background: The aim of our study is to emphasizes the significance of prompt diagnosis and intervention in younger patients affected by osteochondral detachment after patellar dislocation, where the first objective is to minimize in the shortest possible time complications and ingravescence. The method involves a clinical patient assessment and MRI follow-up in subjects who underwent to an immediate surgical intervention for osteochondral damage. Methods: From January 2020 to December 2022, 22 patellar dislocation cases were assessed; osteochondral lesions were identified in 12 (54%) patients; nine of these patients were treated immediately with knee arthroscopy, while in seven instances the osteochondral fragment was reattached using bioabsorbable pins. Post-operative clinical evaluations were conducted at one-, three-, and six-month intervals; finally, a six-month post-operative MRI was performed for all surgically treated patients. Results: The MRI evaluations, conducted six months post-operation for all seven patients, indicated successful integration of the reattached osteochondral fragment. Every patient returned to their pre-injury activities after surgery. However, two of them reported mild pain in the anterior region of the knee post-surgery. Conclusions: in young patients, swift diagnosis and immediate surgical intervention for osteochondral detachment resulting from patellar dislocation are crucial. This approach has been identified as the best practice, since it substantially minimizes immediate functional restrictions and significantly lowers the long-term risk of femoral-patellar osteoarthritis.

During the pandemic, Piacenza's Orthopedic and Traumatology Dep. firstly dealt with the emergency with the complete closure of all the elective surgical and outpatient activities.As general population, also healthcare workers were affected by Coronavirus, increasing difficulties of epidemic management.The aim of our study is to evaluate the activity trend of the first 6months of 2020 in our hospital.Data will be compared to the two semesters of 2019, in order to have two objective samples. We retrospectively analyzed all the orthopedics surgical procedures performed at Guglielmo da Saliceto Hospital (Piacenza, Emilia Romagna, Northern Italy)between 1/1/20 and 30/06/20. 2019 semesters (1/01/20-30/6/20 and 1/07/20-31/12/20) have been used as control group to evaluate the activity trend of the first six months of 2020, compared to the two semesters of 2019. We noticed a significant increase of domestic and retirement houses accidents, a consistent increase in one-month mortality rate of 2020 first semester and a decrease of mean hospitalization time.About surgical procedures, we detect a drop in the total number: in the first semester of 2020 we performed 499 (-39.9%) surgeries less than the first semester of 2019 and 337 (-30.9%) then the second one. Traumatology recorded a decrease of 27.6% than the first semester of 2019 (-204 surgeries) and of 26.3% than the second one (-191 surgeries).Concerning orthopedic procedures, in comparison to the first semester of 2019 we registered a reduction of 57.6% (-295 surgeries) and of 40.2% to the second semester (-146 surgeries). Covid-19 forced a reorganization of the Italian Health System that led to a clear reduction of surgical procedures performed in the orthopedic and traumatology department.The "Phase 2" can't be consider the last step of the emergency.We surely will have to get used to live with this enemy, at least until we will find an effective cure or a vaccine.

Introduction: Implant removal in orthopedics and traumatology is still a controversial topic. Benefits and drawbacks lead to relative indications, mainly depending on patients’ demands and surgeons’ perspectives. This study aims to report the current attitudes and practices of Italian surgeons who participated in a survey. Materials and Methods: An online-based questionnaire of 25 items was distributed to all the members of the Italian Society of Orthopedic Surgery and Traumatology (SIOT) regarding their indications, usual practices, and complications encountered with hardware removal in upper and lower limbs. The survey was open from July 2024 to October 2024. Exclusion and inclusion criteria were applied. Results: Five hundred answers were received. While implant removal is primarily achieved in symptomatic patients, in the case of asymptomatic patients, it is not routinely performed, with a slightly higher tendency of removal in those aged 16–40 years old. These tendencies were registered both for the upper and lower limbs, with more reticence in hardware removal in the upper limbs. 96% of respondents declared the lack of hospital guidelines regarding this kind of surgery. The most feared intraoperative complications during the removal concerned screw stripping and implant breakage, with only 0.6% of respondents reporting no intraoperative difficulties. While patient discomfort and avoidance of future complications were the main indications for removal, postoperative complications occurred as wound scarring concerns, persistence of symptoms and bleeding. Despite not being considered a “procedure for the resident”, when residents were specifically questioned, in 76% of cases they felt self-confident ≥ 7 on a scale from 1 to 10. Lastly, according to 62% of the respondents, titanium implants are more difficult to remove than stainless steel ones. Conclusion: This survey describes a general tendency to not routinely remove implants, even in younger patients in the lower and especially upper limbs, unless in case of symptoms. Hardware removal could evolve from a simple procedure into a more complex surgery due to intraoperative technical difficulties. A lack of universal policy and guidelines exists throughout the Italian territory.

The Coronavirus pandemic represents one of the most massive health emergencies in the last century. Aim of the study is to evaluate the trend of E.R. accesses and orthopaedic events during the pandemic of Covid-19. we retrospectively analysed all data related to patients admitted to the E.R. Department of the Hospital of Piacenza from August 26th 2019 to August 23rd 2020, splitting this period on February 23rd 2020. Our analysis shows a reduction of -18.0% in E.R. accesses. We calculated a growth of deaths in the E.R. equal to +220%. Our orthopaedic pathway recorded a drop of -26.8%. Traumas occurred at home increased (+19.1%). We note an actual drop only on proximal femur fractures (weighted average of -17.7%), while all the others underwent an increase. The amount of E.R. accesses registered a drop -18.0%, while the pathway dedicated to emergency cases underwent an increase. The major complexity of clinical conditions influenced the number of hospitalizations and the fear of the infection increased hospitalization refusals. There has been a zeroing of school traumas, a reduction in sport, transfer home-work/work-home, work, roadside, injuries. Total amount of fractures strongly increase after the end of the lockdown. our data confirmed the decrease of retirement houses, sports, works and roadsides traumas and a zeroing of schools ones, while those occurred inside domestic environment underwent a consistent raise. We noticed a reduction in femur fractures and significant spread of all fractures after the end of the lockdown.