➤ Bone marrow edema (BME) is a nonspecific but relevant finding, usually indicating the presence of an underlying pathology. ➤ The gold standard technique for detecting BME is magnetic resonance imaging (MRI), as it allows for a correct diagnosis to be made, which is extremely important given the heterogeneity of BME-related diseases. ➤ Depending on the severity of painful symptomatology and the MRI evidence, different treatment strategies can be followed: physical modalities, pharmacological options, and surgical therapy.

Background: Periprosthetic femoral fractures are challenging complications of hip arthroplasty. They are supposed to be a rare complication, but their incidence is rapidly increasing. Surgical treatment aims to achieve early mobilization and avoid the complications of prolonged bed rest. Aim of this study is to evaluate the clinical outcomes of surgical treatment comparing two surgical approaches: revision arthroplasty (RA) versus open reduction and internal fixation (ORIF). Methods: Authors retrospectively reviewed a series of 117 patients with total hip arthroplasty treated for periprosthetic femur fractures in the period between January 2013 and March 2018 at a single tertiary referral center. Of these, 70 patients satisfied strict inclusion criteria. Patients were classified according to the Unified Classification System (UCS) and distributed in two groups according to surgical treatment. Clinical outcomes were assessed using the Oxford Hip recorded preoperatively and post operatively, Barthel Score, CIRS score (Cumulative illness rating scale), type of fracture and post-operative complications with a minimum follow up of 1 year. Results: Nominal univariate statistical analysis revealed significant differences between the post and pre-operative Oxford Hip Score (Δ Oxford) and the surgical treatment (p = 0.008) and CIRS score (p = 0.048). Moreover, we observed a significant relationship between type of treatment and type of fracture (p = 0.0001). Multivariate analyses revealed that CIRS score was independently associated with Oxford Score improvement after surgery (p = 0.024). Conclusions: Data from this case series confirmed that surgical treatment was correlated to type of fracture, according to UCS classification. Patients treated by RA had a better functional outcome than patients treated with ORIF, but these results are strongly influenced from the patients’ age, Barthel index and CIRS score. Also, authors found a correlation between functional outcome and comorbidities evaluated by CIRS score. Based on these data we suggest a multimodal approach to these patients, like those used for proximal femoral fractures.

Traumatic hip dislocations typically result of high-energy trauma and frequently involve young patients. The obturator dislocation is not a common condition and rarely combined with acetabular fracture. We report a rare case of a 48-year-old male patient with a trauma of the left hip following a car-vs-car frontal accident. He presented with an obturator hip dislocation combined with ipsilateral quadrilateral plate fracture. The patient underwent a clinical and imaging evaluation to identify the acetabular fracture dislocation. The CT scan showed a severe dislocation of the acetabular medial wall. Closed reduction under conscious sedation was performed in Emergency Department. The patient underwent open reduction and internal fixation. During surgery, obturator nerve was entrapped inside the fracture rim and then it was released. No intra-operative complications were observed. The patient was followed, with accurate clinical and radiological follow up assessments for 24 months reporting excellent clinical outcomes according to Oxford Hip Score (47/48 points), a good hip range of motion and a complete recovery of basic activities of daily living. After two years of follow-up, no evidence of femoral head necrosis was reported and the patient returned to sport activity.

Extremely low-frequency and low-intensity electromagnetic fields show positive effects on the treatment of several osteoarticular diseases, such as osteoarthritis, and are currently applied in the clinical setting with promising results on tissue regeneration. However, the biological mechanisms underlying the beneficial effects triggered by this type of physical stimulation still need to be deciphered. We tested the hypothesis that ultra-low complex electromagnetic fields stimulation using an innovative medical device could enhance chondrogenesis in human adipose-derived stem cells (ADSCs), and analyzed its biological effects. Chondrogenic lineage markers, like ACAN, SOX9, RUNX2, COL2A1, and COL10A1, were evaluated after 21 days of treatment. Thus far, we have provided preliminary evidence that a dedicated pattern of ultra-weak complex electromagnetic sequences emitted by a cutting-edge technology can promote cartilage regeneration, inducing the chondrogenic differentiation and maturity of ADSCs.

Purpose: A trauma team (TT) is reported to improve the management and polytraumas outcome. To assess the impact on, the decision-making process in the execution of surgical and interventional procedures, trauma patient results were examined before and after TT introduction.Methods: This was a non-randomized single-center retrospective study of major trauma patients who accessed our level III university hospital Shock Room (SR) in the 20 months prior to the establishment of the TT (preTT group) and in the following 20 months (postTT group).Results: There were 947 patients (418 preTT, 529 postTT) admitted in the SR due to a traumatic event. Comparing the 2 periods, a significant decreases in time spent in SR (p = 0.008), Sequential Organ Failure Assessment score in the Intensive Care Unit (p = 0.027), and estimated blood loss in Operating Room (p = 0.003) was observed. A significant increase was observed in the number of days of assisted ventilation (p < 0.001), the number of Damage Control Surgery procedures (p = 0.008), and non-operative managements for splenic and liver injuries (p = 0.004).Conclusion: A significant change in the type of surgical procedures performed and increase in the number of non-operative managements were observed in the period following the implementation of the computed tomography; this was particularly evident in splenic trauma management where a complete alignment with the World Society of Emergency Surgery guidelines recommendations was reached. These results demonstrated the management of traumatic pathology with a dedicated TT represents the best approach for polytraumas.