Nonunion occurs in 2–10% of all forearm fractures due to different mechanical and biological factors, patient characteristics, and surgeon-dependent causes. It is a condition that causes functional and psychosocial disability for the patient because it is a unique anatomical segment in which all the bones and structures involved embody a complex functional unit; therefore, it is a challenge for the orthopedic surgeon. The ultimate goal of the care of these patients is the restoration of function and limitations related to impairment and disability. The aim of this review is to provide an extended description of nonunion forearm fractures, related risk factors, diagnosis, classification systems, and the available evidence for different types of treatment as a tool to better manage this pathology.

Background: Olecranon fractures are common injuries of the upper limb in adults. Simple displaced trasverse fractures are generally surgically treated with tension-band wiring (TBW) or plate fixation (PF). The purpose of this retrospective study is to compare the clinical-functional outcome, complications and reoperation rates between TBW and PF for Mayo IIA fractures. Methods: 72 patients treated with PF or TBW at our institution, completed our survey and clinical evaluation and their demographic and clinical data were recorded and analysed. The clinical-functional outcomes were evaluated assessing ROMs and three validated scoring systems: the Disabilities of the Arm, Shoulder, and Hand (DASH), the Mayo Elbow Performance Score (MEPS) and the Patient American Shoulder and Elbow Surgeons Standardized Elbow Assessment score (pASES-e). Results: 38 patients (53%) underwent TBW and 34 (47%) PF. The mean DASH, MEPS and pASES-e scores were respectively 14.5 ± 17.2, 80.5 ± 14.7 and 83.6 ± 12.4 in the TBW group and 21 ± 21.7, 75.6 ± 15.3 and 75.1 ± 19.2 in the PF group (p = 0.16, p = 0.17 and p = 0.03). The mean duration of surgery and hospitalisation period were longer in the PF group (p = 0.002, p = 0.37) whereas the complication and reoperation rates were higher after TBW (p = 0.15, p = 0.24). Conclusions: According to the literature, both TBW and PF resulted comparable valid surgical options for the treatment of simple isolated displaced olecranon fractures. Our results corroborate previous findings, showing good/excellent outcomes without significant differences.

Objectives: Tibial shaft fractures (TSFs) represent the most common diaphyseal fractures in adults. The gold-standard treatment is intramedullary nailing. Recently, the suprapatellar technique has been increasingly adopted due to its ability to reduce complications associated with the infrapatellar approach. Currently, no clinical score for leg fractures comprehensively assesses the entire lower limb. Therefore, we reviewed the main lower-limb scores available in the literature and developed a new clinical evaluation tool for tibial shaft fractures. The aim of our study was to report our experience with both techniques, to compare the outcomes of our prospective study with the international literature, and to propose a new, easy-to-apply, and reproducible clinical score that evaluates the specific functions of the entire lower limb. Methods: We conducted a prospective analysis of 920 tibial shaft fractures treated with intramedullary nailing via either a suprapatellar or infrapatellar approach. Patients were divided into two groups: Group A, including 420 patients treated with the infrapatellar approach; Group B, including 500 patients treated with the suprapatellar approach. Follow-up included clinical and radiographic assessments at 1, 3, and 6 months, and annually thereafter. We evaluated differences in patient positioning, operation time, radiation exposure, healing rate, incidence of pseudarthrosis and infection, return to ambulation, residual knee pain and fracture site, persistent lameness, and deformities. For the clinical assessment, we devised a new score—the Catania Hospital Score (CHS)—by integrating the most relevant clinical items from existing lower-limb evaluation tools. The CHS includes anterior knee pain (20 points), lameness (5 points), swelling (10 points), stair-climbing ability (10 points), tibial pain (15 points), the ability to perform daily activities (20 points), and evaluation of deformities (varus/valgus, shortening, rotation, and recurvatum/procurvatum (40 points)), for a total of 120 points. Results: Statistically significant differences were observed in Group B regarding a shorter surgical time, a reduced patient positioning time, and decreased radiation exposure. The CHSs were significantly better for Group B at the 3- and 6-month follow-ups. No statistically significant differences were found in infection or pseudarthrosis rates between the two groups. Notably, no cases of chronic knee pain were reported in patients treated with the suprapatellar approach. Conclusions: Both surgical approaches are valid and effective. However, our findings indicate that the suprapatellar approach reduces the complications of the infrapatellar technique, improves postoperative outcomes, and does not result in chronic knee pain. The CHS provides a comprehensive, practical, and reproducible tool to assess functional recovery in patients treated with intramedullary tibial nailing.

Background: Olecranon fractures are common injuries of the upper limb in adults. Simple dis-placed trasverse fractures are generally surgically treated with tension-band wiring (TBW) or plate fixation (PF). The purpose of this retrospective study is to compare the clinical-functional outcome, complications and reoperation rates between TBW and PF for Mayo IIA fractures. Methods: 72 patients treated with PF or TBW at our institution, completed our survey and clinical evaluation and their demographic and clinical data were recorded and analysed. The clini-cal-functional outcomes were evaluated assessing ROMs and three validated scoring systems: the Disabilities of the Arm, Shoulder, and Hand (DASH), the Mayo Elbow Performance Score (MEPS) and the Patient American Shoulder and Elbow Surgeons Standardized Elbow Assess-ment score (pASES-e). Results: 38 patients (53%) underwent TBW and 34 (47%) PF. The mean DASH, MEPS and pASES-e scores were respectively 14.5±17.2, 80.5±14.7 and 83.6±12.4 in the TBW group and 21±21.7, 75.6±15.3 and 75.1±19.2 in the PF group (p=0.16, p=0.17 and p=0.03). The mean duration of surgery and hospitalisation period were longer in the PF group (p=0.002, p=0.37) whereas the complication and reoperation rates were higher after TBW (p=0.15, p=0.24). Conclusion: According to the literature, both TBW and PF resulted comparable valid surgical op-tions for the treatment of simple isolated displaced olecranon fractures, revealing that they both provide good/excellent outcomes with no significant differences.

Background: Robotic assistance and personalized alignment may alter operating work-flow and outcomes after total knee arthroplasty (TKA). We compared conventional me-chanically aligned TKA and CORI-assisted personalized TKA across two centres. Methods: The study includes 240 patients (120 per strategy) with repeated Oxford Knee Score (OKS), Knee Society Score (KSS) and Forgotten Joint Score (FJS-12) values through 12 months, operative phases and individual satisfaction responses. Exploratory one-year contrasts used Welch tests and Holm adjustment for four score outcomes. Results: Mean surgical time was 70.9 ± 7.9 versus 68.9 ± 7.7 min (difference 2.03, 95% CI 0.05–4.02; p = 0.044). At 12 months, OKS was 40.9 ± 2.7 versus 41.3 ± 3.7 (p = 0.304); KSS objective 90.0 ± 0.0 versus 88.7 ± 4.5 (p = 0.002); KSS Function 92.3 ± 4.0 versus 89.5 ± 5.5 (p < 0.001); and FJS-12 84.8 ± 0.4 versus 84.6 ± 0.7 (p = 0.0048). Satisfaction was reported by 99/120 (82.5%) versus 96/120 (80.0%) patients (Fisher p = 0.741). Conclusions: CORI-assisted personal-ized TKA was associated with modestly longer operative time and higher one-year KSS values. The FJS-12 mean difference was only 0.21 points, and OKS and satisfaction were similar. The observational design and nonrandom treatment selection do not isolate the contributions of robotic assistance and alignment philosophy.

Background: Orthopedic implants are increasingly used in both trauma and reconstruc-tive surgery. Fractures occurring in the presence of implants are currently described with multiple terms (periprosthetic, peri-implant, hardware-related, implant-associated), lea-ding to inconsistent communication. Objective: To systematically review the existing terminology, quantify its heterogeneity, and evaluate the rationale for a unified umbrella concept. Methods: A systematic literature search was performed across PubMed, Scopus, and Web of Science (2000–2023) using predefined keywords. Inclusion criteria were clinical studies, reviews, or consensus papers that used or discussed terminology for fractures related to orthopedic implants. Data on terminology, anatomical site, and year of publication were extracted. A bibliometric frequency analysis was conducted. Results: Of 1,142 records screened, 184 met inclusion criteria. The terms “periprosthetic fracture” (68%), “implant-related fracture” (14%), “peri-implant fracture” (9%), and “hardware-related fracture” (7%) were most frequent, with substantial variation by ana-tomical site (hip: 52%, knee: 19%, shoulder: 11%, spine: 8%, trauma fixation devices: 10%). Historical consensus groups (AO/OTA, ISFR, ICS) have debated umbrella terms but re-jected them due to concerns about ambiguity. Discussion: Current terminology is fragmented, site-specific, and inconsistently applied. We propose the descriptive label “artificial fracture” to denote any fracture in which the biomechanics, morphology, or management are significantly influenced by the presence of an implant. This concept is intended as a transversal descriptor to complement, not re-place, existing classification systems. Conclusion: Standardized terminology may improve interdisciplinary communication, research comparability, and registry documentation. Future validation should include Delphi surveys, stakeholder engagement, and consensus endorsement.