The Charcot foot is a condition characterized by a progressive derangement of the foot. The type of deformity and patient clinical conditions will lead to the proper surgical approach among exostectomy, arthrodesis (through external and/or internal fixation) and amputation. Many authors report good clinical outcomes performing the arthrodesis in Charcot foot; however, the choice of the most appropriate hardware is still an issue. The aim of this study is to analyze the outcomes of different hardware in midfoot and hindfoot Charcot arthrodesis.

Background and aim: Cancers are one of the most frequent causes of death and disability in humans. Skeletal involvement has a major impact on the quality of life and prognosis of cancer patients. Electrochemotherapy is a palliative and minimally invasive oncologic treatment that was first used to treat subcutaneous nodules for malignant tumors. The aim of our review is to evaluate the results of electrochemotherapy in the treatment of bone metastases. Methods: A systematic review of the literature indexed in the PubMed MEDLINE and Cochrane Library databases using the search key words “electrochemotherapy” AND (“metastasis” OR “metastases”) was performed. The Preferred Reporting Items for Systematic Reviews and MetaAnalyses was followed. Inclusion criteria were proven involvement of the appendicular skeleton in metastatic carcinoma or melanoma, through at least one percutaneous electrochemotherapy session on the metastatic bone lesion. The exclusion criterion was no skeletal metastatic involvement. Results: Eight articles were finally included. We reached a population of 246 patients. The mean age and follow up were 60.1 years old and 11.4 months, respectively. The most represented primary tumor was breast cancer (18.9%). A total of 250 bone lesions were treated with electrochemotherapy. According to RECIST criteria, in our population we observed 55.5% stable diseases. The mean pre-electrochemotherapy VAS value was 6.9, which lowered to 2.7 after treatment. Adverse events occurred in 3.4% of patients. Conclusions: Electrochemotherapy as a minimally invasive and tissue-sparing treatment should be considered for patients with no other alternative to obtain tumor control and improvement in quality of life.

To report the history and clinical presentation of a 60-year-old male who developed a rare soft tissue infection of the right leg caused by Bacillus megaterium and to perform a Literature review focusing on clinical manifestations and diagnostic difficulties of the aforementioned bacterium. Medical history and clinical presentation suggested the infectious etiology, which led to the surgical procedure of fistulectomy and to further histological and microbiological investigations with bacterial cultures. The histological report tested negative for osteomyelitis. Bacterial cultures revealed Bacillus megaterium, which was sensitive to all antibiotics against which it was tested. The oral antibiotic therapy was set for 12 days with benefits. The patient has always been apyretic, inflammation indexes and white cells count have been within normal limits. This was a rare case of soft tissue infection caused by Bacillus megaterium known to be a “non-pathogenic” bacterium. The infection was likely acquired by the penetration through the injury wound. The combination of surgical and antibiotic therapy lead to complete skin healing and infection resolution at the 6-months follow up.

Achondroplasia is a growth plate dysplasia caused by FGFR-3 gene mutation. In addition to dysmorphic short stature, genu varum is very common. Therefore, a certain part of the achondroplasic population is interested in extensive cosmetic limb lengthening and deformity correction to achieve a functional height so that they can attain total autonomy in everyday life. All patients who underwent bone lengthening treatment from March 2014 to December 2022, were retrospectively analyzed in terms of inclusion and exclusion criteria. To determine any angular deformity in the coronal plane, the Mechanical Axis Deviation was calculated. Patients were divided into two groups: group A included patients who had no angular deformity and therefore performed exclusively cosmetic bilateral tibial lengthening, group B included patients undergoing cosmetic lengthening and simultaneous bilateral multiplanar correction of tibial deformities with hexapod external fixator. The achieved distraction, the external fixator index and the consolidation index were calculated and compared for the two groups. Any adverse event was recorded. According to inclusion and exclusion criteria, 14 patients (28 tibias) diagnosed with Achondroplasia were included (20 tibias group A and 8 tibias group B). We found a statistically significant difference between the two groups regarding the mean age at the time of surgery (p 0.01). The mean MAD value within group B showed a substantial improvement from 56.50 ± 19.1 mm to 14.6 ± 5 mm. Comparing the two groups, we observed a statistically significant difference between both preoperative (p 0.0001) and postoperative (p 0.006) MAD values. The difference found between the two groups was significant also in terms of mean external fixator index (35.9 days/cm versus 52.5 days/cm) and consolidation index (24.2 days/cm versus 37.9 days/cm). Comparing the adverse events found in the two groups no significant differences emerged (p 0.7). In the context of cosmetic lower limb lengthening program for achondroplasic patients, most studies have focused on linear lengthening often underestimating the importance of any associated deformities correction. In our experience, the genu varum correction with the hexapod system showed relevant results in term of MAD improvement. Our results show a significant difference between the two groups in consolidation (p 0.002) and thus also in external fixation (p 0.001) time to the disadvantage of the hexapod group probably due to: higher age (p 0.01) with lower healing potential, greater difficulty in weightbearing and in dynamizing the fixator.

Background: Pycnodysostosis (PYCD) is a rare genetic disorder causing skeletal dysplasia. It is inherited in an autosomal recessive manner, and it is caused by a gene mutation leading cathepsin K (CTSK) deficiency. PYCD is characterized among many by short-limbed short stature, typical facial appearance and osteosclerosis with increased bone fragility. The altered bone quality typical of this disease cause the bones to be fragile and brittle with the medullary canal present while often narrowed so as a result, these individuals have an increased fracture rate. Methods: A systematic review of the literature indexed in PubMed, MEDLINE, and Cochrane Library databases using as search terms “pycnodysostosis fracture” was performed in January 2022. To be considered for this review at least a section of the population understudy needed to be affected by PYCD, bone fracture and the treatment performed needed to be explicit. Literature focused on maxillofacial manifestations/surgery were excluded. The methodological quality of the studies was assessed using the modified Coleman methodology score (mCMS). Results: Only 23 studies met the inclusion criteria and were included in the review. The reached population consisted of 36 patients for a total of 57 fractures secondary mainly to low energy trauma (91%). Fractures occurred mainly in long bones, 54% were femur and 26% were tibia. The 60%. Of fractures were treated surgically. Bony union was achieved at an average of 11 months after surgery/trauma. The most frequent complications reported were refracture (19%) and pseudoarthrosis (31%). Six femur “impending fracture” cases have also been reported. Conclusions: Treatments such as intramedullary nailing or internal plate fixation offer continuous support for the delayed bone healing and the high risk of refracture in PYCD which are the most common complications. Prolonged follow-up over time could help these patients with a rare disease to treat and sometimes prevent disease-related events. To date, therefore, there are no standardized guidelines on this matter.

Introduction: The elbow is a rare site for bone tumors, and for this reason, the literature provides little data on the epidemiology of metastatic lesions involving the distal humerus, proximal ulna, and radius. Before performing surgery of the metastatic bone, it is first necessary to consider both patients’ and metastatic lesions’ features in order to better choose the best possible treatment. This systematic review aims to collect data on elbow metastases, delineate primary tumors leading to such metastases, guide surgical treatment decisions, and evaluate reconstructive techniques and associated complications. Material and Methods: A systematic literature review was conducted in April 2024, searching the PubMed, MEDLINE, and Cochrane Library databases using specific search terms related to elbow metastases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) was followed. Eligible studies reported at least one patient with metastatic bone disease involving the elbow region and specified the undertaken treatment. For studies reporting multiple skeletal sites, only elbow-specific data were extracted. We excluded recurrences of primary elbow tumors. The methodological quality of included studies was assessed with the modified Coleman Methodology Score (mCMS). Results: In total, 28 articles (103 patients) were included. The studies were predominantly case reports (68%), with a mean mCMS of 31. Gender was reported for only 41 patients: 71% were male and 29% female. The mean age at diagnosis of elbow metastatic lesion was 55 years old. Renal cell carcinoma was the most common primary tumor (28%), followed by breast (9%) and lung cancer (6%). The distal humerus was the most frequently affected site (85%). A surgical approach was adopted in 90% of cases, whereas 10% of patients were managed conservatively. Forty-five patients underwent wide tumor resection followed by reconstructive surgery while forty-eight patients received a surgical treatment for either pathological fractures or impending fractures. Conclusions: When treating elbow metastasis, a thorough evaluation of the patient is crucial, considering the patient’s functional status, pain management needs, and overall prognosis; all these features influence the treatment of choice. The selected treatment should aim to provide optimal functional outcomes and minimize complications. For patients with pathological or impending fractures, single or double plate fixation is typically the preferred approach. For patients with severe, symptomatic lesions unresponsive to conservative therapy, resection followed by the implantation of a modular prosthesis usually offers the best clinical and functional outcomes.