Telemedicine is the combination of technologies and activities that offer new remote ways of medical care. The Sm@rtEven application project is a remote assistance service that follows patients affected by lower limb fractures surgically treated at Galeazzi Orthopedic Institute (Milan, Italy). The Sm@rtEven application aims to evaluate the clinical conditions of patients treated for lower limb fracture after discharge from hospital using remote follow-up (FU). The project is not a substitute for traditional clinical consultations but an additional tool for a more complete and prolonged view over time. The Sm@rtEven application is installed on patients’ smartphones and is used daily to communicate with healthcare personnel. In the first protocol, patients had to complete different tasks for 30 days, such as monitoring the load progression on the affected limb, the number of steps during the day, and body temperature and completing a questionnaire. A simplified protocol was proposed due to the pandemic and logistical issues. The revised protocol enrolled patients after more than 30 days of their operation, prioritized the rehabilitation phase, and required patients to use the app for fewer days. After an initial phase of correct use, a reduction in patient compliance was gradually reported in the first protocol. However, patient compliance in the second protocol remained high (96.25%) in the recording of all the required parameters. The Sm@rtEven application has proven to be a valuable tool for following patients remotely, especially during the pandemic. Telemedicine has the same value as traditional clinical evaluations, and it enables patients to be followed over long distances and over time, minimizing any discomfort.

Pseudarthrosis (PSA) is a possible complication of femoral shaft fracture treatment. It is often associated with reduced bone quality and can, therefore, adversely affect quality of life. Its treatment poses a major challenge for orthopaedic surgeons. Several authors have set forth different surgical approaches for the treatment of pseudarthrosis, such as internal fixation with plate and screws, replacement of an intramedullary nail or prosthetic replacement. In cases associated with bone loss, osteopenia, or comminution of fracture fragments, autologous or homologous bone grafts may also be used. The chronic outcomes of the surgical treatment of femoral shaft pseudarthrosis, even when consolidation is achieved, are linked to disabling sequelae of clinical-functional relevance, deserving an adequate medico-legal evaluation. The purpose of this retrospective study is to analyse a clinical case series of patients treated for atrophic femoral shaft pseudarthrosis at the IRCCS Orthopaedic Institute Galeazzi, Milan, Italy, from 2014 to 2020 and their orthopaedic-traumatological and medico-legal implications.

Background: No consensus in the literature has been found about the necessity of implementing a decolonization screening protocol for Staphylococcus aureus in patients who undergo prosthesis implantation of the knee (TKA) or of the hip (THA), with the aim of reducing periprosthetic infections (PJIs). Methods: A systematic literature search was conducted using PubMed, Web of Science, and Embase in April 2024. Studies conducted on patients who underwent a TKA or THA and who followed a screening and decolonization protocol from S. aureus were included. The benefits of implementing this protocol were evaluated through the number of infections overall caused by S. aureus and other pathogens. The risk of bias and quality of evidence were assessed using Cochrane guidelines. Results: A total of 922 articles were evaluated, and of these, 12 were included in the study for a total of 56,930 patients. The results of the meta-analysis showed a reduced risk of overall PJI (p = 0.002), PJI caused by S. aureus (p < 0.0001), and PJI caused by MRSA (p < 0.0001) and highlighted no differences between the two groups in the onset of a PJI caused by other bacteria (p = 0.50). Conclusions: This study showed that the screening and decolonization of S. aureus in patients undergoing THA or THA procedures reduced the risk of a PJI. The screening and decolonization protocol for this kind of patient represents an important procedure for the safety of the patient and in social-economic and medico-legal terms.

Background/Objectives: Femoroacetabular impingement (FAI) is a common cause of hip pain in athletes and active individuals, often requiring hip arthroscopy followed by a structured rehabilitation program. Effective rehabilitation is crucial for optimizing surgical outcomes and facilitating a return to sport. Methods: A systematic review following PRISMA guidelines was conducted to evaluate post-operative rehabilitation protocols after hip arthroscopy for FAI. Databases searched included PubMed, Embase, and Cochrane Library up to April 2024. Inclusion criteria focused on studies documenting rehabilitation post-arthroscopy for FAI, with a final selection of 14 studies encompassing 1105 patients. Data extraction focused on rehabilitation techniques, functional outcomes, and return-to-sport rates. The risk of bias was assessed using RoB2 and ROBINS-I tools. Results: Rehabilitation protocols were categorized into four phases, emphasizing manual therapy, strengthening, stretching, aquatic exercises, and sport-specific drills. The average return-to-sport rate was 90.3%. Manual therapy and aquatic programs were critical in early recovery, while strengthening and proprioception exercises were central to later stages. Variability in protocols across studies was noted. Conclusions: Post-operative rehabilitation following hip arthroscopy for FAI is essential for recovery. A phased, individualized approach, integrating manual therapy, aquatic exercises, and sport-specific training, yields positive outcomes. However, the heterogeneity of protocols suggests the need for standardized guidelines tailored to individual patient needs and activity levels.

Background/Objectives: Total hip arthroplasty (THA) is a widely performed procedure to alleviate pain and improve function in patients with hip disorders. However, leg length discrepancy (LLD) remains a prevalent complication. LLD can cause gait disturbances, back pain, postural imbalance, and patient dissatisfaction, along with significant medico-legal implications. This review examines the evaluation, management, and medico-legal aspects of LLD. Methods: The review analyzed literature on the prevalence, evaluation methods, and management strategies for LLD in THA. Radiographic and clinical assessment tools were considered, alongside factors such as pelvic obliquity and pre-existing conditions. The importance of preoperative planning, intraoperative techniques (including computer-assisted methods), and comprehensive documentation was evaluated to address both clinical and legal challenges. Results: The review shows that leg length discrepancy (LLD) following total hip arthroplasty (THA) occurs in 3% to 30% of cases, with mean values ranging from 3 to 17 mm. LLD may result from anatomical or procedural factors, and effective evaluation requires both radiographic imaging and clinical assessment. Preoperative planning plays a critical role in accurately assessing anatomical parameters and selecting appropriate prosthetic components to preserve or restore limb length symmetry. Advanced intraoperative techniques, including computer-assisted surgery, help reduce LLD incidence. While some complications may be unavoidable, proper documentation and patient communication, particularly regarding informed consent, are essential to mitigate medico-legal risks Conclusions: LLD after THA requires a multidimensional approach incorporating clinical, radiological, biomechanical, and legal considerations. Effective preoperative and intraoperative strategies, combined with robust communication and documentation, are essential to minimize LLD and its associated risks. A focus on precision and patient-centered care can improve outcomes and reduce litigation.