Fracture non-union is a challenging orthopaedic issue and a socio-economic global burden. Several biological therapies have been introduced to improve traditional surgical approaches. Among these, the latest research has been focusing on adipose tissue as a powerful source of mesenchymal stromal cells, namely, adipose-derived stem cells (ADSCs). ADSC are commonly isolated from the stromal vascular fraction (SVF) of liposuctioned hypodermal adipose tissue, and their applications have been widely investigated in many fields, including non-union fractures among musculoskeletal disorders. This review aims at providing a comprehensive update of the literature on clinical application of ADSCs for the treatment of non-unions in humans. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Only three articles met our inclusion criteria, with a total of 12 cases analyzed for demographics and harvesting, potential manufacturing and implantation of ADSCs. The review of the literature suggests that adipose derived cell therapy can represent a promising alternative in bone regenerative medicine for the enhancement of non-unions and bone defects. The low number of manuscripts reporting ADSC-based therapies for long bone fracture healing suggests some critical issues that are discussed in this review. Nevertheless, further investigations on human ADSC therapies are needed to improve the knowledge on their translational potential and to possibly achieve a consensus on their use for such applications.

Introduction: Calprotectin is a protein endowed with antimicrobial properties, rendering it a distinctive marker for infection. Two methods are currently available for the assay of calprotectin: the enzyme-linked immunosorbent assay (ELISA) and the lateral flow test (LFT). We aimed to assess the diagnostic accuracy of synovial fluid calprotectin and to compare the accuracy of the laboratory-based test and the qualitative assessment for the diagnosis of hip and knee prosthetic infection. Materials and methods: We searched (from inception to November 2023) MEDLINE, Scopus, EMBASE, Web of Science, and Cochrane for studies on calprotectin in the diagnosis of periprosthetic joint infection (PJI). Sensitivity, specificity, positive and negative likelihood ratio (LR), and diagnostic odds ratio were analyzed. The receiver-operating curve for each method was calculated. Results: We included 14 articles in our meta-analysis, including 902 patients who underwent total hip and knee arthroplasties revision; 331 (37%) had a joint infection according to MSIS, MSIS-modified criteria, ICM 2018 and EBJIS 2021. Considering the false-positive result rate of 6% and false-negative result rate of 7%, pooled sensitivity and specificity were 0.92 (95% CI 0.89–0.94) and 0.93 (0.91–0.95), respectively. The area under the curve (AUC) was 0.93 (95% CI 0.91–0.94). No statistical differences in terms of sensitivity and specificity were found between ELISA and LFT. The pooled sensitivity and specificity of the two calprotectin assessment methods were: LFT 0.90 (95% CI 0.869–0.935) and 0.92 (95% CI 0.894–0.941), respectively; ELISA 0.96 (95% CI 0.914–0.986) and 0.97 (95% CI 0.934–0.988), respectively. The diagnostic odds ratio of the ELISA was superior to that of the LFT (906.6667, 95% CI 271.2686–3030.3712 versus 113.8886, 95% CI 70.4001-184.2414; p < 0.001). The AUC for ELISA and LFT was 0.968 (95% CI 0.944–0.984) and 0.915 (95% CI 0.895–0.933), respectively. Conclusions: Detection of synovial calprotectin is an accurate test for diagnosis of hip and knee prosthetic infections. The diagnostic accuracy of the two calprotectin assessment methods is almost comparable. The LFT is a valid, rapid, and more available diagnostic tool, particularly to rule out PJI.

Background: The posterior wall fracture is the most frequent pattern of acetabular fractures. Many techniques of fixation have been described in the literature and involve plates, screws, or a combination of both. This study aims to investigate the clinical and radiological outcomes of spring plates in the treatment of comminuted posterior wall acetabular fractures. (2) Methods: A retrospective multicenter (four level I trauma centers) observational study was performed. Patients with a comminuted posterior wall acetabular fracture treated with a spring plate (DePuy Synthes, West Chester, PA) were included. Diagnosis was made according to the Judet and Letournel classification. Diagnosis was confirmed with plain radiographs in an antero-posterior view and Judet views, iliac and obturator oblique views, and thin-slice CT with multiplanar reconstructions. (3) Results: Forty-six patients (34 males and 12 females) with a mean age of 51.7 years (range 19–73) were included. The most common mechanism of injury was motor vehicle accident (34 cases). In all cases, spring plates were placed under an overlapping reconstruction plate. The mean follow-up was 33.4 months (range 24–48). The mean period without weight-bearing was 4.9 weeks (range 4–7), and full weight-bearing was allowed at an average of 8.2 weeks (range 7–11) after surgery. (4) Conclusions: According to the present data, spring plates can be considered a viable additional fixation of the posterior wall acetabular fractures.

Purpose Total knee arthroplasty (TKA) in patients who underwent previous knee surgeries can be a challenging procedure both technically and for the complication rate. Conversion TKA is affected by a higher risk of infection compared to primary TKA. The aims of this meta-analysis are i) to compare the infectious risk among patients undergoing TKA after a prior hardware implantation, evaluating removal vs maintenance of the hardware, and ii) within the removal group, to compare staged vs concurrent procedure. Methods In accordance with the PRISMA guidelines, a systematic literature review was conducted up to January 2024. The review was registered in the PROSPERO database: CRD42024510444. The inclusion criteria comprised the following: i) patients aged 18 years or older, ii) individuals who had undergone total knee replacement and iii) those with a history of prior nonabsorbable hardware implantation. The pooled incidence of periprosthetic joint infections (PJI) was reported using odds ratios with corresponding 95% confidence intervals (CIs). Results The investigation of database and references identified 284 studies. PJI risks differed significantly among groups, with a higher risk in the removal group (z = 3.5630, P = 0.0004). Furthermore, within the removal group, the risk of PJI was lower in cases of staged removal compared to concurrent removal (z = 2.0931, P = 0.0363). Conclusions TKA following a previous knee hardware implantation indicates a higher PJI risk when the hardware is removed compared to leaving it in place. If hardware removal is necessary, staged removal is recommended. The presence of minor hardware is the only scenario where, if removal is necessary, one-stage approach is preferred. Abstract Purpose Total knee arthroplasty (TKA) in patients who underwent previous knee surgeries can be a challenging procedure both technically and for the complication rate. Conversion TKA is affected by a higher risk of infection compared to primary TKA. The aims of this meta-analysis are i) to compare the infectious risk among patients undergoing TKA after a prior hardware implantation, evaluating removal vs maintenance of the hardware, and ii) within the removal group, to compare staged vs concurrent procedure. Methods In accordance with the PRISMA guidelines, a systematic literature review was conducted up to January 2024. The review was registered in the PROSPERO database: CRD42024510444. The inclusion criteria comprised the following: i) patients aged 18 years or older, ii) individuals who had undergone total knee replacement and iii) those with a history of prior nonabsorbable hardware implantation. The pooled incidence of periprosthetic joint infections (PJI) was reported using odds ratios with corresponding 95% confidence intervals (CIs). Results The investigation of database and references identified 284 studies. PJI risks differed significantly among groups, with a higher risk in the removal group (z = 3.5630, P = 0.0004). Furthermore, within the removal group, the risk of PJI was lower in cases of staged removal compared to concurrent removal (z = 2.0931, P = 0.0363). Conclusions TKA following a previous knee hardware implantation indicates a higher PJI risk when the hardware is removed compared to leaving it in place. If hardware removal is necessary, staged removal is recommended. The presence of minor hardware is the only scenario where, if removal is necessary, one-stage approach is preferred.

Background: Pelvic insufficiency fractures (PIF) are typical in geriatric populations with reduced bone quality, most commonly in elderly postmenopausal women. These fractures are usually caused by low-energy forces over the bones during ordinary life and cause disabling pain. Treatment options range from conservative to operative. The aim of this study is to assess the outcomes of treatments for pelvic insufficiency fractures, determining optimal approaches between surgical intervention and conservative management. Methods: This literature review systematically examines articles focusing on patients with PIF, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and using PubMed, Medline, and the Cochrane Library database. We took into account only full-text articles in indexed journals with available English abstracts, considering data about patient demographics, surgery, and outcomes. Results: After screening 128 articles, this study reviewed 20 manuscripts involving 1499 patients, mostly elderly females and focusing on sacrum fractures. Common treatments included conservative methods and sacroplasty, with a few complications reported. Osteoporosis was the prevalent comorbidity, and the survival rate post-treatment was high at 92.3%. Mobility outcomes varied, with some patients experiencing significant autonomy loss. The average follow-up period was over 17 months. Conclusions: This study found a cautious approach to surgery (timing of three weeks), which is reserved only for specific patterns, and it leads to increased autonomy and a lower risk of mortality. Due to the lack of pre- and postoperative scores as well as conflicting results, it is imperative to undertake further studies and research to be able to compare the alternative treatments efficiently.

Purpose: Acetabular fractures in elderly patients are increasing and present complex management challenges. This multicentric retrospective study compares mid-term clinical and radiographic outcomes of acute “fix and replace” versus ORIF, focusing on implant survival, complications, and functional performance at a minimum five-year follow-up, addressing the current lack of extended outcome data. Methods: This study is an update of a previously published multicentric retrospective cohort including patients aged ≥ 60 years with acetabular fractures treated surgically at three hospitals in central Italy between 2013 and 2025. Patients received either acute “fix and replace” (ORIF combined with acute THA) or ORIF alone, with a minimum clinical and radiographic follow-up of five years. Functional outcomes were assessed using PROMs (SF-12, PDI) and clinician-based scores (HHS, Modified Merle d’Aubigné and Postel). Radiographs were reviewed for healing, implant integrity, osteolysis, loosening, osteoarthritis, and heterotopic ossifications. Complications and implant survival were analyzed using Kaplan–Meier curves with revision surgery as the endpoint. Results: A total of 41 patients (21 ORIF, 20 CHP) completed a minimum five-year follow-up. No significant differences were found between groups regarding age, BMI, or follow-up duration. Two revisions to total hip arthroplasty occurred in the ORIF group, with no revisions in the CHP group. Radiographic findings, including heterotopic ossifications and implant loosening, were comparable. Functional scores (HHS, MAPM, SF-12 PCS and MCS) showed no significant differences between groups at both two and five years. The CHP group, however, demonstrated significantly lower pelvic discomfort index (PDI) scores at 60 months ( p = 0.04). No significant intra-group variations were observed over time. Conclusion: Both ORIF and CHP provide satisfactory mid-term outcomes in elderly patients with acetabular fractures. However, CHP demonstrated fewer reoperations and better pelvic discomfort scores at five years. These findings support the growing evidence favoring acute fix-and-replace strategies in this population.