Background: Biophysical stimulation therapy, Pulsed Electromagnetic Fields (PEMFs) and Capacitively Coupled Electric Fields (CCEFs) have significantly increased in the last twenty years. Due to this, it is necessary to have clear information regarding their efficacy, therapeutic indications and expected objectives. Application fields: There is a unanimous opinion regarding the usefulness of applying biophysical therapy on the bone compartment both in terms of the tissue-healing process and the symptoms associated with this situation. Differently, but no less important, positive results were observed in the joint compartment, especially with regard to the inhibition of the inflammatory process. Good results for chondroprotection were obtained in vitro and after a surgical procedure. New studies have shown the effectiveness also in cases of osteoporosis. Conclusions: The effectiveness of PEMFs and CCEFs on the bone-healing process and on joint preservation in the orthopedic and traumatology fields has consolidated evidence in the literature. We have also found positive results for symptoms and patient compliance with rehabilitation therapies. Therefore, their notable applications can be envisaged in the fields of prosthetic surgery and sports medicine.

The development of biomaterials in recent years has made it possible to broaden their use in the surgical field. Although iliac crest bone graft harvesting currently remains the gold standard as an autograft, the properties of hydroxyapatite bone substitutes appear to be beneficial. The first fundamental step to consider is the safety of using these devices. The purpose of this retrospective cohort study is to consider all the adverse events observed in our population and assess their relationships with the bone substitute device. The population analyzed consisted of patients undergoing trauma osteosynthesis with at least one implanted porous hydroxyapatite device. We considered a court of 114 patients treated at “Azienda Ospedaliera Universitaria di Ferrara—U.O. di Ortopedia e Traumatologia” in the period from January 2015 to December 2022. Upon analyzing our population, no adverse events related to the device emerged. Taking into consideration different study groups from other National Hospital Centers, no critical issues were detected except for three cases of extrusion of the biomaterial. It is necessary to clarify that bone substitutes cannot replace compliance with the correct principles linked to the biomechanics of osteosynthesis. This report outlines a safety profile for the use of these devices as bone substitutes in trauma orthopedic surgery.

Background and Objectives: There are numerous techniques for the surgical treatment of Achilles tendon lesions described in the literature, and it is possible to distinguish repair techniques as either open surgery or percutaneous repair techniques. Both approaches have advantages and disadvantages. With this retrospective study, we aim to analyze the incidence of re-ruptures and other complications, return to sport and overall quality of life at a long-term follow-up in the treatment of acute ATRs, comparing the results of percutaneous repair with those of open repair. Materials and Methods: This is a retrospective study on a consecutive series of patients with complete tear of the AT who were managed through a surgical approach by the Operative Unit of Orthopaedics and Traumatology of Sant’Anna University Hospital (Ferrara, Emilia-Romagna, Italy) between April 2014 and December 2021. Patients were treated with a percutaneous or an open technique according to the surgeon’s preference without randomization. Results: We considered 155 patients who met the established inclusion criteria. Of these, 103 (66.45%) patients underwent percutaneous treatment with the Tenolig^® system, and 52 (33.55%) underwent open surgery, with an average ATRS in the first group of 92.5 compared to an average ATRS value of 82 in patients treated with the open technique. Conclusions: In our experience, following overlapping rehabilitation protocols in all patients included, we observed that the Tenolig^® repair system led to a better ATRS at long-term follow-up, with comparable complication rates to open surgery.

Diaphyseal femur fractures are relatively common, and up to 39% of these cases involve a third fragment. These types of fractures present a unique challenge due to their high risk of non-union, reported in up to 14% of cases. Despite their frequency, there is still no consensus on the optimal management of the third fragment in these fractures. The purpose of this retrospective study was to compare the clinical and radiological outcomes of patients who underwent reduction of the third fragment with those who did not, to determine the characteristics of the third fragment that warrant reduction, and to suggest the best approach. The hypothesis is that an open reduction of the third fragment is to be avoided as it increases the risk of non-union. This retrospective monocentric study analysed clinical data from patients diagnosed with diaphyseal femur fractures at our Unit between 2010 and 2022. Radiological data encompassed the length and width of the third fragment, the fracture gap, its proximity to the proximal and distal cortex, the greatest cortex-to-cortex distance, and the orientation of the third fragment. Other factors considered included patient age, BMI, sex, type of surgery performed, fracture fixation method, occurrence of complications, specific complication types, incidence of mortality, and duration of follow-up. Seventy patients were included in the study; 24 patients underwent osteosynthesis with plates and screws, while 46 patients were treated with intramedullary nailing. Descriptive analysis revealed no statistically significant difference in the characteristics of the third fragment between patients who experienced complications and those who did not. Surgical technique for osteosynthesis (plates and screws Vs intramedullary nailing) also showed no statistically significant differences, conversely the open reduction and synthesis of the third fragment is a statistically significant complication predictor. The management of the third fragment remains a challenge. In our series of patients third fragment characteristics and type of osteosynthesis did not influence the risk of complications. However, the determining factor was found to be the open reduction of the third fragment. IV.

Background: biophysical stimulation therapy, and in particular Pulsed Electromagnetic Fields (PEMFs) and capacitively coupled electric fields (CCEFs) has significantly increased in the last twenty years. For this, it is necessary to have clear information regarding the efficacy, the therapeutic indication and the expected objectives. Methods: we conducted a narrative review taking into consideration different types of studies with different areas of application. The objective was to take into consideration and analyze the different fields of use and the relevant information present in the literature. Results: There is unanimous opinion regarding the usefulness of applying biophysical therapy on the bone compartment both in terms of the tissue healing process and the symptoms associated with this situation. Differently, but no less importantly, in the joint compartment positive opinions were observed mainly on the inflammatory and catabolic process, however, at present,we did not report evidence regarding cartilaginous tissue regeneration. Conclusion: the effectiveness of PEMFs and CCEFs on the bone healing process in the Orthopedic and Traumatology fields is consolidated evidence in the literature. We have also found positive results on symptoms and patient compliance with rehabilitation therapies. Therefore, notable application can be envisaged in the fields of Prosthetic Surgery and Sports Medicine.