Giuseppe Polizzotti

Background: Considering the increasing number of young and active patients needing TKA, orthopedic surgeons are looking for a long-lasting and physiological bond for the prosthetic implant. Multiple advantages have been associated with cementless fixation including higher preservation of the native bone stock, avoidance of cement debris with subsequent potential third-body wear, and the achievement of a natural bond and osseointegration between the implant and the bone that will provide a durable and stable fixation. Discussion: Innovations in technology and design have helped modern cementless TKA implants to improve dramatically. Better coefficient of friction and reduced Young’s modulus mismatch between the implant and host bone have been related to the use of porous metal surfaces. Moreover, biologically active coatings have been used on modern implants such as periapatite and hydroxyapatite. These factors have increased the potential for ingrowth by reducing micromotion and increasing osteoconductive properties. New materials with better biocompatibility, porosity, and roughness have been introduced to increase implant stability. Conclusions: Innovations in technology and design have helped modern cementless TKA implants improve primary stability in both the femur and tibia. This means that short-term follow-up are comparable to cemented. These positive prognostic factors may lead to a future in which cementless fixation may be considered the gold-standard technique in young and active patients.

Variable epidemiological data are known on medial clavicle fractures (MCFs). To obtain demographic information regarding the etiopathogenesis of MCFs. All fractures were radiographically evaluated. Age; gender; side; date of fracture; fragment dislocation; associated fractures; fracture mechanism were collected. Three age groups were distinguished. 1096 patients were enrolled: 29 (2.6%) had an MCF. Nineteen (66%) were males; mean age was 51.6 years (SD±24.4; range: 18-87). The right side was involved in 19 cases (66%). Nineteen fractures (66%) were un-displaced. Five patients (16.6%) had associated fractures. Accidental falls represent the main cause of fracture. In advanced age (Group III), simple fall was the only cause of fracture. On the occasion of a fall, the right side was significantly more involved (p <0.05). Sports injuries were responsible for 22.2% of fractures, but for 42.9% of fractures in younger patients (Group I). Traffic accidents were responsible for five fractures (16.7%). During the sunny seasons, the highest number of fractures occurred; the vast majority of fractures (83.3%) occurred on working days (p <0.05). Medial clavicle fractures represent 2.6% of all clavicle fractures. Middle-aged males and the right side are more involved. Two-thirds of fractures are un-displaced. Accidental falls represent the main cause of fracture. During sunny seasons, the highest number of fractures occurred.