Stefano Cattaneo

Background: Skeletal muscle atrophy is a pervasive complication of critical illness that worsens survival and recovery, yet remains poorly explained by current clinical or molecular markers. Methods: To directly connect disease‐associated molecular states to the contractile machinery, this study combined sequential functional, transcriptomic and proteomic profiling of the same single human skeletal myofibres from critically ill patients in the intensive care unit with acquired weakness (ICU‐AW) and controls. This integrated approach provides a framework for validating molecular signals directly within the cellular and biomechanical context. Results: Differential expression analyses between control and ICU‐AW myofibres show marked donor‐level heterogeneity, with no differentially expressed features (FDR < 0.05). Ranked gene set enrichment analyses revealed distinct transcriptional and proteomic signatures between conditions, as well as a subtle yet conserved myofibre state enriched in ICU‐AW, characterised by inflammatory and chemotactic gene programmes, intracellular structural remodelling and bioenergetic adaptation. Nineteen features were significantly (FDR < 0.05) altered at both RNA and protein levels from the same myofibre. Overall, these 19 overlapping features link an inflammatory transcriptional landscape to a proteomic shift toward mitochondrial and translational machinery, revealing a coordinated stress‐adaptation programme with selective post‐translational control in fibres from patients with ICU‐AW. Further integration with the functional dataset revealed fibres in this state displayed selectively disrupted myosin dynamics, evidenced by prolonged ATP turnover time of myosin heads in their super‐relaxed conformation, suggesting altered myosin energetics as a contributor to muscle dysfunction. Conclusions: These findings define a discrete, disease‐associated myofibre state and validate a proof‐of‐concept integrative single‐fibre framework for connecting multi‐omic heterogeneity to molecular motor function in complex human disease. The identification of coordinated transcriptomic and proteomic programmes, validated through functional measurement, suggests that targeting this fibre state may offer new therapeutic opportunities in ICU‐acquired dysfunction and related muscle disorders.

Skeletal muscle dysfunction is a pervasive complication of critical illness that worsens survival and recovery, yet remains poorly explained by current clinical or molecular markers. To directly connect disease-associated molecular states to the contractile machinery, this study combined sequential functional, transcriptomic, and proteomic profiling of the same single human skeletal myofibers from critically ill patients in the intensive care unit with acquired weakness (ICU-AW) and controls. Despite marked donor-level heterogeneity, integrated analysis revealed a subtle yet conserved myofiber state enriched in ICU-AW, characterized by inflammatory and chemotactic gene programs, intracellular structural remodeling, and bioenergetic adaptation. Nineteen features were significantly altered at both RNA and protein levels from the same myofiber, linking an inflammatory transcriptional landscape to a proteomic shift toward mitochondrial and translational machinery and away from membrane-associated signaling. Functionally, fibers in this state displayed selectively disrupted myosin dynamics, evidenced by prolonged ATP turnover time of myosin heads in their super-relaxed conformation, implicating altered myosin energetics as a contributor to muscle dysfunction. These findings define a discrete, disease-associated myofiber state and establish an integrative single-fiber framework for connecting multi-omic heterogeneity to molecular motor function in complex human disease. Graphical Single-fiber multi-omic and functional analysis reveals a stress-adapted myofiber state in ICU-AW. Specifically, for the present study, myofibers from ICU-AW donors and control donors were isolated and functionally profiled for myosin dynamics before being split for simultaneous transcriptomic and proteomic analysis. Integrated analysis then identified a reproducible fiber phenotype enriched in ICU-AW, characterized by inflammatory transcriptional signatures coordinated with mitochondrial proteomic remodeling and altered myosin super-relaxed state energetics.

Pelvic fractures associated with hemodynamic instability present a major challenge in trauma care, carrying mortality rates up to 30%. Successful management requires a multidisciplinary approach focused on resuscitation, mechanical stabilization, and hemorrhage control. Based on the 2024 International Orthopaedic Trauma Association (IOTA) Annual Meeting Pelvic Symposium, this review summarizes current recommendations for the management of hemodynamically unstable patients with pelvic fractures. Initial skeletal stabilization typically involves noninvasive pelvic binding devices, such as sheets or commercially available binders, employed in both pre-hospital and hospital settings. Subsequent resuscitation strategies include hypotensive resuscitation—restricting fluid administration to maintain lower blood pressure until bleeding is controlled—and damage control resuscitation—consisting of rapid surgical interventions aimed at achieving hemostasis. Current best practice also includes early empirical administration of balanced transfusion products guided by massive transfusion protocols, with targeted adjustments based on point-of-care testing results. Hemorrhage control methods vary depending on available resources: angioembolization effectively manages arterial bleeding in well-resourced facilities, whereas preperitoneal pelvic packing offers a quick, accessible solution for venous and bone-related hemorrhage, particularly in low-resource environments. Although the timing of pelvic binder removal and definitive invasive skeletal stabilization remains controversial, recent evidence supports early definitive internal fixation within 24 hours post-injury.

Purpose: The assessment of functional outcomes after pelvic ring fracture remains a controversial topic. The Majeed pelvic score (MPS) is the most commonly used pelvic-specific questionnaire in the literature. The aim of this study is translation, cross-cultural adaptation and validation of the Italian version of MPS. Methods: The study was articulated in two phases. Phase 1 consisted in translation and cross-cultural adaptation of MPS, from English into Italian. The psychometric properties were tested on 52 Italian patients (Phase 2). Construct validity was assessed by correlation with Short-Form 12 (SF-12). 33 patients repeated the questionnaire after 14 days to assess its reproducibility. All data were subsequently analyzed (descriptive statistics, multitrait analysis, reliability and construct validity assessment). Results: The questionnaire was clear and easily understood (no missing data). A ceiling effect was detected for all items of the scale. Multitrait analysis showed good results for each outcome measure, except for the item “walking distance” that showed poor item discriminant validity. A significant correlation between the MPS and the physical component summary (PCS) of the SF-12 was found, while there was a weak correlation with the mental component summary (MCS). The questionnaire showed high internal consistency (Cronbach’s alpha: 0.91–0.99) and very good test–retest reliability (intraclass correlation coefficients: 0.92–0.96). Conclusions: The Italian version of the MPS has demonstrated to be reliable and valid in the evaluation of patients with pelvic ring fractures. There is still however a need for an instrument capable of evaluating the mental component in these types of injuries.

Purpose Pelvic osteotomies present a surgical option to restore pelvic alignment, improve function and pain in sequelae of pelvic ring fractures. Understanding the three-dimensional deformity is a crucial step within preoperative planning; furthermore, accurate intraoperative execution of the planning can be challenging. In recent years, patient-specific guides and 3D modeling have emerged as promising technologies in orthopedic and trauma surgery to enhance surgical precision and facilitate intraoperative decision-making. Methods We present the case of a 41-year-old male patient with a pelvic malunion, resulting from a vertical shear fracture occurring 8 years prior. The patient presented with a 4-cm cranial displacement of the right hemipelvis, accompanied by pubic symphysis disruption and fusion of S1 to L5 vertebra. Severely altered posture in the coronal and sagittal plane was associated with sitting imbalance, impaired gait, and chronic pain. Results We analyzed the deformity and planned the surgical correction on a 3D interactive virtual model. Moreover, we developed 2 patient-specific cutting guides and one patient-specific reduction guide, allowing accurate bilateral pelvic osteotomies, subsequent realignment, and restoration of the pelvic anatomy. Conclusion For the first time, 3D modeling and 3D-printed patient-specific guides were effectively employed in pelvic malunion surgery, enhancing the precision of preoperative planning, and providing valuable assistance during intraoperative procedures.

Trauma is one of the main causes of death in younger people and ongoing disability worldwide. In Europe, while there is generally good organization of trauma reception and acute treatment, rehabilitation from major musculoskeletal injuries is less well defined and provided. This article documents the diverse approaches to rehabilitation after major injury in 6 European nations. The recognition of need is universal, but achieving a robust rehabilitation strategy is more elusive across the varying health care systems. Switzerland has the most robust service in the insured population. In the other countries, particularly where there is a reliance on public institutes, this provision is at best patchy. In the Netherlands, innovative patient-empowering strategies have gained traction with notable success, and in the United Kingdom, a recent randomized trial also showed this approach to be reproducible and robust. Overall, there is a clear need for learning across the national systems and implementation of a minimum set of standards.

Background: Scapular osteotomy for malunion can lead to resolution of pain and functional improvement in scapula fracture sequelae. Understanding three-dimensional bone morphology and analysing post-traumatic deformity is the main step of planning and the key to success of the procedure. 3D models and patient-specific guides are a growing technology to enhance accuracy of planning and to assist during surgery. Case presentation: We report the case of a 50 years old male, complaining of pain and limited function after a malunited scapular body fracture. Clinical assessment showed a severe impairment of shoulder function with active and passive forward flexion limited to 80°, absent external rotation, and internal rotation limited to the buttock. X-rays and CT scan showed an excessive lateral border offset of 53 mm and complete displacement of the glenoid segment anteriorly and medially to the scapular body, with impingement between the lateral most prominent scapular bone spur and humeral shaft. Glenopolar angle was 19°, scapular body angulation on the sagittal plane was 12°. Corrective osteotomy was planned on a virtual interactive rendering and on 3D printed models. Patient-specific guides were developed to perform a body-spine osteotomy with removal of a bone wedge, and a glenoid-spine osteotomy; a patient-specific wedge spacer was used to hold the reduction during plate fixation. Follow-up up to 12 months after surgery demonstrated improvement in scapula anatomy, shoulder girdle function, and patient-reported outcomes. Conclusions: For the first time in scapula malunion surgery, patient-specific osteotomy guides were succesfully used during surgery to perform osteotomies and to assist in reduction maneuvers.

Posterior column fractures are common acetabular injuries. Although displaced fractures require open reduction and fixation, undisplaced patterns may benefit from percutaneous screw fixation. The combination of iliac oblique with inlet and outlet views offers an intuitive and panoramic rendering of the bony corridor into the posterior column; lateral cross table view completes the sequence of fluoroscopic projections. Herein we describe the use of outlet/inlet iliac views and a detailed procedure for percutaneous retrograde posterior column screw fixation.

Purpose The assessment of functional outcomes after pelvic ring fracture remains a controversial topic. The Majeed pelvic score (MPS) is the most commonly used pelvic-specific questionnaire in the literature. The aim of this study is translation, cross-cultural adaptation and validation of the Italian version of MPS.Methods The study was articulated in two phases. Phase 1 consisted in translation and cross-cultural adaptation of MPS, from English into Italian. The psychometric properties were tested on 52 Italian patients (Phase 2). Construct validity was assessed by correlation with Short-Form 12 (SF-12). 33 patients repeated the questionnaire after 14 days to assess its reproducibility. All data were subsequently analyzed (descriptive statistics, multitrait analysis, reliability and construct validity assessment).Results The questionnaire was clear and easily understood (no missing data). A ceiling effect was detected for all items of the scale. Multitrait analysis showed good results for each outcome measure, except for the item “walking distance” that showed poor item discriminant validity. A significant correlation between the MPS and the physical component summary (PCS) of the SF-12 was found, while there was a weak correlation with the mental component summary (MCS). The questionnaire showed high internal consistency (Cronbach’s alpha: 0.91–0.99) and very good test-retest reliability (intraclass correlation coefficients: 0.92–0.96).Conclusions The Italian version of the MPS has demonstrated to be reliable and valid in the evaluation of patients with pelvic ring fractures. There is still however a need for an instrument capable of evaluating the mental component in these types of injuries.