Emidio Di Gialleonardo

Lateral femoral neck and peritrochanteric fractures are common and clinically challenging injuries, particularly in the elderly population, with significant implications for morbidity, mortality, and functional recovery. Traditional classification systems are widely used to guide treatment, yet their reproducibility and clinical applicability remain debated. Increasing attention has been directed toward trabecular architecture and its role in fracture behavior and reduction strategies. This review aims to summarize current evidence on classification systems, trabecular-based fracture patterns, pre-operative reduction techniques, and fixation strategies. A narrative review was conducted using PubMed/MEDLINE, Embase, and Scopus databases up to May 2026. Original studies, reviews, and biomechanical investigations focusing on proximal femur fracture classification, reliability, trabecular alignment, reduction techniques, and fixation methods were included. Data were qualitatively analyzed, with emphasis on interobserver reliability, biomechanical implications, and clinical outcomes. Conventional classification systems, including anatomical, Evans–Jensen, and AO/OTA frameworks, demonstrated variable and generally moderate reproducibility, with reported interobserver agreement ranging from approximately κ = 0.30 to 0.60. Emerging evidence highlights the importance of trabecular architecture, distinguishing intradigital fractures—confined within trabecular pathways and relatively stable—from extradigital fractures, which disrupt load-bearing structures and are associated with increased mechanical instability and higher failure rates. Biomechanical and clinical studies indicate that inadequate reduction with trabecular misalignment significantly increases the risk of varus collapse and implant cut-out. Reduction strategies tailored to fracture pattern, such as internal rotation for intradigital fractures and external or combined maneuvers for extradigital patterns, improve alignment and load transfer. In terms of fixation, dynamic hip screws remain effective in stable fractures, whereas cephalomedullary nails demonstrate superior performance in unstable patterns, with lower reoperation rates reported (approximately 5–8% vs. 10–15%). Management of lateral femoral neck and peritrochanteric fractures should extend beyond traditional classification systems to incorporate trabecular biomechanics. Restoration of trabecular alignment, alongside established parameters such as neck–shaft angle and tip–apex distance, is critical for optimizing outcomes. Further prospective studies are needed to validate trabecular-based classifications and standardize reduction strategies.

Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure, but graft failure remains a significant complication, particularly in young and active individuals. Understanding the multifactorial etiology of failure and optimizing revision strategies are crucial for improving outcomes. A structured narrative review of the literature was conducted, including studies published from January 2000 to May 2024. Databases searched included PubMed/MEDLINE, Embase, and Google Scholar. Eligible studies addressed definitions, etiology, classification, and surgical management of ACL reconstruction failure. Data were synthesized qualitatively, integrating evidence on technical, biological, and traumatic causes, as well as neuromuscular and psychosocial factors influencing functional outcomes. ACL reconstruction failure is primarily caused by technical errors, particularly tunnel malposition (60–70% of cases), followed by traumatic (15–25%) and biological (10–15%) mechanisms. Failure timing provides diagnostic clues: early (12 months) to trauma or degeneration. Revision strategies include individualized graft selection, anatomical tunnel placement, repair of associated lesions, and consideration of biomechanical abnormalities. Overall success rates of revision procedures average 70–75%, with lower outcomes in adolescents and high-demand athletes. Emerging techniques, including lateral extra-articular tenodesis and biologic augmentation, may enhance revision outcomes, although long-term evidence remains limited. ACL reconstruction failure is a multifactorial event requiring thorough preoperative assessment, precise surgical planning, and individualized management. Addressing technical, biological, and neuromuscular factors, alongside patient-specific considerations, is essential to optimize functional outcomes and reduce failure rates. Future research should focus on standardized reporting, multicenter prospective studies, and advanced surgical planning tools to further improve revision success.

Background: Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure, but graft failure remains a significant complication, particularly in young and active individuals. Understanding the multifactorial etiology of failure and optimizing revision strategies are crucial for improving outcomes. Methods: A structured narrative review of the literature was conducted, including studies published from January 2000 to May 2024. Databases searched included PubMed/MEDLINE, Embase, and Google Scholar. Eligible studies addressed definitions, etiology, classification, and surgical management of ACL reconstruction failure. Data were synthesized qualitatively, integrating evidence on technical, biological, and traumatic causes, as well as neuromuscular and psychosocial factors influencing functional outcomes. Results: ACL reconstruction failure is primarily caused by technical errors, particularly tunnel malposition (60–70% of cases), followed by traumatic (15–25%) and biological (10–15%) mechanisms. Failure timing provides diagnostic clues: early (< 3 months) failures often relate to fixation or infection, mid-term (3–12 months) to technical errors, and late (>12 months) to trauma or degeneration. Revision strategies include individualized graft selection, anatomical tunnel placement, repair of associated lesions, and consideration of biomechanical abnormalities. Overall success rates of revision procedures average 70–75%, with lower outcomes in adolescents and high-demand athletes. Emerging techniques, including lateral extra-articular tenodesis and biologic augmentation, may enhance revision outcomes, although long-term evidence remains limited. Conclusions: ACL reconstruction failure is a multifactorial event requiring thorough preoperative assessment, precise surgical planning, and individualized management. Addressing technical, biological, and neuromuscular factors, alongside patient-specific considerations, is essential to optimize functional outcomes and reduce failure rates. Future research should focus on standardized reporting, multicenter prospective studies, and advanced surgical planning tools to further improve revision success.

Background/Objectives: Total ankle replacement (TAR) is considered an effective solution for end-stage ankle arthritis. New-generation implants have shown promising intermediate clinical outcomes and are available in two main designs: fixed-bearing and mobile-bearing prostheses. The aims of this study are to compare both prosthetic systems, focusing on (i) the revision rate for major complications, including conversion to arthrodesis, revision of components, and below-knee amputation; (ii) minor complications requiring additional surgery; and (iii) providing a comprehensive overview of total ankle replacement. Methods: A systematic review of the literature was conducted using the main databases. The inclusion criteria were patients aged 18 years or older and individuals who had undergone total ankle arthroplasty. Case reports, case series, original articles, and systematic reviews were excluded from the final selection. The pooled incidence of events was reported using odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Results: A total of 33 studies, pooling data from 3652 observations and identifying 635 events, met the inclusion criteria. Relevant demographic and surgical data were systematically extracted and analyzed. A meta-analysis of comparable data revealed revision and failure risks for both prosthesis types. No statistically significant differences in complication rates were observed between fixed-bearing and mobile-bearing prostheses. Conclusions: Both fixed-bearing and mobile-bearing prostheses are viable options for treating ankle arthritis, demonstrating an intermediate risk of complications over short, medium, and long-term follow-ups.

Introduction: Total knee arthroplasty is a commonly performed procedure with postoperative complications including blood loss, pain, and hematoma formation. The role of intra-articular drainage in reducing these complications remains controversial. This study aims to evaluate the effects of intra-articular drainage on hemoglobin levels, pain, hematoma formation, and the need for blood transfusion in patients undergoing knee replacement. Materials and Methods: A prospective study was conducted on 60 patients divided into two groups: Drainage (D) and No Drainage (ND). Hemoglobin levels, pain scores, ultrasound evaluation of intra-articular hematoma, and transfusion rates were recorded on the first, third, and fifth postoperative days. The estimated blood loss was calculated using the Meunier formula. Pain was evaluated using the Visual Analog Scale, while hematoma size was measured using ultrasound. Results: The postoperative hemoglobin drop was significantly higher in the D group ( p = 0.0027), with a mean estimated blood loss of 1366 mL in the D group compared to 957 mL in the ND group. Four patients in the D group required blood transfusions, while none in the ND group did ( p = 0.0003). Pain scores were lower in the D group on the first postoperative day ( p = 0.0001), but no significant differences were observed on the third and fifth days. Ultrasound showed a larger hematoma in the ND group on the first postoperative day ( p = 0.02), but no significant difference was found by the fifth day. Conclusion: The use of drainage in TKA is associated with increased blood loss and transfusion rates without providing long-term clinical benefits. While it may offer temporary pain relief and reduce early hematoma formation, its routine application should be reconsidered given the potential for increased postoperative anemia and patient discomfort, along with the lack of sustained pain reduction. Surgeons should carefully weigh its short-term benefits against its risks, particularly in patients with pre-existing anemia or those at risk for significant blood loss.

Background: Proximal femur fractures are common in elderly patients and are strongly associated with frailty, increased mortality, and functional decline. The Clinical Frailty Scale (CFS) has emerged as a key predictor of outcomes, influencing perioperative management and rehabilitation strategies. This study aims to evaluate the impact of frailty on mortality, surgical timing, and length of hospital stay (LOS) in patients with hip fractures. Methods: This single-center retrospective study analyzed data from patients aged ≥ 65 years admitted with AO type 31A and 31B proximal femur fractures between 2018 and 2023. Patients were stratified according to CFS scores to assess the relationship between frailty and in-hospital mortality, surgical delay, and LOS. Multivariate logistic regression was performed to identify independent risk factors. Results: Among 2312 patients (median age: 85 years), frailty was a significant predictor of mortality ( p = 0.019). Patients with CFS 7–9 had a 6.6-fold higher mortality risk than those with CFS 1–3. Delays in surgery beyond 48 h were associated with a doubled risk of mortality ( p = 0.009), particularly in frail patients. Prolonged LOS (> 7.1 days) correlated with an increased incidence of infections, cardiovascular events, and mortality ( p < 0.001). Conclusions: Frailty significantly impacts hip fracture prognosis in elderly patients, increasing mortality, complications, and LOS. Early identification of frail patients and prioritization of timely surgery are crucial to improving outcomes. Future studies should explore tailored surgical strategies and optimized rehabilitation protocols to enhance recovery in this high-risk population.

Background: An ankle sprain is a frequent musculoskeletal injury, often leading to chronic instability and an increased risk of post-traumatic osteoarthritis. Kinesio Tape, an elastic adhesive tape, is widely used in rehabilitation for its supposed benefits in reducing pain, controlling edema, and improving ankle function. However, its effectiveness in managing acute ankle sprains remains debated. Methods: This systematic review aims to evaluate the evidence on the impact of Kinesio Taping on pain reduction, edema control, and return to sport in patients with acute ankle sprains. A systematic review was conducted in line with the PRISMA guidelines. The literature from PubMed, MEDLINE, and the Cochrane Library was searched for studies published from 2004 to 2024. Seven studies met the inclusion criteria, involving 247 patients with acute ankle sprains. Data on patient demographics, follow-up duration, Kinesio Taping protocols, and clinical outcomes were extracted and analyzed. Results: The review revealed mixed findings. Some studies reported short-term pain relief and reduced need for analgesics in the Kinesio Taping group, especially when combined with manual therapy. However, no significant differences were found in the edema control compared to bracing or casting. Functional recovery, as assessed by scales like the Karlsson scoring scale, showed no clear advantage for Kinesio Taping over other treatments. Conclusions: Kinesio Taping provides limited benefits for ankle sprain management, particularly in terms of long-term functional recovery and edema reduction. While it may offer short-term pain relief, it should be considered as an adjunctive treatment rather than a primary intervention.

Background: This comprehensive systematic review aims to explore and discuss existing treatment modalities for infections in total ankle arthroplasty (TAA), providing insights that may contribute to the establishment of a “standard of care” for these challenging cases. The study analyses the intricate landscape of infected TAA, addressing gaps in the current literature and emphasizing the need to refine treatment strategies. With the reported incidence of periprosthetic joint infection after TAA surpassing rates observed in total hip and knee replacements, the research navigates through various treatment modalities, underscoring the lack of a universally accepted standard of care. Methods: In this systematic review, following PRISMA guidelines, PubMed, Scopus, and Google Scholar, we identified 15 papers addressing the management strategies for infected TAA (162 infected ankle arthroplasty cases).These databases were chosen for their extensive coverage, strong relevance to the research topic, and ease of access, ensuring a thorough and focused retrieval of pertinent literature on the treatment of infected ankle prostheses. The review involved the identification and evaluation of articles providing insights into complications, treatment outcomes, and risk factors. Extracted data were summarized and reported. A descriptive analysis was performed, and when feasible, a statistical analysis was conducted. Results: Treatment modalities included irrigation and debridement (48.8%), revision total ankle arthroplasty (36.3%), primary arthrodesis (7.9%), spacer arthroplasty (4.5%), and primary amputation (3.9%). Complication rates varied, with 46.5% for irrigation and debridement, 20% for two-stage revision, 7.14% for primary arthrodesis, and 25% for spacer arthroplasty. Conclusions: The rising prevalence of TAA underscores the need for a definitive treatment protocol due to severe complications. This review emphasizes careful patient selection and accurate diagnosis. Irrigation and debridement are effective for acute infections, while two-stage revision is a valid alternative for chronic infections. High-quality randomized controlled trials are important for establishing an evidence-based treatment protocol.

(1) Background: Osteoarthritis (OA) significantly impacts patients’ quality of life and negatively affects public healthcare costs. The aim of this systematic review is to identify the effectiveness of pulsed electromagnetic fields (PEMFs) in OA treatment across different anatomical districts, determining pain reduction and overall improvement in the patient’s quality of life. (2) Methods: In this systematic review following PRISMA guidelines, PubMed and Google Scholar were searched for randomized controlled trials involving patients with osteoarthritis undergoing PEMF therapy. Seventeen studies (1197 patients) were included. (3) Results: PEMF therapy demonstrated positive outcomes across various anatomical districts, primarily in knee osteoarthritis. Pain reduction, assessed through VAS and WOMAC scores, showed significant improvement (60% decrease in VAS, 42% improvement in WOMAC). The treatment duration varied (15 to 90 days), with diverse PEMF devices used. Secondary outcomes included improvements in quality of life, reduced medication usage, and enhanced physical function. (4) Conclusions: Diverse PEMF applications revealed promising results, emphasizing pain reduction and improvement in the quality of life of patients. The variability in the treatment duration and device types calls for further investigation. This review informs future research directions and potential advancements in optimizing PEMF therapies for diverse osteoarthritic manifestations.