Introduction: On 9 March 2020 the Italian Government declared a national lockdown to curb the spread of Covid-19. The aim of our study was to analyze the effects of such intervention on the traumatological emergency service, with particular emphasis on variations in trauma incidence and patients’ characteristics. Materials and Methods: An observational analysis was performed. Medical records were collected from 3 different trauma centers within a wide metropolitan area, and compared between 2 time periods: the full Italian lockdown period and the same period from the past year. The study population included all patients who were admitted to the Emergency Department (ED). For those who accessed for orthopedic reasons, the analyzed variables included the date of ED admission, age, gender, after visit discharge or hospitalization, place where the injury occurred, traumatic mechanism, diagnosis, relationship with sport activity, and time from injury/symptoms debut to ED access. Results: A total of 17591 ED accesses and 3163 ED trauma visits were identified. During the lockdown, ED trauma visits decreased by -59.8%, but required patient’s hospitalization significantly more frequently. The rate of ED trauma admissions in the elderlies significantly increased, together with the proportion of fragility fractures such as hip fractures. Road accident traumas (-79.6%) and sport-related injuries (-96.2%) significantly dropped. Admissions for less-severe reasons such as atraumatic musculoskeletal pain significantly decreased (-81.6%). Conclusions: The lockdown reduced the pressure on the Health System in at least 2 ways: directly, by curbing viral transmission and indirectly, by more than halving the ED trauma visits. Nonetheless, we observed an increased proportion of traumas in older patients, requiring hospitalizations, while the rate of less-severe cases decreased. This analysis may raise awareness of the effects of a lockdown on trauma services and may be helpful for those ones around the world who are now facing the emergency.

BackgroundSacral fractures with spinopelvic dissociation are rare, and hard to diagnose and treat. Fractures with a H- or U-shaped line are severely unstable, due to a dissociation of the spine and of the upper body of the sacrum from the pelvis. They are commonly due to high-energy trauma events, with severe neurological injuries in 80% of cases.Cases presentationFive polytraumatized Caucasian patients, three women and two men (mean age: 34 years old) with spinopelvic dissociation were selected. All patients underwent level I–II examinations with radiographs and computed tomography total-body scans; all patients needed damage-control procedures. Sacral fractures were classified according to Denis and Roy-Camille classifications, and neurologic injuries of cauda equina according to Gibbons classification. Patients’ outcome was analyzed with the Majeed score. Definitive surgical treatment was appropriate for two patients (lumbar-pelvic fixation or transverse bar). Clinical and radiographic outcomes were analyzed periodically. Four patients survived, all of them suffered severe neurologic deficits. One case of osteomyelitis was treated with the removal of the fixation implants 23 months after the accident.ConclusionsDiagnosis of spinopelvic dissociation is frequently overlooked due to the severe associated injuries affecting these patients. In cases of a fall from high height, this lesion should be investigated with a lateral sacral radiographic view and computed tomography scan of the pelvis. If untreated, it can lead to severe and progressive neurologic deficit with muskuloskeletal deformities and persistent pain. Early decompression treatment is controversial, but an early lumbopelvic fixation is recommended. A correct diagnosis and early treatment can reduce morbidity and strongly improve the outcome of these patients.

Periprosthetic joint infection (PJI) is one of the most dramatic complications of joint arthroplasty. Although streptococcal bone and joint infections are less common than staphylococcal cases, their role as causative agents of bone and joint remains significant accounting for at least 10% of PJIs. Streptococcus anginosus group (SAG) bacteria are usually found in the normal flora of the urogenital tract, intestinal tract and oropharynx and could cause pyogenic infections to affect brain, lungs and liver. SAG bacteria are uncommonly reported as a cause of osteomyelitis and the involvement of a joint represent a rare event. S. anginosus has been anecdotical related to implant devices infections such as vascular prosthesis or orthopedic implants, however, PJI of the knee has never been fully reported before. We describe the case of a late onset periprosthetic knee infection due to Streptococcus anginosus successfully treated by a two-stage revision arthroplasty and postoperative parenteral Vancomycin, (2 g per day) and Levofloxacin (750 mg per day) for 4 weeks and then oral Levofloxacin for a further 2 weeks.

Background and Objectives: The purpose of this study was to evaluate the feasibility, safety and efficacy of microwave ablation (MWA) in combination with open surgery nail positioning for the treatment of fractures or impending fractures of long bone metastases. Material and Methods: Eleven patients (four men, seven women) with painful bone metastases of the humerus, femur or tibia with non-displaced fractures (one case) or impending fractures (10 cases) underwent open MWA in combination with osteosynthesis by locked nail positioning. Pain intensity was measured using a VAS score before and after treatment. CT or MRI were acquired at one month before and 1, 3, 6, 12 and 18 months after treatment. Results: All procedures were successfully completed without major complications. The level of pain was significantly reduced one month after treatment. For the patients with humerus metastases, the complete recovery of arm use took 8 weeks, while for the patients with femoral metastases the complete recovery of walking capacity took 11 weeks. The VAS score ranged from 7 (4–9) before treatment to 1.5 (0–2.5) after treatment. During a mid-term follow-up of 18 months (range 4–29 months), none of the patients showed tumor relapse or new fractures in the treated site. Two patients died due to tumor disease progression. Conclusion: Results of this preliminary study suggest that combined MWA and surgical osteosynthesis with locked nails is a safe and effective treatment for pathological fractures or malignant impending fractures of long bone metastases of the humerus, femur and tibia. Further analyses with larger cohorts are warranted to confirm these findings.

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