We conducted a literature review to better understand the correct application and indications of negative pressure wound therapy (NPWT) in orthopedics and traumatology. A literature search was conducted on PubMed and all articles in English, Spanish, and Italian were included. Relevant articles, references, data, and relevant findings were identified, reviewed, extracted, and accepted by consensus of at least 66% of the researchers. Relevant articles were discussed by the research group. NPWT has several beneficial effects on the wound that contribute to the maintenance of a favorable biochemical and cellular environment, to the formation of granulation tissue and to faster healing. NWPT can be useful in the treatment of septic wounds after initial debridement surgery and removal of the septic foci, and in necrotizing fasciitis in the presence of gas gangrene, venous or pressure ulcers. NPWT can also be used "for prophylactic purposes" (incisional NPWT) in patients with risk factors for skin dehiscence and with a high risk of wound drainage in the post-operative period and after prosthetic surgery or internal fixation to protect the surgical scar. However, the available evidence is mostly unclear. The appropriate use of NPWT seems to reduce the number of dressing changes in complex wounds, reduce hospitalization times, and offer greater comfort to the patient; when applied on surgical incisions, it may reduce the risk of delayed healing and the risk of infections.

Background The treatment of proximal humerus fracture complicated by bone fragility is still controversial. The aim of this study is to compare the Neer classification and the Control Volume severity grade for the accuracy in the selection of the type of treatment and for prognostic evaluation. Materials and methods We retrospectively collected the records of all patients admitted at the Emergency Department of our Institute, from 2013 to 2020, for a closed displaced proximal humerus fracture further investigated with a CT scan before treatment decision. We selected all patients with a minimum age of 65 years. The included fractures were retrospectively classified according to Neer, and Control Volume severity grade. The included patients were evaluated with Simple Shoulder Test (SST). A statistical analysis was performed to correlate the type of treatment and the clinical results to the Neer classification and the Control Volume severity grade. Results Sixty-four patients (80%), were available for the telephonically interview at a mean follow up of 4 years and were included. According to the Control Volume model, we identified fracture with a low, medium and high severity grade, in 23 (36%), 13 (20%), and, 28 (44%) cases, respectively. Fifteen patients (23,5%) were conservatively treated, whether fourty-nine patients (76,5%) were operated. We find a statistical correlation between control volume severity grade and type of treatment. No Therapeutic correlation was detected for the Neer classification. A statistical correlation between the severity grade and clinical outcome could be observed only for patients with the same type of treatment. Conclusions The use of Control Volume severity grade is associated with better therapeutic and prognostic informations in confront to the Neer classification.