Introduction Megaprosthesis represent the most commonly used limb salvage method after musculoskeletal tumor resections. Nevertheless, they are burdened by high complication rate, requiring several surgical revisions and eventually limb amputation. The aims of this study were to evaluate the effect of rescuing the limb with subsequent revisions on complication rates (a), incidence of amputations (b), and whether complications reduce functional outcome after the first surgical revision (c). Materials and methods We retrospectively reviewed 444 lower limb megaprosthesis implanted for primary musculoskeletal tumors or metastatic lesions, from February 2000 to November 2017. 59 patients received at least one revision megaprosthesis surgery. MSTS score was used to assess final functional results. Complication-revision-amputation free survival rates were calculated both at 5 and 10 years of follow-up. Results Complication free survival, revision free survival and amputation free survival at 10 years were 47% and 53%, 61% and 67%, 90% and 86% among all 444 patients and the group of 59 revised patients, respectively. The incidence of further complications after the first complication was 26% in the group treated with no subsequent revision surgeries and 51% in the group with at least one revision surgery. We found a trend of inverse linear relationship between the number of complications needing subsequent revision surgeries and the final MSTS. Conclusion The number of further revision surgeries after limb salvage with megaprosthesis increases the incidence of complications. Repeated surgical revisions, in particular after infection, increase the amputation rate. The most frequent causes of failure were structural failures and infections. MSTS score was superior for patients undergoing limb salvage than amputees. However, MSTS progressively decreased with multiple revisions becoming inferior to the functional score of an amputated patient.

Background: The effect of past climatic changes on the distribution of organisms is a fertile field of research that has been tackled in many different ways. Because the fossil record provides direct access to the chronological and geographic dimensions of biological events occurred in the past, it can be a useful tool for assessing range contractions and expansions related to climatic changes.Results: Here, we provide support for the 'recent' shrinkage of the range of a frigophilous anuran, the common frog, Rana temporaria Linnaeus, 1758, by analyzing the amphibian fossil assemblage coming from the Grotta di Equi, a Late Pleistocene site (about 45 ka) located in the Apuan Alps (northern Apennine chain, Massa-Carrara Province, Italy). Besides, R. temporaria, the assemblage includes cf. Salamandra salamandra Linnaeus, 1758 and Bufo bufo Linnaeus, 1758. Conclusions:The presence of R. temporaria in the Apuan Alps during a cold interglacial phase at an elevation that is much lower than the minimum current elevation in the region (about 300 m lower) supports the previously reported hypothesis that the Pleistocene coolings favored the dispersal of this frigophilous species along the Apennine chain and that its current, locally disjointed distribution is the effect of the post Pleistocene raise in temperature. Our results concur in predicting that the current global warming will further affect, negatively, the range of this frigophilous species by further reducing its distribution in the southern sectors of its range.

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In this article we report a 74 year old patient with Ideberg-type III fracture who was treated with indirect reduction and fixation. The patient was a sportive biker who suffered from a high energy trauma (road accident). X-ray revealed a scapula fracture, and only after a CT-Scan we could confirm the fracture type (Ideberg-type III glenoid fracture). The patient was operated and re-evaluated at follow-up. During the surgery we prefered not to access intra-articular due to the low joint involvement. He was able to resume his daily activities at two months postoperatively. At three months ASES Score was 91.5; Constant Score was 71 (vs 96 of unaffected arm). The patient revealed to be satisfied with the treatment, moreover the clinical results are encouraging in view of further improvements in the following months.