Objective:
Vertebral fractures (VF) are the most common type of osteoporotic fracture and are often undiagnosed. The objective of this study is to determine the prevalence of VF in post-menopausal patients with persistent, nonspecific backache without history of trauma, and to evaluate the efficacy of teriparatide in managing vertebral fractures in a developing country.

Methods:
This cross-sectional study includes 200 post-menopausal patients aged 45 years and above who presented with persistent, nonspecific backache. Patients were evaluated for the presence of radiological VF, with the most prevalent types and locations recorded. Patients with prevalent VF were randomized to daily placebo or teriparatide(20 μg) in the Fracture Prevention Trial and followed for 24 months.

Results:Among 200 patients, 112(56%) had radiological VF, with the wedge type being the most common. The thoracic spine was the most frequently affected location, followed by the lumbar spine.Multiple thoracolumbar spine fractures were observed in some patients. Most identified VF were classified as mild by the Genant's grading system. Among the patients randomized to teriparatide, there was no significant increase in vertebral or nonvertebral fracture risk. Compared to the placebo group,15% of patients developed moderate or severe vertebral fractures and 9% developed nonvertebral fractures.

Conclusion:
Post-menopausal patients with persistent, nonspecific backache are at high risk for the consequences of unrecognized and untreated VF. Teriparatide appears to be an effective treatment for managing VF in a developing country setting, though further research is needed to evaluate its long-term efficacy and cost-effectiveness.

Purpose: This investigation aimed to study the outcome of percutaneous repair of Achilles tendon ruptures regarding patient-reported and objective outcomes. Methods: This is a retrospective review of a cohort of patients (n=24) who underwent percutaneous repair of neglected Achilles rupture in the period between 2013 to 2019. Included patients were adults with closed injuries, presented 4-10 weeks after rupture, with intact deep sensation. All underwent clinical examination, X-rays to exclude bony injury and MRI for diagnosis confirmation. All underwent percutaneous repair by the same surgeon, using the same technique and rehabilitation protocol. The postoperative assessment was done subjectively using ATRS and AOFAS score and objectively using a percentage of heel rise comparison to the normal side and calf circumference difference. Results: The mean follow-up period was 14.85 months ± 3 months. Average AOFAS scores at 6,12 months were 91 and 96, respectively, showing statistically significant improvement from pre-op level (P<0.001). Percentage of heel rise on the affected side and calf circumference showed statistically significant improvement over the 12 month follow up period (P<0.001). Superficial infection was reported in two patients (8.3%), and two cases reported transient sural nerve neuritis. Conclusion: Percutaneous repair of neglected Achilles rupture using the index technique proved a satisfactory patient-reported and objective measurement at a one-year follow-up. With only minor transient complications.

Purpose
The purpose of the work is to evaluate the differences between the routine accesses to Pediatric Emergency Room in a second level Children’s Hospital and that one during an extraordinary event as the first month of the lockdown for the Sars CoV 2 Pandemic in relation to types, sites and severity of Orthopaedic trauma, age, sex, and place in which the trauma occurred.
Methods
Authors compared retrospectively all children who had an access during the first month of lockdown for the Sars CoV 2, from March 10th 2020 to April 10th 2020 to the Emergency Room of Children Hospital Giovanni XXIII of Bari and than to Pediatric Orthopedic Unit, with the children that had an access in the same hospital from March 10th 2019 to April 10th 2019 for the sites, the types and the severity of the Orthopedic injuries.
Results
In 2019 there were 261 access to Emergency Room, in 2020 69: during lockdown the reduction was of 75%.
The datas were statistical significative about: the age, lower in 2020 during lockdown, (p<0.0001) and the worst prognosis of the lesions in the same period, 42.65% of fractures versus 28.05% (p<0003). No statistical evidence about sex, anatomical site of trauma and kind of lesion.
Conclusions
The volume of the accesses for trauma during lockdown was decreased of 75%, it means that to avoid the potential risk of Covid’s infection in Hospital, only children with major trauma were brought to it by parents, staying at home for contusions and sprains.

Objective: To assess the correlation between MRI features and clinical severity in patients with lumbar canal stenosis. Methodology: A prospective observational study including 150 patients with lumbar canal stenosis. Data including demographic, anthropometric profile and clinical features, VAS score for back pain and leg pain, modified oswestry disability index (mODI) scores were collected. Schizas 7 grade classification system was used to classify the MRI severity of lumbar canal stenosis. Results: 87 males and 63 females with a mean age of 56.5 ±11.3 years were part of the study. The mean VAS score for back and leg pain were 6.3 ± 1.1 and 7.6 ± 1.3 respectively. The mean mODI score was 47 ± 13.8. Central, lateral and foraminal stenosis were noted in 71, 41 and 38 patients respectively. Mild, moderate, severe and extreme stenosis were reported in 63, 42, 28 and 17 patients respectively. MRI grade of LCS does not correlated with mODI score (p=0.082) or VAS score for back pain (p=0.092) but strong correlation with VAS score for leg pain (p=0.023). Of all the MRI parameters studied, Antero-posterior (AP) diameter of the bony canal, the diameter of the foramen, height of lateral recess and cross sectional area of the dural sac showed strong correlation with both the mODI and VAS scores. Discussion/conclusion: AP diameter and cross sectional area of dural sac for the central, diameter of the foramen for foraminal and height of lateral recess for lateral stenosis were the most commonly used criteria in the diagnosis of LCS.

Introduction: Knee dislocations (KDs) are rare in orthopaedic trauma but can have devastating effects. This study aims to examine the risk factor(s) of vascular injury in patients with KDs, examine variables that differ between obese patients and non-obese patients with KDs, and analyse the modalities used to identify vascular injuries in the KD population. Methods: A retrospective analysis at a major trauma centre was performed to identify knee dislocations from 2015 to 2022. These were stratified based on age, gender, BMI, mechanism of injury, vascular injury, non-vascular complications, and laterality. Co-variates were inputted into a univariable regression analysis, followed by a multivariable regression analysis to identify risk factors of vascular injury in patients with knee dislocations. Results: Forty patients were identified with a KD, with twenty-eight males and twelve females. The average age was 42.9 years, seventeen patients had a BMI of thirty or over, and eleven patients (27.5%) had a vascular injury. Open injuries (OR: 2.21; p=0.038) and obesity (OR: 2.66; p=0.027) are risk factors for vascular injury in patients with knee dislocation. Compared to non-obese patients, obese patients had a higher rate of open injury (p=0.028), vascular injury (p=0.017), low-energy injuries (p=0.014), non-vascular complications (p=0.017), and amputation (p=0.036). Conclusion: Open injuries and obesity are risk factors for vascular injury in patients with KD. Compared to non-obese patients, obese patients have low-energy injuries and an increased rate of non-vascular complications, meaning that clinicians could err on the side of caution when investigating vascular injury.

Aim: The V-osteotomy is one of the most versatile osteotomies that isolate the ankle, the hindfoot and the forefoot as three separate components that could be corrected in relation to each other, either acutely with subsequent internal fixation or gradually with a circular frame. The aim of this study is to evaluate a minimally invasive variation of this osteotomy and assess its potential benefits. Material: Prospectively collected data from 20 patients who presented with severe equino-cavo-varus deformities. Method: The osteotomy was performed minimally invasive with a high-torque low-speed Shannon burr. Acute correction of some elements of the deformity was done including calcaneal translation and rotation. Ilizarov frame was then applied to gradually correct the deformity. Results: The mean follow up was 36 months (range 25-68). All patients reached a plantigrade foot. The time to achieve a plantigrade foot ranged from 35 to 51 days. The frame period ranged from 155 to 215 days. No cases of premature consolidation or non-union were reported. Apart from one patient who developed complex regional pain syndrome, all patients had a significant improvement in their Manchester Oxford Foot questionnaire (MOXFQ) score, physical and mental components, at the 6month post frame removal point. Conclusion: Performing the V-osteotomy with a minimally invasive technique allowed correction of some elements of the deformity acutely which reduced the time for achieving a plantigrade foot and therefore allowed the patients to start walking with the frame sooner. This technique can shorten the period that the patient must spend in the frame.