Third supplement of the Italian Orthopaedic Society: "Trauma care in Italy: A country-related approach with interregional variability"

The elective care of orthopaedic patients has been dominated by the application of guided protocols deriving from randomised control trials (RCTs). In contrast, such approach and standardisation of care does not exist in the orthopaedic trauma setting. Consequently, one could describe the current status quo of trauma practice in Italy as a ‘country-related approach with interregional variability’. Therefore, defining the standard of care in trauma patients still remains an issue to be addressed, even in current times. This supplement provides a general view of the clinical approach to the care of the patient with fractures and soft tissue injuries in Italy. Far from being exhaustive, clinical manuscripts cover a wide range of topics of great interest to the readership of the journal. Regional diversity is witnessed by the fact that two different research groups provided contributions on the management of periprosthetic fractures around hip implants, and developed guidelines for treatment in terms of surgical revision or fixation. Two manuscripts dealing with paediatric orthopaedics also indicated treatments to the hip and the femur, namely about the use of cannulated screws for neck of femur fracture in children, and the use of elastic nails in osteogenesis imperfecta. Other manuscripts in this issue explored fractures and injuries around the shoulder and the humeral shaft of the upper extremity investigating the role of external fixation and current osteosynthesis techniques. From a biomechanical point of view, two studies contributed to the study of the centre of rotation of reverse shoulder arthroplasty implants, and to the tensile strength different pattern of suture in rotator cuff repair. Several contributions focused on the management of the foot and ankle injuries. For instance, studies on the management of calcaneal fractures, open tibial pilon fractures, and tarsometatarsal joint complex give a close insight to the current management of fractures in this delicate region. The supplement includes also interesting reviews on cutting edge topics. One performs a systematic analysis on the management of the multiligamentous injuries to the knee; another one reports on the etiology of development of post-traumatic compartment syndrome. A third review explores the management of atypical femoral fractures, appearing more frequent since the introduction and diffusion of bisphosphonate therapy. We would like to thank all the contributing authors for their manuscripts. Once more, these articles outline the clinical and scientific standards of the Italian Orthopaedic Community. We believe that the content of this Supplement will be interesting to the orthopaedic surgeons dedicated to the management of patients with trauma to the musculoskeletal system.