The present systematic review determined the effects of physical activity/exercise added to Denosumab, Romosozumab, Abaloparatide or Teriparatide-therapy on bone strength and fall incidence in middle-aged and older people with osteopenia/osteoporosis. A systematic literature search of five electronic databases and two registers (up to 30/05/2023) without language restrictions included studies with (a) postmenopausal women and men ≥45 years, with low bone mass that compared study arms with (b) combined interventions of physical activity/exercise and Denosumab or Romosozumab or Abaloparatide or Teriparatide versus (c) isolated pharmaceutical therapy on (d) Bone Mineral Density (BMD) and prospective fall and/or fracture events (e) applying a randomized controlled study design. Finally only one study that compared the effect of Teriparatide and whole-body vibration versus isolated Teriparatide therapy on bone strength parameters was eligible. This trial reported a significant effect of combined vs. isolated therapy for lumbar spine BMD however not for total hip-, radius- and tibia-BMD, bone microarchitecture or bone turnover biomarkers. Thus, reviewing the literature there is rather limited data on additive effects of exercise on novel pharmaceutic therapy for osteoporosis. Nethertheless, considering age, bone status and physical function of most people under corresponding therapies might already justify the recommendation of exercise programs dedicated to reduce number and impact of falls and fall impact that complement the effects of pharmacological therapy on bone strength. Due to the enormous socioeconomic importance of osteoporosis-induced low trauma fractures more studies should focus on the dissection of the impact of individualized exercise programs when combined with medical treatment.

Purpose: The relationship between time to surgical debridement and complications for open tibia fractures remains debatable. The American College of Surgeons guidelines recommend debridement within 24 hours of presentation. However, there are various reasons that debridement may be delayed beyond this due to patient instability from life-threatening injuries. This study evaluates the safety of non emergent debridement of open tibia shaft fractures beyond 12 and 24 hours.

Methods: Patients with open tibia shaft fractures undergoing surgical debridement were retrospectively reviewed. Patient demographics, injury severity, type of fixation, time to antibiotics, Gustilo classification and time to debridement were recorded. Patients were grouped into < 12h, 12-24h, and > 24h cohorts, based on time to debridement. Primary outcomes included rates of infection, tibia nonunion, and implant failure. Univariate analysis and logistic regression were performed.

Results: 66 patients were included in our study, with a median follow-up of 7.5 months (IQR = 4.8-13.5). Mean time-to-debridement was 15 hours ± 11.7. 33 patients (50%) underwent debridement < 12h, 24 patients (36%) between 12-24h, and 9 patients (14%) > 24h. In total, 12 patients (18%) went on to nonunion, 6 patients (9%) had an implant failure, and 14 patients (21%) experienced an infection. Infection, nonunion and implant failure rates did not vary between patients who underwent debridement < 12h (p = 0.22), between 12-24h (p = 0.55), and > 24h (p= 0.89).

Conclusion: In this study, surgical debridement of open tibia fractures 24 hours following presentation was not associated with increased complications. These findings suggest a possibly favorable outcome even for patients who cannot undergo urgent debridement due to medical issues or other traumatic factors.

Introduction and Importance: The management of post traumatic long bone osteomyelitis remains a challenging clinical problem. Multiple methods are described to treat large bone gaps, which are defined as segmental defects > 6 cm. The induced membrane technique de Masquelet constitutes a contribution for bone reconstruction in these cases.

Case Presentation: A 56-year-old man, admitted in March 2023 for proximal left femoral diaphysis fracture due to after-effects of chronic osteomyelitis since 2012. Last septic episode dates back to 2013. The patient did not present any cutaneous or vascular complications. the infectious assessment is negative. The patient underwent emergency immobilization using an external fixator type orthofix, then the fracture was treated using the two-stage induced membrane technique according to Masquelet.

Clinical Discussion: The management of long bone fractures resulting from chronic osteomyelitis remains a challenge. The bone defect after debridement is often significant, its reconstruction is difficult because it requires several techniques and operating times. As used in our case, the induced membrane technique, described for the first time by Masquelet in 1986, is a benefit for these fractures resulting from chronic osteomyelitis where the bone gap after debridement is often significant: gives time to control an infection and poses a reconstruction problem.

Conclusion: Large segmental bone defects can be managed using several methods. The induced membrane technique of bone reconstruction first proposed by Masquelet for large bone defects constitutes the gold standard for two-stage bone reconstruction.

Introduction: Osteo Articular Infections (OAI) refer to all musculoskeletal disorders affecting bones and/or joints caused by the penetration of a pathogenic microorganism into the human body. The aim of this study was to manage IOA in our department.

Patients and methods: We conducted an observational study covering a six-year period, January 2017 December 2022. We included patients and records of hospitalized patients treated and followed up for HAI.

Results: HAIs accounted for 2.9% of hospitalizations and were dominated by chronic osteomyelitis and osteitis. The average age was 29.4 years, with a male predominance of 64.7% and a sex ratio of 1.83. Septic wounds (95.6%), pain (94.1%) and fistulas (92.6%) were the most common signs. Radiographic signs were dominated by sequestration (67.6%). ECB performed in 100% of cases revealed Staphylococcus aureus in 77.9%, with sensitivity to β-lactam antibiotics (54.4%) and eight cases of absence of germs. At final follow-up, we recorded a very good result in six patients (31.6%), a good result in eight patients (42.1%) and a poor result in five patients (26.3%).

Conclusion: HAIs are common, and are diagnosed clinically, radiologically and microbiologically. Good results can be achieved with appropriate treatment.