Introduction and Objective

Over the past few years, a reorganization of the educational pathways has been promoted with the purpose of optimizing the acquisition of competences and their assessment, so as to reduce the risks to both health care professionals and end users. Virtual reality (VR) has been repeatedly tested, initially as a positive reinforcement for more traditional educational pathways and, more recently, as their potential substitute. The aim of this study was to demonstrate the potentiality of VR simulation training in spine surgery.

Reduction and fixation with a paracortical sliding screw or an intramedullary nail are the most used treatments for intertrochenteric fractures.

In cases of complications the attempt to perform further internal fixation may lead to failure because of the poor quality of bone and cartilage. Conversion to a hip replacement seems a better choice and the use of long stems with a distal, diaphyseal fit appears to be a good option, allowing to by-pass the intertrochanteric region. Authors report their experience in hip replacement for failed treatment of hip fractures that allow to restore immediately the function of the hip.

In Italy the osteoporosis cause approximately 250000 fracture/year. A useful aid in the treatment of this pathology comes from the Teriparatide, a synthetic form of the natural human parathyroid hormone, that stimulates the formation of new bone by increasing the number and action of bone-forming cells, unlike estrogen and bisphosphonate which are only able in slowing or stopping bone loss by blocking the action of osteoclasts. The Authors presents theirs first results after treatment with 20 mcg per day of Forsteo (Ely Lilly), trade name of the teriparatide, along with calcium (1000mg) and vitamin D (400UI) supplementation, for the previewed maximum period of 18 months, in women older than 65 years with unsatisfactory bisphosphonate treatment, T-score equal or inferior to −4, multiple vertebral osteoporotic fractures and one or more age-independent factors risk like: BMI< 19 kg/m2, maternal familiarity with neck-femoral fractures before 65 years old, premature menopause, conditions associated with the extended immobility. The treatment induced in all patients an increase of Ca plasmatic concentrations for 16–24 hours with a maximum peak in 4–6 hours. Condition like hypercalcemia, severe renal insufficiency, renal calculosis, hyperpara-thyroidism, Paget, alkaline hyperphosphatasaemia and previous therapy radiating are the main parameter of exclusion from the treatment.

B and C vertebral fractures types sec. Magherl have univocal indication to the surgery even if are in discussion both type and number of approaches than the characteristics of the osteosynthesis. About A type, instead, is debated if the treatment must be conservative or surgical. With the acquired experience in vertebro/kyphoplasty for the treatment of metastatic osteolytic or ostheoporotic fractures, Verlaan et al, in 2002, emphasized the possibility to use the kyphoplasty, in association to posterior stabilization, for treatment of traumatic toraco-lumbar A1-A2-A3 fractures, in order to reinforce the front column and to increase the vertebral body resistance. This idea, the experience of the kyphoplasty, the sophisticated B-Twin Expandable Spinal System mechanism, initially studied like intersomatic cage, are the base of a our technique for the treatment of great part of A type vertebral fractures.

The expansion of B-twin, introduced with transpe-duncolar approach, raise the plate reducing the fracture and creating an intraspongy space in which is possible to inject the cement at low pressure. We apply this technique approximately from one year, even if still experimental, without any cement complications or vertebral late sinking evidenced although we have always authorized the premature and not protected walking.

Different revision stems are described in literature: from the primary systems, with or without cementation, used for minor defects of the proximal femoral region, to special revision stems employs in order to by-pass meta-epiphyseal zones with high loss of bone-stock and to search a distal fit.

The Authors describe their experience with modular system ZMR (Zimmer, Warsaw, IN, USA), in Titanium alloy, available in two “configurations”: porous, in three distinct porous body styles with variable inclination neck to pair with straight or porous bowed spline stems available in different lengths and diameters optimising axial and rotational stability, and Taper, designed to provide a better distal fixation transmitting axial, torsional and bending loads to the adjacent bone through a splined taper stem, a more physiological cervical-diaphyseal angle and a neck planned in order to save the calcar zone. The mid-stem junction uses a Morse-type taper connection with a dynamometric system to assure locking of the body and stem components.. The Authors underline the benefit to use a versatile system able to allow the intraoperatory choice of antiversion, diameter and length more adapted diminishing the risks of a post-operative sinking and avoiding the corrosion phenomena of splice sites.