The "Orthoplastic" combined surgical approach to open tibia fractures: a multicentric prospective outcome study

Introduction: Open fractures of the leg represent a severe trauma. The combined approach, shared between plastic and orthopaedic surgeons, is considered to be important, although this multidisciplinary treatment is not routinely performed. Aim of this study was to verify whether the orthoplastic treatment is of any advantage over the traditional simply orthopedic treatment, through a multicentric inclusion of these unfrequent injuries into a prospective study. Material and methods: The following trauma centres were involved: Rizzoli Orthopaedic Institute/University of Bologna (leading centre) and Maggiore Hospital (Bologna, Italy), Frenchay Hospital (Bristol, United Kingdom), Jinnah Hospital (Lahore, Pakistan). All patients consecutively hospitalized in the mentioned centres between January 2012 and December 2013 due to tibial open fractures were included in the study and prospectively followed up to December 2014. Demographics and other clinical features were recorded, including the type of treatment (orthopaedic or orthoplastic). The considered outcome measures included duration of hospitalization, time for bone union and soft tissue closure, Enneking score at 3, 6 and 12 months, the incidence of osteomyelitis and other complications. Results: A total of 164 patients were included in the study. Out of them 68% were treated with an orthoplastic approach, whereas 32% received a purely orthopedic treatment. All considered outcome measures showed to be improved by the orthoplastic approach, compared to the orthopaedic one: time for soft tissue closure (2 versus 25 weeks), duration of hospital stay (22 versus 55 days), time for bone union (6 versus 8.5 months) , number of additional operations (0.6 versus 1.2) and functional recovery of the limb at 12 months (27 versus 19, Enneking’s score). All results were statistically significant. Conclusion: The combined orthoplastic approach to the treatment of open tibia fractures, in particular for high grade injuries (Gustilo 3B), is proven to improve the outcome of these severe injuries.

The European legal approach to Open Science and research data

This dissertation proposes an analysis of the governance of the European scientific research, focusing on the emergence of the Open Science paradigm: a new way of doing science, oriented towards the openness of every phase of the scientific research process, able to take full advantage of the digital ICTs. The emergence of this paradigm is relatively recent, but in the last years it has become increasingly relevant. The European institutions expressed a clear intention to embrace the Open Science paradigm (eg., think about the European Open Science Cloud, EOSC; or the establishment of the Horizon Europe programme). This dissertation provides a conceptual framework for the multiple interventions of the European institutions in the field of Open Science, addressing the major legal challenges of its implementation. The study investigates the notion of Open Science, proposing a definition that takes into account all its dimensions related to the human and fundamental rights framework in which Open Science is grounded. The inquiry addresses the legal challenges related to the openness of research data, in light of the European Open Data framework and the impact of the GDPR on the context of Open Science. The last part of the study is devoted to the infrastructural dimension of the Open Science paradigm, exploring the e-infrastructures. The focus is on a specific type of computational infrastructure: the High Performance Computing (HPC) facility. The adoption of HPC for research is analysed from the European perspective, investigating the EuroHPC project, and the local perspective, proposing the case study of the HPC facility of the University of Luxembourg, the ULHPC. This dissertation intends to underline the relevance of the legal coordination approach, between all actors and phases of the process, in order to develop and implement the Open Science paradigm, adhering to the underlying human and fundamental rights.