The 3rd Orthopaedic and Traumatologic Clinic prevalently Oncologic includes a hospitalization ward, an orthopaedic and surgical day hospital, a specialized outpatient clinic. It has 36 beds, organized in rooms with a bathroom and 3 beds each, provided with wi-fi connection. The presence of a physician is guaranteed in the ward every day from 8.00 a.m. to 8.00 p.m. Two nurses are on duty for night shifts.  

Clinical Practice

The Orthopaedic and Traumatology Clinic III with a prevalent focus on Oncology is part of the Centre for the Treatment of Sarcomas of the Musculoskeletal Apparatus of the Rizzoli Orthopaedic Institute. It is therefore a regional reference hub for the treatment of sarcomas of the bone and soft parts and also part of the European Rare Tumour Euracan network. 

It comprises:

• inpatient ward;
• beds for thoracic surgery for the treatment of sarcomas;
• medical and surgical day hospital;
• medical outpatient clinic for specialist examinations of:
• Oncological orthopaedics
• Paediatric Oncological Orthopaedics
• Infections in Orthopaedic-Oncology

The ward has 30 beds, organised in rooms with 2 beds each, wi-fi connection and Smart TV. All rooms have a bathroom. The presence of the doctor on the ward is guaranteed every weekday from 8.00 a.m. to 7.30 p.m., while nursing and support staff are present 24 hours a day. 

Clinical Activity

Clinic III mainly treats patients with tumours of the musculoskeletal system, both bone and soft tissue. In particular, the activity of Clinic III is aimed at the diagnosis and treatment of:

Most of the cases are primitive tumours, both paediatric and adult, which involve complex reconstructive techniques: resection prostheses, custom-made 3D printing prostheses, extensible prostheses for paediatric patients, homoplastic bone grafts, vascularised fibula grafts with the involvement of other surgical disciplines such as plastic surgery.

At the Orthopaedic Clinic III, minimally invasive treatments are also performed for the treatment of tumours of the musculoskeletal system, including bone metastases: electrochemotherapy, cryotherapy, thermoablation, embolisation, focused ultrasound surgery (FUS), in collaboration with Diagnostic and Interventional Radiology.

Patients with failed hip and knee joint replacements are also treated. Patients with sports and road trauma sequelae with severe disabling outcomes, delayed fracture consolidation and bone necrosis. Finally, patients with heterotopic ossifications of the hips and those with paraplegia are treated (to whom surgical removal of the ossifications is proposed for recovery of joint motility).

Particular attention is given to smaller patients. 
In this case, hospitalisation is carried out in an environment suitable for both paediatric patients and their carers.

Diagnostic-therapeutic pathway for paediatric patients with tumours of the musculoskeletal system: an outpatient clinic dedicated to paediatric patients treated for neoplasms of the musculoskeletal system has been set up.

Clinic III works in close collaboration with the Osteo-oncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies Unit of the Institute. This enables the most efficient coordination of care during all phases of treatment of sarcoma patients.

Clinic III also collaborates with the Rare Skeletal Diseases Unit of the Institute, which is part of the regional Hub & Spoke project on the diagnosis and treatment of rare skeletal diseases (Exostosseous disease and other chondrodysplasias).

Clinic III also performs Day Surgery activities mainly aimed at meniscal pathologies, benign tumours of the hand and foot, and pseudotumoral lesions in children.
Telematic counselling for tumour pathology of the locomotor system is performed nationally and internationally.

Overall, an average of around 1,000 new cases per year of patients with musculoskeletal diseases are treated.
The Unit and the Institute participate in a clinical care pathway of Bologna and province on the multidisciplinary care of patients with musculoskeletal metastases and collaborate in a national multicentre prospective study on surgically treated bone metastases (Sofia Proget).

Care

The care pathway begins with taking charge of the patient and his or her family with the first visit to our outpatient clinics, continues in the event of the need for surgical treatment with the planning of a protected discharge as the cancer patient must be guaranteed continuity of care. Continuity is guaranteed by the entire care team:

• Orthopaedic physicians
• Nurses
• Support staff
• Physiotherapists
• Physiotherapists
• Social workers
• Psychologist
• Doctors specialising in pain therapy

Professionals are involved in the care pathway through established operational mechanisms based on the team's assessment of clinical and care needs. The nurse and the doctor in charge of welcoming the patient in the ward on the day of admission, through an accurate interview will be able to: detect the socio-assistential needs, complete further diagnostic examinations if required, plan the provision of care, for the entire hospital stay with particular attention to discharge.

Particular attention is paid to pain control. Throughout the hospital stay, nurses and a specialist doctor will systematically monitor pain and adjust the analgesic therapy if necessary.

Discharge is planned and prepared by the entire care team; where necessary, we request the presence of the social worker in order to guarantee continuity of care. The social worker, the nurse and the ward doctor activate the socio-assistance network in the area, when the family network is unable to take charge of the relative.

Research Activity

Clinic III staff actively participate in both national and international research projects aimed at improving the diagnosis and treatment of sarcoma patients. Clinical research activity is supported by dedicated staff in the Clinical Trials Office.
Clinical research activities are carried out along the following departmental research lines:

• use of modular resection prostheses in orthopaedic oncological surgery;
• vascularised fibula transplantation and bone grafts in skeletal reconstructions;
• study of pelvic sarcomas and their treatment;
• bone metastases from carcinoma: prognostic and therapeutic factors;
• surgery of soft tissue sarcomas;
• infections in large joint reconstructions;
• identification of the potential for malignant transformation of chondrodysplasias of oncological interest (Ollier's disease, Maffucci syndrome, etc.);
• evaluation of radiofrequency thermo-ablation techniques under T.C. guidance of bone tumours;
• treatment of benign tumours of the musculoskeletal system;
• study on the comparison of imaging with Dynamic Magnetic Resonance Imaging and the histological reading of necrosis after chemotherapy and/or radiotherapy in osteosarcomas and Ewing's sarcomas, as well as in some soft part sarcomas.

The following projects, concerning the qualification of care activities and quality of life on the ward, are currently in progress at the Clinic III:

• Interactive training project for internal nursing staff. The aim of this project is to promote and improve specific communication skills of the group of professional nurses through an active and interdisciplinary methodology;
• Internal reorganisation project based on the assessment of care complexity. The project envisages the inclusion of the figure of the 'Case Manager' with the aim of facilitating the discharge and out-of-hospital care of patients with high care complexity at home.

School-hospital project

A school-to-hospital project is active on the ward to ensure that hospitalised children can continue their schooling.