1
|
Paderni S, Pari C, Raggini F, Busatto C, Delmastro E, Belluati A. Third generation Dual Mobility Cups: could be the future in total hip arthroplasty? A five-year experience with dualis. Acta Biomed 2022; 92:e2021553. [PMID: 35604267 DOI: 10.23750/abm.v92is3.12541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The concept of dual mobility (DM) is currently approved as a valid option for reducing the risk of dislocation, with an incidence ranging from 0% to 4.6%. The principle is to achieve a high joint stability through a large diameter polyethylene (PE) liner, and to reduce cutting forces due to a "low-friction" head-liner coupling mechanism. METHODS From March 2015 to March 2020, 138 patients were treated with Dualis Cup (Gruppo Bioimpianti-Peschiera Borromeo, MI, Italy) for a total of 141 implants (three cases were bilateral). The average age at the time of the surgery was 77. Patients' clinical and X-ray follow-up was at 1, 3, 6, 12 months and then once a year. RESULTS Seven patients (4.9%) had complications which required a second surgery, but only one case (0.7%) of intraprosthetic dislocation (which required cup revision), was directly ascribable to the DM cup. CONCLUSIONS Improvements in design and materials of the third generation DM cups allowed both to reduce the rate of dislocations in high-risk patients (i.e., patients with neuro-muscular diseases and cognitive disorders, patients needing revisions, osteosynthesis failures, femoral neck fractures) and to achieve a survival rate similar to standard cups, ensuring a range of motion (ROM) very close to the physiological one. In our brief experience, Dualis Cups showed results comparable to those reported in the literature for Dual Mobility. If this data is confirmed by long-term studies, the use of DM cups could be extended even for young patients with high functional demands. (www.actabiomedica.it).
Collapse
Affiliation(s)
- Stefania Paderni
- Orthopaedic and Trauma Department, Hospital Santa Maria delle Croci, Ravenna, Italy.
| | - Carlotta Pari
- Orthopaedic and Trauma Department, Hospital Santa Maria delle Croci, Ravenna, Italy.
| | - Filippo Raggini
- Orthopaedic and Trauma Department, University Vita-Salute San Raffaele, Milan, Italy.
| | - Carlo Busatto
- Orthopaedic and Trauma Department, Hospital Santa Maria delle Croci, Ravenna, Italy.
| | - Elena Delmastro
- Orthopaedic and Trauma Department, University Vita-Salute San Raffaele, Milan, Italy.
| | - Alberto Belluati
- Orthopaedic and Trauma Department, Hospital Santa Maria delle Croci, Ravenna, Italy.
| |
Collapse
|
2
|
Pari C, Raggini F, Paderni S, Bettinelli G, Salini V, Vicenti G, Belluati A. One-stage procedure for open tibial fractures: feasible without orthoplastic surgery? Acta Biomed 2021; 92:e2021018. [PMID: 34313664 PMCID: PMC8420821 DOI: 10.23750/abm.v92is3.11736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/19/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Open tibial fractures are mostly the result of high-energy traumas and often involve severe injuries with extensive bone and soft tissue loss, damage of muscles and neurovascular structures. Over recent- years, - the growth of Ortho-Plastic teams, as a well-coordinated bone, joint and soft tissue treatment, contributed to change the approach to these fractures and to achieve higher successful results in lower limb salvage. Unfortunately, many hospitals cannot benefit of a combined team in emergency, and the orthopedic surgeon is forced to manage personally these kinds of traumas. METHODS We retrospectively reviewed all the open tibial fractures treated at our Orthopaedic Department over the last 10 years, in order to assess the treatments performed (one-stage fixation with Intramedullary Nailing or Open Reduction Internal Fixation - ORIF, versus two/multiple-stage fixation with temporary External Fixation followed by nailing or ORIF) and the differences in the outcome between the different methods. PURPOSE Based on our experience and review of the literature, the purpose of this paper is to define what cases can be managed by a single-stage orthopaedic approach, and when the orthopaedist should lay down his arms in favor of other specialties.
Collapse
Affiliation(s)
- Carlotta Pari
- Orthopaedic and Trauma Department, Hospital Santa Maria delle Croci, Ravenna, Italy.
| | - Filippo Raggini
- Orthopaedic and Trauma Department, University Vita-Salute San Raffaele, Milan, Italy.
| | - Stefania Paderni
- Orthopaedic and Trauma Department, Hospital Santa Maria delle Croci, Ravenna, Italy.
| | - Giulia Bettinelli
- Orthopaedic and Trauma Department, University Vita-Salute San Raffaele, Milan, Italy.
| | - Vincenzo Salini
- Orthopaedic and Trauma Department, University Vita-Salute San Raffaele, Milan, Italy.
| | - Giovanni Vicenti
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari -Aldo Moro‖ - AOU Consorziale -Policlinico‖, Bari, Italy.
| | - Alberto Belluati
- Orthopaedic and Trauma Department, Hospital Santa Maria delle Croci, Ravenna, Italy.
| |
Collapse
|
3
|
Chesser TJS, Handley R, Kloos J, De Wachter G, Putzeys G, Gómez-Vallejo J, Sánchez-Pérez C, Chana-Rodríguez F, Raggini F, Pari C, Paderni S, Contini A, Belluati Md A, Daskalakis I, Sperelakis I, Kostakos A, Tosounidis TH, Halvachizadeh Md S, Pape Md HC, Bouillon B, de Bruin BJ, Ponsen KJ. International trauma care: initial European approaches during the COVID 19 pandemic. OTA Int 2021; 4:e112. [PMID: 38630066 PMCID: PMC7959856 DOI: 10.1097/oi9.0000000000000112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/28/2020] [Indexed: 11/25/2022]
Abstract
The world was not prepared for the global of pandemic in early 2020 with the arrival of COVID 19. Europe has some of the most developed health care systems in the world and this article explains the initial response to the pandemic from an orthopaedic and trauma viewpoint from 8 nations. Italy reported the first cluster in February, which then rapidly spread around the continent, requiring a rapid reorganization of services. The reports highlight how elective surgery was universally stopped, surgical services were reconfigured, and new practices, such as the widespread use of telemedicine, may well become permanent. It also emphasizes how the pandemic has re-educated us on the importance of a consistent and central approach to deal with a global health crisis, and how medical services need to remain flexible and responsive to new ways of working.
Collapse
Affiliation(s)
| | | | - Johannes Kloos
- Orthopaedic and Traumatology Surgeon, Jessa Hospital, Hasselt
| | | | - Guy Putzeys
- Orthopaedic and Traumatology Surgeon, Groeninge Hospital Kortrijk, Belgium
| | | | - Coral Sánchez-Pérez
- Orthopaedic Department, General University Hospital Gregorio Marañón, Madrid, Spain
| | | | - Filippo Raggini
- Orthopaedic and Trauma Department, University Vita-Salute San Raffaele, Milan
| | - Carlotta Pari
- Orthopaedic and Trauma Department, Hospital Santa Maria delle Croci, Ravenna
| | - Stefania Paderni
- Orthopaedic and Trauma Department, Hospital Santa Maria delle Croci, Ravenna
| | - Achille Contini
- Orthopardic and Trauma Department, Ospedale del Mare, Naples
| | - Alberto Belluati Md
- Orthopaedic and Trauma Department, Hospital Santa Maria delle Croci, Ravenna, Italy
| | | | | | | | | | | | - Hans-Christoph Pape Md
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Zurich, Switzerland
| | - Bertil Bouillon
- Department of Trauma and Orthopaedic Surgery, University of Witten/Herdecke, Cologne Merheim Medical Center, Cologne, Germany
| | | | - Keesjan J Ponsen
- Department of Surgery, TraumaUnit, Noordwest ZH Groep, Alkmaar, the Netherlands
| |
Collapse
|
4
|
Goretti C, Pari C, Puzzo A, Rizqallah Y, Bonanno MG, Belluati A. Injury of the brachial artery accompanying simple closed elbow dislocation: a case report. Acta Biomed 2020; 91:e2020030. [PMID: 33559638 PMCID: PMC7944710 DOI: 10.23750/abm.v91i14-s.8507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 03/01/2020] [Indexed: 11/30/2022]
Abstract
Background: Elbow dislocation is the second common dislocation in adults, after the shoulder. The anatomical proximity to the joint of the brachial artery could lead to concomitant vascular injuries, even if their occurrence remains very rare. Method: It is reported the case of a right-hand-dominant 42-year-old man who sustained a simple closed posterior elbow dislocation of his left elbow, associated to a complete brachial artery rupture. He urgently underwent the reduction of the joint dislocation and an artery-repairing surgical procedure using a graft from ipsilateral saphenous vein. Results: The full functional capacity of the elbow was obtained. Conclusions: The abundance of the brachial artery collateral network may hide the presence of a vascular injury, potentially associated to a closed elbow dislocation. Therefore, a high index of suspicious should be maintained. The Emergency Team plays a crucial role in its early diagnosis, which is essential to avoid irreversible ischemia related damages. A prompt reduction of the joint dislocation and the vascular injury surgical repair are required. Regarding the treatment of the concomitant collateral ligaments and capsular injuries, the indication to proceed to the simultaneous ligaments reconstruction is still controversial in literature.
Collapse
|
5
|
Puzzo A, Pari C, Bettinelli G, Raggini F, Paderni S, Belluati A. An unusual two-stage infection following a scolopendra bite. Acta Biomed 2020; 91:e2020009. [PMID: 33559643 PMCID: PMC7944685 DOI: 10.23750/abm.v91i14-s.10783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022]
Abstract
Background: Scolopendrae represent the best-known genus of centipedes. They are nocturnal general feeders with strong mandibles and venomous fangs which leave visible puncture marks at the bite site. The bite accidents occur during the warm rainy season and mostly take place on the extremities. Following the bite, the most common symptoms are mild: limited localized erythema, pain, swelling, local itching and burning sensation. However, more severe local and systemic sequelae can not be excluded. Method: we report the case of a 63-year-old man with fever and a widespread edema of the right hand and forearm, happened as a consequence of a Scolopendra Subspinipes bite. During the weeks following the bite, he developed a severe unusual superinfection via hematogenous dissemination, which required a double surgical debridement and a targeted intravenous antibiotic therapy. Results: the complete clinical recovery took over two months. Conclusions: Many victims of Scolopendra envenomation do not seek medical attention since most symptoms will resolve spontaneously. The case presented falls within the spectrum of those rare cases which escalate due to bacterial superinfection.
Collapse
Affiliation(s)
- Agnese Puzzo
- Orthopaedic and Trauma Department, Hospital Santa Maria delle Croci, Ravenna, Italy.
| | | | - Giulia Bettinelli
- Orthopaedic and Trauma Department, University Vita-Salute San Raffaele, Milan, Italy.
| | - Filippo Raggini
- Orthopaedic and Trauma Department, University Vita-Salute San Raffaele, Milan, Italy.
| | - Stefania Paderni
- Orthopaedic and Trauma Department, Hospital Santa Maria delle Croci, Ravenna, Italy.
| | - Alberto Belluati
- Orthopaedic and Trauma Department, Hospital Santa Maria delle Croci, Ravenna, Italy.
| |
Collapse
|
6
|
Mischler D, Babu S, Osterhoff G, Pari C, Fletcher J, Windolf M, Gueorguiev B, Varga P. Comparison of optimal screw configurations in two locking plate systems for proximal humerus fixation - a finite element analysis study. Clin Biomech (Bristol, Avon) 2020; 78:105097. [PMID: 32623297 DOI: 10.1016/j.clinbiomech.2020.105097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/08/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Management of proximal humerus fractures is challenging, especially in elderly. Locking plating is a common surgical treatment option. The Proximal Humerus Internal Locking System (plate-A) has shown to lower complication rates compared to conventional plates, but is associated with impingement risk, which could be avoided using Peri-articular Proximal Humerus Plate (plate-B). Nevertheless, biomechanical performance and optimal screw configuration of plate-B is unknown. The aim of this study was to evaluate different screw configurations of plate-B and compare with plate-A using finite element analyses. METHODS Twenty-six proximal humerus models were osteotomised to create unstable three-part fractures, fixed with either of the two plates, and tested under three anatomical loading conditions using a previous established and validated finite element simulation framework. Various clinically relevant screw configurations were investigated for both plates and compared based on the predicted peri-implant bone strain, being a validated surrogate of cyclic cut-out failure. FINDINGS Besides increasing the number of screws, the placement of the posterior screws in combination with the calcar screw in the plate-B significantly decreased the predicted failure risk. Generally, plate-A had a lower predicted failure risk than plate-B. INTERPRETATION The posterior and calcar screws may be prioritized in plate-B. Compared to plate-A, the more distal positioning, less purchase in the posterior aspect and a smaller screw spread due to not fitting of the most distal calcar screw in most investigated subjects led to a significantly higher predicted failure risk for most plate-B configurations. The findings of the simulations study require clinical corroboration.
Collapse
Affiliation(s)
| | - Satish Babu
- Trauma and Orthopaedic Department, Frimley Park Hospital, Camberley, UK
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Carlotta Pari
- Orthopaedic, and Trauma Department, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - James Fletcher
- AO Research Institute Davos, Davos, Switzerland; Department for Health, University of Bath, Bath, UK
| | | | | | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
| |
Collapse
|
7
|
Colasanti GB, Pari C, Puzzo A, Paderni S, Goretti C, Belluati A. A 2-free-end flexor carpi radialis tendon graft for treating a complex index finger extensor tendon injury. Acta Biomed 2020; 91:276-279. [PMID: 32555110 PMCID: PMC7944807 DOI: 10.23750/abm.v91i4-s.9475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/10/2020] [Indexed: 11/30/2022]
Abstract
Background: Volar plating has increasingly become the most used technique for the treatment of unstable distal radius fractures due to the low soft-tissue disturbance and its biomechanical reliability, which allows the early mobilization of the wrist. One of the main goals of the volar locking compression plates design is to avoid those soft tissue complications historically associated to the dorsal plating. However, extensor tendon complications can not be completely excluded. Method: The authors report the case of a patient with a complete rupture of the index finger extensor tendons after volar plate fixation of the distal radius. Due to the presence of a severe tendons retraction with a 4-centimeter gap and the neighbouring soft tissues damage, it was decided to fill the gap with a 2-free-end autograft harvested from the Flexor Carpi Radialis (FCR) tendon, using the volar surgical approach performed to remove the plate. Results: At the 2-month follow-up, the patient showed the complete recovery of the flexion-extension movements. Conclusions: Even though the 2-free-end FCR tendon graft is not commonly reported for the reconstruction of extensor tendons defects, we assume it deserves to be considered as an adequate technique whenever the neighbouring tendons are critically compromised. (www.actabiomedica.it)
Collapse
Affiliation(s)
| | - Carlotta Pari
- Orthopaedic and Trauma Department - Hospital Santa Maria delle Croci - Ravenna.
| | - Agnese Puzzo
- Orthopaedic and Trauma Department - Hospital Santa Maria delle Croci - Ravenna.
| | - Stefania Paderni
- Orthopaedic and Trauma Department - Hospital Santa Maria delle Croci - Ravenna.
| | - Claudio Goretti
- Orthopaedic and Trauma Department - Hospital Santa Maria delle Croci - Ravenna.
| | - Alberto Belluati
- Orthopaedic and Trauma Department - Hospital Santa Maria delle Croci - Ravenna.
| |
Collapse
|
8
|
Osterhoff G, Wulsten D, Babu S, Heyland M, Pari C. Antegrade versus retrograde screw fixation of anterior column acetabular fractures: a biomechanical in vitro study. Eur J Trauma Emerg Surg 2019; 47:1307-1312. [PMID: 31664465 DOI: 10.1007/s00068-019-01255-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/22/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND To compare the mechanical strength of antegrade versus retrograde lag screw fixation of anterior column acetabular fractures. METHODS Standardised anterior column fractures were created in synthetic pelvis models and stabilised by either antegrade (ANTE, n = 4) or retrograde (RETRO, n = 4) anterior column screw fixation. In a validated setup, a cyclic loading protocol was applied with increasing axial force (750 cycles, 250-750 N) followed by load to failure. Construct survival, energy absorbed, construct stiffness, and load to failure were assessed. Descriptive and opto-metric methods were used to describe the mode of failure. RESULTS All constructs failed with loads below 1500 N. With regard to energy absorbed until failure, the ANTE group resisted to 3.763 × 105 N*cycles (range 3.760 × 105-3.763 × 105) and the RETRO group to 3.762 × 105 N*cycles (range 3.761 × 105-3.765 × 105; p = 1.0). The load to failure was 1254 N (range 977-1299) in the ANTE group and 1234 N (range 1087-1456) in the RETRO group (p = 1.0). Construct stiffness with 250 N was not different between the two groups (ANTE 192 N/mm vs. RETRO 215 N/mm, p = 0.486). In all samples, the mode of failure was a transiliac fracture with screw breakout due to rotation of the pubic fragment around the axis of the screw with a range of rotational motion [ROM] during cyclic testing of 0.96° in one ANTE sample and 0.82° in one RETRO sample for 750 N, and ROM at failure of 2.53° in one ANTE sample and 2.23° in one RETRO sample. There was some plastic deformation of the screws in all cases but no breakage. CONCLUSIONS In this in vitro mechanical study, antegrade screw fixation of an anterior column acetabular fracture was not different in construct survival, load to failure, stiffness, and mode of failure when compared to retrograde screw fixation.
Collapse
Affiliation(s)
- Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Dag Wulsten
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Satish Babu
- Trauma and Orthopaedic Department, Frimley Park Hospital, Camberley, UK
| | - Mark Heyland
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Carlotta Pari
- Orthopaedic, and Trauma Department, Santa Maria Delle Croci Hospital, Ravenna, Italy
| |
Collapse
|
9
|
Pari C, Puzzo A, Paderni S, Belluati A. Annular ligament repair using allograft for the treatment of chronic radial head dislocation: a case report. Acta Biomed 2018; 90:154-157. [PMID: 30715016 PMCID: PMC6503397 DOI: 10.23750/abm.v90i1-s.8010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 12/19/2018] [Indexed: 11/24/2022]
Abstract
Background: The annular ligament has a crucial role in the radial head stability and it is critical to the proper functioning of the proximal radio-capitellar joint. Its chronic injury may lead to radial head instability, elbow pain with decrease in motion and valgus deformity. Method: We present the case of a 53-year-old heavy laborer who reported a complex trauma of the right upper limb with a Floating Elbow Injury, associated to an open Monteggia fracture-dislocation. One month later, despite the definitive fixation with plates of both the forearm and the supracondylar fractures, X-rays showed the persistence of the radial head dislocation. A triceps autograft reconstruction for treating the chronic radial head dislocation, as described in literature, was not indicated in our patient, due to the recent surgery at the distal humerus site. Thus, it was decided to proceed to allograft reconstruction using a peroneal tendon from a cadaveric donor, fixed by modified Bell-Tawse Technique. Results: Two years after the surgery, x-rays showed the complete fractures’ healing; however a radial head notching was found. Conclusions: Allograft reconstruction of the annular ligament deserves to be considered as an adequate technique, whenever the surrounding soft tissues are critically compromised. In literature, the radial head notching complication is reported to be up to 36 %, and it may be related to the surgical technique, regardless of the graft used. (www.actabiomedica.it)
Collapse
Affiliation(s)
- Carlotta Pari
- Orthopaedic and Traumatology Department, Hospital Santa Maria delle Croci, Ravenna, Italy.
| | | | | | | |
Collapse
|
10
|
Belluati A, Pari C, Busatto C, Pantalone A, Salini V. Intercalary allograft reconstruction in a patient with large tibial defect: Case report. Injury 2018; 49 Suppl 4:S39-S42. [PMID: 30518509 DOI: 10.1016/j.injury.2018.09.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/29/2018] [Indexed: 02/02/2023]
Abstract
A fit 26 year-old-man presented to our Department with an open fracture of the left tibial shaft (AO 42-C3). The fracture was initially treated with an External Fixator, which was replaced by an intramedullary Grosse Kempf nail after 4 months. In the following year he developed an atrophic non-union and we witnessed the increasing bone resorption at the fracture site which led to the nail breakage. An accurate CT pre-operative planning was made and a revision surgery was successfully performed: the broken nail was removed and intercalary allograft reconstruction was made, using a compressible intramedullary nail. Whereas in literature it is well described how intercalary allografts can be used to fill the massive diaphyseal defects after tumor resections, we assumed it could also be an adequate technique to treat a large bone defect at a non-union site.
Collapse
Affiliation(s)
- Alberto Belluati
- Orthopaedic and Traumatology Department, Hospital Santa Maria delle Croci, Ravenna, Italy.
| | - Carlotta Pari
- Orthopaedic and Traumatology Department, Hospital Santa Maria delle Croci, Ravenna, Italy
| | - Carlo Busatto
- Orthopaedic and Traumatology Department, Hospital Santa Maria delle Croci, Ravenna, Italy
| | - Andrea Pantalone
- Orthopaedic and Traumatology Division, Department of Medicine and Science of Aging, University of Study "G. d'Annunzio" Chieti-Pescara, Italy
| | - Vincenzo Salini
- Orthopaedic and Traumatology Division, Department of Medicine and Science of Aging, University of Study "G. d'Annunzio" Chieti-Pescara, Italy
| |
Collapse
|
11
|
Caruso G, Andreotti M, Tonon F, Pari C, Massari L. Rapid Femoral Head Collapse after Removal of a Kuntscher Nail Implanted 35 Years Earlier: A Case Report. J Long Term Eff Med Implants 2018; 28:141-144. [PMID: 30317964 DOI: 10.1615/jlongtermeffmedimplants.2018027778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We report the case of a 54-year-old man who developed femoral head collapse after removal of a Kuntscher nail used to fix a shaft femoral fracture that occurred 35 years earlier. The removal of fixation devices implanted several years earlier can be a difficult procedure and can expose patients to several complications. Literature is still controversial regarding the correct timing and indications. It is mandatory to evaluate potential complications and inform the patients before undertaking this procedure when really necessary.
Collapse
Affiliation(s)
- Gaetano Caruso
- Department of Biomedical and Specialty Surgical Sciences, Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale Sant'Anna, University of Ferrara, Italy
| | - Mattia Andreotti
- Department of Morphology, Experimental Medicine and Surgery, Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale Sant'Anna, University of Ferrara, Italy
| | - Francesco Tonon
- Department of Morphology, Experimental Medicine and Surgery, Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale Sant'Anna, University of Ferrara, Italy
| | - Carlotta Pari
- Department of Morphology, Experimental Medicine and Surgery, Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale Sant'Anna, University of Ferrara, Italy
| | - Leo Massari
- Department of Biomedical and Specialty Surgical Sciences, Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale Sant'Anna, University of Ferrara, Italy
| |
Collapse
|
12
|
Caruso G, Andreotti M, Pari C, Soldati F, Gildone A, Lorusso V, Massari L. Can TAD and CalTAD predict cut-out after extra-medullary fixation with new generation devices of proximal femoral fractures? A retrospective study. J Clin Orthop Trauma 2017; 8:68-72. [PMID: 28360501 PMCID: PMC5359527 DOI: 10.1016/j.jcot.2016.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Intramedullary and extramedullary strategies of pertrochanteric fracture fixation are still controversial, but new percutaneous devices may give advantages regarding operative time, blood loss and rate of cardiovascular complications. We retrospectively analyze our cases regarding Anteversa® plate (Intrauma, Turin, Italy) fixation of pertrochanteric femoral fractures, focusing on the correlation between two radiographical parameters (tip-apex distance "TAD" and calcar referenced tip-apex distance "CalTAD") and the occurrence of cut-out. The purpose of this study was to determine if these predicting factors of cut-out are reliable in the treatment of proximal femoral fractures with the Anteversa plate. METHODS A series of 77 patients with 53 31-A1 fracture types and 24-A2 fractures completed a 12-month-follow-up. Clinical outcomes were evaluated according to Parker-Palmer Mobility Score at the final follow-up. TAD and CalTAD were considered to determine their correlation with cut-out events. RESULTS The mean Parker-Palmer Score was 6.94 in A1 group and 7.41 in A2 group (p = 0.47). Mean value of TAD index was 29.58, 29.81 in the A1 group and 29.08 in the A2 group, and mean value of CalTAD index was 30.87, 31.03 in the A1 group and 30.50 in the A2 group. We observed 3 cases of implant cut-out. We shared our sample in two groups, one group with TAD and CalTAD indices lower than 25 mm and another group higher than 25 mm to evaluate how the Palmer Parker score changed and no statistical differences were found between the two groups. CONCLUSIONS Taking into consideration that good clinical results were obtained for TAD and CalTAD values superior to 25 mm, the prognostic value of 25 mm of TAD and CalTAD indices might not be appropriate to this new percutaneous plate.
Collapse
|
13
|
Osti R, Pari C, Salvatori G, Massari L. Tri-length laser therapy associated to tecar therapy in the treatment of low-back pain in adults: a preliminary report of a prospective case series. Lasers Med Sci 2014; 30:407-12. [PMID: 25376670 DOI: 10.1007/s10103-014-1684-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/23/2014] [Indexed: 01/08/2023]
Abstract
Low-back pain is very frequent, especially in active adult population. There are several different orthopaedic condition that can cause low-back pain, and the pain worsen the quality of life significantly. The treatments vary from drugs, physical therapies, kinesiology, local infiltrations, and so on. Laser therapy has an important role in the treatment of the inflammatory causes of pain, with several studies that demonstrate the efficacy of low and high energy laser therapy in the treatment of low-back pain. Sixty-six consecutive patients with low-back pain with or without leg pain were treated using a combination of Tri-length laser I-Triax® (Mectronic Medicale, Bergamo, Italy) and Pharon® tecar therapy (Mectronic Medicale, Bergamo, Italy). The patients were treated three times a week, every other day, for a total of 10 sessions. Clinical results were evaluated using visual analogic scale for individual pain (0 to 10) and the Oswestry disability scale (ODS). Tests started before the beginning of therapies and 8 weeks after the end of the therapies. Visual analogic scale (VAS) score significantly improved from an average value of 8.1 ± 1.58 pre-treatment to an average value 8-weeks post-treatment of 2.63 ± 2.74 (P < .01). ODS values start from a pre-treatment average value of 53.0 ± 13.0 to a post-treatment average value of 23.5 ± 19.8 (P < .01). A higher improvement both in VAS and in ODS was denoted in the group of patient with low-back pain and leg pain (respectively, VAS from 8.66 ± 1.58 to 2.86 ± 2.94 and ODS from 57.8 ± 15.5 to 23.7 ± 19.5). Low-back pain, associated or not with leg pain, is a very common clinical situation. The treatments of this condition are different, and an important role can be given to the laser therapy. The conclusion of this study is that the association between laser therapy iLux-Triax® and tecar therapy Pharon® in the treatment of low-back pain, with or without leg pain, can significantly reduce pain and improve the quality of life in patients with degenerative and inflammatory problems.
Collapse
Affiliation(s)
- Raffaella Osti
- Orthopaedic Institute, University of Ferrara, Ferrara, Italy,
| | | | | | | |
Collapse
|
14
|
Osti L, Soldati F, Cheli A, Pari C, Massari L, Maffulli N. Biceps instability and Slap type II tear in overhead athletes. Muscles Ligaments Tendons J 2012; 2:258-266. [PMID: 23738307 PMCID: PMC3666530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Type II lesions are common lesions encountered in overhead athletes with controversies arising in term of timing for treatment, surgical approach, rehabilitation and functional results. The aim of our study was to evaluate the outcomes of arthroscopic repair of type II SLAP tears in overhead athletes, focusing on the time elapsed from diagnosis and treatment, time needed to return to sport, rate of return to sport and to previous level of performance, providing an overview concerning evidence for the effectiveness of different surgical approaches to type II SLAP tears in overhead athletes. A internet search on peer reviewed Journal from 1990, first descriprion of this pathology, to 2012, have been conducted evaluating the outcomes for both isolated Slap II tear overhead athletes and those who presented associated lesions treated. The results have been analyzed according to the scale reported focusing on return to sport and level of activity. Apart from a single study, non prospective level I and II studies were detected. Return to play at the same level ranged form 22% to 94% with different range of technique utilized with the majority of the authors recommending the fixation of these lesions but biceps tenodesis can lead to higher satisfaction racte when directly compated to the anchor fixation. Associated pathologies such as partial or full tickness rotator cuff tear did not clearly affect the outcomes and complications rate. There is no consensus regarding timing and treatment for type II SLAP, especially in overhead athletes who need to regain a high level of performance.
Collapse
Affiliation(s)
- Leonardo Osti
- Unit of Arthroscopy and Sports Medicine, Hesperia Hospital, Modena, Italy
| | | | - Andrea Cheli
- Unit of Orthopaedics and Traumatology, University of Ferrara, Italy
| | - Carlotta Pari
- Unit of Orthopaedics and Traumatology, University of Ferrara, Italy
| | - Leo Massari
- Unit of Orthopaedics and Traumatology, University of Ferrara, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK
| |
Collapse
|
15
|
Busetto L, Pilone V, Schettino AM, Furbetta N, Zappa M, Di Maro A, Borrelli V, Giardiello C, Battistoni M, Gardinazzi A, Perrotta N, Micheletto G, De Meis P, Martelli S, Marangon M, Forestieri P, Pari C, Gennai S, Mozzi E. Determinants of health-related quality of life in morbid obese candidates to gastric banding. Eat Weight Disord 2012; 17:e93-100. [PMID: 22314259 DOI: 10.3275/8244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To analyse determinants of self reported health-related quality of life (HR-QoL) in morbid obese patients candidates to laparoscopic adjustable gastric banding (LAGB). METHODS Determinants of HR-QoL were investigated in 383 morbid obese patients (82 M and 301 F) with BMI≥40 kg/m² (BMI≥35 kg/m² if complicated obesity) and age 18-60 years. HR-QoL was determined with the SF-36 questionnaire. Determinants of the two summary measures of SF-36 (physical component and mental component) were analysed by stepwise multiple linear regression analysis with age, BMI, physical comorbidites, mental comorbidites and eating behaviour disorders as independent variables. Physical comorbities (diabetes, hypertension, hypertriglyceridemia, low HDL, sleep apnea and osteoarthritis) were coded as present or absent on the basis of simple diagnostic clinical criteria; mental comorbidities (depression) and eating behaviour disorders (binge eating, sweet eating and nibbling) on the basis of an unstructured clinical interview. RESULTS Mean age was 38.8±10.2 years and mean BMI was 41.5±5.4 kg/m². Scores in the eight SF-36 subscales were lower in women than in men and lower than in the general Italian population. However, 18.4-43.5% of the participants had HR-QoL levels above the normative values, depending on the scale. In both genders, low scores in the mental component of the SF-36 were associated to the presence of depression and eating behaviour disorders and not to physical comorbidities or BMI levels. Low physical self-perceived well being was associated to high BMI levels in men and to depression, hypertension and hypertriglyceridemia in women. CONCLUSION HR-QoL was poor in morbid obese candidates to LAGB, particularly in women, and was negatively affected more by mental comorbidites and eating behaviour disorders than by physical comorbidities or BMI levels.
Collapse
Affiliation(s)
- L Busetto
- Clinica Medica I, Policlinico Universitario, Via Giustiniani 2, 35128 Padova, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Ferrucci PF, Tosti G, di Pietro A, Passoni C, Pari C, Tedeschi I, Cataldo F, Martinoli C, Testori A. Newly identified tumor antigens as promising cancer vaccine targets for malignant melanoma treatment. Curr Top Med Chem 2012; 12:11-31. [PMID: 22196269 DOI: 10.2174/156802612798919213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 04/15/2011] [Indexed: 11/22/2022]
Abstract
Immunogenicity of tumour cells, immunomodulation and direct targeting of signalling pathways are promising avenues and matter of dated and innovative research in melanoma. Unfortunately, tumour cells are considered to be antigenic, but not immunogenic, either due to presentation of weakly recognized antigens or to the inability of the immune system to recognize them. However, spontaneous complete remission can be rarely observed in patients affected by melanoma, which are mainly attributed to the immune response against the tumour. Also, an elevated frequency of spontaneous humoral immune responses against tumour antigens was occasionally found in patients. These data confirm the existence of an interaction of the immune system with the tumour which can be used as a promising pathway for intervention and incorporates all portions of the immune system. The cancer immunotherapy approach is based on artificial activation of the immune system against the tumour and groups several types of treatments including immunization/vaccination but also modulation of immunity by cytokines or antibodies. Immunization approaches could either be based on undefined tumour antigens (e.g. whole tumour cells, tumour cell lysates, or tumour-antigen enriched fractions) or aimed at eliciting T-cell responses against specific tumour antigens. Novel and contemporary antigen-targeted therapy strategies, mainly directed to Cancer Testis and Heat Shock Proteins, leading to a possible active immunization against melanoma through T-cell specific activation, are discussed in this review.
Collapse
Affiliation(s)
- P F Ferrucci
- Melanoma and Muscle Cutaneous Sarcomas Division, IEO-European Institute of Oncology, Milan, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
di Pietro A, Ferrucci P, Munzone E, Mosconi M, Gandini S, Pari C, Cataldo F, Verrecchia F, Nole F, Testori A. Dacarbazine (DTIC) plus bevacizumab (B) combination therapy in chemotherapy (CTh)-naïve advanced melanoma (MM) patients (pts): A phase II study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
18
|
Filicori M, Cognigni GE, Arnone R, Carbone F, Falbo A, Tabarelli C, Pari C, Ciampaglia W, Casadio P, Spettoli D, Pecorari R. Is multiple pregnancy an unavoidable complication of ovulation induction? The case for pulsatile GnRH. Eur J Obstet Gynecol Reprod Biol 1996; 65 Suppl:S19-21. [PMID: 8735007 DOI: 10.1016/0301-2115(96)02414-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Ovarian hyperstimulation (OHS) and multiple pregnancy are dreaded complications of ovulation induction. The use of pulsatile GnRH permits to prevent the occurrence of OHS and results in few multiple pregnancies. Low-dose GnRH administration, avoidance of preovulatory hCG, patient selection, and the use of GnRH agonist pituitary desensitization in selected patients permits to limit multiple conceptions to a level comparable with the occurrence of this complication in normal unstimulated women.
Collapse
Affiliation(s)
- M Filicori
- Department of Obstetrics and Gynecology, University of Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|