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Pavone V, DE Cristo C, Testa G, Canavese F, Lucenti L, Sessa G. Does age affect outcome in children with clavicle fracture treated conservatively? QuickDash and MRC evaluation of 131 consecutive cases. Minerva Pediatr (Torino) 2023; 75:339-346. [PMID: 29651831 DOI: 10.23736/s2724-5276.18.05101-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Non-operative treatment with immobilization is the gold-standard for paediatric clavicular fractures. Purpose of this study is to evaluate functional outcomes and efficacy of non-operative treatment of clavicular fractures in a succession of 131 children. METHODS Between 2006 and 2012, we treated non-surgically 131 children for a clavicular fracture. All fractures have been classified according to Robinson classification. Clavicle shortening, range of movements and muscular strength through the Medical Research Council (MRC) Scale were evaluated. To assess the outcomes, QuickDASH questionnaire, dividing the sample in 3 age-related group, was administered. RESULTS The average follow-up was 26 months (8-84 months). Clavicle shortening at the time of injury occurred in 18 cases. All fractures reached union. Average time to union was 34 days. Mean time return to activity was 12.6 weeks. No cases of nonunion or delayed union were reported. Complications occurred in 21 cases. A shortening persisted in 2 cases. Only one patient had a slight functional restriction. Average QuickDASH Score was 6.2±1.1 (range 4.3-9.4). All patients recovered to an MRC Score of 5, except for one patient with a score of 4. Best QuickDASH Scores were observed in the group aged under 8 years and in non-comminuted and lateral third fractures of the clavicle. CONCLUSIONS Observing results, clavicle fractures have a satisfactory clinical healing as shown by the good scores at QuickDASH and MRC Scale. Younger children under 8 years can achieve the best results with a conservative treatment in terms of bone healing and activity level.
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Affiliation(s)
- Vito Pavone
- Department of Orthopedics, "Policlinico Vittorio Emanuele" University Hospital, University of Catania, Catania, Italy
| | - Claudia DE Cristo
- Department of Orthopedics, "Policlinico Vittorio Emanuele" University Hospital, University of Catania, Catania, Italy
| | - Gianluca Testa
- Department of Orthopedics, "Policlinico Vittorio Emanuele" University Hospital, University of Catania, Catania, Italy -
| | - Federico Canavese
- Department of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand, France
| | - Ludovico Lucenti
- Department of Orthopedics, "Policlinico Vittorio Emanuele" University Hospital, University of Catania, Catania, Italy
| | - Giuseppe Sessa
- Department of Orthopedics, "Policlinico Vittorio Emanuele" University Hospital, University of Catania, Catania, Italy
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Altamura G, Nurchis MC, Santoli G, Riccardi MT, Sapienza M, Sessa G, Damiani G. Incremental net benefit of wearable devices for home monitoring of chronically ill patients. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.012] [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: 11/13/2022] Open
Abstract
Abstract
Background
Hospital overcrowding is a growing problem worldwide. Studies demonstrated that up to 40% to 67% of hospitalizations of residents in nursing homes may be avoidable, causing health and economic damages. Furthermore, research shows that for non-critical patients there are arguably no differences between home and hospital recovery in terms of health outcomes, with a preference for home settings in most patients. During COVID-19 pandemic, telemedicine and homecare increased its range of possible intervention, allowing efficient and cost-effective processes of care. Transdermal sensors are indeed a cheap and easy to use alternative to conventional instruments, allowing a continuously operative and ready-to-use tool to care providers. This systematic review aims to map the application fields of these technologies, demonstrating their accuracy and assessing their cost-effectiveness in chronically ill home-assisted patients.
Methods
Articles were retrieved from Scopus, Web of Science, and PubMed. The dominance ranking matrix (DRM) tool was applied to allow a qualitative synthesis of the studies. Incremental net benefits (INBs) were estimated and meta-analysis was implemented to pool INBs across studies. A comparison between wearables and conventional tools accuracy was simultaneously carried out through a literature review.
Results
The database search identified 1156 publications of which six articles were considered eligible for the meta-analysis. According to DRM, 80% of evaluated studies showed the cost-effectiveness of wearable devices. The pooled INB of wearables over conventional measurement was estimated at US$1280 (95% CI US$952 - US$2849). In 85% of evaluated wearables the accuracy resulted comparable to conventional measurement tools.
Conclusions
Wearables performances resulted as accurate as conventional methods and their application cost-effective. A continuous measurement of parameters may relate to a better process of care for chronically ill outpatients.
Key messages
• Wearables are a cheap and accurate alternative to conventional life parameters measurement tools.
• Technology evolution might soon reduce the pressure on hospitals, changing the care process of chronically ill outpatients allowing continuous evaluation of their health status.
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Affiliation(s)
- G Altamura
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
| | - MC Nurchis
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
- Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli , Rome, Italy
| | - G Santoli
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
| | - MT Riccardi
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
| | - M Sapienza
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
| | - G Sessa
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
| | - G Damiani
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
- Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli , Rome, Italy
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Papotto G, Testa G, Mobilia G, Perez S, Dimartino S, Giardina SMC, Sessa G, Pavone V. Use of 3D printing and pre-contouring plate in the surgical planning of acetabular fractures: A systematic review. Orthopaedics & Traumatology: Surgery & Research 2022; 108:103111. [DOI: https:/doi.org/10.1016/j.otsr.2021.103111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
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Papotto G, Testa G, Mobilia G, Perez S, Dimartino S, Giardina SMC, Sessa G, Pavone V. Utilisation de l’impression 3D et des plaques précontournées pour la planification et le traitement chirurgical des fractures de l’acetabulum : analyse systématique. Revue de Chirurgie Orthopédique et Traumatologique 2022; 108:221. [DOI: 10.1016/j.rcot.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
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5
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Tarantino U, Greggi C, Cariati I, Caldora P, Capanna R, Capone A, Civinini R, Colagrande S, De Biase P, Falez F, Iolascon G, Maraghelli D, Masi L, Cerinic MM, Sessa G, Brandi ML. Bone Marrow Edema: Overview of Etiology and Treatment Strategies. J Bone Joint Surg Am 2022; 104:189-200. [PMID: 34780382 DOI: 10.2106/jbjs.21.00300] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Bone marrow edema (BME) is a nonspecific but relevant finding, usually indicating the presence of an underlying pathology. ➤ The gold standard technique for detecting BME is magnetic resonance imaging (MRI), as it allows for a correct diagnosis to be made, which is extremely important given the heterogeneity of BME-related diseases. ➤ Depending on the severity of painful symptomatology and the MRI evidence, different treatment strategies can be followed: physical modalities, pharmacological options, and surgical therapy.
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Affiliation(s)
- Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy.,Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - Chiara Greggi
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy.,Medical-Surgical Biotechnologies and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - Ida Cariati
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy.,Medical-Surgical Biotechnologies and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | | | - Rodolfo Capanna
- Department of Orthopaedics and Traumatology, Universal Hospital of Pisa, Pisa, Italy
| | - Antonio Capone
- Department of Surgical Sciences, University of Cagliari, Monserrato, Italy
| | - Roberto Civinini
- Department of Surgical Science, University of Florence, Florence, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Pietro De Biase
- General Orthopaedics and Traumatology, AOU Careggi, Florence, Italy
| | - Francesco Falez
- Orthopaedic and Traumatology Department, S. Spirito Hospital, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli," Caserta, Italy
| | - Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Laura Masi
- Metabolic Bone Diseases Unit, University Hospital of Florence, AOU Careggi, Florence, Italy
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuseppe Sessa
- Section of Orthopaedics and Traumatology, Department of General Surgery and Medical Surgical Specialties, University Hospital Policlinico Rodolico-San Marco, University of Catania, Catania, Italy
| | - Maria L Brandi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Altamura G, Riccardi MT, Nurchis MC, Sapienza M, Sessa G, Damiani G, Ricciardi W. Algorithms and Artificial Intelligence in Primary Care for conscious drug use: a systematic review. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.339] [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: 11/14/2022] Open
Abstract
Abstract
Primary care is a growing medical field willing to become a more integrated and technological asset. Although big changes already happened and more investments have been made, a limited amount of literature describes processes and technologies there applied or to be used. This paper aims to evaluate the efficacy and usability of different types of algorithms in primary care to improve drug safety by speeding up processes and achieving greater accuracy opening the path to providing better healthcare overall. The PICO model was adopted, three electronic databases (PubMed, Cochrane, Web of Science) were searched using appropriate keywords. Selected studies were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment of Controlled Intervention Studies. Data were analysed using descriptive statistic, comparison of drug usage between algorithms or artificial intelligence application and usual care was performed using a χ2 test(α = 0.05). Out of 2207,19 studies were included,37% of them regarding error prevention,21% drug interactions,21% drug monitoring,16% drug prescription,5% drug administration. Results showed an easier and safer medication use in 74% of studies, a loss of safeness and accuracy in 16%; 10% of total studies did not come up with a valid esteem of results either for inadequate availability of the AI machine or because of the heterogeneity of the results in different settings. The evaluation of errors prevention, 40% of total studies, showed the most statistically significant results with 88% of positive outcomes from AI application. The results support that this technological approach to drugs management could contribute to the safety of treatment and to increase patients' and general practitioners' satisfaction. The application of AI or algorithms is significantly associated with a reduction of drug use errors (p < 0.05). Future studies should work toward establishing a gold standard to measure AI performances.
Key messages
Artificial Intelligence and Algorithms in primary care have the potentiality to disrupt patient care with a safer and faster medication management. A comparison between Artificial Intelligence or algorithms and standard clinical practice may help finding the medication fields where a technological support could lead to better results.
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Affiliation(s)
- G Altamura
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - MT Riccardi
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - MC Nurchis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M Sapienza
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Sessa
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Damiani
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - W Ricciardi
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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7
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Pavone V, Vescio A, Denaro R, Costa D, Condorelli G, Caruso VF, Sessa G, Testa G. Use of different devices for surgical treatment of proximal humerus fractures in adults: a systematic review. Acta Biomed 2021; 92:e2021198. [PMID: 34487079 PMCID: PMC8477127 DOI: 10.23750/abm.v92i4.11394] [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: 02/25/2021] [Accepted: 03/23/2021] [Indexed: 11/23/2022]
Abstract
Background and aim: Proximal humeral fracture is one of the most common osteoporotic fractures in elderly people. The proper treatment choice is controversial. Open reduction and internal fixation (ORIF) with plate and screws is currently the most common treatment for the majority of displaced proximal humeral fractures. The aim of this systematic review is to investigate the surgical treatment outcomes of PHFs, focusing on main used devices and surgical approaches. Methods: From the earliest record up to 21 July 2020, two independent authors conducted a systematic review of two medical electronic database (PubMed and Science Direct). To achieve the maximum sensitivity of the search strategy, the following terms were combined: “(proximal NOT shaft NOT distal) AND humeral AND fracture AND (plate OR locking plate OR osteosynthesis NOT nail NOT arthroplasty)” as either key words or MeSH terms. The risk of bias of the included studies was assessed, agreeing to the Cochrane Handbook guidelines. Results: Thirty-four articles were initially noticed after the term string research in the two electronic databases. Finally, after full-text reading and analyzing the reference list, 8 studies were selected. The mean age recorded was 69.5 years (Range 67-72). All the studies included two-, three-, four-fragments fracture. Seven studies investigated PHILOS (Synthes, Bettlach, Switzerland) implants results, while one investigated CFR-PEEK plate (PEEK Power Humeral Fracture Plate; Arthrex, Naples, Florida, USA) outcomes or other plates. Deltopectoral and Transdeltoid approaches were the more common used. Conclusions: Both deltopectoral and transdeltoid approaches are valid approach in plating after proximal humerus fractures, for these reasons, the surgeon experience is crucial in the choice. The more valid implant is still unclear. The develop of prospective randomized comparative studies is strongly encourages. (www.actabiomedica.it)
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy.
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy.
| | - Regina Denaro
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy.
| | - Danilo Costa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy.
| | - Giuseppe Condorelli
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy.
| | - Vincenzo Fabrizio Caruso
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy.
| | - Giuseppe Sessa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy.
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy.
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8
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Pavone V, de Cristo C, Vescio A, Lucenti L, Sapienza M, Sessa G, Pavone P, Testa G. Dynamic and Static Splinting for Treatment of Developmental Dysplasia of the Hip: A Systematic Review. Children (Basel) 2021; 8:104. [PMID: 33557053 PMCID: PMC7913860 DOI: 10.3390/children8020104] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/21/2021] [Accepted: 02/01/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is one of the most common pediatric conditions. The current gold-standard treatment for children under six months of age with a reducible hip is bracing, but the orthopedic literature features several splint options, and each one has many advantages and disadvantages. The aim of this review is to analyze the available literature to document the up-to-date evidence on DDH conservative treatment. METHODS A systematic review of PubMed and Science Direct databases was performed by two independent authors (C.d.C. and A.V.) using the keywords "developmental dysplasia hip", "brace", "harness", "splint", "abduction brace" to evaluate studies of any level of evidence that reported clinical or preclinical results and dealt with conservative DDH treatment. The result of every stage was reviewed and approved by the senior investigators (V.P. and G.T.). RESULTS A total of 1411 articles were found. After the exclusion of duplicates, 367 articles were selected. At the end of the first screening, following the previously described selection criteria, we selected 29 articles eligible for full text reading. The included articles mainly focus on the Pavlik harness, Frejka, and Tubingen among the dynamic splint applications as well as the rhino-style brace, Ilfeld and generic abduction brace among the static splint applications. The main findings of the included articles were summarized. CONCLUSIONS Dynamic splinting for DDH represents a valid therapeutic option in cases of instability and dislocation, especially if applied within 4-5 months of life. Dynamic splinting has a low contraindication. Static bracing is an effective option too, but only for stable hips or residual acetabular dysplasia.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (C.d.C.); (A.V.); (L.L.); (M.S.); (G.S.); (G.T.)
| | - Claudia de Cristo
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (C.d.C.); (A.V.); (L.L.); (M.S.); (G.S.); (G.T.)
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (C.d.C.); (A.V.); (L.L.); (M.S.); (G.S.); (G.T.)
| | - Ludovico Lucenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (C.d.C.); (A.V.); (L.L.); (M.S.); (G.S.); (G.T.)
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (C.d.C.); (A.V.); (L.L.); (M.S.); (G.S.); (G.T.)
| | - Giuseppe Sessa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (C.d.C.); (A.V.); (L.L.); (M.S.); (G.S.); (G.T.)
| | - Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, 95123 Catania, Italy;
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (C.d.C.); (A.V.); (L.L.); (M.S.); (G.S.); (G.T.)
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Damiani G, Pascucci D, Sessa G, Morini M, Fantini MP, Buja A, Lonati F, Adja KYC. [Fragility in a Public Health perspective: principles and tools for a "life course" approach prevention- oriented]. Ig Sanita Pubbl 2021; 77:381-403. [PMID: 33883749] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The Covid-19 pandemic significantly increased the workload for the Italian Health Service. There is few information in the literature on the pediatric population and on the management of pediatric hospitals. The aim of this article is to describe the management of healthcare services during Covid-19 emergency in Regina Margherita Children's Hospital. The Regina Margherita Children's Hospital is specialized in the prevention, diagnosis and treatment of pediatric diseases. About 1000 health worker work in this Hospital and 278 hospitalization places are available.
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Affiliation(s)
- G Damiani
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - D Pascucci
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - G Sessa
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - M Morini
- Coordinatore Gruppo di lavoro Assistenza Primaria Società Italiana Igiene e Medicina Preventiva
| | - M P Fantini
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna, Italia
| | - A Buja
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università di Padova, Italia
| | - F Lonati
- Presidente Associazione APRIREnetwork-Salute a Km0
| | - K Y C Adja
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna, Italia
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Evola FR, Evola G, Sessa G. Use of short stems in revision of standard femoral stem: A case report. World J Orthop 2020; 11:528-533. [PMID: 33269220 PMCID: PMC7672800 DOI: 10.5312/wjo.v11.i11.528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/14/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Short stems are usually uncemented prosthetics and are recommended in the treatment of traumatic or degenerative diseases of hip. In revision procedures for elderly patients with serious comorbidity, applying a short stem could reduce peri- and post-operative secondary surgical risks to femoral osteotomy, which are necessary for the removal of parts of the implant or acrylic cement from the medullary canal. There are no cases in the literature that apply a short stem for prosthetic revision by acrylic cement anchorage.
CASE SUMMARY A male patient had a left hip replacement in 1995 due to coxarthrosis. At the age of eighty the patient reported an accidental trauma and walked with pain in the left thigh. The X-ray highlighted the stem breakage in the distal section without fracturing the femoral cortex. The patient had various comorbidities (diabetes, anaemia, heart deficiency, and arrhythmia) presenting a high operation risk (ASA 4). During the revision procedure, the distal apex of the stem could not be removed from the femoral cortex. Because of the poor general health of the patient, the surgeon decided not to perform a Wagner femoral osteotomy to remove the distal section of the stem and decided to implant a short stem to avoid removing the stem section of the previous implant. The patient had his left femur X-rayed 15 d post-trauma.
CONCLUSION A field of application of short stem may be the development of a cemented short stem to reduce the complexity of the revision procedure.
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Affiliation(s)
| | - Giuseppe Evola
- General and Emergency Surgery Department, Surgery Clinic, Catania 95124, Italy
| | - Giuseppe Sessa
- University of Catania, Department of Surgery, Clinic Orthopaedic, Catania 95124, Italy
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11
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Testa G, Vescio A, Zuccalà D, Petrantoni V, Amico M, Russo GI, Sessa G, Pavone V. Diagnosis, Treatment and Prevention of Sarcopenia in Hip Fractured Patients: Where We Are and Where We Are Going: A Systematic Review. J Clin Med 2020; 9:jcm9092997. [PMID: 32957453 PMCID: PMC7563874 DOI: 10.3390/jcm9092997] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Sarcopenia is defined as a progressive loss of muscle mass and muscle strength associated to increased adverse events, such as falls and hip fractures. The aim of this systematic review is to analyse diagnosis methods of sarcopenia in patients with hip fracture and evaluate prevention and treatment strategies described in literature. Methods: Three independent authors performed a systematic review of two electronic medical databases using the following inclusion criteria: Sarcopenia, hip fractures, diagnosis, treatment, and prevention with a minimum average of 6-months follow-up. Any evidence-level studies reporting clinical data and dealing with sarcopenia diagnosis, or the treatment and prevention in hip fracture-affected patients, were considered. Results: A total of 32 articles were found. After the first screening, we selected 19 articles eligible for full-text reading. Ultimately, following full-text reading, and checking of the reference list, seven articles were included. Conclusions: Sarcopenia diagnosis is challenging, as no standardized diagnostic and therapeutic protocols are present. The development of medical management programs is mandatory for good prevention. To ensure adequate resource provision, care models should be reviewed, and new welfare policies should be adopted in the future.
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Affiliation(s)
- Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, 95124 Catania, Italy; (A.V.); (D.Z.); (V.P.); (M.A.); (G.S.); (V.P.)
- Correspondence:
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, 95124 Catania, Italy; (A.V.); (D.Z.); (V.P.); (M.A.); (G.S.); (V.P.)
| | - Danilo Zuccalà
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, 95124 Catania, Italy; (A.V.); (D.Z.); (V.P.); (M.A.); (G.S.); (V.P.)
| | - Vincenzo Petrantoni
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, 95124 Catania, Italy; (A.V.); (D.Z.); (V.P.); (M.A.); (G.S.); (V.P.)
| | - Mirko Amico
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, 95124 Catania, Italy; (A.V.); (D.Z.); (V.P.); (M.A.); (G.S.); (V.P.)
| | - Giorgio Ivan Russo
- Department of General Surgery and Medical Surgical Specialties, Urology Section, University Hospital Policlinico-San Marco, University of Catania, 95124 Catania, Italy;
| | - Giuseppe Sessa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, 95124 Catania, Italy; (A.V.); (D.Z.); (V.P.); (M.A.); (G.S.); (V.P.)
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, 95124 Catania, Italy; (A.V.); (D.Z.); (V.P.); (M.A.); (G.S.); (V.P.)
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Sessa G, Milani C, Occhini G, Marini G, Sarro A. Renewing primary care: the bottom-up experience of an Italian health professional movement. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1283] [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: 11/14/2022] Open
Abstract
Abstract
Sustainability of the National Health Systems (NHS) has been facing different challenges. A community-oriented Comprehensive Primary Health Care (CommOr C-PHC) could help its survival. Such a framework, focused on health promotion, primary prevention, not communicable disease management, requires new capabilities among health professionals. Considering teamwork and interprofessional collaboration (IPC) as PHC core elements, there is growing recognition of the need of interprofessional education (IPE). Nevertheless, italian medical education is distant from other disciplines and mainly based on hospital care settings. Since this situation represents an obstacle to implement a CommOr C-PHC model of health service, new ways of training students and retraining actual health workers should be developed.
The aim of the project is to design IPE programs and to improve IPC within the C-PHC framework, shared learning environments placed in the community were developed.
At the end of 2017 a group of young italian health professionals (public health resident, young general practitioner, social assistant, nurse, medical anthropologist, etc) founded the Campaign “2018 Primary Health care: Now or never”, a cultural movement of public health advocacy. Its goals are: The creation of a common cultural background through the study of PHC evidence and best italian and international practices. Organization of workshops all over Italy: peer education training session, site-visits, lectures with Italian and foreigner health professionals, based on need assessment methods.
Individuation of learning environments placed in the community and in a primary care setting where students can apprehend social determinants of health, exercise critical thinking and develop transprofessional knowledge.
Key messages
Young health professionals from Italy, starting from the need for a different educational framework, based on IPE, created a movement to defend the NHS and promote PHC principles. The success and large participation of a national campaign sustaining PHC and aimed at promoting interprofessional education shows the need for a change in the medical education field.
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Affiliation(s)
- G Sessa
- Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Milani
- Department of Public health, University of Florence, Florence, Italy
| | - G Occhini
- Local Health Organization Toscana Centro, Florence, Italy
| | - G Marini
- Dipartimento di medicina clinica e sperimentale, University of Ferrara, Ferrara, Italy
| | - A Sarro
- Dipartimento di medicina clinica e sperimentale, Università del Piemonte Orientale, Novara, Italy
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Sessa G, Occhini G, Milani C, Marini G, Sarro A. A public health Italian ethical movement to sustain the beveridge model: health promotion and equity. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1284] [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: 11/14/2022] Open
Abstract
Abstract
Worldwide sustainability of the National Health Systems (NHS) has been facing different challenges, such as population ageing, epidemiologic transition and deep social transformations. All these changes are struggling Italian welfare state and its public NHS. Following the principle of the Right to Health of the Declaration of Human Right and the Italian Constitution, a group of young health professionals from all over Italy founded a campaign called “2018 Primary Health care: Now or Never”(PHC Campaign) reminding WHO report of 2008 “primary Health Care: Now more than never”. This movement promotes a reform of the NHS focusing on comprehensive-PHC (C-PHC) and health promotion to guarantee sustainability of the Beveridge model italian system, fight health inequalities and answer the complexity of population needs in a period of spending cuts.
Since the beginning, the movement started an educational program through the study of the literature and the research of the Italian and international best practices of C-PHC and community health promotion. As a result, to achieve the goal of this project, PHC campaign organized peer education training sessions, educational site-visit of some Italian best practices, lectures and workshops with Italian and foreigner health professionals experts on the field. Several national and regional events had been organized all over Italy. Members of “PHC” Campaign have been invited to write books, news on web-based newspapers on this topic and participate in congresses. To date, PHC campaign might be considered one of the strongest not-institutional voices in Italy in supporting the public beveridge-model NHS
Moved from a strong ethical health policy view underlined the importance of the Right-to-Health and of a C-PHC based NHS, since the beginning, “2018 Primary Health care: Now or Never” Movement identified three asset of action: advocacy, education/knowledge and diffusion.
Key messages
The experience showed the importance of health professionals engagement in public health topics such as sustainability of public NHS in order to promote a reform towards health promotion and equity. PHC Campaign is an example of how a bottom-up ethical movement on public health from different Health professionals could actively contribute to promoting cultural and health policy change.
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Affiliation(s)
- G Sessa
- Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Occhini
- Local Health Organization Toscana Centro, Florence, Italy
| | - C Milani
- Department of Public health, University of Florence, Florence, Italy
| | - G Marini
- Dipartimento di medicina clinica e sperimentale, University of Ferrara, Ferrara, Italy
| | - A Sarro
- Dipartimento di medicina clinica e sperimentale, Università del Piemonte Orientale, Novara, Italy
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Testa G, Vescio A, Aloj DC, Costa D, Papotto G, Gurrieri L, Sessa G, Pavone V. Treatment of Infected Tibial Non-Unions with Ilizarov Technique: A Case Series. J Clin Med 2020; 9:1352. [DOI: https:/doi.org/10.3390/jcm9051352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024] Open
Abstract
Background: The Ilizarov external fixation technique has been widely used for the treatment of long-bone infected non-unions. After surgical infected bone resection, to allow filling of the remaining bone gap, biomaterials with antibacterial properties could be used. The aim of this study was to report outcomes of infected tibial non-unions treated using the Ilizarov technique and antibacterial bioactive glass. Methods: Between April 2009 and December 2014, 26 patients with infected tibial non-unions were treated with the Ilizarov technique and possible use of the bioactive glass, S53P4. The Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, a clinical and radiographic evaluating tool, was used for assessing the sample. Results: The average age at the start of treatment was 51 years. The mean follow-up time was 113 weeks. According to the ASAMI Functional Scoring System, 10 excellent (38.5%) cases and 12 good (46.1%) values were recorded. According to the ASAMI Radiological System, they were excellent in 16 (61.5%) cases and good in nine (34.6%). Conclusions: Treatment of infected tibial non-unions using the Ilizarov technique was effective in bone segment regeneration. To fill the remaining bone gap, additional bioactive glass S53P4 could be used, allowing a decrease in re-interventions and minimizing complications.
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Testa G, Vescio A, Aloj DC, Costa D, Papotto G, Gurrieri L, Sessa G, Pavone V. Treatment of Infected Tibial Non-Unions with Ilizarov Technique: A Case Series. J Clin Med 2020; 9:jcm9051352. [PMID: 32380709 PMCID: PMC7291197 DOI: 10.3390/jcm9051352] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/06/2020] [Revised: 04/26/2020] [Accepted: 05/02/2020] [Indexed: 12/01/2022] Open
Abstract
Background: The Ilizarov external fixation technique has been widely used for the treatment of long-bone infected non-unions. After surgical infected bone resection, to allow filling of the remaining bone gap, biomaterials with antibacterial properties could be used. The aim of this study was to report outcomes of infected tibial non-unions treated using the Ilizarov technique and antibacterial bioactive glass. Methods: Between April 2009 and December 2014, 26 patients with infected tibial non-unions were treated with the Ilizarov technique and possible use of the bioactive glass, S53P4. The Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, a clinical and radiographic evaluating tool, was used for assessing the sample. Results: The average age at the start of treatment was 51 years. The mean follow-up time was 113 weeks. According to the ASAMI Functional Scoring System, 10 excellent (38.5%) cases and 12 good (46.1%) values were recorded. According to the ASAMI Radiological System, they were excellent in 16 (61.5%) cases and good in nine (34.6%). Conclusions: Treatment of infected tibial non-unions using the Ilizarov technique was effective in bone segment regeneration. To fill the remaining bone gap, additional bioactive glass S53P4 could be used, allowing a decrease in re-interventions and minimizing complications.
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Affiliation(s)
- Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, AOU Policlinico—Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (G.T.); (A.V.); (D.C.); (G.P.); (L.G.); (G.S.)
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, AOU Policlinico—Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (G.T.); (A.V.); (D.C.); (G.P.); (L.G.); (G.S.)
| | | | - Danilo Costa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, AOU Policlinico—Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (G.T.); (A.V.); (D.C.); (G.P.); (L.G.); (G.S.)
| | - Giacomo Papotto
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, AOU Policlinico—Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (G.T.); (A.V.); (D.C.); (G.P.); (L.G.); (G.S.)
| | - Luca Gurrieri
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, AOU Policlinico—Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (G.T.); (A.V.); (D.C.); (G.P.); (L.G.); (G.S.)
| | - Giuseppe Sessa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, AOU Policlinico—Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (G.T.); (A.V.); (D.C.); (G.P.); (L.G.); (G.S.)
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, AOU Policlinico—Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (G.T.); (A.V.); (D.C.); (G.P.); (L.G.); (G.S.)
- Correspondence: ; Tel.: +39-0953-7822-73
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Testa G, Vescio A, Perez S, Consoli A, Costarella L, Sessa G, Pavone V. Extracorporeal Shockwave Therapy Treatment in Upper Limb Diseases: A Systematic Review. J Clin Med 2020; 9:E453. [PMID: 32041301 PMCID: PMC7074316 DOI: 10.3390/jcm9020453] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Rotator cuff tendinopathy (RCT), subacromial impingement (SAIS), and medial (MEP) and lateral (LEP) epicondylitis are the most common causes of upper limb pain caused by microtrauma and degeneration. There are several therapeutic choices to manage these disorders: extracorporeal shockwave therapy (ESWT) has become a valuable option. METHODS A systematic review of two electronic medical databases was performed by two independent authors, using the following inclusion criteria: RCT, SAIS, MEP, and LEP, ESWT therapy without surgical treatment, with symptoms duration more than 2 months, and at least 6 months of follow-up. Studies of any level of evidence, reporting clinical results, and dealing with ESWT therapy and RCT, SAIS, MEP, and LEP were included. RESULTS A total of 822 articles were found. At the end of the first screening, following the previously described selection criteria, we selected 186 articles eligible for full-text reading. Ultimately, after full-text reading, and reference list check, we selected 26 articles following previously written criteria. CONCLUSIONS ESWT is a safe and effective treatment of soft tissue diseases of the upper limbs. Even in the minority cases when unsatisfied results were recorded, high energy shockwaves were nevertheless suggested in prevision of surgical treatment.
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Affiliation(s)
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (G.T.); (S.P.); (A.C.); (L.C.); (G.S.); (V.P.)
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Chisari E, Pavone V, Sessa G, Ravalli S, Musumeci G. Electromyostimulation and whole-body vibration effects in elder sarcopenic patients. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.03.2019.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- E. Chisari
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, AOU Policlinico-Vittorio Emanuele, University of Catania, 95100 Catania, Italy
| | - V. Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, AOU Policlinico-Vittorio Emanuele, University of Catania, 95100 Catania, Italy
| | - G. Sessa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, AOU Policlinico-Vittorio Emanuele, University of Catania, 95100 Catania, Italy
| | - S. Ravalli
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, University of Catania, Via S. Sofia n°87, Catania, Italy
| | - G. Musumeci
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, University of Catania, Via S. Sofia n°87, Catania, Italy
- Research Center on Motor Activities (CRAM), University of Catania, Catania 95123, Italy
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Testa G, Vescio A, Aloj DC, Papotto G, Ferrarotto L, Massé A, Sessa G, Pavone V. Definitive Treatment of Femoral Shaft Fractures: Comparison between Anterograde Intramedullary Nailing and Monoaxial External Fixation. J Clin Med 2019; 8:1119. [DOI: https:/doi.org/10.3390/jcm8081119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024] Open
Abstract
Background: Femoral shaft fractures result from high-energy trauma. Despite intramedullary nailing (IMN) representing the gold standard option of treatment, external fixation (EF) can be used temporarily for damage control or definitively. The purpose of this study is to compare two different options, anterograde IMN and monoaxial EF, for the treatment of femoral shaft fractures. Methods: Between January 2005 and December 2014, patients with femoral shaft fractures operated on in two centers were retrospectively evaluated and divided into two groups: the IMN group (n = 74), and the EF group (n = 73). For each group, sex; laterality; age; and AO classification type mean follow-up, mean union time, and complications were reported. Results: Both groups were found to have no statistical differences (p > 0.05) in sex, laterality, age, and AO classification types. In the IMN group the average surgery duration was 79.7 minutes (range 45–130). The average time for bone union was 26.9 weeks. Major complications occurred in 4 (5.4%) patients. In the EF group the average follow-up duration was 59.8 months (range 28–160). The average time for bone union was 24.0 weeks. Major complications occurred in 16 (21.9%) patients. Conclusions: IMN is the gold standard for definitive treatment of femoral shaft fractures. In patients with severe associated injuries, EF should be a good alternative.
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Pavone V, Testa G, Riccioli M, Di Stefano A, Condorelli G, Sessa G. Surgical treatment with cannulated screws for pediatric femoral neck fractures: A case series. Injury 2019; 50 Suppl 2:S40-S44. [PMID: 30770123 DOI: 10.1016/j.injury.2019.01.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Femoral neck fractures are uncommon injuries in children, but the high incidence of long-term complications makes it important clinical entity. Early surgical treatment to achieve optimal results and to avoid a high rate of complications is widely advised. The purpose of this study was to retrospectively analyze the outcome of 8 children who sustained a femoral neck fracture. PATIENTS AND METHODS The patients (6 boys and 2 girls with an average age of 9.2 years) were treated within 24 h following admission to hospital by closed reduction and internal fixation. The type of fracture was distinguished according to Delbet's classification system. The outcome was analyzed using Ratliff's criteria, and a detailed record of complications was maintained. RESULTS According Delbet's classification system, there were 3 type I, 2 type II, 2 type III, and 1 type IV fractures. The average follow-up was 39.2 months (range 8-95). A satisfactory outcome was obtained in 6 (75%) children. Avascular necrosis was the most notable complication, which was reported in the 2 fair outcomes (25%). CONCLUSIONS Early and aggressive surgical treatment aimed at anatomical reduction result in a satisfactory outcome in pediatric femur neck fractures. Development of avascular necrosis is the main complication.
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Affiliation(s)
- Vito Pavone
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
| | - Gianluca Testa
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Maria Riccioli
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Antonio Di Stefano
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Giuseppe Condorelli
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Giuseppe Sessa
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
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Abstract
BACKGROUND Periprosthetic femoral fractures (PFFs) following total hip arthroplasty are becoming more prevalent and management of these fractures is often demanding. The surgeon has to assess in detail implant loosening, bone loss and type of fracture. The aim of the study is to identify the suitability of a treatment algorithm, based on the Vancouver classification that takes into account the activity and comorbidity of each patient. PATIENTS AND METHODS This study retrospectively assessed 38 patients who were surgically treated for a PFF around total hip arthroplasty between 2010 and 2014. All fractures were classified according to the Vancouver classification. There were 14 type B1, 8 type B2, 10 type B3 and 6 type C fractures. The data examined were age, sex, mechanism of injury, type of fracture, ASA score, type of surgery and complications. Radiographic evaluations were performed at 1, 3, 6 months and every 12 months thereafter. Clinical results were measured using the Merle-d'Aubigné-Postel score. Treatment options included an ORIF in 22 patients and a stem revision in 16 patients, with or without plates or supplemental cortical strut grafting when required. RESULTS The mean duration of follow-up was 3.1 years, mean age was 71.2 years and six patients (15.7%) died. Union was obtained in all patients in a mean of 16 weeks. Three patients required a surgical revision: one for stem loosening and two for re-fracture after a new fall. One patient had varus malunion of the femur. The mean postoperative Merle-d'Aubigné-Postel score was 13.2. Thirteen patients showed excellent results, 14 had a good result, three had a fair outcome and two had a poor result. Twenty patients returned to their baseline mobility status, while 12 patients had either a decline in their ambulatory status or a need for additional assistive devices. CONCLUSIONS PFF remains a serious complication of hip arthroplasty that is accompanied by high morbidity and mortality rates. This study shows how patients' comorbidities and functional demand can direct the proper treatment. This is a suitable algorithm for the treatment of PFF, which can provide satisfactory results in terms of pain and function.
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Affiliation(s)
- Vito Pavone
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
| | - Claudia de Cristo
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Antonio Di Stefano
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Luciano Costarella
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Gianluca Testa
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Giuseppe Sessa
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
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Testa G, Vescio A, Di Masi P, Bruno G, Sessa G, Pavone V. Comparison between Surgical and Conservative Treatment for Distal Radius Fractures in Patients over 65 Years. J Funct Morphol Kinesiol 2019; 4:jfmk4020026. [PMID: 33467341 PMCID: PMC7739362 DOI: 10.3390/jfmk4020026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/06/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Fractures of the distal radius (DRF) are the most common orthopedic injuries, representing one of the typical fractures indicating underlying osteoporosis. The aim of the study was to compare conservative and surgical treatment, analyzing quality of life and clinical outcome in an over 65 years old population. METHODS Ninety one patients were divided into two groups: the ORIF group (39 patients) underwent surgery, and the conservative group (52 patients) was treated conservatively. The clinical and functional outcomes of all patients were evaluated using Short Form 36 (SF36), Modified Mayo Wrist Score (MMWS), Disability of the Arm Shoulder Hand (DASH), and Visual Analogue Scale (VAS). Range of motion at the joint was measured and compared with the contralateral healthy wrist. RESULTS No significant difference was found between the overall SF36 score, DASH score, MMWS, and VAS results. Role limitation was significantly better in the surgical group (p < 0.05), and complication incidence was significantly higher (p < 0.05) in the conservative group. CONCLUSION The results of this study conform to recent literature, suggesting that a surgical reconstruction of the radius articular surface in an elderly population provides no clear clinical advantage. Treatment decisions must arise from careful diagnoses of the fracture and communication with the patient.
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Pavone V, Vescio A, Canavese F, Costa D, Sessa G, Testa G. Effects of body weight on the clinical and radiological outcomes of children with flexible flatfeet managed with the 'calcaneo-stop' procedure. J Pediatr Orthop B 2019; 28:228-234. [PMID: 30664046 DOI: 10.1097/bpb.0000000000000590] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study aimed to evaluate the clinical and radiological outcomes of normal, overweight, and obese children with symptomatic flexible flatfeet managed with the 'calcaneo-stop' procedure (CSP), and to determine whether any correlation exists between patient weight and outcome. One hundred and seventy-four symptomatic flexible flatfeet were managed with CSP during the study period. The patients were divided into three groups according to their BMI and weight Z-scores: normal, overweight, and obese. Their clinical and radiographic outcomes were assessed preoperatively, and at 1 and 5 years after the index procedure. Although the radiographic criteria were comparable between the three groups, the clinical outcome was worse in obese children than in normal and overweight patients (P<0.05). BMI and the Z-score affected the outcomes of obese patients treated with CSP for symptomatic flexible flatfeet. Although the radiographic outcome was similar irrespective of BMI and Z-scores, obese patients had significantly lower clinical scores than the other patients.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, University of Catania, Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, University of Catania, Catania, Italy
| | - Federico Canavese
- Department of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand, France.,Department of Pediatric Orthopedic Surgery, Guangzhou Women and Children Medical Center, Guangzhou, China
| | - Danilo Costa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, University of Catania, Catania, Italy
| | - Giuseppe Sessa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, University of Catania, Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, University of Catania, Catania, Italy
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Pavone V, Vescio A, Valenti F, Sapienza M, Sessa G, Testa G. Growing pains: What do we know about etiology? A systematic review. World J Orthop 2019; 10:192-205. [PMID: 31041161 PMCID: PMC6475815 DOI: 10.5312/wjo.v10.i4.192] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/15/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Growing pains is the most common cause of musculoskeletal pain in early childhood and was first described in 1823 by French physician Marcel Duchamp. Although it has been researched extensively, the etiology is still unknown. Several theories have been proposed throughout the years.
AIM Analyze the available scientific literature to provide an update on the latest evidence on the etiology.
METHODS According to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the scientific literature on the etiology of growing pains was systematically reviewed using the following inclusion criteria: studies of any level of evidence reporting clinical or preclinical results and dealing with the etiology of growing pains. The medical electronic databases PubMed and Web of Science were searched by two independent authors on October 20, 2018. The search string used was “(growing pains OR benign nocturnal limb pains OR musculoskeletal pains) AND (etiology OR pathogenesis) AND (pediatrics)”.
RESULTS A total of 32 articles were included. The etiology of growing pains still remains poorly understood. Many theories have been proposed, but none of them are decisive. A lower pain threshold has been found among patients suffering from growing pains in comparison to healthy controls. Furthermore, evidence suggests an association between growing pains and reduced bone strength in young patients, although this finding still remains controversial. Changes in the vascular perfusion pattern have also been studied. However, the etiology of growing pains does not seem related to a vascular component. The anatomical/mechanical theory has not been supported, but the role of vitamin D deficiency has been investigated many times. Strong recent evidence indicates a genetic susceptibility in the pathogenesis of growing pains. Furthermore, psychological factors also seem to play a strong role in the onset.
CONCLUSION The scientific literature about the etiology of growing pains presents heterogeneity and lack of consensus; more studies are needed to understand the genesis of benign musculoskeletal pain syndrome of childhood.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
| | - Fabiana Valenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
| | - Giuseppe Sessa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
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Testa G, Ganci M, Amico M, Papotto G, Giardina SMC, Sessa G, Pavone V. Negative prognostic factors in surgical treatment for trimalleolar fractures. Eur J Orthop Surg Traumatol 2019; 29:1325-1330. [PMID: 30968203 DOI: 10.1007/s00590-019-02430-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/02/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Trimalleolar fractures are a common injury of the ankle that require surgical treatment to obtain an anatomic reduction of both malleoli and stabilization of the syndesmosis. This study aims to report the outcomes of surgical treatment for trimalleolar fractures, identifying the risk factors determining a worse result. MATERIALS AND METHODS Between January 2013 and December 2016, 48 patients with trimalleolar fracture treated with open reduction and internal fixation were retrospectively analyzed. The mean age was 44.69 years, and average body mass index (BMI) was 29.04. According to the Danis-Weber classification, 30 (62.5%) fractures were type B and 18 (37.5%) were type C. Clinical and radiographic evaluations at 3, 6, and 12 months were assessed. The functional results of Visual Analogue Staircases and Olerud-Molander (O&M) ankle score were reported. RESULTS No significant difference was found among the size of the PM in patients with and without ankle dislocation (p = 0.364). Therefore, there is no correlation between the size of the posterior fragment and the ankle dislocation and the size of the posterior malleolus and syndesmosis stability (p = 0.328). Age over 61 years, BMI > 40, ASA > 1, type C fracture, and fracture dislocation were considered as negative prognostic fractures. CONCLUSIONS Surgical treatment for trimalleolar fractures needs accurate preoperative planning. Age over 61 years, BMI > 40, ASA > 1, type C fracture, and fracture dislocation were considered as negative prognostic fractures.
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Affiliation(s)
- Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico - Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, 95123, Catania, Italy.
| | - Marco Ganci
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico - Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, 95123, Catania, Italy
| | - Mirko Amico
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico - Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, 95123, Catania, Italy
| | - Giacomo Papotto
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico - Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, 95123, Catania, Italy
| | - Serena Maria Chiara Giardina
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico - Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, 95123, Catania, Italy
| | - Giuseppe Sessa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico - Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, 95123, Catania, Italy
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico - Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, 95123, Catania, Italy
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Pavone V, Chisari E, Vescio A, Lizzio C, Sessa G, Testa G. Aetiology of Legg-Calvé-Perthes disease: A systematic review. World J Orthop 2019; 10:145-165. [PMID: 30918798 PMCID: PMC6429000 DOI: 10.5312/wjo.v10.i3.145] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/06/2018] [Accepted: 01/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Legg-Calvé-Perthes disease (LCPD) is a clinical condition affecting the femoral head of children during their growth. Its prevalence is set to be between 0.4/100000 to 29.0/100000 children less than 15 years of age with a peak of incidence in children aged from 4 years to 8 years. LCPD aetiology has been widely studied, but it is still poorly understood.
AIM To analyse the available literature to document the up-to-date evidence on LCPD aetiology.
METHODS A systematic review of the literature was performed regarding LCPD aetiology, using the following inclusion criteria: studies of any level of evidence, reporting clinical or preclinical results and dealing with the aetiology or pathogenesis of LCPD. Two reviewers searched the PubMed and Science Direct databases from their date of inception to the 20th of May 2018 in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. To achieve the maximum sensitivity of the search strategy, we combined the terms: ‘‘Perthes disease OR LCPD OR children avascular femoral head necrosis” with “pathology OR aetiology OR biomechanics OR genetics” as either key words or MeSH terms.
RESULTS We include 64 articles in this review. The available evidence on LCPD aetiology is still debated. Several hypotheses have been researched, but none of them was found decisive. While emerging evidence showed the role of environmental risk factors and evidence from twin studies did not support a major role for genetic factors, a congenital or acquired predisposition cannot be excluded in disease pathogenesis. One of the most supported theories involved mechanical induced ischemia that evolved into avascular necrosis of the femoral head in sensible patients.
CONCLUSION The literature available on the aetiology of LCPD presents major limitations in terms of great heterogeneity and a lack of high-profile studies. Although a lot of studies focused on the genetic, biomechanical and radiological background of the disease, there is a lack of consensus on one or multiple major actors of the etiopathogenesis. More studies are needed to understand the complex and multifactorial genesis of the avascular necrosis characterizing the disease.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95100, Italy
| | - Emanuele Chisari
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95100, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95100, Italy
| | - Claudio Lizzio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95100, Italy
| | - Giuseppe Sessa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95100, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95100, Italy
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Ascione T, Barrack R, Benito N, Blevins K, Brause B, Cornu O, Frommelt L, Gant V, Goswami K, Hu R, Klement MR, Komnos G, Malhotra R, Mirza Y, Munhoz Lima AL, Nelson C, Noor SS, O'Malley M, Oussedik S, Portillo ME, Prieto H, Saxena A, Sessa G. General Assembly, Diagnosis, Pathogen Isolation - Culture Matters: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S197-S206. [PMID: 30360977 DOI: 10.1016/j.arth.2018.09.071] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Nuti R, Brandi ML, Checchia G, Di Munno O, Dominguez L, Falaschi P, Fiore CE, Iolascon G, Maggi S, Michieli R, Migliaccio S, Minisola S, Rossini M, Sessa G, Tarantino U, Toselli A, Isaia GC. Guidelines for the management of osteoporosis and fragility fractures. Intern Emerg Med 2019; 14:85-102. [PMID: 29948835 PMCID: PMC6329834 DOI: 10.1007/s11739-018-1874-2] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/06/2018] [Indexed: 12/16/2022]
Abstract
The purpose of this document, a result of the harmonisation and revision of Guidelines published separately by the SIMFER, SIOMMMS/SIR, and SIOT associations, is to provide practical indications based on specific levels of evidence and various grades of recommendations, drawn from available literature, for the management of osteoporosis and for the diagnosis, prevention, and treatment of fragility fractures. These indications were discussed and formally approved by the delegates of the Italian Scientific Associations involved in the project (SIE, SIGG, SIMFER, SIMG, SIMI, SIOMMMS, SIR, and SIOT).
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Affiliation(s)
- Ranuccio Nuti
- SIMI, (Italian Society of Internal Medicine), Rome, Italy
| | | | - Giovanni Checchia
- SIMFER (Italian Society of Physical and Rehabilitation Medicine), Rome, Italy
| | | | - Ligia Dominguez
- SIOMMMS (Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases), Rome, Italy
| | - Paolo Falaschi
- SIGG (Italian Society of Gerontology and Geriatrics), Firenze, Italy
| | | | - Giovanni Iolascon
- SIMFER (Italian Society of Physical and Rehabilitation Medicine), Rome, Italy
| | - Stefania Maggi
- SIGG (Italian Society of Gerontology and Geriatrics), Firenze, Italy
| | - Raffaella Michieli
- SIMG (Italian Society of General Medicine and of Primary Care), Firenze, Italy
| | | | | | | | | | | | - Antonella Toselli
- SIMG (Italian Society of General Medicine and of Primary Care), Firenze, Italy
| | - Giovanni Carlo Isaia
- SIOMMMS (Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases), Rome, Italy
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Pavone V, Vescio A, Di Silvestri CA, Andreacchio A, Sessa G, Testa G. Outcomes of the calcaneo-stop procedure for the treatment of juvenile flatfoot in young athletes. J Child Orthop 2018; 12:582-589. [PMID: 30607205 PMCID: PMC6293325 DOI: 10.1302/1863-2548.12.180032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/05/2018] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Flexible flatfoot (FFF) is a widespread condition in juvenile patients. If symptomatic, FFF can require surgical treatment. The calcaneo-stop procedure has shown excellent clinical and radiographic outcomes and low rates of complications. The aim of the present study was to assess the sport practice of young athletes affected by FFF having undergone the calcaneo-stop procedure. METHODS Between 2008 and 2016, 68 sport practitioners were bilaterally treated by the calcaneo-stop procedure, for a total of 136 FFF cases. Clinical evaluation, including the American Orthopedic Foot and Ankle Score (AOFAS), the Yoo et al score and The Foot & Ankle Disability Index (FADI) and FADI Sport scores were assessed. Radiographic evaluation was based on measurement of talar declination, Costa-Bertani's angle and calcaneal pitch. RESULTS Mean follow-up was 57.6 months (sd 16.8). The AOFAS score mean increased from 79.3 (sd 5.7) to 97.3 (sd 4.5) three years after surgery. The Yoo score improved from 3.1 (sd 1.0) preoperatively to 11.7 (sd 0.6) three years after surgery. The FADI Sport subscale mean improved from 74.1 (sd 10.4) preoperatively to 95.9 (sd 4.9) three years after surgery.Costa-Bertani's angle decreased from 156.1° (sd 4.2°) to 135.8° (sd 7.3°) at three years postoperatively; mean talar declination angle decreased from 44.2° (sd 6.3°) to 30.6° (sd 3.2°) at three years postoperatively and mean calcaneal pitch increased from 12.6° (sd 2.3°) to 16.3° (sd 1.3°) at three years postoperatively. CONCLUSION Adolescent patients who underwent the calcaneo-stop procedure reported satisfactory outcomes in terms of clinical and radiological evaluations. Moreover, our results showed an improvement of sport activity levels, with patients recovering sports activity within three months of surgery and without limitation in the execution of preferred activities. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- V. Pavone
- Department of General Surgery and Medical Surgical Specialties – Section of Orthopaedics and Traumatology, University Hospital ‘Policlinico-Vittorio Emanuele’, University of Catania, Italy
| | - A. Vescio
- Department of General Surgery and Medical Surgical Specialties – Section of Orthopaedics and Traumatology, University Hospital ‘Policlinico-Vittorio Emanuele’, University of Catania, Italy
| | - C. A. Di Silvestri
- Department of General Surgery and Medical Surgical Specialties – Section of Orthopaedics and Traumatology, University Hospital ‘Policlinico-Vittorio Emanuele’, University of Catania, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - A. Andreacchio
- Department of Paediatric Orthopaedic Surgery, Regina Margherita Children’s Hospital, Torino, Italy
| | - G. Sessa
- Department of General Surgery and Medical Surgical Specialties – Section of Orthopaedics and Traumatology, University Hospital ‘Policlinico-Vittorio Emanuele’, University of Catania, Italy
| | - G. Testa
- Department of General Surgery and Medical Surgical Specialties – Section of Orthopaedics and Traumatology, University Hospital ‘Policlinico-Vittorio Emanuele’, University of Catania, Italy
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Pavone V, Chisari E, Vescio A, Lucenti L, Sessa G, Testa G. The etiology of idiopathic congenital talipes equinovarus: a systematic review. J Orthop Surg Res 2018; 13:206. [PMID: 30134936 PMCID: PMC6104023 DOI: 10.1186/s13018-018-0913-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/15/2018] [Indexed: 12/19/2022] Open
Abstract
Background Also known as clubfoot, idiopathic congenital talipes equinovarus (ICTEV) is the most common pediatric deformity and occurs in 1 in every 1000 live births. Even though it has been widely researched, the etiology of ICTEV remains poorly understood and is often described as being based on a multifactorial genesis. Genetic and environmental factors seem to have a major role in the development of this disease. Thus, the aim of this review is to analyze the available literature to document the current evidence on ICTEV etiology. Methods The literature on ICTEV etiology was systematically reviewed using the following inclusion criteria: studies of any level of evidence, reporting clinical or preclinical results, published in the last 20 years (1998–2018), and dealing with the etiology of ICTEV. Results A total of 48 articles were included. ICTEV etiology is still controversial. Several hypotheses have been researched, but none of them are decisive. Emerging evidence suggests a role of several pathways and gene families associated with limb development (HOX family; PITX1-TBX4), the apoptotic pathway (caspases), and muscle contractile protein (troponin and tropomyosin), but a major candidate gene has still not been identified. Strong recent evidence emerging from twin studies confirmed major roles of genetics and the environment in the disease pathogenesis. Conclusions The available literature on the etiology of ICTEV presents major limitations in terms of great heterogeneity and a lack of high-profile studies. Although many studies focus on the genetic background of the disease, there is lack of consensus on one or multiple targets. Genetics and smoking seem to be strongly associated with ICTEV etiology, but more studies are needed to understand the complex and multifactorial genesis of this common congenital lower-limb disease.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Via Plebiscito, 628, 95124, Catania, Italy
| | - Emanuele Chisari
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Via Plebiscito, 628, 95124, Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Via Plebiscito, 628, 95124, Catania, Italy
| | - Ludovico Lucenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Via Plebiscito, 628, 95124, Catania, Italy
| | - Giuseppe Sessa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Via Plebiscito, 628, 95124, Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Via Plebiscito, 628, 95124, Catania, Italy.
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Pizzolo S, Testa G, Papotto G, Mobilia G, Di Stefano G, Sessa G, Pavone V. Open Tibial Fracture in a Non-Compliant Patient: A Case Report. J Funct Morphol Kinesiol 2018; 3:44. [DOI: https:/doi.org/10.3390/jfmk3030044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024] Open
Abstract
Open tibial fractures represent the most frequent fractures of long bones, comprising approximately 1.9% of all fractures. Although locked intramedullary nailing is the gold standard for treating closed and unstable tibia diaphyseal fractures, for most exposed fractures, an external fixator can first be used, followed by conversion through an intramedullary nail. The present report describes the case of a 17-year-old male who presented with a complex multi-segmented displaced tibia fracture, type 42-C3, with exposure of IIIB type according to the Gustilo–Anderson classification, and with an attached disrupted fracture of peroneal malleolus, type 44-B2. External fixation was the preferred treatment method. Before the definitive surgical treatment, the patient had a second accident that caused refracture and damage to the soft tissues and external fixation system. This prolonged the time estimated for the conversion from the external fixator to the intramedullary nail. The reported case shows the use of various treatment steps with different timelines and an intervention with vacuum-assisted closure therapy for soft tissue healing as well as subsequent intramedullary nailing in order to reach the definitive healing of a non-compliant patient. These combined methods achieved an acceptable reduction and good stability of such a complex fracture.
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Pavone V, Testa G, Lucenti L, Falsaperla R, Sessa G. Transverse cervical megapophysis as an uncommon cause of torticollis. Journal of Pediatric Surgery Case Reports 2018. [DOI: 10.1016/j.epsc.2018.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Massari L, Benazzo F, Falez F, Cadossi R, Perugia D, Pietrogrande L, Aloj DC, Capone A, D'Arienzo M, Cadossi M, Lorusso V, Caruso G, Ghiara M, Ciolli L, La Cava F, Guidi M, Castoldi F, Marongiu G, La Gattuta A, Dell'Omo D, Scaglione M, Giannini S, Fortina M, Riva A, De Palma PL, Gigante AP, Moretti B, Solarino G, Lijoi F, Giordano G, Londini PG, Castellano D, Sessa G, Costarella L, Barile A, Borrelli M, Rota A, Fontana R, Momoli A, Micaglio A, Bassi G, Cornacchia RS, Castelli C, Giudici M, Monesi M, Branca Vergano L, Maniscalco P, Bulabula M, Zottola V, Caraffa A, Antinolfi P, Catani F, Severino C, Castaman E, Scialabba C, Tovaglia V, Corsi P, Friemel P, Ranellucci M, Caiaffa V, Maraglino G, Rossi R, Pastrone A, Caldora P, Cusumano C, Squarzina PB, Baschieri U, Demattè E, Gherardi S, De Roberto C, Belluati A, Giannini A, Villani C, Persiani P, Demitri S, Di Maggio B, Abate G, De Terlizzi F, Setti S. Can Clinical and Surgical Parameters Be Combined to Predict How Long It Will Take a Tibia Fracture to Heal? A Prospective Multicentre Observational Study: The FRACTING Study. Biomed Res Int 2018; 2018:1809091. [PMID: 29854729 PMCID: PMC5952440 DOI: 10.1155/2018/1809091] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/22/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. METHODS The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. RESULTS 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r = 0.63 (p < 0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. CONCLUSIONS This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings.
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Affiliation(s)
- Leo Massari
- Orthopaedic and Traumatology Department, “S. Anna” Hospital, University of Ferrara, Ferrara, Italy
| | - Francesco Benazzo
- Orthopaedic and Traumatology Department, IRCCS Foundation “San Matteo” Hospital, University of Pavia, Pavia, Italy
| | - Francesco Falez
- Orthopaedic and Traumatology Department, “Santo Spirito in Sassia” Hospital, Rome, Italy
| | - Ruggero Cadossi
- Research and Development, IGEA Clinical Biophysics, Carpi, Modena, Italy
| | - Dario Perugia
- Orthopaedic and Traumatology Department, “Sant'Andrea” Hospital, Rome, Italy
| | - Luca Pietrogrande
- Health Sciences Department, Operative Unit of Orthopaedics and Traumatology, “San Paolo” Hospital, University of Milan, Milan, Italy
| | - Domenico Costantino Aloj
- Orthopaedic, Traumatology and Rehabilitation Department, II Orthopaedics Clinic, CTO Hospital, Torino, Italy
| | - Antonio Capone
- Orthopaedic Department, University of Cagliari, Cagliari, Italy
| | - Michele D'Arienzo
- Orthopaedic and Traumatology Department, “Paolo Giaccone” Hospital, University of Palermo, Palermo, Italy
| | - Matteo Cadossi
- Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
| | - Vincenzo Lorusso
- Orthopaedic and Traumatology Department, “S. Anna” Hospital, University of Ferrara, Ferrara, Italy
| | - Gaetano Caruso
- Orthopaedic and Traumatology Department, “S. Anna” Hospital, University of Ferrara, Ferrara, Italy
| | - Matteo Ghiara
- Orthopaedic and Traumatology Department, IRCCS Foundation “San Matteo” Hospital, University of Pavia, Pavia, Italy
| | - Luigi Ciolli
- Orthopaedic and Traumatology Department, “Santo Spirito in Sassia” Hospital, Rome, Italy
| | - Filippo La Cava
- Orthopaedic and Traumatology Department, “Santo Spirito in Sassia” Hospital, Rome, Italy
| | - Marco Guidi
- Orthopaedic and Traumatology Department, “Sant'Andrea” Hospital, Rome, Italy
| | - Filippo Castoldi
- Orthopaedic, Traumatology and Rehabilitation Department, II Orthopaedics Clinic, CTO Hospital, Torino, Italy
| | | | - Alessandra La Gattuta
- Orthopaedic and Traumatology Department, “Paolo Giaccone” Hospital, University of Palermo, Palermo, Italy
| | - Dario Dell'Omo
- Translational Research on New Surgical and Medical Technologies Department, Orthopaedics and Traumatology II°, University of Pisa, Pisa, Italy
| | - Michelangelo Scaglione
- Translational Research on New Surgical and Medical Technologies Department, Orthopaedics and Traumatology II°, University of Pisa, Pisa, Italy
| | - Sandro Giannini
- Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
| | - Mattia Fortina
- Orthopaedics and Traumatology Clinic, “S. M. alle Scotte” Hospital, University of Siena, Siena, Italy
| | - Alberto Riva
- Orthopaedics and Traumatology Clinic, “S. M. alle Scotte” Hospital, University of Siena, Siena, Italy
| | - Pier Luigi De Palma
- Clinical and Molecular Science Department, Faculty of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Antonio Pompilio Gigante
- Clinical and Molecular Science Department, Faculty of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Biagio Moretti
- Basic Medical Science, Neurosciences and Sensory Organs Department, University of Bari, Bari, Italy
| | - Giuseppe Solarino
- Basic Medical Science, Neurosciences and Sensory Organs Department, University of Bari, Bari, Italy
| | - Francesco Lijoi
- Orthopaedic and Trauma Department, “Morgagni-Pierantoni” Hospital, Forlì, Italy
| | - Giovanni Giordano
- Orthopaedic and Trauma Department, “Morgagni-Pierantoni” Hospital, Forlì, Italy
| | - Pier Giorgio Londini
- Orthopaedic and Traumatology Department, “Misericordia” Hospital ASL 9, Grosseto, Italy
| | - Danilo Castellano
- Orthopaedic and Traumatology Department, “Misericordia” Hospital ASL 9, Grosseto, Italy
| | - Giuseppe Sessa
- Surgery Department, “Vittorio Emanuele” Hospital, University of Catania, Catania, Italy
| | - Luciano Costarella
- Surgery Department, “Vittorio Emanuele” Hospital, University of Catania, Catania, Italy
| | - Antonio Barile
- Orthopaedic and Trauma Department, “San Michele” Nursing Home Hospital, Maddaloni, Caserta, Italy
| | - Mariano Borrelli
- Orthopaedic and Trauma Department, “San Michele” Nursing Home Hospital, Maddaloni, Caserta, Italy
| | - Attilio Rota
- Orthopaedic and Traumatology Department, “Sandro Pertini” Hospital, ASL RMB, Rome, Italy
| | - Raffaele Fontana
- Orthopaedic and Traumatology Department, “Sandro Pertini” Hospital, ASL RMB, Rome, Italy
| | - Alberto Momoli
- Orthopaedic and Traumatology Department, “San Bortolo” Hospital, Vicenza, Italy
| | - Andrea Micaglio
- Orthopaedic and Traumatology Department, “San Bortolo” Hospital, Vicenza, Italy
| | - Guido Bassi
- Orthopaedic and Traumatology Department, A.O. Pavia Voghera Hospital, Pavia, Italy
| | | | - Claudio Castelli
- Orthopaedics and Trauma Department, “Papa Giovanni XXIII” Hospital, Bergamo, Italy
| | - Michele Giudici
- Orthopaedics and Trauma Department, “Papa Giovanni XXIII” Hospital, Bergamo, Italy
| | - Mauro Monesi
- Orthopaedic and Traumatology Department, “M. Bufalini” Hospital, Cesena, Italy
| | | | - Pietro Maniscalco
- Orthopaedic and Traumatology Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy
| | - M'Putu Bulabula
- Orthopaedic and Traumatology Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy
| | - Vincenzo Zottola
- Traumatology and Reconstructive Surgery Functional Department, “S. Anna” Hospital, Como, Italy
| | - Auro Caraffa
- Orthopaedics and Traumatology Clinic, “S. M. Misericordia” Hospital, University of Perugia, Perugia, Italy
| | - Pierluigi Antinolfi
- Orthopaedics and Traumatology Clinic, “S. M. Misericordia” Hospital, University of Perugia, Perugia, Italy
| | - Fabio Catani
- Orthopaedic Surgery Department, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudio Severino
- Orthopaedic Surgery Department, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Castaman
- Orthopaedic and Traumatology Department, Montecchio Maggiore Hospital, Vicenza, Italy
| | - Carmelo Scialabba
- Orthopaedic and Traumatology Department, Montecchio Maggiore Hospital, Vicenza, Italy
| | - Venceslao Tovaglia
- Orthopaedic and Traumatology Department, CTO Hospital ASL RM “C”, Rome, Italy
| | - Pietro Corsi
- Orthopaedic and Traumatology Department, CTO Hospital ASL RM “C”, Rome, Italy
| | - Paolo Friemel
- Orthopaedic and Traumatology Department, Regione Veneto Azienda ULSS 18, Rovigo, Italy
| | - Marco Ranellucci
- Orthopaedic and Traumatology Department, Regione Veneto Azienda ULSS 18, Rovigo, Italy
| | - Vincenzo Caiaffa
- Orthopaedics and Traumatology Department, “Di Venere” Hospital, Bari, Italy
| | - Giovanni Maraglino
- Orthopaedics and Traumatology Department, “SS. Annunziata” Hospital, Taranto, Italy
| | - Roberto Rossi
- Orthopaedic and Traumatology SCDU Department, “Mauriziano Umberto I” Hospital, University of Torino, Torino, Italy
| | - Antonio Pastrone
- Orthopaedic and Traumatology SCDU Department, “Mauriziano Umberto I” Hospital, University of Torino, Torino, Italy
| | - Patrizio Caldora
- Orthopaedic and Traumatology Surgery Department, “San Donato” Hospital, Arezzo, Italy
| | - Claudio Cusumano
- Orthopaedic and Traumatology Surgery Department, “San Donato” Hospital, Arezzo, Italy
| | | | - Ugo Baschieri
- Orthopaedics Department, NOCSAE Hospital, Modena, Italy
| | - Ettore Demattè
- Orthopaedics and Traumatology Department, “Santa Chiara” Hospital, Trento, Italy
| | - Stefano Gherardi
- Orthopaedics and Traumatology Department, “Santa Chiara” Hospital, Trento, Italy
| | - Carlo De Roberto
- Orthopaedics Unit, “Santa Maria di Loreto Mare” Hospital, Loreto Mare, Napoli, Italy
| | - Alberto Belluati
- Specialized Surgery Department, “S. Maria delle Croci” Hospital, Ravenna, Italy
| | - Antonio Giannini
- Specialized Surgery Department, “S. Maria delle Croci” Hospital, Ravenna, Italy
| | - Ciro Villani
- Orthopaedic Department, Sapienza University of Rome, Rome, Italy
| | - Pietro Persiani
- Orthopaedic Department, Sapienza University of Rome, Rome, Italy
| | - Silvio Demitri
- Orthopaedic and Trauma Department, “Santa Maria della Misericordia” Hospital, AOUD Udine, Udine, Italy
| | - Bruno Di Maggio
- Orthopaedics and Traumatology Unit, Piedimonte Matese Hospital, Caserta, Italy
| | - Guglielmo Abate
- Orthopaedics and Traumatology Unit, Piedimonte Matese Hospital, Caserta, Italy
| | | | - Stefania Setti
- Research and Development, IGEA Clinical Biophysics, Carpi, Modena, Italy
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Pavone V, DE Cristo C, Testa G, Canavese F, Lucenti L, Sessa G. Does age affect outcome in children with clavicle fracture treated conservatively? QuickDash and MRC evaluation of 131 consecutive cases. Minerva Pediatr 2018:S0026-4946.18.05101-0. [PMID: 29651831 DOI: 10.23736/s0026-4946.18.05101-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Non-operative treatment with immobilization is the gold-standard for paediatric clavicular fractures. Purpose of this study is to evaluate functional outcomes and efficacy of non-operative treatment of clavicular fractures in a succession of 131 children. METHODS Between 2006 and 2012, we treated non-surgically 131 children for a clavicular fracture. All fractures have been classified according to Robinson classification. Clavicle shortening, range of movements and muscular strength through the Medical Research Council (MRC) scale were evaluated. To assess the outcomes, QuickDASH questionnaire, dividing the sample in 3 age-related group, was administered. RESULTS The average follow-up was 26 months (8-84 months). Clavicle shortening at the time of injury occurred in 18 cases. All fractures reached union. Average time to union was 34 days. Mean time return to activity was 12.6 weeks. No cases of nonunion or delayed union were reported. Complications occurred in 21 cases. A shortening persisted in 2 cases. Only one patient had a slight functional restriction. Average QuickDASH score was 6.2±1.1 (range 4.3-9.4). All patients recovered to a MRC score of 5, except for one patient with a score of 4. Best QuickDASH scores were observed in the group aged under 8 years and in non-comminuted and lateral third fractures of the clavicle. CONCLUSIONS Observing results, clavicle fractures have a satisfactory clinical healing as shown by the good scores at QuickDASH and MRC scale. Younger children under 8 years can achieve the best results with a conservative treatment in terms of bone healing and activity level.
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Affiliation(s)
- Vito Pavone
- Department of Orthopaedics, University Hospital "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Claudia DE Cristo
- Department of Orthopaedics, University Hospital "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Gianluca Testa
- Department of Orthopaedics, University Hospital "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy -
| | - Federico Canavese
- Pediatric Surgery Department, University Hospital Estaing, Clermont Ferrand, France
| | - Ludovico Lucenti
- Department of Orthopaedics, University Hospital "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Giuseppe Sessa
- Department of Orthopaedics, University Hospital "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
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Sessa G, Testa G, Gioitta Iachino S, Costarella L, Puma Pagliarello C, Ferrante M, Grasso A, Pavone V. Potential presence of metals in patients treated with metal-metal coupling prostheses for hip arthroplasty at 7 and 10 years of follow-up. Eur J Orthop Surg Traumatol 2018; 28:637-643. [PMID: 29356908 DOI: 10.1007/s00590-018-2129-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/07/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Beginning in 2008, metal-on-metal prostheses have been in the spotlight owing to much higher revision rates than expected. Adverse local tissue reactions have been well described in the literature as potential complications. METHODS Between 2012 and 2013, 13 patients with metal-on-metal total hip replacements were evaluated clinically and radiologically and with laboratory samples. The same tests were repeated between 2015 and 2016 on eight patients to assess any changes. In the laboratory assessment, we searched for chromium, cobalt, molybdenum, and nickel in blood and urine samples over 24 h. RESULTS Clinical assessment has shown good score in all patients except one. On a second examination, between 2015 and 2016, all patients obtained results similar to those obtained in the first assessment, except a patient, who reported a recent fall. In the radiological assessment between 2012 and 2013, results were optimal, apart from a case of aseptic mobilization. The patients reassessed 3 years after the first examination showed radiological results similar to those previously obtained, apart from a patient, who showed signals of mobilization. Metal levels found in their blood decreased in most cases after 3 years. Urine levels of nickel increased in five subjects, and chromium levels increased in four, but levels of cobalt and molybdenum decreased in four patients. CONCLUSION It could be hypothesized that the decreasing trend of metal ion levels is associated with a stable wear status. On the contrary, a progressive increase in metal ion levels must be considered as early proof of implant loosening.
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Affiliation(s)
- Giuseppe Sessa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
| | - Salvatore Gioitta Iachino
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Luciano Costarella
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Calogero Puma Pagliarello
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Margherita Ferrante
- Department of Medical, Surgical and Advanced Technologies 'G.F. Ingrassia', University of Catania, Catania, Italy
| | - Alfina Grasso
- Department of Medical, Surgical and Advanced Technologies 'G.F. Ingrassia', University of Catania, Catania, Italy
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
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Bottone C, Camerlingo R, Miceli R, Salbitani G, Sessa G, Pirozzi G, Carfagna S. Antioxidant and anti-proliferative properties of extracts from heterotrophic cultures of Galdieria sulphuraria. Nat Prod Res 2018; 33:1659-1663. [PMID: 29334254 DOI: 10.1080/14786419.2018.1425853] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study explores the possibility to use the extremophilic microalga Galdieria sulphuraria (strain 064) as a source of natural biomolecules with beneficial and protective effects on human health. Galdieria was cultivated in heterotrophy conditions and cells extracts for their antioxidant and anti-proliferative properties were tested. Galdieria extracts showed high antioxidant power tested through ABTS assay and revealed high glutathione and phycocyanin contents. Based on Annexin-V FITC/propidium iodide and MTT analysis, algae extracts inhibited the proliferation of human adenocarcinoma A549 cells (51.2% inhibition) through the induction of apoptosis without cell cycle arrest. Besides, cytotoxicity and cytometry assays showed a positive pro-apoptotic mechanism. On these bases, we suggest that G. sulphuraria from heterotrophic culture, for its therapeutic potential, could be considered a good candidate for further studies with the aim to isolate bioactive anti-cancer molecules.
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Affiliation(s)
- Claudia Bottone
- a Dipartimento di Biologia , Università di Napoli Federico II , Napoli , Italy
| | - Rosa Camerlingo
- b Dipartimento della Ricerca , Istituto Nazionale Tumori Fondazione "G. Pascale" , Napoli , Italy
| | - Roberta Miceli
- b Dipartimento della Ricerca , Istituto Nazionale Tumori Fondazione "G. Pascale" , Napoli , Italy
| | - Giovanna Salbitani
- a Dipartimento di Biologia , Università di Napoli Federico II , Napoli , Italy
| | - Giuseppe Sessa
- b Dipartimento della Ricerca , Istituto Nazionale Tumori Fondazione "G. Pascale" , Napoli , Italy
| | - Giuseppe Pirozzi
- b Dipartimento della Ricerca , Istituto Nazionale Tumori Fondazione "G. Pascale" , Napoli , Italy
| | - Simona Carfagna
- a Dipartimento di Biologia , Università di Napoli Federico II , Napoli , Italy
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Pavone V, Testa G, Giardina SMC, Vescio A, Restivo DA, Sessa G. Pharmacological Therapy of Osteoporosis: A Systematic Current Review of Literature. Front Pharmacol 2017; 8:803. [PMID: 29163183 PMCID: PMC5682013 DOI: 10.3389/fphar.2017.00803] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [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: 09/05/2017] [Accepted: 10/24/2017] [Indexed: 01/22/2023] Open
Abstract
Osteoporosis is the most common bone disease affecting millions of people worldwide, particularly in elderly or in post-menopausal women. The pathogenesis is useful to understand the possible mechanism of action of anti-osteoporotic drugs. Early diagnosis, possible with several laboratory and instrumental tests, allows a major accuracy in the choice of anti-osteoporosis drugs. Treatment of osteoporosis is strictly related to severity of pathology and consists on prevention of fragility fractures with a correct lifestyle and adequate nutritional supplements, and use of pharmacological therapy, started in patients with osteopenia and history of fragility fracture of the hip or spine. The purpose of this review is to focus on main current pharmacological products to treat osteoporotic patients.
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Affiliation(s)
- Vito Pavone
- Dipartimento di Chirurgia Generale e Specialità Medico-Chirurgiche, Sezione di Ortopedia, A.O.U.P. Vittorio Emanuele, Università di Catania, Catania, Italy
| | - Gianluca Testa
- Dipartimento di Chirurgia Generale e Specialità Medico-Chirurgiche, Sezione di Ortopedia, A.O.U.P. Vittorio Emanuele, Università di Catania, Catania, Italy
| | - Serena M C Giardina
- Dipartimento di Chirurgia Generale e Specialità Medico-Chirurgiche, Sezione di Ortopedia, A.O.U.P. Vittorio Emanuele, Università di Catania, Catania, Italy
| | - Andrea Vescio
- Dipartimento di Chirurgia Generale e Specialità Medico-Chirurgiche, Sezione di Ortopedia, A.O.U.P. Vittorio Emanuele, Università di Catania, Catania, Italy
| | - Domenico A Restivo
- Neurologic Unit, Department of Internal Medicine, Nuovo "Garibaldi" Hospital, Catania, Italy
| | - Giuseppe Sessa
- Dipartimento di Chirurgia Generale e Specialità Medico-Chirurgiche, Sezione di Ortopedia, A.O.U.P. Vittorio Emanuele, Università di Catania, Catania, Italy
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Evola FR, Costarella L, Evola G, Barchitta M, Agodi A, Sessa G. Acetabular revisions using porous tantalum components: A retrospective study with 5-10 years follow-up. World J Orthop 2017; 8:553-560. [PMID: 28808626 PMCID: PMC5534404 DOI: 10.5312/wjo.v8.i7.553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/15/2017] [Accepted: 05/31/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the clinical and X-ray results of acetabular components and tantalum augments in prosthetic hip revisions.
METHODS Fifty-eight hip prostheses with primary failure of the acetabular component were reviewed with tantalum implants. The clinical records and X-rays of these cases were retrospectively reviewed. Bone defect evaluations were based on preoperative CT scans and classified according to Paprosky criteria of Radiolucent lines and periprosthetic gaps; implant mobilization and osteolysis were evaluated by X-ray. An ad hoc database was created and statistical analyses were performed with SPSS software (IBM SPSS Statistics for Windows, version 23.0). Statistical analyses were carried out using the Student’s t test for independent and paired samples. A P value of < 0.05 was considered statistically significant and cumulative survival was calculated by the Kaplan-Meier method.
RESULTS The mean follow-up was 87.6 ± 25.6 mo (range 3-120 mo). 25 cases (43.1%) were classified as minor defects, and 33 cases (56.9%) as major defects. The preoperative HHS rating improved significantly from a mean of 40.7 ± 6.1 (range: 29-53) before revision, to a mean of 85.8 ± 6.1 (range: 70-94) at the end of the follow-up (Student’s t test for paired samples: P < 0.001). Considering HHS only at the end of follow-up, no statistically significant difference was observed between patients with a major or minor defect (Student’s t test for independent samples: P > 0.05). Radiolucent lines were found in 4 implants (6.9%). Postoperative acetabular gaps were observed in 5 hips (8.6%). No signs of implant mobilization or areas of periprosthetic osteolysis were found in the x-rays at the final follow-up. Only 3 implants failed: 1 case of infection and 2 cases of instability. Defined as the end-point, cumulative survival at 10 years was 95% (for all reasons) and 100% for aseptic loosening of the acetabular component.
CONCLUSION The medium-term use of prosthetic tantalum components in prosthetic hip revisions is safe and effective in a wide variety of acetabular bone defects.
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Evola FR, Costarella L, Pavone V, Caff G, Cannavò L, Sessa A, Avondo S, Sessa G. Biomarkers of Osteosarcoma, Chondrosarcoma, and Ewing Sarcoma. Front Pharmacol 2017; 8:150. [PMID: 28439237 PMCID: PMC5383728 DOI: 10.3389/fphar.2017.00150] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/09/2017] [Indexed: 02/03/2023] Open
Abstract
Osteosarcoma is the most frequent malignant bone neoplasm, followed by chondrosarcoma and Ewing sarcoma. The diagnosis of bone neoplasms is generally made through histological evaluation of a biopsy. Clinical and radiological features are also important in aiding diagnosis and to complete the staging of bone cancer. In addition to these, there are several non-specific serological or specific molecular markers for bone neoplasms. In bone tumors, molecular markers increase the accuracy of the diagnosis and assist in subtyping bone tumors. Here, we review these markers and discuss their role in the diagnosis and prognosis of the three most frequent malignant bone neoplasms, namely osteosarcoma, chondrosarcoma, and Ewing sarcoma.
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Affiliation(s)
- Francesco R Evola
- Clinica Ortopedica, Dipartimento di Chirurgia, Azienda Ospedaliera-Universitaria Policlinico Vittorio Emanuele di CataniaCatania, Italy
| | - Luciano Costarella
- Clinica Ortopedica, Dipartimento di Chirurgia, Azienda Ospedaliera-Universitaria Policlinico Vittorio Emanuele di CataniaCatania, Italy
| | - Vito Pavone
- Clinica Ortopedica, Dipartimento di Chirurgia, Azienda Ospedaliera-Universitaria Policlinico Vittorio Emanuele di CataniaCatania, Italy
| | - Giuseppe Caff
- Clinica Ortopedica, Dipartimento di Chirurgia, Azienda Ospedaliera-Universitaria Policlinico Vittorio Emanuele di CataniaCatania, Italy
| | - Luca Cannavò
- Clinica Ortopedica, Dipartimento di Chirurgia, Azienda Ospedaliera-Universitaria Policlinico Vittorio Emanuele di CataniaCatania, Italy
| | - Andrea Sessa
- Clinica Ortopedica, Dipartimento di Chirurgia, Azienda Ospedaliera-Universitaria Policlinico Vittorio Emanuele di CataniaCatania, Italy
| | - Sergio Avondo
- Clinica Ortopedica, Dipartimento di Chirurgia, Azienda Ospedaliera-Universitaria Policlinico Vittorio Emanuele di CataniaCatania, Italy
| | - Giuseppe Sessa
- Clinica Ortopedica, Dipartimento di Chirurgia, Azienda Ospedaliera-Universitaria Policlinico Vittorio Emanuele di CataniaCatania, Italy
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De Cicco P, Panza E, Ercolano G, Armogida C, Sessa G, Pirozzi G, Cirino G, Wallace JL, Ianaro A. ATB-346, a novel hydrogen sulfide-releasing anti-inflammatory drug, induces apoptosis of human melanoma cells and inhibits melanoma development in vivo. Pharmacol Res 2016; 114:67-73. [PMID: 27777130 DOI: 10.1016/j.phrs.2016.10.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [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: 05/30/2016] [Revised: 09/14/2016] [Accepted: 10/18/2016] [Indexed: 01/04/2023]
Abstract
Inflammation plays a key role in tumor promotion and development. Indeed, cyclooxygenase-2 (COX-2) expression is strongly associated with different types of cancer. An emerging class of compounds with significant anti-inflammatory properties is the hydrogen sulfide-releasing non-steroidal anti-inflammatory drugs (H2S-NSAIDs). They consist of a traditional NSAID to which an H2S-releasing moiety is covalently attached. We have recently demonstrated that H2S donors inhibit melanoma cell proliferation. In the current study, we evaluated the potential beneficial effects of a new H2S-releasing derivative of naproxen, ATB-346 [2-(6-methoxynapthalen-2-yl)-propionic acid 4-thiocarbamoyl phenyl ester] which inhibits COX activity but also releases H2S. We used cell culture and a mouse melanoma model to evaluate the effect of ATB-346 on: i) in vitro growth of human melanoma cells; ii) in vivo melanoma development in mice. Cell culture studies demonstrated that ATB-346 reduced the in vitro proliferation of human melanoma cells and this effect was associated to induction of apoptosis and inhibition of NF-κB activation. Moreover, ATB-346 had novel Akt signaling inhibitory properties. Daily oral dosing of ATB-346 (43μmol/kg) significantly reduced melanoma development in vivo. This study shows that ATB-346, a novel H2S-NSAID, inhibits human melanoma cell proliferation by inhibiting pro-survival pathways associated with NF-κB and Akt activation. Furthermore, oral treatment with ATB-346 inhibits melanoma growth in mice. In conclusion, the combination of inhibition of cyclooxygenase and delivery of H2S by ATB-346 may offer a promising alternative to existing therapies for melanoma.
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Affiliation(s)
- Paola De Cicco
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Elisabetta Panza
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Giuseppe Ercolano
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Chiara Armogida
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Giuseppe Sessa
- Department of Experimental Oncology, National Cancer Institute, G. Pascale, Naples, Italy
| | - Giuseppe Pirozzi
- Department of Experimental Oncology, National Cancer Institute, G. Pascale, Naples, Italy
| | - Giuseppe Cirino
- Department of Pharmacy, University of Naples Federico II, Naples, Italy.
| | - John L Wallace
- Department of Physiology & Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Angela Ianaro
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
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Nardella M, Guglielmi L, Musa C, Iannetti I, Maresca G, Amendola D, Porru M, Carico E, Sessa G, Camerlingo R, Dominici C, Megiorni F, Milan M, Bearzi C, Rizzi R, Pirozzi G, Leonetti C, Bucci B, Mercanti D, Felsani A, D'Agnano I. Down-regulation of the Lamin A/C in neuroblastoma triggers the expansion of tumor initiating cells. Oncotarget 2016; 6:32821-40. [PMID: 26439802 PMCID: PMC4741732 DOI: 10.18632/oncotarget.5104] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/21/2015] [Indexed: 01/30/2023] Open
Abstract
Tumor-initiating cells constitute a population within a tumor mass that shares properties with normal stem cells and is considered responsible for therapy failure in many cancers. We have previously demonstrated that knockdown of the nuclear envelope component Lamin A/C in human neuroblastoma cells inhibits retinoic acid-mediated differentiation and results in a more aggressive phenotype. In addition, Lamin A/C is often lost in advanced tumors and changes in the nuclear envelope composition occur during tumor progression. Based on our previous data and considering that Lamin A/C is expressed in differentiated tissues, we hypothesize that the lack of Lamin A/C could predispose cells toward a stem-like phenotype, thus influencing the development of tumor-initiating cells in neuroblastoma. This paper demonstrates that knockdown of Lamin A/C triggers the development of a tumor-initiating cell population with self-renewing features in human neuroblastoma cells. We also demonstrates that the development of TICs is due to an increased expression of MYCN gene and that in neuroblastoma exists an inverse relationship between LMNA and MYCN expression.
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Affiliation(s)
- Marta Nardella
- Institute of Cell Biology and Neurobiology-CNR, Monterotondo, Rome, Italy
| | - Loredana Guglielmi
- Institute of Cell Biology and Neurobiology-CNR, Monterotondo, Rome, Italy
| | - Carla Musa
- Institute of Cell Biology and Neurobiology-CNR, Monterotondo, Rome, Italy
| | - Ilaria Iannetti
- Institute of Cell Biology and Neurobiology-CNR, Monterotondo, Rome, Italy
| | - Giovanna Maresca
- Institute of Cell Biology and Neurobiology-CNR, Monterotondo, Rome, Italy
| | | | | | - Elisabetta Carico
- UOD Cytopathology, Department of Molecular and Clinical Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Giuseppe Sessa
- Department of Experimental Oncology, National Cancer Institute-IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Rosalba Camerlingo
- Department of Experimental Oncology, National Cancer Institute-IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Carlo Dominici
- Department of Paediatrics and Infantile Neuropsychiatry, Sapienza University, Rome, Italy.,School of Reproductive and Developmental Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Francesca Megiorni
- Department of Paediatrics and Infantile Neuropsychiatry, Sapienza University, Rome, Italy
| | - Marika Milan
- Institute of Cell Biology and Neurobiology-CNR, Monterotondo, Rome, Italy
| | - Claudia Bearzi
- Institute of Cell Biology and Neurobiology-CNR, Monterotondo, Rome, Italy.,I.R.C.C.S Multimedica, Scientific and Technology Pole, Milan, Italy
| | - Roberto Rizzi
- Institute of Cell Biology and Neurobiology-CNR, Monterotondo, Rome, Italy.,I.R.C.C.S Multimedica, Scientific and Technology Pole, Milan, Italy
| | - Giuseppe Pirozzi
- Department of Experimental Oncology, National Cancer Institute-IRCCS "Fondazione G. Pascale", Naples, Italy
| | | | | | - Delio Mercanti
- Institute of Cell Biology and Neurobiology-CNR, Monterotondo, Rome, Italy
| | - Armando Felsani
- Institute of Cell Biology and Neurobiology-CNR, Monterotondo, Rome, Italy
| | - Igea D'Agnano
- Institute of Cell Biology and Neurobiology-CNR, Monterotondo, Rome, Italy
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Pavone V, de Cristo C, Cannavò L, Testa G, Buscema A, Condorelli G, Sessa G. Midterm results of surgical treatment of displaced proximal humeral fractures in children. Eur J Orthop Surg Traumatol 2016; 26:461-7. [PMID: 27151160 DOI: 10.1007/s00590-016-1773-z] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 04/24/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To analyse the clinical outcomes of 26 children treated surgically for displaced proximal humerus fracture. MATERIALS AND METHODS From January 2008 to December 2012, 26 children/adolescents (14 boys, 12 girls) were treated surgically for displaced fractures at the proximal extremity of the humerus. Ten were grade III and 16 were grade IV according to the Neer-Horowitz classification with a mean age of 12.8 ± 4.2 years. Twenty young patients were surgically treated with a closed reduction and direct percutaneous pinning; six required an open approach. To obtain a proper analysis, we compared the Costant scores with the contralateral shoulder (Δ Costant). RESULTS The mean follow-up period was 34 months (range 10-55). Two grade IV patients showed a loss in the reduction after percutaneous treatment. This required open surgery with a plate and screws. On average, the treated fractures healed at 40 days. The mean Δ Costant score was 8.43 (range 2-22). There was a statistically significant improvement in the mean Δ Costant score in grade III patients. In grade IV patients, there was a significant improvement in the mean Δ Costant score in those treated with open surgery versus mini-invasive surgery. CONCLUSIONS Our study shows excellent results with percutaneous k-wires. This closed surgery had success in these patients, and the excellent outcomes noted here lead us to prefer the mini-invasive surgical approach in NH grade III fractures. In grade IV, the best results were noted in patients treated with open surgery. We suggest an open approach for these patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vito Pavone
- Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy.
| | - Claudia de Cristo
- Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy
| | - Luca Cannavò
- Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy
| | - Gianluca Testa
- Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy
| | - Antonio Buscema
- Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy
| | - Giuseppe Condorelli
- Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy
| | - Giuseppe Sessa
- Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy
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Pavone V, Signorelli SS, Praticò AD, Corsello G, Savasta S, Falsaperla R, Pavone P, Sessa G, Ruggieri M. Total Hemi-overgrowth in Pigmentary Mosaicism of the (Hypomelanosis of) Ito Type: Eight Case Reports. Medicine (Baltimore) 2016; 95:e2705. [PMID: 26962770 PMCID: PMC4998851 DOI: 10.1097/md.0000000000002705] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pigmentary mosaicism of the (hypomelanosis of) Ito type is an umbrella term, which includes phenotypes characterized by mosaic hypopigmentation in the form of streaks, whorls, patchy, or more bizarre skin configurations (running along the lines of Blaschko): these cutaneous patterns can manifest as an isolated skin disorder (pigmentary mosaicism of the Ito type) or as a complex malformation syndrome in association with extracutaneous anomalies (most often of the musculoskeletal and/or nervous systems) (hypomelanosis of Ito). Affected individuals are anecdotally reported to have also partial or total body hemi-overgrowth (HOG), which often causes moderate to severe complications.We studied the occurrence and features of HOG in the 114 children and adults with mosaic pigmentary disorders of the Ito type diagnosed and followed up (from 2 to 22 years; average follow-up 16 years) at our Institutions.Eight patients (5 M, 3 F; aged 4 to 25 years; median age 16 years) out of the 114 analyzed (7%) fulfilled the criteria for unilateral HOG, with differences in diameter ranging from 0.4 to 4.0 cm (upper limbs) and 1.0 to 9.0 cm (lower limbs). Moreover, among these 8 patients, 5/8 filled in the 75th to 90th percentile for height; 6/8 had associated kyphoscoliosis; and 5/8 showed cognitive delays. No tumour complications were recorded. Overall, 6/8 HOG patients presented with additional (extracutaneous) syndromic manifestations, apart from the HOG (ie, with a clinical phenotype of hypomelanosis of Ito).The present study, which includes children and adults with the longest follow-up so far recorded, confirms the association between pigmentary mosaicism of the Ito type and HOG lowering previous estimates (7% vs 16%) for HOG in the context of mosaic hypopigmentation. A careful examination, looking at subtle to moderate asymmetries and associated complications within the spectrum of these mosaic pigmentary disorders, is recommended.
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Affiliation(s)
- Vito Pavone
- From the Department of Orthopaedics, AOU "Policlinico-Vittorio Emanuele," (VP, GS); Department of Clinical and Experimental Medicine, University of Catania, (SSS); Department of Biomedical and Biotechnological Sciences (ADP); Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania (ADP, MR); Department of Sciences for Health Promotion and Mother and Child Health Care, Pediatric Unit, University of Palermo, Palermo, (GC); Department of Pediatrics, IRCCS Hospital San Matteo, University of Pavia, Pavia (SS); and Unit of Paediatrics and Emergency Paediatrics, AOU "Policlinico-Vittorio Emanuele," (RF, PP) Catania, Italy
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Pavone V, Testa G, Restivo DA, Cannavò L, Condorelli G, Portinaro NM, Sessa G. Botulinum Toxin Treatment for Limb Spasticity in Childhood Cerebral Palsy. Front Pharmacol 2016; 7:29. [PMID: 26924985 PMCID: PMC4759702 DOI: 10.3389/fphar.2016.00029] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 12/28/2015] [Accepted: 02/03/2016] [Indexed: 12/18/2022] Open
Abstract
CP is the most common cause of chronic disability in childhood occurring in 2–2.5/1000 births. It is a severe disorder and a significant number of patients present cognitive delay and difficulty in walking. The use of botulinum toxin (BTX) has become a popular treatment for CP especially for spastic and dystonic muscles while avoiding deformity and pain. Moreover, the combination of physiotherapy, casting, orthotics and injection of BTX may delay or decrease the need for surgical intervention while reserving single-event, multi-level surgery for fixed musculotendinous contractures and bony deformities in older children. This report highlights the utility of BTX in the treatment of cerebral palsy in children. We include techniques for administration, side effects, and possible resistance as well as specific use in the upper and lower limbs muscles.
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Affiliation(s)
- Vito Pavone
- Dipartimento di Chirurgia Generale e Specialità Medico-chirurgiche, Sez. Ortopedia, Azienda Ospedaliera Universitaria Policlinico-Vittorio Emanuele Catania, Italy
| | - Gianluca Testa
- Dipartimento di Chirurgia Generale e Specialità Medico-chirurgiche, Sez. Ortopedia, Azienda Ospedaliera Universitaria Policlinico-Vittorio Emanuele Catania, Italy
| | - Domenico A Restivo
- Neurologic Unit, Department of Internal Medicine, Nuovo "Garibaldi" Hospital Catania, Italy
| | - Luca Cannavò
- Dipartimento di Chirurgia Generale e Specialità Medico-chirurgiche, Sez. Ortopedia, Azienda Ospedaliera Universitaria Policlinico-Vittorio Emanuele Catania, Italy
| | - Giuseppe Condorelli
- Dipartimento di Chirurgia Generale e Specialità Medico-chirurgiche, Sez. Ortopedia, Azienda Ospedaliera Universitaria Policlinico-Vittorio Emanuele Catania, Italy
| | - Nicola M Portinaro
- Humanitas Clinical and Research Center, Clinica Ortopedica e Traumatologica Milan, Italy
| | - Giuseppe Sessa
- Dipartimento di Chirurgia Generale e Specialità Medico-chirurgiche, Sez. Ortopedia, Azienda Ospedaliera Universitaria Policlinico-Vittorio Emanuele Catania, Italy
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Agodi A, Auxilia F, Barchitta M, Cristina M, D'Alessandro D, Mura I, Nobile M, Pasquarella C, Avondo S, Bellocchi P, Canino R, Capozzi C, Casarin R, Cavasin M, Contegiacomo P, Deriu MG, Evola FR, Farsetti P, Grandi A, Guareschi D, Longhitano AM, Longo G, Malatesta R, Marenghi P, Marras F, Maso A, Mattaliano AR, Montella MT, Moscato U, Navone P, Romeo MA, Rossi F, Ruffino M, Santangelo C, Sartini M, Sessa G, Tardivo S, Tranquilli Leali P, Torregrossa MV, Vitali P. Operating theatre ventilation systems and microbial air contamination in total joint replacement surgery: results of the GISIO-ISChIA study. J Hosp Infect 2015; 90:213-9. [DOI: 10.1016/j.jhin.2015.02.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
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Testa G, Pavone V, Mangano S, Riccioli M, Arancio A, Evola FR, Avonda S, Sessa G. NORMAL NUTRITIONAL COMPONENTS AND EFFECTS ON BONE METABOLISM IN PREVENTION OF OSTEOPOROSIS. J BIOL REG HOMEOS AG 2015; 29:729-736. [PMID: 26403414] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Osteoporosis is the most common bone disease, affecting millions of people and causing a high risk of fractures and a loss of quality of life. It is characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. A primary method of prevention, in order to reduce the risk of fractures, is represented by an appropriate lifestyle and a correct diet. There are potentially numerous nutrients and dietary components that can influence bone health, and these range from macronutrients to micronutrients as well as bioactive food ingredients. The purpose of this review is to overview osteoporosis, including its definition, etiology, and incidence, and then provide some information on possible dietary strategies for optimizing bone health and preventing osteoporosis. A correct diet to prevent osteoporosis should contain adequate amounts of calcium, vitamins D and K, protein, and fatty acids. The effects of these elements are briefly discussed, reporting on their correlation with bone benefits.
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Affiliation(s)
- G Testa
- Orthopaedic Clinic, University of Catania, Azienda Ospedaliera Universitaria, Policlinico Vittorio Emanuele, Catania, Italy
| | - V Pavone
- Orthopaedic Clinic, University of Catania, Azienda Ospedaliera Universitaria, Policlinico Vittorio Emanuele, Catania, Italy
| | - S Mangano
- Orthopaedic Clinic, University of Catania, Azienda Ospedaliera Universitaria, Policlinico Vittorio Emanuele, Catania, Italy
| | - M Riccioli
- Orthopaedic Clinic, University of Catania, Azienda Ospedaliera Universitaria, Policlinico Vittorio Emanuele, Catania, Italy
| | - A Arancio
- Orthopaedic Clinic, University of Catania, Azienda Ospedaliera Universitaria, Policlinico Vittorio Emanuele, Catania, Italy
| | - F R Evola
- Orthopaedic Clinic, University of Catania, Azienda Ospedaliera Universitaria, Policlinico Vittorio Emanuele, Catania, Italy
| | - S Avonda
- Orthopaedic Clinic, University of Catania, Azienda Ospedaliera Universitaria, Policlinico Vittorio Emanuele, Catania, Italy
| | - G Sessa
- Orthopaedic Clinic, University of Catania, Azienda Ospedaliera Universitaria, Policlinico Vittorio Emanuele, Catania, Italy
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Evola FR, Evola G, Graceffa A, Sessa A, Pavone V, Costarella L, Sessa G, Avondo S. Performance of the CLS Spotorno uncemented stem in the third decade after implantation. Bone Joint J 2014; 96-B:455-61. [PMID: 24692610 DOI: 10.1302/0301-620x.96b4.32607] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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] [Indexed: 12/13/2022]
Abstract
In 2012 we reviewed a consecutive series of 92 uncemented THRs performed between 1986 and 1991 at our institution using the CLS Spotorno stem, in order to assess clinical outcome and radiographic data at a minimum of 21 years. The series comprised 92 patients with a mean age at surgery of 59.6 years (39 to 77) (M:F 43;49). At the time of this review, seven (7.6%) patients had died and two (2.2%) were lost to follow-up. The 23-year Kaplan-Meier survival rates were 91.5% (95% confidence intervals (CI) 85.4% to 97.6%; 55 hips at risk) and 80.3% (95% CI, 71.8% to 88.7%; 48 hips at risk) respectively, with revision of the femoral stem or of any component as endpoints. At the time of this review, 76 patients without stem revision were assessed clinically and radiologically (mean follow-up 24.0 years (21.5 to 26.5)). For the 76 unrevised hips the mean Harris hip score was 87.1 (65 to 97). Femoral osteolysis was detected in five hips (6.6%) only in Gruen zone 7. Undersized stems were at higher risk of revision owing to aseptic loosening (p = 0.0003). Patients implanted with the stem in a varus position were at higher risk of femoral cortical hypertrophy and thigh pain (p = 0.0006 and p = 0.0007, respectively). In our study, survival, clinical outcome and radiographic data remained excellent in the third decade after implantation. Nonetheless, undersized stems were at higher risk of revision owing to aseptic loosening.
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Affiliation(s)
- F R Evola
- Department of Surgery, Section of Orthopaedics and Traumatology, The University of Catania, Via Plebiscito 628, 95100, Catania, Italy
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Pavone V, Testa G, Costarella L, Pavone P, Sessa G. Congenital idiopathic talipes equinovarus: an evaluation in infants treated by the Ponseti method. Eur Rev Med Pharmacol Sci 2013; 17:2675-2679. [PMID: 24142617] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Congenital talipes equinovarus (CTEV) is a common but still not fully understood disorder of the lower limb. It is usually defined as a fixation of the foot in adduction, supination, and varus. Different treatment options exist including the Ponseti method. AIM We report here the results obtained in infants with CTEV treated by the Ponseti method. PATIENTS AND METHODS Eighty two patients (114 clubfeet) were enrolled at the Orthopaedic Clinic of Catania University during the period of March 2004 to January 2010 and followed prospectively up to February 2011: 56 patients (68.29%) were male, the anomaly was bilateral in 32 (39%) cases, unilateral in 50 (60.9%) in the right side in 28 (56%). The mean age at initiation of treatment was 14 days (range 3-81 days), severity of the club foot deformity by the Pirani Severity score was 5.56 points (range 4.3-6 points). Total numbers of Ponseti casts before tenotomy, details of tenotomy, and compliance with CTEV brace were recorded. Clinical evaluation was performed using the functional Ponseti Scoring System. Mean follow up was 4 years: range 13-83 months. RESULTS An average of 6.6 casts was necessary before performing the tenotomy. Tenotomy was performed by a single surgeon (V.P.) in a total of 68 patients (82.93%) always in an operating room under general anaesthesia by a percutaneous approach at a mean age of 106 days (range 45-213 days). Compliance with CTEV brace was satisfactory in 79 patients (96.3%). Functional Ponseti Scores were good/excellent in 79 (96.34%) patients (109 clubfeet; 95.61%). Only 3 patients; 3.7% (5 clubfeet; 4.4%) suffered relapse. Poor compliance with the Denis Browne splint was thought to be the main cause of failure. CONCLUSIONS The Ponseti method provides an excellent outcome at follow up in the treatment of congenital idiopathic clubfoot.
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Affiliation(s)
- V Pavone
- Orthopaedic Clinic, and 1Pediatric Clinic; Polyclinic Vittorio Emanuele, Azienda Ospedaliera Universitaria, University of Catania, Catania, Italy.
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Tirino V, Camerlingo R, Bifulco K, Irollo E, Montella R, Paino F, Sessa G, Carriero MV, Normanno N, Rocco G, Pirozzi G. TGF-β1 exposure induces epithelial to mesenchymal transition both in CSCs and non-CSCs of the A549 cell line, leading to an increase of migration ability in the CD133+ A549 cell fraction. Cell Death Dis 2013; 4:e620. [PMID: 23640462 PMCID: PMC3674353 DOI: 10.1038/cddis.2013.144] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Metastasis is the leading cause of death by cancer. Non-small-cell lung cancer (NSCLC) represents nearly 85% of primary malignant lung tumours. Recent researches have demonstrated that epithelial-to-mesenchymal transition (EMT) plays a key role in the early process of metastasis of cancer cells. Transforming growth factor-β1 (TGF-β1) is the major inductor of EMT. The aim of this study is to investigate TGF-β1's effect on cancer stem cells (CSCs) identified as cells positive for CD133, side population (SP) and non-cancer stem cells (non-CSCs) identified as cells negative for CD133, and SP in the A549 cell line. We demonstrate that TGF-β1 induces EMT in both CSC and non-CSC A549 sublines, upregulating the expression of mesenchymal markers such as vimentin and Slug, and downregulating levels of epithelial markers such as e-cadherin and cytokeratins. CSC and non-CSC A549 sublines undergoing EMT show a strong migration and strong levels of MMP9 except for the CD133(-) cell fraction. OCT4 levels are strongly upregulated in all cell fractions except CD133(-) cells. On the contrary, wound size reveals that TGF-β1 enhances motility in wild-type A549 as well as CD133(+) and SP(+) cells. For CD133(-) and SP(-) cells, TGF-β1 exposure does not change the motility. Finally, assessment of growth kinetics reveals major colony-forming efficiency in CD133(+) A549 cells. In particular, SP(+) and SP(-) A549 cells show more efficiency to form colonies than untreated corresponding cells, while for CD133(-) cells no change in colony number was observable after TGF-β1 exposure. We conclude that it is possible to highlight different cell subpopulations with different grades of stemness. Each population seems to be involved in different biological mechanisms such as stemness maintenance, tumorigenicity, invasion and migration.
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Affiliation(s)
- V Tirino
- Department of Experimental Medicine, Second University of Naples, Naples, Italy
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Pavone V, Costarella L, Testa G, Conte G, Riccioli M, Sessa G. Calcaneo-stop procedure in the treatment of the juvenile symptomatic flatfoot. J Foot Ankle Surg 2013; 52:444-7. [PMID: 23623303 DOI: 10.1053/j.jfas.2013.03.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Indexed: 02/03/2023]
Abstract
Flexible flatfoot is the most prevalent condition seen in pediatric orthopedic clinics. It is characterized by an absence of the medial arch and a valgus position of the calcaneus. The purpose of the present study was to report on the results obtained in children treated using the calcaneo-stop procedure. A total of 410 flatfeet in 242 consecutive patients were treated using the calcaneo-stop procedure from January 1999 to March 2010 (10 years, 3 months) and were followed up to February 2012. The mean age at surgery was 11 (range 7 to 14) years, and the mean follow-up duration was 88 (range 14 to 157) months. A clinical evaluation, podoscopic examination, and radiologic assessment were performed in the participating patients preoperatively and at 6 months postoperatively. Of the 242 patients, 168 (69.42%) underwent bilateral foot surgery and 74 (30.58%) unilateral intervention, involving 33 right (44.6%) and 41 left (55.4%) feet. At follow-up, the outcome was satisfactory in 397 feet (96.83%); heel valgus was observed in only 12 feet (2.92%), and the footprint was normalized in 328 feet (80%). The calcaneo-stop procedure is a simple, reliable, and minimally invasive procedure for the treatment of pediatric flexible flatfoot. It allows alignment of the talus and calcaneus, restoring a proper foot arch.
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Affiliation(s)
- Vito Pavone
- Orthopaedic Clinic, University of Catania, Azienda Ospedaliera Universitaria, Policlinico Vittorio Emanuele, Catania, Italy.
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Abstract
BACKGROUND AND PURPOSE Congenital talipes equinovarus (clubfoot) can present in 2 forms: "syndromic", in which other malformations exist, and the more common "idiopathic" form, where there are no other associated malformations. We analyzed the epidemiology of congenital talipes equinovarus in the Sicilian population, looking for potential etiological factors. PATIENTS AND METHODS Among the 801,324 live births recorded between January 1991 and December 2004, 827 cases were registered (560 males; M/F sex ratio: 2.1). Control infants were randomly selected from a historical cohort of live births without any major congenital malformations. RESULTS A positive family history of clubfoot, gender, and maternal smoking were found to be risk factors for clubfoot. Patients with clubfoot were born most frequently during the period January-March. No association was found between clubfoot and reproductive history, peri-conceptional maternal drug exposure, maternal education, or ethnicity. INTERPRETATION Our findings emphasize the importance of birth defects surveillance programs and their usefulness in investigating potential risk factors.
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Affiliation(s)
| | | | - Giuseppe Grosso
- “G.F. Ingrassia” Department – Section of Hygiene and Public Health, University of Catania
| | - Piero Pavone
- Pediatrics Unit, AOU OVE-Polyclinic, University of Catania, Italy
| | - Antonio Mistretta
- “G.F. Ingrassia” Department – Section of Hygiene and Public Health, University of Catania
| | | | - Silvia Marino
- Pediatrics Unit, AOU OVE-Polyclinic, University of Catania, Italy
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