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Vicenti G, Solarino G, Ottaviani G, Carrozzo M, Simone F, Zavattini G, Zaccari D, Buono C, Bizzoca D, Maccagnano G, Moretti B. Atypical Vancouver B1 Periprosthetic Fractures: The Unsolved Problem. Geriatr Orthop Surg Rehabil 2023; 14:21514593221145884. [PMID: 36950184 PMCID: PMC10026097 DOI: 10.1177/21514593221145884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 03/24/2023] Open
Abstract
Atypical femoral fractures (AFF) are stress or insufficiency fractures induced by low energy trauma or no trauma, frequently correlated with prolonged bisphosphonate therapy. The diagnosis follows major and minor criteria, originally described by the Task Force of the American Society for Bone and Mineral Research in 2010 and updated in 2014. However, the definition of AFFs in the report excluded periprosthetic fractures. When atypical fractures occur close to a prosthetic implant the situation become critical, the surgical treatment is often demolitive and supported by medical treatment. Moreover, acute ORIF as a first line treatment is frequently burdened by a high failure rate , and often a stem revision is required as second line treatment. The healing process is long and difficult with poor functional results and impairing outcomes. We present a case treated at our institution of a 78 year old woman with a history of a femoral atypical periprosthetic fracture, complicated by multiple surgical revisions. Its arduous management reflects all the difficulties that these type of fractures could present to the surgeon, while its good final result may teach us how to approach them in a correct way.
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Affiliation(s)
- Giovanni Vicenti
- School of Medicine, University of Bari “Aldo Moro”- AOU
Policlinico Consorziale, Bari, Italy
- Giovanni Vicenti, School of Medicine,
University of Bari “Aldo Moro”- AOU Policlinico Consorziale, Piazza Giulio
Cesare 11, Bari 70124, Italy.
| | - Giuseppe Solarino
- School of Medicine, University of Bari “Aldo Moro”- AOU
Policlinico Consorziale, Bari, Italy
| | - Guglielmo Ottaviani
- School of Medicine, University of Bari “Aldo Moro”- AOU
Policlinico Consorziale, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari “Aldo Moro”- AOU
Policlinico Consorziale, Bari, Italy
| | - Filippo Simone
- School of Medicine, University of Bari “Aldo Moro”- AOU
Policlinico Consorziale, Bari, Italy
| | - Giacomo Zavattini
- School of Medicine, University of Bari “Aldo Moro”- AOU
Policlinico Consorziale, Bari, Italy
| | - Domenico Zaccari
- School of Medicine, University of Bari “Aldo Moro”- AOU
Policlinico Consorziale, Bari, Italy
| | - Claudio Buono
- School of Medicine, University of Bari “Aldo Moro”- AOU
Policlinico Consorziale, Bari, Italy
| | - Davide Bizzoca
- School of Medicine, University of Bari “Aldo Moro”- AOU
Policlinico Consorziale, Bari, Italy
| | - Giuseppe Maccagnano
- Department of Basic Medical
Sciences, Neuroscience and Sense Organs, Foggia University
Hospital, Foggia, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari “Aldo Moro”- AOU
Policlinico Consorziale, Bari, Italy
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Vicenti G, Bizzoca D, Zaccari D, Buono C, Carlet A, Solarino G, Giorgino R, Santolini E, Lunini E, Zavattini G, Ottaviani G, Carrozzo M, Simone F, Marinelli A, Rotini R, Franchini A, Moretti B. Choice of treatments of the coronal shear fractures of the humerus. A national survey of Italian AO members. Injury 2022; 54 Suppl 1:S78-S84. [PMID: 36400627 DOI: 10.1016/j.injury.2022.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 10/10/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Coronal shear fractures of the distal humerus are uncommon injuries representing 6% of distal humeral fractures. There is no univocal consensus about the correct management of this type of fracture. A national survey was conducted to gain more insight into the current classification, diagnosis and treatment of coronal shear fractures in Italy. MATERIALS AND METHODS A postal survey was sent to all AO Italian members including residency orthopaedic surgeons. The survey consisted of general questions about personal experience in the management of these fractures: types of classification systems used, surgical approaches, treatment options and rehabilitation programs. RESULTS 114 orthopaedic surgeons answered a 13-items questionnaire. The most used classification system was AO/OTA (72,8%). Independent screws and if necessary plates were the most answered regarding surgical treatment (81,6%). The most encountered post-surgical complication was stiffening of the elbow (81,6%). CONCLUSION An algorithm of treatment has been proposed. To better classify coronal shear fractures, the authors recommended the integration of two classification systems: AO and Dubberley classifications. In the case of posterior wall comminution, a Kocher extensile approach is recommended, otherwise, if a posterior wall is intact, Kocher or Kaplan approach can be used. The posterior transolecranic approach can be reserved to Dubberley type III or AO 13B3.3. The best treatment choice is represented by independent screws and plates placed according to fracture patterns while arthroplasty is indicated when a stable ORIF is not possible. Mobilization is postponed for about 2 weeks.
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Affiliation(s)
- Giovanni Vicenti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Davide Bizzoca
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Domenico Zaccari
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Claudio Buono
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Arianna Carlet
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Emmanuele Santolini
- Orthopedics and Trauma Unit, Emergency Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Enricomaria Lunini
- Orthopedics and Trauma Unit, ASST Lariana Ospedale Sant'Anna, Como, Italy
| | - Giacomo Zavattini
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Guglielmo Ottaviani
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy.
| | - Filippo Simone
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | | | - Roberto Rotini
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Franchini
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
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Vicenti G, Solarino G, Carrozzo M, Simone F, Ottaviani G, Bizzoca D, Zavattini G, Zaccari D, Buono C, Moretti B. Is the Posterior Approach With Posterior locking compression plate and Anterior Allograft Useful and Safe in the Treatment of Periprosthetic Humeral Fractures Following Reverse Total Shoulder Arthroplasty? Geriatr Orthop Surg Rehabil 2022; 13:21514593221080961. [PMID: 35433099 PMCID: PMC9006377 DOI: 10.1177/21514593221080961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction As the reverse total shoulder arthroplasty (RTSA) surgery has dramatically increased in the last few decades, many complications have followed through. The periprosthetic fracture, at the moment, is still a subject of debate in the orthopedic world. In this monocentric study, along with a literature review of periprosthetic humeral fractures, we would present our institutional experience with the treatment of periprosthetic humeral fractures with a posterior humeral approach, posterior cortex plate fixation, anterior strut allograft, screws, and cerclage wires. Materials and Methods Our study consisted in a prospective monocentric study based on 18 patients, with a mean age of 75.3 years (range 64–88), all following a reverse shoulder total arthroplasty (RTSA). Postoperative follow-ups were taken at 1, 6, and 12 months with objective measurement of shoulder motion and strength, while clinical outcome measures were assessed using the American Shoulder and Elbow Surgeons (ASES score) and visual analog scale (VAS) for pain. Together with that, we performed a literature review focused on the management of periprosthetic humeral fractures after shoulder arthroplasty. Results All fractures consolidated without complication at a mean 4.2 months (range 3–6). At final follow-up, the average active shoulder flexion was 88° (range 62–129°), active abduction 73° (range 52–91°) and active external rotation 22° (range 3–56°). The average ASES score was 73 (range 59–97), while average VAS score was 1.1 (range 0–3). Discussion Surgical treatment of periprosthetic humeral fractures following a shoulder arthroplasty remains a hard challenge for every surgeon, and their treatment must consider fracture’s location, displacement, and local bone quality. Conclusions The posterior approach with a posterior plate placement and anterior strut allograft, which is appliable only in case of a B or C type fracture according to Worland classification, could be a good treatment option for periprosthetic humeral fractures.
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Affiliation(s)
- Giovanni Vicenti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Giuseppe Solarino
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Massimiliano Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Filippo Simone
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Guglielmo Ottaviani
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Davide Bizzoca
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Giacomo Zavattini
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Domenico Zaccari
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Claudio Buono
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Biagio Moretti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
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De Giorgi S, Vicenti G, Bizzoca D, Carrozzo M, Baglioni M, Virgilio A, Moretti L, Moretti B. Lateral collateral ulnar ligament reconstruction techniques in posterolateral rotatory instability of the elbow: A systematic review. Injury 2022; 53 Suppl 1:S8-S12. [PMID: 33187675 DOI: 10.1016/j.injury.2020.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/13/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Elbow chronic instability is a disable complication, presenting as recurrent joint subluxations or dislocations. This systematic review aims to assess (1) the clinical outcome and (2) the complication rates of the surgical techniques currently used in the management of posterolateral rotatory elbow instability. METHODS OVID-MEDLINE®, SCOPUS, and PubMed were searched from January 2009 to February 2019 to identify relevant studies. The search terms used were "LUCL", "Posterolateral dislocation", "Elbow Docking technique", "Elbow Jobe technique" and "Elbow single strand technique". The methodological qualities of the studies were evaluated, relevant data were extracted. RESULTS Three studies, published between 2012 and 2015, were included in this review. No studies concerning the single strand technique met the inclusion criteria. The included studies had a level of evidence IV and recruited 33 patients undergoing a Jobe technique reconstruction and 8 patients undergoing a Docking technique. Jobe procedure registered better clinical and functional outcome, assessed using the Mayo Clinic Elbow Performance Scale (MEPS), compared with patients managed with Docking technique. Nonetheless, this difference is not significant. There was not a significantly different complication rate (p = 0.57) between patients treated with these two different techniques. CONCLUSION This systematic review showed that both Jobe and Docking techniques are safe and effective in the treatment of posterolateral elbow instability. However, future studies with larger sample size and a longer follow-up interval are needed to draw stronger conclusions on the efficacy of the different LUCL surgical reconstruction techniques.
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Affiliation(s)
- Silvana De Giorgi
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Giovanni Vicenti
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy.
| | - Davide Bizzoca
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Massimiliano Carrozzo
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Marco Baglioni
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Antonio Virgilio
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Lorenzo Moretti
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Biagio Moretti
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
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Vicenti G, Solarino G, Bizzoca D, Simone F, Maccagnano G, Zavattini G, Ottaviani G, Carrozzo M, Buono C, Zaccari D, Moretti B. Use of the 95-degree angled blade plate with biological and mechanical augmentation to treat proximal femur non-unions: a case series. BMC Musculoskelet Disord 2022; 22:1067. [PMID: 35227245 PMCID: PMC8886749 DOI: 10.1186/s12891-022-05089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intertrochanteric and subtrochanteric non-union are rare but challenging complications. In the present study, we investigate the use of a 95° blade, in association with biological and mechanical augmentation, in the management of intertrochanteric and subtrochanteric femoral non-unions. METHODS Between October 2015 and February 2021, a retrospective cohort study was conducted at our institution to investigate the use of a 95° blade, in association with biological and mechanical augmentation, in the management of intertrochanteric and subtrochanteric femoral non-unions, following the mechanical failure of the first device. All the patients underwent a clinical and radiographic follow-up at 6 weeks, 3, 6, 9, 12 and 18 months; at each follow-up, a plain radiograph of the femur was performed and patients were assessed using Harris Hip Score (HHS) and the Short Form-12 (SF-12) questionnaire. RESULTS From October 2015 and February 2021, 40 proximal femur non-unions were managed at our Institution. Fifteen patients out of forty (37.5%) met the inclusion criteria. The main data of the study are summarized in Table 1; patients' mean was 57 years old (range 19-83); 10 males and 5 females were included in the study. All the patients completely healed clinically and radiologically at an average of 6.1 months (range 4-13). All these patients returned to their pre-injury mobility status. During an average follow-up period of 25 months (range 8-60), the observed complications included wound dehiscence, which was treated with a superficial surgical debridement, a below-the-knee deep vein thrombosis, and a blade plate failure 3 months after the first revision surgery. CONCLUSIONS This study shows the treatment of inter-and sub-trochanteric non-unions with a 95° blade plate, medial strut allograft, and bone autograft obtained with RIA system, together with a varus malalignment correction, leads to a high percentage of bone healing, with a low incidence of complications and good clinical outcome.
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Affiliation(s)
- Giovanni Vicenti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | - Davide Bizzoca
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy.
- University of Bari "Aldo Moro, PhD course in Public Health, Clinical Medicine, and Oncology, Piazza Giulio Cesare 11, 70100, Bari, Italy.
| | - Filippo Simone
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | | | - Giacomo Zavattini
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | - Guglielmo Ottaviani
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | - Massimiliano Carrozzo
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | - Claudio Buono
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | - Domenico Zaccari
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Orthopaedic & Trauma Unit, Bari, Italy
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Solarino G, Maccagnano G, Vicenti G, Buono C, Simone F, Ottaviani G, Zavattini G, Zaccari D, Carrozzo M, Spinarelli A, Bizzoca D, Moretti B. A Newly Identified Complication of Patellofemoral Arthroplasty: Case Report and Literature Review. Geriatr Orthop Surg Rehabil 2022; 13:21514593221138662. [DOI: 10.1177/21514593221138662] [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: 12/12/2022] Open
Abstract
Background Patellofemoral arthroplasty (PFA) is a surgical option for patients older than 40 years old who are affected by patellofemoral osteoarthritis. Regarding the complications of PFAs, few studies have investigated periprosthetic fractures. The purpose of this literature review was to highlight a previously overlooked complication of primary prosthetic surgery of the patellofemoral joint. Methods Three literature databases were searched for studies published between 2000 to 2020 using relevant keywords. A total of 4,942 articles were originally identified. After excluding duplicates and analysing the titles and abstracts, 20 studies were considered. From these, data regarding the number of cases, clinical outcomes and complications were extracted. Results Among the 20 selected articles, only one described periprosthetic fractures as a complication of PFAs. Herein, we also report an illustrative case of an unknown fracture complication. No cases in the literature were found that described the type of complications experienced by our patient during the postoperative period. Conclusions This review confirms the lack of data about clinical outcomes and fracture complications of PFAs. In primary prosthetic surgery of the patellofemoral joint, patient selection and close consideration of demographic factors (such as BMI and age) and intraoperative factors (such as patellar thickness and size of the trochlear component) play a key role in optimising pre-operative planning to avoid intraoperative periprosthetic fractures.
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Affiliation(s)
- Giuseppe Solarino
- School of Medicine, University of Bari “Aldo Moro”-AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Giuseppe Maccagnano
- Orthopedic and Trauma Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, General Hospital, Foggia, Italy
| | - Giovanni Vicenti
- School of Medicine, University of Bari “Aldo Moro”-AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Claudio Buono
- School of Medicine, University of Bari “Aldo Moro”-AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Filippo Simone
- School of Medicine, University of Bari “Aldo Moro”-AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Guglielmo Ottaviani
- School of Medicine, University of Bari “Aldo Moro”-AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Giacomo Zavattini
- School of Medicine, University of Bari “Aldo Moro”-AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Domenico Zaccari
- School of Medicine, University of Bari “Aldo Moro”-AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari “Aldo Moro”-AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Antonio Spinarelli
- School of Medicine, University of Bari “Aldo Moro”-AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Davide Bizzoca
- School of Medicine, University of Bari “Aldo Moro”-AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari “Aldo Moro”-AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
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Solarino G, Vicenti G, Carrozzo M, Ottaviani G, Moretti B, Zagra L. Modular neck stems in total hip arthroplasty: current concepts. EFORT Open Rev 2021; 6:751-758. [PMID: 34667646 PMCID: PMC8489472 DOI: 10.1302/2058-5241.6.200064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Modular neck (MN) implants can restore the anatomy, especially in deformed hips such as sequelae of development dysplasia. Early designs for MN implants had problems with neck fractures and adverse local tissue, so their use was restricted to limited indications. Results of the latest generation of MN prostheses seem to demonstrate that these problems have been at least mitigated. Given the results of the studies presented in this review, surgeons might consider MN total hip arthroplasty (THA) for a narrower patient selection when a complex reconstruction is required. Long MN THA should be avoided in case of body mass index > 30, and should be used with extreme caution in association with high offset femoral necks with long or extra-long heads. Cr-Co necks should be abandoned, in favour of a titanium alloy connection. Restoring the correct anatomic femoral offset remains a challenge in THA surgeries. MN implants have been introduced to try to solve this problem. The MN design allows surgeons to choose the appropriate degree and length of the neck for desired stability and range of motion.
Cite this article: EFORT Open Rev 2021;6:751-758. DOI: 10.1302/2058-5241.6.200064
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Affiliation(s)
- Giuseppe Solarino
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Giovanni Vicenti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Massimiliano Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Guglielmo Ottaviani
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Biagio Moretti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
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Schmidt E, Rashid H, Marzano A, Lamberts A, Di Zenzo G, Diercks G, Alberti‐Violetti S, Barry R, Borradori L, Caproni M, Carey B, Carrozzo M, Cianchini G, Corrà A, Dikkers F, Feliciani C, Geerling G, Genovese G, Hertl M, Joly P, Meijer J, Mercadante V, Murrell D, Ormond M, Pas H, Patsatsi A, Rauz S, van Rhijn B, Roth M, Setterfield J, Zillikens D, C.Prost, Zambruno G, Horváth B, Caux F. European Guidelines (S3) on diagnosis and management of mucous membrane pemphigoid, initiated by the European Academy of Dermatology and Venereology - Part II. J Eur Acad Dermatol Venereol 2021; 35:1926-1948. [PMID: 34309078 PMCID: PMC8518905 DOI: 10.1111/jdv.17395] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/24/2021] [Indexed: 01/21/2023]
Abstract
This guideline has been initiated by the task force Autoimmune Blistering Diseases of the European Academy of Dermatology and Venereology, including physicians from all relevant disciplines and patient organizations. It is a S3 consensus-based guideline that systematically reviewed the literature on mucous membrane pemphigoid (MMP) in the MEDLINE and EMBASE databases until June 2019, with no limitations on language. While the first part of this guideline addressed methodology, as well as epidemiology, terminology, aetiology, clinical presentation and outcome measures in MMP, the second part presents the diagnostics and management of MMP. MMP should be suspected in cases with predominant mucosal lesions. Direct immunofluorescence microscopy to detect tissue-bound IgG, IgA and/or complement C3, combined with serological testing for circulating autoantibodies are recommended. In most patients, serum autoantibodies are present only in low levels and in variable proportions, depending on the clinical sites involved. Circulating autoantibodies are determined by indirect IF assays using tissue substrates, or ELISA using different recombinant forms of the target antigens or immunoblotting using different substrates. The major target antigen in MMP is type XVII collagen (BP180), although in 10-25% of patients laminin 332 is recognized. In 25-30% of MMP patients with anti-laminin 332 reactivity, malignancies have been associated. As first-line treatment of mild/moderate MMP, dapsone, methotrexate or tetracyclines and/or topical corticosteroids are recommended. For severe MMP, dapsone and oral or intravenous cyclophosphamide and/or oral corticosteroids are recommended as first-line regimens. Additional recommendations are given, tailored to treatment of single-site MMP such as oral, ocular, laryngeal, oesophageal and genital MMP, as well as the diagnosis of ocular MMP. Treatment recommendations are limited by the complete lack of high-quality randomized controlled trials.
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Rashid H, Lamberts A, Borradori L, Alberti‐Violetti S, Barry R, Caproni M, Carey B, Carrozzo M, Caux F, Cianchini G, Corrà A, Diercks G, Dikkers F, Di Zenzo G, Feliciani C, Geerling G, Genovese G, Hertl M, Joly P, Marzano A, Meijer J, Mercadante V, Murrell D, Ormond M, Pas H, Patsatsi A, Prost C, Rauz S, van Rhijn B, Roth M, Schmidt E, Setterfield J, Zambruno G, Zillikens D, Horváth B. European guidelines (S3) on diagnosis and management of mucous membrane pemphigoid, initiated by the European Academy of Dermatology and Venereology - Part I. J Eur Acad Dermatol Venereol 2021; 35:1750-1764. [PMID: 34245180 PMCID: PMC8457055 DOI: 10.1111/jdv.17397] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022]
Abstract
This guideline on mucous membrane pemphigoid (MMP) has been elaborated by the Task Force for Autoimmune Blistering Diseases of the European Academy of Dermatology and Venereology (EADV) with a contribution of physicians from all relevant disciplines and patient organizations. It is a S3 consensus-based guideline encompassing a systematic review of the literature until June 2019 in the MEDLINE and EMBASE databases. This first part covers methodology, the clinical definition of MMP, epidemiology, MMP subtypes, immunopathological characteristics, disease assessment and outcome scores. MMP describes a group of autoimmune skin and mucous membrane blistering diseases, characterized by a chronic course and by predominant involvement of the mucous membranes, such as the oral, ocular, nasal, nasopharyngeal, anogenital, laryngeal and oesophageal mucosa. MMP patients may present with mono- or multisite involvement. Patients' autoantibodies have been shown to be predominantly directed against BP180 (also called BPAG2, type XVII collagen), BP230, laminin 332 and type VII collagen, components of junctional adhesion complexes promoting epithelial stromal attachment in stratified epithelia. Various disease assessment scores are available, including the Mucous Membrane Pemphigoid Disease Area Index (MMPDAI), the Autoimmune Bullous Skin disorder Intensity Score (ABSIS), the 'Cicatrising Conjunctivitis Assessment Tool' and the Oral Disease Severity Score (ODSS). Patient-reported outcome measurements (PROMs), including DLQI, ABQOL and TABQOL, can be used for assessment of quality of life to evaluate the effectiveness of therapeutic interventions and monitor disease course.
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Vicenti G, Bizzoca D, Solarino G, Carrozzo M, Belluati A, D'Arienzo A, De Carolis O, Moretti B. Periprosthetic femoral re-fractures pathogenesis, classification, and surgical implications. Injury 2020; 54 Suppl 1:S24-S30. [PMID: 33218615 DOI: 10.1016/j.injury.2020.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 11/10/2020] [Indexed: 02/02/2023]
Abstract
Periprosthetic femoral re-fractures (PFRFs) represent an emerging challenge for orthopaedic surgeons, since their incidence is growing in the last years, but very few experiences about their management have been currently published. The present study aims to (1) introduce, for the first time, an etiologic classification for PRFRs and (2) to provide surgical and pharmacological tips for the correct management of these injuries. Periprosthetic femoral re-fractures (PFRFs) could be classified into traumatic-PFRFs (T-PFRFs) and pathological-PFRFs (P-PFRFs). T-PFRFs, i.e. the "true" periprosthetic re-fractures, present as new fracture lines occurring proximally or distally to a previous periprosthetic fracture, that has correctly healed. They are generally unpredictable injuries but, in selected cases, it is possible to predict them by analyzing the construct used in the treatment of the previous periprosthetic fracture. P-PFRFs, on the other hand, define re-fractures occurring on a previous periprosthetic non-union or delayed union: the new fracture line appears in the same district of the old one. According to the etiologic factors influencing the P-PFRFs pathogenesis, it is possible to define re-fractures caused by mechanical failures, biological failures, septic failures and multifactorial failures, i.e., a combination of the previously mentioned concerns. A successful postoperative outcome, following the surgical management of PFRFs, requires the correct identification of all the underlying causes, which should be promptly and appropriately managed.
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Affiliation(s)
- Giovanni Vicenti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy.
| | - Davide Bizzoca
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Alberto Belluati
- Ospedale "Santa Maria delle Croci", Ravenna, AUSL Romagna, Italy
| | | | - Oronzo De Carolis
- Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
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11
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Bizzoca D, Vicenti G, Caiaffa V, Abate A, De Carolis O, Carrozzo M, Solarino G, Moretti B. Assessment of fracture healing in orthopaedic trauma. Injury 2020; 54 Suppl 1:S46-S52. [PMID: 33234266 DOI: 10.1016/j.injury.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
Fracture healing is a complex physiologic process, relying on the crucial interplay between biological and mechanical factors. It is generally assessed using imaging modalities, including conventional radiology, CT, MRI and ultrasound (US), based on the fracture and patient features. Although these techniques are routinely used in orthopaedic clinical practice, unfortunately, they do not provide any information about the biomechanical status of the fracture site. Therefore, in recent years, several non-invasive techniques have been proposed to assess bone healing using ultrasonic wave propagation, changes in electrical properties of bones and callus stiffness measurement. Moreover, different research groups are currently developing smart orthopaedic implants (plates, intramedullary nails and external fixators), able to provide information about the fracture healing process. These devices could significantly improve orthopaedic and trauma clinical practice in the future and, at the same time, reduce patients' exposure to X-rays. This study aims to define the role of traditional imaging techniques and emerging technologies in the assessment of the fracture healing process.
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Affiliation(s)
- Davide Bizzoca
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giovanni Vicenti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy.
| | - Vincenzo Caiaffa
- Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy
| | - Antonella Abate
- Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy
| | - Oronzo De Carolis
- Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
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12
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Barki M, Losito M, Carrozzo M, Caracciolo M, Rovida M, Bandera F, Alfonzetti E, Guazzi M. Adverse cardiovascular outcome predicted by left atrial strain in acute decompensated heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
A significant proportion of patients hospitalized for acute decompensated heart failure (ADHF) are readmitted to the hospital within 30 days, resulting in a major social and economic burden. Thus, risk stratification and identification of targets of therapy is of basic importance. Non-invasive imaging modality such as transthoracic echocardiography (TTE) represents a cornerstone tool to approach this clinical scenario for early recognition of high-risk patients.
Purpose
To define whether left atrial (LA) dynamics, evaluated by means of speckle tracking echocardiography (STE), may represent a predictor of cardiac events and early re-hospitalization in patients admitted to the emergency department (ED) for ADHF, in comparison with other non-invasive established prognostic index in heart failure (HF) such as NT-proBNP, B-lines at lung ultrasonography (LUS) and right ventricular (RV) to Pulmonary Circulation (PC) uncoupling evaluated through Tricuspid Annular Plane Systolic Excursion (TAPSE)/Pulmonary Arterial Systolic Pressure (PASP) ratio.
Methods
Seventy patients (mean age 75.6±11 years, 57% males) presenting with ADHF were prospectively enrolled within 24–48 hours from admission. In the acute phase and at pre-discharge the following variables have been collected: NT-proBNP, B-lines, TAPSE/PASP ratio, Left Atrial Volume indexed (LAVi) and global-peak atrial longitudinal strain (G-PALS).
Results
During a median follow-up of nine months we observed 18 events consisting of 7 deaths, 8 re-hospitalizations for ADHF, 1 re-hospitalization for acute coronary syndrome, 1 stroke and 1 mitral valve replacement. Multivariate Cox-regression analysis identified LAVi and GPALS at discharge, along with NT-proBNP, B-lines and TAPSE/PASP ratio, as independent predictors of major adverse CV events (LAVi: p=0.04; GPALS: p=0.05; NT-proBNP: p<0.001; B-lines: p=0.03; TAPSE/PASP: p<0.001) (Table 1).
Conclusions
Short-term re-hospitalization in ADHF is crucial and the identification of a higher risk through sensitive and potentially new hemodynamic phenotypes is of relevance. Our findings, although preliminary, may suggest a primary role of LA dynamics in this context.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Barki
- IRCCS Polyclinic San Donato, Milan, Italy
| | - M Losito
- IRCCS Polyclinic San Donato, Milan, Italy
| | - M Carrozzo
- IRCCS Polyclinic San Donato, Milan, Italy
| | | | - M Rovida
- IRCCS Polyclinic San Donato, Milan, Italy
| | - F Bandera
- IRCCS Polyclinic San Donato, Milan, Italy
| | | | - M Guazzi
- IRCCS Polyclinic San Donato, Milan, Italy
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13
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Carrozzo M, Baglioni M, Moretti B. Letter to the Editor on "The Direct Anterior Approach for Total Hip Arthroplasty for Severe Dysplasia (Crowe III and IV) Provides Satisfactory Medium to Long-Term Outcomes". J Arthroplasty 2020; 35:3064-3065. [PMID: 32703712 DOI: 10.1016/j.arth.2020.06.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/24/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Massimiliano Carrozzo
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari -Aldo Moro - AOU Consorziale -Policlinico, Bari, Italy
| | - Marco Baglioni
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari -Aldo Moro - AOU Consorziale -Policlinico, Bari, Italy
| | - Biagio Moretti
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari -Aldo Moro - AOU Consorziale -Policlinico, Bari, Italy
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14
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Vicenti G, Bizzoca D, Nappi V, Pesce V, Solarino G, Carrozzo M, Moretti F, Dicuonzo F, Moretti B. Serum biomarkers in the diagnosis of periprosthetic joint infection: consolidated evidence and recent developments. Eur Rev Med Pharmacol Sci 2020; 23:43-50. [PMID: 30977870 DOI: 10.26355/eurrev_201904_17473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Periprosthetic Joint Infection (PJI) represents one of the leading causes of revision prosthetic surgery, accounting for 25% of failed Total Knee Replacement (TKR) and 15% of failed Total Hip Replacement (THR). The search for a biomarker that, together with clinical and radiological findings, could improve the management of such a kind of patients is currently a big challenge for orthopaedic surgeons. This review aims (1) to assess the accuracy and the limitations of the traditional (Serum Erythrocytes Sedimentation Rate, C-reactive Protein, Procalcitonin, Interleukin 6, Tumor Necrosis Factor alpha), (2) and to analyse the emerging serum biomarkers (Presepsin, Toll-like Receptor 2, soluble urokinase-type Plasminogen Activator Receptor, Chemokine Ligand 2 and Osteopontin) in the diagnosis of PJI. A special attention will be given to the emerging serum biomarkers, that could play an important role as first-line investigations, in the screening of PJI in a close future.
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Affiliation(s)
- G Vicenti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs. Orthopaedic & Trauma Unit, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Bari, Italy.
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15
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Vicenti G, Bizzoca D, Nappi VM, Carrozzo M, Miolla MP, Ottaviani G, Solarino G, Moretti B. Minimally invasive osteosynthesis technique in the treatment of transverse patellar fractures in the elderly. Injury 2020; 51 Suppl 3:S50-S55. [PMID: 31948780 DOI: 10.1016/j.injury.2020.01.012] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/17/2019] [Accepted: 01/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This prospective study aims to describe our experience in the management of transverse patellar fractures in elderly patients with minimally invasive osteosynthesis technique (MIOT), at 12-months follow-up. METHODS Patients older than 60, with transverse patellar fracture, type 34-C1 according to the AO/OTA classification system, referred to our trauma centre, between January 2014 and December 2017 were prospectively recruited. All the patients were managed using MIOT surgical procedure and underwent a clinical and radiological follow-up at 2 weeks, 6 weeks and at 3, 6, 12 and 15 months postoperatively. The clinical evaluation was performed using the Lysholm Knee Scoring System (LKSS) and the Visual Analogue Scale (VAS) for pain. The hardware removal was planned at 12-months follow-up. The paired t-test was performed. The test was two-tailed with a confidence level of 5%. RESULTS 61 patients were recruited. The mean VAS was significantly lower in MIOT group until the 3-months follow-up (p = 0.001). ROM in flexion and LKSS score were significantly better in MIOT-group at all follow-ups, whereas ROM in extension showed no differences, between the two groups, starting from the 6-months follow-up. In the open surgery group, a significantly higher rate of delayed wound healing (p = 0.014), broken wires (p = 0.001) and non-cosmetic scar (p = 0.0221) was observed. CONCLUSIONS This prospective study shows that MIOT is a safe option for treatment of patellar transverse fractures in elderly patients, since it reduces the intra-operative blood loss, shortens the operating time, and is endowed with lower rates of postoperative complications.
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Affiliation(s)
- Giovanni Vicenti
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Davide Bizzoca
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Vittorio Maria Nappi
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Massimiliano Carrozzo
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy.
| | - Maria Paola Miolla
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Guglielmo Ottaviani
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Giuseppe Solarino
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Biagio Moretti
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
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16
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Vicenti G, Bizzoca D, Cotugno D, Carrozzo M, Riefoli F, Rifino F, Belviso V, Elia R, Solarino G, Moretti B. The use of a gentamicin-coated titanium nail, combined with RIA system, in the management of non-unions of open tibial fractures: A single centre prospective study. Injury 2020; 51 Suppl 3:S86-S91. [PMID: 31591005 DOI: 10.1016/j.injury.2019.09.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Received: 06/05/2019] [Revised: 09/01/2019] [Accepted: 09/19/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Nonunion is a quite common complication of open tibial shaft fractures. This prospective case series investigates the use of the gentamicin-coated titanium intramedullary tibial nail, in association with the RIA system, in patients with tibial exposed nonunions. METHODS Between January 2015 and January 2018, patients meeting the inclusion and exclusion criteria were recruited. INCLUSION CRITERIA patients aged 18 or more; non-union after an open tibial shaft fracture; previous treatment with a circular external fixator. EXCLUSION CRITERIA a known allergy to aminoglycosides; pin tract infections; persistent soft-tissues damage; patients pregnant, breastfeeding or planning to become pregnant during the study; history of malignant disease; a life expectancy of fewer than three months; medical illness or cognitive disorders precluding participation in the follow-up examination. All the patients underwent a clinical and radiological follow-up at one-, three-, six- and twelve-months post-operatively. Clinical evaluation was performed using the following validated scores: Euro-Quality 5 D (EQ-5D); American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and the Visual Analogue Scale (VAS) for pain. RESULTS Seventeen patients met the inclusion and exclusion criteria (male: 11; female: 6; mean age: 41.12 ± 11.4). Fracture healing was observed in all the patients; the mean time needed to obtain the fracture healing was 7.18 months. A significant improvement of the quality of life, evaluated with the EQ-5D, and of the mean VAS for pain was observed from the three-months follow-up. The mean AOFAS score showed a significant increase at six-months follow-up. CONCLUSIONS The use of gentamicin-coated nails in association with the RIA system demonstrated a safe and effective treatment of tibial non-unions.
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Affiliation(s)
- Giovanni Vicenti
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Davide Bizzoca
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Domenico Cotugno
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Massimiliano Carrozzo
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy.
| | - Flavia Riefoli
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Francesco Rifino
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Vito Belviso
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Rossella Elia
- Division of Plastic and Reconstructive Surgery, University of Bari, Italy
| | - Giuseppe Solarino
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Biagio Moretti
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
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17
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Vicenti G, Bizzoca D, Nappi VS, Carrozzo M, Delmedico M, Solarino G, Moretti B. The impact of lag screw in the healing time of distal tibia fractures treated with minimally invasive plate osteosynthesis: A randomized clinical trial. Injury 2020; 51 Suppl 3:S80-S85. [PMID: 32070556 DOI: 10.1016/j.injury.2020.02.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/05/2019] [Revised: 01/26/2020] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND In recent years, Minimally Invasive Plate Osteosynthesis (MIPO) has been gaining popularity in the treatment of distal tibia fractures, because it is a minimally invasive surgical procedure, thus it limits the soft-tissues damage. This prospective randomized study aims to assess the impact of lag screw in the healing time of distal tibia fractures treated with MIPO technique, in a six-month follow-up. METHODS Patients between 20 and 70 years of age with distal tibial fracture, type 43-A according to AO/OTA classification system were included. All the patients were randomized into two groups, to receive MIPO without lag screw (Group-A) or MIPO with percutaneous lag screw (Group-B). Patients were followed clinically and radiographically at 3, 6, 12 and 24 weeks postoperatively. The main outcome measure was the time needed to achieve the painless full weight-bearing (FWB) after surgery. Unpaired t-test after ANOVA (analysis of variance) was performed to assess AOFAS score differences between the 2 groups at each follow-up. Pearson correlation test also was performed. The tests were two-tailed with a confidence level of 5%. RESULTS 42 patients (24 male and 18 female, mean age 49.54 years old, range 25-80) were recruited. A significant shorter mean time until painless FWB (p = 0.016) was observed in Group-B (11.22 ± 3.06 weeks) compared with Group-A (13.48 ± 2.42 weeks) (Table 2). The mean AOFAS score was comparable in patients treated with (Group-B) and without lag screw (Group-A) at all follow-ups. CONCLUSIONS This prospective randomized clinical study has shown that the use of lag screw in distal tibia fractures treated with MIPO technique speeds the fracture healing, thus shortening the time needed to achieve FWB.
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Affiliation(s)
- Giovanni Vicenti
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Davide Bizzoca
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Vittorio Saverio Nappi
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Massimiliano Carrozzo
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy.
| | - Michelangelo Delmedico
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Giuseppe Solarino
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Biagio Moretti
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
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Carrozzo M, Eriksen JG, Bensadoun RJ, Boers-Doets CB, Lalla RV, Peterson DE. Oral Mucosal Injury Caused by Targeted Cancer Therapies. J Natl Cancer Inst Monogr 2020; 2019:5551364. [PMID: 31425602 DOI: 10.1093/jncimonographs/lgz012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/14/2019] [Accepted: 05/01/2019] [Indexed: 02/06/2023] Open
Abstract
Targeted cancer therapies have fundamentally transformed the treatment of many types of cancers over the past decade, including breast, colorectal, lung, and pancreatic cancers, as well as lymphoma, leukemia, and multiple myeloma. The unique mechanisms of action of these agents have resulted in many patients experiencing enhanced tumor response together with a reduced adverse event profile as well. Toxicities do continue to occur, however, and in selected cases can be clinically challenging to manage. Of particular importance in the context of this monograph is that the pathobiology for oral mucosal lesions caused by targeted cancer therapies has only been preliminarily investigated. There is distinct need for novel basic, translational, and clinical research strategies to enhance design of preventive and therapeutic approaches for patients at risk for development of these lesions. The research modeling can be conceptually enhanced by extrapolating "lessons learned" from selected oral mucosal conditions in patients without cancer as well. This approach may permit determination of the extent to which pathobiology and clinical management are either similar to or uniquely distinct from oral mucosal lesions caused by targeted cancer therapies. Modeling associated with oral mucosal disease in non-oncology patients is thus presented in this context as well. This article addresses this emerging paradigm, with emphasis on current mechanistic modeling and clinical treatment. This approach is in turn designed to foster delineation of new research strategies, with the goal of enhancing cancer patient treatment in the future.
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Affiliation(s)
- M Carrozzo
- Center for Oral Health Research, Oral Medicine Department, School of Dental Sciences, Newcastle University, UK
| | - J Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - R-J Bensadoun
- Institut Niçois de Cancérologie (INC), Centre de Haute Energie, Nice, France
| | - C B Boers-Doets
- CancerMed, Department of Medical Strategy, Wormer, The Netherlands.,Impaqtt Foundation, Department of Adverse Event Research & Valorisation, Wormer, The Netherlands
| | - R V Lalla
- Section of Oral Medicine, Department of Oral Health & Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT
| | - D E Peterson
- Section of Oral Medicine, Department of Oral Health & Diagnostic Sciences, School of Dental Medicine & Neag Comprehensive Cancer Center, UConn Health, Farmington, CT
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Vicenti G, Bizzoca D, Carrozzo M, Nappi VS, Franchini A, Moretti L, Solarino G, Moretti B. Humeral shaft butterfly fractures managed with intramedullary nail: could the third fragment features predict the fracture healing time? J BIOL REG HOMEOS AG 2020; 34:97-104. ADVANCES IN MUSCULOSKELETAL DISEASES AND INFECTIONS-SOTIMI 2019. [PMID: 32856447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
To assess the impact of the radiological features of the third fragment on the outcome of humeral shaft fractures type 12-B managed with endomedullary nails. We retrospectively evaluated a series of 80 patients, divided into 3 groups, according to the fracture healing time: within 6 months (group-A), between 6 and 12 months (group-B) or fracture non-union after 12 months (group-C). In 26 patients out of 80 the fracture healing was observed at 6 months follow-up; in 47 out of 80 at 12 months after trauma and in 7 out of 80 no fracture healing was observed at 12 months follow-up. Regression analysis showed that the third fragment displacement and angulation are the most important features that affect the fracture healing. The mean third fragment dislocation (cut-off: 12 mm) is the main parameter to influence the fracture healing within or in more than six months.
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Affiliation(s)
- G Vicenti
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico" - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic & Trauma Unit, Bari, Italy
| | - D Bizzoca
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico" - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic & Trauma Unit, Bari, Italy
| | - M Carrozzo
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico" - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic & Trauma Unit, Bari, Italy
| | - V S Nappi
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico" - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic & Trauma Unit, Bari, Italy
| | - A Franchini
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico" - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic & Trauma Unit, Bari, Italy
| | - L Moretti
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico" - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic & Trauma Unit, Bari, Italy
| | - G Solarino
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico" - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic & Trauma Unit, Bari, Italy
| | - B Moretti
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico" - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic & Trauma Unit, Bari, Italy
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Vicenti G, Carrozzo M, Solarino G, Caizzi G, De Crescenzo A, Portaluri M, Mori CM, Vittore D, Moretti B. Comparison of plate, calcanealplasty and external fixation in the management of calcaneal fractures. Injury 2019; 50 Suppl 4:S39-S46. [PMID: 31133288 DOI: 10.1016/j.injury.2019.04.014] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 04/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Managing displaced intra-articular calcaneal fractures remains controversial. The purpose of this study is to compare and identify the surgical technique with the best outcomes for the treatment of intra-articular calcaneal fractures. MATERIALS AND METHODS This is a retrospective multicentric study conducted between February 2000 and June 2014 in 206 patients with intra-articular calcaneal fractures presenting to the outpatient or emergency department of three different orthopaedic departments. The patients were treated with one of the following techniques: 1. Open reduction and internal fixation with screws and plate; 2. Percutaneous reduction and monolateral external fixation; and 3. Balloon-assisted reduction, pin fixation and tricalcium phosphate augmentation. RESULTS Patients treated with open reduction and internal fixation using an extensive lateral approach had a mean AOFAS score of 71 points; those treated through a minimal incision and reduction and fixation with an external fixator had a mean score of 83.1 points; and those treated with the balloon-assisted reduction, pin fixation and tricalcium phosphate augmentation had a mean score of 78.75 points. No statistically difference was found comparing the three types of treatment. CONCLUSION Displaced intra-articular calcaneal fractures are still technically demanding injuries to manage. The results of this study suggest that in comparison to open reduction, a percutaneous reduction and fixation leads to higher but not statistical functional scores minimizing the wound-healing complications.
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Affiliation(s)
- Giovanni Vicenti
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy.
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Gianni Caizzi
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Angelo De Crescenzo
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Mauro Portaluri
- Department of Orthopaedics and Traumatology, Sacro Cuore di Gesù Hospital, Gallipoli, Italy
| | - Claudio Maria Mori
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Donato Vittore
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs; Orthopaedic &Trauma Unit, Bari, Italy
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Abstract
PURPOSE The purpose of this systematic review was to address the treatment of multiligament knee injuries in three major aspects, specifically (1) surgical versus nonoperative treatment, (2) repair versus reconstruction of injured ligamentous structures, and (3) early versus late surgery of damaged ligaments. METHODS Two independent reviewers performed a search on PubMed from 1966 to March 2016 using Levy's review as a starting-point, and the same terms "knee dislocation," "multiple ligament-injured knee," and "multiligament knee reconstruction." Study inclusion criteria were (1) levels I to IV evidence, (2) "multiligament" defined as disruption of at least 2 of the 4 major knee ligaments, (3) measures of functional and clinical outcomes, and (4) minimum of 12 months' follow-up, with a mean of at least 24 months. RESULTS Two high-level studies compared surgical treatment with nonoperative treatment. There was a higher Lyshom scores (85 v 67) in surgically treated patients, as well as higher excellent/good IKDC scores (69% v 64%) and return to sport (41% v 18%). There were four studies comparing repair with reconstruction of damaged structures, with similar mean Lysholm scores (84 v 84) and excellent/good IKDC scores (63% v 63%). Nevertheless, repair of the posterolateral corner had a higher failure rate (39% v 8%) and a lower return to sport activities (25% v 51%). Similarly, repair of the cruciates achieved decreased stability and range of motion. There were six studies comparing early surgery (within 3 weeks) with delayed surgery. Early treatment resulted in higher mean Lysholm scores (89 v 82) and a higher percentage of excellent/good IKDC scores (57% v 41%), as well as higher mean ROM (129° v 124°). CONCLUSIONS Our review suggests that the best treatment does not exist, but better functional and clinical outcomes have been achieved with reconstruction rather than repair. Surgery must be performed within the first three weeks. Delayed ACL reconstruction allows to reduce arthrofibrosis rate.
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Affiliation(s)
- Giovanni Vicenti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari, Italy
| | - Giuseppe Solarino
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari, Italy
| | - Massimiliano Carrozzo
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari, Italy.
| | - Silvana De Giorgi
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari, Italy
| | - Lorenzo Moretti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari, Italy
| | - Angelo De Crescenzo
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari, Italy
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari, Italy
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Vicenti G, Antonella A, Filipponi M, Conserva V, Solarino G, Carrozzo M, Moretti B. A comparative retrospective study of locking plate fixation versus a dedicated external fixator of 3- and 4-part proximal humerus fractures: Results after 5 years. Injury 2019; 50 Suppl 2:S80-S88. [PMID: 30926138 DOI: 10.1016/j.injury.2019.01.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Fractures of the proximal humerus (PHF) represent a common injury among orthopedic department; especially for three- and four-part fractures no consensus about the best treatment is still achieved. The aim of our study was to compare clinical and radiological outcomes in patients alternatively treated with plates and screws or external fixation system for a type III-IV proximal humerus fracture. MATERIAL AND METHODS Sixty-nine patients went surgery for type III-IV PHF between January 2011 and January 2014. According to the Neer classification, fractures were classified as type III in 50 cases (72,46%) and type IV in 19 cases (24,56%). 45 patients were treated with plates (65%) and 24 external fixators (35%). The patients' mean age was 62 years (range, 31-87 y). At five years, 60 patients (86,9%) were assessed using the visual analog scale (VAS) pain score, Constant Score (CS), the range of motion, and radiological evaluation. The CS at five years was the primary outcome measure. Results were evaluated and compared with the contralateral unaffected side to avoid bias related to different ages. RESULTS At the final follow up, we found no clinical differences when comparing the two procedures. Moreover, when age was considered as a variable, a significative difference of the CS was observed in the group of patients younger than 65 years treated with a plate (Plate Group Mean: 79; SD: +/- 15. Ex Fi Mean: 58; SD:+/- 4. P = 0,008). In the group of patients older than 65 years, the two procedures did not show significative differences in outcomes (Plate Group Mean: 69; SD: +/- 15. Ex Fi Mean: 63; SD:+/- 7. P = 0,032). External fixation procedure was overall associated with a reduction in blood loss, surgical time, length of hospital stay. CONCLUSION Percutaneous techniques have a long tradition in PHF treatment; the introduction of dedicated external fixation system has the advantage to improve the stability and allow early rehabilitation when compared to the classical pinning technique. In our experience, the indication elderly patients with osteoporosis and comorbidities may benefit by this type of mini-invasive surgery with low soft tissue damages.
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Affiliation(s)
- Giovanni Vicenti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs University of Bari, Italy
| | - Abate Antonella
- Orthopedics and Traumatology, Di Venere Hospital, Bari, Italy
| | - Marco Filipponi
- Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Vito Conserva
- Orthopedics and Traumatology, Lorenzo Bonomo Hospital, Andria, Italy
| | - Giuseppe Solarino
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs University of Bari, Italy
| | - Massimiliano Carrozzo
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs University of Bari, Italy.
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs University of Bari, Italy
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Vicenti G, Carrozzo M, Bizzoca D, Moretti B. Reply to "Letter to the Editor on: The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: a radiological study". Int Orthop 2019; 43:1545. [PMID: 30798350 DOI: 10.1007/s00264-019-04313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Giovanni Vicenti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Massimiliano Carrozzo
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy.
| | - Davide Bizzoca
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Biagio Moretti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
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Vincenti G, Solarino G, Carrozzo M, Bizzoca D, Martinelli A, Rotini R, Moretti B. Box-loop technique in the management of complex elbow instability: a prospective controlled trial. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.02.2018.08] [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)
- G. Vincenti
- Department of Neuroscience and Organs of Sense, Orthopedic Secrion, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - G. Solarino
- Department of Neuroscience and Organs of Sense, Orthopedic Secrion, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - M. Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopedic Secrion, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - D. Bizzoca
- Department of Neuroscience and Organs of Sense, Orthopedic Secrion, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - A. Martinelli
- Shoulder and Elbow Unit, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - R. Rotini
- Shoulder and Elbow Unit, Rizzoli Orthopaedic Institute, Bologna, Italya
| | - B. Moretti
- Department of Neuroscience and Organs of Sense, Orthopedic Secrion, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
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Giorgio N, Moretti L, Pignataro P, Carrozzo M, Vicenti G, Moretti B. Correlation between fixation systems elasticity and bone tunnel widening after ACL reconstruction. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.04.2016.07] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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)
- N. Giorgio
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospedaliero Universitaria “Policlinico di Bari”, Bari, Italy
| | - L. Moretti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospedaliero Universitaria “Policlinico di Bari”, Bari, Italy
| | - P. Pignataro
- UO University Diagnostic Radiology, Azienda Ospedaliero Universitaria “Policlinico di Bari”, Bari, Italy
| | - M. Carrozzo
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospedaliero Universitaria “Policlinico di Bari”, Bari, Italy
| | - G. Vicenti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospedaliero Universitaria “Policlinico di Bari”, Bari, Italy
| | - B. Moretti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospedaliero Universitaria “Policlinico di Bari”, Bari, Italy
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Vicenti G, Maruccia M, Carrozzo M, Elia R, Giudice G, Moretti B. Free vascularized osteoseptocutaneous fibular flap for radius shaft nonunion: The final solution when the iliac crest autograft fails. A case report. Injury 2018; 49 Suppl 4:S63-S70. [PMID: 30526951 DOI: 10.1016/j.injury.2018.11.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 02/02/2023]
Abstract
Treatment of forearm nonunion associated with bone defects can be challenging. Restoring the correct length and rotation are two main principles for the management of these patients. Herein, we describe a patient with isolated radius nonunion already treated with an iliac crest autograft with no success. A free vascularized osteoseptocutaneous fibular autogenous graft was harvested as the final solution to managed long bone defect after previous multiple surgeries. At the 1- year follow-up, the patient gained full range of motion and was functioning well.
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Affiliation(s)
- Giovanni Vicenti
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Unit, Bari, Italy
| | - Michele Maruccia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Unit, Bari, Italy.
| | - Rossella Elia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Giudice
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Unit, Bari, Italy
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Demitri S, Vicenti G, Carrozzo M, Bizzoca D, De Franceschi D, Moretti B. The Masquelet technique in the treatment of a non-infected open complex fracture of the distal tibia with severe bone and soft tissue loss: A case report. Injury 2018; 49 Suppl 4:S58-S62. [PMID: 30526950 DOI: 10.1016/j.injury.2018.11.039] [Citation(s) in RCA: 14] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/19/2018] [Accepted: 11/23/2018] [Indexed: 02/02/2023]
Abstract
The treatment of open distal tibia fractures remains challenging, particularly when the fracture involves severe soft tissue damage and segmental bone loss. We present the case of a 33-year-old woman who sustained an open distal tibia fracture type 43-A3.3, with segmental bone loss, and a closed bifocal fibular fracture. The fractures were initially fixed with a temporary external fixator. The open distal tibial fracture underwent an intramedullary nailing on day six post-trauma, while the segmental bone loss was refilled with a temporary cement spacer, in order to create a biologic chamber, according to the technique by Masquelet et al. At three months post-trauma, the temporary cement spacer was removed and the bone loss was filled with an autologous bone graft obtained with the Reaming Irrigation Aspiration (RIA) system. The fracture successfully healed at 13 months post-trauma. Masquelet technique, in association with the RIA system, represents a valid strategy in the treatment of non-infected open complex fracture of the distal tibia with severe bone and soft tissue loss.
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Affiliation(s)
- Silvio Demitri
- Clinic of Orthopaedics, Academic Hospital of Udine, Italy
| | - Giovanni Vicenti
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Unit, Bari, Italy.
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Unit, Bari, Italy
| | - Davide Bizzoca
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Unit, Bari, Italy
| | | | - Biagio Moretti
- School of Medicine, University of Bari "Aldo Moro"- AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Unit, Bari, Italy
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De Carolis O, Mori CM, Vicenti G, Carrozzo M, Abate A, Caiaffa V. A lifelong story: Case report of a humeral shaft nonunion successfully treated after 30 years. Injury 2018; 49 Suppl 4:S43-S47. [PMID: 30526949 DOI: 10.1016/j.injury.2018.11.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 02/02/2023]
Abstract
Nonunion of the humeral shaft occurs in 2%-10% of nonsurgically treated fractures and in up to 15% of fractures treated by primary open reduction and internal fixation. Gunshot humerus shaft fractures are a frequent type of injury; the degree of comminution and bone loss, as well as soft tissue disruption may influence the healing process, causing major sequelae with loss of function. Here we describe a 30 years old midshaft nonunion of the humerus, that occurred in a young woman after a gunshot. She was initially treated with hanging cast with definitive nonunion and secondary loss of limb function. After 30 years, careful management of the non union fracture ends, locked intramedullary nailing and bone grafting harvested from the femoral canal using the Reamer Irrigator Aspirator (RIA) system led to union with recovery of limb function.
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Affiliation(s)
- O De Carolis
- Department of Orthopaedics and Traumatology, Di Venere Hospital, Bari, Italy
| | - C M Mori
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - M Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - A Abate
- Department of Orthopaedics and Traumatology, Di Venere Hospital, Bari, Italy.
| | - V Caiaffa
- Department of Orthopaedics and Traumatology, Di Venere Hospital, Bari, Italy
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Vicenti G, Carrozzo M, Caiaffa V, Abate A, Solarino G, Bizzoca D, Maddalena R, Colasuonno G, Nappi V, Rifino F, Moretti B. The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: a radiological study. Int Orthop 2018; 43:193-200. [PMID: 30488127 DOI: 10.1007/s00264-018-4214-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Femoral shaft fractures with third fragments have a high non-union rate, which may reach 14%. This study aims to assess the impact of the radiological features of the third fragment, evaluated on post-operative X-rays, on the outcome of femoral shaft fractures type 32-B managed with intramedullary nailing, in order to obtain an algorithm which could predict the fracture healing time. MATERIALS AND METHODS We have retrospectively evaluated a series of 52 patients. On post-operative X-rays, four radiological parameters were evaluated: the third fragment angle, the fracture gap, the third fragment size, and the mean third fragment displacement. All the patients underwent a radiologic follow-up at one, two, three, six, nine and 12 months post-operatively, to assess the bone healing. The patients were then divided into three groups, according to the fracture healing time: within six months (group A), between six and 12 months (group B), or fracture non-union after 12 months (group C). RESULTS In 28 patients, out of 52 (53.85%), the fracture healing was observed at 6-month follow-up; in 18 patients, out of 52 (34.62%), the fracture healed within 12 months after trauma; and in six patients, out of 52 (11.54%), no fracture healing was observed at 12-month follow-up. The mean third fragment size was significantly different in each group (p < 0.05), while the mean third fragment displacement was significantly higher in group C, compared with group A (p = 0.0006) and group B (p = 0.0027). In group B, a positive correlation was found between the fracture healing time and the mean third fragment size (R = 0.594, p = 0.036); in group C, the fracture union time was positively related to the third fragment size (R = 0.689, p = 0.013) and the mean third fragment displacement (R = 0.7107, p = 0.006). Regression analysis showed that the third fragment size and the mean third fragment displacement are the most important features which affect the fracture healing time. CONCLUSIONS The third fragment size (cutoff 40 mm) is the leading parameter to influence the fracture healing within or in more than six months. The mean third fragment displacement (cutoff 12 mm); on the other hand, impacts on the fracture delayed rather than absent healing.
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Affiliation(s)
- Giovanni Vicenti
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Massimiliano Carrozzo
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy.
| | - Vincenzo Caiaffa
- Department of Orthopaedics and Traumatology, Di Venere Hospital, Bari, Italy
| | - Antonella Abate
- Department of Orthopaedics and Traumatology, Di Venere Hospital, Bari, Italy
| | - Giuseppe Solarino
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Davide Bizzoca
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Roberto Maddalena
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Giulia Colasuonno
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Vittorio Nappi
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Francesco Rifino
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Biagio Moretti
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
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Vicenti G, Bizzoca D, Carrozzo M, Solarino G, Moretti B. Multi-omics analysis of synovial fluid: a promising approach in the study of osteoarthritis. J BIOL REG HOMEOS AG 2018; 32:9-13. [PMID: 30644275] [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: 06/09/2023]
Abstract
Osteoarthritis (OA), affecting 250 million individuals worldwide, is a significant social health problem. Therefore, the search for synovial fluid (SF) biomarkers that could anticipate the diagnosis of OA is gaining increasing importance in orthopaedics. This review summarizes the recent progresses preformed in the multi-omics approach to OA, mainly focusing on proteome and metabolome analysis of SF. Proteomics of the SF has shown the up-regulation of several components of the classic complement pathway in OA samples, including C1, C2, C3, C4A, C4B, C5 and C4 C4BPA, thus depicting that complement is involved in the pathogenesis of OA. Moreover, proteomics has displayed that some pro-inflammatory cytokines, namely IL-6, IL-8 and IL-18, have a role in OA. The metabolomic profiling of the SF in OA has identified some metabolites as potential biomarkers of OA and has shown the existence of metabolically different OA subgroups. However, further studies with larger samples sizes and matched-control groups are needed to identify SF biomarkers that could be useful in the diagnosis, treatment and follow-up of OA.
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Affiliation(s)
- G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - D Bizzoca
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - M Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - G Solarino
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - B Moretti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
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Vicenti G, Bizzoca D, Nappi VS, Moretti F, Carrozzo M, Belviso V, Moretti B. Biophysical stimulation of the knee with PEMFs: from bench to bedside. J BIOL REG HOMEOS AG 2018; 32:23-28. [PMID: 30644277] [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: 06/09/2023]
Abstract
Clinical biophysics investigates the relationship between non-ionizing physical energy and the human body. Although several types of electrical stimulation devices have received US FDA approval for orthopaedic application, the use of Pulsed Electromagnetic Field (PEMFs) play a central role in joint biophysics. This narrative review aims to summarize the current evidences on the efficacy of PEMF-therapy in the treatment of knee articular diseases. Preclinical studies have assessed the effects of PEMFs on chondrocytes, synoviocytes, articular cartilage explants and animal models, showing positive effects of PEMF-therapy on cells proliferation, extracellular matrix (ECM) production, chondrocytes apoptosis and inflammatory cytokines down-regulation. Currently, PEMF-therapy is a valid option in the conservative management of several knee articular diseases, including early OA, patellofemoral pain syndrome and SONK. PEMFs could be also used as an adjunct after an arthroscopic knee procedure or TKA implantation, in order to control the joint post-operative inflammatory state.
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Affiliation(s)
- G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - D Bizzoca
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - V S Nappi
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - F Moretti
- National Center For Chemicals, Cosmetic Products And Consumer Protection, National Institute of Health, Rome, Italy
| | - M Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - V Belviso
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - B Moretti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
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Vicenti G, Solarino G, Caizzi G, Carrozzo M, Picca G, De Crescenzo A, Cotugno D, Nappi V, Moretti B. Balloon-assisted reduction, pin fixation and tricalcium phosphate augmentation for calcaneal fracture: A retrospective analysis of 42 patients. Injury 2018; 49 Suppl 3:S94-S99. [PMID: 30415676 DOI: 10.1016/j.injury.2018.09.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 06/28/2018] [Accepted: 09/25/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The treatment of intra-articular calcaneal fractures is still complex and controversial. Although open reduction and internal fixation (ORIF) is favored by many authors, several percutaneous techniques have been introduced to reduce complications and to obtain satisfactory clinical and radiological results. Among these percutaneous treatments, balloon reduction and bone graft augmentation is gaining an increasing popularity. MATERIALS AND METHODS We retrospectively examined a series of 42 patients treated operatively with a minimally invasive reduction technique using an inflatable bone tamp filled with tricalcium phosphate (calcaneoplasty) for Sander's type II, III and IV calcaneal fractures between 2010 and 2015. Conventional X-rays and CT scan were performed pre-operatively, at 3 and 12 months post-operatively and at the last-follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) score and the Maryland Foot Score (MFS) were used for clinical evaluation. Bohler's angle and the Score Analysis of Verona (SAVE) were calculated to assess bone reduction. RESULTS All 42 patients were available for clinical and radiographic follow-up at an average of 665 months (range 38-92). At the last follow-up the mean AOFAS score was 82.1 (good) and the mean MFS was 80.8 (good). The mean Bohler's angle improved from 1.29° pre-operatively to 27.8° at the last follow-up. The SAVE highlighted good and excellent results in 30 (72%) patients. There were only 3 (7.1%) cases of superficial skin infection with only 6 (14.2%) patients complaining of residual pain. No cases of adverse reaction or deep infection were observed. CONCLUSIONS Calcaneoplasty appears to be a valid option of treatment for calcaneal fractures and a reliable alternative to ORIF. This technique allows stable fracture reduction and early weight-bearing combined with good clinical and radiological results and few complications.
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Affiliation(s)
- Giovanni Vicenti
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
| | - Gianni Caizzi
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy.
| | - Girolamo Picca
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
| | - Angelo De Crescenzo
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
| | - Domenico Cotugno
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
| | - Vittorio Nappi
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
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Mighell AJ, Freeman C, Atkin PA, Bennett JH, Buchanan JAG, Carrozzo M, Crighton AJ, Escudier MP, Gibson J, Healy CM, Hegarty AM, Kerr JS, McCreary CE, Pemberton MN, Rajlawat B, Richards A, Staines K, Theaker ED, Willis A. Oral Medicine for undergraduate dental students in the United Kingdom and Ireland-A curriculum. Eur J Dent Educ 2018; 22:e661-e668. [PMID: 29877053 DOI: 10.1111/eje.12366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/29/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Oral Medicine focuses on care for patients with chronic, recurrent and medically related disorders of the orofacial region that are distinct from diseases of the periodontal and tooth tissues, with an emphasis on non-surgical management. At present, there are no shared outcomes for Oral Medicine to define the standards to be achieved before new graduates become registered dentists engaged with ongoing professional development. CURRICULUM We present a consensus undergraduate curriculum in Oral Medicine agreed by representatives from 18 Dental Schools in the United Kingdom and Republic of Ireland. The scope of Oral Medicine practice includes conditions involving the oral mucosa, salivary glands, neurological system or musculoskeletal tissues that are not directly attributable to dental (tooth and periodontium) pathology. Account is taken of the priorities for practice and learning opportunities needed to support development of relevance to independent clinical practice. The outcomes triangulate with the requirements set out by the respective regulatory bodies in the UK and Republic of Ireland prior to first registration and are consistent with the framework for European undergraduate dental education and greater harmonisation of dental education. CONCLUSIONS This curriculum will act as a foundation for an increasingly shared approach between centres with respect to the outcomes to be achieved in Oral Medicine. The curriculum may also be of interest to others, such as those responsible for the training of dental hygienists and dental therapists. It provides a platform for future collective developments with the overarching goal of raising the quality of patient care.
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Affiliation(s)
| | - C Freeman
- The University of Sheffield, Sheffield, UK
| | | | | | | | - M Carrozzo
- The University of Newcastle, Newcastle, UK
| | | | - M P Escudier
- The University of London (Kings College), London, UK
| | - J Gibson
- The University of Glasgow, Glasgow, UK
| | - C M Healy
- The University of Dublin, Dublin, Ireland
| | | | - J S Kerr
- University of Central Lancashire, Preston, UK
| | | | | | - B Rajlawat
- The University of Liverpool, Liverpool, UK
| | - A Richards
- The University of Birmingham, Birmingham, UK
| | - K Staines
- The University of Bristol, Bristol, UK
| | | | - A Willis
- Queen's University Belfast, Belfast, UK
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Vicenti G, Bizzoca D, Caruso I, Nappi VS, Giancaspro G, Carrozzo M, Moretti B. New insights into the treatment of non-healing diabetic foot ulcers. J BIOL REG HOMEOS AG 2018; 32:15-21. [PMID: 30644276] [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: 06/09/2023]
Abstract
Diabetic foot ulcers (DFUs) are one of the most serious and devastating complication of diabetes mellitus, affecting about 15% of diabetic patients. This review describes the innovative treatment options currently available in the treatment of non-healing DFUs. The use of Platelet-Rich-Plasma (PRP) is a safe and valid approach in the treatment of DFUs. However, the methods used to obtain and prepare autologous PRP vary between the studies, thus further evidences are eagerly awaited. Adipose tissue-derived mesenchymal stem cells (ADSCs) are a promising tool in the treatment of DFUs, but additional largescale and long-term follow-up clinical trials are needed. Bone marrow mesenchymal stem cells (BM-MSCs) transplantation, on the other hand, revealed effective in reducing incidents and improving the quality of life of patients with amputations. Autologous Peripheral Blood Mononuclear Cells (A-PBMNCs) showed a good efficacy in the treatment of diabetic patients with CLI, but further RCTs are awaited to best investigate this new therapeutic approach. Photobiomodulation (PBM) therapy revealed effective in the treatment of DFUs in two RCTs, but a standardization of therapeutic protocols as well as level-I studies are needed.
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Affiliation(s)
- G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - D Bizzoca
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - I Caruso
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - V S Nappi
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - G Giancaspro
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - M Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - B Moretti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
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Vicenti G, Moretti L, Carrozzo M, Pesce V, Solarino G, Moretti B. Evaluation of long-term postoperative outcomes between mini-open and arthroscopic repair for isolated supraspinatus tears: a retrospective analysis. Musculoskelet Surg 2018; 102:21-27. [PMID: 30343477 DOI: 10.1007/s12306-018-0549-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/12/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite arthroscopic repair of the rotator cuff is an increasingly popular procedure, the mini-open (MO) repair still remains a viable and appreciated technique. The purpose of the study was to analyze the long-term clinical outcomes of patients with isolated supraspinatus tear undergoing MO or arthroscopic surgery (AS) repair. PATIENTS AND METHODS Forty-six patients underwent supraspinatus repair with anchors: 24 with MO technique and 22 with AS procedure. They were evaluated postoperatively at 3, 6, 12 months and 2 years. RESULTS The mean surgery time, the mean hospital stay and the average costs were shorter in the MO patients respect to the AS group. Despite an initial better Disabilities of Arm, Shoulder and Hand and Constant Murley Score in the first 6 months of follow-up in the AS group, no differences were detected at 24 months. CONCLUSION This study suggests that isolated supraspinatus tears can be treated with a MO or arthroscopic repair procedure with similar clinical outcome in the long-term postoperative period. The mean surgery time and the average costs are less in the MO group respect to the AS group.
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Affiliation(s)
- G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - L Moretti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - M Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - V Pesce
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - G Solarino
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - B Moretti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Carbone M, Cabras M, Conrotto D, Arduino PG, Garzino Demo P, Carrozzo M. Positive clinical outcome of an oral in situ
melanoma: 6 years of follow-up. Clin Exp Dermatol 2018; 43:603-605. [DOI: 10.1111/ced.13572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 10/16/2022]
Affiliation(s)
- M. Carbone
- Department of Surgical Sciences; Oral Medicine Section; CIR Dental School; University of Turin; Via Nizza 230 10126 Turin Italy
| | - M. Cabras
- Department of Surgical Sciences; Oral Medicine Section; CIR Dental School; University of Turin; Via Nizza 230 10126 Turin Italy
| | - D. Conrotto
- Department of Surgical Sciences; Oral Medicine Section; CIR Dental School; University of Turin; Via Nizza 230 10126 Turin Italy
| | - P. G. Arduino
- Department of Surgical Sciences; Oral Medicine Section; CIR Dental School; University of Turin; Via Nizza 230 10126 Turin Italy
| | - P. Garzino Demo
- Department of Surgical Sciences; Maxillofacial Unit; University Hospital Città della Scienza e della Salute; University of Turin; Turin Italy
| | - M. Carrozzo
- Oral Medicine Department; Centre for Oral Health Research; Newcastle University; Newcastle upon Tyne UK
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Gambino A, Carbone M, Broccoletti R, Carcieri P, Conrotto D, Carrozzo M, Arduino PG. A report on the clinical-pathological correlations of 788 gingival lesion. Med Oral Patol Oral Cir Bucal 2017; 22:e686-e693. [PMID: 29053652 PMCID: PMC5813986 DOI: 10.4317/medoral.21845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 09/05/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The diagnosis and treatment of a variety of non-plaque related gingival diseases have become an integrated aspect of everyday dentistry. The aim of this study was to analyse the relationship between clinical appearance and histopathological features of gingival lesions in a large Northern Italian population. MATERIAL AND METHODS A retrospective study of 788 cases of gingival and alveolar mucosal biopsies was set up. Statistical analysis was performed by calculating the odds ratio and 95% confidence interval (C.I.), in order to assess the degree of association between the clinical parameters considered (primary lesions) and the single pathologies, statistically evaluated by Mantel-Haenszel tests. The correlation between clinical and histological diagnosis was classified as follow: 1) expected data (ED): provisional clinical diagnosis; 2) real data (RD): final histopathology diagnosis; 3) concordant data (CD): correspondence between the expected data and real data. The correlation was calculated as follow: CC (complete concordance) = CD x 100 / ED, this expressing the percentage in which the clinical and the histological diagnosis overlapped. RESULTS The most frequently observed and biopsied primary lesions resulted to be exophytic, followed by mucosal colour changes and finally by losses of substance. The statistically significant association between primary lesion and their manifestation in gingival pathologies was reported. Volume increases, for instance, were positively correlated to plasma cell epulis, pyogenic granuloma, fibrous reactive hyperplasia and hemangioma. Verrucous-papillary lesions were most often seen in verrucous carcinoma, verrucous leukoplakia and mild dysplasia. White lesion resulted to be related to leukoplakia or oral lichen planus. Red lesions resulted to be related only oral lichen planus. Erosive vesicle-bullous lesions were linked to disimmune pathologies. Ulcerative lesions were positively associated to oral squamous cell cancer. Finally, potentially malignant disorders have the most percentage high concordance. Among the malignant lesions, the correlation increased up to the squamous cell carcinoma and leukaemia. CONCLUSIONS This article presented the frequency and the clinico-pathological concordance of all primary lesions and the histopathological diagnosis of gingival lesions. For every primary lesion, it is possible to correlate a specific histopathological diagnosis in a statistical manner. This can be a valuable aid for not specialist clinicians who daily observe mucosae and have the opportunity to intercept major diseases.
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Affiliation(s)
- A Gambino
- Department of Surgical Sciences, University of Turin, CIR - Dental School, Oral Medicine Section, Via Nizza 230, 10126 Turin, Italy,
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Vicenti G, Pesce V, Bizzoca D, Nappi V, Palmiotto F, Carrozzo M, Moretti B. Perioperative plasmatic presepsin levels in patients undergoing total hip or knee replacement: a preliminary study. J BIOL REG HOMEOS AG 2017; 31:1081-1086. [PMID: 29254318] [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: 06/07/2023]
Abstract
Presepsin (sCD14-ST) is an emerging biomarker in the diagnosis of sepsis. In the field of orthopaedics, it could be useful in the diagnosis and management of periprosthetic joint infections (PJI). The aim of this study is to define the normal perioperative plasmatic levels of presepsin in patients undergoing primary cementless total hip replacement (THR) or primary cemented total knee replacement (TKR). For this purpose, 50 patients (19 male, 31 female, mean age= 64.04±8.88) were recruited. The patients were divided into two groups: Group A patients underwent cementless THR, whereas Group B patients underwent cemented TKR. On recruitment, anthropometric data, smocking status, osteoarthritis stage according to Kellgren and Lawrence, Harris Hip Score (HHS) for Group A patients and Knee Society Score (KSS) for Group B patients, drugs assumption and comorbidities were recorded. All the patients underwent serial blood tests, including complete blood count, presepsin (PS), C-reactive protein (CRP) and procalcitonin (PCT) 24 hours before arthroplasty (T0) and at 24 (T1), 48 (T2), 72 (T3) and 96 (T4) hours postoperatively. Body temperature (θ) was recorded every six hours in the time lapse T0-T4. Presepsin plasmatic concentration was comparable at baseline in both groups. After surgery, however, a significant increase of presepsin was observed in Group A, whereas in Group B no significant changes of presepsin were recorded. A comparable trend of this biomarker was found in the two groups, i.e. presepsin increased from T0 to T3, when it reached its maximum value, and its decrease started at T4. Finally, presepsin resulted more accurate than CRP in the evaluation of perioperative inflammatory response in patients undergoing THR or TKR. These data will be helpful in defining a reference interval for presepsin in patients with prosthetic joint implants, and a cut-off of this biomarker for the diagnosis of PJI.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip
- Arthroplasty, Replacement, Knee
- Biomarkers/blood
- C-Reactive Protein/metabolism
- Calcitonin/blood
- Female
- Humans
- Lipopolysaccharide Receptors/blood
- Male
- Middle Aged
- Osteoarthritis, Hip/blood
- Osteoarthritis, Hip/complications
- Osteoarthritis, Hip/diagnosis
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/blood
- Osteoarthritis, Knee/complications
- Osteoarthritis, Knee/diagnosis
- Osteoarthritis, Knee/surgery
- Peptide Fragments/blood
- Perioperative Period
- Preliminary Data
- Sepsis/blood
- Sepsis/complications
- Sepsis/diagnosis
- Sepsis/surgery
- Severity of Illness Index
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Affiliation(s)
- G Vicenti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy
| | - V Pesce
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy
| | - D Bizzoca
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy
| | - V Nappi
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy
| | - F Palmiotto
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy
| | - M Carrozzo
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy
| | - B Moretti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy
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Vicenti G, Solarino G, Pesce V, Moretti L, Notarnicola A, Carrozzo M, Rifino F, Moretti B. Autologous lipotransfer versus stromal vascular fraction enriched lipoinjection for diabetic foot wounds healing: a pilot study. J BIOL REG HOMEOS AG 2017; 31:141-146. [PMID: 29188676] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Chronic ulcers of the lower limbs represent a significant social and economic burden. Diabetes is a strong risk factor for development of chronic lesions. Adult stem cells and growth factors derived from the adipose tissue are among the most promising therapeutic strategies for hard to heal wounds. Fat grafts have been used for several decades to treat soft tissue deformities, but despite its excellent characteristics, the outcome was unpredictable, due to partial necrosis and resorption of the graft. Stem cells’ enrichment of these grafts or their injection into the edges of the ulcers have shown encouraging results in various experimental settings. In this pilot study, we compared the standard of care to autologous lipotransfer and stromal vascular fraction (SVF) enriched lipoinjection in 30 patients with diabetic foot ulcers, showing clear superiority of SVF enriched lipoinjection in terms of percentage of reduction of ulcers size and healing time.
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Affiliation(s)
- G Vicenti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Human Anatomy and Histology, School of Medicine-University of Bari, Italy
| | - G Solarino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Human Anatomy and Histology, School of Medicine-University of Bari, Italy
| | - V Pesce
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Human Anatomy and Histology, School of Medicine-University of Bari, Italy
| | - L Moretti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Human Anatomy and Histology, School of Medicine-University of Bari, Italy
| | - A Notarnicola
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Human Anatomy and Histology, School of Medicine-University of Bari, Italy
| | - M Carrozzo
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Human Anatomy and Histology, School of Medicine-University of Bari, Italy
| | - F Rifino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Human Anatomy and Histology, School of Medicine-University of Bari, Italy
| | - B Moretti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Human Anatomy and Histology, School of Medicine-University of Bari, Italy
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Rollo G, Vicenti G, Rotini R, Abate A, Colella A, D'Arienzo A, Carrozzo M, Moretti B. Clavicle aseptic nonunion: is there a place for cortical allogenic strut graft? Injury 2017; 48 Suppl 3:S60-S65. [PMID: 29025612 DOI: 10.1016/s0020-1383(17)30660-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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
We investigated functional and radiological outcome in 57 cases of midshaft clavicle nonunion treated with open reduction and internal fixation with plate and screws over a 13 year-period. Intercalary bone graft was used in 42 patients; opposite autologous strut graft was used in 31 cases to provide mechanical support to the host bone. Patients were analysed using chart and radiological review and assessed with DASH questionnaire obtained at the latest follow-up. 37 patients were male while 20 were females, with a mean age of 35 years (63-17). All cases were of nonunion, 35 atrophic and 22 hypertrophic. The dominant side was injured in 32 cases and the non dominant in 25 cases. Primarily, 43 cases were treated conservatively with a figure of eight bandage. Time between fracture and our operative treatment was on average 44 months (13-72 months). Only those patients who were symptomatic were included in this study. We used straight reconstruction LCP and low profile precontoured plates. By reviewing patients charts all the cases but one of nonunion progressed to osseous healing at a mean time of 14 weeks (range 12-16). The patient with non-union refused further surgery. 49 patients were available for a final follow up. DASH score was 16.7 at an average of 42 months. Open surgery and internal fixation, using plate and screws in a compression construct is the treatment of choice for symptomatic clavicular non-unions. Intercalary autologous or allograft bone graft should be used especially in patient with significant bone loss; autologous cortical strut graft provides optimum mechanical stability, thus assuring optimal screw purchase and allowing immediate limb movement.
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Affiliation(s)
| | - Giovanni Vicenti
- Department of Neuroscience and Organs of Sense, Orthopedic Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy.
| | - Roberto Rotini
- Shoulder and Elbow Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Antonella Abate
- Department of Neuroscience and Organs of Sense, Orthopedic Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Antonio Colella
- Department of Neuroscience and Organs of Sense, Orthopedic Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Antonio D'Arienzo
- Orthopedic and Trauma Section, University of Palermo, Palermo, Italy
| | - Massimiliano Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopedic Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Biagio Moretti
- Department of Neuroscience and Organs of Sense, Orthopedic Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
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Arduino PG, Broccoletti R, Carbone M, Conrotto D, Pettigiani E, Giacometti S, Gambino A, Elia A, Carrozzo M. Describing the gingival involvement in a sample of 182 Italian predominantly oral mucous membrane pemphigoid patients: A retrospective series. Med Oral Patol Oral Cir Bucal 2017; 22:e149-e152. [PMID: 28160581 PMCID: PMC5359700 DOI: 10.4317/medoral.21431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Received: 05/23/2016] [Accepted: 01/23/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The oral cavity has been frequently described as the only site of involvement or as the first manifestation of mucous membrane pemphigoid (MMP), being the gingival tissues often involved, but usually this has been effusively detailed in limited case series. This is a retrospective evaluation of the gingival involvement in 182 Italian patients with oral MMP. MATERIAL AND METHODS The diagnosis of MMP was established by both clinical morphology and direct immunofluorescence finding. Patient information (age, gender, risk factors and medical status) and parameters of manifestation (lesions' distribution, site and type) were detailed. RESULTS The mean age was 62 years for women (n=137) and 67 years for men (n=45). Patients had several sites of oral involvement; the gingiva was the most common one, affecting 151 patients (82.96%; 119 f - 32 m). Female subjects had more possibilities to develop gingival lesions than male patients (P = 0.005). Sixty-five patients (35.7%; 58 f - 7 m) had pure gingival involvement. Patients with lower gingival involvement statistically had more complaints (P = 0.006). CONCLUSIONS This report is one of the largest about predominantly oral MMP cases, detailing the very frequent gingival involvement; this could be crucial not only for oral medicine specialists but also for primary dental healthcare personnel and for periodontists.
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Affiliation(s)
- P-G Arduino
- Department of Surgical Sciences; CIR - Dental School, School of Medicine, University of Turin, Via Nizza 230, 10126 Turin, Italy,
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Tartaglia N, Vicenti G, Carrozzo M, Abate A, Rifino F, Picca G, Solarino G, Moretti B. The treatment of distal third humeral diaphyseal fractures: Is there still a place for the external fixation? Musculoskelet Surg 2016; 100:45-51. [PMID: 27900703 DOI: 10.1007/s12306-016-0419-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/20/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The treatment for humeral diaphyseal fractures is still controversial. The purpose of this study was to evaluate the clinical and radiographic outcomes of treating humeral distal third diaphyseal fractures by using external fixation technique. MATERIALS AND METHODS We retrospectively review 65 cases of diaphyseal humeral fractures (31 type A, 23 type B and 11 type C of the AO/OTA classification) treated with external fixation (Orthofix FAD small) between 2008 and 2013. The mean follow-up was 48 months (24-72 months). There were 12 open fractures; however, no cases of concomitant vascular injury were described. The transolecranic traction was always applied to promote partial reduction through ligamentotaxis. In case of interposition of soft tissues impeding reduction, a small incision was performed allowing mobilization of bone ends. RESULTS All fractures resulted healed at a mean of 11 weeks (range 9-13 weeks); the average time of removal of the external fixator was 88 days (range 65-95 days). At the last follow-up, the mean elbow flexion was 132.6° (Min 126°-Max 137°) and the mean elbow extension was 6.4° (Max 0°-Min 13°). The Cassebaum's index rated as excellent in 47.8 % (31 patients), good in 37 % (24 patients), fair in 9.2 % (6 patients) and poor in 6 % (4 patients). The mean DASH score at the final follow-up was 14.7 (range 0-33); 15 patients had a range score between 10 and 20, 43 had less than 10, and seven had more than 20. We observed three cases of superficial infections and two cases of acute radial nerve palsy recovered within 3 months. CONCLUSION According to the excellent clinical results and full rate of consolidation, we state external fixation as a valid option in the treatment of distal third humeral diaphyseal fractures.
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Affiliation(s)
- N Tartaglia
- Department of Trauma and Orthopaedics, Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - M Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - A Abate
- Department of Orthopedics and Traumatology, Monsignor Raffaele Dimiccoli Hospital, Barletta, Italy
| | - F Rifino
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - G Picca
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - G Solarino
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - B Moretti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Vicenti G, Solarino G, Spinarelli A, Carrozzo M, Picca G, Maddalena R, Rifino F, Moretti B. Restoring the femoral offset prevent early migration of the stem in total hip arthroplasty: an EBRA-FCA study. J BIOL REG HOMEOS AG 2016; 30:207-212. [PMID: 28002921] [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: 06/06/2023]
Abstract
The use of modular stems is still debated and controversial. Some authors have highlighted a number of disadvantages of modular prostheses including high costs, the tendency to fracture, the fretting and corrosion and the increased production of debris. Other authors have emphasized several advantages to adapt the prosthesis to the morphometric differences of patients, to allow better accuracy in restoring the anatomy and biomechanics of hip joint. The advantages of the modular devices appear to be more evident in patients with developmental dysplasia of the hip (DDH). In our study we compared 96 patients, operated for arthritis of the hip with 55 modular neck prostheses (PROFEMUR®, Wright® Arlington, Tennesse, USA) and 41 standard femoral stems (SYMAX®, Striker® Kalamazoo, Michigan, USA). The precision of restoring the natural offset during surgery was correlated with the clinical outcome and the radiological early migration of each stem measured using the computer-assisted EBRA-FCA method. The average preoperative HHS (Harris Hip Score) was 44 (23-66); the postoperative 86.56 in the 55 patients operated with modular prostheses and 81.70 in the 41 patients with monoblock stem. The worst HH Scores were seen in patients in whom the offset was not restored properly. On the contrary, the best scores have been reached in patients in which that value is closer to the target value (offset value of the contralateral hip). Restoring the proper offset seems to determine an appropriate tension of the abductor muscles of the hip and implies a better functioning of the joint and a better primary stability of the implant, with less early migration. This has to be a primary objective of THA surgery.
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Affiliation(s)
- G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - G Solarino
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - A Spinarelli
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - M Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - G Picca
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - R Maddalena
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - F Rifino
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - B Moretti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
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Vicenti G, Moretti L, De Giorgi S, Caruso I, La Malfa M, Carrozzo M, Solarino G, Moretti B. Thyroid and shoulder diseases: the bases of a linked channel. J BIOL REG HOMEOS AG 2016; 30:867-870. [PMID: 27655513] [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: 06/06/2023]
Abstract
The association between thyroid disorders and musculoskeletal diseases has long been suspected, but it is still debated whether they have a role in the pathogenesis of shoulder diseases. In vivo and in vitro studies describe the role of thyroid hormones in bone, cartilage and tendon biology. Retrospective studies and case reports suggest that thyroid diseases should be considered as risk factors and hold prognostic value in some of the most common causes of shoulder pain. Thus, it is advisable to search for underlying thyroid disorders in these patients. The pathophysiologic mechanisms by which thyroid hormone imbalance affects the onset, progression and response to treatment of these diseases are yet to be thoroughly defined and demand further studies.
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Affiliation(s)
- G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
| | - L Moretti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
| | - S De Giorgi
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
| | - I Caruso
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
| | - M La Malfa
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
| | - M Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
| | - G Solarino
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
| | - B Moretti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
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Giorgio N, Moretti L, Pignataro P, Carrozzo M, Vicenti G, Moretti B. Correlation between fixation systems elasticity and bone tunnel widening after ACL reconstruction. Muscles Ligaments Tendons J 2016; 6:467-472. [PMID: 28217568 DOI: 10.11138/mltj/2016.6.4.467] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Femoral and tibial tunnel widening (TW) after ACL reconstruction is a phenomenon increasing talk in the literature. It is underlying biological and mechanical causes. OBJECTIVE The aim of this study was to evaluate the relationship between bone tunnel enlargement and two different ACL fixation systems. PATIENTS AND METHODS 40 patient underwent ACL reconstruction with hamstring; randomly divided into group A with 20 patients treated with stiff systems (femoral Rigidfix and tibial interference screw), and into group B, with 20 patients treated with morel elastic system (femoral and tibial Tight-rope). Evaluated postoperatively with knee MRI at 40 days, 3 months, 6 months to measure bone tunnel diameters widening. RESULTS At 40 days tunnel widening between two groups shows no statistically difference. At 3 months postoperatively, femoral bone tunnel widening amounted on average to 1.84 mm in middle of tunnel and 1 mm at the mouth in joint in group A, and respectively 3.2 mm and 2.5 mm in group B (p<0.05). Tibial tunnel widening was 1.24 mm at the mouth in joint and 1.3 mm in middle in group A and respectively 2.26 mm and 2.43 mm in group B (p<0.05). At 6 months femoral tunnel widening amounted on average to 2.45 mm in middle and 1.35 mm at the mouth in joint in group A and respectively 3.5 mm and 2.7 mm in group B (p<0.01). Tibial tunnel widening amounted on average to 1.27 at mouth in joint and 1 mm in middle of tunnel in group A and respectively 2.6 mm and 2.3 mm in group B (p<0.01). CONCLUSIONS This study results suggest elastic fixation system increases bone tunnel enlargement after ACL reconstruction with hamstring without correlation with worse clinical performance. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nicola Giorgio
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospe - daliero Universitaria "Policlinico di Bari", Bari, Italy
| | - Lorenzo Moretti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospe - daliero Universitaria "Policlinico di Bari", Bari, Italy
| | - Paolo Pignataro
- UO University Diagnostic Radiology, Azienda Ospedaliero Universitaria "Policlinico di Bari", Bari, Italy
| | - Massimiliano Carrozzo
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospe - daliero Universitaria "Policlinico di Bari", Bari, Italy
| | - Giovanni Vicenti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospe - daliero Universitaria "Policlinico di Bari", Bari, Italy
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospe - daliero Universitaria "Policlinico di Bari", Bari, Italy
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Vicenti G, Pesce V, Abate A, Carrozzo M, Cagnetta V, Rifino F, Solarino G, Moretti B. VITAMIN D DEFICIENCY IN ADULTS: SEARCHING FOR THE PROPER LOADING DOSE. J BIOL REG HOMEOS AG 2015; 29:87-94. [PMID: 26652494] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Vitamin D is the main hormone regulating calcium phosphate homeostasis and mineral bone metabolism. Vitamin D deficiency is indeed extremely frequent in musculoskeletal diseases. Recent studies have shown that the treatment of osteoporosis needs to have an optimal vitamin D and calcium supplementation for its efficacy. Actually no agreement exists on the estabilished dose of vitamin D to administer in deficency states. We conducted a prospective study to develop a practical cholecalciferol loading dose regimen that would enable rapid correction of vitamin D deficiency. Sixty post-menopausal age woman were enrolled secondary to a fragility fracture (hip, vertebral, wrist) and screened for 25-hydroxyvitamin D (25(OH)D), calcium, and PTH at baseline (T0), after one month (T1), two months (T2), three months (T3) and six months (T4). Secondary to initial blood values of vitamin D patients were divided into 2 groups; the first group (group A, n=30) included patients with 25(OH)D values between 10-30 ng/ml and the second group (group B, n=30) with values under 10 ng/ml. Each group was then divided in 3 subgroups secondary to the randomized administered dose of 25(OH)D. By this, patients can alternatively receive 25000 UI two times monthly, 100000 UI monthly, 10000 UI (25 drops) weekly. The highest values of mean increase of 25(OH)D were observed in patients treated with 100000 UI. Patients treated with 10000 UI weekly did never achieve the target value. Additionally, as vitamin levels increased, pain intensity decreased. Vitamin D supplementation of 100000 UI monthly seems to be adequate to ensure that serum 25(OH)D values reach the threshold level; by this, it will confer the expected effects without risks of toxicity.
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Affiliation(s)
- G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - V Pesce
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - A Abate
- Department of Orthopedics and Traumatology, Monsignor Raffaele Dimiccoli Hospital, Barletta Italy
| | - M Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - V Cagnetta
- Department of Neurology, Neurorehabilitation and Spinal Unit, IRCCS S. Maugeri Foundation, Cassano Murge, Italy
| | - F Rifino
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - G Solarino
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - B Moretti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
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Solarino G, Vicenti G, Spinarelli A, Abate A, Carrozzo M, Cagnetta V, Moretti B. ASSESSING BONE MINERAL DENSITY IN ITALIAN ADULT CYSTIC FIBROSIS PATIENTS: A CROSS SECTIONAL STUDY. J BIOL REG HOMEOS AG 2015; 29:79-85. [PMID: 26652493] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to assess bone mineral density in a cystic fibrosis (CF) outpatient clinic population and to investigate the relationship between BMD and forced expiratory volume in one second (FEV1), DEXA T-scores and 25-hidroxivitamin D (25-OHD) serum levels. We examined a consecutive series of 44 CF patients. Bone mass density was measured by dual-photon X-ray absorptiometry of lumbar spine and femur (total and neck) and lung function was performed in all patients. Medication data were obtained from medical records. A correlation analysis was performed to determine the relationship between BMD and forced expiratory volume in one second (FEV1), DEXA T-scores and 25-hidroxivitamin D (25-OHD) serum levels. In the results, age showed a significant inverse correlation indicating that as the age increases, bone density decreases and we concluded that most CF patients have low BMD and that there is a positive correlation with lung function and an inverse correlation with age.
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Affiliation(s)
- G Solarino
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - A Spinarelli
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - A Abate
- Department of Orthopedics and Traumatology, Monsignor Raffaele Dimiccoli Hospital, Barletta, Italy
| | - M Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - V Cagnetta
- Department of Neurology, Neurorehabilitation and Spinal Unit, IRCCS Maugeri Foundation, Cassano Murge, Italy
| | - B Moretti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
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Solarino G, Vicenti G, Abate A, Carrozzo M, Picca G, Moretti B. Mason type II and III radial head fracture in patients older than 65: is there still a place for radial head resection? Aging Clin Exp Res 2015. [PMID: 26215317 DOI: 10.1007/s40520-015-0425-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of radial head excision for multifragmentary radial head fracture in patients over 65 years old. METHODS We retrospectively examined 30 patients over 65 years of age treated with radial head excision for comminuted radial head fractures. Patients were evaluated through clinical examinations, administrative questionnaires (DASH--Disabilities of the Arm, Shoulder and Hand; MEPS--Mayo Elbow Performance Score, VAS--Visual Analog Scale) and plain films. RESULTS The mean follow-up was 40 months (range 24-72 months); 27 out of 30 patients claimed to be satisfied. The mean DASH score was 13 (range 3-45.8) and mean MEPS was 79 (range 65-97). The radiographic evaluation showed 21 cases of elbow arthritis; only two of them complained about pain. Heterotopic ossification was evident in six cases with functional impairment in only one patient. Six patients with increased ulnar variance had clinical distal radio-ulnar joint instability. DISCUSSION Radial head excision has been considered a safe surgical procedure with satisfactory clinical outcomes. Development in biomechanical studies and prosthetic replacement of the radial head question the validity of radial head excision. In current literature, there are neither long-term follow-up studies on radial head prosthesis outcomes nor studies which consider elderly patient samples. CONCLUSION Radial head resection remains a good option when a radial head fracture occurs in elderly patients, taking into account the influence of poor bone quality and comorbidities on the outcome. Radial head excision is not indicated in the presence of associated lesions, because of the risk of residual elbow instability; complications associated with advanced age must be considered and a strict follow-up granted.
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Affiliation(s)
- Giuseppe Solarino
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Giovanni Vicenti
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy.
| | - Antonella Abate
- Orthopaedic and Trauma Department, University of Foggia, Foggia, Italy
| | - Massimiliano Carrozzo
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Girolamo Picca
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Biagio Moretti
- Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
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Taylor J, McMillan R, Shephard M, Setterfield J, Ahmed R, Carrozzo M, Grando S, Mignogna M, Kuten-Shorrer M, Musbah T, Elia A, McGowan R, Kerr A, Greenberg M, Hodgson T, Sirois D. World Workshop on Oral Medicine VI: a systematic review of the treatment of mucous membrane pemphigoid. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:161-71.e20. [DOI: 10.1016/j.oooo.2015.01.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/20/2015] [Accepted: 01/26/2015] [Indexed: 01/06/2023]
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