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Cursaru A, Popa M, Cretu B, Iordache S, Iacobescu GL, Spiridonica R, Rascu A, Serban B, Cirstoiu C. Exploring Individualized Approaches to Managing Vancouver B Periprosthetic Femoral Fractures: Insights from a Comprehensive Case Series Analysis. Cureus 2024; 16:e53269. [PMID: 38435949 PMCID: PMC10905061 DOI: 10.7759/cureus.53269] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
The increasing prevalence of periprosthetic femoral fractures, specifically in the vicinity of the hip, has emerged as a significant issue in recent times. Consequently, there is a need for a thorough examination to enhance the effectiveness of management and treatment approaches. The findings of this study emphasize a significant disparity in the occurrence and characteristics of these fractures, and the multiple cases have highlighted the efficacy of various treatment strategies, such as open reduction and internal fixation, as well as the utilization of cortical strut allografts. Furthermore, the study has identified potential risk factors that have an impact on the characteristics of fractures, providing valuable insights that could be crucial in the development of preventive strategies. This study provides a thorough examination of periprosthetic femoral fractures, highlighting the importance of a cohesive treatment algorithm to improve the handling of such fractures. Moreover, it promotes the need for a collaborative endeavor in conducting research in this field, cultivating a more profound comprehension that has the potential to drive progress in therapeutic approaches, ultimately enhancing patient results over an extended period of time. It is crucial that forthcoming research endeavors persist in expanding upon these discoveries, striving towards a unified methodology in tackling this substantial clinical obstacle.
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Affiliation(s)
- Adrian Cursaru
- Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, ROU
- Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Mihnea Popa
- Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, ROU
- Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Bogdan Cretu
- Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, ROU
- Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Sergiu Iordache
- Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, ROU
- Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Georgian L Iacobescu
- Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, ROU
- Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Razvan Spiridonica
- Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, ROU
| | - Angel Rascu
- Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, ROU
| | - Bogdan Serban
- Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, ROU
| | - Catalin Cirstoiu
- Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, ROU
- Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
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Cursaru A, Iordache S, Costache M, Serban B, Popa M, Cretu B, Cirstoiu C. Management of Acetabular Bone Loss in Hip Revision Arthroplasty: Case Series Presentation. Cureus 2023; 15:e45432. [PMID: 37859882 PMCID: PMC10582587 DOI: 10.7759/cureus.45432] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 10/21/2023] Open
Abstract
Considering the increase in life expectancy in the general population and the need for a more active lifestyle, total hip arthroplasty has become an absolutely necessary surgical intervention to maintain these desired results. Along with the evolution of medicine and the increase in the quality and performance of the materials used to make prostheses, the number of patients who benefit from total hip replacement is constantly increasing, and proportionally, the number of patients who will require revision arthroplasty is increasing. Before discussing the need for hip arthroplasty revision, it is necessary to carry out a rigorous clinical and imaging examination for differential diagnosis with other pathologies such as low back pain, the presence of bone or soft tissue tumors, arterial occlusions and claudication, or other systemic diseases. One of the biggest challenges for the orthopedic surgeon in planning a hip revision is the compensation of the remaining acetabular bone defect, either as a result of the osteolysis process or following the process of removing the acetabular component, which in some cases can lead to severe bone loss that is difficult to anticipate in the preoperative planning. In this paper, we will present the short-term results of the use of reinforcement cages fixed with screws and cemented retentive acetabular cups in the case of hip revisions with extensive bone loss. The discussions that derive from the presented series of cases are related to the use of reinforcement cages, which are based on the principle of primary stability obtained with the help of screw fixation but whose risk of osteolysis and implant fixation damage is greater than in the case of implants that also associate biological integration at bone level. The use of reinforcement cages together with the retentive acetabular cup in the case of elderly patients with associated comorbidities, a moderate level of physical activity, and severe muscle insufficiency at the hip level as a result of not using the affected pelvic limb is still a viable solution that allows the patient to walk immediately after the surgery, avoiding the risk of dislocation (especially in patients who use the posterolateral approach) and avoiding morbidity induced by prolonged bed rest.
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Affiliation(s)
- Adrian Cursaru
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Sergiu Iordache
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Mihai Costache
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Serban
- Orthopedics and Trauma, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Mihnea Popa
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Cretu
- Orthopedics, Bucharest Emergency University Hospital, Bucharest, ROU
| | - Catalin Cirstoiu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
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Cursaru A, Popa M, Lupu A, Iordache S, Costache M, Cretu B, Serban B, Cirstoiu C. An Examination of Personalized Approaches in the Management of Ankle Fractures: A Thorough Evaluation of Soft Tissue Factors, Treatment Methods, and Patient Adherence. Cureus 2023; 15:e45507. [PMID: 37868385 PMCID: PMC10585051 DOI: 10.7759/cureus.45507] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
This study offers a thorough analysis of tibial pilon fractures, accounting for patient compliance, diverse treatment options, and soft tissue implications. The article discusses varied treatment pathways, ranging from single-stage interventions to two-stage methods for open fractures by presenting seven clinical cases. The emphasis is on the intricate interplay of trauma intensity, bone damage, and adjacent soft tissue in dictating treatment plans and patient outcomes. The challenges posed by non-compliant patients rejecting advised treatments are underscored, illuminating the inherent risks. Drawing from varied patient demographics, comorbidities, and fracture types, a comprehensive guide for clinicians emerges. The findings underscore the importance of a tailored, patient-centric approach, considering the multifaceted nature of ankle fractures, local soft tissue health, patient's overall well-being, and their adherence to the proposed treatment regimen.
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Affiliation(s)
- Adrian Cursaru
- Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Mihnea Popa
- Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Alexandru Lupu
- Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Sergiu Iordache
- Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Mihai Costache
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Cretu
- Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Serban
- Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Catalin Cirstoiu
- Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
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Cretu B, Costache M, Cursaru A, Serban B, Spiridonica R, Popa M, Cirstoiu C, Iordache S. Restoring Anatomical Features in Primary Total Knee Arthroplasty. Cureus 2023; 15:e40616. [PMID: 37342300 PMCID: PMC10278159 DOI: 10.7759/cureus.40616] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 06/22/2023] Open
Abstract
Today, the number of people affected by gonarthrosis symptoms is increasing proportionally. Total knee arthroplasty (TKA) is a successful intervention that aims to reduce pain and restore knee function. However, studies have shown that active young patients still have limitations in performing activities such as skiing, golfing, surfing, and dancing. Over the last few years, total knee arthroplasty has undergone significant changes. Most of the modern TKA implants are designed to reproduce the normal biomechanics of the knee joint, mimicking the physiological pattern with greater compliance in the medial compartment between the tibial insert and femoral condyle and less congruence on the lateral side. Unfortunately, functional outcomes are compromised in approximately half of TKA patients. This loss may be caused by the abnormal kinematics and inherent instability of many contemporary implants. The proper alignment of the femoral component during TKA is a crucial step that influences postoperative results. The position of the femoral component in the axial plane is responsible for flexion stability, knee joint kinematics, flexion alignment, and patellar tracking. The main goal when choosing a type of prosthesis is to achieve an adequate recovery that leads to an improvement in mobility and an increase in the efficiency of the quadriceps.
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Affiliation(s)
- Bogdan Cretu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Mihai Costache
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Adrian Cursaru
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Serban
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Razvan Spiridonica
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Mihnea Popa
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Catalin Cirstoiu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Sergiu Iordache
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
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Iordache S, Costache M, Cursaru A, Serban B, Spiridonica R, Popa M, Cirstoiu C, Cretu B. A Narrative Review of Patellar Resurfacing Versus Non-resurfacing in Total Knee Arthroplasty. Cureus 2023; 15:e39362. [PMID: 37228351 PMCID: PMC10207997 DOI: 10.7759/cureus.39362] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 05/27/2023] Open
Abstract
The number of individuals who experience the symptoms of gonarthrosis rises proportionally as life expectancy rises and the population becomes more active. The purpose of total knee arthroplasty (TKA) is to lessen pain and restore knee function, and it has a high success rate. The restoration of patellar tracking in addition to the proper alignment of the femoral and tibial components contributes to the success of the arthroplasty and the patient's happiness. Replacement of the knee is not an easy process. One of the major objectives of total knee replacement is to achieve the proper rotation of the femoral components. A critical step that affects postoperative outcomes in total knee arthroplasty is the correct alignment of the femoral component. The axial plane of the femoral component is to blame for flexion stability, knee joint kinematics, flexion alignment, and patellar tracking. The patella is the largest sesamoid bone in the human body, and its major role is to enhance the quadriceps' moment arm, which allows the knee to expand. The distribution of patellofemoral compressive pressures during knee flexion and the centralization of the quadriceps muscles' multidirectional pull during extension are both critical functions of the patella. After primary knee arthroplasty, there are 8% more cases of anterior knee discomfort than there were before. Whether or not the patella was resurfaced, patients with primary TKA experience anterior knee discomfort. Patella baja is caused by excessive joint line elevation, which causes persistent overload and discomfort. The design of the TKR might have an impact on postoperative patellofemoral problems. After TKR, patellofemoral maltracking and patellar dislocation are often caused by surgical mistakes.
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Affiliation(s)
- Sergiu Iordache
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Mihai Costache
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Adrian Cursaru
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Serban
- Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Razvan Spiridonica
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Mihnea Popa
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Catalin Cirstoiu
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Cretu
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
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Cretu B, Iordache S, Cursaru A, Serban B, Costache M, Cirstoiu C, Spiridonica R. Metagenomic Next-Generation Sequencing for Periprosthetic Joint Infections. Cureus 2023; 15:e38726. [PMID: 37168414 PMCID: PMC10166283 DOI: 10.7759/cureus.38726] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 05/13/2023] Open
Abstract
Periprosthetic joint infection (PJI) after arthroplasty is a major complication, which requires significant resources, resulting in high costs for the medical system. In recent years, significant progress has been made in the diagnosis and treatment of periprosthetic infections, the identification of the pathogen being the central element in the establishment of targeted antibiotic therapy. Next-generation sequencing (NGS) or metagenomic NGS (mNGS) represents a promising, fast alternative, with increased specificity and sensitivity compared to identification methods using conventional culture media, thus enabling an increased rate of identification of pathogenic microorganisms and antibiotic resistance genes (ARG). The purpose of this article was to highlight new molecular diagnostic methods for periprosthetic joint infections and their involvement in treatment efficiency. NGS technologies are cutting-edge techniques that may challenge the PJI diagnostic model.
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Affiliation(s)
- Bogdan Cretu
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Sergiu Iordache
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Adrian Cursaru
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Serban
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Mihai Costache
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Catalin Cirstoiu
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Razvan Spiridonica
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
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Iordache S, Cursaru A, Serban B, Costache M, Spiridonica R, Cretu B, Cirstoiu C. Melorheostosis: A Review of the Literature and a Case Report. Medicina (Kaunas) 2023; 59:medicina59050869. [PMID: 37241101 DOI: 10.3390/medicina59050869] [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] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/07/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Melorheostosis, also referred to in the literature as Leri's disease, is an unusual mesenchymal dysplasia with the clinical appearance of benign sclerosing bone dysplasia; it frequently occurs in late adolescence. Any bone in the skeletal system can be affected by this disease, though the long bones of the lower extremities are the most common, at any age. Melorheostosis has a chronic evolution, and symptoms are usually absent in the early stages. The etiopathogenesis is still unknown, however, numerous theories have been proposed that could explain the appearance of this lesion formation. An association with other benign or malignant bone lesions is also possible, and associations with osteosarcoma, malignant fibrous histiocytoma, or Buschke-Ollendorff syndrome have also been reported. There have also been reported cases of the malignant transformation of a pre-existing melorheostosis lesion into malignant fibrous histiocytoma or osteosarcoma. The diagnosis of melorheostosis can be made only based on radiological images, but, due to its polymorphism, additional imaging investigations are often necessary and sometimes only a biopsy can establish a definite diagnosis. Because there are currently no guidelines for treatment based on scientific evidence, due to the low number of cases diagnosed worldwide, our objective was to highlight the early recognition and specific surgical treatments for better prognosis and outcomes. Materials and Methods: We conducted a review of the literature consisting of original papers, case reports, and case series and presented the clinical and paraclinical characteristics of melorheostosis. We aimed to synthesize the treatment methods available in the literature as well as determine possible future directions related to the treatment of melorheostosis. Furthermore, we presented the results of a case of femoral melorheostosis admitted to the orthopedics department of the University Emergency Hospital of Bucharest in a 46-year-old female patient with severe pain in the left thigh and limitation of joint mobility. Following the clinical examination, the patient complained of pain in the middle third of the left thigh in the antero-medial compartment; the pain appeared spontaneously and was aggravated during physical activity. The pain started about two years prior, but the patient experienced complete pain relief after the administration of non-steroidal anti-inflammatory drugs. In the last six months, the patient presented an increase in pain intensity without significant improvement following the administration of non-steroidal anti-inflammatory drugs. The patient's symptoms were mainly determined by the increase in the volume of the tumor and the mass effect on the adjacent tissues, especially on the vessels and the femoral nerve. The CT examination and bone scintigraphy showed a unique lesion in the middle third of the left femur and no oncological changes in the thoracic, abdominal, and pelvic regions; however, at the level of the femoral shaft, there was a localized cortical and pericortical bone lesion formation that surrounded approximately 180 degrees of the femoral shaft (anterior, medial, and lateral). It had a predominantly sclerotic structure but was associated with lytic areas with thickening of the bone cortex and areas of periosteal reaction. The next therapeutic gesture was to perform an incisional biopsy using a lateral approach at the level of the thigh. The histopathological result supported the diagnosis of melorheostosis. Additionally, immunohistochemical tests completed the data obtained after the microscopic examination through the classic histopathological technique The patient was discharged and included in a full medical recovery program for eight weeks in a specialized medical center, during which she also received analgesic treatment in maximum doses, but without improvement regarding her symptoms. Taking into account the chronic evolution of the pain, the complete lack of response to conservative treatment after eight weeks, and the lack of treatment guidelines in the case of melorheostosis, a surgical approach needed to be considered. The surgical option in this case, considering the circumferential location of the lesion at the level of the femoral diaphysis, was a radical resection. The surgical approach consisted of segmental resection to healthy bone tissue and reconstruction of the remaining defect with a modular tumoral prosthesis. At the 45-day postoperative control, the patient no longer complained of pain in the operated-on limb and was mobile with full support without gait difficulties. The follow-up period was one year, and the patient presented complete pain relief and a very good functional outcome. Results: In the case of asymptomatic patients, conservative treatment seems to be a good option with optimal results. However, for benign tumors, it remains unclear whether radical surgery is a viable option. Conclusions: Melorheostosis remains an incompletely understood disease, given the limited number of cases worldwide, and thus, there is a lack of clinical guidelines regarding specialized treatment.
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Affiliation(s)
- Sergiu Iordache
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
| | - Adrian Cursaru
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
| | - Bogdan Serban
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
| | - Mihai Costache
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
| | - Razvan Spiridonica
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
| | - Bogdan Cretu
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
| | - Catalin Cirstoiu
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
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Crețu B, Șerban B, Iordache S, Cursaru A, Costache MA, Cîrstoiu C. Medial Pivot Knee in Total Knee Arthroplasty. RJMM 2023. [DOI: 10.55453/rjmm.2023.126.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
"In the context in which life expectancy increases and the population becomes more active, the number of people who are affected by gonarthrosis symptoms increases proportionally. By the year 2030, in the United States of America, one in three adults is expected to suffer from gonarthrosis, this prediction will be the beginning of an epidemic. Total knee arthroplasty has been shown to relieve pain and improve joint function; however, studies have shown that active young patients still have limitations in performing high-level activities such as dancing, golfing, skiing, and gardening. Currently, modern TKA implants are designed to reproduce the normal biomechanics of the knee joint, mimicking the physiological “medial pivot” pattern with greater compliance on the medial compartment between the tibial insert and femoral condyle and less congruence on the lateral side. "
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Toader DM, Mirea O, Craciun-Mirescu A, Magareata G, Florescu D, Iordache S, Iovanescu M, Cirstea I, Aniculesei A, Busu M, Istratoaie O, Militaru C. The link between left atrial longitudinal reservoir strain and mitral apparatus geometry in patients with dilated cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.109] [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: 11/13/2022] Open
Abstract
Abstract
Background
4-Dimensional Automated Left Atrial Quantification (4D Auto LAQ) is a technique that uses 3D volume data to determine LA strain. 4-Dimensional Automated Mitral Valve Quantification (4D Auto MVQ) evaluates anatomical and functional mitral valve parameters. Our study evaluated patients with dilated cardiomyopathy and tried to find a correlation between LA strain and mitral apparatus geometry.
Methods
We enrolled 61 patients with dilated cardiomyopathy and 25 healthy volunteers. The evaluation consisted of clinical examination, laboratory tests, 12 leads electrocardiography. All participants underwent a complete transthoracic echocardiogram to determine cardiac structure and function according to the current guidelines. Measurement of LA strain and MV was performed using 4D Auto-quantification software. The study evaluated longitudinal strain during reservoir phase (LASr) and the parameters of the MV geometry that could interfere with left atrial function: annulus area, annulus perimeter, anteroposterior (A-P) diameter, posteromedial-anterolateral diameter (PM-AL), (the longest diameter of MV perpendicular to AP diameter); commissural diameter (CD), inter-trigonal distance, tenting height, tenting area, and tenting volume.
Results
1. The patients were divided in two groups: 26 with ischemic dilated cardiomyopathy and 35 with non-ischemic dilated cardiomyopathy. 2. Mean values of MV parameters in patients with dilated cardiomyopathy compare with healthy volunteers were: annulus area: 19.46 cm2 vs 11.85 cm2; annulus perimeter: 16.86 cm vs 12.71cm, A-P diameter 4.53 cm vs 3.45 cm, PM-AL diameter 4.84 cm vs 3.92 cm, CD 4.83 cm, vs 3.94 cm, inter-trigonal distance 3.9 cm vs 2.9 cm, tenting height 1.64 cm vs 1.05 cm, tenting area 4.82 cm2 vs 1.78 cm2, tenting volume 13.49 ml vs 4.27 ml. For LASr, mean values were 10.26 in patients with dilated cardiomyopathy vs 32.14 in healthy volunteers. Mean values of mitral valve parameters and LASr were comparable in ischemic vs non-ischemic cardiomyopathy patients. 3. LASr correlated with anatomical mitral valve parameters: annulus area: r=−0.6, annulus perimeter: r=−0.57, AP diameter: r=−0.58, PM-AL diameter: r=−0.58, commissural diameter: r=−0.66, inter-trigonal distance: r=−0.57, tenting height r=−0.53, tenting area r=−0.55 and tenting volume r=−0.54.
Conclusions
1. In patients with dilated cardiomyopathy phenotype, anatomical parameters of the mitral valve and LASr were altered. Results did not reveal significant differences between ischemic and non-ischemic etiology. 2. A correlation was found between the decrease in LASr and anatomical parameters of the mitral valve, suggesting a link between atrial function deterioration and deformity of mitral apparatus geometry in patients with dilated cardiomyopathy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - O Mirea
- University of Medicine and Pharmacy of Craiova , Craiova , Romania
| | | | | | | | | | | | - I Cirstea
- Cardiology Center , Craiova , Romania
| | | | - M Busu
- Cardiology Center , Craiova , Romania
| | - O Istratoaie
- University of Medicine and Pharmacy of Craiova , Craiova , Romania
| | - C Militaru
- University of Medicine and Pharmacy of Craiova , Craiova , Romania
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Cretu B, Serban B, Iordache S, Cursaru A, Costache M, Cirstoiu C. New anatomical landmark for rotational assessment of total knee arthroplasty. RJMM 2022. [DOI: 10.55453/rjmm.2022.125.3.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
One of the most controversial topics in total knee arthroplasty is rotation of the femoral component. The current gold-standard in total knee arthroplasty consists in positioning the femoral component in 3 degrees of external rotation to the epicondylar axis, having as reference the tangent to the posterior condyles. Achieving the correct rotation of the femoral components is one of the main goals during total knee arthroplasty. Multiple complications can result from internal femoral rotation, such as lateral patellar tilt, patellar subluxation or dislocation, mobilization with movement on pain, and low survival rates of the femoral components. Postoperative rotational assessment of protective components can only be performed correctly using computed tomography. The known evaluation methods are related to anteversion of the femoral neck, femoral trans-epicondylar line, insertion of the posterior cruciate ligament from the tibia and tibial tuberosity. The purpose of this study was to evaluate the rotation of the prosthetic components in the group of patients with the methods validated by studies and to find alternatives to evaluate the rotation of the femoral component. Thirty-four patients diagnosted with gonarthrosis, proposed for total knee arthroplasty, were included in the study. This is a prospective cohort study in which applied statistics consisted of analyzing data using frequency and percentage for qualitative and mean variables and standard deviation for quantitative variables
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Abstract
Bone metastases are difficult to treat surgically, necessitating a multidisciplinary approach that must be applied to each patient depending on the specifics of their case. The main indications for surgical treatment are a lack of response to chemotherapy, radiation therapy, hormone therapy, immunotherapy, and bisphosphonates which is defined by persistent pain or tumor progression; the risk of imminent pathological bone fracture; and surgical treatment for single bone metastases. An important aspect of choosing the right treatment for these patients is accurately estimating life expectancy. Improved chemotherapy, postoperative radiation therapy, and sustainable reconstructive modalities will increase the patient’s life expectancy. The surgeon should select the best surgical strategy based on the primary tumor and its characteristics, the presence of single or multiple metastases, age, anatomical location, and the functional resources of the patient. Preventive osteosynthesis, osteosynthesis to stabilize a fracture, resections, and reconstructions are the main surgical options for bone metastases. Resection and reconstruction with a modular prosthesis remain the generally approved surgical option to restore functionality, increase the quality of life, and increase life expectancy. Preoperative embolization is necessary, especially in the case of metastases of renal or thyroid origin. This procedure is extremely important to avoid complications, with a major impact on survival rates.
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Affiliation(s)
- Catalin Cirstoiu
- Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Bogdan Cretu
- Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Sergiu Iordache
- Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Mihnea Popa
- Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Bogdan Serban
- Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Adrian Cursaru
- Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
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12
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Popa M, Cursaru A, Popa V, Munteanu A, Șerban B, Crețu B, Iordache S, Smarandache C, Orban C, Cîrstoiu C. Understanding orthopedic infections through a different perspective: Microcalorimetry growth curves. Exp Ther Med 2022; 23:263. [DOI: 10.3892/etm.2022.11189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/05/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Mihnea Popa
- Department of Orthopedics and Traumatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian Cursaru
- Department of Orthopedics and Traumatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Vlad Popa
- ‘Ilie Murgulescu’ Institute of Physical Chemistry, 060021 Bucharest, Romania
| | - Alexandru Munteanu
- Department of Medical Microbiology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bogdan Șerban
- Department of Orthopedics and Traumatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bogdan Crețu
- Department of Orthopedics and Traumatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Sergiu Iordache
- Department of Orthopedics and Traumatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Catalin Smarandache
- Department of General Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Carmen Orban
- Department of Anaesthesia and Intensive Care, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cătălin Cîrstoiu
- Department of Orthopedics and Traumatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
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13
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Cursaru A, Crețu B, Șerban B, Iordache S, Popa M, Smarandache C, Orban C, Cîrstoiu C. Minimally invasive treatment and internal fixation vs. extended lateral approach in calcaneus fractures of thalamic interest. Exp Ther Med 2022; 23:196. [PMID: 35126699 PMCID: PMC8794544 DOI: 10.3892/etm.2022.11119] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/13/2021] [Indexed: 11/06/2022] Open
Abstract
The extended lateral side approach is a common technique in the surgical treatment of calcaneal fractures, with thalamic collapse offering a good exposure of the fractured site; however, it can be burdened with complications due to soft tissue trauma. The present study aimed to compare patients treated with minimally invasive osteosynthesis through a minimum lateral approach and internal fixation with patients that were treated using internal fixation with an extended lateral side approach in cases of intra-articular calcaneal fractures with thalamic fracture. Patients were evaluated preoperatively and postoperatively by performing clinical and imagistic examinations, with radiography scans of the anterior-posterior calcaneal profile and computer tomography. Furthermore, preoperative and postoperative analyses of the Böhler angle on the radiological profile, complications and duration of the hospital admission for both groups were performed. There were 36 patients (39 calcaneal fractures) in group 1 and 24 patients (29 calcaneal fractures) in group 2. The results demonstrated no statistically significant differences in the preoperative (P=0.72) and postoperative (P=0.20) Böhler angle values. The postoperative Böhler angle average values were 26.9 in group 1 and 29.3 in group 2. A total of 11 patients were treated with Kirschner wires inserted in the calcaneus, and in 2/ll cases, one of the brooches registered a migration movement. There were no cases of material migration in the fractures that were stabilized by inserting Kirschner brooches up to the astragalus and cuboid bones. Taken together, the results of the present study demonstrated no significant differences in the Böhler angle values between the minimally invasive and open reduction techniques. However, the antibiotic therapy period, as well as the infection rate were lower in patients that were treated using the minimally invasive technique, suggesting that this technique was superior with respect to lower complication rates and improved functional results.
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Affiliation(s)
- Adrian Cursaru
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bogdan Crețu
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bogdan Șerban
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Sergiu Iordache
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihnea Popa
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Catalin Smarandache
- Department of General Surgery, University Emergency Hospital, 050098 Bucharest, Romania
| | - Carmen Orban
- Department of Anesthesiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cătălin Cîrstoiu
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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14
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Creţu I, Bojincă M, Milicescu M, Cursaru A, Șerban B, Crețu B, Iordache S, Pop CS, Cîrstoiu C, Ionescu R. Musculoskeletal adverse reactions after immunotherapy for cancer: A case series. Exp Ther Med 2021; 22:1027. [PMID: 34373713 PMCID: PMC8343871 DOI: 10.3892/etm.2021.10459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/09/2021] [Indexed: 12/19/2022] Open
Abstract
Immunotherapy has revolutionized cancer treatment. Immune checkpoint inhibitors (ICIs) including antibodies targeting cytotoxic T lymphocyte associated antigen-4 and programmed cell death 1 have been shown to be effective in the treatment of certain types of cancer. The benefit of these therapies is to prolong life expectancy in the case of metastatic malignancies. Rheumatic adverse events are not very common. In the present study, 9 patients were monitored between November 2018 and January 2020. The oncologist, who identified the occurrence of rheumatic toxicities after the treatment with ICIs, evaluated the patients. Only oncological patients with rheumatic manifestations after the start of immunotherapy were included. Toxicity grading was performed by both the oncologist and the rheumatologist, on a scale from 1 to 5 (1, mild; 2, moderate; 3, severe; 4, life-threatening; 5, death related to toxicity). The results showed that rheumatoid factor, which was sampled in each patient, was negative in all cases. Patients were treated with nonsteroidal anti-inflammatory drugs or prednisone depending on the severity of the adverse events. The results varied with the severity of the adverse events. In conclusion, as the number of patients treated with ICIs increases, so will the number of patients presenting with immune-related adverse events (irAEs). The collaboration between oncologists and rheumatologists should be intimate to provide optimal treatment to patients. Musculoskeletal manifestations secondary to ICIs are slightly different from other rheumatologically conditions making diagnosis, treatment and monitoring difficult. Thus, irAEs are new and challenging for oncologists, thus understanding of the pathogenesis and clinical characteristics must be improved for better treatment guidelines.
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Affiliation(s)
- Ioana Creţu
- Department of Internal Medicine and Rheumatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Internal Medicine and Rheumatology, 'Dr. Ion Cantacuzino' Hospital, 917151 Bucharest, Romania
| | - Mihai Bojincă
- Department of Internal Medicine and Rheumatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Internal Medicine and Rheumatology, 'Dr. Ion Cantacuzino' Hospital, 917151 Bucharest, Romania
| | - Mihaela Milicescu
- Department of Internal Medicine and Rheumatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Internal Medicine and Rheumatology, 'Dr. Ion Cantacuzino' Hospital, 917151 Bucharest, Romania
| | - Adrian Cursaru
- Department of Internal Medicine and Rheumatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Orthopedics and Traumatology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Bogdan Șerban
- Department of Internal Medicine and Rheumatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Orthopedics and Traumatology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Bogdan Crețu
- Department of Internal Medicine and Rheumatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Orthopedics and Traumatology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Sergiu Iordache
- Department of Internal Medicine and Rheumatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Orthopedics and Traumatology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Corina Silvia Pop
- Department of Internal Medicine and Rheumatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Internal Medicine, University Emergency Hospital, 050098 Bucharest, Romania
| | - Cătălin Cîrstoiu
- Department of Internal Medicine and Rheumatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Orthopedics and Traumatology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Ruxandra Ionescu
- Department of Internal Medicine and Rheumatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Internal Medicine and Rheumatology, 'Sf. Maria' Clinical Hospital, 011172 Bucharest, Romania
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15
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Iordache S, Saftoiu A, Gheonea D, Popescu C, Ciurea T. Assessment of vascularity in gastric malignant tumors. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)71789-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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16
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Iordache S, Rath E, Atar D, Vindzberg A. [Vacuum phenomenon in the hip joint: diagnostic value]. Harefuah 1998; 135:108-9, 167. [PMID: 9885654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Vacuum phenomenon is well known in degenerative spinal disease in the elderly, but is seldom seen in other joints, especially in children. The phenomenon does not represent a pathological finding, and can be used for imaging of the articular facets, mainly in the hip and knee joints. We report a patient with this phenomenon in the hip joint.
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Affiliation(s)
- S Iordache
- Orthopedics Dept., Soroka Medical Center, Beer Sheba
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