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Guidi M, Guzzini M, Civitenga C, Lanzetti RM, Kim BS, Besmens IS, Riegger M, Lucchina S, Calcagni M, Perugia D. Multifactorial Analysis of Treatment of Long-Bone Nonunion with Vascularized and Nonvascularized Bone Grafts. J Hand Microsurg 2023; 15:106-115. [PMID: 37020609 PMCID: PMC10070005 DOI: 10.1055/s-0042-1748783] [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] [Indexed: 10/15/2022] Open
Abstract
Introduction The purpose of the study was to evaluate the results of treatment of the nonunion of long bones using nonvascularized iliac crest grafts (ICGs) or vascularized bone grafts (VBGs), such as medial femoral condyle corticoperiosteal flaps (MFCFs) and fibula flaps (FFs). Although some studies have examined the results of these techniques, there are no reports that compare these treatments and perform a multifactorial analysis. Methods The study retrospectively examined 28 patients comprising 9 women and 19 men with an average age of 49.8 years (range: 16-72 years) who were treated for nonunion of long bones between April 2007 and November 2018. The patients were divided into two cohorts: group A had 17 patients treated with VBGs (9 patients treated with MFCF and 8 with FF), while group B had 11 patients treated with ICG. The following parameters were analyzed: radiographic patterns of nonunion, trauma energy, fracture exposure, associated fractures, previous surgeries, diabetes, smoking, age, and donor-site morbidity. Results VBGs improved the healing rate (HR) by 9.42 times more than the nonvascularized grafts. Treatment with VBGs showed a 25% decrease in healing time. Diabetes increased the infection rate by 4.25 times. Upper limbs showed 70% lower infection rate. Smoking among VBG patients was associated with a 75% decrease in the HR, and diabetes was associated with an 80% decrease. Conclusion This study reports the highest success rates in VBGs. The MFCFs seem to allow better clinical and radiological outcomes with less donor-site morbidity than FFs.
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Affiliation(s)
- Marco Guidi
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Matteo Guzzini
- Department of Orthopedics and Traumatology, S. Andrea Hospital, University of Rome “La Sapienza,” Rome, Italy
| | - Carolina Civitenga
- Department of Orthopedics and Traumatology, S. Andrea Hospital, University of Rome “La Sapienza,” Rome, Italy
| | | | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Inga Swantje Besmens
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Martin Riegger
- Department of Orthopedics and Traumatology, Lugano's Regional Hospital, Viganello, Switzerland
| | - Stefano Lucchina
- Hand Surgery Unit, Locarno Hand Center, Locarno's Regional Hospital, Locarno, Switzerland
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Dario Perugia
- Department of Orthopedics and Traumatology, S. Andrea Hospital, University of Rome “La Sapienza,” Rome, Italy
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Previ L, Guidi M, Rescigno G, Niccolo RD, Marzilli F, Perugia D. First Metatarsal Bilateral Stress Fracture: A Case Report. J Orthop Case Rep 2023; 13:34-37. [PMID: 37144074 PMCID: PMC10152933 DOI: 10.13107/jocr.2023.v13.i02.3546] [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] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/18/2022] [Indexed: 05/06/2023] Open
Abstract
Introduction Metatarsal stress fractures typically occur in the second and third metatarsus metaphysis, with only rare cases in the fourth and first. The main factors influencing its onset are repetitive stress from prolonged training, biomechanical factors and bone weakness. There is only a paucity of literature documenting first metatarsal stress fractures; the authors present a rare bilateral first metatarsal stress fracture. Case Report A Caucasian 52-years-old amateur female runner with no other risk factors or medical condition was admitted in our institute with complaints of severe bilateral forefoot pain for 2 weeks arisen after a 20 km run of an amateur race. The patient presented bilateral hallux valgus (HVA) and advanced osteoarthritis of the first metatarsal-phalangeal joint, which is not usually considered a biomechanical risk factor for metatarsal stress fractures. Radiographs of both feet showed linear sclerosis, perpendicular to the diaphysis of the first metatarsal, approximatively in the half of the bone. Signs of osteoarthritis of the first metatarsal-phalangeal were also detected bilaterally.The patient was treated with rest, bilateral post-operative rocker sole shoes that she has worn for 6 weeks, cryotherapy, analgesics as needed and pulsed electromagnetic fields for 8 h per day for 40 days with a complete resolution of symptoms and the previous radiological findings. Conclusion The authors believed that the bilateral HVA condition could be considered an indirect sign of overuse, and it may be investigated and eventually treated as a responsible for this pathologic condition.
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Affiliation(s)
- Leonardo Previ
- Department of Trauma and Orthopaedics, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Guidi
- Department of Orthopaedics Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich, Switzerland
| | - Giulia Rescigno
- Department of Trauma and Orthopaedics, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
- Address of Correspondence: Dr. Giulia Rescigno, Department of Trauma and Orthopaedics, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy. E-mail:
| | - Riccardo Di Niccolo
- Department of Trauma and Orthopaedics, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Fabio Marzilli
- Department of Orthopaedics, Orthopaedic and Traumatology Unit, Santo Spirito Hospital, Pescara, Italy
| | - Dario Perugia
- Department of Trauma and Orthopaedics, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Guidi M, Bufalini C, Guzzini M, Koverech G, Cenci G, Lucchina S, Kim BS, Calcagni M, Perugia D. Distraction Arthroplasty for Basal Thumb Osteoarthritis: 10-Year Follow-Up. J Hand Surg Am 2022:S0363-5023(22)00255-6. [PMID: 35718582 DOI: 10.1016/j.jhsa.2022.04.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 03/15/2022] [Accepted: 04/27/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Trapeziectomy has frequently been used to treat basal thumb osteoarthritis. However, complications, such as shortening of the thumb ray and reduced mobility and strength, can occur. The aim of this study was to present a 10-year follow-up of distraction arthroplasty without trapeziectomy. METHODS Fifteen patients were followed for a mean of 121 months (range, 121-124 months). Subjective outcomes were evaluated with the Disabilities of the Arm, Shoulder, and Hand questionnaire, while the pain intensity was assessed with a Visual Analog Scale both before surgery and at the end of follow-up. Objective outcomes were obtained using the Kapandji score and an assessment of grip and pinch strength. Preoperative and final postoperative x-rays were obtained to evaluate metacarpal subsidence and progression of trapezial-metacarpal joint arthritis. RESULTS The Visual Analog Scale score was reduced from 9.4 ± 0.5 before surgery to 2.5 ± 1 at follow-up. The mean Disabilities of the Arm, Shoulder, and Hand questionnaire score was 75.6 ± 12.6 before surgery and 16.9 ± 4 at 10 years. Hand grip strength of the operated side (26 ± 5.5 kg) achieved 95% of functionality compared to the opposite side, while key pinch strength (6.4 ± 1.6 kg) reached 93%. A Kapandji opposition score of 10 points was found in 12 patients, a score of 9 was found in 1, and a score of 8 was found in 2. CONCLUSIONS Distraction arthroplasty of the trapeziometacarpal joint ensures good results in long-term follow-up, when performed in patients with stage I-II basal thumb osteoarthritis. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Marco Guidi
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
| | | | - Matteo Guzzini
- Department of Orthopedics, S. Andrea Hospital, University of Rome "La Sapienza," Rome, Italy
| | - Guido Koverech
- Department of Orthopedics, S. Andrea Hospital, University of Rome "La Sapienza," Rome, Italy
| | - Giulia Cenci
- Department of Orthopedics, S. Andrea Hospital, University of Rome "La Sapienza," Rome, Italy
| | - Stefano Lucchina
- Hand Surgery Unit, Locarno's Regional Hospital, Locarno Hand Center, Locarno, Switzerland
| | - Bong Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Dario Perugia
- Department of Orthopedics, S. Andrea Hospital, University of Rome "La Sapienza," Rome, Italy
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Ciatti C, Maniscalco P, Quattrini F, Gattoni S, Magro A, Capelli P, Banchini F, Fiazza C, Pavone V, Puma Pagliarello C, Valenti F, Maccauro G, Cauteruccio M, Accetta R, Basile G, Ruosi C, Di Santo F, Orabona N, Coppola C, Perugia D, Lanzetti RM, Roselli M, Montanari G, Benazzo F, Mosconi M, Perticarini L, Pesce V, Maccagnano G, Moretti L, Moretti B, Solarino G. The epidemiology of proximal femur fractures during COVID-19 emergency in Italy: a multicentric study. Acta Biomed 2021; 92:e2021398. [PMID: 34738558 PMCID: PMC8689341 DOI: 10.23750/abm.v92i5.11925] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022]
Abstract
Background and aim: After the first Italian case of Covid-19, the Government imposed the complete closure of all areas involved by the spread of the virus to contain transmissions. There was a massive reorganization of Hospitals, a stop of all elective activities and a convertion of many hospitals in “Covid Centers’’. AITOG (Associazione Italiana Traumatologia e Ortopedia Geriatrica) conducted a retrospective study on all proximal femur fractures surgeries that occurred in this period, to find out whether the pandemic and the correlated lockdown somehow changed the incidence of these events. Methods: 10 Italian orthopedic centers were involved in the study. Considering the geographic location, three groups were created (North, Centre and South). The considered period is the Italian “Phase 1” (February 23rd - May 3rd 2020). Results: the cohort is composed of 412 patients, 116 male and 296 female (mean age 81.1 ± 9.1 years). The same period of 2019 has been used as control group, with 558 patients, 156 male and 402 female (mean age 84.2 ± 8.0 years). In 2020 we counted 323 (78.4%) fractures occurred at home, 61 (14.8%) in retirement houses and 28 (6.8%) in different locations. We mainly treated fractures with intramedullary nails (n.237 57.5%). Among all patients we had 46 (11.1%) Covid-19 positive. The mortality rate within 30 days was of 51 patients (12.4%); 23 of these died because of complications related to Covid-19 while 31 of these were in treatment with anticoagulant/antiaggregant. Conclusions: AITOG analysis demonstrates a decrease in surgical interventions for proximal femur fractures from 2019 to 2020, a reduction in patients mean age and an increase in trauma occurred in domestic environment. We also registered a consistent difference between the North, Center and South of the Country. (www.actabiomedica.it)
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Affiliation(s)
- Corrado Ciatti
- Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - Pietro Maniscalco
- Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - Fabrizio Quattrini
- Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - Serena Gattoni
- Orthogeriatric Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - Alessandra Magro
- Orthogeriatric Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - Patrizio Capelli
- Surgery Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - Filippo Banchini
- Surgery Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - Caterina Fiazza
- Hospital Pharmacy, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - Vito Pavone
- Orthopedics and Traumatology Department, University of Catania, Italy.
| | | | - Fabiana Valenti
- Orthopedics and Traumatology Department, University of Catania, Italy.
| | - Giulio Maccauro
- Orthopedics Department, IRCCS Fondazione Policlinico Gemelli, Rome, Italy.
| | | | - Riccardo Accetta
- Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute, Milano, Italy.
| | - Giuseppe Basile
- Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute, Milano, Italy.
| | - Carlo Ruosi
- Department of Orthopaedics, Federico II University, Napoli.
| | - Fabio Di Santo
- Orthopedics and Traumatology Department, AORN "Cardarelli" Hospital, Napoli.
| | - Nicola Orabona
- Orthopedics and Traumatology Department, ASL 1 "Ospedale del Mare " Hospital, Napoli.
| | - Cristiano Coppola
- Orthopedics and Traumatology Department, ASL 1 "Ospedale del Mare " Hospital, Napoli.
| | - Dario Perugia
- Orthopedics and Traumatology Department, San Camillo Forlanini Hospital, Rome, Italy.
| | | | - Mauro Roselli
- Orthopedic and Traumatology Unit, Maria Vittoria Hospital, Turin, Italy.
| | | | - Francesco Benazzo
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
| | - Mario Mosconi
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
| | - Loris Perticarini
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
| | - Vito Pesce
- U.O.C. di Ortopedia e Traumatologia Universitaria, Azienda Ospedaliero Universitaria Policlinico "Riuniti di Foggia", Dipartimento di Medicina Clinica e Sperimentale, Università di Medicina e Chirurgia Università di Foggia.
| | - Giuseppe Maccagnano
- U.O.C. di Ortopedia e Traumatologia Universitaria, Azienda Ospedaliero Universitaria Policlinico "Riuniti di Foggia", Dipartimento di Medicina Clinica e Sperimentale, Università di Medicina e Chirurgia Università di Foggia.
| | - Lorenzo Moretti
- School of Medicine, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, University of Bari Aldo Moro, Bari, Italy.
| | - Biagio Moretti
- School of Medicine, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, University of Bari Aldo Moro, Bari, Italy.
| | - Giuseppe Solarino
- School of Medicine, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, University of Bari Aldo Moro, Bari, Italy.
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Vertuccio A, Perugia D, Lanzetti R, Massimiani A, Lacopo A, Nusca S, Baldini R, Santoboni F, Latini E, Vetrano M, Vulpiani M. Demographic and Clinical Factors Predict Focused Shockwave Therapy Results on Patients With Plantar Fasciitis. A Multilevel Analysis. Muscles Ligaments Tendons J 2021. [DOI: 10.32098/mltj.03.2021.02] [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: 11/05/2022]
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Pecchia S, Guzzini M, Koverech G, Arioli L, Andreozzi V, Perugia D. Surgical Treatment of a Voluminous Median Nerve Lipofibromatous Hamartoma Involving Distal Forearm: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00054. [PMID: 33914715 DOI: 10.2106/jbjs.cc.20.01022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Lipofibromatous hamartoma (LFH) is a rare benign tumor of the peripheral nerves, which often affects upper extremity. There is no consensus regarding management of these lesions. We report a case of median nerve LFH in the volar forearm of a 24-year-old man with carpal tunnel syndrome symptoms. Clinically, the mass appeared tender to palpation, ill-defined and soft, located on the volar aspect of the left forearm. Open epineurotomy and neurolysis of the median nerve were performed with full recovery at 1 year. CONCLUSION Surgical approach may be resolutive in patients with large masses refractory to conservative treatment.
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Affiliation(s)
- Stefano Pecchia
- Hand and Foot Surgery Division, Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, Sant'Andrea Hospital, University of Rome "La Sapienza," Rome, Italy
| | - Matteo Guzzini
- Hand and Foot Surgery Division, Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, Sant'Andrea Hospital, University of Rome "La Sapienza," Rome, Italy
| | | | - Leopoldo Arioli
- Hand and Foot Surgery Division, Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, Sant'Andrea Hospital, University of Rome "La Sapienza," Rome, Italy
| | - Valerio Andreozzi
- Hand and Foot Surgery Division, Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, Sant'Andrea Hospital, University of Rome "La Sapienza," Rome, Italy
| | - Dario Perugia
- Hand and Foot Surgery Division, Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, Sant'Andrea Hospital, University of Rome "La Sapienza," Rome, Italy
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7
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Basile A, Liuni FM, Guidi M, Perugia D, Zoccali C, Baldi J. A Rare Case of First Metatarsal Extrusion: Results of Treatment After 12 Months. J Foot Ankle Surg 2021; 59:629-631. [PMID: 31848041 DOI: 10.1053/j.jfas.2018.12.045] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/24/2018] [Accepted: 12/28/2018] [Indexed: 02/03/2023]
Abstract
We present the case of a 21-year-old male with 12 months' follow-up after reimplantation of a completely extruded first metatarsal. The patient had a motorcycle accident involving his right foot and ankle, with multiple lesser metatarsal fractures, lateral malleolus fracture, and a total first metatarsal extrusion (without fracture) through a large dorso-medial forefoot wound. The extruded bone was recovered at the site of the motor vehicle accident and was transported to the hospital with the patient. Before the reimplantation surgery was undertaken, the first metatarsal was immersed in a chlorhexidine solution for 20 minutes and then washed in an antibiotic solution. Metatarsal fixation was performed with Kirschner wires; the lateral malleolus fracture was fixed with plate and screws. An external fixator was then applied. Throughout the 12-month follow-up period, there was no evidence of infection. At the present time, this case suggests that, after antiseptic cleansing and prompt surgery, extruded first metatarsal reimplantation is possible with a reasonable degree of clinical success.
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Affiliation(s)
- Attilio Basile
- Surgeon, Department of Orthopaedics and Traumatology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Federico Maria Liuni
- Surgeon, Department of Orthopaedics and Traumatology, Santa Maria Hospital, Borgo Val di Taro, Italy.
| | - Marco Guidi
- Surgeon, Department of Orthopaedics and Traumatology, Azienda Ospedaliero-Universitaria Sant'Andrea, Rome, Italy
| | - Dario Perugia
- Surgeon, Department of Orthopaedics and Traumatology, Azienda Ospedaliero-Universitaria Sant'Andrea, Rome, Italy
| | - Carmine Zoccali
- Surgeon, Oncological Orthopaedics Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Jacopo Baldi
- Surgeon, Oncological Orthopaedics Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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8
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Lanzetti RM, Astone A, Pace V, D'Abbondanza L, Braghiroli L, Lupariello D, Altissimi M, Vadalà A, Spoliti M, Topa D, Perugia D, Caraffa A. Neurolysis versus anterior transposition of the ulnar nerve in cubital tunnel syndrome: a 12 years single secondary specialist centre experience. Musculoskelet Surg 2021; 105:69-74. [PMID: 32036564 DOI: 10.1007/s12306-020-00647-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/15/2018] [Accepted: 02/02/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Various conservative treatments and surgical techniques have been reported in the literature as efficient and feasible measures to treat the cubital tunnel syndrome. However, there has been no consensus on the best management of the syndrome, and uniform standardised guidelines have not yet been accepted or introduced. With our study, we present our experience on the clinical efficacies and outcomes of the surgical techniques of neurolysis alone and neurolysis associated with ulnar nerve anterior transposition at the elbow joint in patients with neuropathic symptoms due to cubital tunnel syndrome. MATERIALS AND METHODS A total of 107 patients with cubital tunnel syndrome were retrospectively enrolled, surgically treated and followed up in our study. The cohort was divided into two groups: 41 patients treated only with neurolysis of the ulnar nerve (Group 1), and 66 patients treated with neurolysis and anterior transposition (Group 2). Of the participants, 35 were women and 72 were men. The average age was 54 years. Significant comorbidities were preoperatively diagnosed in 26 patients. Conservative measures had been considered, followed by surgical management if appropriate. A pre-op electromyography was performed for all patients. All surgical procedures were performed by the same surgical team. A post-operative follow-up was carried out, and the findings were recorded. The "McGowan" and "Wilson and Krout" classifications and the DASH score were used. A satisfaction questionnaire was administered to all patients post-operatively at 2 weeks). RESULTS Ulnar nerve neurolysis and anterior transposition surgery were all successfully performed. Overall complications were post-operative haematoma (8%) and wound problems (5%). In 6% there was recurrence of symptoms. In 11% there was no improvement of symptoms. Pre-op McGowan classifications for groups 1 and 2 were 0% and 0% (grade 0), 21% and 24% (grade 1), 46% and 44% (grade 2), and 33% and 34% (grade 3), respectively. The post-op McGowan classifications were 34% and 37% (grade 0), 39% and 40% (grade 1), 23% and 20% (grade 2), and 4% and 3% (grade 3), respectively. The post-op Wilson and Krout classifications were 45% and 46% (excellent), 26% and 28% (good), 19% and 15% (fair), and 10% and 11% (poor), respectively. The DASH score means for groups 1 and 2 were 14.8 and 15.2, respectively. A negative Froment's sign was present in 73.2% and 71.2%, respectively. In Group 1, the post-op satisfaction questionnaire scores were 0 for one patient, 1 for four patients, 2 for seven patients, 3 for ten patients, 4 for twelve patients and 5 for seven patients. In Group 2, the post-op satisfaction questionnaire scores were 0 for three patients, 1 for nine patients, 2 for twelve patients, 3 for fifteen patients, 4 for eighteen patients and 5 for nine patients. CONCLUSIONS In our experience, the surgical technique to treat the cubital tunnel syndrome most efficiently and feasibly has not yet been established in terms of indications and outcomes. This is supported by the data present in the international literature. Good and similar results were obtained with neurolysis alone and neurolysis associated with anterior transposition of the ulnar nerve (in line with the international data). In conclusion, more high-quality studies of greater statistical power are needed to provide a consensus on the surgical indications and techniques to treat the cubital tunnel syndrome and to establish internationally standardised guidelines.
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Affiliation(s)
- R M Lanzetti
- Orthopaedics and Traumatology Unit, Department Emergency and Acceptance, San Camillo- Forlanini Hospital Rome, Rome, Italy.
- , Rome, Italy.
| | - A Astone
- Orthopaedics and Traumatology Unit, Università di Perugia, Perugia, Italy
| | - V Pace
- Orthopaedics and Traumatology Unit, Università di Perugia, Perugia, Italy
| | - L D'Abbondanza
- Orthopaedics and Traumatology Unit, Università di Perugia, Perugia, Italy
| | - L Braghiroli
- Orthopaedics and Traumatology Unit, Università di Perugia, Perugia, Italy
| | - D Lupariello
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" University of Rome, Rome, Italy
- Orthopaedic Unit, Sant'Andrea University Hospital, Rome, Italy
| | - M Altissimi
- Orthopaedics and Traumatology Unit, Università di Perugia, Perugia, Italy
| | - A Vadalà
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" University of Rome, Rome, Italy
- Orthopaedic Unit, Sant'Andrea University Hospital, Rome, Italy
| | - M Spoliti
- Orthopaedics and Traumatology Unit, Department Emergency and Acceptance, San Camillo- Forlanini Hospital Rome, Rome, Italy
| | - D Topa
- Orthopaedics and Traumatology Unit, Department Emergency and Acceptance, San Camillo- Forlanini Hospital Rome, Rome, Italy
| | - D Perugia
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" University of Rome, Rome, Italy
- Orthopaedic Unit, Sant'Andrea University Hospital, Rome, Italy
| | - A Caraffa
- Orthopaedics and Traumatology Unit, Università di Perugia, Perugia, Italy
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9
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Perugia D, Lanzetti R, Vetrano M, Vavala C, Pascali S, Nusca S, Santoboni F, Vulpiani M. Mind Term Effects of a Single Injecton versus three Injecton of Hyaluronic Acid in Patients with Rhizarthrosis. Muscles Ligaments Tendons J 2020. [DOI: 10.32098/mltj.01.2020.18] [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] [Indexed: 11/05/2022]
Affiliation(s)
- D. Perugia
- Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Orthopedic Unit, Sant’Andrea University Hospital, Rome, Italy
| | - R.M. Lanzetti
- Orthopedic and traumatology Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - M. Vetrano
- Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Physical Medicine and Rehabilitation Unit, Sant’Andrea University Hospital, Rome, Italy
| | - C. Vavala
- Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Physical Medicine and Rehabilitation Unit, Sant’Andrea University Hospital, Rome, Italy
| | - S. Pascali
- Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Physical Medicine and Rehabilitation Unit, Sant’Andrea University Hospital, Rome, Italy
| | - S.M. Nusca
- Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Physical Medicine and Rehabilitation Unit, Sant’Andrea University Hospital, Rome, Italy
| | - F. Santoboni
- Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Physical Medicine and Rehabilitation Unit, Sant’Andrea University Hospital, Rome, Italy
| | - M.C. Vulpiani
- Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Physical Medicine and Rehabilitation Unit, Sant’Andrea University Hospital, Rome, Italy
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Massari L, Benazzo F, Falez F, Perugia D, Pietrogrande L, Setti S, Osti R, Vaienti E, Ruosi C, Cadossi R. Biophysical stimulation of bone and cartilage: state of the art and future perspectives. Int Orthop 2019; 43:539-551. [PMID: 30645684 PMCID: PMC6399199 DOI: 10.1007/s00264-018-4274-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/03/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Biophysical stimulation is a non-invasive therapy used in orthopaedic practice to increase and enhance reparative and anabolic activities of tissue. METHODS A sistematic web-based search for papers was conducted using the following titles: (1) pulsed electromagnetic field (PEMF), capacitively coupled electrical field (CCEF), low intensity pulsed ultrasound system (LIPUS) and biophysical stimulation; (2) bone cells, bone tissue, fracture, non-union, prosthesis and vertebral fracture; and (3) chondrocyte, synoviocytes, joint chondroprotection, arthroscopy and knee arthroplasty. RESULTS Pre-clinical studies have shown that the site of interaction of biophysical stimuli is the cell membrane. Its effect on bone tissue is to increase proliferation, synthesis and release of growth factors. On articular cells, it creates a strong A2A and A3 adenosine-agonist effect inducing an anti-inflammatory and chondroprotective result. In treated animals, it has been shown that the mineralisation rate of newly formed bone is almost doubled, the progression of the osteoarthritic cartilage degeneration is inhibited and quality of cartilage is preserved. Biophysical stimulation has been used in the clinical setting to promote the healing of fractures and non-unions. It has been successfully used on joint pathologies for its beneficial effect on improving function in early OA and after knee surgery to limit the inflammation of periarticular tissues. DISCUSSION The pooled result of the studies in this review revealed the efficacy of biophysical stimulation for bone healing and joint chondroprotection based on proven methodological quality. CONCLUSION The orthopaedic community has played a central role in the development and understanding of the importance of the physical stimuli. Biophysical stimulation requires care and precision in use if it is to ensure the success expected of it by physicians and patients.
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Affiliation(s)
- Leo Massari
- University of Ferrara, Via Vigne 4, 44121, Ferrara, Italy.
| | - Franco Benazzo
- IRCCS Foundation "San Matteo" Hospital, University of Pavia, 27100, Pavia, Italy
| | | | | | | | | | | | | | - Carlo Ruosi
- Federico II University Naples, 80100, Naples, Italy
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Guzzini M, Perugia D, Proietti L, Iorio R, Mazza D, Masi V, Ferretti A. Suspension arthroplasty versus interposition arthroplasty in the treatment of trapeziometacarpal osteoarthritis: a clinical and magnetic resonance imaging study. International Orthopaedics (SICOT) 2019; 43:647-651. [DOI: 10.1007/s00264-019-04292-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
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12
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Massari L, Benazzo F, Falez F, Cadossi R, Perugia D, Pietrogrande L, Aloj DC, Capone A, D'Arienzo M, Cadossi M, Lorusso V, Caruso G, Ghiara M, Ciolli L, La Cava F, Guidi M, Castoldi F, Marongiu G, La Gattuta A, Dell'Omo D, Scaglione M, Giannini S, Fortina M, Riva A, De Palma PL, Gigante AP, Moretti B, Solarino G, Lijoi F, Giordano G, Londini PG, Castellano D, Sessa G, Costarella L, Barile A, Borrelli M, Rota A, Fontana R, Momoli A, Micaglio A, Bassi G, Cornacchia RS, Castelli C, Giudici M, Monesi M, Branca Vergano L, Maniscalco P, Bulabula M, Zottola V, Caraffa A, Antinolfi P, Catani F, Severino C, Castaman E, Scialabba C, Tovaglia V, Corsi P, Friemel P, Ranellucci M, Caiaffa V, Maraglino G, Rossi R, Pastrone A, Caldora P, Cusumano C, Squarzina PB, Baschieri U, Demattè E, Gherardi S, De Roberto C, Belluati A, Giannini A, Villani C, Persiani P, Demitri S, Di Maggio B, Abate G, De Terlizzi F, Setti S. Can Clinical and Surgical Parameters Be Combined to Predict How Long It Will Take a Tibia Fracture to Heal? A Prospective Multicentre Observational Study: The FRACTING Study. Biomed Res Int 2018; 2018:1809091. [PMID: 29854729 PMCID: PMC5952440 DOI: 10.1155/2018/1809091] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/22/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. METHODS The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. RESULTS 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r = 0.63 (p < 0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. CONCLUSIONS This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings.
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Affiliation(s)
- Leo Massari
- Orthopaedic and Traumatology Department, “S. Anna” Hospital, University of Ferrara, Ferrara, Italy
| | - Francesco Benazzo
- Orthopaedic and Traumatology Department, IRCCS Foundation “San Matteo” Hospital, University of Pavia, Pavia, Italy
| | - Francesco Falez
- Orthopaedic and Traumatology Department, “Santo Spirito in Sassia” Hospital, Rome, Italy
| | - Ruggero Cadossi
- Research and Development, IGEA Clinical Biophysics, Carpi, Modena, Italy
| | - Dario Perugia
- Orthopaedic and Traumatology Department, “Sant'Andrea” Hospital, Rome, Italy
| | - Luca Pietrogrande
- Health Sciences Department, Operative Unit of Orthopaedics and Traumatology, “San Paolo” Hospital, University of Milan, Milan, Italy
| | - Domenico Costantino Aloj
- Orthopaedic, Traumatology and Rehabilitation Department, II Orthopaedics Clinic, CTO Hospital, Torino, Italy
| | - Antonio Capone
- Orthopaedic Department, University of Cagliari, Cagliari, Italy
| | - Michele D'Arienzo
- Orthopaedic and Traumatology Department, “Paolo Giaccone” Hospital, University of Palermo, Palermo, Italy
| | - Matteo Cadossi
- Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
| | - Vincenzo Lorusso
- Orthopaedic and Traumatology Department, “S. Anna” Hospital, University of Ferrara, Ferrara, Italy
| | - Gaetano Caruso
- Orthopaedic and Traumatology Department, “S. Anna” Hospital, University of Ferrara, Ferrara, Italy
| | - Matteo Ghiara
- Orthopaedic and Traumatology Department, IRCCS Foundation “San Matteo” Hospital, University of Pavia, Pavia, Italy
| | - Luigi Ciolli
- Orthopaedic and Traumatology Department, “Santo Spirito in Sassia” Hospital, Rome, Italy
| | - Filippo La Cava
- Orthopaedic and Traumatology Department, “Santo Spirito in Sassia” Hospital, Rome, Italy
| | - Marco Guidi
- Orthopaedic and Traumatology Department, “Sant'Andrea” Hospital, Rome, Italy
| | - Filippo Castoldi
- Orthopaedic, Traumatology and Rehabilitation Department, II Orthopaedics Clinic, CTO Hospital, Torino, Italy
| | | | - Alessandra La Gattuta
- Orthopaedic and Traumatology Department, “Paolo Giaccone” Hospital, University of Palermo, Palermo, Italy
| | - Dario Dell'Omo
- Translational Research on New Surgical and Medical Technologies Department, Orthopaedics and Traumatology II°, University of Pisa, Pisa, Italy
| | - Michelangelo Scaglione
- Translational Research on New Surgical and Medical Technologies Department, Orthopaedics and Traumatology II°, University of Pisa, Pisa, Italy
| | - Sandro Giannini
- Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
| | - Mattia Fortina
- Orthopaedics and Traumatology Clinic, “S. M. alle Scotte” Hospital, University of Siena, Siena, Italy
| | - Alberto Riva
- Orthopaedics and Traumatology Clinic, “S. M. alle Scotte” Hospital, University of Siena, Siena, Italy
| | - Pier Luigi De Palma
- Clinical and Molecular Science Department, Faculty of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Antonio Pompilio Gigante
- Clinical and Molecular Science Department, Faculty of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Biagio Moretti
- Basic Medical Science, Neurosciences and Sensory Organs Department, University of Bari, Bari, Italy
| | - Giuseppe Solarino
- Basic Medical Science, Neurosciences and Sensory Organs Department, University of Bari, Bari, Italy
| | - Francesco Lijoi
- Orthopaedic and Trauma Department, “Morgagni-Pierantoni” Hospital, Forlì, Italy
| | - Giovanni Giordano
- Orthopaedic and Trauma Department, “Morgagni-Pierantoni” Hospital, Forlì, Italy
| | - Pier Giorgio Londini
- Orthopaedic and Traumatology Department, “Misericordia” Hospital ASL 9, Grosseto, Italy
| | - Danilo Castellano
- Orthopaedic and Traumatology Department, “Misericordia” Hospital ASL 9, Grosseto, Italy
| | - Giuseppe Sessa
- Surgery Department, “Vittorio Emanuele” Hospital, University of Catania, Catania, Italy
| | - Luciano Costarella
- Surgery Department, “Vittorio Emanuele” Hospital, University of Catania, Catania, Italy
| | - Antonio Barile
- Orthopaedic and Trauma Department, “San Michele” Nursing Home Hospital, Maddaloni, Caserta, Italy
| | - Mariano Borrelli
- Orthopaedic and Trauma Department, “San Michele” Nursing Home Hospital, Maddaloni, Caserta, Italy
| | - Attilio Rota
- Orthopaedic and Traumatology Department, “Sandro Pertini” Hospital, ASL RMB, Rome, Italy
| | - Raffaele Fontana
- Orthopaedic and Traumatology Department, “Sandro Pertini” Hospital, ASL RMB, Rome, Italy
| | - Alberto Momoli
- Orthopaedic and Traumatology Department, “San Bortolo” Hospital, Vicenza, Italy
| | - Andrea Micaglio
- Orthopaedic and Traumatology Department, “San Bortolo” Hospital, Vicenza, Italy
| | - Guido Bassi
- Orthopaedic and Traumatology Department, A.O. Pavia Voghera Hospital, Pavia, Italy
| | | | - Claudio Castelli
- Orthopaedics and Trauma Department, “Papa Giovanni XXIII” Hospital, Bergamo, Italy
| | - Michele Giudici
- Orthopaedics and Trauma Department, “Papa Giovanni XXIII” Hospital, Bergamo, Italy
| | - Mauro Monesi
- Orthopaedic and Traumatology Department, “M. Bufalini” Hospital, Cesena, Italy
| | | | - Pietro Maniscalco
- Orthopaedic and Traumatology Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy
| | - M'Putu Bulabula
- Orthopaedic and Traumatology Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy
| | - Vincenzo Zottola
- Traumatology and Reconstructive Surgery Functional Department, “S. Anna” Hospital, Como, Italy
| | - Auro Caraffa
- Orthopaedics and Traumatology Clinic, “S. M. Misericordia” Hospital, University of Perugia, Perugia, Italy
| | - Pierluigi Antinolfi
- Orthopaedics and Traumatology Clinic, “S. M. Misericordia” Hospital, University of Perugia, Perugia, Italy
| | - Fabio Catani
- Orthopaedic Surgery Department, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudio Severino
- Orthopaedic Surgery Department, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Castaman
- Orthopaedic and Traumatology Department, Montecchio Maggiore Hospital, Vicenza, Italy
| | - Carmelo Scialabba
- Orthopaedic and Traumatology Department, Montecchio Maggiore Hospital, Vicenza, Italy
| | - Venceslao Tovaglia
- Orthopaedic and Traumatology Department, CTO Hospital ASL RM “C”, Rome, Italy
| | - Pietro Corsi
- Orthopaedic and Traumatology Department, CTO Hospital ASL RM “C”, Rome, Italy
| | - Paolo Friemel
- Orthopaedic and Traumatology Department, Regione Veneto Azienda ULSS 18, Rovigo, Italy
| | - Marco Ranellucci
- Orthopaedic and Traumatology Department, Regione Veneto Azienda ULSS 18, Rovigo, Italy
| | - Vincenzo Caiaffa
- Orthopaedics and Traumatology Department, “Di Venere” Hospital, Bari, Italy
| | - Giovanni Maraglino
- Orthopaedics and Traumatology Department, “SS. Annunziata” Hospital, Taranto, Italy
| | - Roberto Rossi
- Orthopaedic and Traumatology SCDU Department, “Mauriziano Umberto I” Hospital, University of Torino, Torino, Italy
| | - Antonio Pastrone
- Orthopaedic and Traumatology SCDU Department, “Mauriziano Umberto I” Hospital, University of Torino, Torino, Italy
| | - Patrizio Caldora
- Orthopaedic and Traumatology Surgery Department, “San Donato” Hospital, Arezzo, Italy
| | - Claudio Cusumano
- Orthopaedic and Traumatology Surgery Department, “San Donato” Hospital, Arezzo, Italy
| | | | - Ugo Baschieri
- Orthopaedics Department, NOCSAE Hospital, Modena, Italy
| | - Ettore Demattè
- Orthopaedics and Traumatology Department, “Santa Chiara” Hospital, Trento, Italy
| | - Stefano Gherardi
- Orthopaedics and Traumatology Department, “Santa Chiara” Hospital, Trento, Italy
| | - Carlo De Roberto
- Orthopaedics Unit, “Santa Maria di Loreto Mare” Hospital, Loreto Mare, Napoli, Italy
| | - Alberto Belluati
- Specialized Surgery Department, “S. Maria delle Croci” Hospital, Ravenna, Italy
| | - Antonio Giannini
- Specialized Surgery Department, “S. Maria delle Croci” Hospital, Ravenna, Italy
| | - Ciro Villani
- Orthopaedic Department, Sapienza University of Rome, Rome, Italy
| | - Pietro Persiani
- Orthopaedic Department, Sapienza University of Rome, Rome, Italy
| | - Silvio Demitri
- Orthopaedic and Trauma Department, “Santa Maria della Misericordia” Hospital, AOUD Udine, Udine, Italy
| | - Bruno Di Maggio
- Orthopaedics and Traumatology Unit, Piedimonte Matese Hospital, Caserta, Italy
| | - Guglielmo Abate
- Orthopaedics and Traumatology Unit, Piedimonte Matese Hospital, Caserta, Italy
| | | | - Stefania Setti
- Research and Development, IGEA Clinical Biophysics, Carpi, Modena, Italy
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Guzzini M, Lanzetti RM, Perugia D, Lupariello D, Vadalà A, Guidi M, Civitenga C, Ferretti A. The treatment of long bones nonunions of upper limb with microsurgical cortico-periosteal free flap. Injury 2017; 48 Suppl 3:S66-S70. [PMID: 29025613 DOI: 10.1016/s0020-1383(17)30661-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Medial condyle corticoperiosteal flap is an emerging option for the treatment of upper limb non-infected nonunions. The hypothesis of our study is that corticoperiosteal flap could be an effective and safe procedure for the treatment of upper limb non-infected nonunions, evaluating radiographic and clinical outcome. METHODS We enrolled 14 patients who underwent vascularized medial femoral condyle corticoperiosteal free flaps from January 2011 to December 2014. All patients were clinically evaluated (VAS, DASH) before surgery and at 6 and 12 months post surgery. The radiographic evaluation was performed every 30 days until the complete healing and at 12-month follow-up. We also recorded the range of motion pre and post surgery at the donor site. RESULTS All nonunion sites healed primarily at an average time period of 5.2 months ±1. Preoperative DASH score was 70 ± 15.6; at 6 month follow-up was 21.51 ± 10.63; at 12 month follow-up 18.0 ± 9.9. Preoperative VAS was 7.05 ± 2; at 6-month follow-up was 2.1 ± 2; at 12-month follow-up was 1.8 ± 1.16. Statistical analysis showed a significant difference (p <0.001) about the preoperative and the postoperative VAS and DASH evaluation both at 6 and 12-month follow-up, but we did not record any statistical difference between the 6-month and 12-month follow-up. At the donor site, the mean VAS score was 2 ± 2.1 at seven days post operatively. All patients restore the full ROM at 7 days post surgery. CONCLUSIONS Vascularized medial condyle corticoperiosteal free flap represents an effective and safe procedure for the treatment of upper limb nonunions.
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Affiliation(s)
- Matteo Guzzini
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy
| | - Riccardo Maria Lanzetti
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy
| | - Dario Perugia
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy
| | - Domenico Lupariello
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy..
| | - Antonio Vadalà
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy
| | - Marco Guidi
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy
| | - Carolina Civitenga
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy
| | - Andrea Ferretti
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy
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Guzzini M, Lanzetti RM, Lupariello D, Morelli F, Princi G, Perugia D, Ferretti A. Comparison between carbon-peek plate and conventional stainless steal plate in ankle fractures. A prospective study of two years follow up. Injury 2017; 48:1249-1252. [PMID: 28366469 DOI: 10.1016/j.injury.2017.03.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/11/2017] [Accepted: 03/21/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of our study is to compare the clinical and radiological outcomes of the treatment of distal fibular fracture with the traditional stainless steel or the new radiolucent CFR-PEEK plates. The hypothesis is that there are no differences in clinical and radiological outcomes at the final follow-up between the two fixation devices. METHODS All consecutive patients aged from 18 or over, who had undergone operative treatment for malleolar fracture between 2013 and 2014, have been included in the study. 87 were available for the study. The patients were assigned to group A (47 patients, radiolucent plate group) and group B (41 patients, stainless steal plate group). At 6, 12 and 24 months all patients were prospectively reviewed with radiographic and clinical evaluations (OMAS scale, AOFAS, VAS, ROM). RESULTS The groups were homogenous with regard to age, gender, BMI, dominance and disease duration. The mean follow-up was 23+/-2 months. The mean waiting time to operation was 2.94days (SD 2.74) (range 0.2-6.8). Statistical analysis showed no difference (p>0.05) about the VAS, OMAS, AOFAS and ROM evaluation at 6, 12 and 24 month follow-up between two groups. Radiographic evaluation showed no difference between two groups at all the follow-up with similar results obtained with the two fixation devices. DISCUSSION Our results showed a substantial equivalence of the two fixation devices at 6, 12 and 24 month of clinical and radiographic follow-up. Fixation of the lateral malleolus fractures with a CFR-PEEK plate provides satisfying clinical and radiographic results after 2 years of follow-up. These results are comparable to those achieved with conventional plates.
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Affiliation(s)
- Matteo Guzzini
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Riccardo Maria Lanzetti
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Domenico Lupariello
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy.
| | - Federico Morelli
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Giorgio Princi
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Dario Perugia
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Andrea Ferretti
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
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Fabbri M, Monaco E, Lanzetti RM, Perugia D, Guzzini M, Labianca L, Ferretti A. Single harvesting in the all-inside graft-link technique: is the graft length crucial for success? A biomechanical study. J Orthop Traumatol 2016; 18:17-22. [PMID: 27435413 PMCID: PMC5310998 DOI: 10.1007/s10195-016-0420-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 11/21/2015] [Accepted: 07/07/2016] [Indexed: 01/10/2023] Open
Abstract
Background The all-inside graft-link technique for anterior cruciate ligament reconstruction is performed with two cortical suspension devices with adjustable loops on both femur and tibia. This technique requires meticulous graft preparation. The aim of this study was to biomechanically test three different graft configurations resulting from differences in initial graft length. Materials and methods Thirty bovine digital extensor tendons were arranged in three different ways: “half-quadrupled”, “tripled” and “quadrupled”. The final graft length was 65–75 mm. The specimens were fixed vertical to the loading axis of a tensile testing machine. After a static pre-conditioning of 50 N for 5 min, a load to failure test was performed and data regarding the ultimate failure load (UFL), the stiffness and mode of failure were recorded. Results The evaluation of UFL showed a significant differences between group means as determined by one-way analysis of variance (F = 21.92, p = 0.002). Post hoc comparisons showed a significantly better UFL of “tripled” (p = 0.007) and “quadrupled” preparations (p = 0.014) compared to the “half-quadrupled” configuration, with no significant differences between “tripled” and “quadrupled” grafts (p = 0.061). No significant differences were found when evaluating the stiffness between the groups. Failure occurred by tendon slippage across the suture in all specimens. Conclusion The “quadrupled” tendon achieved the best UFL, with even the “tripled” configuration having sufficient biomechanical characteristics to withstand the loads experienced during early rehabilitation. For this reason, with a total semitendinosus length of less than 260 mm it could be better to “triple” instead of “half-quadruple” it to achieve better performance of the graft.
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Affiliation(s)
- Mattia Fabbri
- Orthopaedic Department and "Kirk Kilgour" Sports Injury Center, Sant' Andrea Hospital, "La Sapienza" University of Rome, via di grottarossa, 1035-1039, Rome, Italy.
| | - Edoardo Monaco
- Orthopaedic Department and "Kirk Kilgour" Sports Injury Center, Sant' Andrea Hospital, "La Sapienza" University of Rome, via di grottarossa, 1035-1039, Rome, Italy
| | - Riccardo Maria Lanzetti
- Orthopaedic Department and "Kirk Kilgour" Sports Injury Center, Sant' Andrea Hospital, "La Sapienza" University of Rome, via di grottarossa, 1035-1039, Rome, Italy
| | - Dario Perugia
- Orthopaedic Department and "Kirk Kilgour" Sports Injury Center, Sant' Andrea Hospital, "La Sapienza" University of Rome, via di grottarossa, 1035-1039, Rome, Italy
| | - Matteo Guzzini
- Orthopaedic Department and "Kirk Kilgour" Sports Injury Center, Sant' Andrea Hospital, "La Sapienza" University of Rome, via di grottarossa, 1035-1039, Rome, Italy
| | - Luca Labianca
- Orthopaedic Department and "Kirk Kilgour" Sports Injury Center, Sant' Andrea Hospital, "La Sapienza" University of Rome, via di grottarossa, 1035-1039, Rome, Italy
| | - Andrea Ferretti
- Orthopaedic Department and "Kirk Kilgour" Sports Injury Center, Sant' Andrea Hospital, "La Sapienza" University of Rome, via di grottarossa, 1035-1039, Rome, Italy
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Calderaro C, Guzzini M, Pagnottelli M, Fabbri M, Perugia D. Partial tendon tear as unusual cause of trigger finger: a case report. Case Reports Plast Surg Hand Surg 2016; 3:56-8. [PMID: 27583273 PMCID: PMC4996053 DOI: 10.1080/23320885.2016.1205952] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/22/2016] [Indexed: 12/02/2022]
Abstract
We report a case of post-traumatic trigger finger due to a partial longitudinal tear of the flexor digitorum superficialis. The suspect came from the clinical history and the young age of the patient. It was successfully treated with tendon flap suture and pulley A1 release.
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Affiliation(s)
- Cosma Calderaro
- Orthopaedic and Traumatology Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, ‘Sapienza’ University of Rome, Rome, Italy
| | - Matteo Guzzini
- Orthopaedic and Traumatology Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, ‘Sapienza’ University of Rome, Rome, Italy
| | - Marco Pagnottelli
- Orthopaedic and Traumatology Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, ‘Sapienza’ University of Rome, Rome, Italy
| | - Mattia Fabbri
- Orthopaedic and Traumatology Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, ‘Sapienza’ University of Rome, Rome, Italy
| | - Dario Perugia
- Orthopaedic and Traumatology Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, ‘Sapienza’ University of Rome, Rome, Italy
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Abstract
The radiolucent plate has many advantageous properties in the treatment of complex ankle fractures, particularly trimalleolar fractures. Surgeons may sometimes have difficulty observing the posterior malleolus after synthesis of lateral malleolus with a traditional plate because common materials of conventional plates are not radiolucent. In this study, the authors highlight the importance of the radiolucent property in the treatment of ankle fractures and describe their preliminary experience with a carbon fibre-reinforced polyetheretherketone distal fibula plate, with good results at 4 months' follow-up and no signs of tissue inflammatory reaction.
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Affiliation(s)
- Marco Caforio
- Department of Orthopaedics and Traumatology, AUSL Piacenza, Italy.
| | - Dario Perugia
- Department of Orthopaedics and Traumatology, S. Andrea Hospital, University of Rome, La Sapienza, Italy
| | - Massimiliano Colombo
- Reparative Orthopaedic Surgery Department, G. Pini Institute, University of Milan, Italy
| | - Giorgio Maria Calori
- Reparative Orthopaedic Surgery Department, G. Pini Institute, University of Milan, Italy
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18
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Perugia D, Fabbri M, Guidi M, Lepri M, Masi V. Salter-Harris type III and IV displaced fracture of the hallux in young gymnasts: A series of four cases at 1-year follow-up. Injury 2014; 45 Suppl 6:S39-42. [PMID: 25457317 DOI: 10.1016/j.injury.2014.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to describe four exceptional cases of Salter-Harris type III and IV fractures of the proximal phalanx of the hallux in young high-level gymnasts. All gymnasts underwent the same mechanism of injury of hyperadduction, which indicates a role of the abductor hallucis muscle in the genesis and displacement of these fractures. An open reduction and internal fixation was performed to achieve an anatomical reduction and avoid chronic disability. At 1-year follow-up, all patients had an excellent American Orthopaedic Foot and Ankle Society (AOFAS) score (100 points), and there was no shortening or angulation of the first ray and no evidence of degenerative joint disease on X-ray. Moreover, all the gymnasts had returned to pre-injury levels of sporting activity. To our knowledge, there are no previous studies that address these types of injuries and how they are handled in gymnasts.
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Affiliation(s)
- Dario Perugia
- Orthopaedic and Traumatology Department, Sant'Andrea Hospital Faculty of Medicine and Psychology, University "La Sapienza" of Rome, Italy.
| | - Mattia Fabbri
- Orthopaedic and Traumatology Department, Sant'Andrea Hospital Faculty of Medicine and Psychology, University "La Sapienza" of Rome, Italy
| | - Marco Guidi
- Orthopaedic and Traumatology Department, Sant'Andrea Hospital Faculty of Medicine and Psychology, University "La Sapienza" of Rome, Italy
| | - Marco Lepri
- Orthopaedic and Traumatology Department, Sant'Andrea Hospital Faculty of Medicine and Psychology, University "La Sapienza" of Rome, Italy
| | - Vincenzo Masi
- Orthopaedic and Traumatology Department, Sant'Andrea Hospital Faculty of Medicine and Psychology, University "La Sapienza" of Rome, Italy
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D'Arrigo C, Carcangiu A, Perugia D, Scapellato S, Alonzo R, Frontini S, Ferretti A. Intertrochanteric fractures: comparison between two different locking nails. Int Orthop 2012; 36:2545-51. [PMID: 23104674 DOI: 10.1007/s00264-012-1684-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of this study was to compare two intramedullary devices used in the treatment of intertrochanteric fractures. METHOD During the period 2006-2007 46 TGN and 51 PFNA were used for the treatment of intertrochanteric fractures in our hospital. Clinical and radiological follow-up were available. Surgical time, blood loss and complications have been considered. RESULTS The mean operative time for the TGN group was significantly higher than in the PFNA group (62 min and 45 min, respectively) with a p = 0.04. The mean blood loss was significantly higher in the TGN group (285 ml; SD 145) in relation to the PFNA group (226 ml; SD 136) with p = 0.03. Also, rate of complications was higher in the TGN group (p = 0.01). Clinical outcomes were good for both groups. Intra-operative and post-operative complications in the TGN group were associated with a longer operative time and a higher blood loss, probably due to the reaming needed in TGN that can increase blood loss and risk of comminution or fracture propagation. Moreover, all but one of the procedure-related complications were observed in very elderly patients. CONCLUSIONS Based on our results in the intertrochanteric fracture, use of PFNA should be recommended in cases of elderly and osteoporotic patients, while TGN should be used in more severely displaced fractures in patients with a slightly better bone mineral density.
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Affiliation(s)
- Carmelo D'Arrigo
- Orthopaedic and Traumatology Department, S. Andrea Hospital, University of Rome La Sapienza, Via di Grottarossa 1035-1039, Rome, 00189, Italy
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20
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Morelli F, Perugia D, Vadalà A, Serlorenzi P, Ferretti A. Modified Watson-Jones technique for chronic lateral ankle instability in athletes: clinical and radiological mid- to long-term follow-up. Foot Ankle Surg 2011; 17:247-51. [PMID: 22017895 DOI: 10.1016/j.fas.2010.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 08/17/2010] [Accepted: 08/21/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND We clinically and radiologically assessed mid- to long-term follow-up of a group of patients treated with a modified Watson-Jones technique for chronic ankle instability. METHODS Fourteen athletes were retrospectively evaluated with physical examination, and Tegner, Good and AOFAS scales; moreover, a 2-view stress, side-to-side X-ray, was performed. RESULTS All patients were followed-up at a mean of 10.8 years. No one reported further ankle sprains. Mean Good scale value decreased from 3.7 to 1.6, while the Tegner scale decreased from 6.8 to 5.1; the mean AOFAS score was 92.2. Mean sagittal-plane ROM was 62.3° (4.9° S/S difference), while mean coronal-plane ROM was 25.5° (3.8° S/S difference). Mean X-ray talar tilt angle was 4.5° (0.1° S/S difference), while mean anterior drawer test angle was 5.4 mm (0.5 mm S/S difference). CONCLUSIONS The modified Watson-Jones procedure seems to be a reliable technique in providing satisfactory mid- to long-term clinical and radiological results.
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Affiliation(s)
- Federico Morelli
- Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, S. Andrea Hospital, University of Rome Sapienza, Via Grottarossa, 1035 Rome, Italy
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21
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De Carli A, Vadalà A, Perugia D, Frate L, Iorio C, Fabbri M, Ferretti A. Shoulder adhesive capsulitis: manipulation and arthroscopic arthrolysis or intra-articular steroid injections? Int Orthop 2011; 36:101-6. [PMID: 21833684 DOI: 10.1007/s00264-011-1330-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 07/15/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to compare shoulder manipulation and arthroscopic arthrolysis with glenohumeral steroid injections in patients affected by idiopathic adhesive shoulder capsulitis. METHODS In this prospective study we randomly assigned patients to enter group A (23 patients, shoulder manipulation and arthroscopic arthrolysis) and group B (21 patients, glenohumeral steroid injections). Patients were followed-up at three, six and 12 weeks, and at six and 12 months with the Constant and Murley, ASES, UCLA and SST evaluation scales. Moreover, passive forward flexion, abduction, and internal and external rotations were recorded. RESULTS Range of motion showed satisfactory results in both groups at final follow-up: in group A the mean ABD increased from 60° to 154°, ER from 20° to 40°, and FF from 75° to 174°; in group B, ABD raised from 76° to 145°, ER from 20° to 35°, and FF from 115° to 164°. All the evaluation scales performed increased significantly at final follow-up in both groups. However, while patients of group A had already reached significant improvement at the six-week follow-up (p <0.03), in group B this happened only at the 12 week follow-up (p <0.03). CONCLUSIONS Both types of treatment were effective in improving final range of motion; however, while patients of group A accomplished their goal by the six-week follow-up, in group B the same result was obtained at the 12-week follow-up.
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Affiliation(s)
- Angelo De Carli
- Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, S Andrea Hospital, University of Rome Sapienza, Via Grottarossa 1035, Rome, Italy
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22
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Gumina S, Carbone S, Perugia D, Vestri AR, Postacchini F. Shoulder adhesive capsulitis in the early freezing phase: correlations between blood exams and Constant Score. Musculoskelet Surg 2011; 95 Suppl 1:S37-S42. [PMID: 21479867 DOI: 10.1007/s12306-011-0121-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We analysed the possibility that some blood values could be considered as a prognostic index of shoulder adhesive capsulitis. Fifty-six conservatively treated patients were clinically evaluated and prospectively followed at the moment of their freezing phase. At the beginning of the disease (time 0) and after 4 months (time 1), we registered some blood parameters values and their Constant Score (CS). Differences emerged for the white blood cell count (P = 0.037) that decreased and for the CS (P < 0.00001) that increased. At time 0, no significant correlation emerged between the studied parameters and the CS. At time 1, significant inverse correlations with the CS were found for glycaemia (P = 0.007), triglycerides (P = 0.05), ESR (P = 0.017) and CRP (P = 0.013). At time 1, patients with a better shoulder function were those with a low value of glycaemia, triglycerides, ESR and CRP.
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Affiliation(s)
- Stefano Gumina
- Deptartment of Orthopaedic Surgery Policlinico Umberto I, University of Sapienza, Rome, Italy
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23
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D’Arrigo C, Perugia D, Carcangiu A, Monaco E, Speranza A, Ferretti A. Hip arthroplasty for failed treatment of proximal femoral fractures. Int Orthop 2010; 34:939-42. [PMID: 19572131 PMCID: PMC2989031 DOI: 10.1007/s00264-009-0834-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 06/15/2009] [Accepted: 06/15/2009] [Indexed: 12/26/2022]
Abstract
Failed treatment of an intertrochanteric fracture typically leads to profound functional disability and pain. Salvage treatment with hip arthroplasty may be considered. The aim of this study was to evaluate the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of an intertrochanteric hip fracture. Twenty-one patients were treated in our hospital with hip arthroplasty for failed treatment of intertrochanteric hip fracture. There were sixteen women and five men with a mean age of 75.8 years (range 61-85 years). Fourteen patients had failure of a previous nail fixation procedure, five had failure of a plate fixation, one of hip screws fixation and one of Ender nail fixation. In 19 out of 21 patients we performed a total hip arthroplasty-14 cases used modular implants with long-stems and five cases used a standard straight stem. In 2 of 21 cases we used a bipolar hemiarthroplasty. A statistically significant improvement was found comparing pre and postoperative conditions (p < 0.05). Our experience confirms that total hip arthroplasty is a satisfactory salvage procedure after failed treatment of an intertrochanteric fracture in elderly patients with few serious orthopaedic complications and acceptable clinical outcomes.
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Affiliation(s)
- Carmelo D’Arrigo
- School of Medicine, Orthopaedic Unit, S. Andrea Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Dario Perugia
- School of Medicine, Orthopaedic Unit, S. Andrea Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Alessandro Carcangiu
- School of Medicine, Orthopaedic Unit, S. Andrea Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Edoardo Monaco
- School of Medicine, Orthopaedic Unit, S. Andrea Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Attilio Speranza
- School of Medicine, Orthopaedic Unit, S. Andrea Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Andrea Ferretti
- School of Medicine, Orthopaedic Unit, S. Andrea Hospital, “Sapienza” University of Rome, Rome, Italy
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24
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Gumina S, Carbone S, Perugia D, Perugia L, Postacchini F. Rupture of the long head biceps tendon treated with tenodesis to the coracoid process. Results at more than 30 years. Int Orthop 2010; 35:713-6. [PMID: 20680275 DOI: 10.1007/s00264-010-1099-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 07/06/2010] [Accepted: 07/08/2010] [Indexed: 12/20/2022]
Abstract
We evaluated patients at very long term with rupture of the long head biceps tendon (LHBT) in whom the tendon stump had been sutured to the coracoid tip (Gilcreest technique). Our aim was to determine the natural history of shoulders deprived of the LHBT and to assess the validity of the surgical technique. Between 1969 and 1981, 30 patients with rupture of the LHBT and no evidence of cuff tear underwent the Gilcreest operation. The mean age of the patients was 32 years (range, 20-49). Six of them were professional gymnasts. The 28 patients that could be traced were evaluated a mean of 31 years after operation. The mean Constant score (CS) was 74 in the entire group, and 86 in 22. The latter patients complained occasionally of mild shoulder pain. The remaining six patients had a mean CS of 56 (range, 40-81). Of the six, four (aged 66-71 years) had clinical and MR evidence of rotator cuff tear. The other two had undergone arthroscopic cuff repair (CS, 75-81). After operation, all professional gymnasts had returned to sport activity and all the other patients had resumed their jobs. After 30 years, the majority of the patients who had undergone the Gilcreest operation had good functional and cosmetic outcomes. Only a few patients had a cuff tear. The role of the LHBT as depressor of the humeral head is probably less important than generally believed.
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Affiliation(s)
- Stefano Gumina
- Department of Orthopaedic Surgery, University Sapienza, Rome, Italy.
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25
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Albisetti W, Perugia D, De Bartolomeo O, Tagliabue L, Camerucci E, Calori GM. Stress fractures of the base of the metatarsal bones in young trainee ballet dancers. Int Orthop 2009; 34:51-5. [PMID: 19415273 DOI: 10.1007/s00264-009-0784-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Accepted: 04/03/2009] [Indexed: 10/20/2022]
Abstract
Classical ballet is an art form requiring extraordinary physical activity, characterised by rigorous training. These can lead to many overuse injuries arising from repetitive minor trauma. The purpose of this paper is to report our experience in the diagnosis and treatment of stress fractures at the base of the second and third metatarsal bones in young ballet dancers. We considered 150 trainee ballet dancers from the Ballet Schools of "Teatro Alla Scala" of Milan from 2005 to 2007. Nineteen of them presented with stress fractures of the base of the metatarsal bones. We treated 18 dancers with external shockwave therapy (ESWT) and one with pulsed electromagnetic fields (EMF) and low-intensity ultrasound (US); all patients were recommended rest. In all cases good results were obtained. The best approach to metatarsal stress fractures is to diagnose them early through clinical examination and then through X-ray and MRI. ESWT gave good results, with a relatively short time of rest from the patients' activities and a return to dancing without pain.
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Affiliation(s)
- Walter Albisetti
- Institute of Orthopaedic, Trauma, Rheumatology Sciences, Orthopaedic Rehabilitation, University of Milan, Milan, Italy
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26
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Perugia D, Basiglini L, Vadalà A, Ferretti A. Clinical and radiological results of arthroscopically treated tibial spine fractures in childhood. Int Orthop 2008; 33:243-8. [PMID: 19043709 DOI: 10.1007/s00264-008-0697-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 10/06/2008] [Accepted: 10/06/2008] [Indexed: 10/21/2022]
Abstract
The objective of this study is to report the clinical and radiological long-term follow-up evaluation of young patients arthroscopically treated for anterior tibial eminence fracture. Ten patients (mean age: 13.5 years) were treated between 1992 and 2006. At follow-up they were clinically and radiologically evaluated. Moreover, they underwent assessment with the International Knee Documentation Committee (IKDC) forms, Lysholm and Tegner knee scales and measurement with the KT-1000 arthrometer. At a mean follow-up of 85.8 months, all of the patients reported a subjective good-excellent outcome. Objectively, the Lachman test was negative in seven patients and positive in three patients; six patients (60%) registered a slight (+) to mild (++) pivot-glide test. The mean value of KT-1000 arthrometer measurements was 3 mm; all knee scales showed satisfactory results. Radiological exam always showed good healing of the fracture. Fractures of the tibial spine often lead to anterior and rotational knee laxity. However, despite this instrumental finding, patients usually do not report any type of restriction in their functional or sports activities.
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Affiliation(s)
- D Perugia
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "Sapienza", Rome, Italy.
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27
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Perugia D, Ciurluini M, Ferretti A. Spontaneous rupture of the extensor pollicis longus tendon in a young goalkeeper: a case report. Scand J Med Sci Sports 2008; 19:257-9. [DOI: 10.1111/j.1600-0838.2008.00779.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Trapeziometacarpal distraction arthroplasty is a surgical technique for the treatment of trapeziometacarpal arthrosis. It consists of distracting the first metacarpal and then anchoring it in suspension to the second metacarpal by means of a tendon graft. Both a reduction of the subluxation of the base of the first metacarpal and an opening or distraction of the trapeziometacarpal joint, with a clear decrease in the forces of attrition on its joint surfaces, are thereby obtained. Compared with the traditional techniques of arthroplasty, this technique avoids trapeziectomy; it is therefore less destructive and is quicker and easier to carry out. It appears to be equally effective regarding pain, correcting the deformity, and recovering grip strength.
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Affiliation(s)
- Carlo Bufalini
- Day Surgery Center Maurizio Bufalini, Florence, Italy; University of Rome La Sapienza, Rome, Italy
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29
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Gumina S, Di Giorgio G, Perugia D, Postacchini F. Deltoid detachment consequent to open surgical repair of massive rotator cuff tears. Int Orthop 2007; 32:81-4. [PMID: 17410365 PMCID: PMC2219931 DOI: 10.1007/s00264-006-0285-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Accepted: 09/26/2006] [Indexed: 11/29/2022]
Abstract
Deltoid detachment is one of the complications in open rotator cuff repair. Although it is often described, the actual prevalence, time at which it occurs and the predisposing causes are still unknown. We prospectively studied 112 patients with massive rotator cuff tears with a mean age of 67. The surgical approach was performed with a lateral para-acromial incision. Clinical assessment was performed with Constant's method. Of the 112 patients, 9 (8%) had deltoid detachment. It occurred about 3 months after surgery. Of the nine patients, two underwent revision surgery for the deltoid trans-bone reattachment. At the follow-up, the patients with deltoid detachment had a mean increase of only 5.5 points in the Constant score compared to that of 16.9 obtained by the control group. Deltoid reattachment, performed on the two patients, provided a mean increase of 7 points only with respect to the post-operative control at the 4th month. Considering the unsatisfactory functional result consequent to deltoid detachment and the slight improvement obtained with the reattachment, we recommend the following: use suture thread thicker than #2, do not use a simple stitch and avoid extending acromioplasty to the lateral margin of the acromion.
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Affiliation(s)
- S Gumina
- Department of Orthopaedic and Traumatology Surgery, University of Rome La Sapienza, Via Tacito, Rome, Italy.
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30
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Fanucci E, Masala S, Fabiano S, Perugia D, Squillaci E, Varrucciu V, Simonetti G. Treatment of intermetatarsal Morton?s neuroma with alcohol injection under US guide: 10-month follow-up. Eur Radiol 2004; 14:514-8. [PMID: 14531002 DOI: 10.1007/s00330-003-2057-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2002] [Revised: 06/02/2003] [Accepted: 07/14/2003] [Indexed: 11/24/2022]
Abstract
Morton's neuroma (MN) is a frequent cause of metatarsalgia. The aim of our study was to evaluate the efficacy of neuroma alcohol-sclerosing therapy (NAST) under US guide in MN after a 10-month follow-up. Forty intermetatarsal neuromas underwent alcohol-sclerosing therapy after sonographic evaluation of their dimensions and echotexture. After subcutaneous anesthesia, a sclerosing solution composed of anesthetic (carbocaine-adrenaline 70%) and ethylic alcohol (30%) was injected inside the mass under US guidance. The procedure was repeated at intervals of 15 days until the resolution of the symptoms. A total or partial symptomatic relief was obtained in 36 cases (90%). No procedure-related complications were observed. Transitory plantar pain, due to the flogistic reaction induced by the sclerosing solution, occurred in 6 cases (15%). The 10-month follow-up revealed a 20-30% mass volume reduction and an adiposus-like change in echotexture. In the 4 cases (10%) of therapeutic failure, the preliminary sonography demonstrated a hypoechoic echotexture with a strong US beam attenuation corresponding to a highly fibrous neuroma after surgical resection. The NAST is a feasible and cost-efficient procedure with high rates of therapeutic success.
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Affiliation(s)
- Ezio Fanucci
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
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31
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Abstract
We reviewed the outcome of 33 patients (45 feet) treated by scarf osteotomy for hallux valgus deformity with an intermetatarsal (IM) angle equal to or greater than 16 degrees. The average follow-up was 26 months. The hallux valgus angle improved by an average of 21.1 degrees from a preoperative mean value of 32.1 degrees. The IM 1-2 angle improved an average of 9.9 degrees from a preoperative mean value of 18.3 degrees. American Orthopedic Foot and Ankle Society (AOFAS) score changed from a preoperative average of 35.7 points to 89.8 at follow-up. Our midterm results indicate that the scarf osteotomy provides an effective method for the treatment of severe bunion deformity.
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32
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Perugia D, Basile A, Battaglia A, Stopponi M, De Simeonibus AUM. Fracture dislocations of Lisfranc's joint treated with closed reduction and percutaneous fixation. Int Orthop 2003; 27:30-5. [PMID: 12582806 PMCID: PMC3673684 DOI: 10.1007/s00264-002-0396-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/04/2002] [Indexed: 10/25/2022]
Abstract
We reviewed 42 patients (mean age 37.7+/-14.2 years) with closed fracture dislocations of Lisfranc's joint treated with percutaneous screw fixation. Mean follow-up was 58.4+/-17.3 months. The aim was to compare dislocations in which a perfect anatomical reduction had been reached with dislocations in which reduction was only near anatomical. The mean American Orthopaedic Foot and Ankle Society score for all patients was 81.0+/-13.5. There were no significant differences in outcome scores between patients with perfect anatomical reduction and patients with near anatomical reduction. However, patients with combined fracture dislocations obtained statistically better scores than patients with pure dislocations.
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Affiliation(s)
- Dario Perugia
- Università Tor Vergata, Via G.A. Plana, 13, 00197, Rome, Italy.
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Abstract
Forty-five patients who presented between 1983 and 1998 with acute closed dislocation of the subtalar joint were selected for this study. There were 37 medial and eight lateral dislocations. The mean follow-up was 7.5 years (range: 2-17 years). The mean American Orthopaedic Foot and Ankle Society Hindfoot Score (AOFAS) at follow-up was 84. Subtalar fusion was required in one patient with persistent severe hind-foot instability. There was no significant difference in the AOFAS score between medial and lateral subtalar dislocations. We conclude that pure subtalar dislocation produced by low energy trauma, promptly reduced and immobilised for 4 weeks has a favourable long-term outcome.
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34
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Abstract
A 49-year-old woman had a haemangiopericytoma in the distal third of the arm, which is an extremely rare location. There was no recurrence of the tumor 5 years after wide margin surgical excision.
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Affiliation(s)
- D Perugia
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
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35
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Postacchini F, Gumina S, Perugia D, De Martino C. Early fracture callus in the diaphysis of human long bones. Histologic and ultrastructural study. Clin Orthop Relat Res 1995:218-28. [PMID: 7641443] [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: 01/26/2023]
Abstract
The medullary callus and the periosteal callus of fractured long bones were studied in 26 adults undergoing open reduction and internal fixation of closed diaphyseal fractures that occurred 1 to 21 days before surgery. In the 1st week after fracture, a progressive increase was observed in the number of polymorphic mesenchymal cells in the medullary callus and of fibroblast-like cells in the periosteum, where the first calcification foci were seen 7 days after injury. In the 2nd week after fracture, the medullary callus presented numerous mesenchymal cells, fibroblasts, and newly formed capillaries, whereas the inner periosteal layer showed many osteoblast-like cells. New bone trabeculae were first seen in the periosteal callus 12 days after injury. In the 3rd week after fracture, new trabecular bone appeared in the medullary callus. Cartilage also became apparent in the medullary and periosteal callus but remained limited in amount. Calcification within cartilage was first observed in the periosteum 18 days after fracture. The process of fracture healing in long bones in humans is similar, though not identical, to that described for long bones in laboratory animals.
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Postacchini F, Gumina S, Cinotti G, Perugia D, DeMartino C. Ligamenta flava in lumbar disc herniation and spinal stenosis. Light and electron microscopic morphology. Spine (Phila Pa 1976) 1994; 19:917-22. [PMID: 8009349 DOI: 10.1097/00007632-199404150-00009] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
METHODS Ligamenta flava obtained from nine patients with lumbar disc herniation and ten patients with lumbar stenosis were studied at histologic, histochemical, and ultrastructural levels. Lumbar ligamenta flava removed from six patients who underwent surgeries for thoracolumbar fractures were used as controls. RESULTS Ligamenta flava from control subjects consisted of large elastic fibers, thin bundles of collagen fibers, and few spindle-shaped fibroblasts. In proximity to the laminal insertion, the ligaments had fibrocartilagineous features. In the control subjects who were age 50 or older, the cells decreased in number and areas that had fewer and thinner elastic fibers and a more abundant collagen component were visible occasionally. In patients with disc herniation, the ligaments had similar morphologic features to those of the controls of similar ages. The ligamenta flava from patients with lumbar stenosis showed areas of fibrosis in which the cells were often represented by actively synthesizing fibroblasts and areas of chondroid metaplasia. Degenerating elastic fibers were seen occasionally, while calcified areas were observed often. CONCLUSIONS Ligamenta flava undergo slight fibrotic and chondrometaplastic changes with aging. No peculiar changes occur in patients with disc herniation. In spinal stenosis, fibrotic changes, chondroid metaplasia, and calcification reduce the elasticity of the ligaments, which may thus bulge into the spinal canal in the standing position even if they are normal in thickness.
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Postacchini F, Perugia D, Gumina S. Acromioclavicular joint cyst associated with rotator cuff tear. A report of three cases. Clin Orthop Relat Res 1993:111-3. [PMID: 8358902] [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: 01/30/2023]
Abstract
Acromioclavicular joint cyst (AJC) is a rare condition, usually occurring in the presence of a wide communication between glenohumeral and acromioclavicular joints in patients with a massive rotator cuff tear. In the presence of AJC, accurate evaluation of the status of the rotator cuff should always be made. Removal of the cyst only must be avoided because the condition tends to recur if the cuff tear is not repaired. When the tear is so large that it cannot be repaired, excision of the cyst should be associated with a resection of the lateral end of the clavicle.
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Affiliation(s)
- F Postacchini
- I Orthopaedic Department, University La Sapienza, Rome, Italy
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Postacchini F, Cinotti G, Perugia D, Gumina S. The surgical treatment of central lumbar stenosis. Multiple laminotomy compared with total laminectomy. J Bone Joint Surg Br 1993; 75:386-92. [PMID: 8496205 DOI: 10.1302/0301-620x.75b3.8496205] [Citation(s) in RCA: 148] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We assigned 67 patients with central lumbar stenosis alternately to either multiple laminotomy or total laminectomy. The protocol, however, allowed multiple laminotomy to be changed to total laminectomy if it was thought that the former procedure might not give adequate neural decompression. There were therefore three treatment groups: group I consisting of 26 patients submitted to multiple laminotomy; group II, 9 patients scheduled for laminotomy but submitted to laminectomy; and group III, 32 patients scheduled for, and submitted to, laminectomy. The mean follow-up was 3.7 years. Bilateral laminotomy at two or three levels required a longer mean operating time than total laminectomy at an equal number of levels. The mean blood loss at surgery and the clinical results did not differ in the three groups. The mean subjective improvement score for low back pain was higher in group I but there was also a higher incidence of neural complications in this group. No patient in group I had postoperative vertebral instability, whereas this occurred in three patients in groups II and III, who had lumbar scoliosis or degenerative spondylolisthesis preoperatively. Multiple laminotomy is recommended for all patients with developmental stenosis and for those with mild to moderate degenerative stenosis or degenerative spondylolisthesis. Total laminectomy is to be preferred for patients with severe degenerative stenosis or marked degenerative spondylolisthesis.
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Postacchini F, Cinotti G, Gumina S, Perugia D. Long-term results of surgery in lumbar stenosis. 8-year review of 64 patients. Acta Orthop Scand Suppl 1993; 251:78-80. [PMID: 8451996 DOI: 10.3109/17453679309160127] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Affiliation(s)
- F Postacchini
- Institute of Clinical Orthopaedics and Traumatology, University of Rome, La Sapienza, Italy
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Postacchini F, Cinotti G, Perugia D. Degenerative lumbar spondylolisthesis. II. Surgical treatment. Ital J Orthop Traumatol 1991; 17:467-77. [PMID: 1816152] [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: 12/28/2022]
Abstract
The authors analyze the results of operative treatment in 32 cases of degenerative spondylolisthesis with various degrees of compression of the nervous structures. Five types of surgery were performed: unilateral laminotomy; bilateral laminotomy with or without transverse process fusion; bilateral laminectomy with or without spinal fusion; and laminectomy, spinal fusion, and interspinous wiring. Satisfactory results were achieved in 84% of the cases. Seventy-six percent of the patients had further vertebral displacement, and 81% showed varying degrees of articular process regeneration more than two years after surgery; these findings concern both patients who had been treated with spinal fusion and those who had not. Bilateral laminotomy is indicated in patients with isolated nerve root canal stenosis; as the olisthesis is mild and lateral flexion-extension radiographs show no vertebral hypermobility, spinal fusion is not necessary. When central spinal canal stenosis is present, bilateral laminectomy, extensive lateral decompression, and spinal fusion are recommended. Interspinous wiring may be useful for immediate vertebral stabilization.
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Affiliation(s)
- F Postacchini
- I Clinica Ortopedica dell'Università La Sapienza, Roma
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Postacchini F, Amatruda A, Morace GB, Perugia D. Magnetic resonance imaging in the diagnosis of lumbar spinal canal stenosis. Ital J Orthop Traumatol 1991; 17:327-37. [PMID: 1783545] [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: 12/28/2022]
Abstract
Twenty-two patients with clinical symptoms suggesting lumbar spinal canal stenosis underwent myelography, computed tomography (CT), and magnetic resonance imaging (MRI). Patients were divided into two groups according to myelographic findings. Group I included 19 cases in which myelograms showed spinal canal stenosis, and group II consisted of 3 patients with myelograms negative for this condition. MRI showed uniform narrowing of the dural sac, indentations on the posterior aspect, or interruption of the outline of the sac in the sagittal scans and reduced area of the sac in the transverse scans. In group I patients, the diagnostic accuracy of MRI was greater than that of CT and myelography. In Group II patients, all of whom had moderate or severe lumbar scoliosis, MRI suggested spinal canal stenosis in contrast with myelography. In spinal canal stenosis surgery may be planned on the basis of MRI findings alone, except in scoliotic patients.
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Affiliation(s)
- F Postacchini
- I Clinica Ortopedica dell'Università, La Sapienza, Roma
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Postacchini F, Perugia D. Degenerative lumbar spondylolisthesis. Part I: Etiology, pathogenesis, pathomorphology, and clinical features. Ital J Orthop Traumatol 1991; 17:165-73. [PMID: 1839154] [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: 12/29/2022]
Abstract
The authors analyze the clinical features and the results of various imaging studies in 77 patients with degenerative lumbar spondylolisthesis. The most commonly olisthetic vertebra was L-4, followed by L-3. The extent of the olisthesis ranged from 8-43%. Forty-two percent of the patients with L-3 or L-4 olisthesis had reduced mobility of the underlying vertebra. Five different clinical pictures were present: no symptoms except occasional low back pain; chronic low back pain with no radicular symptoms; radicular symptoms and no signs of nerve root compression, with or without low back pain; radicular symptoms with neurologic deficit; intermittent claudication. Various pathological conditions were identified: slight narrowing of the central spinal canal without compression of neural structures; isolated stenosis of the nerve root canal; stenosis of both the nerve root canal and the central spinal canal. The onset of degenerative spondylolisthesis seems to be connected to excessive shear forces on the olisthetic vertebra. The extent of neural structure compression, and thus the clinical picture, depends on three factors: the primitive size of the spinal canal, the extent of degenerative changes in the zygapophyseal joints, and the extent of olisthesis.
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Affiliation(s)
- F Postacchini
- I Clinica Ortopedica dell'Università, La Sapienza, Roma
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Abstract
Two normal proximal femoral growth plates and core biopsies from six patients with slipped capital femoral epiphysis (SCFE) were studied by electron microscopy. In these SCFE patients, chondrocytes from all the zones of the plate were frequently smaller than normal, more irregular in shape, and many of them were degenerating, with formation of matrix vesicles and cellular debris. Floccular electron-dense material, most likely abnormal proteoglycan, was present in the hypertrophic rough-surfaced endoplasmic reticulum and Golgi apparatus as well as in the extracellular matrix, intermingled with collagen fibrils thinner than normal and loosely arranged. Mineralization of the abnormal matrix of the longitudinal septa of the degenerating zone was either scanty or absent, with scanty formation of irregular and thin bone trabeculae. The abnormalities observed in SCFE seem to be caused by a change in chondrocyte metabolism with consequent altered synthesis and/or extracellular aggregation of both collagen and proteoglycan, and scanty mineralization of the abnormal cartilage matrix.
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Affiliation(s)
- E Ippolito
- Department of Orthopedic Surgery, University of Reggio Calabria, Rome, Italy
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