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Deodato M, Granato A, Martini M, Buoite Stella A, Galmonte A, Murena L, Manganotti P. Neurophysiological and Clinical Outcomes in Episodic Migraine Without Aura: A Cross-Sectional Study. J Clin Neurophysiol 2024; 41:388-395. [PMID: 37934069 DOI: 10.1097/wnp.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
PURPOSE The aim of this study was to assess differences between people with episodic migraine and healthy controls in some neurophysiological and clinical outcomes, which, in turn, may highlight the differences in sensory processing, especially in cortical excitability, pain processing, and executive function. METHODS A cross-sectional study was performed, including the following outcomes: pressure pain thresholds with algometry; resting motor threshold, short-interval intracortical inhibition, and intracortical facilitation with transcranial magnetic stimulation; and executive functions with the trail making test and the frontal assessment battery. RESULTS Thirty adults with migraine (36 ± 10 years) and 30 healthy controls (29 ± 14 years) were included in this study. Compared with the healthy controls, participants with migraine presented lower pressure pain thresholds values in all the assessed muscles ( P < 0.001), lower resting motor threshold (-10.5% of the stimulator output, 95% CI: -16.8 to -4.2, P = 0.001, Cohen d = 0.869) and higher short-interval intracortical inhibition motor-evoked potential's amplitude at 3 ms (0.25, 95% CI: 0.05 to 0.46, P = 0.015, Cohen d = 0.662), and worse performances both in trail making test (7.1, 95% CI: 0.9 to 13.4, P = 0.027, Cohen d = 0.594) and frontal assessment battery (-1.1, 95% CI: -1.7 to -0.5, P = 0.001, Cohen d = 0.915). CONCLUSIONS Participants with migraine presented significant differences in cortical excitability, executive functions, and pressure pain thresholds, compared with healthy controls.
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Affiliation(s)
- Manuela Deodato
- PhD Program in Neural and Cognitive Sciences, Department of Life Sciences, University of Trieste, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; and
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Antonio Granato
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Miriam Martini
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; and
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Alex Buoite Stella
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; and
| | - Alessandra Galmonte
- PhD Program in Neural and Cognitive Sciences, Department of Life Sciences, University of Trieste, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; and
| | - Luigi Murena
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; and
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Paolo Manganotti
- PhD Program in Neural and Cognitive Sciences, Department of Life Sciences, University of Trieste, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; and
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
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Di Lenarda L, Buoite Stella A, Ratti C, Ruggiero L, Bernard M, Cavarzerani LP, Canton G, Murena L. Assessing Muscle Mass in the Orthopedic Clinical Setting: Application of the Ultrasound Sarcopenia Index in Elderly Subjects with a Recent Femoral Fracture. Nutrients 2024; 16:711. [PMID: 38474844 PMCID: PMC10934151 DOI: 10.3390/nu16050711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Sarcopenia poses a risk factor for falls, disability, mortality, and unfavorable postoperative outcomes. Recently, the Ultrasound Sarcopenia Index (USI) has been validated to assess muscle mass, and this study aimed to apply the USI in the clinical setting. METHODS This prospective observational study included 108 patients aged >65 years, hospitalized for proximal femoral traumatic fracture. Patients were divided into two groups based on anamnestic data: patients with independent walking (IW) and patients requiring walking aid (WA) before admission. All the participants received an ultrasound examination. Other parameters evaluated were handgrip strength, limb circumferences, nutrition (MNA), and activity of daily living (ADL) scores. RESULTS Fifty-six IW patients (83 ± 6 y; 38 females) and 52 WA patients (87 ± 7 y; 44 females) were recruited. The USI was significantly higher in the IW group compared to the WA group (p = 0.013, Cohen's d = 0.489). Significant correlations were found between the USI and other sarcopenia-associated parameters, such as handgrip strength, MNA, ADLs, other muscle ultrasound parameters, and limb circumferences. CONCLUSION The application of the USI in the orthopedic surgery setting is feasible and might support the diagnosis of sarcopenia when combined with other measures of strength and function.
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Affiliation(s)
- Luca Di Lenarda
- Orthopaedics and Traumatology Unit, Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Cattinara University Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (L.D.L.); (C.R.); (L.R.); (M.B.); (G.C.); (L.M.)
| | - Alex Buoite Stella
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
- Single-Cycle Master’s Degree Course in Medicine and Surgery, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Chiara Ratti
- Orthopaedics and Traumatology Unit, Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Cattinara University Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (L.D.L.); (C.R.); (L.R.); (M.B.); (G.C.); (L.M.)
| | - Luca Ruggiero
- Orthopaedics and Traumatology Unit, Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Cattinara University Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (L.D.L.); (C.R.); (L.R.); (M.B.); (G.C.); (L.M.)
| | - Monica Bernard
- Orthopaedics and Traumatology Unit, Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Cattinara University Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (L.D.L.); (C.R.); (L.R.); (M.B.); (G.C.); (L.M.)
| | - Luisa Priscamaria Cavarzerani
- Single-Cycle Master’s Degree Course in Medicine and Surgery, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Gianluca Canton
- Orthopaedics and Traumatology Unit, Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Cattinara University Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (L.D.L.); (C.R.); (L.R.); (M.B.); (G.C.); (L.M.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
- Single-Cycle Master’s Degree Course in Medicine and Surgery, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Luigi Murena
- Orthopaedics and Traumatology Unit, Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Cattinara University Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (L.D.L.); (C.R.); (L.R.); (M.B.); (G.C.); (L.M.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
- Single-Cycle Master’s Degree Course in Medicine and Surgery, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
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Buoite Stella A, Cargnel A, Raffini A, Mazzari L, Martini M, Ajcevic M, Accardo A, Deodato M, Murena L. Shoulder tensiomyography and isometric strength in swimmers before and after a fatiguing protocol. J Athl Train 2023:497275. [PMID: 38014804 DOI: 10.4085/1062-6050-0265.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
CONTEXT. Shoulder muscles are active during front crawl swimming to provide propulsion and stabilize the glenohumeral and scapulothoracic joints. It has been proposed that fatigue might contribute to altered activation of these muscles and represent a risk factor for injuries. Tensiomyography (TMG) might represent a non-invasive tool to detect exercise-induced neuromuscular fatigue changes in contractile parameters of the skeletal muscles, and it has never been used in the shoulder muscles in swimmers. OBJECTIVE. The aim of this study was to assess the effects of a fatiguing swimming protocol on shoulder muscles TMG parameters and isometric strength in competitive swimmers. DESIGN. A cross-sectional study. SETTING. A swimming pool facility. PATIENTS OR OTHER PARTICIPANTS. Sixteen young front crawl competitive swimmers were invited to participate in the study, and 14 of them (21 y, range 17-26, 11 males 3 females) completed all the assessments before and after a 30-min high-intensity swimming training. MAIN OUTCOME MEASURE(S). The main outcome included the TMG assessment which was performed on seven muscles of the shoulder according to front crawl biomechanics and applicability of the technique, in order to obtain data such as time to contraction and muscle belly radial displacement (Dm), whereas isometric strength was assessed with a digital dynamometer during shoulder flexion, extension, external rotation and internal rotation. RESULTS. Fatigue induced a smaller Dm (-0.5 mm, 95% CI: -0.7 - -0.3, p< 0.001, pη2= 0.692), mostly observable in latissimus dorsi and pectoralis major muscles. Only shoulder extension showed a significant isometric strength reduction after the fatiguing protocol (-0.03 N/kg, 95% CI: -0.05 - -0.01, p= 0.045, pη2= 0.275). CONCLUSIONS. This study provides preliminary evidence for the usefulness of TMG to detect fatigue-induced changes in contractile properties of the shoulder muscles in swimmers, in particular the latissimus dorsi, pectoralis major and lower trapezius.
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Affiliation(s)
- Alex Buoite Stella
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34141, Trieste, Italy
| | - Andrea Cargnel
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34141, Trieste, Italy
| | - Alessandra Raffini
- Department of Engineering and Architecture, University of Trieste, via A. Valerio 10, 34100, Trieste, Italy
| | - Laura Mazzari
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34141, Trieste, Italy
| | - Miriam Martini
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34141, Trieste, Italy
| | - Milos Ajcevic
- Department of Engineering and Architecture, University of Trieste, via A. Valerio 10, 34100, Trieste, Italy
| | - Agostino Accardo
- Department of Engineering and Architecture, University of Trieste, via A. Valerio 10, 34100, Trieste, Italy
| | - Manuela Deodato
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34141, Trieste, Italy
| | - Luigi Murena
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34141, Trieste, Italy
- Orthopedics and Traumatology unit, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
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Deodato M, Martini M, Buoite Stella A, Citroni G, Ajčević M, Accardo A, Murena L. Inertial Sensors and Pressure Pain Threshold to Evaluate People with Primary Adhesive Capsulitis: Comparison with Healthy Controls and Effects of a Physiotherapy Protocol. J Funct Morphol Kinesiol 2023; 8:142. [PMID: 37873901 PMCID: PMC10594492 DOI: 10.3390/jfmk8040142] [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: 08/29/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/25/2023] Open
Abstract
Inertial sensors (IMUs) have been recently widely used in exercise and rehabilitation science as they can provide reliable quantitative measures of range of motion (RoM). Moreover, the pressure pain threshold (PPT) evaluation provides an objective measure of pain sensation in different body areas. The aim of this study was to evaluate the efficacy of physiotherapy treatment in people with adhesive capsulitis in terms of RoM and pain improvement measured by IMUs and the PPT. A combined prospective cohort/cross-sectional study was conducted. Nineteen individuals with adhesive capsulitis (10/19 females, 54 ± 8 years) and nineteen healthy controls (10/19 females, 51 ± 6 years) were evaluated for active glenohumeral joint RoM and PPT on shoulder body areas. Then, individuals with adhesive capsulitis were invited to 20 sessions of a physiotherapy protocol, and the assessments were repeated within 1 week from the last session. The range of motion in the flexion (p = 0.001) and abduction (p < 0.001) of the shoulder increased significantly after the physiotherapy protocol. Similarly, the PPT was found to increase significantly in all the assessed shoulder body areas, leading to no significant differences compared to the healthy controls. IMU and PPT assessments could be used to evaluate the efficacy of physical therapy in people with adhesive capsulitis.
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Affiliation(s)
- Manuela Deodato
- Department of Medicine, Surgery, and Health Sciences, School of Physiotherapy, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (M.D.); (M.M.); (G.C.); (L.M.)
| | - Miriam Martini
- Department of Medicine, Surgery, and Health Sciences, School of Physiotherapy, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (M.D.); (M.M.); (G.C.); (L.M.)
| | - Alex Buoite Stella
- Department of Medicine, Surgery, and Health Sciences, School of Physiotherapy, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (M.D.); (M.M.); (G.C.); (L.M.)
| | - Giulia Citroni
- Department of Medicine, Surgery, and Health Sciences, School of Physiotherapy, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (M.D.); (M.M.); (G.C.); (L.M.)
| | - Miloš Ajčević
- Department of Engineering and Architecture, University of Trieste, Via Alfonso Valerio 10, 34100 Trieste, Italy; (M.A.); (A.A.)
| | - Agostino Accardo
- Department of Engineering and Architecture, University of Trieste, Via Alfonso Valerio 10, 34100 Trieste, Italy; (M.A.); (A.A.)
| | - Luigi Murena
- Department of Medicine, Surgery, and Health Sciences, School of Physiotherapy, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (M.D.); (M.M.); (G.C.); (L.M.)
- Orthopedics and Traumatology Unit, Department of Medicine, Surgery, and Health Sciences, Cattinara Hospital—ASUGI, Strada di Fiume 447, 34149 Trieste, Italy
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Deodato M, Grosso G, Drago A, Martini M, Dudine E, Murena L, Buoite Stella A. Efficacy of manual therapy and pelvic floor exercises for pain reduction in primary dysmenorrhea: A prospective observational study. J Bodyw Mov Ther 2023; 36:185-191. [PMID: 37949558 DOI: 10.1016/j.jbmt.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/28/2023] [Accepted: 07/04/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Primary dysmenorrhea represents one of the most common causes of pelvic and low back pain. Pharmacological treatment can present some side effects, and non-pharmacological treatments should be considered to improve the symptoms of primary dysmenorrhea. The aim of this study was to evaluate the efficacy of manual therapy (MT), pelvic floor exercises (PFE), and their combination (MT + PFE) to improve clinical outcomes and pain sensitivity in women with primary dysmenorrhea. METHODS A prospective observational study was conducted. Thirty females (age 25.0 ± 6.1 y) with history of primary dysmenorrhea participated to 8 sessions of 60 min of either MT, PFE or MT + PFE, twice per week. They participated to the different treatments according to the different services offered by the school of physiotherapy. A 0-10 numeric rating scale (NRS) was administered to assess subjective pain, while short-form 36 (SF-36) was used to evaluate quality of life. The pressure pain threshold (PPT) was assessed with a portable algometer on different pelvic and lumbar areas. RESULTS Independently from the treatment, significant improvements were reported for general pain NRS (p < 0.001; pη2 = 0.511), as well as most the domains of the SF-36, although the general health domain did not reach statistical significance (p = 0.613; pη2 = 0.010). PPT revealed a general improvement in all tested body areas, although on the quadratus lumborum, the PFE treatment did not induce a significant improvement compared to the MT and MT + PFE protocols (p = 0.039). CONCLUSIONS These findings highlight the importance of proposing physiotherapy treatments to females with primary dysmenorrhea to improve symptoms, with manual therapy combined with active pelvic floor exercise providing the best outcomes including an improvement of lumbar pain thresholds.
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Affiliation(s)
- Manuela Deodato
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Giulia Grosso
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Alice Drago
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Miriam Martini
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Erica Dudine
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Luigi Murena
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy; Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Alex Buoite Stella
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy.
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Deodato M, Saponaro S, Šimunič B, Martini M, Murena L, Buoite Stella A. Trunk muscles' characteristics in adolescent gymnasts with low back pain: a pilot study on the effects of a physiotherapy intervention including a postural reeducation program. J Man Manip Ther 2023:1-15. [PMID: 37649443 DOI: 10.1080/10669817.2023.2252202] [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] [Received: 01/11/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Trunk muscles' function and characteristics are of great importance for both static and dynamic tasks in different sports, and abnormalities of trunk flexors and extensors might be associated with low back pain (LBP). The aim of this study was to provide a comprehensive evaluation of the functional, morphological and contractile properties in trunk flexors and extensors of young gymnasts with and without LBP. METHODS Young gymnasts (14/25 females, 14-18 y) were screened for the presence of chronic LBP. Abdominal and lumbar muscles were tested for function (McGill's endurance tests), thickness (ultrasound), and contractile responses (tensiomyography). An 8-sessions physiotherapy intervention including postural reeducation was performed by a subsample of 10 subjects with LBP. RESULTS LBP was found to be associated to higher flexors-to-extensors endurance ratio (OR 11.250, 95% CI: 1.647-76.849, p = 0.014), reduced mean lumbar multifidus thickness (OR 16.500, 95% CI: 2.246-121.228, p = 0.006), and reduced mean erector spinae radial displacement (OR 16.500, 95% CI: 2.246-121.228, p = 0.006). The physiotherapy intervention was found to reduce LBP symptoms and it was associated with a significant improvement in the flexors-to-extensors ratio (p < 0.001). CONCLUSIONS This study provides preliminary evidence of functional, morphological, and contractile trunk muscles' alterations associated with chronic LBP in young gymnasts, and presents the effects of a postural reeducation program on symptoms and muscles' functional properties.
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Affiliation(s)
- Manuela Deodato
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- PhD Program in Neural and Cognitive Sciences, Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Serena Saponaro
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Boštjan Šimunič
- Institute for Kinesiology Research, Science and Research Center of Koper, Koper, Slovenia
| | - Miriam Martini
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Luigi Murena
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Alex Buoite Stella
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Deodato M, Coan L, Buoite Stella A, Ajčević M, Martini M, Di Lenarda L, Ratti C, Accardo A, Murena L. Inertial sensors-based assessment to detect hallmarks of chronic ankle instability during single-leg standing: Is the healthy limb "healthy"? Clin Biomech (Bristol, Avon) 2023; 107:106036. [PMID: 37406582 DOI: 10.1016/j.clinbiomech.2023.106036] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 04/02/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Chronic ankle instability can be common in sportsmen and can increase the risk of damaging the articular surfaces and result in negative consequences to joint health. Balance assessment is often used to evaluate ankle instability characteristics and guide rehabilitation protocols. This study aims to investigate balance-related parameters in people with chronic ankle instability and healthy-matched controls, using inertial sensors. METHODS Ten young adults with a history of multiple ankle sprains (30 y, 25-34, 5 females) and ten matched healthy controls (30 y, 23-39, 5 females) were invited to participate in the study. Inertial sensors were placed on the head of the astragalus and on the chest to collect kinematic parameters during a 20-s single-leg stance performed on the leg with ankle instability (and corresponding for the healthy controls) and on the contralateral leg, randomly. Outcomes were calculated with MATLAB and subsequently analyzed. FINDINGS A significant group effect was found only for the inversion angle (F1,15 = 12.514, p = 0.003, pη2 = 0.455), consisting of individuals with ankle instability being characterized by higher inversion angles (4.999 degrees, 95% CI: 1.987-8.011, p = 0.003) without significant side differences. No significant side x group effects were found for the assessed parameters. INTERPRETATION Results from this study suggest that young adults with chronic ankle instability might be characterized by worse single-stance control in terms of inversion angle, and such worse performance could also be found in the contralateral leg. As such, inertial sensors could be used to assess kinematic parameters during balance tasks in people with chronic ankle instability.
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Affiliation(s)
- Manuela Deodato
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100 Trieste, Italy
| | - Lorenzo Coan
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100 Trieste, Italy
| | - Alex Buoite Stella
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100 Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
| | - Miloš Ajčević
- Department of Engineering and Architecture, University of Trieste, via Alfonso Valerio 10, 34127 Trieste, Italy
| | - Miriam Martini
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100 Trieste, Italy
| | - Luca Di Lenarda
- Orthopedics and Traumatology Unit, Trieste University Hospital, Azienda Sanitaria Universitaria Giuliana Isontina, Strada di Fiume 447, 34149, Italy
| | - Chiara Ratti
- Orthopedics and Traumatology Unit, Trieste University Hospital, Azienda Sanitaria Universitaria Giuliana Isontina, Strada di Fiume 447, 34149, Italy
| | - Agostino Accardo
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100 Trieste, Italy; Department of Engineering and Architecture, University of Trieste, via Alfonso Valerio 10, 34127 Trieste, Italy
| | - Luigi Murena
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100 Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; Orthopedics and Traumatology Unit, Trieste University Hospital, Azienda Sanitaria Universitaria Giuliana Isontina, Strada di Fiume 447, 34149, Italy
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Canton G, Tomic M, Tosolini L, Di Lenarda L, Murena L. Use of bone marrow aspirate concentrate (BMAC) in the treatment of delayed unions and nonunions: a single-center case series. Acta Biomed 2023; 94:e2023118. [PMID: 38193517 DOI: 10.23750/abm.v94is2.13870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/16/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND AND AIM Surgical treatment of delayed unions and nonunions requires adherence to the principles of mechanical stability, as well as consideration of biological environment. Bone marrow aspirate concentrate (BMAC) provides cellular and growth factor supply acting as an osteoinductive and osteogenic stimulus in bone healing. The aim of the study is to analyze the outcome of delayed unions and nonunions treatment with autologous bone marrow concentrate supplementation at our institution. METHODS Study included all patients treated at the Orthopedic and Traumatology Unit of Cattinara Hospital-ASUGI (Trieste, Italy) between September 2015 and January 2022 for delayed union or nonunion who received bone marrow aspirate concentrate (BMAC) supplementation. Initial treatment, definitive surgical treatment, radiographic healing and complications were retrospectively evaluated. Data collection was conducted by clinical database searching. RESULTS The study population included 11 patients, F:M 7:4, mean age 61 years. Initial treatment was surgical in 82% of patients. Radiographic healing of the fracture occurred in 100% of cases. None of the patients presented complications. CONCLUSIONS Bone marrow aspirate concentrate (BMAC) has shown encouraging results and a high safety profile. Thus, it could be an effective and safe method in the treatment of delayed unions and nonunion. However, further studies will be needed to clarify its role.
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Affiliation(s)
| | - Marko Tomic
- a:1:{s:5:"en_US";s:22:"Università di Trieste";}.
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Canton G, Barbo G, Roberto Fattori R, Nicholas Rasio N, Murena L. Total hip arthroplasty monobloc stem neck rupture in patient with massive heterotopic ossifications: a case report and literature review. Acta Biomed 2023; 94:e2023117. [PMID: 38193574 DOI: 10.23750/abm.v94is2.13888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/16/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND AND AIM OF THE WORK Fractures of the femoral stem neck are a rare complication in hip prosthetic surgery, especially in non-modular components. The authors report a case associated with massive heterotopic ossifications, with the purpose to analyze risk factors and specific characteristics. METHODS A case of femoral monobloc stem neck rupture is described. A non-systematic literature review regarding risk factors for femoral stem neck fracture was conducted in the PubMed database. RESULTS We report the case of a 61-year-old male who underwent surgery to remove calcifications four years after THA. Four months later the patient reported acute pain in the left hip, arising after a combined movement of external rotation and axial load while standing on the left foot, in the absence of any prodromic symptom. On radiographs, a displaced fracture of the neck of the hip prosthesis was revealed, together with massive heterotopic ossifications. After THA revision the patient's symptoms were resolved. CONCLUSIONS Prosthetic femoral neck fractures are a rare complication. We suggest that this case represents a unique type of fatigue rupture, where neck length and the presence of massive heterotopic calcifications contributed to flexion forces, resulting in failure in the midpoint of the neck.
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Affiliation(s)
- Gianluca Canton
- Orthopedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy) .
| | | | - Roberto Roberto Fattori
- Orthopedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy) .
| | - Nicholas Nicholas Rasio
- Orthopedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy) .
| | - Luigi Murena
- Orthopedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy) .
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10
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Fazzari F, Canton G, Giraldi G, Falcioni N, Clocchiatti S, Rasio N, Murena L. Avascular necrosis of humeral head after proximal humerus fracture: comparison between classification systems in predicting necrosis risk. Acta Biomed 2023; 94:e2023089. [PMID: 38193586 DOI: 10.23750/abm.v94is2.13871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/06/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND AND AIM Avascular necrosis (AVN) of the humeral head is a relatively frequent complication after proximal humerus fractures (PHF). There are many factors related to the risk of developing AVN, with fracture complexity being one of the most relevant. Aim of the present study is to evaluate the correlation between different classification systems and the risk of post-operative AVN in patients treated with locking plate fixation for Neer 3 and 4-part PHFs. METHODS The study population included 44 patients (F:M 2:1, mean age 62) treated between December 2014 and April 2019. Fractures were classified according to Neer, Russo and Lego classifications and Hertel's criteria. AVN was established on postoperative radiographs after a minimum follow-up of 6 months. The odds ratio (OR) for AVN for each classification subtype was calculated. RESULTS The incidence of necrosis was 11%. Significant association with AVN was found for Neer 4 part (OR=8), Russo IVB (OR=4), Lego pattern 12 (OR=8) and in presence of 3 mayor Hertel's criteria (OR=15,5). CONCLUSIONS There is a significant association between AVN and Neer 4 part, Russo type IVB and Lego pattern 12 fractures. AVN risk is also significantly higher in presence of 3 major Hertel's criteria.
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Affiliation(s)
- Francesco Fazzari
- a:1:{s:5:"en_US";s:142:"Orthopaedics and Traumatology Unit, Cattinara Hospital, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy)";}.
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11
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Canton G, Nassiz P, Ratti C, De Luca A, Murena L. Can the medullary diameter/cortical thickness ratio be a predictor of diaphyseal fracture in elderly patients treated with cephalo-medullary nail for proximal femur fractures? A retrospective cohort study on 488 patients. Acta Biomed 2023; 94:e2023119. [PMID: 38193583 DOI: 10.23750/abm.v94is2.13868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/16/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND AND AIM OF THE WORK Diaphyseal femoral fracture occurring distal to the CM nail tip is an infrequent complication that presents some similarities with periprosthetic hip fractures. The purpose of this study is to evaluate the correlation between medullary diameter (MD) and cortical width (CW) ratio, a known risk factor for periprosthetic fracture, with the occurrence of diaphyseal fracture distal to the nail tip. RESEARCH DESIGN AND METHODS Study population included patients > 65 years old treated with short CM nail for proximal femur fractures (PFF) at the Cattinara Hospital-ASUGI of Trieste (Italy) Orthopedics and Traumatology Unit between July 2014 and May 2018. Latest follow-up X-rays were evaluated to identify diaphyseal fracture occurrence. We recorded type of trauma, time lapse between CM nailing and diaphyseal fracture and calculate the MD/CW ratio on intra-operative X-rays. Data were analyzed to find out a correlation with the occurrence of diaphyseal fractures. RESULTS The study population counted 488 patients. Diaphyseal fracture occurred in 14 cases (2.9%, F:M ratio 6:1, mean age 87 years), at mean 26.07 months after CM nailing. The MD/CW ratio identified a trend of increased risk of diaphyseal fractures as the ratio increases (OR 4.51; CI 0.826-24.642) although the correlation does not reach statistical significance (p 0.082). CONCLUSIONS The results of the present study demonstrate a trend towards a higher risk of diaphyseal fracture as the MD/CW ratio increases, although the association did not reach statistical significance due to the small number of events.
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Affiliation(s)
| | - Pamela Nassiz
- a:1:{s:5:"en_US";s:149:"Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy";}.
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12
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Zanetti M, De Colle P, Niero M, Gortan Cappellari G, Barazzoni R, Ratti C, Murena L. Multidimensional prognostic index predicts short- and long-term mortality and rehospitalizations in older patients with hip fracture. Aging Clin Exp Res 2023:10.1007/s40520-023-02433-8. [PMID: 37178430 DOI: 10.1007/s40520-023-02433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Multidimensional Prognostic Index (MPI), calculated on cognitive, functional, nutritional, social, pharmacological and comorbidity domains, strongly correlates with mortality in older patients. Hip fractures are a major health problem and are associated with adverse outcomes in those affected by frailty. AIM We aimed at evaluating whether MPI is a predictor of mortality and rehospitalization in hip fracture older patients. METHODS We investigated the associations of MPI with all-cause 3- and 6-month mortality and rehospitalization in 1259 older patients admitted for hip fracture surgical treatment and managed by an orthogeriatric team [age 85 years (65-109); male gender: 22%]. RESULTS Overall mortality was 11,4%, 17% and 23,5% at 3, 6 and 12 months from surgery (rehospitalizations: 15, 24,5 and 35,7%). MPI was associated (p < 0.001) with 3-, 6- and 12- month mortality and readmissions; Kaplan-Meier estimate for rehospitalization and survival according to MPI risk classes confirmed these results. In multiple regression analyses these associations were independent (p < 0.05) of mortality and rehospitalization-associated factors not included in the MPI, such as gender, age and post-surgical complications. Similar MPI predictive value was observed in patients undergoing endoprosthesis or other surgeries. ROC analysis confirmed that MPI was a predictor (p < 0.001) of both 3- and 6- month mortality and rehospitalization. CONCLUSIONS In hip fracture older patients, MPI is a strong predictor of 3-, 6- and 12- months mortality and rehospitalization, independently of surgical treatment and post-surgical complications. Therefore, MPI should be considered a valid pre-surgical tool to identify patients with higher clinical risk of adverse outcomes.
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Affiliation(s)
- Michela Zanetti
- Department of Medical Sciences, University of Trieste, Trieste, Italy.
- Geriatric Clinic, Maggiore Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.
| | - Paolo De Colle
- Geriatric Clinic, Maggiore Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Michele Niero
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | | | - Rocco Barazzoni
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Chiara Ratti
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Orthopedic Clinic, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Luigi Murena
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Orthopedic Clinic, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
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13
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Mezzarobba S, Grassi M, Galliussi J, Murena L, Bernardis P. Perception of biological motion. No sensitivity differences between patients with Parkinson's disease and healthy observers. Appl Neuropsychol Adult 2023; 30:63-70. [PMID: 33886377 DOI: 10.1080/23279095.2021.1910511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The use of biological motion (BM) stimuli (point-light walkers PLW) may be a novel alternative to improve the clinical impact of Action Observation treatments in Parkinson's Disease, by directing the patient's attentional focus on gait kinematics. However, the recognition of biological motion in Parkinson's patients has thus far been controversial. To evaluate the clinical feasibility of using BM stimuli in Action Observation treatments, we aimed at investigating whether Parkinson's patients in the ON-state condition can identify and use gender-specific cues conveyed by the body structure and by the kinematics of gait of a PLW. 30 Parkinson's patients and 30 healthy elderly observers were tested in a gender identification task with PLW. Parkinson's patients were able to correctly identify the gender of PLW; no differences were found between the two groups of observers. While for both groups, the gender identification task was easier when it required a judgment on a healthy PLW. Lastly, we found that females were more sensitive than males in our identification task. Our study shows that Parkinson's patients in the ON-state condition are able to extract subtle structural and kinematic characteristics from biological motion stimuli, which is favorable to the use of BM in Action Observation treatments.
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Affiliation(s)
- Susanna Mezzarobba
- Department of Life Sciences, University of Trieste, Trieste, Italy.,Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Michele Grassi
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | | | - Luigi Murena
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Paolo Bernardis
- Department of Life Sciences, University of Trieste, Trieste, Italy
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14
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Buoite Stella A, Galimi A, Martini M, Di Lenarda L, Murena L, Deodato M. Muscle Asymmetries in the Lower Limbs of Male Soccer Players: Preliminary Findings on the Association between Countermovement Jump and Tensiomyography. Sports (Basel) 2022; 10:177. [PMID: 36422945 PMCID: PMC9694285 DOI: 10.3390/sports10110177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 09/01/2023] Open
Abstract
Strength and power asymmetries have been observed in different sports, including soccer. Such asymmetries, as well as the bilateral deficit (BLD), can be assessed during different tasks, static or dynamic, and with different methods and devices, in order to detect the possible different aspects, as well as the association with physical performance and injuries. The aim of this study was to investigate the association between muscle asymmetries and BLD during a countermovement jump (CMJ), and tensiomyography (TMG) parameters and asymmetries, in the lower limbs of male soccer players. A total of 23 male soccer players (18 ± 4 years) were recruited. Bilateral and unilateral CMJs were performed, and peak power (W) and height (cm) were obtained. TMG was performed on different muscles of the lower limbs, and lateral and functional symmetries were obtained. Playing position and history of injuries were collected. CMJ inter-limb symmetry was found to significantly correlate with biceps femoris (r = 0.574, p = 0.004) and soleus (r = 0.437, p = 0.037) lateral symmetry. Players in central roles presented significantly worse functional symmetry scores of the knee than defense players (-17.5%, 95% CI -31.2--3.9; p = 0.10). Participants reporting a history of injury at the ankle were characterized by significantly lower functional symmetry in both the dominant (43%, 39.5-48.0 vs. 74.5%, 46.5-89.3, p = 0.019) and non-dominant (45%, 42.5-46.0 vs. 81.0%, 45.8-90.3, p = 0.024) ankle. Findings from this preliminary study suggest an association between lower-limb muscle asymmetries during a dynamic task, such as jumping, and muscle contractile properties evaluated with TMG; moreover, functional asymmetries may be present after ankle injuries. Future studies in larger samples should evaluate the presence of such asymmetries as predictors or characteristics of different muscular and joint injuries.
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Affiliation(s)
- Alex Buoite Stella
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy
- Clinical, Integrative and Translational Physiology, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Annalisa Galimi
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy
| | - Miriam Martini
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy
| | - Luca Di Lenarda
- Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUGI, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Luigi Murena
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy
- Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUGI, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Manuela Deodato
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy
- Ph.D. Program in Neural and Cognitive Sciences, Department of Life Sciences, University of Trieste, Via Weiss 2, 34100 Trieste, Italy
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15
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Trevisan M, Di Lenarda L, Pastore S, Saccari A, Canton G, Lucangelo U, Taddio A, Murena L. "Shoulder pain and limitation of motion in a young girl: think different". Ital J Pediatr 2022; 48:139. [PMID: 35908061 PMCID: PMC9338533 DOI: 10.1186/s13052-022-01332-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Primary Synovial Chondromatosis (PSC) is a rare benign tumor of the synovial membrane in which cartilage metaplasia produces calcific loose bodies within the articular space. Only a few cases are reported in the pediatric population and its etiology remains unknown. This condition typically affects large weight-bearing joints with pain, swelling and decrease range of motion. Due to its slow progressions, delayed diagnosis is frequent and differential diagnosis should consider other chronic arthritis and malignancies. While arthroscopic removal of loose bodies is the current treatment up to now, the association of partial or complete synovectomy is debated. Case presentation We report about a 14-year-old girl with a long-lasting right shoulder pain, especially during movements or exercise, localized tenderness and hypotonia of the glenohumeral joint. No previous trauma was mentioned. Blood exams, Mantoux test and plain radiography of the right shoulder were unremarkable. Ultrasound imaging revealed echogenic and calcified bodies stretching the glenohumeral joint and dislocating the long head of biceps tendon. Magnetic resonance showed a “rice-grain” pattern of the right shoulder. From an arthroscopic surgery, multiple loose white bodies were removed within the synovial membrane, and synovial chondromatosis was confirmed by histological analysis. At one month follow up visit, the patient completely recovered without pain. Conclusion Synovial chondromatosis is a very uncommon cause of mono articular pain in children, especially when it affects shoulder. Pediatricians should keep in mind this condition to avoid delayed diagnosis and treatment, even in consideration of the low risk of malignant transformation. Through this case, we would highlight common diagnostic pitfalls and treatment of synovial chondromatosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-022-01332-4.
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Affiliation(s)
- Matteo Trevisan
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Via dell'Istria 65/1, 34100, Trieste, Italy.
| | - Luca Di Lenarda
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Via dell'Istria 65/1, 34100, Trieste, Italy
| | - Serena Pastore
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alessia Saccari
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Umberto Lucangelo
- Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, Trieste University, Trieste, Italy
| | - Andrea Taddio
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Via dell'Istria 65/1, 34100, Trieste, Italy.,Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
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16
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De Luca A, Murena L, Zanetti M, De Colle P, Ratti C, Canton G. Should the early surgery threshold be moved to 72 h in over-85 patients with hip fracture? A single-center retrospective evaluation on 941 patients. Arch Orthop Trauma Surg 2022; 143:3091-3101. [PMID: 35788762 DOI: 10.1007/s00402-022-04509-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/10/2022] [Indexed: 11/02/2022]
Abstract
AIM Aim of the study was to assess whether early surgery and other clinical and orthogeriatric parameters could affect mortality rate in hip fracture patients aged > 85. MATERIALS AND METHODS Data regarding a 42-month period were retrospectively obtained from the institutional medical records and registry data. Gender, age, fracture pattern, surgical technique, type of anesthesia, timing of surgical intervention (within 24, 48 or 72 h from admission), days of hospitalization, mortality rate divided in intra-hospital, at 30 days and at 1 year were collected for the whole population. Some additional data were collected for an orthogeriatric subgroup. RESULTS 941 patients were considered, with a mean age of 89 years. Surgery was performed within 24, 48 and 72 h in 24.4%, 54.5% and 66.1% of cases, respectively. Intra-hospital mortality rate resulted to be 3.4%, while mortality at 30 days and 1 year resulted to be 4.5% and 31%, respectively. Early surgery within 48 and 72 h were significantly associated with a lower intra-hospital and 30-day mortality rate. In the orthogeriatric subgroup (394 patients), a significant association with a higher mortality rate was found for general anesthesia, number of comorbidities, ADL (Activities of Daily Living) < 3, transfer to other departments. CONCLUSIONS In over-85 hip fracture patients, the threshold for early surgery might be moved to 72 h to allow patients pre-operative stabilization and medical optimization as intra-hospital and 30-day mortality rates remain significantly lower. Advanced age, male sex, number of comorbidities, pre-operative dependency in ADL, general anesthesia, length of hospitalization and transfer to other departments were significantly related to mortality rate.
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Affiliation(s)
- Alessandro De Luca
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy. .,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy. .,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy.
| | - Luigi Murena
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy.,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Michela Zanetti
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy.,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Paolo De Colle
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy.,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Chiara Ratti
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy.,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Gianluca Canton
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy.,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
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17
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Canton G, Sborgia A, Dussi M, Rasio N, Murena L. Early weight bearing in tibial plateau fractures treated with ORIF: a systematic review of literature. J Orthop Surg Res 2022; 17:261. [PMID: 35549974 PMCID: PMC9097122 DOI: 10.1186/s13018-022-03156-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To review the current clinical evidence on advantages and risks of early weight bearing (EWB) after internal fixation for tibial plateau fracture. METHODS Data source: PubMed and Google Scholar from inception of database to 20 August 2021, using PRISMA guidelines. The included studies were randomized controlled trials, prospective and retrospective observational studies, case reports. Data extraction was performed independently by 2 reviewers. Collected data were compared to verify agreement. Statistical analysis was not performed in this study. RESULTS The literature search produced 174 papers from PubMed and 186 from Google Scholar, with a total amount of 360 papers. The two reviewers excluded 301 papers by title or duplicates. Of the 59 remaining, 33 were excluded after reading the abstract, and 17 by reading the full text. Thus, 9 papers were finally included in the review. CONCLUSIONS EWB can be considered safe and effective in selected cases after internal fixation for tibial plateau fractures. Level of evidence Therapeutic Level III.
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Affiliation(s)
- Gianluca Canton
- Orthopaedics and Traumatology Unit, Department of Medical, Surgical and Life Sciences, Cattinara Hospital, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy
| | - Andrea Sborgia
- Orthopaedics and Traumatology Unit, Department of Medical, Surgical and Life Sciences, Cattinara Hospital, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Micol Dussi
- Orthopaedics and Traumatology Unit, Department of Medical, Surgical and Life Sciences, Cattinara Hospital, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy
| | - Nicholas Rasio
- Orthopaedics and Traumatology Unit, Department of Medical, Surgical and Life Sciences, Cattinara Hospital, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy
| | - Luigi Murena
- Orthopaedics and Traumatology Unit, Department of Medical, Surgical and Life Sciences, Cattinara Hospital, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy
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Porcari A, Pagura L, Longo F, Sfriso E, Barbati G, Murena L, Longo E, Ramella V, Arnez ZM, Rapezzi C, Merlo M, Sinagra G. 146 Prognostic significance of unexplained left ventricular hypertrophy in patients undergoing carpal tunnel surgery. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab145.006] [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
Abstract
Aims
Carpal tunnel (CT) syndrome is a recognized red-flag of cardiac amyloidosis (CA) and increased cardiovascular (CV) morbidity. We designed this study to characterize the CV profile of patients with CT syndrome at the time of first surgery and to identify high-risk presentations.
Methods and results
We retrospectively reviewed 643 patients who underwent CT surgery between 2007 and 2019. Of them, 130 patients (77 years, 45% males, LVEF 62%) with available CV characterization within ±12 months from CT surgery were included. Abnormal loading conditions causing cardiac hypertrophy (LVH) were investigated to distinguish explained LVH (Ex-LVH) from unexplained LVH (Un-LVH). The primary outcome of the study was all-cause mortality. The secondary outcome measures were the occurrence of (i) new-onset heart failure (HF) or worsening HF requiring hospitalization (HHF) or (ii) pacemaker implantation. New-onset HF was defined as the development of HF signs and symptoms requiring an unplanned cardiologic examination or hospitalization. Median follow-up was 63 months [interquartile range (IQR): 30–95]. LVH was found in 65 (50%) patients, 33% of them presented Un-LVH. Compared to the others, Un-LVH patients were older (77, 75 vs. 70 years in Un-LVH, Ex-LVH, and non-LVH, respectively; P = 0.002), had higher rates of ECG-echo discrepancy (70%, 14.3% and 1.6%, respectively; P < 0.001) and of echocardiographic findings of CA (24%, 7%, and 0%, P < 0.001). Among Un-LVH patients, 9 (43%) experienced death and 7 (33%) developed HF at 3.8 and 2.4 years from CT surgery, respectively. Compared to the others, death and HF development rates were higher in Un-LVH patients both at unadjusted (P = 0.01 and P = 0.02, respectively) and adjusted analysis for age, gender, and renal insufficiency (P = 0.00038 and P = 0.050, respectively).
Conclusions
At the time of CT surgery, Un-LVH was found in more than 30% of patients with LVH and 24% of them showed echocardiographic features suggesting an underdiagnosed CA. Un-LVH was associated with higher all-cause mortality and HF development.
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Affiliation(s)
- Aldostefano Porcari
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Linda Pagura
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Francesca Longo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Enrico Sfriso
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital—Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Emiliano Longo
- Orthopaedics and Traumatology Unit, Cattinara Hospital—Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Vittorio Ramella
- Plastic and Reconstructive Surgery Unit, Cattinara Hospital—Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Zoran Marij Arnez
- Plastic and Reconstructive Surgery Unit, Cattinara Hospital—Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Claudio Rapezzi
- Cardiothoracic Department, University of Ferrara, Ferrara, Italy
| | - Marco Merlo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
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Porrelli D, Abrami M, Pelizzo P, Formentin C, Ratti C, Turco G, Grassi M, Canton G, Grassi G, Murena L. Trabecular bone porosity and pore size distribution in osteoporotic patients - A low field nuclear magnetic resonance and microcomputed tomography investigation. J Mech Behav Biomed Mater 2021; 125:104933. [PMID: 34837800 DOI: 10.1016/j.jmbbm.2021.104933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 01/19/2023]
Abstract
The study of bone morphology is of great importance as bone morphology is influenced by factors such as age and underlying comorbidities and is associated with bone mechanical properties and fracture risk. Standard diagnostic techniques used in bone disease, such as Dual-Energy X-ray absorptiometry and ultrasonography do not provide qualitative and quantitative morphological information. In recent years, techniques such as High Resolution Computed Tomography (HR-CT), micro- CT, Magnetic Resonance Imaging (MRI), and Low Field Nuclear Magnetic Resonance (LF-NMR) have been developed for the study of bone structure and porosity. Data obtained from these techniques have been used to construct models to predict bone mechanical properties thanks to finite element analysis. Cortical porosity has been extensively studied and successfully correlated with disease progression and mechanical properties. Trabecular porosity and pore size distribution, however, have increasingly been taken into consideration to obtain a comprehensive analysis of bone pathology and mechanic. Therefore, we have decided to evaluate the ability of micro- CT (chosen for its high spatial resolving power) and LF-NMR (chosen to analyze the behavior of water molecules within trabecular bone pores) to characterize the morphology of trabecular bone in osteoporosis. Trabecular bone samples from human femoral heads collected during hip replacement surgery were from osteoporosis (test group) and osteoarthritis (control group) patients. Our data show that both micro- CT and LF-NMR can detect qualitative changes in trabecular bone (i.e., transition from plate-like to rod-like morphology). Micro- CT failed to detect significant differences in trabecular bone morphology parameters between osteoporotic and osteoarthritic specimens, with the exception of Trabecular Number and Connectivity Density, which are markers of osteoporosis progression. In contrast, LF-NMR was able to detect significant differences in porosity and pore size of trabecular bone from osteoporotic versus osteoarthritic (control) samples. However, only the combination of these two techniques allowed the detection of structural morphometric changes (increase in the larger pore fraction and enlargement of the larger pores) in the trabecular bone of osteoporotic specimens compared to osteoarthritic ones. In conclusion, the combined use of LF-NMR and micro- CT provides a valuable tool for characterizing the morphology of trabecular bone and may offer the possibility for a new approach to the study and modeling of bone mechanics in the context of aging and disease.
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Affiliation(s)
- Davide Porrelli
- Department of Medicine, Surgery and Health Sciences, Maggiore Ospital, Trieste University, Piazza dell'Ospitale 1, I-34125, Trieste, Italy
| | - Michela Abrami
- Department of Engineering and Architecture, University of Trieste, Via Valerio 6/A, I 34127, Trieste, Italy
| | - Patrizia Pelizzo
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Cristina Formentin
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Chiara Ratti
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Gianluca Turco
- Department of Medicine, Surgery and Health Sciences, Maggiore Ospital, Trieste University, Piazza dell'Ospitale 1, I-34125, Trieste, Italy
| | - Mario Grassi
- Department of Engineering and Architecture, University of Trieste, Via Valerio 6/A, I 34127, Trieste, Italy.
| | - Gianluca Canton
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Gabriele Grassi
- Department of Life Sciences, Cattinara University Hospital, Trieste University, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Luigi Murena
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, I-34149, Trieste, Italy
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20
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Porcari A, Pagura L, Longo F, Sfriso E, Barbati G, Murena L, Longo E, Ramella V, Arnež ZM, Rapezzi C, Merlo M, Sinagra G. Prognostic significance of unexplained left ventricular hypertrophy in patients undergoing carpal tunnel surgery. ESC Heart Fail 2021; 9:751-760. [PMID: 34755478 PMCID: PMC8787962 DOI: 10.1002/ehf2.13606] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/08/2021] [Accepted: 08/25/2021] [Indexed: 11/21/2022] Open
Abstract
Aims Carpal tunnel (CT) syndrome is a recognized red‐flag of cardiac amyloidosis (CA) and increased cardiovascular (CV) morbidity. We designed this study to characterize the CV profile of patients with CT syndrome at the time of first surgery and to identify high‐risk presentations. Methods and results We retrospectively reviewed 643 patients who underwent CT surgery between 2007 and 2019. Of them, 130 patients (77 years, 45% male patients, left ventricular ejection fraction 62%) with available CV characterization within ±12 months from CT surgery were included. Abnormal loading conditions causing cardiac left ventricular hypertrophy (LVH) were investigated to distinguish explained LVH (Ex‐LVH) from unexplained LVH (Un‐LVH). LVH was found in 66 (51%) patients, 33% of them presented Un‐LVH. Compared with the others, Un‐LVH patients were older (77 and 75 vs. 70 years in Un‐LVH, Ex‐LVH, and non‐LVH, respectively; P = 0.002), had higher rates of electrocardiogram‐echo discrepancy (70%, 14.3%, and 1.6%, respectively; P < 0.001) and of echocardiographic findings of CA (24%, 7%, and 0%, P < 0.001). Among Un‐LVH patients, 9 (43%) experienced death and 7 (33%) developed heart failure (HF) at 3.8 and 2.4 years from CT surgery, respectively. Compared with the others, death and HF development rates were higher in Un‐LVH patients both at unadjusted (P = 0.01 and P = 0.02, respectively) and adjusted analysis for age, gender, and renal insufficiency (P = 0.00038 and P = 0.050, respectively). Conclusions At the time of CT surgery, Un‐LVH was found in more than 30% of patients with LVH, and 24% of them showed echocardiographic features suggesting an underdiagnosed CA. Un‐LVH was associated with higher all‐cause mortality and HF development.
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Affiliation(s)
- Aldostefano Porcari
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteVia P. Valdoni 7Trieste34100Italy
| | - Linda Pagura
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteVia P. Valdoni 7Trieste34100Italy
| | - Francesca Longo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteVia P. Valdoni 7Trieste34100Italy
| | - Enrico Sfriso
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteVia P. Valdoni 7Trieste34100Italy
| | - Giulia Barbati
- Department of Medical Sciences, Biostatistics UnitUniversity of TriesteTriesteItaly
| | - Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital‐ Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteTriesteItaly
| | - Emiliano Longo
- Orthopaedics and Traumatology Unit, Cattinara Hospital‐ Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteTriesteItaly
| | - Vittorio Ramella
- Plastic and Reconstructive Surgery Unit, Cattinara Hospital‐ Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteTriesteItaly
| | - Zoran Marij Arnež
- Plastic and Reconstructive Surgery Unit, Cattinara Hospital‐ Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteTriesteItaly
| | - Claudio Rapezzi
- Cardiothoracic DepartmentUniversity of FerraraFerraraItaly
- Maria Cecilia HospitalGVM Care & ResearchCotignola, RavennaItaly
| | - Marco Merlo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteVia P. Valdoni 7Trieste34100Italy
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteVia P. Valdoni 7Trieste34100Italy
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Murena L, Colin G, Dussi M, Canton G. Is intraoperative neuromonitoring effective in hip and pelvis orthopedic and trauma surgery? A systematic review. J Orthop Traumatol 2021; 22:40. [PMID: 34647237 PMCID: PMC8514601 DOI: 10.1186/s10195-021-00605-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/26/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Sciatic nerve injury is an uncommon but potentially devastating complication in hip and pelvis surgery. Intraoperative nerve monitoring (IONM) was applied since the seventies in neurosurgery and spine surgery. Nowadays, IONM has gained popularity in other surgical specialities including orthopaedic and trauma surgery. Aim of this systematic review is to resume the literature evidences about the effectiveness of intraoperative monitoring of sciatic nerve during pelvic and hip surgery. Methods Two reviewers (GC and MD) independently identified studies by a systematic search of PubMed and Google Scholar from inception of database to 10 January 2021. Inclusion criteria were: (a) English written papers, (b) use of any type of intraoperative nerve monitoring during traumatic or elective pelvic and hip surgery, (c) comparison of the outcomes between patients who underwent nerve monitoring and patient who underwent standard procedures, (d) all study types including case reports. The present review was conducted in accordance with the 2009 PRISMA statement. Results The literature search produced 224 papers from PubMed and 594 from Google Scholar, with a total amount of 818 papers. The two reviewer excluded 683 papers by title or duplicates. Of the 135 remaining, 72 were excluded after reading the abstract, and 31 by reading the full text. Thus, 32 papers were finally included in the review. Conclusions The use of IONM during hip and pelvis surgery is debated. The review results are insufficient to support the routine use of IONM in hip and pelvis surgery. The different IONM techniques have peculiar advantages and disadvantages and differences in sensitivity and specificity without clear evidence of superiority for any. Results from different studies and different interventions are often in contrast. However, there is general agreement in recognizing a role for IONM to define the critical maneuvers, positions or pathologies that could lead to sciatic nerve intraoperative damage. Level of evidence Level 2.
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Affiliation(s)
- Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUGI, Strada di Fiume 447, 34149, Trieste, Italy
| | - Giulia Colin
- Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUGI, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Micol Dussi
- Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUGI, Strada di Fiume 447, 34149, Trieste, Italy
| | - Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUGI, Strada di Fiume 447, 34149, Trieste, Italy
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Murena L, Canton G, Hoxhaj B, Sborgia A, Fattori R, Gulli S, Vaienti E. Early weight bearing in acetabular and pelvic fractures. Acta Biomed 2021; 92:e2021236. [PMID: 34487095 PMCID: PMC8477081 DOI: 10.23750/abm.v92i4.10787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: The incidence of pelvic and acetabular fractures is increasing during the years, counting 37 pelvic fractures per 100000 people annually. No weight bearing or toe touch weight bearing are usually chosen in the initial management to allow fracture and ligamentous healing and avoid fracture displacement and fixation failure. On the other hand, early weight bearing may stimulate fracture healing and allow prompt functional recovery, faster return to work and recreational activities and reduce complications linked to late rehabilitation. Aim of the study is to review the literature about weight bearing indications for pelvic and acetabular fractures to highlight clinical and biomechanical evidence supporting early weight bearing. Methods: Two independent reviewers independently extracted studies on early weight bearing of pelvic and acetabular fractures. All selected studies were screened independently based on title and abstract. Then the full text of any article that either judged potentially eligible was acquired and reviewed again. Any disagreement was resolved by discussing the full text manuscripts. Results: 44 studies including reviews, meta-analysis, clinical and biomechanical studies were selected. Conclusions: Despite biomechanical data, few clinical evidences can be found to support early weight bearing in pelvic and especially acetabular fractures treatment. The promising results of some clinical experiences, however, should direct further studies to clearly define the indications and limits of early weight bearing in these injuries. Recognizing intrinsic lesion stability and bone and fixation technique quality, together with patient age and compliance, should be the mainstay for post-operative management choice. (www.actabiomedica.it)
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Affiliation(s)
- Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy)..
| | - Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy)..
| | | | - Andrea Sborgia
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy)..
| | - Roberto Fattori
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy)..
| | - Stefano Gulli
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy)..
| | - Enrico Vaienti
- Orthopaedics and Traumatology Clinic, Department of Medicine and Surgery, University of Parma (Italy)..
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Canton G, Roman F, Ghassempour D, Murena L. Simultaneous bilateral olecranon fracture: a case report and review of the literature. Acta Biomed 2021; 92:e2021029. [PMID: 34313662 PMCID: PMC8420827 DOI: 10.23750/abm.v92is3.11744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/26/2021] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: A bilateral fracture of the olecranon is a rare injury, with only few cases reported in the literature. Methods: A single case of bilateral Mayo type II A olecranon fracture in a 88 years old woman is described. A research of all articles regarding simultaneous bilateral olecranon fracture was performed in the PubMed database. Result: The reported case demonstrated good clinical and radiographic results at 5 months follow-up with surgical treatment. The literature search produced other 6 cases in 5 case reports. Except for one case of fatigue fracture that had been treated conservatively, the others received surgical treatment with satisfactory results. Conclusion: Simultaneous bilateral olecranon fracture is very uncommon. Bilateral internal fixation yields good clinical and radiographic results in most cases. (www.actabiomedica.it)
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Affiliation(s)
- Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Federico Roman
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Dario Ghassempour
- a:1:{s:5:"en_US";s:109:"1Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Strada di Fiume 447, 34149 Trieste (Italy)";}.
| | - Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Strada di Fiume 447, 34149 Trieste (Italy).
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Canton G, Maritan G, Impellizzeri F, Formentin C, Murena L. Bucket-handle meniscal tears in children under the age of 10: a literature review. Acta Biomed 2021; 92:e2021020. [PMID: 34313663 PMCID: PMC8420820 DOI: 10.23750/abm.v92is3.11742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022]
Abstract
Background and aim of the work: Traumatic meniscal tears are raising in skeletally immature patients due to increasing participation in sport activities. Nonetheless, meniscal tears remain a rare injury in children, with a lack of evidence regarding treatment and outcome. The aim of the study is to review the literature on BHMT in children aged under 10 years. Methods: Two independent reviewers conducted a systematic search of Embase, Medline and Pubmed databases to report a summary of literature evidence about epidemiology, clinical presentation, diagnosis, treatment and outcome of BHMTs in children under the age of 10. Result: Eight papers have been considered, including seven case reports and one case series, for a total amount of 21 cases of BHMTs in children under 10 years. Complete clinical information was retrieved for 12 cases, which were analyzed in detail. The injury occurred in the medial meniscus in 8 cases (66,7%), while in 4 cases (33,3%) on a lateral discoid meniscus. The mean reported age is 4,6 years (range 2 years - 9 years), with prevalence of the female sex (62,5%). Conclusion: BHMT is an uncommon lesion in children under 10 years old. It can be suspected after a history of knee trauma in patients with knee pain, effusion and locking. MRI is the best technique for the diagnosis. Current strategy of treatment is to preserve the meniscus through different arthroscopic suture techniques, unless the lesion occurs on a discoid meniscus. (www.actabiomedica.it)
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Affiliation(s)
- Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUGI, Trieste (Italy).
| | - Guido Maritan
- Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUGI, Trieste (Italy).
| | | | - Cristina Formentin
- Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUGI, Trieste (Italy)
| | - Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUGI, Trieste (Italy).
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Canton G, Tomic M, Giunta M, Maritan G, Murena L. Distal femur periprosthetic knee fractures in elderly patients: clinical and radiographic outcome after internal fixation. Acta Biomed 2021; 92:e2021028. [PMID: 34313656 PMCID: PMC8420835 DOI: 10.23750/abm.v92is3.11770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: The incidence of periprosthetic knee fractures is steadily increasing, especially in the geriatric population. Surgical treatment in these patients must consider the poor bone quality and the risks of general complications related to age and comorbidities. The aim of the present study is to analyze the clinical and radiographic outcome of internal fixation for periprosthetic knee fractures of the distal femur in elderly patients (>75aa). Methods: All patients treated at the Orthopedic and Traumatology Unit of Cattinara Hospital-ASUGI (Trieste, Italy) between September 2014 and September 2019 for distal femur periprosthetic fracture after total knee replacement were included in the study. Mortality, complications, radiographic healing and functional outcomes were retrospectively evaluated. Data collection was conducted by clinical database searching and telephone interview. Results were compared with the literature. Results: The study population included 19 patients, F:M 16:3, mean age 84 years. Plate fixation was used in the majority of cases (90%). One-year mortality was 21.05%. Radiographic healing of the fracture occurred in 92% of cases. Nonetheless, 61% of patients saw a worsening in their functional outcome. Conclusion: Internal fixation is a valuable and safe option for distal femur periprosthetic fracture treatment in the elderly. The significant impact of periprosthetic knee fractures on the medium- to long-term survival and quality of life of the elderly patient is confirmed. (www.actabiomedica.it)
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Affiliation(s)
| | - Marko Tomic
- a:1:{s:5:"en_US";s:22:"Università di Trieste";}.
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Canton G, Sborgia A, Maritan G, Fattori R, Roman F, Tomic M, Morandi MM, Murena L. Fibula fractures management. World J Orthop 2021; 12:254-269. [PMID: 34055584 PMCID: PMC8152440 DOI: 10.5312/wjo.v12.i5.254] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/01/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
Isolated distal fibula fractures represent the majority of ankle fractures. These fractures are often the result of a low-energy trauma with external rotation and supination mechanism. Diagnosis is based on clinical signs and radiographic exam. Stress X-rays have a role in detecting associated mortise instability. Management depends on fracture type, displacement and associated ankle instability. For simple, minimally displaced fractures without ankle instability, conservative treatment leads to excellent results. Conservative treatment must also be considered in overaged unhealthy patients, even in unstable fractures. Surgical treatment is indicated when fracture or ankle instability are present, with several techniques described. Outcome is excellent in most cases. Complications regarding wound healing are frequent, especially with plate fixation, whereas other complications are uncommon.
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Affiliation(s)
- Gianluca Canton
- Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy
| | - Andrea Sborgia
- Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy
| | - Guido Maritan
- Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy
| | - Roberto Fattori
- Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy
| | - Federico Roman
- Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy
| | - Marko Tomic
- Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy
| | - Massimo Max Morandi
- Department of Orthopaedic Surgery, Louisiana State University Health Science Center, Shreveport, LA 71103, United States
| | - Luigi Murena
- Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy
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Murena L, Elleni A, De Luca A, Canton G. A rare case of subcutaneous traumatic index finger both extensor tendons rupture. Results of WALANT extensor digiti minimi transfer and literature review. Acta Biomed 2021; 92:e2021577. [PMID: 35604254 PMCID: PMC9437693 DOI: 10.23750/abm.v92is3.12579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/24/2022] [Indexed: 11/18/2022]
Abstract
Traumatic subcutaneous index finger both extensor tendons ruptures are rare injuries. Aim of the present paper is to review the literature about this uncommon lesion and to describe the case of 56 years old woman injured when her hand became stuck under a weight during a wrist hyperflexion movement. Surgical treatment was undertaken after 7 days. An extensor digiti minimi (EDM) tendon transfer and a Pulvertaft tenodesis on the index EDC to middle EDC using wide awake local anesthesia no tourniquet (WALANT) technique was performed. The advantage is to allow immediate visualization of active motion and confirmation of appropriate soft tissue tensioning. In our patient no complications were observed and an early rehabilitation program was started. The patient recovered full function at 2 months and resumed hear heavy labour working activity at 4 months.
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Affiliation(s)
| | - Alice Elleni
- a:1:{s:5:"en_US";s:66:"Cl ortopedica e traumatologica Università degli studi di trieste ";}.
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Canton G, Rasio N, Garlatti M, Ratti C, Kristan A, Murena L. Should age be a factor in treatment choice of periprosthetic Vancouver B2-B3 proximal femur fractures? A retrospective analysis of mortality and functional outcomes in elderly patients. Acta Biomed 2021; 92:e2021581. [PMID: 35604253 PMCID: PMC9437666 DOI: 10.23750/abm.v92is3.12581] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022]
Abstract
Background and aim of the work Revision Arthroplasty (RA) is considered the treatment of choice for periprosthetic femur fractures (PFF) presenting with a loose stem. In the elderly RA may be associated with high post-operative mortality and complications. The aim of this study is to compare mortality and functional outcomes of open reduction internal fixation (ORIF) and RA for B2-B3 PFF in the elderly. Methods The study population included 29 patients (>65 years) surgically treated for B2-B3 PFF at the Orthopedic and Traumatology Unit of Cattinara University Hospital in Trieste (Italy) between January 2015 and December 2019. 16 patients were treated with ORIF and 13 with RA. Mortality and functional outcomes were analyzed. Results In-hospital (6,25% vs 7,69%) and 3 months (6,25 vs 15,38%) mortality was higher in the RA group. Mortality rates were particularly high in the > 85-year-old patients within four months from RA treatment. One year (38,46% and 16,67%) and overall mortality (69,22% and 25%) was higher after ORIF. Average time to weight-bearing and ambulation was 2.6 and 5.25 months for ORIF patients and 1.3 and 2.4 months for RA. A correlation was found between delayed weight-bearing and overall mortality. Conclusions Age is a risk factor for short term mortality following RA. Patients >85 years of age could benefit from a less invasive procedure such as ORIF. Long term outcomes are generally better for patients who undergo RA but further studies are necessary to evaluate the risk-benefit ratio of RA treatment compared to ORIF in elderly patients.
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Affiliation(s)
- Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital — ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste, Italy
| | - Nicholas Rasio
- Orthopaedics and Traumatology Unit, Cattinara Hospital — ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste, Italy
| | - Mauro Garlatti
- Orthopaedics and Traumatology Unit, Cattinara Hospital — ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste, Italy
| | - Chiara Ratti
- Orthopaedics and Traumatology Unit, Cattinara Hospital — ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste, Italy
| | - Ante Kristan
- Traumatology Department, University Medical Centre Ljubljana (Slovenia), Department of Surgery, Faculty of Medicine, University of Ljubljana (SloveniaJ
| | - Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital — ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste, Italy
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Di Lenarda L, Ramella V, Ratti C, Grezar L, Canton G, Papa G, Murena L. Flexor hallucis longus transfer and composite anterolateral thigh fascio-cutaneous flap for reconstruction of massive chronic and infected Achilles tendon lesion. A case report and review of the literature. Acta Biomed 2021; 92:e2021578. [PMID: 35604249 PMCID: PMC9437678 DOI: 10.23750/abm.v92is3.12598] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022]
Abstract
Achilles tendon reconstruction with substance loss and infection in the overlying soft tissues is a challenge. There is no standardized treatment in literature for these cases. We describe a one-stage tendon reconstruction, using flexor hallucis longus (FHL) tendon transfer and an anterolateral thigh flap with vascularized fascia lata in a patient with re-rupture of the Achilles tendon, soft tissue infection and a tendon defect of 10 cm in length. The surgical procedure has had a successful outcome; patient has recovered normal gait, has recovered complete ankle range of motion with only a partial loss in plantar flexion of the big toe, without any loss in strength. No complications have emerged at follow-up. This technique is promising in treating large Achilles tendon defects with overlying soft tissue infection in a one-stage procedure.
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Affiliation(s)
- Luca Di Lenarda
- Orthopaedics and Traumatology Unit, Cattinara Hospital — Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste (Italy)
| | - Vittorio Ramella
- Plastic Surgery Unit, Cattinara Hospital — Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste (Italy)
| | - Chiara Ratti
- Orthopaedics and Traumatology Unit, Cattinara Hospital — Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste (Italy)
| | - Laura Grezar
- Plastic Surgery Unit, Cattinara Hospital — Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste (Italy)
| | - Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital — Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste (Italy)
| | - Giovanni Papa
- Plastic Surgery Unit, Cattinara Hospital — Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste (Italy)
| | - Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital — Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste (Italy)
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Benulič Č, Canton G, Rasio N, Murena L, Kristan A. Mechanobiology of indirect bone fracture healing under conditions of relative stability: a narrative review for the practicing clinician. Acta Biomed 2021; 92:e2021582. [PMID: 35604250 PMCID: PMC9437681 DOI: 10.23750/abm.v92is3.12584] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/31/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND AIM Mechanical influence on secondary fracture healing remains an incompletely understood phenomenon. This is of special importance in biological osteosynthesis, where stability is sacrificed for the sake of an optimal biological fracture environment. Under condition of relative stability, a wide range of biomechanical conditions can be achieved. Mechanobiology, which studies mechanical influences on biological systems has become a large, interdisciplinary field. The aim of this article is to present a comprehensive synthesis of the literature for the practicing clinician, with insights relevant to their practice of fracture care. METHODS The MEDLINE online database (Pubmed) was searched in September 2021 for relevant articles Results: The search provided 816 results, which were scanned by the first author by the title and abstract. With relevance to the research topic, 59 articles were chosen and read in detail. Another 70 articles were added by screening the references of relevant articles. A total of 129 articles were read and analysed Conclusions: Mechanical environment plays a crucial role in the fracture healing process. The definition of an optimal mechanical environment still evades us, due to the complexity of the problem. Computational models could replicate the complex mechanical environment of bone healing in humans but require detailed knowledge of mechano-transduction and material properties of healing tissues. The literature reminds us of the importance of adequate stiffness of constructs used under conditions of relative stability. Hopefully, further research in this field will result in not only empirical but more accurate and evidence-based assessments of osteosynthesis fixations.
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Affiliation(s)
- Črt Benulič
- Traumatology Department, University Medical Centre Ljubljana, Slovenia
| | - Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital — ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste, Italy
| | - Nicholas Rasio
- Orthopaedics and Traumatology Unit, Cattinara Hospital — ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste, Italy
| | - Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital — ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste, Italy
| | - Anže Kristan
- Traumatology Department, University Medical Centre Ljubljana, Slovenia,Department of Surgery, Faculty of Medicine, University of Ljubljana, Slovenia
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Canton G, Fattori R, Pinzani E, Monticelli L, Ratti C, Murena L. Prevention of postoperative surgical wound complications in ankle and distal tibia fractures: results of Incisional Negative Pressure Wound Therapy. Acta Biomed 2020; 91:e2020006. [PMID: 33559636 PMCID: PMC7944683 DOI: 10.23750/abm.v91i14-s.10784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK complications in surgical wound healing represent the main postoperative complication in ankle and distal tibia fractures. Whereas the use of Incisional Negative Pressure Wound Therapy (INPWT) is recognized to have a role in wound complications prevention in prosthetic surgery, literature about its use in trauma surgery is scarce. The aim of this study was to compare the effectiveness of INWPT with a conventional dressing in order to prevent surgical wound complications in ankle and distal tibia fractures. METHODS The study population included patients over 65 years as well as patients under 65 years considered at risk for wound complications (smokers, obese, affected by diabetes), who underwent ORIF for bi/tri-malleolar ankle fractures or distal tibia (pilon) fractures. After surgery, patients were randomized to receive a conventional dressing or INPWT. Complications in surgical wound healing were classified in major (requiring surgical intervention) and minor complications. RESULTS 65 patients were included in the study. The rate of minor and major complications between the two groups was not significantly different, although a positive trend towards a lower minor complications rate was noted in the INPWT group (12.6% vs 34.7%). No complications or complaints were reported for the INPWT device. CONCLUSIONS INPWT proved to be safe, well-tolerated and showed promising results in preventing surgical wound complications in ankle and distal tibia fractures.
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Affiliation(s)
- Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy).
| | | | - Emanuele Pinzani
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy).
| | - Luca Monticelli
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy).
| | - Chiara Ratti
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy).
| | - Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy).
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Benulic C, Canton G, Gril I, Murena L, Kristan A. Management of acute bone loss following high grade open tibia fractures. Acta Biomed 2020; 91:e2020012. [PMID: 33559616 PMCID: PMC7944690 DOI: 10.23750/abm.v91i14-s.10890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/19/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Optimal treatment for acute post-traumatic bone loss in the tibia remains unclear. Distraction osteogenesis (DO) and induced membrane technique (IM) have been established as the mainstays of treatment. Aim of this article is to review the current evidence regarding the use of these two methods. METHODS A review of the MEDLINE database was performed with strict inclusion and exclusion criteria focusing on treatment of the acute bone loss after open tibia fractures with DO and IM. Bone union rate was taken as the primary outcome and infection rate as secondary outcome. RESULTS Four studies out of 78 on the use of the DO and three studies out of 18 on the use of the IM technique matched the inclusion criteria. Union rate in the DO group ranged between 92% and 100%, with infection rates between 0 and 4%. In the IM group, union was reached in 42% to 100% of cases, with septic complications occurring in 12% to 43%. Differences in union rate and infection rate reached statistical significance. DISCUSSION We found a considerable evidence gap regarding treatment of bone loss in high grade open tibia fractures. The limitations of our study prevented us from drawing clear causative conclusions on the results. Although our study points to higher union rates and lower infection rate with the use of the DO technique, the results remain preliminary and further high-level evidence is needed to establish the roles of DO and IM in treatment of acute bone loss in open tibia fractures.
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Affiliation(s)
- Crt Benulic
- Department of traumatology, UMC Ljubljana, Slovenia.
| | - Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy).
| | - Iztok Gril
- Department of traumatology, UMC Ljubljana, Slovenia.
| | - Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy).
| | - Anze Kristan
- Department of traumatology, UMC Ljubljana, Slovenia.
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Benazzo F, Rossi SMP, Maniscalco P, Moretti B, Vaienti E, Ruggieri P, Massè A, Medici A, Formica A, Di Maggio B, Caiaffa V, Mosconi M, Murena L, D'Angelo F, Belluati A, Mazza EL, Rivera F, Castelli A, Ghiara M, Rosolani M, Cioffi R, Pezzella R, Scaravilli G, Bove G, Stissi P, Mazzacane M, Quattrini F, Ciatti C, Trovarelli G, Pala E, Angelini A, Sanna F, Nonne D, Colombelli A, Raggini F, Puzzo A, Canton G, Maritan G, Iuliano A, Randelli P, Solarino G, Moretti L, Vicenti G, Garofalo N, Nappi V, Ripanti S, Chinni C, Pogliacomi F, Visigalli A, Bini N, Aprato A, Perticarini L. The orthopaedic and traumatology scenario during Covid-19 outbreak in Italy: chronicles of a silent war. Int Orthop 2020; 44:1453-1459. [PMID: 32591960 PMCID: PMC7319215 DOI: 10.1007/s00264-020-04637-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND From February 21, the day of hospitalisation in ICU of the first diagnosed case of Covid-19, the social situation and the hospitals' organisation throughout Italy dramatically changed. METHODS The CIO (Club Italiano dell'Osteosintesi) is an Italian society devoted to the study of traumatology that counts members spread in public and private hospitals throughout the country. Fifteen members of the CIO, Chairmen of 15 Orthopaedic and Trauma Units of level 1 or 2 trauma centres in Italy, have been involved in the study. They were asked to record data about surgical, outpatients clinics and ER activity from the 23rd of February to the 4th of April 2020. The data collected were compared with the data of the same timeframe of the previous year (2019). RESULTS Comparing with last year, overall outpatient activity reduced up to 75%, overall Emergency Room (ER) trauma consultations up to 71%, elective surgical activity reduced up to 100% within two weeks and trauma surgery excluding femoral neck fractures up to 50%. The surgical treatment of femoral neck fractures showed a stable reduction from 15 to 20% without a significant variation during the timeframe. CONCLUSIONS Covid-19 outbreak showed a tremendous impact on all orthopaedic trauma activities throughout the country except for the surgical treatment of femoral neck fractures, which, although reduced, did not change in percentage within the analysed timeframe.
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Affiliation(s)
- Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
- Clinica Ortopedica e Traumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Università degli Studi di Pavia, Pavia, Italy
| | - Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.
| | - Pietro Maniscalco
- Orthopaedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Biagio Moretti
- UOC Ortopedia E Traumatologia- Azienda Ospedaliero-Universitaria, "Policlinico" Universita, Bari, Italy
| | - Enrico Vaienti
- Clinica Ortopedica, Azienda Ospedaliero - Universitaria di Parma, Parma, Italy
| | - Pietro Ruggieri
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, Padua, PD, Italy
| | - Alessandro Massè
- School of Medicine Clinica Ortopedica e Traumatologica I Città della Salute e della Scienza - C.T.O, University of Torino, Torino, Italy
| | | | - Alessandro Formica
- UOC Ortopedia e Traumatologia, Az. Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Bruno Di Maggio
- Orthopaedic and Traumatology Unit, A.S.L. Caserta, Piedimonte Matese Hospital, Piedimonte Matese, Italy
| | - Vincenzo Caiaffa
- Orthopedics and Trauma Department, Di Venere Hospital, Bari, Italy
| | - Mario Mosconi
- Clinica Ortopedica e Traumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Università degli Studi di Pavia, Pavia, Italy
| | - Luigi Murena
- SC (UCO) Clinica Ortopedica e Traumatologica, Azienda sanitaria universitaria Giuliano Isontina (ASU GI), Trieste, Italy
| | - Fabio D'Angelo
- Division of Orthopaedics and Traumatology, ASST dei Sette Laghi, Department of Biotechnologies and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - Alberto Belluati
- Orto-Trauma Dept., Ospedale Santa Maria delle Croci Ravenna, Ravenna, Italy
| | - Emilio Luigi Mazza
- Centro Specialistico Ortopedico Traumatologico Gaetano Pini - CTO (ASST Pini-CTO), Milan, MI, Italy
| | - Fabrizio Rivera
- Orthopaedics and Trauma Department, SS Annunziata Hospital, Savigliano, CN, Italy
| | - Alberto Castelli
- Clinica Ortopedica e Traumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Ghiara
- Clinica Ortopedica e Traumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Rosolani
- Clinica Ortopedica e Traumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Gabriele Scaravilli
- Orthopaedic and Traumatology Unit, A.S.L. Caserta, Piedimonte Matese Hospital, Piedimonte Matese, Italy
| | - Giovanni Bove
- Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy
| | - Placido Stissi
- Division of Orthopaedics and Traumatology, ASST dei Sette Laghi, Department of Biotechnologies and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - Michael Mazzacane
- Division of Orthopaedics and Traumatology, ASST dei Sette Laghi, Department of Biotechnologies and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - Fabrizio Quattrini
- Orthopaedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Corrado Ciatti
- Orthopaedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Giulia Trovarelli
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, Padua, PD, Italy
| | - Elisa Pala
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, Padua, PD, Italy
| | - Andrea Angelini
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, Padua, PD, Italy
| | - Francesco Sanna
- Orthopaedics and Trauma Department, SS Annunziata Hospital, Savigliano, CN, Italy
| | - Daniela Nonne
- Orthopaedics and Trauma Department, SS Annunziata Hospital, Savigliano, CN, Italy
| | - Andrea Colombelli
- Orto-Trauma Dept., Ospedale Santa Maria delle Croci Ravenna, Ravenna, Italy
| | - Filippo Raggini
- Orto-Trauma Dept., Ospedale Santa Maria delle Croci Ravenna, Ravenna, Italy
| | - Agnese Puzzo
- Orto-Trauma Dept., Ospedale Santa Maria delle Croci Ravenna, Ravenna, Italy
| | - Gianluca Canton
- SC (UCO) Clinica Ortopedica e Traumatologica, Azienda sanitaria universitaria Giuliano Isontina (ASU GI), Trieste, Italy
| | - Guido Maritan
- SC (UCO) Clinica Ortopedica e Traumatologica, Azienda sanitaria universitaria Giuliano Isontina (ASU GI), Trieste, Italy
| | - Angela Iuliano
- Centro Specialistico Ortopedico Traumatologico Gaetano Pini - CTO (ASST Pini-CTO), Milan, MI, Italy
| | - Pietro Randelli
- Centro Specialistico Ortopedico Traumatologico Gaetano Pini - CTO (ASST Pini-CTO), Milan, MI, Italy
| | - Giuseppe Solarino
- UOC Ortopedia E Traumatologia- Azienda Ospedaliero-Universitaria, "Policlinico" Universita, Bari, Italy
| | - Lorenzo Moretti
- UOC Ortopedia E Traumatologia- Azienda Ospedaliero-Universitaria, "Policlinico" Universita, Bari, Italy
| | - Giovanni Vicenti
- UOC Ortopedia E Traumatologia- Azienda Ospedaliero-Universitaria, "Policlinico" Universita, Bari, Italy
| | - Nunzia Garofalo
- Orthopedics and Trauma Department, Di Venere Hospital, Bari, Italy
| | - Vittorio Nappi
- Orthopedics and Trauma Department, Di Venere Hospital, Bari, Italy
| | - Simone Ripanti
- UOC Ortopedia e Traumatologia, Az. Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Carmela Chinni
- UOC Ortopedia e Traumatologia, Az. Ospedaliera San Giovanni Addolorata, Rome, Italy
| | | | - Alberto Visigalli
- Clinica Ortopedica, Azienda Ospedaliero - Universitaria di Parma, Parma, Italy
| | - Nathalie Bini
- School of Medicine Clinica Ortopedica e Traumatologica I Città della Salute e della Scienza - C.T.O, University of Torino, Torino, Italy
| | - Alessandro Aprato
- School of Medicine Clinica Ortopedica e Traumatologica I Città della Salute e della Scienza - C.T.O, University of Torino, Torino, Italy
| | - Loris Perticarini
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
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Grassi FA, Alberio R, Ratti C, Surace MF, Piazza P, Messinese P, Saccomanno MF, Maccauro G, Murena L. Shoulder arthroplasty for proximal humerus fractures in the elderly: The path from Neer to Grammont. Orthop Rev (Pavia) 2020; 12:8659. [PMID: 32913595 PMCID: PMC7459385 DOI: 10.4081/or.2020.8659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 11/22/2022] Open
Abstract
Shoulder replacement is indicated for the surgical treatment of proximal humeral fractures in elderly patients, when severe comminution and osteoporosis jeopardize the chances of success of any fixation technique. Two different implants are available for this purpose: anatomical hemiarthroplasty (HA) and reverse total shoulder arthroplasty (RTSA). HA for fractures was popularized by Charles Neer in the ‘50s and for several decades remained the only reliable implant for these injuries. However, many authors reported inconsistent results with HA as a consequence of the high rate of tuberosity and rotator cuff failure. In 1987, Paul Grammont designed the first successful RTSA, which was the end result of a long thought process on functional surgery of the shoulder. This implant was initially used to treat cuff tear arthropathy and shoulder pseudoparalysis, but indications have gradually expanded with time. Since RTSA does not rely on a functional cuff for shoulder elevation, it was felt that results in fractures could be improved by this prosthesis. In this study, the salient features of these implants are described to understand the rationale behind both approaches and highlight their pros and cons. Several clinical studies comparing HA vs RTSA for proximal humeral fractures have been published during the last two decades. A literature review is carried out to analyze and compare outcomes of both implants, analyzing clinical results, radiographic findings and complications. The final goal is to provide an overview of the different factors to consider for making a choice between these two prostheses.
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Affiliation(s)
- Federico A Grassi
- Orthopaedic and Trauma Unit, Department of Health Sciences, University Hospital University of East Piedmont, Novara
| | - Riccardo Alberio
- Orthopaedic and Trauma Unit, Department of Health Sciences, University Hospital University of East Piedmont, Novara
| | - Chiara Ratti
- Orthopaedic and Trauma Unit, Department of Medicine, Surgery and Health Sciences, University Hospital University of Trieste
| | - Michele F Surace
- Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria, Varese
| | - Piero Piazza
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piermarco Messinese
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Giulio Maccauro
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Murena
- Orthopaedic and Trauma Unit, Department of Medicine, Surgery and Health Sciences, University Hospital University of Trieste
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Murena L, Ratti C, Maritan G, Rasio N, Grandesso M, Barbati G, Cusitore M, Canton G. Predictive value of valgus head-shaft angle in identifying Neer 4-part proximal humerus fractures. A radiographic and CT-scan analysis of 120 cases. Acta Biomed 2020; 91:217-223. [PMID: 32555100 PMCID: PMC7944809 DOI: 10.23750/abm.v91i4-s.9717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: Understanding the fracture morphology and its relation to the expected outcome and risk of complications is fundamental for proximal humerus fractures (PHFs) management. Most Neer 3- and 4-part fractures may deserve surgical treatment. Unfortunately, plain x-rays may not be able to differentiate between a 3- or 4-part fractures unless an axillary or analogue projection is carried out. Aim of the present study is to evaluate whether a high valgus head-shaft angle degree is predictive of a Neer 4-part rather than a 3-part fracture. Methods: The study included 120 3-(75 cases) and 4-(45 cases) part PHFs (valgus displaced in 98 cases), M:F ratio = 1:2.6, mean age 65.7 years, classified on CT scan images. The humeral head shaft angle was calculated on AP x-rays and statistically correlated with 3 and 4-part fractures to identify values predictive of 4-part fracture. Results: Valgus head/shaft angle was significantly higher in 4-part fractures, especially in the valgus displaced group (p < 0.001). A cutoff value of 168.5° was identified as predictive of a 4-part fracture with a sensibility of 74% and specificity of 78%. Increasing by 1 degree the humeral head-shaft angle, the chance to have a 4-part fracture increases of 3% in the whole population and of 11% in the valgus sub-group. Conclusion: The severity of PHF can be predicted analysing valgus head shaft angle on AP x-rays with a sensibility of 74% and specificity of 78% in identifying a 4-part fracture with a cutoff value of 168.5°.
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Affiliation(s)
- Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Chiara Ratti
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Guido Maritan
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Nicholas Rasio
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Maria Grandesso
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Giulia Barbati
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Marcello Cusitore
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
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Murena L, Ratti C, Maritan G, Rasio N, Pistorio S, Cusitore M, Canton G. Epidemiology and risk factors for contralateral proximal femur fracture: a single center retrospective cohort study on 1022 patients. Acta Biomed 2020; 91:115-121. [PMID: 32555086 PMCID: PMC7944826 DOI: 10.23750/abm.v91i4-s.9716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/23/2022]
Abstract
Summary. BACKGROUND AND AIM OF THE WORK Given the high impact of proximal femur fractures (PFFs) on elderly patients and healthcare systems, the burden of contralateral PFFs might be overlooked. Aim of the study is to analyze the epidemiology and risk factors of contralateral proximal femur fractures. Secondary aim is to detect mortality rate differences in first and contralateral PPF. METHODS A population of 1022 patients admitted for proximal femur fractures in a single center was studied. Prevalence at admission as well as incidence of contralateral PFF during a 18 to 36 months follow-up was recorded. Epidemiology of contralateral PFF was studied recording number of events, time to second fracture and fracture type. Mortality at 1-year was recorded for all patients and compared between first and second PFF patients. Comorbidities, pharmacotherapy, BMI, MNA and SPMSQ were studied as possible risk factors. RESULTS Prevalence and incidence of contralateral PFFs were 9.4% and 6.5% respectively. Median time to second fracture was 12 months. One-year mortality of contralateral PFFs was significantly lower (20.5% vs 25.1%, p 0.003) than first PFF. Contralateral fracture patients had a significantly lower BMI and a significantly lower proportion of malnourished patients. CONCLUSIONS The incidence and prevalence of contralateral PFFs is relevant. Mortality of contralateral PFFs results to be lower than first PFF. Patients with higher BMI and malnourished patients have a lower risk of contralateral PFF.
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Affiliation(s)
- Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Chiara Ratti
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Guido Maritan
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Nicholas Rasio
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Sabrina Pistorio
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Marcello Cusitore
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
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Murena L, Canton G, Ratti C, Hoxhaj B, Giraldi G, Surace MF, Grassi FA. Indications and results of osteosynthesis for proximal humerus fragility fractures in elderly patients. Orthop Rev (Pavia) 2020; 12:8559. [PMID: 32391138 PMCID: PMC7206366 DOI: 10.4081/or.2020.8559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/13/2020] [Indexed: 02/08/2023] Open
Abstract
Proximal humerus fractures (PHF) are common injuries in the elderly population. Conservative treatment is indicated for undisplaced and stable fractures, which account for almost 80% of the cases. More complex fracture patterns might need surgery, with a wide variety of indication criteria and surgical techniques described in the literature. Surgical treatment should be reserved for patients in good clinical conditions, autonomous in daily living activities and able to adhere to postoperative rehabilitation protocols. In the elderly population with severe osteoporosis, cognitive impairment and clinical comorbidities, the risk of surgical failures is high. In these patients, the choice between surgical and conservative treatment, as well as for the type of procedure, is even more difficult, with no general consensus in the literature. Final indication is usually conditioned by surgeon’s experience and preference. Two independent reviewers (B.H and G.G) independently extracted studies on proximal humeral fractures. All selected studies were screened independently (B.H and G.G) based on title and abstract. Then the full text of any article that either judged potentially eligible was acquired and reviewed again. Any disagreement was resolved by discussing the full text manuscripts. Aim of the present paper is to review the literature about indications and results of osteosynthesis for proximal humerus fragility fractures in the elderly population.
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Affiliation(s)
- Luigi Murena
- Orthopedics and Trauma Unit - ASUGI, Department of Medicine, Surgery and Health Sciences, University of Trieste
| | - Gianluca Canton
- Orthopedics and Trauma Unit - ASUGI, Department of Medicine, Surgery and Health Sciences, University of Trieste
| | - Chiara Ratti
- Orthopedics and Trauma Unit - ASUGI, Department of Medicine, Surgery and Health Sciences, University of Trieste
| | - Bramir Hoxhaj
- Orthopedics and Trauma Unit - ASUGI, Department of Medicine, Surgery and Health Sciences, University of Trieste
| | - Gioia Giraldi
- Orthopedics and Trauma Unit - ASUGI, Department of Medicine, Surgery and Health Sciences, University of Trieste
| | - Michele Francesco Surace
- Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria, Varese
| | - Federico Alberto Grassi
- Orthopedic and Trauma Unit, University Hospital "Maggiore della Carità", Department of Health Sciences, University of East Piedmont, Novara, Italy
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Kostoris F, Addevico F, Murena L, Scaglione M, Poggetti A. Proposal of a New Dynamic Distraction Device to Treat Complex Periarticular Fractures of the Metacarpophalangeal Joint of Long Finger. Hand (N Y) 2020; 15:87-91. [PMID: 30015515 PMCID: PMC6966295 DOI: 10.1177/1558944718787859] [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] [Indexed: 11/17/2022]
Abstract
Background: Complex periarticular fractures of the metacarpophalangeal joint (MCPJ) are often challenging to treat. Conservative and operative treatments are often burdened with stiffness, loss of function, and poor clinical outcome. These phenomena could be a direct consequence of long period of immobilization. To promote a short time of immobilization and a quick return to daily activities, it is mandatory to stabilize the fracture maintaining the active range of motion (AROM) of the ray. A simple solution is to reduce the fragments by means of dynamic ligamentotaxis. The authors propose a new dynamic distraction device (DDD) for the MCPJ. Methods: The DDD for the MCPJ was made of Kirschner wires bent and connected to counteract dislocation forces and to allow mobilization of the joint. The DDD was tested on a cadaver model under a simulated load in physiological conditions, and also in metacarpal and proximal phalanx (P1) fracture patterns. The effectiveness of the device was evaluated under fluoroscopy. Results: The data showed that DDD is able to achieve fracture reduction through ligamentotaxis and primary fragments stability and to avoid secondary dislocation during AROM of complex periarticular fractures of the MCPJ. Conclusions: The frame could be an alternative option to treat periarticular fractures of the MCPJ. The DDD implant has several advantages: It is time efficient because assembly and application take only few minutes. Furthermore, it is very versatile; indeed, it can be used in all metacarpal and phalanx bones, even in the central rays.
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Affiliation(s)
- Francesco Kostoris
- Azienda Sanitaria Universitaria
Integrata di Trieste, Italy,Francesco Kostoris, Orthopaedics
Traumatology Unit, Cattinara Hospital, Azienda Sanitaria Universitaria Integrata
di Trieste, Strada di Fiume 447, Trieste 34149, Italy.
| | | | - Luigi Murena
- Azienda Sanitaria Universitaria
Integrata di Trieste, Italy
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Murena L, Maritan G, Concina C, Scamacca V, Ratti C, Canton G. Fracture of Cobalt-Crome Modular Neck in Total Hip Arthroplasty. Acta Biomed 2019; 90:187-191. [PMID: 31821307 PMCID: PMC7233721 DOI: 10.23750/abm.v90i12-s.8941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 10/25/2019] [Indexed: 02/08/2023]
Abstract
Despite the advantages of modular total hip arthroplasty in terms of neck version, offset and length precise reproduction, titanium necks breakage became a concern. Consequently, titanium has been replaced by cobalt-chrome (Co-Cr). However, four cases of Co-Cr modular neck breakage have been reported in the literature. In the present paper, two cases of Co-Cr modular neck fractures are described together with a literature review. The aim of this work is to discuss the risk factors and characteristics of this rare complication. We described two cases of fracture of long varus Co-Cr modular femoral neck connected with cementless press-fit stem. Some risk factors, such as long varus type of modular neck, overweight and/or high demanding physical activity, might have contributed to implant failure.
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Affiliation(s)
- Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
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Canton G, Giraldi G, Dussi M, Ratti C, Murena L. Osteoporotic distal femur fractures in the elderly: peculiarities and treatment strategies. Acta Biomed 2019; 90:25-32. [PMID: 31821280 PMCID: PMC7233703 DOI: 10.23750/abm.v90i12-s.8958] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 10/25/2019] [Indexed: 11/23/2022]
Abstract
Distal femur fractures account for 4-6% of osteoporosis related fractures of the femur in the elderly population. They represent a relevant cause of morbidity and mortality in the geriatric population with a reported 1-year mortality reaching 30%. Non-displaced fractures or even displaced fractures in patients with high operative risk can be treated conservatively. However, operative treatment is the most widely accepted management option for displaced fractures. The advantage resides in early mobilization and weight-bearing, reducing risks related with a prolonged immobilization when compared with conservative treatment. On the other hand, the intrinsic difficulty of fixing an osteoporotic bone is a major concern. The presence of osteosynthesis devices or prosthetic implants in the femur can make the surgical treatment more challenging, sometimes limiting therapeutic options. Aim of the present paper is to review the most recent literature about osteoporotic distal femur fractures in the elderly, including periprosthetic and other hardware related fractures, to highlight current evidence on management options and related results as a guide for the daily clinical practice.
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Affiliation(s)
- Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste, Italy..
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Canton G, Fazzari F, Fattori R, Ratti C, Murena L. Post-operative periprosthetic humeral fractures after reverse shoulder arthroplasty: a review of the literature. Acta Biomed 2019; 90:8-13. [PMID: 31821278 PMCID: PMC7233712 DOI: 10.23750/abm.v90i12-s.8974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 11/24/2022]
Abstract
Background and aim of the work: Post-operative periprosthetic shoulder fractures incidence is gradually raising due to aging of population and increasing of reverse total shoulder arthroplasty (RTSA). Management of this complication represents a challenge for the orthopedic surgeon. Aim of the present study is to critically review the recent literature about epidemiology, risk factors, diagnosis, management and outcome of post-operative periprosthetic humeral fractures occurring on RTSA. Methods: A systematic search of Embase, Medline and Pubmed was performed by two reviewers who selected the eligible papers favoring studies published in the last ten years. Epidemiology, risk factors, diagnostic features, clinical management and outcome of different techniques were all reviewed. Results: 31 studies including reviews, meta-analysis, case reports, clinical and biomechanical studies were selected. Conclusions: Correct clinical management requires adequate diagnosis and evaluation of risk factors. Conservative treatment is rarely indicated. Locking plate fixation and revision arthroplasty are both valuable treatment methods. Surgical technique should be chosen considering age and functional demand, comorbidities, fracture morphology and location, bone quality and stability of the implant. Given the correct indication all surgical treatment can lead to satisfactory clinical and radiographic results despite a relevant complication rate. (www.actabiomedica.it)
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Affiliation(s)
- Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy).
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Kostoris F, Bassini S, Longo E, Murena L. Carpal Tunnel Syndrome Associated with Bifid Median Nerve and Palmaris Profundus - Case Report and Literature Review. J Hand Surg Asian Pac Vol 2019; 24:238-242. [PMID: 31035882 DOI: 10.1142/s2424835519720123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The anatomic variations of the median nerve and of the muscles of the wrist have been widely reported in literature. It is essential for the surgeon to be familiar with these variations in order to avoid accidental injury to the nerve during surgery. We report a rare case of bifid median nerve accompanied by an anomalous tendon of palmaris profundus discovered during the surgical release of carpal tunnel. The transverse carpal ligament was dissected and the anomalous tendon was left in situ because any direct compression over the median nerve was noticed intraoperatively. The patient was evaluated one year postoperatively clinically and radiologically (with MRI). At the follow up the resolution of symptoms was complete and the sleep disturbance was solved. The patient achieved a postoperative QuickDASH score of 9.1 and a Michigan Hand Questionnaire outcome score of 90 points.
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Affiliation(s)
- Francesco Kostoris
- 1 Orthopaedics and Traumatology Unit, Cattinara Hospital, ASUITS, Trieste, Italy
| | - Stefania Bassini
- 1 Orthopaedics and Traumatology Unit, Cattinara Hospital, ASUITS, Trieste, Italy
| | - Emiliano Longo
- 1 Orthopaedics and Traumatology Unit, Cattinara Hospital, ASUITS, Trieste, Italy
| | - Luigi Murena
- 1 Orthopaedics and Traumatology Unit, Cattinara Hospital, ASUITS, Trieste, Italy
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Canton G, Haxhaj B, Fattori R, Murena L. Bent femoral intramedullary nail: a case report and review of the literature. Acta Biomed 2019; 90:187-191. [PMID: 30715023 PMCID: PMC6503421 DOI: 10.23750/abm.v90i1-s.8072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 11/23/2022]
Abstract
Intramedullary nailing is considered the gold standard technique for the treatment of femoral shaft fractures. A rare complication of this technique is nail bending after a new trauma. In these cases nail removal might be really challenging. The present paper provides a brief review of surgical techniques purposed in the literature for bent nail removal and describes a clinical case. (www.actabiomedica.it)
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Canton G, Moghnie A, Cleva M, Kostoris FM, Murena L. Dual mobility total hip arthroplasty in the treatment of femoral neck fractures: a retrospective evaluation at mid-term follow-up. Acta Biomed 2019; 90:98-103. [PMID: 30715006 PMCID: PMC6503413 DOI: 10.23750/abm.v90i1-s.8070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIM OF THE WORK Partial or total hip replacement is the method of choice for displaced femoral neck fractures (FNF) treatment. Dislocation is a major complication, accounting for about 3.8% of cases for hemiarthroplasty (HA) and 10% for total hip arthroplasty (THA). Dual-mobility (DM) socket in total hip arthroplasty showed a very low rate of dislocation in both primary and revision setting THA. Some literature reports show good results with low dislocation rates also in FNF treatment at short term follow-up. Aim of the study was to evaluate clinical and radiographic results of DM-THA in FNF treatment at mid-term follow up. METHODS Study population counted 31 implants in 30 patients treated with DM-THA for FNF between January 2010 and December 2012. Dislocation rate was identified, and HHS and OHS were completed. Twenty-four patients underwent also radiographic evaluation to assess cup integration and sings of loosening. RESULTS No episodes of hip dislocation nor intraprosthetic dislocation were found. Other postoperative complications were recorded in 9,67%. HHS and OHS showed a mean value of 81,22 and 37,37, respectively. There were no cases of clinical and radiographic signs of implant loosening. CONCLUSIONS The present study confirms the good clinical results, low complications and very low dislocation rate with DM THA for FNF treatment.
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Zanetti M, Gortan Cappellari G, Ratti C, Ceschia G, Murena L, De Colle P, Barazzoni R. Poor nutritional status but not cognitive or functional impairment per se independently predict 1 year mortality in elderly patients with hip-fracture. Clin Nutr 2018; 38:1607-1612. [PMID: 30217470 DOI: 10.1016/j.clnu.2018.08.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/23/2018] [Accepted: 08/25/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Hip fractures are strongly associated with mortality in the elderly. Studies investigating predisposing factors have suggested a negative impact of poor nutritional, cognitive and functional status on patient survival, however their independent prognostic impact as well as their interactions remain undefined. This study aimed to determine whether poor nutritional status independently predicts 1 year post-fracture mortality after adjusting for cognitive and functional status and for other clinically relevant covariates. METHODS 1211 surgically treated hip fracture elderly (age ≥ 65) patients consecutively admitted to the Orthopaedic Surgery Unit of the "Azienda Sanitaria Universitaria Integrata Trieste" (ASUITs), Cattinara Hospital, Trieste, Italy and managed by a dedicated orthogeriatric team. Pre-admission nutritional status was evaluated by Mini Nutritional Assessment (MNA) questionnaire, cognitive status by Short Portable Mental Status Questionnaire (SPMSQ) and functional status by Activity of Daily Living (ADL) questionnaire. All other clinical data, including comorbidities, type of surgery, post-operative complications (delirium, deep vein thrombosis, cardiovascular complications, infections, need for blood transfusions) were obtained by hospital clinical records and by mortality registry. RESULTS Poor nutritional status (defined as MNA ≤23.5), increased cognitive and functional impairment were all associated with 3-, 6- and 12 month mortality (p < 0.001). Both cognitive and functional impairment were associated with poor nutritional status (p < 0.001). Logistic regression analysis demonstrated that the association between nutritional status and 3-, 6- and 12- month mortality was independent of age, gender, comorbidities, type of surgery and post-operative complications as well as of cognitive and functional impairment (p < 0.001). In contrast, the associations between mortality and cognitive and functional impairment were independent (p < 0.001) of demographic (age, gender) and clinical covariates but not of malnutrition. Kaplan-Meier analysis showed a lower mean survival time (p < 0.001) in patients with poor nutritional status compared with those well-nourished. CONCLUSIONS In hip fracture elderly patients, poor nutritional status strongly predicts 1 year mortality, independently of demographic, functional, cognitive and clinical risk factors. The negative prognostic impact of functional and cognitive impairment on mortality is mediated by their association with poor nutritional status.
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Affiliation(s)
- Michela Zanetti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.
| | | | - Chiara Ratti
- Orthopaedic Surgery Division, ASUITs, Trieste, Italy
| | | | - Luigi Murena
- Orthopaedic Surgery Division, ASUITs, Trieste, Italy
| | | | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.
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Giannicola G, Bullitta G, Rotini R, Murena L, Blonna D, Iapicca M, Restuccia G, Merolla G, Fontana M, Greco A, Scacchi M, Cinotti G. Results of primary repair of distal triceps tendon ruptures in a general population: a multicentre study. Bone Joint J 2018; 100-B:610-616. [PMID: 29701103 DOI: 10.1302/0301-620x.100b5.bjj-2017-1057.r2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aims The aim of the study was to analyze the results of primary tendon reinsertion in acute and chronic distal triceps tendon ruptures (DTTRs) in the general population. Patients and Methods A total of 28 patients were operated on for primary DTTR reinsertions, including 21 male patients and seven female patients with a mean age of 45 years (14 to 76). Of these patients, 23 sustained an acute DTTR and five had a chronic injury. One patient had a non-simultaneous bilateral DTTR. Seven patients had DTTR-associated ipsilateral fracture or dislocation. Comorbidities were present in four patients. Surgical treatment included transosseous and suture-anchors reinsertion in 22 and seven DTTRs, respectively. The clinical evaluation was performed using Mayo Elbow Performance Score (MEPS), the modified American Shoulder and Elbow Surgeons Score (m-ASES), the Quick Disabilities of the Arm, Shoulder and Hand score (QuickDASH), and the Medical Research Council (MRC) Scale. Results A total of 27 patients (28 DTTRs) were available for review at a mean of 47.5 months (12 to 204). The mean MEPS, QuickDASH, and m-ASES scores were 94 (60 to 100), 10 (0 to 52), and 94 (58 to 100), respectively. Satisfactory results were observed in 26 cases (93%). Muscle strength was 5/5 and 4/5 in 18 and ten DTTRs, respectively. One patient with chronic renal failure experienced a traumatic rerupture of distal triceps. One patient (1 DTTR) experienced mild elbow stiffness. Conclusion Primary repair of acute and chronic DTTRs in a general population yields satisfactory results in the majority of patients with a low rerupture rate. Cite this article: Bone Joint J 2018;100-B:610-16.
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Affiliation(s)
- G Giannicola
- Department of Anatomical, Histological,Forensic Medicine and Orthopedics Sciences,Sapienza University of Rome -PoliclinicoUmberto I, Rome, Italy
| | - G Bullitta
- Department of Anatomical, Histological,Forensic Medicine and Orthopedics Sciences,Sapienza University of Rome - PoliclinicoUmberto I
| | - R Rotini
- Shoulder and Elbow Surgery Unit, RizzoliOrthopedic Institute, Bologna, Bologna, Italy
| | - L Murena
- Clinical University Department of Medical,Surgical and Health Sciences, Orthopaedicsand Traumatology Clinic, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste,Università degli Studi di Trieste, Trieste, Italy
| | - D Blonna
- Orthopedics and Traumatology Department,Mauriziano-Umberto I Hospital, University ofTurin Medical School, Turin, Italy
| | - M Iapicca
- Department of Orthopaedic Surgery, AziendaOspedaliera Papa Giovanni XXIII, Bergamo, Bergamo, Italy
| | - G Restuccia
- S.O.D. Orthopaedics and Traumatology, AOUPAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - G Merolla
- Unit of Shoulder and Elbow Surgery, D. CervesiHospital, Cattolica-AUSL della RomagnaAmbito Territoriale di Rimini, Cattolica, Italy
| | - M Fontana
- Department of Orthopaedics andTraumatology, Ospedale degli Infermi, Faenza, Italy
| | - A Greco
- Department of Orthopaedics andTraumatology, Ospedale San Salvatore, L' Aquila, Italy
| | - M Scacchi
- Department of Anatomical, Histological andForensic Medicine, and Orthopaedic Sciences,Sapienza University of Rome - PoliclinicoUmberto I, Rome, Italy
| | - G Cinotti
- Department of Anatomical, Histological andForensic Medicine, and Orthopaedic Sciences,Sapienza University of Rome - PoliclinicoUmberto I, Rome, Italy
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Murena L, Moretti A, Meo F, Saggioro E, Barbati G, Ratti C, Canton G. Predictors of cut-out after cephalomedullary nail fixation of pertrochanteric fractures: a retrospective study of 813 patients. Arch Orthop Trauma Surg 2018; 138:351-359. [PMID: 29273922 DOI: 10.1007/s00402-017-2863-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Cut-out is the most common mechanical complication of the osteosynthesis of pertrochanteric fractures. This complication determines a significant increase in morbidity in elderly patient. Cut-out is defined as the varus collapse of the femoral head-neck fragment with the extrusion of the cephalic screw. Surgical treatment of cut-out might lead to further complications, longer rehabilitation, increased social burden and healthcare system costs. The aim of the study is to identify the predictors of cut-out to prevent its occurrence. MATERIALS AND METHODS Study population included all patients affected by extracapsular fracture of the proximal femur who were admitted and treated with short cephalomedullary nailing at the Cattinara Hospital-ASUITS of Trieste between 2009 and 2014. A retrospective analysis of clinical and radiographic data was carried out and cut-out cases recorded. The data collected on the study population were analyzed to find an eventual correlation with the occurrence of cut-out. The independent variables were age, gender, side of the fracture, ASA class, Evans classification, nailing system, quality of reduction, TAD, CalTAD, and Parker ratio. RESULTS The study population counted 813 cases, with an F:M ratio of 4:1 and a mean age of 84.7 years. The cut-out was recorded in 18 cases (2.2%). There was no statistically significant association between cut-out and age, sex, side of fracture, ASA class, and nailing system. The Evans classification, the quality of reduction, the TAD, the CalTAD, and the Parker's ratio demonstrated a significant correlation at univariate analysis with cut-out. The results of multivariate analysis confirmed that TAD, Parker AP, and quality of reduction were independently significantly correlated to cut-out. CONCLUSION The results of the present study demonstrate that good quality of reduction and correct position of the lag screw are likely to decrease the risk of cut-out complication. A nomogram for cut-out prediction is proposed for clinical validation.
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Affiliation(s)
- Luigi Murena
- Department of medical surgical and health sciences of Trieste University, Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUITS, Strada di Fiume 447, 34149, Trieste, Italy
| | - Antonio Moretti
- Department of medical surgical and health sciences of Trieste University, Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUITS, Strada di Fiume 447, 34149, Trieste, Italy
| | - Francesca Meo
- Department of medical surgical and health sciences of Trieste University, Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUITS, Strada di Fiume 447, 34149, Trieste, Italy
| | - Enrico Saggioro
- Department of medical surgical and health sciences of Trieste University, Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUITS, Strada di Fiume 447, 34149, Trieste, Italy
| | - Giulia Barbati
- Department of medical surgical and health sciences of Trieste University, Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUITS, Strada di Fiume 447, 34149, Trieste, Italy
| | - Chiara Ratti
- Department of medical surgical and health sciences of Trieste University, Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUITS, Strada di Fiume 447, 34149, Trieste, Italy
| | - Gianluca Canton
- Department of medical surgical and health sciences of Trieste University, Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUITS, Strada di Fiume 447, 34149, Trieste, Italy.
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Kostoris F, Canton G, Longo E, Romano F, Murena L. Treatment of dorsal fracture-dislocation of the proximal interphalangeal joint using the Ligamentotaxor device: clinical and radiographic preliminary results. Acta Biomed 2017; 88:90-95. [PMID: 29083359 DOI: 10.23750/abm.v88i4 -s.6799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Fracture-dislocations of the proximal interphalangeal joint are complex injuries, often difficult to treat. Several treatment options have been described. Among them dynamic external fixation proved to be a safe technique leading to good results in many authors experience. The principles of this treatment are to avoid edema, prevent stiffness and tendon adhesions, promote joint remodelling and facilitate rehabilitation. The Ligamentotaxor® device is a simple and reproducible dynamic external fixation system that has been used in recent years to treat proximal interphalangeal joint fracture-dislocations, with favourable results. The aim of the present study is to evaluate our preliminary results with the Ligamentotaxor® device for treatment of these complex lesions. METHODS Four patients between December 2015 and January 2017 were treated at our institution with the Ligamentotaxor® device. Clinical and radiographic results were evaluated at mean 6 months follow-up. RESULTS Clinical results were meanly good and appeared to be comparable to most recent literature. Mean range of motion was 60,5°, mean extension lag 18,5°. Mean QuickDASH and Michigan Hand Questionnaire scored 21.6 and 72 respectively. Radiographic evaluation showed fracture healing in all cases. No relevant complications were noted. CONCLUSION The Ligamentotaxor® device is simple to implant, provides good stability and allows an immediate gentle active movement. According to present work the preliminary results are encouraging.
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Gortan Cappellari G, De Colle P, Concollato E, Bonato V, Ratti C, Zanetti M, Murena L, Toigo G, Barazzoni R. SUN-P056: Poor Nutritional Status but not Cognitive or Functional Impairment Per Se Independently Predict 3- and 6-Month Mortality N Elderly Hip-Fracture Patients. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30570-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Halib N, Perrone F, Cemazar M, Dapas B, Farra R, Abrami M, Chiarappa G, Forte G, Zanconati F, Pozzato G, Murena L, Fiotti N, Lapasin R, Cansolino L, Grassi G, Grassi M. Potential Applications of Nanocellulose-Containing Materials in the Biomedical Field. Materials (Basel) 2017; 10:ma10080977. [PMID: 28825682 PMCID: PMC5578343 DOI: 10.3390/ma10080977] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [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: 06/29/2017] [Revised: 08/11/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023]
Abstract
Because of its high biocompatibility, bio-degradability, low-cost and easy availability, cellulose finds application in disparate areas of research. Here we focus our attention on the most recent and attractive potential applications of cellulose in the biomedical field. We first describe the chemical/structural composition of cellulose fibers, the cellulose sources/features and cellulose chemical modifications employed to improve its properties. We then move to the description of cellulose potential applications in biomedicine. In this field, cellulose is most considered in recent research in the form of nano-sized particle, i.e., nanofiber cellulose (NFC) or cellulose nanocrystal (CNC). NFC is obtained from cellulose via chemical and mechanical methods. CNC can be obtained from macroscopic or microscopic forms of cellulose following strong acid hydrolysis. NFC and CNC are used for several reasons including the mechanical properties, the extended surface area and the low toxicity. Here we present some potential applications of nano-sized cellulose in the fields of wound healing, bone-cartilage regeneration, dental application and different human diseases including cancer. To witness the close proximity of nano-sized cellulose to the practical biomedical use, examples of recent clinical trials are also reported. Altogether, the described examples strongly support the enormous application potential of nano-sized cellulose in the biomedical field.
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Affiliation(s)
- Nadia Halib
- Department of Basic Sciences & Oral Biology, Faculty of Dentistry, Universiti Sains Islam Malaysia, Level 15, Tower B, Persiaran MPAJ, Jalan Pandan Utama, Kuala Lumpur 55100, Malaysia;.
| | - Francesca Perrone
- Department of Life Sciences, Cattinara University Hospital, Trieste University, Strada di Fiume 447, I-34149 Trieste, Italy.
| | - Maja Cemazar
- Institute of Oncology Ljubljana, Zaloska 2, SI-1000 Ljubljana, Slovenia.
| | - Barbara Dapas
- Department of Life Sciences, Cattinara University Hospital, Trieste University, Strada di Fiume 447, I-34149 Trieste, Italy.
| | - Rossella Farra
- Department of Engineering and Architecture, University of Trieste, Via Valerio 6/A, I-34127 Trieste, Italy.
| | - Michela Abrami
- Department of Engineering and Architecture, University of Trieste, Via Valerio 6/A, I-34127 Trieste, Italy.
| | - Gianluca Chiarappa
- Department of Engineering and Architecture, University of Trieste, Via Valerio 6/A, I-34127 Trieste, Italy.
| | - Giancarlo Forte
- Center for Translational Medicine, International Clinical Research Center, St. Anne's University Hospital, Pekarska 53, 656 91 Brno, Czech Republic.
| | - Fabrizio Zanconati
- Surgery and Health Sciences, Department of Medical, Cattinara Hospital, University of Trieste, I-34127 Trieste, Italy.
| | - Gabriele Pozzato
- Surgery and Health Sciences, Department of Medical, Cattinara Hospital, University of Trieste, I-34127 Trieste, Italy.
| | - Luigi Murena
- Surgery and Health Sciences, Department of Medical, Cattinara Hospital, University of Trieste, I-34127 Trieste, Italy.
| | - Nicola Fiotti
- Surgery and Health Sciences, Department of Medical, Cattinara Hospital, University of Trieste, I-34127 Trieste, Italy.
| | - Romano Lapasin
- Department of Engineering and Architecture, University of Trieste, Via Valerio 6/A, I-34127 Trieste, Italy.
| | - Laura Cansolino
- Department of Clinico-Surgical Sciences, Experimental Surgery Laboratory, University of Pavia and IRCCS S, Matteo Hospital Pavia, 27100 Pavia, Italy.
| | - Gabriele Grassi
- Department of Life Sciences, Cattinara University Hospital, Trieste University, Strada di Fiume 447, I-34149 Trieste, Italy.
| | - Mario Grassi
- Department of Engineering and Architecture, University of Trieste, Via Valerio 6/A, I-34127 Trieste, Italy.
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