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Cioffi A, Rovere G, Bosco F, Sinno E, Stramazzo L, Liuzza F, Ziranu A, Romeo M, Vigni GE, Galvano N, Maccauro G, Farsetti P, Rossello MI, Camarda L. Treatment of Scaphoid Non-Unions with Custom-Made 3D-Printed Titanium Partial and Total Scaphoid Prostheses and Scaphoid Interosseous Ligament Reconstruction. Healthcare (Basel) 2023; 11:3123. [PMID: 38132013 PMCID: PMC10743063 DOI: 10.3390/healthcare11243123] [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: 07/30/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Treatment of scaphoid fracture sequelae is still an unsolved problem in hand surgery. Custom-made 3D-printed titanium partial and total scaphoid prosthesis and scaphoid interosseous ligament reconstruction (SLIL) are performed in cases of non-union and isolated aseptic necrosis of the proximal scaphoid pole and when it is impossible to save the scaphoid bone, respectively. This study aims to evaluate the clinical, functional and radiographic results after these two prosthesis implantations. METHODS Between January 2019 and July 2020, nine partial and ten total scaphoid prostheses were implanted using custom-made 3D-printed titanium implants. Evaluation criteria included carpal height ratio (CHR), radioscaphoid angle, wrist extension and flexion, radial deviation and ulnar deviation of the wrist, grip strength and pinch strength, Visual Analogue Scale (VAS), the Disabilities of Arm, Shoulder, and Hand (DASH) score, and the Patient-Rated Wrist Evaluation (PRWE). RESULTS Clinical, functional, and radiographic improvements were found in all outcomes analyzed for both patient groups. The VAS pain scale obtained the most remarkable improvement at the one-year follow-up. The results of the DASH scores and the PRWE were good, with a great rate of patient satisfaction at the end of the follow-up. SLIL reconstruction also provided excellent stability and prevented a mid-carpal bone collapse in the short- and medium-term follow-up. CONCLUSIONS A custom-made 3D-printed titanium partial or total scaphoid prosthesis is a viable solution for patients with scaphoid non-union and necrosis or complete scaphoid destruction in whom previous conservative or surgical treatment has failed.
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Affiliation(s)
- Alessio Cioffi
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (A.C.); (L.S.); (M.R.); (G.E.V.); (N.G.)
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.R.); (F.L.); (A.Z.); (G.M.)
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, 10126 Turin, Italy;
| | - Ennio Sinno
- Orthopaedic and Traumatology Department, S. Spirito Hospital, 00193 Rome, Italy;
| | - Leonardo Stramazzo
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (A.C.); (L.S.); (M.R.); (G.E.V.); (N.G.)
| | - Francesco Liuzza
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.R.); (F.L.); (A.Z.); (G.M.)
| | - Antonio Ziranu
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.R.); (F.L.); (A.Z.); (G.M.)
| | - Michele Romeo
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (A.C.); (L.S.); (M.R.); (G.E.V.); (N.G.)
| | - Giulio Edoardo Vigni
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (A.C.); (L.S.); (M.R.); (G.E.V.); (N.G.)
| | - Nicolò Galvano
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (A.C.); (L.S.); (M.R.); (G.E.V.); (N.G.)
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.R.); (F.L.); (A.Z.); (G.M.)
| | - Pasquale Farsetti
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Mario Igor Rossello
- Hand Surgery Department “Renzo Mantero”, Ospedale San Paolo, 17100 Savona, Italy;
| | - Lawrence Camarda
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (A.C.); (L.S.); (M.R.); (G.E.V.); (N.G.)
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Stramazzo L, Rovere G, Cioffi A, Vigni GE, Galvano N, D’Arienzo A, Letizia Mauro G, Camarda L, D’Arienzo M. Peri-Implant Distal Radius Fracture: Proposal of a New Classification. J Clin Med 2022; 11:jcm11092628. [PMID: 35566755 PMCID: PMC9105785 DOI: 10.3390/jcm11092628] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 02/01/2023] Open
Abstract
A peri-implant fracture near the volar plate of the distal radius represents a rarity and can be associated with a mechanical failure of the devices. A literature review was conducted including all fractures that occurred around a volar wrist plate, which could be associated with an ulna fracture. All articles published until December 2021 were considered according to the guidelines presented in the PRISMA Statement. The search was conducted with the PubMed electronic database, Cochrane Database of Systematic Reviews, Medline, Embase, and Google Scholar. Only nine cases of these fractures were reported in the literature. The causes could be due to delayed union/non-union of the old fracture after low energy traumas, high energy trauma in patients with poor bone quality, or hardware mechanical failure. Furthermore, the literature review of peri-implant radius fracture shows different level of radius fracture and types of implant failure. In accordance with these different cases, a new classification of peri-implant fracture of the distal radius is proposed.
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Affiliation(s)
- Leonardo Stramazzo
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (L.S.); (A.C.); (G.E.V.); (N.G.); (M.D.)
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Alessio Cioffi
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (L.S.); (A.C.); (G.E.V.); (N.G.); (M.D.)
| | - Giulio Edoardo Vigni
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (L.S.); (A.C.); (G.E.V.); (N.G.); (M.D.)
| | - Nicolò Galvano
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (L.S.); (A.C.); (G.E.V.); (N.G.); (M.D.)
| | - Antonio D’Arienzo
- Department of Orthopaedic Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Giulia Letizia Mauro
- Department of Physical Medicine and Rehabilitation, University of Palermo, 90133 Palermo, Italy;
| | - Lawrence Camarda
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (L.S.); (A.C.); (G.E.V.); (N.G.); (M.D.)
- Correspondence:
| | - Michele D’Arienzo
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (L.S.); (A.C.); (G.E.V.); (N.G.); (M.D.)
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Scaravilli G, Mercurio J, Grazioli A, Gioia C, D’Arienzo A, Toro G, Galvano N, Monteleone G, Battaglini G, Di Santo F, Sepe S, Pagliuca S, Cesarano E, Mastrobuono G, Italiano M, D’Arienzo M, Maniscalco P, Ciatti C, Di Maggio B. Preliminary report in treatment of proximal humeral fracture with closed reduction and DOS external fixation System: a multicentric study. Acta Biomed 2022; 93:e2021494. [PMID: 35546021 PMCID: PMC9171885 DOI: 10.23750/abm.v93i2.11924] [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: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 11/18/2022]
Abstract
Introduction: Proximal humerus fractures are the seventh most frequent fracture in adults, and the third in patients over 65 years old, 5.7% of whole diagnosed fractures. Most of these fractures can be treated conservatively and achieve good results. However, more and more frequently we are confronted with dislocated and multifragmentary fractures, and with elderly and high functional demanding patients. In patients with osteoporosis and poor general conditions external fixation can be performed as rapid and mininvasive procedure with good outcome and low complication rates. The authors investigated the use of external fixation in the treatment of proximal humerus fractures. The objective is to demonstrate the effectiveness of this method as a valid alternative to other surgical techniques. Materials and Methods: A multicentre study was conducted at 7 hospitals in Italy from 2014 through 2018. We recruited all proximal humeral fractures (as classified with the Neer system) that are surgically treated with the same external fixator DOS, for a total of 110 patients, evaluated later with Oxford Shoulder Scale (OSS) and disability of the arm, shoulder and hand score (DASH) at 1, 2 and 6 months. Results: The patients have passed from a score of 75,37 in the first month to a score of 29,47in the sixth month at the DASH and from 47,02 to 27,71 at the OSS. The data further confirm the increased incidence of these fractures in women and in a mean age of about 65. Conclusions: Although it does not represent the golden standard in the treatment of fractures of the proximal humerus, in our experience the minimal osteosynthesis with external fixator turned out to be a very valid help especially for the simplicity and speed of the method, as well as for the exciting functional results. sometimes superior to other methods. The preliminary results from the different centers have confirmed this hypothesis. We hope this will be a good starting point for further in-depth studies. (www.actabiomedica.it)
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Affiliation(s)
| | - Jacopo Mercurio
- Orthopaedic and Trauma Unit, Piedimonte Matese Hospital, ASL CASERTA, Italy
| | - Antonella Grazioli
- Orthopaedic and Trauma Unit, Piedimonte Matese Hospital, ASL CASERTA, Italy
| | - Carmine Gioia
- Orthopaedic and Trauma Unit, Piedimonte Matese Hospital, ASL CASERTA, Italy
| | - Antonio D’Arienzo
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Italy
| | - Giuseppe Toro
- Orthopaedic and Trauma Unit, Sarno Martiri Di Villa Malta Hospital, ASL Salerno, Italy
| | - Nicolò Galvano
- Department of Orthopaedic Surgery, University of Palermo (DiChirOnS), Palermo, Italy
| | - Giuseppe Monteleone
- Orthopaedic and Trauma Unit, Napoli S. Paolo Hospital, ASL Napoli1 Centro, Italy
| | | | - Fabio Di Santo
- Orthopaedic and Trauma Unit, AORN Cardarelli, Napoli, Italy
| | - Salvatore Sepe
- Orthopaedic Clinic CTO, University of Florence, Florence, Italy
| | - Salvatore Pagliuca
- Orthopaedic and Trauma Unit, Napoli S. Giovanni Bosco Hospital, ASL Napoli 1 Centro, Italy
| | - Enrico Cesarano
- Orthopaedic and Trauma Unit, Piedimonte Matese Hospital, ASL CASERTA, Italy
| | | | - Michele Italiano
- Orthopaedic and Trauma Unit, Piedimonte Matese Hospital, ASL CASERTA, Italy
| | - Michele D’Arienzo
- Department of Orthopaedic Surgery, University of Palermo (DiChirOnS), Palermo, Italy
| | - Pietro Maniscalco
- Department of Ortopedia and Traumatologia - Ospedale Civile “Guglielmo da Saliceto”, Piacenza, Italy
| | - Corrado Ciatti
- Department of Ortopedia and Traumatologia - Ospedale Civile “Guglielmo da Saliceto”, Piacenza, Italy
| | - Bruno Di Maggio
- Orthopaedic and Trauma Unit, Piedimonte Matese Hospital, ASL CASERTA, Italy
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Rovere G, Stramazzo L, Cioffi A, Galvano N, Pavan D, Restuccia G, D'Arienzo A, Capanna R, Maccauro G, D'Arienzo M, Camarda L. What's the resolutive surgery for pseudo-ainhum in Vohwinkel syndrome? A case report and review of the literature. Orthop Rev (Pavia) 2021; 12:8868. [PMID: 33633820 PMCID: PMC7883105 DOI: 10.4081/or.2020.8868] [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: 08/26/2020] [Accepted: 10/22/2020] [Indexed: 11/22/2022] Open
Abstract
Vohwinkel Syndrome, also known as Keratoderma Hereditarium Mutilans, is an extremely rare dominant autosomal keratosis. It typically presents with “starfish” keratoses on the knuckles, palmoplantar keratoderma (PPK), hearing impairment and mutilating digital constriction bands (pseudoainhum) that cause strangulation, often leading to autoamputation of the affected digit. Both medical and surgical treatment haven’t shown to date consistent results, in the treatment of pseudoainhum. In this study we present the case of a woman with Vohwinkel syndrome who showed constriction bands causing ischemic changes of the 5th digit of the right hand for which she was treated with surgery. We also present a review of the literature for the management of this disease.
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Affiliation(s)
- Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome
| | - Leonardo Stramazzo
- Department of Orthopaedic Surgery (DICHIRONS), Università degli Studi di Palermo
| | - Alessio Cioffi
- Department of Orthopaedic Surgery (DICHIRONS), Università degli Studi di Palermo
| | - Nicolò Galvano
- Department of Orthopaedic Surgery (DICHIRONS), Università degli Studi di Palermo
| | - Davide Pavan
- Department of Orthopaedic Surgery (DICHIRONS), Università degli Studi di Palermo
| | | | | | - Rodolfo Capanna
- Department of Orthopaedic Surgery, University of Pisa, Italy
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome
| | - Michele D'Arienzo
- Department of Orthopaedic Surgery (DICHIRONS), Università degli Studi di Palermo
| | - Lawrence Camarda
- Department of Orthopaedic Surgery (DICHIRONS), Università degli Studi di Palermo
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5
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Toia F, Romeo M, Abate M, Avarotti E, Battiston B, Bruno G, Cannavò F F, Casamichele C, Colonna M, Catena N, Cherubino M, Coppolino S, Galvano N, Giuca G, Gullo S, Internullo G, Lazzerini A, Marcoccio I, Maruccia M, Melloni C, Pajardi G, Pugliese P, Risitano G, Spata G, Tripoli M, Troisi L, Tos P, Cordova A. Impact of COVID-19 on hand surgery in Italy: A comparison between the Northern and the Southern regions. Hand Surg Rehabil 2020; 40:139-144. [PMID: 33309793 PMCID: PMC7836699 DOI: 10.1016/j.hansur.2020.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/29/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/03/2022]
Abstract
The aims of this study were to evaluate the impact of the COVID-19 pandemic on emergency and elective hand surgery in four Italian regions that had either a high (Lombardy and Piemonte) or a low (Sicilia and Puglia) COVID-19 case load to discuss problems and to elaborate strategies to improve treatment pathways. A panel of hand surgeons from these different regions compared and discussed data from the centers they work in. The COVID-19 pandemic had an enormous impact on both elective and emergency surgery in Italy, not only in highly affected regions but also – and paradoxically even at a higher extent – in regions with a low COVID-19 case load. A durable and flexible redesign of hand surgery activities should be promoted, while changing and hopefully increasing human resources and enhancing administrative support. Telematics must also be implemented, especially for delivering rehabilitation therapy.
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Affiliation(s)
- F Toia
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy.
| | - M Romeo
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
| | - M Abate
- SSD di Ortopedia, ARNAS Garibaldi, Presidio di Nesima, Via Palermo 636, 95123, Catania (CT), Italy
| | - E Avarotti
- Department of Orthopedics and Traumatology, A.R.N.A.S. Piazza Santa Maria di Gesù 5, 95124, Catania (CT), Italy
| | - B Battiston
- Department of Orthopedics and Traumatology, Orthopedic and Trauma Center, AOU Città della Salute e della Scienza, Via Nizza 138, 10126, Torino (TO), Italy
| | - G Bruno
- Department of Orthopedics and Traumatology, A.O. Vittorio Emanuele, Via Plebiscito 632, 95122, Catania (CT), Italy
| | - F Cannavò F
- U.O.S.D. Plastic Surgery A.O. Papardo, Contrada Papardo, 98158, Messina (ME), Italy
| | - C Casamichele
- Department of Orthopedics and Traumatology, A.O. "G. Paolo II", Contrada Cisternazzi, 97010, Ragusa (RG), Italy
| | - M Colonna
- Plastic Surgery Unit, Department of Human Pathology, University of Messina, Via Consolare Valeria1, 98124, Messina (ME), Italy
| | - N Catena
- Pediatric Orthopedic and Traumatology Unit, Children's Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Via Spalto Marengo 46, 15121, Alessandria (AL), Italy
| | - M Cherubino
- Department of Biotechnology and Life Sciences, Division of Plastic and Reconstructive Surgery, University of Insubria, Via Ravasi 2, 21100, Varese (VA), Italy
| | - S Coppolino
- Hospital S. Vincenzo, Contrada Sirina, 98039, Taormina (ME), Italy
| | - N Galvano
- Department of Orthopedics and Traumatology A.O.U.P." Paolo Giaccone", Via Del Vespro 127, 90127 Palermo (PA), Italy
| | - G Giuca
- Department of Orthopedics Ospedale Maggiore, Via Resistenza Partigiana, 97015, Modica (RG), Italy
| | - S Gullo
- Department of Hand Surgery and Traumatology, A.R.N.A.S., Piazza Nicola Leotta 4, 90127, Palermo (PA), Italy
| | - G Internullo
- Department of Orthopedics, Ospedale Gravina, Via Portosalvo 9, 95041, Caltagirone (CT), Italy
| | - A Lazzerini
- Hand Surgery and Microsurgery Unit, IRCCS Humanitas Clinical Institute, Via Alessandro Manzoni 6, 20089, Milano (MI), Italy
| | - I Marcoccio
- Orthopedic Microsurgery and Upper Limb Surgery, Istituto Clinico Città di Brescia, Via Bartolomeo Gualla 15, 25128, Brescia (BS), Italy
| | - M Maruccia
- Department of Emergency and Organ Transplantation, Plastic and Reconstructive Surgery and Burns Unit, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70122, Bari (BR), Italy
| | - C Melloni
- Plastic and Reconstructive Surgery A.O. P. Borsellino, Contrada Cardilla 1, 91025, Marsala (TP), Italy
| | - G Pajardi
- Department of Clinical Sciences and Community Health, The University of Milan, Via Festa del Perdono 7, 20122, Milano (MI), Italy
| | - P Pugliese
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
| | - G Risitano
- ABC Medical, Via Porto Salvo 2, 98121, Messina (ME), Italy
| | - G Spata
- Hand Surgery, Polyclinic Morgagni, Via del Bosco 105, 95030, Catania (CT), Italy
| | - M Tripoli
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
| | - L Troisi
- Department of Clinical Sciences and Community Health, The University of Milan, Via Festa del Perdono 7, 20122, Milano (MI), Italy
| | - P Tos
- Hand Surgery and Reconstructive Microsurgery Unit, Orthopedic Institute G. Pini-CTO, Piazza Cardinale Andrea Ferrari 1, 20122, Milano (MI), Italy
| | - A Cordova
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
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6
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Stramazzo L, Cioffi A, Rovere G, Vigni GE, Galvano N, Sallì M, D'Arienzo A, Camarda L, D'Arienzo M. A rare case of peri-implant distal radius fracture. Trauma Case Rep 2020; 31:100387. [PMID: 33344743 PMCID: PMC7735967 DOI: 10.1016/j.tcr.2020.100387] [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] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 11/16/2022] Open
Abstract
A peri-implant fracture near the volar plate of distal radius represent a very rare injury. The main factor of this lesion is high energy trauma on the wrist. We report a case of a 61-year-old woman with a peri-implant fracture located just proximally to the plate and a fracture of the ulnar head that occurred after a simple fall. The patient was surgically treated by plate and screws removal. The fracture was fixed using a longer volar plate for the radial fracture and a plate for the head ulnar fracture. Different factors such as osteoporosis, BMI and screw position could influence the fracture pattern. However, considering growing use of plates for distal radius fracture fixation, the frequency of these kind of fracture will probably increase.
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Affiliation(s)
- Leonardo Stramazzo
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, Palermo, Italy
| | - Alessio Cioffi
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, Palermo, Italy
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulio Edoardo Vigni
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, Palermo, Italy
| | - Nicolò Galvano
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, Palermo, Italy
| | - Marcello Sallì
- Department of Physical Medicine and Rehabilitation, University of Palermo, Palermo, Italy
| | | | - Lawrence Camarda
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, Palermo, Italy
| | - Michele D'Arienzo
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, Palermo, Italy
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7
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Abstract
The incidence of fractures of the humerus has increased exponentially in recent years. The most used classifications for humerus fracture are morphological (Neer), biological (AO/ASIF) and descriptive (Hertel). The types of surgical treatment for humerus fracture include prosthetic replacement and synthesis using different devices, including the Tension Guide Fixator (TGF), Gex-Fix. External fixation for displaced proximal humeral fractures avoids dissection and soft tissue stripping and has been reported by some authors to be associated with higher union rates, a lower incidence of avascular necrosis, less scarring of the scapulohumeral interface, and faster rehabilitation compared with open reduction and internal fixation. Other authors have reported that external fixation does not ensure acceptable reduction and fracture stability, particularly in patients with osteoporosis. The external fixation technique involves the introduction of Steinmann's pin to keep manual reduction, the introduction of two K-wires in the humeral head, the removal of the Steinmann's pin, and the introduction of two fiches on the humeral shaft. Hub connectors are mounted on the wires and on the chips to connect the outer bar and tensioning system. A total of 84 patients aged 42-84 years with proximal end humeral fractures (66% had two-part fractures) were treated with Fixator TGF in this study from December 2007 to June 2012. The postoperative recovery was earlier and the active-assisted motion was less painful than has been reported with other surgical techniques. The TGF was removed without anaesthesia at the outpatient clinic at a mean of 7 weeks (range 5-8 weeks) after surgery, and there was no loss of reduction or secondary displacement after removal. These results, after five years of experience, confirm that the best indication for this fixator is two- or three-part fractures because the device enables early active mobilisation. The limitations of this fixator are evident in fractures in which closed reduction is not possible and in three-part fractures with varus displacement because the TGF has less stability than other systems, such as the plate or cage. The short learning curve, reduced surgical time and risk, and low cost encourage the use of this technique.
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Affiliation(s)
- A Parlato
- Orthopaedic Clinic of University of Palermo, Italy.
| | - A D'Arienzo
- Orthopaedic Clinic of University of Palermo, Italy
| | - M Ferruzza
- Orthopaedic Clinic of University of Palermo, Italy
| | - N Galvano
- Orthopaedic Clinic of University of Palermo, Italy
| | - M D'Arienzo
- Orthopaedic Clinic of University of Palermo, Italy
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