1,721,155 research outputs found
Trapianti osteo-articolari e protesi composite nelle ricostruzionio dell’arto superiore.
No full textGli innesti massivi omoplastici e le protesi composite vengono utilizzati nelle rico-
struzioni osteoarticolari dell’arto superiore a seguito di resezioni oncologiche, negli
esiti traumatici e nelle revisioni di fallimenti di impianti protesici convenzionali. Le
alternative ricostruttive sono: a livello dell’omero prossimale, le protesi da resezio-
ne modulari e l’artrodesi di spalla con innesti omologhi e/o autologhi; a livello del
gomito, le protesi modulari da resezione e le protesi “custom made”; a livello del
radio distale, gli innesti autoplastici di perone prossimale (vascolarizzato o libero) e
l’artrodesi di polso con innesti omologhi o autologhi. Nel presente lavoro viene
riportata l’esperienza su 29 pazienti operati di resezione di un tumore osseo dell’ar-
to superiore e ricostruzione con innesto massivo osteoarticolare in 21 casi e protesi
composita in 8 casi. In sedici casi è stato ricostruito l’omero prossimale, in 6 casi il
gomito ed in 7 casi il radio distale. Alla luce dei dati riportati in letteratura, vengono
discusse le indicazioni ad utilizzare gli innesti massivi osteoarticolari e le protesi
composite nelle diverse sedi anatomiche dell’arto superiore, analizzando i risultati
funzionali ottenuti e le complicazioni osservate
General Guidelines and Modulation of Surgical Treatment According to Site, Stage and Radiographycal Appearance of Aneurysmal Bone Cysts
No full textGeneral Guidelines and Modulation of Surgical Treatment According to Site, Stage and Radiographycal Appearance of Aneurysmal Bone Cyst
Unicameral and aneurysmal bone cysts
No full textUnicameral and aneurysmal bone cysts are considered tumorlike conditions of unclear origin. The diagnosis of unicameral bone cysts is almost always based on the radiographic appearance, whereas aneurysmal bone cyst imaging may sometimes mimic a sarcomatous lesion. Several pathogenetic hypotheses [correction of hypothesis] reported in literature have been described. Classifications have been proposed to detect the activity of the cysts and to predict the prognostic behavior. The results observed with different options of treatment have been discussed
Skeletal reconstruction after tumor resection of the distal femur
No full textAfter tumor resection of the distal femur, limb salvage with preservation of joint function may be achieved using endoprostheses or osteoarticular allografts or a combination of the two (composite allografts). The choice among these reconstructive solutions must be made considering the functional results achievable and the risk of failure of the implant. The present literature review suggested that prosthetic replacement of the distal femur is more reliable than osteoarticular allograft at long-term follow-up
Modular endoprosthetic replacement after total resection of the femur for malignant tumour
No full textSeven patients underwent total resection of the femur with replacement by the Kotz modular femur and tibia reconstruction system (KMFTR); three of these operations were for primary malignant tumours and four were salvage procedures after failed limb-sparing surgery. Clinical and radiological results were excellent or good at final follow up at an average of 23 months. A new method of radiological assessment has been used for the acetabular component of bipolar hip endoprosthesis. The polyethylene bush of the hinged knee component may wear. Reattachment of the abductors to the endoprostheses often fails and we now suture the abductors to the fascia lata. The rectus femoris muscle should be saved, if possible, after resection. When total excision of the quadriceps is indicated, the knee should be arthrodesed. The KMFTR is easy to use and has provided good medium to long term results in our cases
Healing of large bone defects with allogenic bone grafts enriched with autologous bone marrow buffy coat and platelet-rich plasma.
No full textThe reconstruction of large bone segments is a major goal in orthopaedic surgery. Autologous cancellous bone is recognized as the most biologically active graft material, but autologous bone harvest is associated with significant morbidity and founds its limit in the available quantity. Biomaterials or allografts do not encounter these limitations, but have no osteogenic and limited osteinductive potential. In order to enhance tissue regeneration and healing we have tried to obtain a graft with osteconductive, inductive and osteogenic properties. The day before operation 350 cc of autologous blood is donated from the patient and centrifuged to obtain a platelet-rich plasma. Bone marrow is aspirated from the posterior iliac crests with the patient under spinal anaesthesia and is processed to increase its stem cell content. The structural scaffold used is morcellized cancellous bone provided from our Bone Bank. At operation bone is mixed with bone marrow buffy coat and Platelet Rich Plasma in a sterile glass becker with addition of CaCl2 till clot formation to produce a gel-like component that is handled easily. We have utilized this technique from November 2000 till January 2004 for 68 patients: 41 of these patients required healing of large bone defects: 22 males and 19 females. Fresh bone marrow alone was used for a percutaneous injection in 11 cases; open surgery with autologous growth factors, bone marrow buffy coat and allograft was used in 30 patients. The radiological and clinical results showed early healing of the defects treated with this technique and no complications related to the procedure at an average follow up of 23 months (3–40)
Synovial Chondromatosis in a Lumbar Apophyseal Joint
No full textA 31-year-old woman presented with painful swelling in the right paravertebral region that had been present for 2 years. Radiography and CT revealed an area of increased density due to multiple calcifications localized at the fourth lumbar vertebra. Histological examination revealed that the lesion consisted of nodules of hyaline cartilage, with focal areas of calcification, growing within synovial tissue
Bizarre parosteal osteochondromatous proliferation (Nora's lesion). Description of six cases and a review of the literature
No full textThe authors report their experience with 6 cases of bizarre parosteal osteochondromatous proliferation (BPOP) observed in 4 patients in its typical site (distal ends of the limbs), and in 2 patients where it was instead atypically localized in the humerus and femur. The histories of the patients revealed that 50% reported previous trauma in the site of lesion. Five patients were submitted to surgical exeresis, while the remaining patient refused to undergo any type of treatment because he was asymptomatic. At a mean follow-up of 36 months 1 patient presented with recurrence (20%). BPOP is a rare pseudotumorous lesion with typical radiographic and histopathologic findings similar to to those of other benign and malignant tumor forms. A review of the small amount of literature in existence is used to analyze the elements that may lead to accurate differential diagnosis
Allograft reconstruction in bone tumor surgery
No full textWe have followed 171 allograft reconstructions for more than 1 year and made the following observations. Knee arthrodesis (46). 1 infection, 6 fractures and 16 delayed unions. There were 3 major reoperations. 36 patients had satisfactory (excellent or good) result. Hip arthrodesis (1 1). 6 delayed union with 2 major and 1
minor reoperation. 8 patients had satisfactory result. Intercalay reconstruction (36). 3 infections, 9 fractures and 17 non-unions. A reoperation was performed in 18
patients. Segmental reconstruction, VF+A (28). 1 infection and 7 fractures. 3 patients were reoperated.
Osteoarticular reconstruction (35). 10 fractures and 10 delayed unions. I2patients were reoperated. Composite allografts (6 hips). No reoperations and excel- lent results in all cases. Pelvic reconstructions (9). 1 infection and3 instabilities, 6 patients had an excellent result. In conclusion we had the best results with arthrodesis and recommend a combination with a vascularizedfibulafor inter- calary grafts. The best indication for an osteoarticular graft seems to be the elbow, wrist and hip
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