1,720,992 research outputs found
The RoboticScope can be a Useful Tool for Hand and Microsurgical Procedures during the COVID-19 Pandemic
Full text linkIndications for and surgical techniques in surface prostheses: Our experience [Indicazioni e tecnica chirurgica nelle protesi di superficie la nostra esperienza]
No full textAim. Prosthetic hip resurfacing is not a novel concept. Metal-on-polyethylene coupled prostheses implanted in the 1970s and early 1980s produced poor outcomes. The results of implantation of metal-on-metal coupled devices in large case series with adequate follow-up periods are now beginning to emerge. The choice of a surgical technique consistent with the device's biomechanics remains a vital consideration. Methods. From 4 November 2004 to 7 June 2005, 9 ASR Depuy hip prostheses were implanted in 8 patients (1 bilateral implantation) at the Department of Orthopedics and Traumatology, Asti Community Hospital. The instrumentarium furnished by the prosthesis manufacturer was used to place the devices. Results. The small number of implants and short follow-up periods do not provide enough data for achieving a statistically significant analysis of device survival. What can be stated is that no mobilization or dislocation of the prostheses has been observed to date. Patient satisfaction with the outcome was excellent. Conclusion. Based on our experience and the clinical outcomes, we believe that the metal-on-metal surface devices with a cemented femoral component may ensure good implant stability and good resistance to component wear comparable with those offered by conventional prostheses
Compound or Specially Designed Flaps in the Lower Extremities
No full textNovel and combined tissue transfers from the lower extremity provide new tools to combat soft tissue defects of the hand, foot, and ankle, or fracture nonunion. Flaps can be designed for special purposes, such as providing a gliding bed for a grafted or repaired tendon or for thumb or finger reconstruction. Propeller flaps can cover soft tissue defects of the leg and foot. In repairing severe bone and soft tissue defects of the lower extremity, combined approaches, including external fixators, one-stage vascularized bone grafting, and skin or muscle flap coverage of the traumatized leg and foot, have become popular
Personal perception quality of life in 68 patients with traumatic thoraco-lumbar vertebral fractures treated with circumferential arthrodesis [Valutazione soggettiva della qualità di vita in 68 pazienti trattati per fratture vertebrali traumatiche toraco-lombari con artrodesi circonferenziale]
No full textAim. In the last decade techniques in vertebral surgery have made great progress, especially in the treatment of spinal fractures. The aim of this study was to evaluate the efficacy of circumferential arthrodesis surgical technique of vertebral stabilization in accordance with the patient's point of view in terms of personal perception of one's own health condition and quality of life. Methods. The SF-36 Health Survey and the Oswestry low back pain disability questionnaire were supplied to 68 patients with spinal fracture, with or without neurological impairment, followed during a 5.5-year mean period after surgical treatment. A case-control comparative study was developed between the SF-36 health survey patient's scores and the mean SF-36 scores of a representative sample of 2000 Italian people provided together with the SF-36 questionnaire. Results. SF-36 scores in patients with neurological impairment were significantly inferior to those of the representative sample, while not neurological impaired patient's scores were not significantly different from those of the representative sample in no one of each different health concepts explored by the shortform scales. The low back pain concerned disability was severe to crippled in neurological impaired patients, and minimal to moderate in patients without neurological impairment. Conclusion. The surgical technique of vertebral stabilization with circumferential arthrodesis succeeds in bringing patients with not neurological spinal injuries back to a quality of life not significantly different from that of general sound population. Patients with neurological spinal injuries get a quality of life significantly inferior due to irreversibility of neurological damage
Treatment of proximal humerus fractures with shoulder prosthesis [Il trattamento delle fratture dell'omero prossimale con endoprotesi di spalla]
No full textAim. The aim of this study is to evaluate the clinical results of shoulder replacement after trauma, during a follow-up period. Methods. A retrospective analysis has been carried out on 20 patients operated at the 1st University Clinic and at the 1st Division of Orthopedics of the CTO Hospital in Turin between 1996 and 2002 (mean follow-up 31.5 months). The study took into consideration such aspects as work activity, trauma, type pf fracture, prosthesis, and complications. The patients were studied with the Constant score and the Simple Shoulder Test (SST). Results. The mean value of the total score is 46.3/100 (Pondered Constant: 63.3%). The variable strength is the one with the lower score. The results of SST confirm the results of the previous test; in fact, the two questions regarding the recovering of strength and external rotation showed a low rate of positive answers. Conclusion. The results obtained confirm the difficulties in treating proximal humerus fractures, and the unsatisfactory postoperative rehabilitation. However, it is suggested that shoulder replacement is still a good solution in most of the cases
Orthoplastic approach to leg and foot trauma
No full textThe lower limb trauma is a set of complex and challenging clinical situations that need an excellent knowledge of both orthopedic and plastic surgical techniques. It is mandatory that the medical doctor in charge of treating the trauma knows all the steps of the healing process, from the correct diagnosis when the patients arrive in the emergency room, to the final rehabilitation process. Imaging and clinical initial evaluation must be performed in the emergency room. A correct diagnosis of the entity of the trauma can only be done after the debridement of all the non-viable tissue in the operating room. The damage control of the fracture and of the soft tissue allows to post pone the correct reconstruction of a few days. The final soft tissue reconstruction must be done in synergy with the treatment of the bone fracture
Ultrasound-Guided Pulse-Dose Radiofrequency: Treatment of Neuropathic Pain after Brachial Plexus Lesion and Arm Revascularization
No full textNeuropathic pain following brachial plexus injury is a severe sequela that is difficult to treat. Pulsed radiofrequency (PRF) has been proved to reduce neuropathic pain after nerve injury, even though the underlying mechanism remains unclear. This case report describes the use of ultrasound-guided PRF to reduce neuropathic pain in a double-level upper extremity nerve injury. A 25-year-old man who sustained a complete left brachial plexus injury with cervical root avulsion came to our attention. Since 2007 the patient has suffered from neuropathic pain (NP) involving the ulnar side of the forearm, the proximal third of the forearm, and the thumb. No pain relief was obtained by means of surgery, rehabilitation, and medications. Ultrasound-guided PRF was performed on the ulnar nerve at the elbow level. The median nerve received a PRF treatment at wrist level. After the treatment, the patient reported a consistent reduction of pain in his hand. We measured a 70% reduction of pain on the VAS scale. PRF treatment allowed our patient to return to work after a period of absence enforced by severe pain. This case showed that PRF is a useful tool when pharmacological therapy is inadequate for pain control in posttraumatic neuropathic pain
Primary repair of crush nerve injuries by means of biological tubulization with muscle-vein-combined grafts
No full textDespite extensive research and surgical innovation, the treatment of peripheral nerve injuries remains a complex issue, particularly in nonsharp lesions. The aim of this study was to assess the clinical outcome in a group of 16 patients who underwent, in emergency, a primary repair for crush injury of sensory and mixed nerves of the upper limb with biological tubulization, namely, the muscle-vein-combined graft. The segments involved were sensory digital nerves in eight cases and mixed nerves in another eight cases (four median nerves and four ulnar nerves). The length of nerve defect ranged from 0.5 to 4 cm (mean 1.9 cm). Fifteen of 16 patients showed some degree of functional recovery. Six patients showed diminished light touch (3.61), six had protective sensation (4.31), and three showed loss of protective sensation (4.56) using Semmes-Weinstein monofilament test. All the patients who underwent digital nerve repair had favorable results graded as S4 in one case, S3+ in six cases, and S3 in one case. With respect to mixed nerve repair, we observed two S4, two S3+, two S3, one S2, and one S0 sensory recovery. Less favorable results were observed for motor function with three M4, one M3, two M2, and two M0 recoveries. Altogether, the results of this retrospective study demonstrates that tubulization nerve repair in emergency, in case of short nerve gaps, may restore the continuity of the nerve avoiding secondary nerve grafting. This technique preserves donor nerve and, in case of failure, does not preclude a delayed repair with a nerve graft. (c) 2012 Wiley Periodicals, Inc. Microsurgery, 2012
Peripheral Nerve Defects Overviews of Practice in Europe
No full textMany surgical techniques are available for the repair of peripheral nerve defects. Autologous nerve grafts are the gold standard for most clinical conditions. In selected cases, alternative types of reconstructions are performed to fill the nerve gap. Non-nervous autologous tissue based conduits or synthetic ones are alternatives to nerve autografts. Allografts represent another new field of interest. Decision making in the treatment of nerve defects is based on timing of referral, level of the injury, type of lesion, and size of any gap. This review focuses on current clinical practice, influenced by the numerous new experimental researches
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