63 research outputs found
Multifocal Humeral Fractures: Clinical Results, Functional Outcomes and Flowchart of Surgical Treatment
No full textAIM AND OBJECTIVE: Multifocal fractures of the humerus are rare. The aim of our study is to evaluate the effectiveness of surgical treatment and propose a modification to the Maresca–Pascarella classification. A flowchart for surgical treatment is provided. MATERIALS AND METHODS: Thirty-one patients with multifocal humeral fractures were treated and evaluated. The Maresca–Pascarella classification was used. All were treated using with either plates and screws, external fixation or intramedullary nailing. Functional outcomes were evaluated using the QuickDASH test, the University of California – Los Angeles (UCLA) shoulder score and the Mayo elbow performance score (MEPS). RESULTS: There were 12 Type A, 17 Type B, 1 Type C and 1 of combined fractures of the proximal and distal epiphysis. Of the 31 patients, 5 were lost to the follow-up (FU), 1 died of pulmonary embolism (PE) and the remaining 25 had a mean FU of 19.8 (7–35) months. Three patients had radial nerve damage and 1 went to a non-union that required further surgical intervention. The mean QuickDASH score was 15.7, the average UCLA shoulder score was 26.3 and the mean MEPS elbow score resulted to be 83.0. CONCLUSION: Although multifocal fractures are severe injuries, patients are able to recover good functionality if treated judiciously. CLINICAL SIGNIFICANCE: We proposed a standardised surgical approach based on the fracture characteristics, site and a modified Maresca–Pascarella classification. HOW TO CITE THIS ARTICLE: Scaglione M, Casella F, Ipponi E, et al. Multifocal Humeral Fractures: Clinical Results, Functional Outcomes and Flowchart of Surgical Treatment. Strategies Trauma Limb Reconstr 2022;17(2):81–87
3Dprinting in orthopedic oncology surgery
No full text“3D printing” is a common term that refers to a large variety of additive-based technologies which operate on the principle of converting a computer-generated 3D image into a physical model. 3D printed parts can assume virtually any complex shape, with solid and porous components that can be combined to provide the best combination of strength and performances. Currently, the primary applications for 3D printing are the production of anatomical models for planning and surgery simulation, patient-specific instruments and custom-made prosthesis. Orthopedic oncological surgery often requires, for its own nature, accurate and often wide resections of bone and soft tissues involved by the tumoral mass or next to it. one of the latest and most promising innovations is represented by the 3D printing technology, whose main advantage, in this field of application, is represented by the patient-specificity, essential in a surgery that demands high precision and maximal respect for the patients’ healthy native bones and soft tissues. As a rule, 3D printing technique finds application, in oncological orthopedics, in the following major fields: 1) 3D printing for pre-operative planning and training in oncological orthopedics; 2) 3D printed surgical cutting; guides in oncological orthopedics; 3) 3D printed custom made prosthesis
Chronic Tear of the Distal Triceps Tendon Treated with Suture Anchors and Fascia Lata Allograft: Case Report, Surgical Technique and Literature Review
No full textChronic tears of the distal triceps tendon are extremely uncommon lesions. Surgical therapy can be performed with a direct reattachment of the 2 sides of the lesion or-in case of significant tendon retraction-using grafts to fill the resulting gap. Herein, we report a case of a torn distal triceps tendon that occurred in a 33-year-old patient suffering from paraplegia. The resulting functional impairment of the elbow impeded her to use a wheelchair, causing a substantial limitation to her mobility and autonomy. Preoperative clinical evaluation, x-rays, muscle-tendon ultrasound, and magnetic resonance imagingwas been performed. In consideration of a 6 cm retraction at the surgery, we reconstructed the tendon using a combination of suture anchors (5 mm Super Reevo ConMed) and a cadaver fascia lata allograft. After surgery, the elbow was immobilized in extension inside a brachio-metacarpal cast for 30 days. In the following month, the cast was replaced with a hinged elbow brace and progressive mobilization was permitted. Five months postoperatively, the patient regained her previous active flexion-extension articular ROM and was able to use her wheelchair again. No complication occurred
Use of Statins and Hip Fracture Risk: a Case-Control Study
No full text: PURPOSE OF THE STUDY To evaluate a possible association between hip fracture and statin use. MATERIAL AND METHODS In this case-control study we compared the use of statins between two groups of 210 patients: the first group (case group) included patients hospitalized for hip fractures while the second group (control group) included patients who did not suffer femur bone injuries. The two groups were matched for age, sex, year of hospitalization and possible confounding factors. Inside the group of cases, we also evaluated the differences in terms of fracture type, presence of previous fragility fracture and mortality between statin users and non-users. RESULTS The use of statins was most common among patients without previous fractures (OR=0.54; 95% CI=0.33-0.89; p=0.0138), especially in older patients (OR=0.40; 95% CI=0.22-0.76). We did not find any significant difference in statin intake between men and women in the control group. In the case group, those who did not use statins were more likely to undergo a medial hip fracture (28.5% vs 16.1%). Patients from case group also presented a greater mortality (27.9% vs 19.35%) and an higher percentage of previous hip fractures (20.11% vs 9.7%). However, they didn't presented a significant higher rate of fragility fractures in other sites. DISCUSSION AND CONCLUSIONS Our study suggests a reduced hip fracture risk, especially in cases aged 80 or more, a different fracture pattern (lower percentage of medial fractures) and a reduced mortality at 9 months in patients treated with HMG-CoA reductase inhibitors, confirming the previous evidences reported in literature. Key words: statin, hip fractures, fracture risk, osteoporosis
Aneurysmal Bone Cyst of the Pelvis in Children and Adolescents: Effectiveness of Surgical Treatment with Curettage, Cryotherapy and Bone Grafting
No full textBackground: Aneurysmal bone cysts (ABCs) are benign but locally aggressive cystic lesions of the bone. Pelvic ABCs are extremely rare and hard to treat due to their high risk of local recurrence and the tough access to pelvic bones. Methods: In this retrospective study, we evaluated pediatric cases with pelvic ABC treated with curettage, cryotherapy and bone grafting treated in our institution between 2016 and 2022. Complications were recorded, as well as local recurrences. Patients’ post-operative functionality was assessed with the MSTS score. Results: Fourteen consecutive cases were included in our study. Their mean age at surgery was 13.5 years. The mean lesion size was 55 mm. The mean follow-up was 38 months. Two cases (11.8%) had local recurrences, which were successfully treated with further curettage. At their latest FU, 13 cases were continuously disease free (CDF), and one had no evidence of disease (NED). Only one case had a post-operative compilation (wound dehiscence). Patients’ mean post-operative MSTS score was 29.6. Conclusions: Pelvic ABCs are a challenge, even for the most experienced orthopedic surgeon. Our study suggests that the association of an accurate curettage, intraoperative cryotherapy and bone grafting can be a reliable and effective therapeutic option for large-sized ABCs of the pelvis
Proximal Humerus Reconstruction after Tumor Resection: An Overview of Surgical Management
No full textProximal humerus is one of the anatomical sites that are most frequently involved by bone and soft tissue malignant tumors. Alone or in association with adjuvant treatments, surgery represents the main therapeutic option to treat and eradicate these diseases. Once the first-line option, in the last decades, amputation lost its role as treatment of choice for the large majority of cases in favor of the modern limb sparing surgery that promises to preserve anatomy and - as much as possible - upper limb functionality. Currently, the main approaches used to replace proximal humerus after a wide resection in oncologic surgery can be summarized in biological reconstructions (allograftsand autografts), prosthetic reconstructions (anatomic endoprostheses, total reverse shoulder prostheses), and graft-prosthetic composite reconstructions. The purpose of this overview is to present nowadays surgical options for proximal humerus reconstruction in oncological patients, with their respective advantages and disadvantages
Use of teriparatide in preventing delayed bone healing in complex biosseous leg fracture: a case report
No full textFracture nonunion is one of the greatest challenges for orthopedic surgeons. We present the case of a young man with a complex open biosseous fracture of the leg who underwent surgery and early systemic pharmacological treatment with teriparatide. Teriparatide is widely used in the treatment of osteoporosis as its anabolic effects promote the deposition of new bone tissue. Associated tibia and fibula fractures have relatively high rates of nonunion and poor long-term outcomes. In this particular case, the fracture had further negative prognostic factors, such as exposure. Two months after the trauma, the radiological healing signs were insufficient, therefore it was decided to use teriparatide, prior to the possible onset of pseudarthrosis, in order to enhance bone healing and promote adequate callus formation. Complete healing of the fracture was achieved after 99 days of treatment. The authors believe that the use of pharmacological aids may be desirable, especially in the presence of risk factors such as complex and open fractures that could seriously slow down the natural regenerative processes of the fractured bone. In this scenario, teriparatide could have an important role in preventing delayed consolidation and improving the healing of nonunion fractures
Schwannomas of the Upper Limb: Clinical Presentation, Preoperative Management and Outcomes of Surgical Treatment
No full textInroduction: Schwannomas are the most common tumors of the peripheral nervous system. Surgical eradication with excision or enucleation is the treatment for symptomatic and large schwannomas. Aim: Few studies have investigated the clinical outcomes related to the surgical approach to schwannomas. Our study aims to evaluate the clinical and functional results of surgery for the treatment of upper limb schwannomas. Materials and methods: Twenty-two cases of upper limb schwannomas were surgically treated in our institution between January 2016 and December 2023. All cases underwent preoperative and 6-month postoperative MRI. For each case, we recorded the diagnostic interval (symptom-diagnosis), symptoms (stenosis or sensory deficits, pain, and Tinel test), and both pre-and postoperative functional status (with DASH and MSTS scores). We also recorded complications and local recurrences. Results: On average, the diagnosis was made 16.7 months after the onset of the first symptom. The mean preoperative MSTS, DASH, and MRC values were 27.9, 5.7, and 4.8, respectively. We had no intra-operative complications. After a mean follow-up of 43.1 months, MSTS, DASH were 29.7/30 and 0.7, respectively. No case developed local recurrences. No case recorded stenosis deficits at the last follow-up. Only one patient developed local paresthesia (9%), while two reported modest dysesthesias. Conclusions: An adequate surgical approach, possibly preceded by a rapid diagnosis, can significantly improve the symptoms caused by schwannoma, restoring the functionality of the upper limb
Is the Combination of Platelet-Rich Plasma and Hyaluronic Acid the Best Injective Treatment for Grade II-III Knee Osteoarthritis? A Prospective Study
No full textBackground. Knee osteoarthritis is a common disease with increasing incidence and prevalence in western countries. It can cause severe pain and functional limitations, thereby representing a threat for patients' quality of life and a burden for national health systems. Intra-articular injections with hyaluronic acid (HA) and platelet-rich plasma (PRP) have been used for decades in order to reduce the symptoms caused by osteoarthritis. In recent years, a combination of HA and PRP has been introduced in clinical practice with the aim to minimize the clinical presentation of osteoarthritis and potentially delay articular degeneration. Materials and Methods. Sixty cases with grade II-III knee osteoarthritis according to the Kellgren-Lawrence classification were included in a prospective study, focused on the evaluation of clinical and functional outcomes after intra-articular knee injections. Cases were randomly divided into three groups. Twenty cases (Group A) were injected with HA, 20 (Group B) had PRP, and the remaining 20 (Group C) received a combination of HA and PRP. Basal WOMAC score and VAS score were recorded before the treatment and repeated within 3 and 6 months after the treatment. Results. At 6-month follow-up, Group C (PRP + HA) was the one with the lowest WOMAC and VAS mean values. It was also the only group that reported a reduction in the two values both in the first three months and in the following three months. No major complication was recorded. Conclusion. The combination of platelet-rich plasma and hyaluronic acid can be effective in the treatment of grade II-III knee osteoarthritis in a short-to-mid-term scenario. It represents an innovative and valuable alternative to the administration of its two components alone
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