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Proposal of a New Dynamic Distraction Device to Treat Complex Periarticular Fractures of the Metacarpophalangeal Joint of Long Finger
No full textBackground: 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. © The Author(s) 2018
Nanosurfaces Scaffold and Magnetic Nanoparticles to Direct the Neuronal Growth Process: Future Strategies for Peripheral Nerve Regeneration
Full text linkPeripheral nerves injuries are common lesions than often cause loss of function and poor outcome. Current strategies to nerve repair take advantage by microsurgical suture. In case of severe nerve gap (>50mm),the gold standard remains the autologous graft. Recently, researchers focused on two main areas of investigation: the role of the interaction between cells with the extracellular membrane (ECM )and the forces acting during axonal elongation
Artrodesi STT nelle artrosi scafotrapeziotrapezoidali: revisione della casistica e risultati
No full textNOSTRA ESPERIENZA NEL TRATTAMENTO DELLE FRATTURE DEL POLO PROSSIMALE DELLO SCAFOIDE CARPALE
No full textLe dfficoltà legate al trattamento delle fratture del polo prossimale dello scafoide carpale (difficoltà diagnostiche; prolungata immobilizzazione nel trattamento conservativo; viziosa consolidazione; pseudoartrosi e talvolta
La necrosi ischemica del polo prossimale) riguardano soprattutto individui giovani, attivi, con richieste funzionali elevate e che mal sopportano prolungate immobilizzazioni. Scopo di questo lavoro è quello di incentivare, di fronte a tali lesioni, il trattamento chirurgico rispetto all'incruento operandole quindi in una buona percentuale di cas
Early post-surgical rehabilitation and functional outcomes of a traumatic ulnar nerve injury: a pediatric case report
No full textBackground Peripheral nerve injuries (PNIs) of the upper limb are very common events within the pediatric population, especially following soft tissue trauma and bone fractures. Symptoms of brachial plexus nerve injuries can differ considerably depending on the site and severity of injury. Compared to median and radial nerves, the ulnar nerve (UN) is the most frequently and severely injured nerve of the upper extremity. Indeed, due to its peculiar anatomical path, the UN is known to be particularly vulnerable to traumatic injuries, which result in pain and substantial motor and sensory disabilities of the forearm and hand. Therefore, timely and appropriate postoperative management of UN lesions is crucial to avoid permanent sensorymotor deficits and claw hand deformities leading to lifelong impairments. Nevertheless, the literature regarding the rehabilitation following PNIs is limited and lacks clear evidence regarding a solid treatment algorithm for the management of UN lesions that ensures full functional recovery.Case presentation The patient is a 11-year-old child who experienced left-hand pain, stiffness, and disability secondary to a domestic accident. The traumatic UN lesion occurred about 8 cm proximal to Guyon's canal and it was surgically treated with termino-terminal (end-to-end) neurorrhaphy. One month after surgery, the patient underwent multimodal rehabilitative protocol and both subjective and functional measurements were recorded at baseline (T0) and at 3- (T1) and 5-month (T2) follow-up. At the end of the rehabilitation protocol, the patient achieved substantial reduction in pain and improvement in quality of life. Of considerable interest, the patient regained a complete functional recovery with satisfactory handgrip and pinch functions in addition with a decrease of disability in activities of daily living.Conclusion A timely and intensive rehabilitative intervention done by qualified hand therapist with previous training in the rehabilitation of upper limb neuromuscular disorders is pivotal to achieve a stable and optimal functional recovery of the hand, while preventing the onset of deformities, in patients with peripheral nerve injuries of the upper limb
Treatment of Scaphoid Waist Nonunion Using Olecranon Bone Graft and Stryker Asnis Micro Cannulated Screw: A Retrospective Study-80 Case Studies and 6 Years of Follow-Up
No full textBackground Screw fixation and bone grafting are the gold standard for scaphoid waist nonunion without avascular necrosis. Question/Purpose Assesses the scaphoid waist nonunion healing rate with use of an uncommon cancellous bone graft (olecranon) and an unusual fixation system (Asnis Micro Cannulated Screw System; Stryker Inc., Kalamazoo, MI, USA). Material and Methods A series of 102 consecutive patients were treated for scaphoid waist nonunion (without deformity). Of these, 80 patients subjected to clinical (Modified Mayo Wrist Score (MMWS), Jamar hydraulic dynamometer) and radiographic examination before and after surgery were evaluated. Ipsilateral olecranon cancellous bone graft and the ASNIS Micro 3.0-mm diameter screw, were used. The average follow up was 6 years (min 3; max 10). Results Radiographic consolidation was achieved in 90% of patients; dorsal intercalated segment instability (DISI) deformities were corrected in 71.4% of cases. Ninety percent improved the range of motion of the wrist and grip strength. All patients showed a significant reduction of peak force in the operated hand. In 6.25% we observed clinical and radiographic screw head-trapezium impingement. Twenty-six patients developed a degenerative wrist sign. The MMWS yielded 68 optimal, 8 good, and 4 bad results. Conclusions To treat scaphoid waist nonunions without misalignment, low-profile headed screw and olecranon bone graft allowed a high consolidation rate with positive results to long-term follow-up. The Asnis Micro 3.0 mm diameter screw may be a suitable option for treating scaphoid waist nonunion. Level of Evidence IV
Treatment of acute scapholunate ligament injuries with bone anchor
No full textScapholunate instability is the most common form of carpal instability. Repair or reconstruction of the scapholunate interosseus ligament is advocated to reduce symptoms, stabilize the scapholunate joint and avoid the progression of carpal degeneration. Aim of this study is to evaluate the results (clinical and radiographic) obtained in 18 patients treated in our department for acute lesions SLIL from 2003 to 2008. Patients were 16 males and 2 females with an average age at the time of the trauma of 33.8 years old (min 17 and max 68 years). The diagnosis of scapholunate dissociation relies on a through history and physical examination and imaging studies. Early surgical repair of the torn schapolunate ligament was performed in all the patients. The method used for the treatment of these lesions was open reduction and direct ligament reinsertion through a minianchor MITEK. In our surgical experience in 3 cases we have found a combination between an isolated scaphoid fractures and a scapholunate ligament rupture without carpal dislocation. We reviewed all patients treated with an average follow-up of 32 months (range 9-68 months). The review was carried out both clinically and radiographically (static and dynamic). We achieved 13 excellent results (Mayo score average 94,77), 3 good results (Mayo score average 84), 1 sufficient results (Wrist score 72) and 1 bad result (Wrist score 35). From the radiographic evaluation we found a loss of reduction in the two cases identified clinically as sufficient and bad. One patient after an optimal ligament healing, underwent to a recurrence of the lesion SLIL 2 years from surgery. Open reduction and direct bony fixation of the torn scapholunate ligament using a suture anchor is generally successful in restoring scapholunate stability and has produced good functional mid-term results. At an average follow up of 32 months excellent or good functional outcomes were reported in 88% of the patients despite a large number of cases with a high energy trauma and other associated injury. The association between an isolated scaphoid fracture and a SLIL lesion is rare but not impossible in presence of a scapholunate instability we recommend the immediate reconstruction of the torn ligament
SUPERFICI NANOSTRUTTURATE E RIGENERAZIONE NERVOSA PERIFERICA
No full textIl gold standard nel trattamento delle grosse perdite di sostanza nervosa rimane l’innesto autologo che, con la presenza cellule di Schwann, offre fattori neurotro ci e substrati d’adesione per la crescita asso- nale. Per i limiti di tale metodica (danno al sito donatore, doppio accesso chirurgico ed indisponibilità d’ingenti quantità d’innesti) sono state proposte delle alternative come la tubulizzazione (biologica o sintetica). Recentemente è stata data importanza all’interazione fra le cellule (nervose e gliali) e gli sti- moli sici e chimici provenienti dall’ambiente extracellulare. L’ingegneria tissutale è oggi in grado di produrre scaffold con strutturazione super ciale delle dimensione dei nanometri in grado di riprodurre le caratteristiche della matrice extracellulare (ECM). La versatilità con cui possono essere prodotte que- ste super ci e la loro possibile funzionalizzazione con molecole biologiche (peptidi/proteine, fattori di crescita, ecc.), può essere applicata nel trattamento delle perdite di sostanza nervosa (>30 mm) con l’o- biettivo di realizzare un device a struttura tubulare con un’adeguata interfaccia nervo-scaffold, essibile, biocompatibile, e non immunogenica.Today, the treatment of big nerve gaps is the autologous nerve graft (with Schwann cells, it provides neurotropic factors and adhesion substrates that aid the axonal growth). The limits of this technique are the donor side damage, the need of double surgical access and unavailability of large amounts of grafts. Some authors proposed alternatives like tubulization (biological or synthetic tubes). Recently, the rese- archers focus on the interaction between the cells (nerve and glial cells) and the physical and chemical signals risen from the extracellular environment.
Tissue engineering is able to produce scaffolds with some degree of micro/nano topographical noise that reproduce the directional stimuli determined by the extracellular matrix (ECM). Moreover these gratings can be functionalized with biological molecules, peptides, proteins, growth factors, ecc.
We can consider these new surfaces like new possibilities for successful implant strategies in the context of peripheral nerve-regeneration devices, especially for the big nerve gap (>30 mm)
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