1,720,961 research outputs found
Complex proximal humerus fractures: Hertel’s criteria reliability to predict head necrosis
No full textBackground: The risk of post-traumatic humeral head avascular necrosis (AVN), regardless of the treatment, has a high reported incidence. In 2004, Hertel et al. stated that the most relevant predictors of ischemia after intracapsular fracture treated with osteosynthesis are the calcar length, medial hinge integrity and some specific fracture types. Based on Hertel’s model, the purpose of this study is to evaluate both its reliability and weaknesses in our series of 267 fractures, assessing how the anatomical configuration of fracture, the quality of reduction and its maintenance were predictive of osteonecrosis development, and so to suggest a treatment choice algorithm. Materials and methods: A retrospective study, level of evidence IV, was conducted to duly assess the radiographic features of 267 fractures treated from 2004 to 2010 following Hertel’s criteria treated with open reduction and internal fixation by angular stability plates and screws. The average age was 65.2 years. The average follow-up was 28.3 ± 17.0 months. The percentage of AVN, the quality and maintenance of reduction obtained during surgery were evaluated. Results: The AVN incidence was 3.7 %. No significant correlation with gender, age and fracture type was found. At the last follow-up X-ray, only 30 % presented all Hertel’s good predictors in the AVN group, 4.7 % in the non-AVN group (p < 0.05). About quality of reduction in the AVN group, it was poor in 50 %; while in the non-AVN group, it was poor in 3.4 % (p < 0.05). Four patients with AVN were symptomatic, and three needed a second surgery. Conclusions: Hertel’s criteria are important in the surgical planning, but they are not sufficient: an accurate evaluation of the calcar area fracture in three planes is required. All fractures involving calcar area should be studied with CT. Level of evidence: IV
Distal radius articular fractures: a comparison between ORIF with angular stability plate and percutaneous Kirschner wires.
No full textDistal radius articular fractures: a comparison between ORIF with angular stability plate and percutaneous Kirschner wires.
Tronci V1, Campochiaro G, Gazzotti G, Rebuzzi M, Tsatsis C, Catani F.
Author information
Abstract
PURPOSE OF THE STUDY:
To analize and compare vantages and disadvantages in long-term of two different techniques to treat distal radius articular fractures: ORIF with plate versus percutaneous pinning with K-wires.
MATERIALS AND METHODS:
We reviewed 77 distal radial articular fractures treated surgically from 2005 to 2009. Fractures were divided in two homogeneous groups according to patient age, gender, fracture-type and follow-up. The first group was treated with ORIF using angular stability volar plate, while the second one with closed reduction, K-wires percutaneous pinning and ante-brachial plaster casting. Functional outcomes were assessed with MAYO and DASH score, wrist range-of-movement and handgrip. Radiographic parameters were calculated in the post-operative and long-term x-rays.
RESULTS:
ORIF group showed better mean DASH and MAYO score, range of movement and handgrip strength compare to K-wires group. Expecially in type C fractures and in younger patients (<65 years). Minor differences were observed in type B fractures. About complications: two cases of surgically-treated medial nerve compression in ORIF group and one in K-wire group, one case of algodystrophy in K-wire group. Referring to radiographic parameters, long term values show data positive for ORIF.
CONCLUSIONS:
Though several studies about these techniques has been performed, but no scientific evidence proves the superiority of one surgical treatment. C-type need to be treated with plate in young patients or in elderly patients with high functional demand. Elderly patients with low functional demand can achieve satisfactory results also with percutaneous pinning, especially in Btype fractures
Imaging of the Unstable Shoulder
Full text linkUnstable shoulder can occur in different clinical scenarios with a broad spectrum of symptoms and presentations: first-time (or recurrent) traumatic acute shoulder anterior dislocation or chronic anterior instability after repeated dislocations.Imaging in unstable shoulder is fundamental for choosing the right treatment preventing recurrence.The goal of imaging depends on clinical scenario and patient characteristics
The rotator cuff tear repair with a new arthroscopic transosseous system: the Sharc-FT(®).
No full textAbstract
PURPOSE:
Today, in rotator cuff tear repair, the transosseous sutures are considered superior from a biological and biomechanical point of view. Our purpose is to present the early clinical and biomechanical data of a new arthroscopic rotator cuff tear transosseous repair system: the Sharc-FT®.
MATERIALS AND METHODS:
A total of 34 patients with rotator cuff tear affecting supraspinatus and infraspinatus, 1 to 3 cm wide, were treated and evaluated from 2010 to 2013. The average age was 63.2 years. Mean follow-up was 18.6 months. All patients were assessed through Constant score in the preoperative step and at 3-, 6-, and 12-month follow-up, performing an MRI 6 months after surgery.
RESULTS:
The patients have shown a mean preoperative Constant score of 24.5 pt that constantly increases after surgery, until a mean value of 86.9 at 12 months. Regarding complications two cases of adhesive capsulitis were recorded.
CONCLUSIONS:
This device permits to obtain transosseous sutures with cortical fixation; to greatly reduce the problems of lack of bone resistance; to decrease motion at tendon-footprint interface improving fatigue resistance; to make the stress-load distribution homogeneous at the footprint, thus optimizing biological healing. A later evaluation will be necessary, especially for the incidence of retears
ULTRASTRUCTURAL ASPECTS OF ARTICULAR CARTILAGE AND SUB-CHONDRAL BONE IN PATIENTS AFFECTED BY POST-TRAUMATIC SHOULDER INSTABILITY
No full textULTRASTRUCTURAL ASPECTS OF ARTICULAR CARTILAGE AND SUB-CHONDRAL BONE IN PATIENTS AFFECTED BY POST-TRAUMATIC SHOULDER INSTABILIT
Arthroscopic Rotator Cuff Tear Transosseous Repair System: The Sharc-FT Using the Taylor Stitcher
No full textTransosseous rotator cuff tear repair was first described in 1944. Over the years, it has represented the gold standard for such lesions. Through open and mini-open approaches, as well as the arthroscopic approach, the transosseous repair system represents one of the most reliable surgical techniques from a biological and mechanical perspective. Nevertheless, further improvements are required. This article describes an arthroscopic rotator cuff tear transosseous repair system, developed in collaboration with NCS Lab (Carpi, Italy): the Sharc-FT using the Taylor Stitcher. Our first experience in the clinical application of the arthroscopic technique using the transosseous suture system has shown encouraging clinical outcomes, confirming its efficacy. The patient satisfaction rate was high, and no patient expressed concern about the implant. The complication rate was very low. By improving the suture technique in the treatment of rotator cuff tears, a remarkable increase in the success rate in the treatment of this pathology could be reached; nevertheless, complications such as retears of the rotator cuff still occur
Ultrastructural aspects of articular cartilage and subchondral bone in patients affected by post-traumatic shoulder instability: preliminary observations
Full text linkPost traumatic shoulder instability is a frequent condition in young active population.
Notwithstanding a lot of data have been collected on capsular-legament lesions
and gleno-humeral defects, no data are available on early ultrastructural ostheo-condral
damages that are known to be highly associated with the onset of invalidating
pathologies, like osteoarthritis (OA). Thus, the mechanisms of joint instability and the
identification of which components in the articular complex are primarily affected in
instability are of clinical significance, particularly in the light of deepening knowledge
on the onset/development of OA. In the present study, biopsies of the articular
cartilage and sub-chondral bone were taken from 10 patients (aged 26-40) underwent
surgery in Policlinico of Modena. The withdrawals were immediately fixed and
embedded for Transmission Electron Microscopy (TEM). The observations were performed
in tangential, arcuate, and radial layers of the articular cartilage as well as
in sub-chondral bone. TEM observations showed that chondrocytes in the superficial
layers (i.e. tangential and arcuate) display normal and very well preserved ultrastructure,
probably due to synovial liquid supply; otherwise, chondrocytes in the radial
layer (not only in calcified but also in the un-calcified one) show various degrees of
degeneration, with cytoplasm partially coerced and variously-sized vacuoles, both
signs of suffering; occasionally, in the radial layer, chondrocytes with morphological
signs of apoptosis or autophagy were also observed. As far as sub-chondral bone is
concerned, osteocytes next the deeper calcified cartilage (within 80-100 micra from
the cement line) also show evidences of degeneration, while osteocytes more distant
from the osteo-chondral border display normal ultrastructure probably due to
the vascular bone supply. In all patients of the study, the ultrastructural features of
osteo-chondral complex are not depending on age. The present study represents the
first ultrastructural investigation of the articular osteo-chondral complex in shoulder
instability, evaluating the state of preservation/viability of both chondrocytes and
osteocytes throughout the successive layers of the articular cartilage and sub-chondral
bone. These preliminary observations are the basis to understand if the early surgical
treatment in shoulder instability could avoid the onset of OA
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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