117,315 research outputs found
Trattamento delle lesioni del rachide nel polifratturato di eta' pediatrica
No full textSpine injuries involve 1 to 5% of children admitted to trauma centers and a high index of suspicion is warranted owing to the potential severe consequences of unstable lesions. Evaluation of cervical and lumbar trauma in children requires an understanding of developmental anatomy to differentiate trauma from age-appropriate findings. Generally speaking, young children more often have ligamentous injuries, whereas older children and adolescents have bone injuries as the spine takes on adult features. The aim of this review is to provide a concise overview of the major aspects involved in spine injuries detection and management in children. Epidemiology is discussed first, and then appropriate precautions and paediatric spine immobilization protocols are presented. Details of paediatric spine radiological anatomy are included and our institutional spine clearance protocol is discussed. Lastly, a short paragraph is devoted to analyze treatment of spinal cord injuries in children and halo immobilization
Clinical evidence for suture anchor repair of rotator cuff tears does add up: some just do not want to see it.
No full textThe burden of percutaneous vertebroplasty: an epidemiological nationwide study in Italy from 2009 to 2015
No full textPurpose: Percutaneous vertebroplasty (PV) is a minimally invasive technique requiring the injection of polymethylmethacrylate cement into a collapsed or weakened vertebral body to stabilize the fracture. The present study aims to determine the trends in PV procedures over the recent years. The longitudinal analysis of national registers may help to understand the yearly trends and the economic burden of PV. The evaluation of the yearly national costs of this procedure is essential to surgeons, policymaker, hospital administrator and the healthcare system. Moreover, to observe possible variation in the trend of hospitalization between countries, the data of the present study were compared to the US population. Methods: Data of this study were collected from the National Hospital Discharge Reports reported at the Italian Ministry of Health regarding the years of this paper (2009–2015). The yearly number of hospital admission for PV, sex, age, days of hospitalization and primary diagnoses in the whole Italian population were calculated. Results: 31,887 vertebroplasties were performed in Italy, with an incidence of 8.8 procedures for every 100,000 inhabitants. Females represented the majority of patients undergoing PV. The median length of hospital stay was 4.15 days. The mean hospital reimbursement was 4,629€ for each PV hospitalization. Conclusion: The burden of vertebral fracture is relevant in the Italian population, and PV constitutes a rapid and effective treatment. Compared to other countries, the costs of PV in Italy are relatively lower; however, it is important to define the incidence of this procedure to understand the economic trend of PV
Trends in Hospitalization and Economic Impact of Percutaneous Kyphoplasty in Italy
No full textVertebral Fractures (VFs) caused by osteoporosis are the most typical reason for performing Percutaneous Kyphoplasty (PK). Globally, VF prevalence is not well described in the literature. In Europe, only Sweden has an accurate record of the incidence of this type of fracture. Moreover, the exact incidence of the PK procedure is not reported. Therefore, the annual patterns and financial burden of PK in Europe is not well known, and it could be may better understood by examining national registers. For surgeons, lawmakers, hospital administrators, and the healthcare system, determining the annual national costs of this treatment is helpful. The National Hospital Discharge Reports (SDOs) submitted to the Italian Ministry of Health during the years covered by this study (2009–2015) were used. A total of 13,113 kyphoplasties were performed in Italy, with a prevalence of 3.6 procedures for every 100,000 Italian inhabitants over 15 years. The average age of patients was 68.28 (±12.9). Females represented the majority of patients undergoing PK procedures (68.6%). The median length of hospital stay was 5.33 days. The prevalence of PK procedures increased from 2009 to 2015, while the average days of hospitalization decreased. Older patients were most at risk in undergoing PK procedures. Reporting the national data on PK in Italy could also help compare the findings across nations. The current study aims to determine the trends of PK hospitalisation and patient features in Italy
Changing Treatment Philosophy of Slipped Capital Femoral Epiphysis (SCFE) after Introduction of the Modified Dunn Procedure (MDP): Our Experience with MDP and Its Complications
No full textBackground. The modified Dunn procedure (MDP) has become popular during the last 16 years to treat severely displaced slipped capital femoral epiphysis (SCFE) while “in situ” pinning (ISP) has remained valid to treat mild to moderate SCFE, although the indication limit of the Southwick angle (SA) has not yet been established for either procedure. In this context, we reviewed two cohorts of patients with SCFE, one treated by ISP and the other by MDP. We also tried to better elucidate the etiopathogenesis of hip instability, a severe complication of MDP. Methods. Fifty-one consecutive patients with 62 hips affected by SCFE were treated by us from 2015 to 2019: 48 hips with a SA ≤ 40° had ISP while 14, with the SA > 40°, had MDP. The latter also had a CT scan to better investigate the SCFE morphology. Results were assessed using the Harris Hip Score. Results. The mean length of follow up of the two cohorts was 5.4 years (range: 3 to 8 years). Of the 35 hips operated by ISP with a full follow-up evaluation, 30 had an excellent or good result, 3, fair, and 2, poor. Of the 14 hips that underwent MDP, 11 had an excellent or good result, 1, fair, and 2, poor. A CT scan showed femoro-acetabular incongruency in two unstable hips following MDP. Conclusions. We performed ISP in chronic SCFE with the SA ≤ 40° and MDP in acute and chronic SCFE with the SA > 40°, with satisfactory results. In both acute-on-chronic and chronic long-lasting SCFE with severe displacement, planned for MDP, a CT scan should be carried out to evaluate possible femoro-acetabular incongruency that may cause hip instability
Characteristics at haematoxylin and eosin staining of ruptures of the long head of the biceps tendon.
No full textOBJECTIVE:
To examine the relative prevalence of histological changes that have been found to be associated with the process of tendinopathy in lesions of the tendon of the long head of the biceps brachii and to evaluate the reliability of histopathological evaluation of tendon tissue in lesions of the tendon of the long head of the biceps.
DESIGN:
Tendon samples were taken from 51 patients (31 men, 20 women; mean age 63.2 years) who underwent arthroscopic release of the long head of the biceps tendon because of refractory biceps tendinopathy and from 5 male patients who died of cardiovascular events (mean age 69.6 years). Histological examination was performed using haematoxylin and eosin staining of sections, which were interpreted using a semiquantitative grading scale assessing fibre structure and arrangement, rounding of the nuclei, regional variations in cellularity, increased vascularity, decreased collagen staining and hyalinisation.
RESULTS:
The mean (SD) pathological sum score of ruptured tendons was greater than that of control tendons (15.76 (3.11) vs 3.4 (1.9), p<0.001). Within each specific category of tendon abnormalities, the chi(2) test showed significant differences between the control and ruptured tendons; all the variables were significantly different (Mann-Whitney U test 0.05, p<0.001). Using the kappa statistic, the agreement between the two readings ranged from 0.53 to 0.85.
CONCLUSIONS:
Unruptured tendons of the long head of the biceps, even at an advanced age and ruptured tendons of the long head of the biceps are clearly part of two distinct populations
Circulating substance P levels and shoulder joint contracture after arthroscopic repair of the rotator cuff.
No full textOBJECTIVE:
To determine the plasma levels of substance P (SP) in patients with postoperative stiffness after arthroscopic rotator cuff repair.
DESIGN:
Plasma samples were obtained at 15 months from surgery from two groups of patients who underwent arthroscopic repair of a rotator cuff tear. In group 1, 30 subjects (14 men, 16 women; mean age 64.6 years, range 47 to 78) with shoulder stiffness 15 months after arthroscopic rotator cuff repair were recruited. In group 2, 30 patients (11 men, 19 women; mean age 57.8 years, range 45 to 77) were evaluated 15 months after successful arthroscopic rotator cuff repair. Immunoassays were performed with commercially available assay kits to measure the plasma levels of SP.
RESULTS:
Plasma levels of SP in patients with postoperative stiffness were significantly greater than those in the control group (mean 81.06 (SD 27.76) versus 23.49 (5.64), p<0.05).
CONCLUSIONS:
The plasma concentrations of substance P in patients with shoulder stiffness after arthroscopic rotator cuff repair are higher compared with plasma levels of SP in patients with a good postoperative outcome. The neuronal upregulation of SP shown in the plasma of patients with postoperative shoulder stiffness may underlie not only the symptoms but also its development of adhesive capsulitis
Higher fasting plasma glucose levels within the normoglycaemic range and rotator cuff tears
No full textAdhesion and collagen production of human tenocytes seeded on degradable poly(urethane urea).
No full textPURPOSE:
The aim of this study was to investigate whether human tenocytes taken from ruptured quadriceps tendon could be seeded on a biodegradable polycaprolactone-based polyurethanes (PU) urea scaffold. Scaffold colonization and collagen production after different culture periods were analyzed to understand whether tenocytes from ruptured tendons are able to colonize these biodegradable scaffolds.
METHODS:
Human primary tenocyte cultures of ruptured quadriceps tendons were seeded on PU scaffolds. After 3, 10 and 15 days of incubation, the samples were stained with haematoxylin and eosin and were examined under white light microscopy. After 15 and 30 days of incubation, samples were examined under transmission electron microscope. Total collagen accumulation was also evaluated after 15, 30 and 45 days of culture.
RESULTS:
After 15 and 30 days of culture, tenocyte-seeded scaffolds showed cell colonization and cell accumulation around interconnecting micropores. Tenocyte phenotype was variable. Collagen accumulation in seeded scaffolds demonstrated a progressive increase after 15, 30 and 45 days of culture, while control non-seeded scaffolds show no collagen accumulation.
CONCLUSION:
These results showed that human tenocytes from ruptured quadriceps tendon can be seeded on polycaprolactone-based PU urea scaffolds and cultured for a long time period (45 days). This study also showed that human tenocytes from ruptured tendons seeded on PU scaffolds are able to penetrate the scaffold showing a progressively higher collagen accumulation after 15, 30 and 45 days of incubation. This study provides the basis to use this PU biodegradable scaffold in vivo as an augmentation for chronic tendon ruptures and in vitro as a scaffold for tissue engineering construct
Arthroscopic management of calcific tendinopathy of the shoulder--do we need to remove all the deposit?
No full textResults of arthroscopic management of chronic, recalcitrant calcific tendinopathy of the shoulder in 28 patients were evaluated. Twenty-six patients (average age, 44 years) were ultimately enrolled in the study. Postoperative radiographs were performed to determine the amount of calcium deposit removal. Radiographic examination 2 months after surgery was performed to evaluate further deposit changes. The Constant score showed a statistically significant improvement in all patients. Better results were obtained when complete removal of the calcifications was achieved. On radiographic examination, performed two months after surgery, no calcification deposit increased in size and no translucent deposit changed into a dense deposit. Most of the dense deposits, partially removed, changed into translucent deposits. In this series, we found arthroscopic management was effective in treating calcific tendinopathy
- …
