190 research outputs found
Custom Reconstruction Around the Knee
No full textWith rapid prototyping technique, an individual-based solution can be performed on the patient anatomy and his clinical needs.
Different products can be obtained starting from custom-made prostheses and specifc instruments. 3D printing allows to design an architecture with similar mechanical characteristic of bone [8], able to induce osteointegration and decrease the stress-shielding phenomenon due to the porosity and the elasticity of trabecular titanium [9]. Moreover, rapid prototyping can be used to
develop specifc instruments for each single step, minimizing the approach and bone loss, reducing the time of surgery and improving the reconstruction. The aim of our research is to develop a new customized implant for knee repair to treat wide
defects that alternatively may require commercial implants such as UKA, TKA, modular prostheses or massive allograft transplantation.
The idea is an hybrid prosthesis composed by a metallic frame with poly-caprolactone (PCL), a biodegradable material on the joint surface that be considered as a scaffold with similar mechanical characteristic of the implant itself in the short term, but potentially able to be substituted from the regenerative activity of the patient during time confguring a sort of biological prosthesis.
This procedure allows to preserve the most bone stock possible, respecting the stability given by soft tissue (ligaments) and maintaining the articular surface on the opposit
Computer Assisted Surgery and 3D Printing in Orthopaedic Oncology: A Lesson Learned by Cranio-Maxillo-Facial Surgery
No full textPrimary bone sarcomas are rare tumors and surgical resection in combination with chemo
and radiation therapy is the mainstay of treatment. Some specific anatomical sites still represent a
reconstructive challenge due to their complex three-dimensional anatomy. In recent years, patient
specific instruments along with 3D printing technology has come to represent innovative techniques
in orthopaedic oncology. We retrospectively reviewed 23 patients affected by primary bone sarcoma
treated with patient-specific instruments and 3D printing custom made prostheses. At follow up
after approximately two years, the infection rate was 26%, mechanical complication rate 13%, and
local recurrence rate 13% (with a five-years implant survival rate of 74%). Based on our experience,
patient-specific instruments and 3D custom-made prostheses represents a reliable and safe technique
for improving the accuracy of resection of primary bone tumour, with a particular use in pelvic
surgery ameliorating functional resul
Custom-made 3D-Printed Prosthesis in Periacetabular Resections Through a Novel Ileo-adductor Approach
No full textResection of sarcomas around the acetabulum presents major challenges. The resulting bone effect can be reconstructed with personalized custom-made prostheses. Patient-specific instruments (PSIs) have been demonstrated to be of added value for bone-cutting accuracy, and they may improve pelvic surgery. The authors describe a novel ileo-adductor approach for pelvic tumor surgery and report the preliminary results of 5 reconstructions using custom 3D-printed prostheses associated with PSI surgical guides. This combined technique allows an optimal restoration of the anatomy with reduced surgical time and reduced postoperative complications such as infections and wound healing problems
Periacetabular Tumour Resection under Anterosuperior Iliac Spine Allows Better Alloprosthetic Reconstruction than Above: Bone Contact Matters
No full textBackground: Periacetabular resections are more affected by late complications than other pelvic resections. Reconstruction using bone allograft is considered a suitable solution. However, it is still not clear how the bone-allograft contact surface impacts on mechanical and functional outcome. Materials and methods: This paper presents the results of a retrospective analysis of 33 patients with resection of the entire acetabulum and reconstruction with an allograft-prosthetic composite for the period 1999 to 2010. Patients were divided in two groups, based on type of resection. In Group 1. patients had resections under anterosuperior iliac spine allowing the highest bone-allograft surface contact in reconstruction, while in Group 2 patients had resections over it. Results: Mechanical survival of the implant and Musculoskeletal Tumor Society functional score were calculated. Impact of age and artificial ligament were investigated as well. Patients in Group 1 had 38% mechanical failure rate of the implant while patients in Group 2 had 88%. Average functional score was higher in Group 1 compared with patients in Group 2. An artificial ligament was shown to have non-significant impact on survival of the reconstruction in Group 1, while significantly improving survival of reconstruction in Group 2. Conclusion: Bone-allograft contact matters: resection under anterosuperior iliac spine allows better mechanical survival and offers better reconstruction functional scores
Current Concepts in the Resection of Bone Tumors Using a Patient-Specific Three-Dimensional Printed Cutting Guide
No full textOrthopedic oncology has begun to use three-dimensional-printing technology, which is expected to improve the accuracy of osteotomies, ensure a safe margin, and facilitate precise surgery. However, several difficulties should be considered. Cadaver and clinical studies have reported more accurate osteotomies for bone-tumor resection using patient-specific cutting guides, especially in challenging areas such as the sacrum and pelvis, compared to manual osteotomies. Patient-specific cutting guides can help surgeons achieve resection with negative margins and reduce blood loss and operating time. Furthermore, this patient-specific cutting guide could be combined with more precise reconstruction using patient-specific implants or massive bone allografts. This review provides an overview of the basic technologies used in the production of patient-specific cutting guides and discusses their current status, advantages, and limitations. Moreover, we summarize cadaveric and clinical studies on the use of these guides in orthopedic oncology
Minimally invasive treatment of long bone non-unions with bone marrow concentrate, demineralized bone matrix and platelet-rich fibrin in 38 patients
No full textTo determine the efficacy of percutaneous injection of autologous bone marrow concentrated (BMC), demineralized bone matrix (DBM), and platelet rich fibrin (PRF) in the treatment of long bone non-unions. From January 2011 to January 2018 patients with non-union of the lower limbs who were on the waiting list for open grafting with established tibial or femoral non-union and minimal deformity were eligible to participate in this study. Patients were treated with a single percutaneous injection of DBM, BMC and PRF. Our study group comprised 38 patients (26 males and 12 females; mean age 39, range 18 to 65). Non-unions were located in the femur (18 cases) and in the tibia (20 cases). Clinical and imaging follow-up ranged from 4 to 60 months (mean 20 months). Bone union occurred in 30 out of 38 patients (79%) in an average of 7 months (range 3 to 12) and all healed patients had full weight bearing after 9 months on average (range 6 to 12) from injection. In 19 cases the osteosynthesis was removed 12 months on average (range 3 to 36) from surgery. One patient developed infection at the non-union site after treatment. Percutaneous injection of DBM, BMC, and PRF is an effective treatment for long-bone non-unions. This technique allows the bone to heal with a minimally invasive approach and with a hospitalization of 2 days. Key elements of bone regeneration consist of a combination of biological and biomechanical therapeutic approach
Recensione a G. Comandè, Medical Law in Italy,Wolters Kluwer, 2014
No full textThe review analyses G. Comandè's work Medical Law in Italy focusing on the main issues analysed by the Author under a criminal law perspectiv
Müller Deutschland 1979-1989. L'istituzione Heiner Müller nella Repubblica Federale Tedesca attraverso l'esempio di Berlino Ovest
No full textObject of this essay is role of the GDR author and dramatist Heiner Müller in West Berlin between 1979 and 1989, contextualizing him in the specific and peculiar artistic and intellectual scenario of the so called "two hearted city"
Los apuntes autobiográficos de un morisco expulsado: algunas reflexiones sobre el prólogo del Ms. S2 de la Colección Gayangos de la Biblioteca de la Real Academia de la Historia de Madrid
No full textThis paper aims to study some details, concerning style and themes, that the anonymous Moorish author determined to provide in the prologue of the manuscript S2 of the Gayangos Collection of the Library of the Real Academia de la Historia in Madrid [ff. 2r-16v]. Particularly, the attention is focused on the autobiographical notes inserted in the prologue, important narrative sequences in which the author tells the tough conditions suffered as a crypto-Muslim in Seventeenth-century Spain.El presente trabajo procura realizar una observación sobre algunos detalles estilísticos y temáticos que el autor morisco anónimo determina brindar en la sección del prólogo del manuscrito S2 perteneciente a la Colección Gayangos de la Biblioteca de la Real Academia de la Historia de Madrid [ff. 2r-16v]. De manera particular, la atención se focaliza en los apuntes autobiográficos intercalados en el mismo prefacio, importantes secuencias narrativas en las que el autor relata la durísima condición que sufrió como criptomusulmán en la España del siglo XVII
Per un teatro che crede nella storia. Pier Paolo Pasolini nell'opera di Heiner Müller
No full textAim of this essay is to analyse the role of Pier Paolo Pasolini in the work and poetics of the GDR-author Heiner Müller. After an analysis of the reception of Pasolini’s works and persona in Germany and in the specific context of the GDR, the current work focuses on the influence of PPP in Müller’s approach to language, identity and history
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