27 research outputs found
Magnesium and osteoporosis: current state of knowledge and future research directions
No full textA tight control of magnesium homeostasis seems to be crucial for bone health. On the basis of experimental and epidemiological studies, both low and high magnesium have harmful effects on the bones. Magnesium deficiency contributes to osteoporosis directly by acting on crystal formation and on bone cells and indirectly by impacting on the secretion and the activity of parathyroid hormone and by promoting low grade inflammation. Less is known about the mechanisms responsible for the mineralization defects observed when magnesium is elevated. Overall, controlling and maintaining magnesium homeostasis represents a helpful intervention to maintain bone integrity
Stress fractures of the base of the metatarsal bones in young trainee ballet dancers
No full textClassical ballet is an art form requiring extraordinary physical activity, characterised by rigorous training. These can lead to many overuse injuries arising from repetitive minor trauma. The purpose of this paper is to report our experience in the diagnosis and treatment of stress fractures at the base of the second and third metatarsal bones in young ballet dancers. We considered 150 trainee ballet dancers from the Ballet Schools of "Teatro Alla Scala" of Milan from 2005 to 2007. Nineteen of them presented with stress fractures of the base of the metatarsal bones. We treated 18 dancers with external shockwave therapy (ESWT) and one with pulsed electromagnetic fields (EMF) and low-intensity ultrasound (US); all patients were recommended rest. In all cases good results were obtained. The best approach to metatarsal stress fractures is to diagnose them early through clinical examination and then through X-ray and MRI. ESWT gave good results, with a relatively short time of rest from the patients' activities and a return to dancing without pain
Anterior cruciate ligament recostruction with bone-patellar tendon-bone autograft in Tanner 3 stage patients with open physes
No full textTen skeletally immature patients were treated with an arthroscopic-assisted anterior cruciate ligament
reconstruction with bone-patellar tendon bone autograft (compass, 50–558; holes, 7–9 mm). Radiological assessments (standard radiograph), Orthopa ̈ dische
Arbeitsgruppe Knie (OAK) score and KT 1000, were conducted on all patients, 1 year after surgery. Skeletal maturity had been reached by all patients and no complications were observed. All patients returned to their
preinjury sport level. Drilling more vertical tunnels when bone-tendon-bone autograft was chosen to avoid partial
epiphysiodesis and offers good functional and isometric results
Synthetic grafts for anterior cruciate ligament rupture : 19-year outcome study
No full textArtificial ligaments for ACL replacement have been widely used in the 1980s and early 1990s in orthopaedic surgery. Synthetic devices have been utilized either as a prosthetic material or as an augmentation for a biological ACL graft substitute. The initial enthusiasm surrounding the introduction of synthetic graft materials stemmed from their lack of donor morbidity, their abundant supply and significant strength of these devices. The disadvantages in long-term follow-up were found to be cross-infections, immunological responses, tunnels osteolysis, femural and tibial fractures, foreign-body synovitis and knee osteoarthritis. A total of 126 patients were treated with artificial ACL substitution with polyethylene terephthalate (PET) synthetic ligaments in our Institute between 1986 and 1990. Of the original group, 51 sportsmen aged 15 to 40 were followed-up at a mean of 19years (range 17.5 to 20.6years) after surgery. Assessment was made with KOOS and IKDC score, Tegner activity scale, clinical examination, KT-1000 arthrometer, and X-ray evaluation. Of the 51 patients followed-up, 27.5% were found to have ruptured their PET ligaments and 100% presented degenerative osteoarthritis at the X-ray evaluation according to Ahlbäck radiological classification of arthritis. The objective evaluation showed functional impairment in 29.4% with an average reduction of 3 points in the Tegner activity scale. The osteoarthritis observed in all patients prompted us to avoid the diffusion of this surgical technique. Although in theory well-conceived, studies have yet to substantiate the function of these augmentation devices or to show clinical better results than those achieved with isolated autograft or allograft ACL substitutes
Renal phosphate handling in Gitelman syndrome : the results of a case–control study
No full textBACKGROUND: Patients with Gitelman syndrome, a hereditary salt-wasting tubulopathy, have loss-of-function mutations in the SLC12A3 gene coding for the thiazide-sensitive sodium chloride co-transporter in the distal convoluted tubule. Since the bulk of filtered phosphate is reabsorbed in the proximal tubule, renal phosphate wasting is considered exceptional in Gitelman syndrome.
METHODS:We investigated the renal handling of inorganic phosphate in 12 unselected Italian patients affected with Gitelman syndrome (5 females and 7 males, aged 6.0-18 years, median age 12 years) and in 12 healthy subjects matched for gender and age (controls). The diagnosis of Gitelman syndrome among the patients had been made clinically and confirmed by molecular biology studies.
RESULTS: The biochemical hallmarks of Gitelman syndrome, namely hypochloremia, hypokalemia, hypomagnesemia, increased urinary excretion of sodium, chloride, potassium and magnesium and reduced urinary excretion of calcium, were present in the 12 patients. In addition, both the plasma inorganic phosphate concentration (median and interquartile range: 1.28 [1.12-1.36] vs. 1.61 [1.51-1.66)] mmol/L) and the maximal tubular reabsorption of inorganic phosphate (1.08 [0.99-1.22] vs. 1.41 [1.38-1.47] mmol/L) were significantly lower (P < 0.001) in Gitelman patients than in control subjects. Circulating levels of 25-hydroxyvitamin D, intact parathyroid hormone and osteocalcin were similar in patients and controls.
CONCLUSIONS: The results of our case-control study disclose a hitherto unrecognized tendency towards renal phosphate wasting with mild to moderate hypophosphatemia in Gitelman syndrome
Surface EMG Evaluation of Patellofemoral Pain Syndrome in a Professional Ballet Dancer : A Case Report
No full textObjective: Because of the repetitive loading of the lower limb, patellar disorders are common in athletes and performing artists. Although this condition might be ascribed to different factors, the main cause is believed to be patellar maltracking. Design: Patellar maltracking is believed to be generated by an asymmetric activation of the vastus lateralis and vastus medialis obliquus muscles. A professional ballet dancer who suffered from anterior knee pain was examined. After clinical and MRI evaluations, he was subjected to surface electromyography (sEMG) of the vastus medialis obliquus and vastus lateralis. Results: We found a difference in the latency of onset of the vastus medialis obliquus and vastus lateralis of the painful right knee as compared to the asymptomatic left knee. Conclusion: Via sEMG, we demonstrate the role of the vastus medialis in patellar maltracking. sEMG is therefore a useful method to help diagnose and guide treatment in performing artists and elite athlete
Tramadol compared with Diclofenac in traumatic musculoskeletal pain
No full textThis multicenter, randomized, controlled, open-label trial of 120 patients (89 men, 31 women) was conducted to compare the efficacy and safety of tramadol and diclofenac (both at 200 mg/d) in the short-term treatment (5 to 7 days) of traumatic musculoskeletal pain. Tile posology of the two treatments was 100 mg twice daily; however, the patients could take three doses per day. Patients were randomly assigned to either treatment. Thirty patients, with strong pain resulting from trauma to bones, joints, and/or ligaments, were admitted to each of four centers. The analgesic effect of both drugs was confirmed by the significant reduction in pain compared with baseline. The analgesic activity of tramadol was higher than that of diclofenac, after both the first dose (between treatments at the 5th and 6th hours), and during repeated therapy (between treatments on day 2 and at the end of treatment). Patients' quality of sleep improved significantly with both drugs, on day 2 and at the end of treatment, compared with baseline. Seven patients discontinued the drugs because of moderate-to-severe adverse reactions (4 receiving tramadol and 3 receiving diclofenac). Another 6 patients had moderate-to-mild reactions (4 receiving tramadol and 2 receiving diclofenac). Final assessments of efficacy and safety were all significantly in favor of tramadol
FRATTURE DA STRESS NEI TERSICOREI: PREVENZIONE E ITER DIAGNOSTICO TERAPEUTICO. ANALISI DEI FATTORI DI RISCHIO MEDIANTE QUESTIONARIO 'SELF REPORTED INJURY' E DATABASE CLINICO
No full textSTRESS FRACTURES IN BALLET DANCERS: OUR PREVENTION AND DIAGNOSTIC PROTOCOL. RISK FACTORS EVALUATION USING A SELF REPORTED INJURY QUESTIONNAIRE AND CLINICAL HISTORY DATA BASE.
STUDY DESIGN: RETROSPECTIVE DESCRIPTIVE STUDY
OBJECTIVE: WE PERFORMED A STUDY TO DESCRIBE OUR DIAGNOSTIC AND CLINICAL APPROACH TO STRESS FRACTURES IN ELITE YOUNG BALLET DANCERS. THE STUDY LASTED ONE DANCE ACADEMIC YEAR.
MATERIAL AND METHODS: OUR POPULATION CONSISTED OF 180 BALLET DANCERS BUT ONLY 111 DANCERS WERE FINALLY ENROLLED TO THE STUDY. AT THE END OF THE ACCADEMIC YEAR EACH DANCER FILLED IN A SELF REPORTED INJURIES QUESTIONNAIRE, AND ALL CLINICAL DATA OF DANCERS MEDICAL HISTORY DURING THE SAME YEAR WERE COLLECTED. IF A STRESS FRACTURE WAS SUPPOSED DURING CLINICAL EVALUATION, A SPECIFIC PROTOCOL WAS APPLIED. THIS WAS BASED ON MRI EVALUATION AND EXTERNAL SHOCK WAVE THERAPY (ESWT) APPLICATIONS. SUSPICIOUS FACTORS OF STRESS FRACTURES WERE IDENTIFIED AND USED TO DECIDE THE TREATMENT OPTIONS.
RESULTS: DESCRIPTIVE DATA REGARDING AGE, SEX, AND ANTHROPOMETRIC MEAUSEREMENTS WERE PUBLISHED IN THE ORIOGINAL WORK. 19 STRESS FRACTURES WERE OCCURRED AT METATARSAL AND TIBIAL REGION. ALL DANCERS UNDERWENT TO THREE APPLICATIONS OF ESWT.
DISCUSSION: USING THE CLINICAL DATA OF THE MEDICAL HISTORY, WE IDENTIFIED SEVERAL SUSPICIOUS FACTORS FOR STRESS FRATURES. POSITIVE SIGNS DURING THE CLINICAL EVALUATION AND AT LEAST TWO SUSPICIOUS FACTORS WERE PEREMPTORY TO DECIDE TO FOLLOW THE TREATMENT WITH ESWT. ALL DANCERS WITH STRESS FRACTURES RECEIVED THREE CONSECUTIVE APPLICATIONS OF ESWT WITH GOOD RESULTS. THEN THESE DANCERS FOLLOWED A PERIOD OF ABSOLUTE REST OF 3 WEEKS (MEAN) AND A PERIOD OF RELATIVE REST OF 4 WEEKS (MEAN). DANCERS NEVER USED CASTS AND CONTINUED TO PRACTISE EXERCISE FOR ELASTICITY IN NON-WEIGHT BEARING DURING ALL THESE PERIODS. AFTER THIS, DANCERS STARTED AGAIN DANCING PROGRESSIVELY WITH A RESTORATION OF A COMPLETE DANCING ACTIVITY AFTER 1 MONTH. WE THINK THAT ESWT AND THE CORRECTION OF ANY PREDISPOSING FACTORS WERE AND ARE ACTUALLY THE GOLD STANDARD IN THE TREATMENT OF STRESS FRACTURES IN ELITE DANCERS. THE PROMPT DIAGNOSIS FOLLOWED A METICULOUS CLINICAL AND ANAMNESTIC EVALUATION. MRI IMAGES CAN HIGHLIGHT STRESS FRACTURES AND THEY SCHOULD BE PERFOMED AT THE BEGINNING OF SYMPTOMS TO START TREATMENT IN TIME.
CONCLUSION: OUR DIAGNOSTIC AND TREATMENT PROTOCOL FOR STRESS FRACTURE PERMITTED A GOOD HEALING OF STRESS FRATURES IN ALL YOUNG ELITE BALLET DANCERS OF OUR STUDY GROUP
Supracondylar humerus fractures in children : a comparison of experiences
No full textThe most common elbow lesions found in pediatric practice are supracondylar fractures. We compared two groups of 34 patients each with a supracondylar humerus
fracture grade III (Gartland classification). The first group
was treated with percutaneous pinning with Kirschner wires, with patients in a supine position, sometimes preceded by transkeletal traction. The second group was treated with percutaneous pinning with Kirschner wires,
with patients in a prone position, within 6 h of the trauma. No statistically significant differences with regard to clinical outcomes and neurovascular complications were revealed in the comparison. Therefore, we can state that both
treatment techniques used are valid
Ultrasonic diagnosis of Osgood-Schlatter and Sinding-Larsen-Johansson diseases of the knee
No full textHigh resolution ultrasonography of the knee was performed on 82 young patients with clinically suspected Osgood-Schlatter disease and on 30 normal subjects; in 45 pathological cases (55%) comparative X-ray films were taken. The ultrasound pictures were equally or more effective than X-ray images in 45/45 cases; their value was particularly marked for soft tissue study. The typical sonographic changes of the ossification center, of the cartilage, and of the surrounding soft tissues are described and classified, both for Osgood-Schlatter and for Sinding-Larsen-Johansson diseases. These signs are based mainly upon cartilage swelling and edema, fragmentation of the ossification center, thickening of the patellar tendon, and bursitis of the infra-patellar bursa. Ultrasonography is proposed as a simple and reliable method for the diagnosis of knee joint osteochondrosis. The ultrasound picture is also suitable for periodical follow-up the course of the disease
