Isolated osteoblastoma of the cuboid bone: A case report and review of the literature

Osteoblastoma is a relatively rare, benign, bone-forming tumor, commonly observed in the second and third decades of life. Spine and the long tubular bones are the most common sites of involvement. Osteoblastoma is infrequently seen in other sites, including the bones of hand and foot. A rare case of a 35-year-old man that presented an osteoblastoma of the cuboid bone is reported. The patient was treated with surgical resection and grafting. After the intervention, the patient recovered with no clinical and radiological evidence of recurrence after one year of follow-up. Several cases of osteoblastoma-like variant of osteosarcoma of the cuboid have been previously reported, but, to our know…

Indications and limits of the Fixator TGF "Gex-Fix" in fractures of the proximal end of the humerus

Le biopsie mini invasive nei tumori ossei e delle parti molli: aspetti gestionali e considerazioni cliniche

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What’s the resolutive surgery for Pseudo-Ainhum in vohwinkel syndrome? A case report and review of the literature

Vohwinkel Syndrome, also known as Keratoderma Hereditarium Mutilans, is an extremely rare dominant autosomal keratosis. It typically presents with “starfish” keratoses on the knuckles, palmoplantar keratoderma (PPK), hearing impairment and mutilating digital constriction bands (pseudoainhum) that cause strangulation, often leading to autoamputation of the affected digit. Both medical and surgical treatment haven’t shown to date consistent results, in the treatment of pseudoainhum. In this study we present the case of a woman with Vohwinkel syndrome who showed constriction bands causing ischemic changes of the 5th digit of the right hand for which she was treated with surgery. We also presen…

Co-morbidities in patients with hip osteoarthritis and treated with ecoguided infiltrations of Hyaluronic acid: study of the effectiveness of the treatment

Hydatid cyst in the vastus lateralis muscle: a case report

Hydatidosis is a zoonotic disease; human infection occurs through the consumption of food and water contaminated with the eggs of parasites of the Echinococcus type. While the liver is the most common site of infection, involvement of the musculoskeletal system is extremely rare. In the context of musculoskeletal involvement, the spine is the most commonly infected site, while the muscles are rarely infected and account for approximately <1% of cases. It has been suggested that muscles provide an unsuitable environment for the parasite, because of the presence of lactic acid. The cysts appear as slow-growing masses of soft tissue, and signs of inflammation and fistulization often coexist. W…

Self-inflicted long bone fractures for insurance fraud.

Self-inflicted fractures simulating traffic accident represent a new social fraud opportunity for criminality. Recognising scams through an increase of awareness of existence of self-inflicted arm fractures for insurance fraud could help community health workers to report these injuries to the competent authorities. In this article, authors have recognised an unusual but consistent pattern of upper and lower limb fractures whose incidence does not coincide in numerical terms with what is reported in literature. The aim of the present study is to describe fracture patterns observed over the past 2 years. Further, authors describe clinical presentations of these fractures and attempt to defin…

Il morbo di Kienbock: esperienza di trattamento con sostituto osseo e PRP

Femoral neck’s fracture in Fahr’s Syndrome: case report

Fahr's syndrome, also known as "Bilateral Striopallidodentate Calcinosis" (BSPDC) primitive, is a rare neurological disease characterized by the presence of idiopathic, bilateral, symmetrical and abnormal deposition of calcium in areas of the brain that control movements including the basal ganglia, dentate nuclei of the cerebellum, nuclei of thalamus and semi-oval center. We describe a case of a 76-year-old male patient underwent reduction and fixation of a subtrochanteric fracture with intramedullary nail. During post-operative rehabilitation therapists's patient management was difficult due to obvious extrapyramidal symptoms characterized by dysarthria, rigidity, bradykinesia, postural i…

Hyperbaric oxygen therapy in the prevention of complications of opens fractures (nonunions, osteomyelitis)

Giant schwannoma of the foot: a case report and literature review

A schwannoma is a rare, benign tumor originating from Schwann cells of peripheral nerve sheath. It commonly occurs in subjects between 20 and 50 years of age, and its malignant transformation is exceptional. While schwannomas usually affect the head and neck region, localization in the lower extremity is exceptionally rare, and even fewer cases have described schwannomas occurring in the foot. We report a case of a giant schwannoma of the foot diagnosed in a 65-year-old woman. A giant schwannoma of the foot is an extremely rare soft tissue tumor. MRI may allow an earlier diagnosis and provide valuable information about the size and possible bone invasion. This case report noted that a compl…

A new method to evaluate the influence of the glenosphere positioning on stability and range of motion of a reverse shoulder prosthesis

Abstract Purpose Shoulder instability and reduced range of motion are two common complications of a total reverse shoulder arthroplasty. In this work, a new approach is proposed to estimate how the glenoid component positioning can influence the stability and the range of motion of a reverse shoulder prosthesis. Materials and methods A standard reverse shoulder prosthesis has been analysed. To perform virtual simulation of the shoulder-prosthesis assembly, all the components of the prosthesis have been acquired via a 3D laser scanner and the solid models of the shoulder bones have been reconstructed through CT images. Loads on the shoulder joint have been estimated using anatomical models d…

Il trattamento infiltrativo eco-guidato nella rizoartrosi: risultati

Indications and limitations of the fixator TGF “Gex-Fix” in proximal end humeral fractures

Abstract The incidence of fractures of the humerus has increased exponentially in recent years. The most used classifications for humerus fracture are morphological (Neer), biological (AO/ASIF) and descriptive (Hertel). The types of surgical treatment for humerus fracture include prosthetic replacement and synthesis using different devices, including the Tension Guide Fixator (TGF), Gex-Fix. External fixation for displaced proximal humeral fractures avoids dissection and soft tissue stripping and has been reported by some authors to be associated with higher union rates, a lower incidence of avascular necrosis, less scarring of the scapulohumeral interface, and faster rehabilitation compare…

Influence of sutures configuration on the strength of tendon-patch joints for rotator cuff tears treatment

Abstract Purpose Massive rotator cuff tears are common in the aging population. The incidence of failed rotator cuff repairs is still quite high, especially in the treatment of full-thickness tears or revision repairs. In this context, natural and synthetic meshes can be used as augmentation scaffolds or as devices to close the gap between a retracted tendon and the bone. The purpose of this work is to evaluate the ultimate tensile strength of different tendon-patch joints in order to consider their use in the treatment of massive cuff tears. Materials and methods Porcine tendons and a synthetic low-density polypropylene mesh have been used. A preliminary study on the tensile strength of te…

Anatomy of the cervical spine

The vertebral column, or spine, consisting of a coordinated series of 33-34 vertebrae separated from each other by intervertebral disks, is divided in five segments or sections: cervical, dorsal, lumbar, sacral and coccygeal [1-7]. Not available

Ultrasound-guided viscosupplementation in glenohumeral microinstability in sports athletes

Case report: laser Nd:YAG e rieducazione funzionale nella sindrome del piriforme

La sindrome del piriforme è caratterizzata da una lombalgia con interessamento del gluteo e con possibile irradiazione all'arto inferiore; può essere definita come una patologia dovuta ad intrappolamento, compressione o irritazione del nervo sciatico a livello del muscolo piriforme con o senza deficit neurologici. In questo studio è stata valutata l'efficacia della sinergia terapeutica tra laser Neodimio:YAG e rieducazione funzionale nella riduzione del dolore e nel miglioramento dell'indipendenza funzionale in una paziente affetta da sindrome del piriforme.

Le fratture dello scafoide carpale

Sono descritte le generalità e le metodiche di diagnosi e trattamento delle fratture dello scafoide carpale

Le fratture dell’estremo distale di radio nel paziente over 80

Le fratture del radio distale sono tra i più comuni traumi trattati dagli ortopedici rappresentando quasi un sesto delle fratture osservate al pronto soccorso e il 75% di tutte le fratture dell’arto superiore e sono seconde solo alle fratture di femore nella popolazione anziana. L’età di distribuzione di questo tipo di frattura è tipicamente bimodale con picchi nei giovani e negli anziani al di sopra dei 65 anni d’età. Nel primo caso il meccanismo traumatico è in genere un trauma ad alta energia come un incidente stradale, mentre nel secondo caso è in genere un trauma a bassa energia come una caduta. Sono stati proposti diversi sistemi classificativi per queste fratture. La classica classif…

Update nella diagnosi delle lesioni posterolaterali del ginocchio

Nell’ultimo decennio sono stati fatti grossi passi in avanti nella chirurgia ricostruttiva legamentosa del ginocchio. La ricerca dei fattori che possono condurre al fallimento della ricostruzione del legamento crociato anteriore (LCA) ha aperto la strada allo studio di diverse strutture anatomiche come quelle posterolaterali, rimaste nella penombra per troppo tempo. Nonostante l’estrema variabilità delle strutture anatomiche posterolaterali, studi di dissezione anatomica hanno permesso di osservare come il legamento collaterale laterale (LCL), il popliteo ed il legamento popliteo-fibulare (LPF) risultino essere quasi costantemente presenti. Sono state inoltre chiarite le specifiche funzioni…

Bilateral ruptures of the extensor mechanism of the knee: A systematic review

Abstract Introduction We conduct a systematic and qualitative review of the current literature to evaluate studies that described bilateral ruptures of the extensor mechanism of the knee. Methods A comprehensive literature search was performed to evaluate all studies included in the literature until September 2016. Results Fourteen studies with a total of 44 patients met the inclusion criteria. There were 14 patients with CRF (61%), 6 patients were affected by diabetes mellitus (14%) while other 6 patients were obese patients (14%). Conclusion CRF represents the most frequent comorbidity in patients with bilateral quadriceps/patellar tendon ruptures.

Il trattamento chirurgico con vite cannulata e PRP della pseudoartrosi dello scafoide carpale

Nonunion is an important complication of carpal navicular fractures. The aim of this study is to report the medium term results of a reconstruction technique with cannulated screw combined with Platelet Rich Plasma (PRP) in Herbert fractures C (late consolidation), D1 (fibrous union without deformity) and D2 (pseudarthrosis with initial deformity).

Patient Specific Instrumentation for Total Knee Arthroplasty: a Literature Review

During the past decade, total knee arthroplasty (TKA) has been markedly increased. Recently, patient-specific custom cutting guides have been commercially introduced in order to achieve an accurate component alignment during TKA. In fact, these cutting blocks are specific to a patient’s knee anatomy and should help the surgeons to perform bone cuts, reducing the complexity of conventional alignment and sizing tools. Nevertheless, there are critical arguments against patient-specific cutting guides for routine use, such as poor evidence and higher costs. Additionally, there are still no mild and long-term results available that describe the clinical outcomes following patient-specific instru…

Denosumab in patients with resectable giant cell tumor of bone (GCTB): Effect on surgical downstaging in a "real world" experience

e21505 Background: Pre- surgical treatment with denosumab has been associated with downstaging in patients (pts) with resectable GCTB. Here, we report our “real world” experience with pre-operative...

Il Fast Track nelle fratture di femore può davvero favorire risultati clinici migliori?

Le attuali linee guida raccomandano di effettuare il trattamento chirurgico di stabilizzazione o sosti- tuzione protesica entro 24-48 ore dall’accesso ospedaliero, al ne di migliorare il risultato funziona- le, ridurre il rischio di mortalità, la degenza ospedaliera e le complicazioni post-operatorie. Tuttavia, la mancanza di studi randomizzati rappresenta un importantissimo limite scienti co dal momento che ad oggi la migliore evidenza scienti ca sul timing chirurgico nelle fratture di collo femore si basa esclusivamente su studi prospettici e retrospettivi. In questo articolo, viene descritto il percorso ospedaliero per il trattamento delle fratture del collo del femore nel paziente anzia…

Does the 5-strand-graft have superior biomechanical behaviour than 4-strand-graft during acl reconstruction?

Purpose. This study aimed to compare the biomechanical proprieties of 4 and 5-strand- grafts. Methods. For the present study, fresh-frozen bovine common digital extensor tendons were used. Tendon grafts were prepared and sized to have a length of almost 27 cm and a cylinder 4 strand diameter of 8 mm. In half of all samples (Group A, n=12,), the graft was formed by 2 bundles duplicated around a metallic rod creating a 4-strand-tendon construct. In the other half of samples (Group B, n= 12,) 5-strand-tendon construct was created duplicating a single tendon around the rod, and tripling the other one. The grafts were preconditioned at 50 N for 10 min, followed by 1,000 cyclic loading between 50…

Approccio farmacologico topico all'artralgia

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Nonunion of the carpal navicular: surgical treatment and PRP

Non-metallic implant for patellar fracture fixation: A systematic review

Abstract Introduction Despite good clinical outcome proposals, there has been relatively little published regarding the use of non-metallic implant for patellar fracture fixation. The purpose of the study was to perform a systematic literature review to summarize and evaluate the clinical studies that described techniques for treating patella fractures using non-metallic implants. Methods A comprehensive literature search was systematically performed to evaluate all studies included in the literature until November 2015. The following search terms were used: patellar fracture, patella suture, patella absorbable, patella screw, patella cerclage. Two investigators independently reviewed all a…

L’algodistrofia post-traumatica

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TERAPIA INFILTRATIVA INTRA-ARTICOLARE ASSOCIATA A MESALAZINA E PROBIOTICI NEL TRATTAMENTO DELL'ARTRITE NEL PAZIENTE CON MALATTIA INFIAMMATORIA CRONICA INTESTINALE (IBD)

L'artrite secondaria a malattia infiammatoria cronica intestinale può essere presente parecchi anni prima della diagnosi oppure manifestarsi come una vera complicanza.

La preartrosi nella attività sportiva

Pre-operative diclofenac HPβCD for pain control of needle biopsy in musculoskeletal neoplasm: preliminary results.

Needle biopsy is the main standard method used for diagnosis of musculoskeletal tumors of the limbs and superficial trunk. Pain control during this procedure is through the use of Local Anaestetic (L.A.). In order to achieve a complete pain control in our cases, recently we started using diclofenac HPβCD 50 mg via s.c. preoperativly. We present the clinical results of a non-randomized study of two eterogeneous groups of patients: "Experimental" Group (1): diclofenac HPβCD 50 mg via s.c. one hour before surgical procedure, local anesthesia and ev. diclofenac HPβCD 50 mg via s.c. 12 hours postoperative; "Conventional" Group (2): local anesthesia and ev. postoperative tramadol 100 mg via oral …

Hamstring Graft Preparation for ACL Reconstruction

Anterior cruciate ligament (ACL) reconstruction represents one of the most common procedures in orthopedic surgery. It usually involves the harvest of both gracilis and semitendinosus tendons from the ipsilateral knee. Different methods of hamstring graft preparation have been proposed in recent years, to create an adequate graft diameter reducing morbidity linked to gracilis tendon harvesting procedure. More recently, the use of only 1 of the tendons (semitendinosus) in a tripled or quadrupled arrangement has been described, especially in an all-inside type of reconstruction. Having a thicker tendon with a quadrupled semitendinosus (ST), instead of double gracilis and ST enables to have a …

Modular megaprosthesis reconstruction for oncological and non-oncological resection of the elbow joint

Abstract Background Reconstruction of large bone defects around the elbow joint is surgically demanding due to sparse soft tissue coverage, complex biomechanics and the close proximity to neurovascular structures. Modular megaprostheses are established reconstruction tools for the elbow, but only small case series have been reported in the literature. Methods Thirty-six patients who underwent reconstruction of the elbow joint with a modular megaprosthesis were reviewed retrospectively. In 31 patients (86.1%), elbow replacement was performed after resection of a bone tumour, whereas five non-oncological patients (13.9%) underwent surgery because of a previous failed elbow reconstruction. Fun…

Le Fratture di Rotula

Patellar fractures are relatively uncommon, accounting for approximately 1% of all fractures. Non-operative treatment represents the best choice for undisplaced patellar fractures. However, surgery becomes necessary when fractures are displaced by more than 2 mm, and may include open reduction and internal fixation. Accurate reduction and rigid fixation are required in order to allow early knee mobilization and to obtain a better clinical outcome. Several techniques have been described for patellar fracture fixation, such as tension band wiring, interfragmentary screw fixation, and the combination of screw fixation and cerclage. In this article up-to-date diagnosis, classification and treat…

Management of Distal Radius Fractures in the Elderly Patients

Distal radius fractures are one of the most common injuries treated by the orthopedic surgeons representing almost 1/6 of the fractures that are treated in the emergency departments and the 75% of all fractures of the upper limb and are second only to hip fractures in elderly population. The age distribution of this kind of injury is typically bimodal with peaks in the young patients (6-25) and in the elderly patients older than 65. In the first case the mechanism of injury is usually a high energy trauma, such as a car accident, whilst in the second one is usually a low energy trauma like a domestic fall. Various classification systems have been proposed for these fractures. The classic ep…

Clavicle aseptic nonunion: is there a place for cortical allogenic strut graft?

Abstract We investigated functional and radiological outcome in 57 cases of midshaft clavicle nonunion treated with open reduction and internal fixation with plate and screws over a 13 year-period. Intercalary bone graft was used in 42 patients; opposite autologous strut graft was used in 31 cases to provide mechanical support to the host bone. Patients were analysed using chart and radiological review and assessed with DASH questionnaire obtained at the latest follow-up. 37 patients were male while 20 were females, with a mean age of 35 years (63–17). All cases were of nonunion, 35 atrophic and 22 hypertrophic. The dominant side was injured in 32 cases and the non dominant in 25 cases. Pri…

Differential diagnosis of vascular necrosis of the femoral head (AVN) and transient hip osteoporosis (THO): role of MRI

Le localizzazioni extravertebrali della tubercolosi osteoarticolare

The effectiveness of eco-guided infiltrations with high molecular weight associated with administration of oral chondroprotective supplements in osteoarthritis of the hip

Osteoarthritis does not mean a degenerative articular process only but a pathologic expression of wear, inflammation and immunological imbalance of the joints. Our study has the aim to demonstrate the effectiveness of eco-guidate infiltrations with high molecular weight associated with administration of oral chondroprotective supplements (glucosamine solfate, chondroitin sulphate, hydrolyzed collagen type II, hyaluronic acid and L carnitine fumarate) in comparison with the only treatment with ecoguided infiltrations with hyaluronic acid in patients suffering from primary osteoarthiritis of the hip.

A rare case of peri-implant distal radius fracture☆

A peri-implant fracture near the volar plate of distal radius represent a very rare injury. The main factor of this lesion is high energy trauma on the wrist. We report a case of a 61-year-old woman with a peri-implant fracture located just proximally to the plate and a fracture of the ulnar head that occurred after a simple fall. The patient was surgically treated by plate and screws removal. The fracture was fixed using a longer volar plate for the radial fracture and a plate for the head ulnar fracture. Different factors such as osteoporosis, BMI and screw position could influence the fracture pattern. However, considering growing use of plates for distal radius fracture fixation, the fr…