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…

Improved Bone Regeneration Using Biodegradable Polybutylene Succinate Artificial Scaffold in a Rabbit Model

The treatment of extensive bone loss represents a great challenge for orthopaedic and reconstructive surgery. Most of the time, those treatments consist of multiple-stage surgeries over a prolonged period, pose significant infectious risks and carry the possibility of rejection. In this study, we investigated if the use of a polybutylene succinate (PBS) micro-fibrillar scaffold may improve bone regeneration in these procedures. In an in vivo rabbit model, the healing of two calvarial bone defects was studied. One defect was left to heal spontaneously while the other was treated with a PBS scaffold. Computed tomography (CT) scans, histological and immunohistochemical analyses were performed …

Effects of levodopa oral bolus on the kinematics of the pointing movements in Parkinson's disease patients.

We studied the time-course of a levodopa oral bolus effects on the kinematics of patients affected by a mild akinetic-rigid form of idiopathic Parkinson's disease (PD). Eleven PD patients were evaluated: a) in OFF-state, that is before their first medication or after its withdrawal, b) in ON-state, that is at 1/2, 1, 2, 3, 4, 5, 6, 24, 30 and 48 hours after the administration of 250 mg of levodopa plus 25mg of carbidopa. The main kinematics (i. e.movement time, peak of velocity, peak of acceleration and peak of deceleration) of pointing movements to six target-stimuli placed on the horizontal plane of a table were recorded. Clinical conditions were assessed according to the Motor Examinatio…

Combined Ligament Injuries of the Knee: Anterior Cruciate Ligament/Posterolateral Corner and Medial Collateral Ligament/Posterior Cruciate Ligament—Diagnosis, Treatment, and Rehabilitation

No association between the cystatin C gene polymorphism and Alzheimer's disease: a case-control study in an Italian population.

Cystatin C is an amyloidogenic protein found together with beta-amyloid in cerebral arteriolar walls of both patients with Alzheimer's Disease (AD) and conghopilic amyloid angiopathy. Several findings implicate cystatin C in the pathogenesis of vascular diseases. Recent genetic association studies proposed cystatin C gene (CST3) as a susceptibility factor for AD, although other reports did not replicate this finding. We conducted a case-control study including 192 probable AD cases and 192 age- and sex-matched controls to test the association between CST3 and AD. Possible interaction between CST3 and age at onset of AD or apolipoprotein E (APOE) was also examined. No significant differences…

Lesioni traumatiche delle parti molli

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…

Three single loops enhance the biomechanical behavior of the transtibial pull-out technique for posterior meniscal root repair

Purpose: To investigate the effect of applying an additional suture to enhance the biomechanical behavior of the suture–meniscus construct used during the transtibial pull- out repair technique. Methods: A total of 20 fresh-frozen porcine tibiae with intact medial menisci were used. In one half of all speci- mens (N = 10), two non-absorbable sutures were passed directly over the meniscal root from the tibia side of the meniscus to the femoral side (2SS). In other ten specimens, three sutures were passed over the meniscal root (3SS). All specimens were subjected to cyclic loading followed by load-to-failure testing. Displacement of the construct was recorded at 100, 500, and 1000 cycles. Fur…

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…

Treatment of Combined Medial and Lateral Collateral Ligament Insufficiency

The medial and lateral collateral ligament complexes represent primary elbow ligament stabilizers. Injury to these structures may occur because of an elbow dislocation or due to a severe varus or valgus force. Most elbow dislocations are stable once reduced and may be treated conservatively. However, if the elbow remains unstable surgical treatment is recommended. Repair should be anatomical and should restore stability to the elbow in order to permit an early active range of motion. Reconstruction may be required in severe cases and where primary repair is not possible. Depending on the degree of instability, either one or both of the collateral ligament complexes may need to be repaired o…

Anatomia e biomeccanica del posterolateral corner del ginocchio

“Dark side of the knee”: letteralmente, lato oscuro del ginocchio. Questa definizione ben si adatta alle strutture postero-esterne del ginocchio. Questa regione anatomica negli ultimi anni ha saputo attirare l’attenzione di ricercatori e studiosi, per molto e forse troppo tempo focalizzata sullo studio del legamento crociato anteriore. Comunque, l’analisi dei risultati e degli insuccessi della chirurgia ricostruttiva del legamento crociato anteriore ha dato uno slancio fondamentale per comprendere ancor di più la complessa biomeccanica del ginocchio e le lesioni associate a rottura dei legamenti del pivot centrale come quelle postero-laterali. In questa rivisitazione della letteratura ci si…

Results of closed subtalar dislocations.

Background The subtalar dislocation (SD) of the foot is an uncommon injury characterized by a simultaneous dislocation of talocalcaneal and talonavicular joints without involvement of the tibiotalar and calcaneocuboid joints. Purposes The purpose of this study was to evaluate the clinical and radiological outcome in a consecutive series of close SD. Methods We retrospectively evaluated a case series of patients who presented a close SD. Thirteen patients were selected for this study. There were 9 patients with a medial SD, 3 patients with a lateral dislocation and 1 patient with a posterior subtalar dislocation. Results The most frequent symptoms observed in our study included transient mil…

Posterior meniscal root repair: a biomechanical comparison between human and porcine menisci

The aim of the present study was to compare the biomechanical characteristics of posterior meniscal root repair of porcine and human menisci. Methods. In vitro biomechanical testing was performed using 12 porcine menisci and 12 human menisci. All menisci were sectioned at the midpoint of their circumference and mounted on an electro-mechanic testing machine. The posterior root was sutured with three single stitches using a no. 2 non-absorbable suture. All specimens were subjected to cyclic axial loading followed by load-to-failure testing. Displacements were recorded at the conclusion of cycles 1, 100, 500 and 1000. Further, load-displacement curves of each specimen were recorded and analyz…

Osteoartropatie infiammatorie e infettive

The Val432Leu polymorphism of the CYP1B1 gene is associated with differences in estrogen metabolism and bone density.

Polymorphisms of the CYP450 genes that encode for the enzymes that metabolize estrogen are linked to hormone-related cancers. We investigated the impact of two polymorphisms of the CYP1B1 gene previously reported to be associated with hormone-related disorders on estrogen metabolism and bone mineral density (BMD), another hormone-dependent condition, in women from different ethnic backgrounds. Four hundred sixty-eight postmenopausal Caucasian women, 220 from St. Louis, MO, USA (mean age=63.5+/-0.53 years) and 248 from Palermo, Italy (mean age=72.9+/-0.44 years) participated in the study. Measurements of urinary estrogen metabolites by enzyme-linked immunoassay, serum estradiol by ultrasensi…

Results of isolated posterolateral corner reconstruction

Abstract Background Isolated posterolateral corner (PLC) tears are relatively rare events. Various surgical techniques to treat posterolateral knee instability have been described; because surgical results are linked to cruciate reconstructions it has been difficult to date to define whether one surgical procedure has better prognosis than another. The goal of this study is to determine the clinical outcome of PLC reconstruction following fibular-based technique. Materials and methods We retrospectively evaluated a case series of patients who received isolated PLC reconstruction between March 2005 and January 2007. Ten patients were surgically treated for isolated injuries and were availabl…

Avoiding tunnel collisions between fibular collateral ligament and ACL posterolateral bundle reconstruction

A case of bilateral luxatio erecta

AbstractLuxatio erecta is an uncommon form of glenohumeral dislocation. Cases of bilateral inferior shoulder dislocation (luxatio erecta) are very rare, and only ten cases have been described in literature. We describe a case of a woman with bilateral luxatio erecta of the shoulders treated with close reduction, immobilization and rehabilitation. The patient had fallen downstairs while clinging to both lateral banisters.

Intracerebral haemorrhage associated with sildenafil citrate

Cognitive impairment in Behçet's disease patients without overt neurological involvement

We investigated the prevalence of cognitive impairment in patients with Behc¸et’s disease (BD) without overt neurological involvement. The influence of disease duration, disease activity, prednisone dosage, and anxiety and depression levels was evaluated. Twenty-six consecutive BD outpatients and 26 healthy controls matched for age, education and sex completed a comprehensive neuropsychological battery including tests of memory, visuospatial and constructional abilities, language, attention and psychomotor speed, non-verbal reasoning and executive functioning. The Hamilton scales for anxiety and depression were administered. Disease activity was assessed using the Behc¸et’s Disease Current …

Mesh Plates for Scapula Fixation

While scapula fractures are often treated nonoperatively, there are a number of displaced fractures in which surgical treatment can be considered. When necessary, open reduction and internal fixation with plates is the accepted method for stabilization. However, there are limited options of commercially available plates for fixation of the scapula. The authors describe 2 cases of scapula fracture and 1 scapula osteotomy that were managed with internal fixation using low-profile mesh plates. The mesh plate is a stainless steel lattice that can be molded and trimmed to create a plate that matches the unusual 3-dimensional anatomy of the scapula. It accepts 2.4/2.7 mm cortical and variable ang…

Does the association of therapeutic exercise and supplementation with sucrosomial magnesium improve posture and balance and prevent the risk of new falls?

Abstract Background Fracture of the proximal femur is the most feared complication of osteoporosis. Given the numerous physiological functions that magnesium performs in our body, in the literature there is a correlation between osteoporosis and low serum levels of magnesium. Aim Evaluate the incidence of hypomagnesemia in patients with lateral fragility fracture of the proximal femur, the possible correlation between serum magnesium levels and fractures, and the effectiveness of supplementing Sucrosomial® magnesium associated with therapeutic exercise on the outcome of these patients. Methods We divided the study into two parts. In the first part, we assessed the preoperative incidence of …

How preconditioning and pretensioning of grafts used in ACLigaments surgical reconstruction are influenced by their mechanical time-dependent characteristics: Can we optimize their initial loading state?

Abstract Purpose Consensus about a pre-implant preparation protocol adaptable to any graft used in Anterior Cruciate Ligament reconstruction is still lacking. In fact, there is not agreement on reliable metrics that consider both specific graft dimensional characteristics, such as its diameter, and the inherent properties of its constitutive material, i.e. ligaments or tendons. Aim of the present study was to investigate and propose the applied engineering stress as a possible metrics. Methods Preconditioning and pretensioning protocol involved groups of grafts with different section (10 or 32 mm2) and materials (i.e. human patellar and hamstring tendons, and synthetic grafts). A 140 N load…

STUDIO DI ASSOCIAZIONE TRA BASSI LIVELLI DI DENSITA' MINERALE OSSEA E MILD COGNITIVE IMPAIRMENT, MALATTIA DI ALZHEIMER E MALATTIA DI PARKINSON. STUDIO SU UN CAMPIONE AMBULATORIALE.

Cement augmentation for trochanteric fracture in elderly: A systematic review()

Abstract Background Cement augmentation of internal fixation of hip fracture has reported to improve fracture stability in osteoporotic hip fractures, reducing the risk of cut-out of the sliding screw through the femoral head. The purpose of present study was to perform a systematic literature review on the effects of augmentation technique in patients with osteoporotic hip fractures. Material and methods A comprehensive literature search was systematically performed to evaluate all papers published in English language included in the literature between January 2010 and July 2020, according to the PRISMA 2009 guidelines. In vivo and in vitro studies, case reports, review articles, cadaveric…

Mid-term results of isolated posterolateral corner reconstruction

Isolated posterolateral corner (PLC) tears are relatively rare events. Various surgical techniques to treat posterolateral knee instability have been described; because surgical results are very much linked to cruciate reconstructions to date it is difficult to define whether one surgical procedure has better prognosis than another. The goal of this study is to determine the clinical outcome of PLC reconstruction following fibular-based technique. MATERIALS AND METHODS: We retrospectively evaluated a case series of patients who had received isolated PLC reconstruction between March 2005 and January 2007. 12 patients were surgically treated for isolated injuries and 10 patients were availabl…

Association of estrogen receptor α gene with Alzheimer's disease: A case-control study

Abstract Recent experimental data have offered the biological background to study the estrogen receptor (ER) alpha gene as a candidate gene for AD. Genetic association studies proposed ERalpha PvuII and XbaI gene polymorphisms as susceptibility factors for AD, although subsequent studies did not replicate this finding. To verify this association in a Caucasian Italian sample, we conducted a case-control study in a dataset of 172 clinic-based probable AD cases and 172 age- and sex-matched controls. Possible interaction between ERalpha polymorphisms and sex, age at onset of AD or apolipoprotein E (APOE) was examined. The xx-genotype of the XbaI polymorphism was associated with the risk of dev…

Biomechanical comparison between the modified rolling-hitch and the modified finger-trap suture techniques

Purpose: The purpose of this study was to characterize the biomechanical effect of two grasping suture techniques used during ligament reconstruction: the modified rolling-hitch (MRH) and the modified finger-trap (MFT). Methods: Flexor profundus tendons were harvested from fresh pig hind-leg trotters. Each specimen was mounted on an electro-mechanic universal testing machine (Instron 3367). In half of all tendons (15 specimens), the suture was passed around the tendon following the MRH knot (Group 1). In the remaining half of all tendons (15 specimens), the suture was passed over a distance of 30 mm according to the MFT suture technique (Group 2). As per standard intra-operative technique, …

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.

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…

The Val432Leu polymorphism of the CYP1B1 gene is associated with differences in estrogen metabolism and bone density.

Polymorphisms of the CYP450 genes that encode for the enzymes that metabolize estrogen are linked to hormone-related cancers. We investigated the impact of two polymorphisms of the CYP1B1 gene previously reported to be associated with hormone-related disorders on estrogen metabolism and bone mineral density (BMD), another hormone-dependent condition, in women from different ethnic backgrounds. Four hundred sixty-eight postmenopausal Caucasian women, 220 from St. Louis, MO, USA (mean age=63.5±0.53 years) and 248 from Palermo, Italy (mean age=72.9±0.44 years) participated in the study. Measurements of urinary estrogen metabolites by enzyme-linked immunoassay, serum estradiol by ultrasensitive…

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…

Reduced-dose computed tomography is the most accurate method to measure ceramic hip resurfacing cup version

Background: A precise assessment of cup version after hip resurfacing is generally requested, especially in clinical trials or in case of complications. Aims: To identify which diagnostic imaging modality, between AP pelvis X-rays, the AP Pelvis CT Scout image and reduced-dose axial CT scan, is the most precise to assess cup version of an all-ceramic hip resurfacing implant in a first-in-human clinical trial. Methods: We retrospectively assessed the cup version of the first 20 patients who underwent an experimental all-ceramic hip resurfacing on AP pelvis X-rays (0.8 mSv of radiation), AP pelvis CT scout images (0.016 mSv) and axial CT slices performed using a reduced dose protocol (0.3 mSv…

Surgical time for graft preparation using different suture techniques

Background: The purpose of the present study was to compare the operative time for graft prepa- ration using different techniques for graft sutur- ing. Material and methods: Flexor profundus tendons were harvested from fresh pig hind-leg trotters. Three different suture techniques were investigat- ed: the Krackow stitch (K), the Whipstitch (W), and the Modified Finger-Trap suture (MFT). Ten- dons were sutured starting at 10 mm from the dis- tal free end of the tendon. The suture configura- tions of the Krackow stitch and Whipstitch were completed with five suture throws. According to the MFT technique, the suture was wrapped five times around the tendon over a distance of 30 mm. The time re…

Similar biomechanical properties of four tripled tendon graft models for ACL reconstruction

Abstract Purpose The present study tested and compared the biomechanical properties of four different triplicate graft tendon techniques. Methods 32 tripled tendons from the common extensor muscle of bovine fingers were tested on a material testing machine, passing the end loop over a metal rod of a clevis connected to the load cell on the upper side, and fixing the lower end to a clamp. The samples were divided into four groups: (A) tripled with a free end sutured only to one of the two fixed bundles (B) tripled with a free end positioned between the two fixed strands and sutured to both (C) tripled with an S-shape and all the three strands sutured together at the upper and lower extremiti…

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…

Lateral Ligament Reconstruction

The lateral collateral ligament complex represents the primary lateral elbow ligament stabilizers. In cases of lateral elbow instability, surgical treatment is recommended. Repair should be anatomical and should restore stability to the elbow in order to permit an early active range of motion. Anatomic repair of soft tissue avulsions from bone can be performed with trans-osseous suture or suture anchors. Reconstruction may be required in severe cases and where primary repair is not possible. This chapter describes the surgical techniques for repair and reconstruction of the lateral collateral ligament of the elbow.

Effect of suturing the femoral portion of a four-strand graft during an ACL reconstruction

Purpose A suture passed along the part of the graft that will be inserted into the femoral tunnel is widely used by surgeons, because it could prevent the graft sliding on the femoral fixation device during pulling from the tibial side. The aim of this study was to evaluate the biomechanical effects of suturing the intratunnel femoral part of the graft during an anterior cruciate ligament (ACL) reconstruction. Methods Bovine digital extensor tendons and tibias were harvested from 20 fresh-frozen mature bovine knees ranging in age from 18 to 24 months. Quadruple-strand bovine tendons were passed through the tibial tunnel and secured distally with a bioabsorbable interference screw. In one ha…

Fratture articolari complesse dell'estremo distale di omero: indicazioni alla Sintesi Ibrida

How to avoid collision between PCL and MCL femoral tunnels during a simultaneous reconstruction.

PURPOSE: The purpose of the present study was to assess the risk of femoral tunnel collisions between the medial collateral ligament (MCL) and the posterior cruciate ligament (PCL) tunnels during a simultaneous PCL and MCL reconstruction. METHODS: Fourth generation medium and large synthetic femur bones were used. On each femur, a MCL tunnel and a PCL tunnel were reamed. The MCL tunnel was drilled at 0°, 20° and 40° of axial and coronal angulations. The PCL femoral tunnel was reamed to simulate two different tunnel directions that could be obtained through an inside-out and outside-in technique. Tunnels were filled with epoxy resin augmented with BaSO4, and a multidetector CT examination of…

TRATTAMENTO DELLE FRATTURE MALLEOLARI

La caviglia è un’articolazione complessa, nella quale sia le strutture ossee che quellelegamentose svolgono un ruolo importante per la funzione e la stabilità, che sono strettamente dipendenti dall’integrità strutturale dell’articolazione. Le fratture malleolarirappresentano oggi circa il 38% di tutti i traumi dell’arto inferiore e, nella maggior partedei casi, sono la conseguenza di forze di tipo rotazionale ed a bassa energia. Lo scopodel trattamento ortopedico è quello di garantire la stabilità dell’articolazione tibiotarsica ristabilendo i normali rapporti anatomici; così si ripristina la biomeccanica e,quindi, la funzionalità della caviglia. Nell’approccio al paziente è essenziale un m…

Posterior subtalar dislocation.

A subtalar dislocation of the foot is an uncommon injury, and cases of posterior subtalar dislocation are even rarer. This injury is characterized by a simultaneous dislocation of talocalcaneal and talonavicular joints while tibiotalar and calcaneocuboid articulations remain intact. Subtalar dislocation is commonly accompanied by fractures of the malleoli, talus, or fifth metatarsal and by a rotational component of the subtalar joint. Subtalar dislocation can occur in any direction and produces significant deformity. This article presents a case of pure posterior subtalar dislocation in an 80-year-old man who presented with pain and deformity in his left ankle following a motorcycle acciden…

Prevalenza di Osteoporosi e Osteopenia in una popolazione adulto-anziana: Zabut Aging Project

MRI evaluation to predict tendon size for knee ligament reconstruction.

Background The aim of this study is to evaluate a possible correlation between specific anthropometric parameters and sizes of knee tendons commonly used for ACL reconstruction. We hypothesized that specific clinical and radiological knee measurements could be better tendon sizes predictors than age, gender, height and weight. Materials and methods 100 consecutive patients were enrolled and 77 patients met the inclusion criteria of the study. All patients underwent a MRI of the knee with a 1.5 T super conducting MR System. For each patient, anthropometric data such as gender, height, weight, body mass index (BMI) and knee circumference were recorded. Specific MRI knee measurements were perf…

Continuous Femoral Catheter for Postoperative Analgesia After Total Knee Arthroplasty

Introduction Postoperative pain management in the total knee replacement (TKR) represent a fundamental step for a positive outcome, allowing rapid mobilization, already on the first day. Further, continuous peripheral nerve block techniques have been reported to allow effective and safe control of acute postoperative pain, ensuring the implementation and completion of an accurate and intensive joint rehabilitation program. Aim The aim of this study was to assess early mobility and compliance of patients that underwent TKR surgery using the femoral block. Methods For the study, all patients that underwent TKR from 2015 to 2018 with ASA score between II-III was evaluated. Patients underwent v…

Circumferential graft for elbow instability

For those patients with instability of the medial and lateral sided of the elbow, there is a place for a circumferential graft. This has the main advantage of simplifying the bone tunnel creation and graft fixation, compared to having both medial- and lateral-sided reconstructions.

Anterior dislocation in a total knee arthroplasty: A case report and literature review.

Dislocations of a total knee arthroplasty (TKA) are an uncommon injury and only few cases of anterior dislocations have been reported. We report a rare case of anterior dislocation of a 10-year-old posterior stabilized total knee arthroplasty in a 74-year-old woman. The patient was successfully treated by close reduction of the dislocation followed by immobilization in full extension with a long leg cast. Because of a high risk of neurovascular complications, a high index of suspicion for vascular injury must be maintained. For this reason, a proper diagnosis is required and immediate reduction is recommended.

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 …

Simultaneous chronic rupture of quadriceps tendon and contra-lateral patellar tendon in a patient affected by tertiary hyperparatiroidism

Abstract Spontaneous ruptures of the extensor mechanism of the knee are very rare. They tend to increase considerably in patients with metabolic diseases such as chronic renal failure, hyperparathyroidism, diabetes, gout, and systemic lupus erythematosus. The reported case regards a 48-year-old man with chronic, spontaneous and simultaneous quadriceps, and contra-lateral patellar tendon rupture. The patient suffered from chronic renal failure and for the past year from tertiary hyperparathyroidism. Ruptured tendons were repaired and both knee were evaluated monthly for the next 12 months. Good functional recovery was achieved on both knees without relapse. This case emphasizes the importanc…

DID THE COVID-19 PANDEMIC CHANGE HIP FRACTURE INCIDENCE IN ELDERLY?

The purpose of this study was to analyze the impact of the national lockdown on femoral neck fractures occurred in the elderly in an Italian city with more than 650 thousand people. We analyzed data related to patients over 65 years-old with femoral neck fractures admitted between March 9th and April 24th, 2020 to five public Hospitals in Palermo and four private Hospitals during lockdown. A total of 152 patients with hip fracture were observed with a significant reduction compared with the same period in 2017-2019. During the Lockdown period a reduction was observed of the mean age from 84.2 ±2.6 years old to 82.5±1.2 with a higher incidence in males, particularly in < 80-year-olds. The na…

Migraine headaches in adolescents: a five-year follow-up study

Background and Objectives.—Longitudinal studies of juvenile migraine are very few. We investigated the prevalence and evolution over 5 years of migraine without aura (MWOA) and migraineous disorder (MD) in an adolescent population. Methods.—Sixty-four subjects (34 girls and 30 boys, mean age 17.3±1.1 years) out of 80 selected in our 1989 epidemiological survey were included in the study. The diagnostic criteria of the International Headache Society were used in both studies. Results.—Thirty-two of 64 subjects (50%) had MWAO, 18 (28.1%) had MD, and 14 (21.9%) had headache not classifiable (HnC). Our results show that MWOA persisted in 56.2%, converted to MD or HnC in 9.4% and 3.1% of cases, …

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…

Rehabilitation approach in robot assisted total knee arthroplasty: an observational study

Abstract Background The purpose of this study is to evaluate the impact of total knee arthroplasty (TKA) with the aid of Navio Robot, comparing it with standard prosthetic surgery on the functional outcomes of patients after an intensive rehabilitation program. Method A case–control observational study was conducted on patients undergoing TKA for severe KOA. All patients underwent the same intensive hospital rehabilitation program of 14 daily sessions lasting 3 h. The following rating scales were administered: Numeric Rating Scale (NRS), Knee Society Score (KSS) and 12-Item Short Form Survey scale. Patient assessments were performed 1 week post-surgery (T0), 1 month post-surgery (T2), and 3…

Le infezioni tubercolari dell’apparato locomotore

Gli AA dopo aver presentato i dati epidemiologici più importanti della TBC osteoarticolare, si soffermano sulla fisiopatologia, il quadro clinico e radiografico delle localizzazioni più frequenti sottolineando i segni clinici e radiografici tipici di queste lesioni e l’importanza della RM, specie se eseguita con mezzo di contrasto, nella diagnosi precoce della malattia. Vengono inoltre presi in considerazione gli aspetti evolutivi della malattia sia prima che dopo l’introduzione dei farmaci antitubercolari, la terapia medica ed il trattamento incruento e chirurgico delle varie forme. Gli AA concludono che la TBC è una malattia purtroppo sempre di attualità contrariamente a quanto si pensava…

Cognitive Impairment and Osteoporosis in persons 50+ years old: a population-based study.

Movements Execution in Amnestic Mild Cognitive Impairment and Alzheimer’s Disease

We evaluated the relationship between motor and neuropsychological deficits in subjects affected by amnestic Mild Cognitive Impairment (aMCI) and early Alzheimer’s Disease (AD). Kinematics of goal-directed movement of aMCI and AD subjects were compared to those of age-matched control subjects. AD showed a slowing down of motor performance compared to aMCI and controls. No relationships were found between motor and cognitive performances in both AD and aMCI. Our results suggest that the different motor behaviour between AD and aMCI cannot be related to memory deficits, probably reflecting the initial degeneration of parietal-frontal circuits for movement planning. The onset of motor dysfunct…

Lack of association between angiotensin converting enzyme polymorphism and sporadic Alzheimer's disease

Epidemiological and pathogenetic evidences suggest a strong association between vascular risk factors and sporadic Alzheimer's disease (sAD). In agreement with the vascular hypothesis of AD, the role of various candidate genes for atherosclerosis has been investigated, leading to conflicting results. In order to clarify the significance of angiotensin-converting enzyme (ACE) gene insertion (I)/deletion (D) polymorphism in a group of patients with sAD, we conducted a case-control study including 149 cases and 149 age and sex matched controls. All subjects were genotyped for ACE and Apolipoprotein E (APOE). There were no significant differences in ACE genotype or allele frequencies between ca…

Giant enchondroma recurrence of the proximal phalanx of the fifth finger: A case report

Enchondroma (EC) is a benign and cartilage-forming tumor that causes intramedullary lesions. Moreover, EC is the most common bone tumor in the phalanges and metacarpal bones of the hand, deforming the structure and causing pain and functional limitation. The management of this neoplasia is the surgical treatment and the approach that is well-accepted consists in the curettage followed by the void augmentation with biological or synthetic fillers. The results from surgery are usually good and the recurrence rate is low (2-15%). In this article we report a case of EC recurrence of the proximal phalanx of the fifth finger of the hand after curettage and grafting. The patient was treated with t…

Tibial tubercle osteotomy: effect of different osteotomy planes on contact surface area and tubercle anteriorization

In 1983, Fulkerson introduced a technique of tibial tubercle osteotomy performed according to an inclined plane with respect to frontal plane. Due to obliquity of the osteotomy plane, this procedure allows both anterior and medial transfer of the tibial tubercle. The purpose of the study was to investigate the influence of the different degrees of the oblique plane of osteotomy on anterior displacement and the contact surface area of tibial tubercle. Synthetic bones were used for the study. An osteotomy of the tibial tubercle (TT) was performed in each specimen. Specifically, 3 different degrees of osteotomy planes relative to the reference frontal plane were examined: 20°, 30° and 40°. On …

Proximal Tibiofibular Joint Reconstruction With Autogenous Semitendinosus Tendon Graft

Isolated and chronic anterolateral instability of the proximal tibiofibular joint (TFJ) is an uncommon condition, generally linked to an unrecognized or unhealed dislocation of the TFJ. Clinically, abnormal anterior movement of the head of the fibula is detected. In acute injuries conservative management should be preferred, whereas surgical treatment have been advocated in patients with chronic TFJ instability. Authors describe a new surgical reconstruction technique for chronic instability of the proximal TFJ using an autogenous semitendinosus tendon. The graft is passed through fibular and tibia tunnels and fixed with 2 interference screws. The tibial tunnel is reamed from the posterolat…

rottura inveterata del tendine quadricipitale e del controlaterale tendine rotuleo in un paziente affetto da iperparatiroidismo terziario

Electromagnetic distal targeting system does not reduce the overall operative time of the intramedullary nailing for humeral shaft fractures

Abstract Introduction We aimed to evaluate the efficacy of the use of the electromagnetic distal targeting system in treating humeral shaft fracture. Methods Patients were divided in: Group 1) patients that received a distal locking screw placement following the free-hand technique; Group 2) patients in which the distal locking screw was performed using the SURESHOT device. Results No differences were noted comparing Group 1 (freehand) [71,9 range 40–135 min] to Group 2 (SURESHOT)[70, range 25–125 min]. Conclusion The use of the EM distal targeting system doesn't reduce the overall operative time of the humeral shaft fracture fixation using IMN.

Mortality Risk Assessment at the Admission in Patient With Proximal Femur Fractures: Electrolytes and Renal Function

In patients over 65y.o. who were surgically treated for a hip fracture, electrolytes have not been specifically studied as predictors of mortality. The main purpose of this study was to assess whether electrolytes and chronic kidney disease (CKD) stages, evaluated at admission, could represent a pre-operative prognostic factor in this population. Moreover, the role of epidemiological and clinical parameters was analyzed with and without a surgical timing stratification. This retrospective study included 746 patients. For each patient, their age, gender, fracture classification, Hb value, comorbidities, ASA class, chronic kidney disease, creatinine levels, electrolytes and surgical timing w…

FiberWire tension band for patellar fractures.

Background Symptomatic hardware represents the most frequent complication reported following surgical treatment of patellar fracture. For this reason, some authors suggested using nonabsorbable sutures to fix the fracture with various techniques. The aim of this study was to evaluate clinical and radiological results of patients treated following a modified Pyriford technique using a FiberWire suture (Arthrex, Naples, FL, USA). Materials and methods We retrospectively evaluated a case series of  seventeen patients with displaced patellar fractures treated by open reduction and internal fixation with a modified tension band using FiberWire sutures. Clinical and radiological outcome were eval…

Peri-Implant Distal Radius Fracture: Proposal of a New Classification

A peri-implant fracture near the volar plate of the distal radius represents a rarity and can be associated with a mechanical failure of the devices. A literature review was conducted including all fractures that occurred around a volar wrist plate, which could be associated with an ulna fracture. All articles published until December 2021 were considered according to the guidelines presented in the PRISMA Statement. The search was conducted with the PubMed electronic database, Cochrane Database of Systematic Reviews, Medline, Embase, and Google Scholar. Only nine cases of these fractures were reported in the literature. The causes could be due to delayed union/non-union of the old fracture…

Anatomic Posterolateral Knee Reconstructions Require a Popliteofibular Ligament Reconstruction Through a Tibial Tunnel

Background: No biomechanical study has been performed analyzing the merits of reconstructing the popliteofibular ligament (PFL) through a tibial tunnel with an anatomic reconstruction of the posterolateral knee. Hypothesis: There is no difference in an anatomic posterolateral knee reconstruction with or without a PFL reconstruction placed through a tibial tunnel in restoring knee motion to the intact, uninjured state, and the knee is not overconstrained with this reconstruction. Study Design: Controlled laboratory study. Methods: Eight paired knees were tested in the intact state and then sectioned to simulate a grade III posterolateral knee injury. The reconstruction for the first paired …

Study of a constrained finite element elbow prosthesis: the influence of the implant placement

Abstract Background The functional results of total elbow arthroplasty (TEA) are controversial and the medium- to long-term revision rates are relatively high. The aim of the present study was to analyze the stresses of TEA in its classic configuration, identify the areas of greatest stress in the prosthesis–bone–cement interface, and evaluate the most wearing working conditions. Materials and methods By means of a reverse engineering process and using a 3D laser scanner, CAD (computer-aided drafting) models of a constrained elbow prosthesis were acquired. These CAD models were developed and their elastic properties, resistance, and stresses were studied through finite element analysis (fin…

Avoiding tunnel collisions between fibular collateral ligament and ACL posterolateral bundle reconstruction

PURPOSE: The purpose of this study was to evaluate the risk of tunnel collisions of the fibular collateral ligament (FCL) and posterolateral bundle anterior cruciate ligament (PLB-ACL) tunnels during a combined FCL and double-dundle (DB) ACL reconstruction. METHODS: Thirty-six 4th-generation synthetic femurs (Sawbones, Pacific Research Laboratories, Vashon, WA) were utilized, and two different femur sizes were used. A FCL tunnel and a PLB-ACL tunnel were reamed on each femur. The tunnels of synthetic specimens that did not have a collision were filled with an epoxy resin augmented with BaSO(4) and radiographic evaluation, and Multidetector CT exams of the specimens were performed. RESULTS: …

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…

No association between Glu298Asp endothelial nitric oxide synthase polymorphism and Italian sporadic Alzheimer's disease.

A great amount of evidence suggests that neuroinflammation may be a major pathogenetic mechanism in the pathophysiology of sporadic Alzheimer's Disease (sAD). Recently, polymorphisms in the endothelial nitric oxide synthase (NOS3) gene have been associated to late onset Alzheimer's Disease in a British population. However, other groups failed to replicate this finding in Asiatic and Caucasian populations. We conducted a case-control study including a clinically well-defined group of 149 sAD patients and 149 age and sex matched controls to test the association between NOS3 Glu298Asp polymorphism and sAD in an ethnically homogenous Italian population. All subjects were genotyped at NOS3 and a…