R Rotini

Istituto Ortopedico Rizzoli, Bolonia, Emilia-Romagna, Italy

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Publications (91)56.98 Total impact

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    ABSTRACT: Locking plate fixation is a reliable treatment for many displaced proximal humeral fractures. Carbon fiber-reinforced-poly-ether-ether-ketone (CFR-PEEK) plates have recently been introduced as an alternative to traditional metallic plates. In a multicenter study involving the Orthopedic Services of 6 Italian hospitals, 182 patients with a proximal humeral fracture were treated with a Diphos H (Lima Corporate, San Daniele del Friuli, Italy) CFR-PEEK plate, 160 of whom were followed clinically and radiographically for 2 years or more. Fractures were classified by Neer's system. The functional results were assessed by Constant and DASH scores. The average time to radiographic healing was 5.6 months in 158 of 160 cases. Mean Constant score was 76, and mean DASH score was 28 at 2 years. There were two nonunions (one septic and one aseptic) and 13 cases of partial (9) or massive (4) humeral head necrosis. In three of the 78 patients treated with the first-generation plates, hardware breakage happened during the operation and the plate was replaced. There was no failure among the cases treated with the thicker second-generation plate. In eight cases, there was a perforation of the humeral head by the cephalic screws. CFR-PEEK plates proved as reliable as metallic plates in the treatment of proximal humeral fractures. The advantages of these new devices include a better visualization of fracture reduction during intraoperative fluoroscopic assessment and easy hardware removal due to the absence of screw-plate cold fusion.
    MUSCULOSKELETAL SURGERY 05/2015; DOI:10.1007/s12306-015-0371-2
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    ABSTRACT: Chronic dislocation of the radial head treatment in Monteggia fracture dislocation is still controversial. We present a large series of patients treated in our Institution. The outcome of 22 children treated surgically between 1988 and 2011 for post-traumatic chronic radial head dislocation is reported. There were 12 girls and 10 boys with a mean age at surgery of 7.2 years (4.1-13.6). The mean interval between injury and treatment was 15.7 months (1-128). Nine patients underwent open reduction with removal of interposed tissue and repair (7) or Bell-Tawse reconstruction (2) of the annular ligament. Ten patients underwent osteotomy, gradual lengthening and angulation of the ulna by external fixation. Two patients underwent angular osteotomy of the proximal ulna with open wedge, open reduction in the radial head and reconstruction of the annular ligament. One patient admitted to the hospital 10 years after injury underwent radial head excision at 13.7 years of age. After a mean follow-up of 5.5 years (1-24.3), the radial head stayed reduced in 15 patients and subluxated in 5. In one case, redislocation occurred. All patients but five were pain-free. The elbow performance score (Kim score) was excellent in 14 cases, good in four and fair in four, with a mean score of 91, corresponding to a good result. Complications included a transient posterior interosseus nerve palsy (1), and one non-union of the ulna. Chronic Monteggia lesions must be treated. The clinical outcomes are usually better than the congruency of the radiocapitellar joint. IV (Case series with no comparison group).
    MUSCULOSKELETAL SURGERY 05/2015; DOI:10.1007/s12306-015-0362-3
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    ABSTRACT: The elbow, the middle joint of the upper limb, enables the hand to be placed at various distances from the body. The articular, muscular and neuromotor complexity of the elbow is such that it is often prone to stiffness, especially if immobilized for long periods of time. Therefore, mobilization of the posttraumatic elbow must be started early. In the presence of lesions to the ligamentous structures, the joint must be protected to prevent these structures from being placed under tension during movement. Rehabilitation of the elbow includes the use of braces. Different types of brace are used depending on clinical situation and the objectives to be achieved. They can have fixed protection or locked articulation, allow an adjustable range of movement to restrict flexion-extension and pronation-supination, or allow dynamic and static progressive movement. The latter plays a special role in conservative treatment and following surgical release. However, the effectiveness of braces in the rehabilitation treatment of elbow stiffness depends on the patient's compliance. Their use requires a considerable amount of physician time to achieve the objectives envisaged by the rehabilitation program.
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    ABSTRACT: The elbow, intermediate joint of the upper limb, frequently undergoes to pathological events and is especially prone to stiffness. Rehabilitation plays an important role in recovering functional activities. For the rehabilitation team, this goal always represents a challenge, as the treatment has to be continuously modeled and calibrated on the needs of the individual patient, even many times during the same rehabilitation cycle. Containing the effects of immobilization, avoiding to excessively stress the healing tissues, satisfying specific clinical criteria before moving to the next rehabilitation stage, basing the rehabilitation plan on up-to-date clinical and scientific data that can be adapted to each patient and to his/her needs are the basic principles of the rehabilitation plan, which can be chronologically grouped into four rehabilitation stages. After summarizing the general principles of elbow treatment, the specific principles of rehabilitation after elbow fractures and elbow instability are presented, and then the rehabilitative approach to the most frequent and feared pathological conditions of the elbow, namely stiffness, is described.
    MUSCULOSKELETAL SURGERY 03/2014; 98(S1). DOI:10.1007/s12306-014-0328-x
  • Roberto Rotini
    MUSCULOSKELETAL SURGERY 03/2014; 98(S1). DOI:10.1007/s12306-014-0330-3
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    ABSTRACT: This article presents the experience at the Rizzoli Orthopaedic Institute in the treatment of intracapsular osteoid osteoma (OO) of the elbow by computed tomography-guided percutaneous radiofrequency thermal ablation (RFA). Our team performed more than 800 RFA procedures to treat OO up to 2010. In 27 cases, the lesion site was the articular area of the elbow (humerus in 13 cases, ulna in 13, and radius in 1). These patients were reviewed and assessed for eradication rate, incidence of complications, and functional results measured by the Mayo Elbow Performance Score. The outcome was evaluated after a mean follow-up period of 67.4 ± 35.3 months (range, 24-128 months). The mean duration of symptoms at the time of diagnosis was 31.0 ± 19.8 months (range, 5-72 months). All patients complained about pain, and in 24 of 27 cases (88.8%), the joint function was significantly impaired by the presence of OO (pretreatment score, 54.8). After RFA, the Mayo Elbow Performance Score improved by a mean of 37.7 ± 14.8 points, with 25 of 27 patients (92.5%) scoring 90 to 100 points at final follow-up. OO recurred in only 1 patient (3.7%), 5 months after the procedure. However, this was successfully retreated by RFA. No adverse effects were observed, and all patients were free of disease at the final follow-up. The RFA procedure can be technically challenging in difficult sites such as the elbow joint. The low invasiveness of RFA compared with traditional surgery allows excellent functional recovery. RFA of elbow OO is effective and safe, and it should be considered the first-choice treatment for this disease.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 01/2014; 23(1):e1-e7. DOI:10.1016/j.jse.2013.08.011 · 2.37 Impact Factor
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    ABSTRACT: Background: Total elbow arthroplasty (TEA) has been normally indicated for chronic inflammatory arthropathy. In the last decades this surgery has also evolved as an acceptable procedure following traumatic lesions of this joint. The aim of this study was to analyze the mid-term outcomes of TEA for the treatment of complex fractures and non-unions of the elbow in selected patients. Methods: Between May 2002 and December 2011, 34 patients with these indications were surgically treated with TEA and divided in two groups. Group 1 included 16 cases of fractures and Group 2 18 of non-union. All patients were clinically assessed using the Mayo Elbow Performance Score (MEPS). A statistical analysis was performed in order to investigate the outcomes of these patients and compare the two groups. Results: Similar results were observed in both groups between operated and non-operated arms. No differences in clinical results were documented between groups. Conclusions: TEA following traumas can be considered as a valid treatment in old patients in complex fractures of the elbow region with low functional demands and in non-unions. Outcomes are influenced by the collaborative capacities of the patients.
    Acta bio-medica: Atenei Parmensis 12/2013; 84(3):212-8.
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    R Rotini
    MUSCULOSKELETAL SURGERY 04/2013; 97(S1). DOI:10.1007/s12306-013-0265-0
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    ABSTRACT: Background Although progress has been made in the treatment of articular cartilage lesions, they are still a major challenge because current techniques do not provide satisfactory long-term outcomes. Tissue engineering and the use of functional biomaterials might be an alternative regenerative strategy and fulfill clinical needs. Decellularized extracellular matrices have generated interest as functional biologic scaffolds, but there are few studies on cartilage regeneration. The aim of this study was to evaluate in vitro the biological influence of a newly developed decellularized human dermal extracellular matrix on two human primary cultures. Methods Normal human articular chondrocytes (NHAC-kn) and human mesenchymal stromal cells (hMSC) from healthy donors were seeded in polystyrene wells as controls (CTR), and on decellularized human dermis batches (HDM_derm) for 7 and 14 days. Cellular proliferation and differentiation, and anabolic and catabolic synthetic activity were quantified at each experimental time. Histology and scanning electron microscopy were used to evaluate morphology and ultrastructure. Results Both cell cultures had a similar proliferation rate that increased significantly (p < 0.0005) at 14 days. In comparison with CTR, at 14 days NHAC-kn enhanced procollagen type II (CPII, p < 0.05) and aggrecan synthesis (p < 0.0005), whereas hMSC significantly enhanced aggrecan synthesis (p < 0.0005) and transforming growth factor-beta1 release (TGF-β1, p < 0.0005) at both experimental times. Neither inflammatory stimulus nor catabolic activity induction was observed. By comparing data of the two primary cells, NHAC-kn synthesized significantly more CPII than did hMSC at both experimental times (p < 0.005), whereas hMSC synthesized more aggrecan at 7 days (p < 0.005) and TGF-β1 at both experimental times than did NHAC-kn (p < 0.005). Conclusions The results obtained showed that in in vitro conditions HDM_derm behaves as a suitable scaffold for the growth of both well-differentiated chondrocytes and undifferentiated mesenchymal cells, thus ensuring a biocompatible and bioactive substrate. Further studies are mandatory to test the use of HDM_derm with tissue engineering to assess its therapeutic and functional effectiveness in cartilage regeneration.
    BMC Musculoskeletal Disorders 01/2013; 14(1):12. DOI:10.1186/1471-2474-14-12 · 1.90 Impact Factor
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    ABSTRACT: Radial head prosthetic replacement is indicated in case of comminuted fracture not amenable to internal fixation, especially when the radial head fracture is part of a pattern of lesions configuring a complex instability of the elbow. Thirty-one SBi radial head prostheses were implanted in 30 patients (one bilateral simultaneous fracture) over a 2 years period. In 10 patients, the mean time from trauma to surgical treatment was 2.4 days, while the remaining 20 patients were treated as "second opinion" cases presenting with elbow stiffness or instability after an average of 19 days from trauma. The implants were monopolar in 12 cases and bipolar in 19. The clinical results were evaluated through the Mayo Elbow performance scoring system. At an average follow-up of 2 years (range 13-36 months), the mean MEPS was 90 points (range 65-100). At late radiographic analysis, radiolucent lines around the stem were found in 11 of the 31 cases. Heterotopic ossifications were found in 14 cases. Bone resorption was observed in 9 cases. Two of the 31 prostheses were removed after 16 and 20 months, in one case to correct stiffness in pronation/supination, in the other one for asymptomatic aseptic mobilization. These short-term results are satisfactory, especially when considering that they were obtained in complex elbow lesions treated in many cases at a delayed stage. Our preference over time went more and more to bipolar implants, but from a comparison of the results we could find no evidence of a superiority of bipolar or monopolar implants. The evolution of these prostheses needs to be evaluated with further studies to assess mid-term and long-term follow-up results.
    MUSCULOSKELETAL SURGERY 04/2012; 96 Suppl 1(S1):S69-79. DOI:10.1007/s12306-012-0198-z
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    ABSTRACT: Interest is increasing in biological scaffolds for tissue regeneration such as extracellular matrix membranes, developed through soft tissue decellularization. Extracellular matrix membranes were developed to heal different tendon and soft tissue lesions that are very frequent in the general population with high health-care costs and patient morbidity. The aim of this research was to evaluate a human dermal matrix (HDM) decellularized by a chemico-physical method. A primary culture of rat tenocytes was performed: tenocytes were seeded on HDM samples and on polystyrene wells as controls (CTR). Cell viability and synthetic activity were evaluated at 3 and 7 days. An in vitro microwound model was used to evaluate HDM bioactivity: after tenocyte expansion, artificial wounds were created, HDM extracts were added, and closure time and decorin synthesis were monitored histomorphometrically at 1, 4, 24, and 72 hr. A significant higher amount of collagen I was observed when cells were cultured on HDM in comparison with that on CTR (3 days: p < 0.0001; 7 days: p < 0.05). In HDM group, fibronectin synthesis was significantly higher at both experimental times (p < 0.0001). At 3 days, proteoglycans and transforming growth factor-β1 releases were significantly higher on HDM (p < 0.0001 and p < 0.005, respectively). The artificial microwound closure time and decorin expression were significantly enhanced by the addition of 50% HDM extract (p < 0.05). In vitro data showed that the decellularization technique enabled the development of a matrix with adequate biological and biomechanical properties.
    Connective tissue research 12/2011; 53(4):298-306. DOI:10.3109/03008207.2011.649929 · 1.98 Impact Factor
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    ABSTRACT: Multidirectional instability (MDI) is a complex shoulder pathology with involuntary subluxation or dislocation in more than one direction accompanied by pain. The pathogenesis is multifactorial including capsular redundancy, significant trauma or repetitive microtrauma. The management of patients with MDI is primarily conservative, with a dedicated rehabilitation protocol of the gleno-humeral and scapulo-thorax joints. When non-operative treatment fails surgical capsuloplasty and labral repair has to be considered.
    LO SCALPELLO-OTODI Educational 07/2011; 25(2). DOI:10.1007/s11639-011-0113-7
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    ABSTRACT: The high incidence of recurrent tendon tears after repair of massive cuff lesions is prompting the research of materials aimed at mechanically or biologically reinforcing the tendon. Among the materials studied upto now, the extracellular matrix (ECM) scaffolds of human origin have proved to be the safest and most efficient, but the current laws about grafts and transplants preclude their use in Europe. In order to overcome this condition in 2006, we started a project regarding the production of an ECM scaffold of human origin which could be implanted in Europe too. In 2009, the clinical study began with the implantation of dermal matrix scaffolds in 7 middle-aged patients affected with large/massive cuff lesions and tendon degeneration. Out of 5 cases, followed for at least 1 year in which the scaffold was employed as an augmentation device, there were 3 patients with complete healing, 1 partial re-tear, and 1 total recurrence. The absence of adverse inflammatory or septic complications allows to continue this line of research with a prospective controlled study in order to define the real advantages and correct indications offered by scaffold application.
    MUSCULOSKELETAL SURGERY 06/2011; 95 Suppl 1:S13-23. DOI:10.1007/s12306-011-0141-8
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    ABSTRACT: A new HPLC-ESI-MS/MS method for the determination of glucosamine (2-amino-2-deoxy-d-glucose) in rabbit cartilage was developed and optimized. Glucosamine was extracted from cartilage by cryogenic grinding followed by protein precipitation with trichloroacetic acid. The HPLC separation was achieved with a polymer-based amino column using a mobile phase composed of 10mM ammonium acetate (pH 7.5)-acetonitrile (20:80%, v/v) at 0.3 mL min flow rate. d-[1-(13)C]Glucosamine was used as internal standard. Selective detection was performed by tandem mass spectrometry with electrospray source, operating in positive ionization mode and in multiple reaction monitoring acquisition (m/z 180→72 and 181→73 for glucosamine and internal standard, respectively). Limit of quantification was 0.045 ng injected, corresponding to 0.25 μg g⁻¹ in cartilage. Linearity was obtained up to 20 μg g⁻¹ (R(2)>0.991). Precision values (%R.S.D.) were <10%. Accuracy (% bias) ranged from -6.0% to 12%. Mean recoveries obtained at 3 concentration levels were higher than 81% (%R.S.D.≤8%). The method was applied to measure glucosamine levels in rabbit cartilage and plasma after single oral administration of glucosamine sulfate at a dose of 98 mg kg⁻¹(n=6). Glucosamine was present in cartilage in physiological condition before the treatment. After dosing, mean concentration of cartilage glucosamine significantly increased from 461 to 1040 ng g⁻¹. Cartilage glucosamine levels resulted to be well correlated with plasma concentrations, which therefore are useful to predict the target cartilage concentration and its pharmacological activity.
    Analytica chimica acta 06/2011; 695(1-2):77-83. DOI:10.1016/j.aca.2011.04.003 · 4.52 Impact Factor
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    ABSTRACT: This article presents a case of a 71-year-old woman with a humeral fracture between a cementless reverse total shoulder arthroplasty and a cemented total elbow arthroplasty and discusses our treatment plan. Surgical treatment was performed after the patient was informed of possible complications and the benefits of surgery including: early, complete restoration of arm anatomy, greater functional improvement of the adjacent joints, and increased risk of nonunion with nonoperative treatment.The fracture was comminuted and extended proximally around the shoulder prosthesis. Through the posterior approach, the radial nerve was identified and protected. Both prostheses were found firmly fixed to bone. The fracture around the shoulder prosthesis was reduced first using a strut allograft and reduction clamps. Next, arm alignment restoration and distal humerus reduction were performed. The construct was neutralized with a 3.5-mm locking plate spanning the whole length of the humerus. The locking plate was positioned posterolaterally and the strut medially in a 90° to 90° configuration secured with wires and cables.A hinged elbow brace was applied for 6 weeks postoperatively. Active range of motion exercises of the wrist and hand and passive motion of the elbow and shoulder were started at 4 to 5 days postoperatively. At 2 weeks postoperatively, passive motion of the elbow and shoulder progressed to strengthening exercises. Thereafter, the patient underwent several weeks of physical therapy to restore motion, strength, and function of the upper extremity with instructions not to overload the arm and avoid heavy work and sports for as long as 1 year. At 10 months postoperatively, radiographs of the arm showed a stable construct; the patient had resumed full activities of daily living.
    Orthopedics 01/2011; 34(4). DOI:10.3928/01477447-20110228-21 · 0.98 Impact Factor
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    ABSTRACT: Le fratture dell’omero prossimale pongono difficoltà e incognite nella definizione diagnostica, nella pianificazione e conduzione chirurgica e nella prognosi. Alla luce delle più recenti acquisizioni nelle indagini diagnostiche, nelle tecniche chirurgiche e nell’evoluzione delle placche a stabilità angolare vengono discusse le principali difficoltà e proposte le soluzioni più efficaci. Vengono inoltre presentate e discusse le caratteristiche tecniche dei sistemi più utilizzati. L’obiettivo finale è soddisfare la necessità di una sintesi stabile con il minore danno biologico possibile e applicabile su qualsiasi tipo di frattura, anche nelle fratture a 4 frammenti gravemente scomposte, nelle fratture con separazione della testa omerale e nelle fratture-lussazioni in pazienti relativamente giovani per una sostituzione protesica.
    01/2011; 7(2):1–12. DOI:10.1016/S2211-0801(11)70338-7
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    ABSTRACT: Proximal humerus fractures raise difficulties and uncertainties in diagnostic definition, planning and surgical procedure, as well as in prognostic assessment. In consideration of the most recent acquisitions in diagnostic imaging, surgical techniques and locking plates, the Authors discuss the main pitfalls and indicate the most effective solutions. Two different fixation devices (Philos and S3 plate) are compared and technical differences are discussed.
    LO SCALPELLO-OTODI Educational 09/2010; 23(1):29-40. DOI:10.1007/s11639-009-0019-9
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    ABSTRACT: Sterno Clavicular Joint (SCJ) dislocations are rare injuries of the shoulder girdle. Their management is controversial due to a not guaranteed outcome after any kind of treatment (conservative or open). Open reduction is challenging because of the anatomical site, while the conservative treatment does not always improve pain or instability discomfort. We report a case of traumatic and painful anterior SCJ dislocation of a young policewoman treated with open reduction by a new surgical technique. Functional result is extremely good at 2 years of follow-up.
    MUSCULOSKELETAL SURGERY 05/2010; 94 Suppl 1:S91-4. DOI:10.1007/s12306-010-0069-4
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    ABSTRACT: We report two cases of scapula-thoracic dyskinesia with different etiologies where both patients complained of functional limitation and pain in the shoulder. The first case was caused by a road accident, the second by sequelae of surgery to remove aggressive scapula-axillary fibromatosis. In both patients, therapy with botulin toxin type A (Botox) was performed, which determined a reduction in pain. In the first case, there was also an improvement in function. There were no side effects in the two patients after the injections.
    MUSCULOSKELETAL SURGERY 05/2010; 94 Suppl 1(S1):S95-8. DOI:10.1007/s12306-010-0071-x
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    ABSTRACT: Invalidating elbow contractures, a frequent problem after injury, are commonly treated by physical therapy or surgical release. In both cases, results can be frustrating: physical therapy is often not sufficient to gain functional range of motion, and after surgical release it is common to lose part of the motion gained in operating room. Thanks to the viscous-elastic properties of the soft tissue, the mobilization elbow braces can stretch the retracting or retracted tissues inducing a biological lengthening of collagen fibres. In post-traumatic contracture, mobilization braces are effectively employable in two main critical situations: to treat recent onset contractures which do not respond to simple physical therapy and to help in preserving range of motion gained after surgical release. We report our experience with mobilization brace used in 42 patients, 5 for post-traumatic contracture, 4 for contracture following articular fracture fixation and 33 after surgical release. Classification, indications and treatment protocols of the mobilization braces utilized are reported.
    MUSCULOSKELETAL SURGERY 05/2010; 94 Suppl 1:S37-45. DOI:10.1007/s12306-010-0068-5

Publication Stats

670 Citations
56.98 Total Impact Points

Institutions

  • 1991–2014
    • Istituto Ortopedico Rizzoli
      • • Laboratory of Preclinical and Surgical Studies
      • • Laboratory for Orthopedic Pathophysiology and Regenerative Medicine
      Bolonia, Emilia-Romagna, Italy
  • 1985–2009
    • Azienda Ospedaliera Santa Maria Nuova di Reggio Emilia
      Reggio nell'Emilia, Emilia-Romagna, Italy