[Show abstract][Hide abstract] ABSTRACT: The “induced membrane” technique described by Masquelet has been used successfully for many years for posttraumatic bone defect reconstruction, non-unions and osteomyelitis. The main advantages are the two-step surgical procedure that in case of primary infection allows repeated debridement if necessary, in case of internal fixation early weight bearing with decreased malalignment risk and it has a short learning curve. A theoretical application of this procedure is the management of acute severe traumatic bone loss of the limbs despite the lack of this experience in literature. We report on a Gustilo IIIB meta-epiphyseal fracture (AO 43-C3) of the leg with a 6 cm in length bone loss that was treated with the Masquelet technique.
[Show abstract][Hide abstract] ABSTRACT: Magnetic resonance imaging (MRI) is the gold standard method for non-invasive assessment of joint cartilage, providing information on the structure, morphology and molecular composition of this tissue. There are certain minimum requirements for a MRI study of cartilage tissue: machines with a high magnetic field (> 1.5 Tesla); the use of surface coils; and the use of T2-weighted, proton density-weighted fast-spin echo (T2 FSE-DP) and 3D fat-suppressed T1-weighted gradient echo (3D-FS T1W GRE) sequences. For better contrast between the different joint structures, MR arthography is a method that can highlight minimal fibrillation or fractures of the articular surface and allow evaluation of the integrity of the native cartilage-repair tissue interface. To assess the biochemical composition of cartilage and cartilage repair tissue, various techniques have been proposed for studying proteoglycans [dGEMRIC, T1rho mapping, sodium (23Na) imaging MRI, etc.], collagen, and water distribution [T2 mapping, "magnetisation transfer contrast", diffusion-weighted imaging (DWI), and so on]. Several MRI classifications have been proposed for evaluating the processes of joint degeneration (WORMS, BLOKS, ICRS) and post-surgical maturation of repair tissue (MOCART, 3D MOCART). In the future, isotropic 3D sequences set to improve image quality and facilitate the diagnosis of disorders of articular structures adjacent to cartilage.
[Show abstract][Hide abstract] ABSTRACT: Autologous chondrocyte implantation (ACI) has demonstrated a high rate of clinical success despite a considerable number of complications. The second-generation ACI techniques require three-dimensional scaffolds. Midterm studies have demonstrated comparable results to ACI, yet with a decreased rate of complications. The aim of this review is to define the requisites of a scaffold and to report clinical results and limits of these techniques.
Archivio di Ortopedia e Reumatologia 12/2013; 124(1-3). DOI:10.1007/s10261-013-0059-9
[Show abstract][Hide abstract] ABSTRACT: This is the medical history of three skeletons from archaeological sites in the province of Varese that are interesting because they show signs of traumatic injury to the skull and postcranial skeleton. Fractures of two of the skeletons were analysed by CT scan and radiological investigations to understand the extent of the damage and to hypothesise the cause. The study of lesions on ancient human remains is important to understand the degree of interpersonal violence within ancient communities and to reconstruct the dynamics of a violent episode.
[Show abstract][Hide abstract] ABSTRACT: The management of open fractures and delayed or non unions continue to be complicated by high rates of treatment failure and significant patient disability and dissatisfaction. The use of bone morphogenetic proteins (BMPs) in the treatment of these injuries has been assessed by several authors. BMPs induce the process of bone healing by recruiting bone-forming cells to the area of lesion. The use of BMP currently has two FDA-approved indications: treatment of open tibial fractures treated with intramedullary fixation and treatment of tibia long bone non-union. Despite this limited target, off-label BMP use continues to push the spectrum for new applications. This review describes the current evidence for the use of BMPs in open fractures and non-unions.
[Show abstract][Hide abstract] ABSTRACT: In recent years it has been proposed the use of scaffolds, in different materials, for the regeneration of a meniscal-like tissue to treat partial meniscus defects, in order to avoid the degenerative changes following the meniscectomy. This study reports the results of the clinical use of currently available scaffolds: Menaflex — collagen and Actifit — polyurethane. 21 patients treated with collagen scaffolds with a minimum 10 years’ follow-up and patients 19 treated with polyurethane scaffolds with a minimum 1 year’s follow-up were studied prospectively. The indication for scaffold implantation was an irreparable meniscus lesion or continuous pain after previous partial meniscectomy. The subjects were evaluated clinically and with MRI. In all patients there was a significant clinical improvement during the first months after surgery. In all patients but one the positive results were unchanged at the last follow-up. The MRI study showed a possible chondroprotective effect of the implant and a progressive maturation of the regenerated tissue. The scaffolds for meniscus regeneration can be considered a viable option to manage meniscus defects.
Archivio di Ortopedia e Reumatologia 12/2012; 123(3). DOI:10.1007/s10261-012-0029-7
[Show abstract][Hide abstract] ABSTRACT: Although it is currently the gold standard for the treatment of primary and secondary coxarthrosis, total hip arthroplasty is associated with long-time complications, primarily, polyethylene liner wear, and production of debris that lead to peri-prosthetic osteolysis and resultant aseptic mobilization. (The definition of these osteolytic areas is based on a radiographic classification first described by DeLee and Charnley in 1976.) We introduced a new radiographic classification method, based on the well-known measuring software Roman® v.170 (Cook e Poullain [2002-2005, Institute of Orthopaedics, Oswestry, U.K.]) that is designed to quantify radiologic parameters. Two case studies are also described. This original method can be easily employed, and returns a precise angular classification of the position of the osteolytic area and a computerized calculation of the extent of the osteolytic lesion.
[Show abstract][Hide abstract] ABSTRACT: The management of distal tibial fractures can be difficult, and requires careful preoperative planning. Fracture pattern,
soft tissue injury, and bone quality critically influence the selection of fixation technique.1 Several surgical methods have been described for the management of these fractures, including external fixation, intramedullary
nailing, and plate fixation. External fixation may result in inaccurate reduction, malunion or nonunion, and pin tract infection.2 Intramedullary nailing is considered the standard method to manage operatively diaphyseal fractures of the tibia, but the
distal tibia poses concerns regarding the stability of fixation, the risk of secondary displacement of the fracture on insertion
of the nail, breakage of nails and locking screws, and final alignment of the tibia.
International Advances in Foot and Ankle Surgery, 12/2011: pages 163-168;
[Show abstract][Hide abstract] ABSTRACT: To compare morphological, power Doppler, and contrast-enhanced ultrasound (CEUS) features of the Achilles tendon between asymptomatic athletes and athletes who had undergone surgical repair of a previous rupture.
Twenty-four athletes were divided in two groups (A and B). Group A included 14 patients with a median age of 32 years (range 27 to 47 years) who had undergone surgical repair for unilateral Achilles tendon rupture. Group B (control group) included 10 subjects with a median age of 34 years (range 27 to 40 years) with no previous or present history of tendinopathy. All patients were evaluated with ultrasound, power Doppler, and CEUS with second-generation contrast agent. We studied the uninjured Achilles tendon in athletes of group A and either the left or the right Achilles tendon of the athletes in group B.
CEUS showed a significantly greater ability to detect a greater number of vascular spots within the uninjured tendon of group A compared to group B (<0.05).
In athletes who had suffered a tear of an Achilles tendon, CEUS detected small vessels that were not identified by power Doppler ultrasound in the uninjured contralateral Achilles tendon. CEUS is useful to evaluate vascularity not detected by other imaging techniques. Vascularity in the uninjured tendon seems to be increased in patients who had a previous rupture.
[Show abstract][Hide abstract] ABSTRACT: Surgical fixation of distal tibia fractures can be difficult, and requires careful preoperative planning. Fracture pattern,
soft tissue injury, and bone quality critically influence the selection of fixation technique.1 Several surgical methods have been described for the treatment of these fractures, including external fixation, intramedullary
nailing, and plate fixation. Classical open reduction and internal plate fixation requires extensive soft tissue dissection
and periosteal stripping, with high rates of complications, including infection, delayed and non-unions.2,3 Moreover, the surgical dissection required to achieve anatomic reduction evacuates the osteogenic fracture ematoma. Several
minimally invasive plate osteosynthesis techniques have been developed, with good results at medium term follow-up.4–6 These techniques aim to reduce surgical trauma and to maintain a more biologically favorable environment for fracture healing.
[Show abstract][Hide abstract] ABSTRACT: The Achilles tendon (AT) is the strongest tendon in the human body, but despite its strength, is the most frequently ruptured
tendon in the body. Ruptures usually occur between 2 and 6 cm of its insertion into the superior surface of the calcaneus,
a relatively hypovascular area.8,17 The major blood supply to tendons is from the mesotendon, and the largest supply is from the anterior mesentery.2 The tendon is at the greatest risk of rupture when the it is obliquely loaded, the muscle is contracting maximally, and tendon
length is short.5 This usually occurs as a result of pushing off with the foot against resistance, and occurs most frequently in males in their
[Show abstract][Hide abstract] ABSTRACT: In this morphological study, we report on the three-dimensional microvascular architecture constituting the toes of a patient affected by diabetic microangiopathy. We applied corrosion casting (CC) technique to the toes of a patient affected by Type 2 diabetes, who underwent surgery for explantation of inferior left limb due to necrotic processes of soft tissues. The toes of a foot traumatically explanted in a motorcycle accident were kept as controls. According to technical protocols, toes were injected with a low-viscosity acrylic resin (Mercox) through the major digital artery, tissues were corroded in KOH solution (8%), and resulting casts processed for SEM observations. Already at low magnification, in diabetic toes, we found an impairment of the linear track-like disposition of the vessels of plantar side, with signs of vascular disruption and obliterations, stopped resin, and leakages. Capillaries under the nail and a lot of vascular villi in eponychium and nail borders were damaged, and vascular regression phenomena acting on them were clearly visible. Resin leakages and impairment of normal vascular architecture were also observed in the root of the nail. This preliminary report represents only the first step for further investigations regarding morphological three-dimensional appearance of diabetic microangiopathy. CC and scanning electron microscopy technique well documented these morphological modifications, highlighting on both structural and ultrastructural features of diabetic toes microvessels. In conclusion, our qualitative data try to better focus on the pathophysiological mechanisms involved in diabetic dermopathy and microangiopathy, proposing CC as useful method to investigate on them.
The Anatomical Record Advances in Integrative Anatomy and Evolutionary Biology 10/2010; 293(10):1639-45. DOI:10.1002/ar.21168 · 1.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To define magnetic resonance (MR) arthrography imaging findings of matrix-induced autologous chondrocyte implantation (MACI) grafts of the knee in order to describe implant behaviour and to compare findings with validated clinical scores 30 and 60 months after MACI implant.
Thirteen patients were recruited (10 male, 3 female) with a total number of 15 chondral lesions. Each patient underwent an MACI procedure and MR arthrography 30 and 60 months after surgery. MR arthrography was performed using a dedicated coil with a 1.5-Tesla unit. The status of the chondral implant was evaluated with the modified MOCART scoring scale. The lining of the implant, the integration to the border zone, the surface and structure of the repaired tissue were assessed, and the presence of bone marrow oedema and effusion was evaluated. For clinical assessment, the Cincinnati score was used.
At 60 months, the abnormality showed worsening in 1 out of 15 cases. Integration showed improvement in 3 out of 15 cases, and worsening in 3 out of 15 cases. Two surfaces of the implant showed further deterioration at 60 months, and 1 afflicted implant fully recovered after the same time interval. Implant contrast enhancement at 30 months was seen in 2 out of 15 cases, 1 of which recovered at 60 months. According to the MOCART score, 4 cases were rated 68.4 out of 75 at 30 months and 65 out of 75 at 60 months. The mean clinical score decreased from 8.6 out of 10 at 30 months to 8.1 out of 10 at 60 months.
Magnetic resonance arthrography improved the evaluation of implants and facilitated the characterisation of MACI integration with contiguous tissues. The follow-up showed significant changes in MACI, even at 60 months, allowing for useful long-term MR evaluations.
[Show abstract][Hide abstract] ABSTRACT: Tendon is a poorly vascularized and highly specialized connective tissue containing few scattered cells that play an important role in the musculoskeletal apparatus by resisting mechanical stress. Because of the slow rate of the metabolism of its molecular components, the tendon gradually loses its mechanical properties and may rupture upon an array of physical activities. In this report, we discuss the molecular changes involved in the extracellular matrix-tendon interactions leading to tissue degeneration and rupture.
Frontiers in bioscience (Elite edition) 01/2010; 2(1):1-12.
[Show abstract][Hide abstract] ABSTRACT: Minimally invasive surgical techniques for pathologies of the Achilles tendon (AT) hold the promise to decrease perioperative morbidity, allow faster recovery times, shorten hospital stays, and improve functional outcomes when compared with open procedures, which can lead to difficulty with wound healing because of the tenuous blood supply and increased chance of wound breakdown and infection. This article presents recent advances in the field of minimally invasive AT surgery for tendinopathy, acute ruptures, and chronic tears. All of the techniques described in this article are inexpensive and do not require highly specialized equipment and training. Future randomized controlled trials are required to address the issue of the comparison between open versus minimally invasive AT surgery.
Orthopedic Clinics of North America 10/2009; 40(4):491-8, viii-ix. DOI:10.1016/j.ocl.2009.05.006 · 1.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The management of distal tibia fractures can be challenging because of the scarcity of soft tissue, their subcutaneous nature, and poor vascularity. Classic open reduction and internal plate fixation require extensive soft tissue dissection and periosteal stripping, with high rates of complications. Minimally invasive plating techniques reduce iatrogenic soft tissue injury and damage to bone vascularity and preserve the osteogenic fracture hematoma. Locking plates (LPs) have the biomechanical properties of internal and external fixators, with superior holding power because of fixed angular stability through the head of locking screws, independent of friction fit. In this review, the rationale for the use of LPs and a description of the technique of minimally invasive LP osteosynthesis of distal tibia fractures are presented.
Orthopedic Clinics of North America 10/2009; 40(4):499-504, ix. DOI:10.1016/j.ocl.2009.05.007 · 1.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study investigated at medium term follow-up the clinical outcomes and any progression of knee osteoarthritis in a population of patients that underwent arthroscopic placement of a collagen meniscus implant. Thirty-four patients underwent arthroscopic placement of a collagen meniscus implant for a symptomatic deficiency of medial meniscal tissue. Follow-up evaluation included Lysholm II score and Tegner activity scores and MR arthrography of the knee at 2 and 5 years after surgery. Plain radiographs were also obtained at 5 years. Six patients were excluded. In eight cases arthroscopic second look evaluation was performed. Lysholm and Tegner activity scores at 2 and 5 years after surgery improved significantly compared to the preoperative score. These patients showed good to excellent clinical results after 5 years from a CMI placement. The chondral surfaces of the medial compartment had not degenerated further since placement of the CMI. MR signal had continued to mature between 2 and 5 years after implant, progressively decreasing signal intensity but in any case comparable to the low signal of a normal meniscus. In most of cases the CMI-new tissue complex had a slight reduction in size, compared to a normal medial meniscus, but the new tissue had no apparent negative effects.
The Knee 10/2009; 17(3):224-9. DOI:10.1016/j.knee.2009.08.011 · 1.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Distal tibial fractures are difficult to manage. Limited soft tissue and poor vascularity impose limitations for traditional plating techniques that require large exposures. The nature of the limitations for traditional plating techniques is intrinsic to the large exposure required to approach distal tibia, a bone characterized by limited soft tissue coverage and poor vascularity. The locking plate (LP) is a new device for treatment of fractures. We assessed the bone union rate, deformity, leg-length discrepancy, ankle range of motion, return to preinjury activities, infection, and complication rate in 21 selected patients who underwent minimally invasive osteosynthesis of closed distal tibia fractures with an LP. According to the AO classification, there were 12 Type A, 5 Type B, and 4 Type C fractures. The minimum followup was 2 years (average, 2.8 years; range, 2-4 years). Two patients were lost to followup. Union was achieved in all but one patient by the 24th postoperative week. Four patients had angular deformity less than 7 degrees . No patient had a leg-length discrepancy more than 1.1 cm. Five patients had ankle range of motion less than 20 degrees compared with the contralateral side. Sixteen patients had not returned to their preinjury sporting or leisure activities. Three patients developed a delayed infection. We judge the LP a reasonable device for treating distal tibia fractures. The level of physical activities appears permanently reduced in most patients. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 08/2009; 468(4):975-82. DOI:10.1007/s11999-009-0991-7 · 2.77 Impact Factor