R Pascarella

Ospedali Riuniti di Bergamo, Bérgamo, Lombardy, Italy

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Publications (49)10.93 Total impact

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    ABSTRACT: Purpose: The incidence of trochanteric fractures has increased significantly during the last few decades, especially in elderly patients with osteoporosis. The dynamic/sliding hip screw and the cephalomedullary nail are the most commonly used fixation methods to treat trochanteric fractures. The improvements in the Gamma Nail System (GNS) associated with a correct surgical technique reduced the postoperative orthopedic complications. The purpose of this study was to compare the results of the different Gamma Nails. Methods: The present study is a retrospective analysis of 2144 patients treated with GNS between January 1997 and December 2011 for trochanteric fractures, classified according to AO classification method. The patients were divided into three groups according to the nailing system: 525 were treated with Standard Gamma Nail (SGN), 422 with Trochanteric Gamma Nail (TGN) and 1197 with Gamma3 Nail. Results: The overall incidence of intra-operative complications was 1.21 %; the incidence of intra-operative complications for each group was 1.71 % for SGN group, 0.47 % for TGN group and 1.25 % for Gamma3 Nail group. The overall incidence of postoperative complications was 5.48 %, and the incidence for each group was 10.73 % for SGN group, 9.92 % for TGN group and 2.92 % for Gamma3 Nail group. Conclusion: The GNS is a safe device with a low rate of intra-operative complications. The evolution of this nail system reduces postoperative complications, thus improving the results at follow-up and confirming that the Gamma3 Nail is a safe and predictable device to fix trochanteric fracture.
    No preview · Article · Dec 2015 · MUSCULOSKELETAL SURGERY
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    ABSTRACT: An increase in the elderly population has resulted in a higher incidence of peritrochanteric fractures of the femur. The goal in the treatment of these fractures is to achieve a stable fixation, which allows for early patient mobilization. The Gamma 3 nail represents a minimally invasive surgical procedure. The minimally invasive technique results in greater respect for tissues, less blood loss and then a quick recovery.
    No preview · Article · Oct 2014 · LO SCALPELLO-OTODI Educational
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    ABSTRACT: Posterior wall fracture is the most common acetabular fracture. Comminuted fractures with an impacted segment represent a subtype of this injury. The subchondral bone of the articular zone is compressed and causes a bone defect. The impacted fragment should be isolated, mobilized, and then reduced. A bone graft should be used to fill the gap. The other fragments are fixed following the reduction of the impacted segment. Ten patients with comminuted fractures and impacted segments with bone defects were enrolled in our study, from January 2010 to July 2012. Autogenous bone grafts from the greater trochanter were used to fill the gap in all patients. The reduction was achieved through the insertion of the graft above the impacted fracture, and plate fixation was performed subsequently. Merle d'Aubigne and Postel scoring, modified by Matta, was applied to evaluate the patients during follow-up. The mean follow-up was 12 months. The clinical results included one "excellent", four "very good", four "good" and one "poor". Pain in the zone of graft harvesting was not detected in any patient. Femoral head necrosis was observed in one case. No other severe complications were detected. Using an autogenous bone graft to fill the bone defect supplies excellent mechanical stability without any severe complications at the donor site. This surgical technique seems to be effective and safe in treating a comminuted fracture of the posterior wall in association with an impacted segment. Level IV.
    Preview · Article · Mar 2014 · Journal of Orthopaedics and Traumatology
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    R Pascarella · C Bettuzzi · G Bosco · D Leonetti · S Dessì · P Forte · L Amendola
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    ABSTRACT: Indications and techniques of locked plate fixation for the treatment of challenging fractures continue to evolve. As design variant of classic locked plates, the polyaxial locked plate has the ability to alter the screw angle and thereby, enhance fracture fixation. The aim of this observational study was to evaluate clinical and radiographic results in 89 patients with 90 fractures of the distal femur treated, between June 2006 and November 2011, with such a polyaxial locked plating system (Polyax™ Locked Plating System, DePuy, Warsaw, IN, USA). Seventy-seven fractures formed the report of this study. These cases were followed up until complete fracture healing or for a mean time of 77 weeks. At the time of last follow-up, 58 of 77 fractures (75.3 %) progressed to union without complication and radiographic healing occurred at a mean time of 16.3 weeks. Complications occurred in ten fractures that did not affect the healing and in nine fractures that showed delayed or non-union. The mean American Knee Society Score at the time of final follow-up was 83 for the Knee Score and 71.1 for the Functional Score. In conclusion, there is a high union rate for complex distal femoral fractures associated with a good clinical outcome in this series.
    Full-text · Article · Dec 2013 · Strategies in Trauma and Limb Reconstruction
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    ABSTRACT: Bleeding associated with pelvic fracture mostly comes from the pre-sacral and lumbar venous plexus, or directly from the fracture site. Bleeding as a consequence of arterial lesion is less common (15-20%), and that resulting from lesion of the external iliac artery (EIA) is extremely rare. The mortality rate associated with iliac artery injury ranges from 38% to 72%. Total body CT-scan with contrast medium, angiography or packing can be performed when there is arterial injury. In some cases, embolisation can stop bleeding; however, when there is involvement of the aorta, common iliac artery or EIA, immediate surgery is mandatory. The aim of this study was to report our experience of pelvic fractures associated with EIA lesion. Six patients with pelvic fracture and associated rupture of the EIA have been observed at our unit from 2004 to 2009. According to Tile classification there were three cases of type C and two cases of type B fracture. One case was a two-column acetabular fracture. Angiography was performed in all cases. Three patients died on the day of trauma: two after angiography, and one after surgery of vascular repair. Three patients survived: two underwent a hemipelvectomy, and one underwent hip disarticulation. Haemodynamic instability in patients with pelvic ring fracture is usually because of venous bleeding from the pre-sacral and lumbar plexus, or from the fracture site. Arterial injury is present in around 20% of cases. EIA lesions require immediate surgical treatment to restore blood flow. Depending on the type of injury, vascular surgery can be associated with pelvic fracture stabilisation. Pelvic ring fracture associated with an EIA lesion is extremely rare, with few cases reported in the literature. Angiography is used for diagnosis, and immediate surgical treatment is required to restore blood flow. Associated injuries and open fracture can lead to fatal complications or amputation. Rates of mortality and severe disability are extremely high.
    Preview · Article · Oct 2013 · Injury
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    ABSTRACT: Multifocal humeral fractures are extremely rare. These may affect the neck and the shaft, the shaft alone, or the diaphysis and the distal humerus. There is no classification of these fractures in the literature. From 2004 to 2010, 717 patients with humeral fracture were treated surgically at our department. Thirty-five patients presented with an associated fracture of the proximal and diaphyseal humerus: synthesis was performed with plate and screws in 34 patients, and the remaining patient had an open fracture that was treated with an external fixator. Mean follow-up was 3 years and 3 months. A classification is proposed in which type A fractures are those affecting the proximal and the humeral shaft, type B the diaphysis alone, and type C the diaphysis in association with the distal humerus. Type A fractures are then divided into three subgroups: A-I, undisplaced fracture of the proximal humerus and displaced shaft fracture; A-II: displaced fracture of the proximal and humeral shaft; and A-III: multifragmentary fracture affecting the proximal humerus and extending to the diaphysis. Multifocal humeral fractures are very rare and little described in the literature, both for classification and treatment. The AO classification describes bifocal fracture of the humeral diaphysis, type B and C. The classification suggested in this article mainly concerns fractures involving the proximal and humeral shaft. A simple classification of multifocal fractures is suggested to help the surgeon choose the most suitable type of synthesis for surgical treatment.
    Full-text · Article · Oct 2013 · Injury
  • R Pascarella · C Bettuzzi · V Digennaro
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    ABSTRACT: Fractures of the pelvis in pediatric population are extremely rare. Children with complex pelvic fractures are most often pedestrians who have been struck by a motor vehicle. Head injuries are the main cause of death, unlike the adult, where severe hemorrhages are common and contribute to mortality. Long-term follow-up studies have reported significant residual morbidity in children's pelvic fractures treated non-operatively. The aim of this study is to analyze our cases in order to evaluate the final outcome and to suggest the surgical indications for the management of this kind of injuries. From January 2000 to July 2011, eight pediatric patients were surgically treated for pelvic ring fractures in our department. The functional result at follow-up was evaluated using the functional independence measure (FIM). In most cases the clinical outcome was good with functional recovery of the hip and complete resumption of physical activity. The mean FIM score was 125.3. One patient underwent permanent colostomy for perineal lacerations, one case showed a slight scoliosis at follow-up, and one patient showed the early fusion of the triradiate cartilage. One patient presented a deep thrombosis of the common femoral vein. Fractures of the pelvic ring should be carefully assessed by radiographs and CT scan. The centralization of these young patients is important to get the experience and ensure the proper treatment. A correct indication for surgery may prevent or limit the consequences of these complex fractures.
    No preview · Article · Jul 2013 · MUSCULOSKELETAL SURGERY
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    ABSTRACT: Complications of treatment with intramedullary nail of lateral femoral fractures can be divided in intraoperative and postoperative. Intraoperative complications are usually related to poor fracture reduction, to the target device, to inadequate X-ray control and to incorrect nail introduction. Postoperative complications are usually related to synthesis malpositioning, to poor fracture reduction, to lateral fractures engaging the femoral neck and generating an unstable fracture, to bone stock loss in low proximal femoral fractures and to fracture non-union.
    No preview · Article · Jul 2013 · LO SCALPELLO-OTODI Educational
  • R. Pascarella · D. Leonetti · V. Digennaro
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    ABSTRACT: Riassunto Le protesi totali d’anca eseguite in seguito a frattura acetabolare rimangono ancora una sfida per l’ortopedico. Lo scopo di questo lavoro è riportare i risultati clinico/radiografici di una serie di 28 casi consecutivi di artroprotesi d’anca in esiti di frattura dell’acetabolo. Materiali e metodi Abbiamo eseguito uno studio prospettico su 28 pazienti affetti da esiti di frattura dell’acetabolo e operati di artroprotesi totale d’anca da dicembre 2004 a dicembre 2010. Risultati Il punteggio Harris medio è migliorato da 39 punti nel pre-operatorio a 90 punti al follow-up. Ventisei pazienti hanno ottenuto un risultato eccellente o buono, 2 un risultato sufficiente. Il tasso di sopravvivenza a 3 anni di distanza è stato del 100%. Discussione Per garantire una lunga sopravvivenza di una protesi d’anca è di fondamentale importanza ripristinare il corretto centro di rotazione. Questo risulta sempre più difficile nei casi in cui esistano gravi difetti ossei acetabolari o gravi alterazioni dell’anatomia della pelvi. Pertanto risulta fondamentale il trattamento chirurgico delle fratture scomposte dell’acetabolo e della pelvi, in quanto ripristinando la corretta anatomia riduce i rischi di sviluppare artrosi precoce e permette l’utilizzo di protesi da primo impianto con un maggior tasso di sopravvivenza.
    No preview · Article · Jun 2012
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    R Pascarella · V Digennaro · G Grandi
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    ABSTRACT: Surgical treatment of a unusual acetabular fracture is described. This fracture was characterized by impaction and breaking down of the posterior articular surface and comminution of lamina quadrilatera lower portion, without cortical fracture of both columns. The fracture was treated surgically through the Kocher-Langenbeck approach. A small hole was created in the acetabulum posterior wall, the impacted fragment was reduced, and the bone defect was filled with autologous bone from the greater trochanter. A plate was shaped in order to fix both bone graft and fractured fragment.
    Full-text · Article · Jun 2011 · Journal of Orthopaedics and Traumatology
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    ABSTRACT: Acetabular fractures are often associated with dislocation of the femoral head. When the dislocation is reduced, > or = 1 fragments may remain inside the joint, especially in posterior dislocation. In this kind of dislocation, the fracture of the posterior wall of the acetabulum may be comminuted. The fragments attached to the joint capsule or free may remain between the femoral head and the acetabulum. During reduction, these fragments are dragged inside the joint. The presence of the fragments in the hip joint may prevent complete reduction of the dislocation. Surgery should be performed early to reduce the risk of aseptic necrosis of the femoral head. Sometimes the fragments derive from a fracture of the femoral head without involving the posterior wall. Fragments are difficult to detect by conventional radiography; therefore, computed tomography scans are always indicated in fracture-dislocations pre- and postoperatively to check that all intra-articular fragments have been removed and the fracture has been reduced. We observed 373 cases of acetabular fracture between January 1, 1997 and December 31, 2007. One hundred twenty-seven cases presented a dislocation: 5 anterior, 13 central, and 109 posterior. In 45 cases, after reduction of the dislocation, 2 anterior and 43 posterior intra-articular fragments were observed. Removing a loose body inside the joint is always necessary because movement causes damage of the cartilage and therefore an early arthritis. The strategy to remove and the approach differs according to the kind of dislocation observed.
    No preview · Article · Jun 2009 · Orthopedics
  • R. Pascarella · G. Bosco · M. Commessatti · S. Boriani
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    ABSTRACT: The Gamma nail was born in 1980 as an evolution of the ideas of G. Küntscher. Forty years before he had developed an “Y” nail for the treatment of pertrocantheric fractures. The Gamma Standard was developed from the Strasbourg Orthopaedic school in 1988 and in a few years good results were reached. In 1997 the TGN (Trochanteric Gamma Nail) was developed as the first evolution of the Gamma Standard. In 2003 the third generation appeared — the Gamma 3 — and completely substitued the old versions. We report a series that includes 1628 cases treated from January 1st 1997 to December 31st 2008. The Gamma Standard was used in 525 cases, the TGN in 422 and the Gamma 3 in 681 cases. During follow-up 704 cases were reviewed and 692 cases healed without any further surgery. The Gamma Standard presented 2.65% of intra-operative complications, the TGN 1.2% and the Gamma 3 1.5%. The Gamma Standard presented 11.7% of postoperative complications, the TGN 10.7% and the Gamma 3 4.7%.
    No preview · Article · May 2009 · LO SCALPELLO-OTODI Educational
  • R. Pascarella
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    ABSTRACT: Fractures of the acetabulum on the horizontal plane include transverse fracture, transverse with anterior or posterior wall, “T” transverse. These fractures, usually associated with a dislocation of the femoral head, present a rotatory component that must be reduced with special clamps. Reduction is complex and requires a precise preoperatory planning and great surgical experience
    No preview · Article · Mar 2009 · Archivio di Ortopedia e Reumatologia
  • R Pascarella · L Marchesini Reggiani · S Boriani

    No preview · Article · Feb 2009 · Injury
  • R. Pascarella · G. Bosco · M. Commessatti · S. Boriani

    No preview · Article · Jan 2009 · LO SCALPELLO-OTODI Educational
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    ABSTRACT: We report on two cases of simultaneous asymmetrical bilateral hip dislocation. Both patients were involved in car accidents. The first case is a 23-year-old man who had a bilateral hip dislocation, anterior on the right side and posterior on the left associated with bilateral femoral head fracture. The second case presented the same dislocations of the hips associated with acetabular fracture on the right side. Closed reduction of the hips was performed in both cases. In the first case the femoral head fragments was subsequently removed. In the second case internal fixation of the acetabular fracture was postponed.
    No preview · Article · Sep 2008 · La Chirurgia degli Organi di Movimento
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    ABSTRACT: Femoral neck fractures are progressively increasing, due to higher survival rates, particularly among the female population. The gamma nail was created to treat intertrochanteric fracture types 31-A1, 31-A2 and 31-A3 and in some cases basicervical fractures of type 31-B2-1. Complications can be classified as intraoperative and postoperative. The intraoperative might be related to the nail's introduction site, lag and distal locking screw positions. Postoperative complications depend mostly on an incorrect surgical technique, which can lead to an inaccurate nail position and consequent implant failure. We rarely observe failures caused by severe bone osteoporosis.
    No preview · Article · May 2008 · La Chirurgia degli Organi di Movimento
  • A Gasbarrini · M Fravisini · R Pascarella · S Boriani

    No preview · Article · Aug 2005 · The journal of knee surgery
  • D. Tigani · R. Pascarella · M. Fravisini · C. Stagni · S. Boriani

    No preview · Article · May 2005 · Osteosynthesis and Trauma Care
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    D Tigani · M Fravisini · C Stagni · R Pascarella · S Boriani
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    ABSTRACT: A series of 179 closed femoral fractures treated by static interlocking nailing (Grosse-Kempf nail) was reviewed to evaluate the effect of dynamization on the time to bony union. In 75 patients, dynamization was performed whereas in 104 the implant was left static. Union occurred in 178 patients. We observed one infection. Time to union was significantly shorter in the static group (103 days) compared to the dynamized group (126 days).
    Full-text · Article · May 2005 · International Orthopaedics

Publication Stats

117 Citations
10.93 Total Impact Points


  • 2013
    • Ospedali Riuniti di Bergamo
      Bérgamo, Lombardy, Italy
  • 2002-2013
    • Ospedale Maggiore Carlo Alberto Pizzardi di Bologna
      • Department of Orthopaedics and Traumatology
      Bolonia, Emilia-Romagna, Italy
  • 1993-2000
    • Istituto Ortopedico Rizzoli
      • Medical Technology Laboratory
      Bolonia, Emilia-Romagna, Italy