La Chirurgia degli organi di movimento最新文献

The Authors analyse the clinical and radiographical results of 14 patients (16 feet) affected by hallux valgus (HV) in flexible abnormal pronation syndrome. Patients were treated by distal osteotomy of the first metatarsal bone and sub-talar arthroerisis in one stage. This treatment was chosen because HV is often associated with abnormal foot pronation. Patients were young and the sub-talar joints had good mobility. The protocol forecasts: X-ray study of the feet and post-surgery planning, day surgery admission, minimally invasive surgery and 5 weeks of immobilisation in a below-knee cast.

Meniscal cysts are a rare disease constantly combined with a horizontal meniscal lesion. Currently, nuclear magnetic resonance (MRI) is the main diagnostic tool, because of its high sensitivity and specificity, and decompression arthroscopy combined with selective meniscectomy is the treatment of choice. The Authors report a case of a voluminous medial meniscal cyst where instrumental examination, MRI, was fundamental for the preoperative diagnosis of the horizontal meniscal lesion causing the cystic degeneration of the meniscus. The treatment performed was selective meniscectomy of the body and posterior horn of the medial meniscus and decompression of the voluminous cyst by arthroscopy. Physical examination after six months showed the complete resolution of swelling at the medial hemirima, no walking pain and normal range of motion.

Synovial chondrosarcoma (SCH) is a rare malignant tumour. The lesion may arise de novo in intra-articular space or, more frequently, it may occur as a malignant degeneration of synovial chondromatosis (SC). The authors report two cases of SCH of the hip joint occurring on a SC diagnosed 23 years earlier in one case and 10 years earlier in another case. In both cases the SCH showed an intermediate grade of malignancy at histology (grade 2). In the first case, the patient underwent an external hemipelvectomy and he was disease-free 10 years after the operation. In the second case, the patient refused the proposed amputation and, after palliative radiation therapy, she was alive with disease 58 months after diagnosis. A review of literature reports on SCH was carried out. The knee was the most affected joint, followed by the hip. An amputation was performed in two thirds of cases. Amputation was done as primary surgery in one fifth of cases and for tumour recurrence after synovectomy in four fifth of cases. Metastatic dissemination was seen in 29% of cases. An early detection of malignant transformation of SC might improve the rate of limb salvage surgery in these patients, although no reliable clinical and imaging signs of malignant degeneration have been identified so far.

Adamantinoma is a rare tumour, which most often affects the tibia and produces lytic and sometimes destructive lesions, which can cause fractures. The lesions occur principally in adults and are more common in males. A small percentage of the patients develop metastases, sometimes quite late in the course. Our institution has treated 42 patients with adamantinomas since 1972 and has evaluated them by imaging studies and histology. The majority of the patients were treated by resection of the lesion and insertion of an intercalary allograft. Only three of the patients died of disease with the time until death ranging from 10 to 17 years. Recurrence occurred in only three patients and the allograft success rate in terms of function was 71% at a mean time of 10 years.

Study design: A unique case of lumbosacral lateral dislocation without fracture is reported.

Objective: To report on the diagnosis and treatment of a traumatic L5-S1 lateral dislocation in a polytrauma 34-year-old male with L5 nerve root paralysis.

Method: Interbody fusion following decompression, posterior reduction and interbody grafting combined with posterior plating was performed.

Results: At an early stage the patient was able to return to work and walk without supports. At the 12-month follow-up evaluation no back pain was referred and fusion was achieved.

Conclusions: Lateral pure dislocation of the lumbosacral joint is very rare and can be easily misdiagnosed. A careful evaluation of the AP standard X-ray can lead to diagnosis and can be confirmed by CT scan. Prompt reduction and fusion is the treatment of choice to allow a quick functional recovery.

Prefabricated tissue represents a bridge between traditional reconstructive surgery and tissue engineering. Initially used in the 1960s in reconstructive plastic surgery, in the 1980s it was also used in orthopedics. The term "prefabricated" indicates a process of neovascularization of a tissue by implanting a vascular pedicle inside the tissue itself; this tissue can be then reimplanted either at a short distance through the pedicle itself, or as a free graft by microvascular anastomosis. The purpose of prefabrication is to build a tissue (muscle, bone, skin, or composite) with characteristics as similar as possible to those of the defect to fill, thus minimizing morbidity in the donor site and improving the reconstructive effectiveness. We present a review of the literature that includes the main experiments performed until now in which a bone segment has been reconstructed using scaffolds and growth factors in relationship to the local blood supply or to the use of a vascular pedicle.

A rare case of a 28-year-old Asiatic male with the isolated absence of a posterior cruciate ligament is reported. Clinical features, diagnostic steps, therapeutic strategies and follow-up are described. A review of the literature is also presented.

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.

Marrow stromal cells (MSC) are increasingly being introduced in orthopaedic practice as potentially powerful effectors of bone regeneration. Since cell recovery of MSC is affected by a high degree of individual variability, sources for collecting adequate amounts of safe and effective MSC under routine conditions are needed. We analysed if femoral bone marrow, which is usually discarded during total hip arthroplasty procedures, is a reliable source of MSC to enhance bone healing and regeneration. Mononuclear cells were isolated, assayed for typical MSC markers, harvested under appropriate culture conditions and evaluated for their ability to differentiate into osteoblasts. Cell recovery and osteogenic potential were independent from donor gender or age, suggesting that elderly individuals are eligible for autologous cell therapy. Although heterogeneous, the pool of MSC recovered from femoral marrow without further in vitro selection or manipulation proved highly effective in proliferating and differentiating along the osteogenic lineage. In conclusion, this source of MSC offers a valuable tool to be used to promote osteogenesis and implant fixation.

The Authors describe a case of Freeman-Sheldon Syndrome, a rare congenital autosomal dominant disorder (gene mapped on chromosome 11p15.5) characterized by microstomia with crinkled lips, camptodactyly with ulnar deviation of the fingers and equinus-varus-supine clubfoot. The autosomal recessive form, even rarer and difficult to recognize, has a more severe clinical manifestation. The symptomatology is worsened by breathing and swallowing disorders due to the small orifices of the mouth and nose, which sometimes require tracheotomy to avoid obstruction of the airways.