La Chirurgia degli organi di movimento最新文献

The long-term successful outcomes of total hip replacement led to an extension of the surgical indications to young and active patients. To achieve a prompt functional recovery, varying surgical techniques have been proposed. In this study we present our anterolateral soft tissue sparing approach characterised by a lesser dissection of the muscles, a capsular repair and an accurate soft tissue tensioning and reconstruction. The target of this procedure is a full and quick restoration of hip function, reducing the rate of early complications such as hip dislocation.

Rupture of the tibialis posterior tendon may occur during a trauma in pronation-external rotation of the foot or, less commonly, during a direct trauma of the ankle. When an isolated fracture of the medial malleolus is present, it is more likely that a direct trauma has occurred. A 36-year-old man with a non-displaced medial malleolar fracture was evaluated. Repair of the tendon and reduction of the fracture were performed. Twenty-four months after the operation, the fracture was completely healed, the patient was asymptomatic, he had a normal ankle range of motion, and the function and strength of the tibialis posterior tendon were equal to those on the contralateral side. Early surgical repair of the tibialis posterior tendon combined with malleolar fracture reduction is recommended to avoid progression to a plano-valgus foot.

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.

The Authors report the case of a 28-year-old patient with type 1 neurofibromatosis, who presented a pathological dislocation of the hip. This event was preceded by the development of a neurological pattern of spastic paraparesis and decreased pain sensation in both lower limbs, secondary to the progression of a dystrophic kyphoscoliosis. Pathological dislocation of the hip in neurofibromatosis has been reported in the literature as a consequence of intra-articular growth of neurofibromas. Conversely, in the case described here, clinical and radiographic features and the absence of neurofibromas in the joint, verified by means of radiographic and histological examinations, suggested the diagnosis of neuropathic arthropathy. The treatment of hip dislocation should be differentiated according to the aetiology, given the underlying articular instability in cases of neuropathic arthropathy.

The treatment of large (6 cm) segmental bone defects, especially in areas associated with soft tissue damages and exposure, is challenging. Massive bone allografts are widely used in reconstructive surgery to replace missing bone parts such as critical size defects, nevertheless, early vascular invasion is a critical factor in bone allograft incorporation and in the consequent success of the surgery. Unfortunately, it has been proven that only slow and incomplete bone integration is possible by using frozen allografts in the treatment of large bone defects. An allogenic frozen bone graft was engineered with bone marrow mononuclear cells (BMMCs) to repair a large ulna defect in a male patient. When infection and sinus developed at the graft site 4 months after implantation, the partially reabsorbed graft was removed and send to the lab for examination. The histological and immunohistochemical analysis performed on a graft removed from the central zone of the defect demonstrated areas of neo-vascularisation, indicating that a remodelling process was actively occurring even in an area not usually repopulated with the conventional techniques. For these reasons, we may hypothesise that the use of BMMCs has a role in the re-building of large segmental defects.

One of the most common complications of cemented prostheses is aseptic loosening of the implant, which is often due to mechanical breakdown at the bone-cement interface. To improve the characteristics of PMMA, the addition of fluoride has been proposed, which, without jeopardising its mechanical qualities, should provide better integration with the surrounding bone. An experimental study was performed in 4 sheep. A cylinder of cement (with and without fluoride) was inserted in the meta-epiphysis of the distal femur. A clinical study followed 7 patients. The cement with added fluoride was used as a filler after the curettage of a benign tumour located in the meta-epiphysis around the knee. Histological results in animals combined with long-term radiographic results in humans have shown the positive influence of fluoride in the cement, as it allows better integration of the cement with the surrounding bone.

Neurogenic arthropathy or Charcot's Joint is an articular pathology that can strike patient with neurological effects or can be the result of a neurological lesion with deficit of the superficial and deep sensitivity. In this article we introduce one case Charcot's Joint of the hip, caused by an epidural anaesthesia performed for a surgery of the other hip.

In the field of orthopaedics, autologous chondrocyte implantation is a technique currently used for the regeneration of damaged articular cartilage. There is evidence of the neo-formation of tissue displaying characteristics similar to hyaline cartilage. In vitro chondrocyte manipulation is a crucial phase of this therapeutic treatment consisting of different steps: cell isolation from a cartilage biopsy, expansion in monolayer culture and growth onto a three-dimensional biomaterial to implant in the damaged area. To minimise the risk of in vitro cell contamination, the manipulation must be performed in a controlled environment such as a cleanroom. Moreover, the choice of reagents and raw material suitable for clinical use in humans and the translation of research protocols into standardised production processes are important. In this study we describe the preliminary results obtained by the development of chondrocyte manipulation protocols (isolation and monolayer expansion) in cleanrooms for the application of autologous implantation.

The Authors present a paper with a dual goal: in vitro evaluation of the elution of vancomycin and monitoring of its bactericidal action when the antibiotic is used in acrylic cement. Discs of cement with different concentrations of vancomycin alone or combined with meropenem were prepared. To assess the elution of vancomycin the discs were kept in physiological solution and periodically sampled for five weeks. The bactericidal action was assessed by putting the antibiotic discs in contact with colonies of Staphylococcus, Enterococcus, Pseudomonas and Escherichia coli. Two combinations of antibiotic-loaded cement were tested: the first one to act as a spacer and the second to stabilise the revision prosthesis.

Open reduction and internal fixation is the treatment of choice in distal humerus fractures. The aims of the treatment are to obtain anatomic reconstruction and restoration of the elbow's geometry followed by stable internal fixation that allows immediate rehabilitation. The plates are pre-contoured to fit the natural anatomy of the elbow and in the case of complex fractures they provide a guide for the anatomic restoration of the distal humerus. The two plates are placed parallel with the screws locked together by interdigitation creating a fixed angle in the distal fragments that provides stability to the entire distal humerus. Using this method we obtained good results according to the Mayo Elbow Performance Score (MEPS) and we are able to reduce the incidence of complications. Our experience shows also that it can be useful to obtain an anatomical reduction of distal humeral fractures using the pre-contoured plates in a parallel position recovering the anatomical antiversion of the articular surface.