1
|
Gatti SD, Gaddi D, Turati M, Leone G, Arts JJ, Pessina F, Carminati M, Zatti G, De Rosa L, Bigoni M. Clinical outcomes and complications of S53P4 bioactive glass in chronic osteomyelitis and septic non-unions: a retrospective single-center study. Eur J Clin Microbiol Infect Dis 2024; 43:489-499. [PMID: 38195783 DOI: 10.1007/s10096-023-04737-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Dead space management following debridement surgery in chronic osteomyelitis or septic non-unions is one of the most crucial and discussed steps for the success of the surgical treatment of these conditions. In this retrospective clinical study, we described the efficacy and safety profile of surgical debridement and local application of S53P4 bioactive glass (S53P4 BAG) in the treatment of bone infections. METHODS A consecutive single-center series of 38 patients with chronic osteomyelitis (24) and septic non-unions (14), treated with bioactive glass S53P4 as dead space management following surgical debridement between May 2015 and November 2020, were identified and evaluated retrospectively. RESULTS Infection eradication was reached in 22 out of 24 patients (91.7%) with chronic osteomyelitis. Eleven out of 14 patients (78.6%) with septic non-union achieved both fracture healing and infection healing in 9.1 ± 4.9 months. Three patients (7.9%) developed prolonged serous discharge with wound dehiscence but healed within 2 months with no further surgical intervention. Average patient follow-up time was 19.8 months ± 7.6 months. CONCLUSION S53P4 bioactive glass is an effective and safe therapeutic option in the treatment of chronic osteomyelitis and septic non-unions because of its unique antibacterial properties, but also for its ability to generate a growth response in the remaining healthy bone at the bone-glass interface.
Collapse
Affiliation(s)
| | - Diego Gaddi
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Marco Turati
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy.
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy.
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France.
- Department of Paediatric Orthopedic Surgery, Hospital Couple Enfants, Grenoble Alpes University, Grenoble, France.
| | - Giulio Leone
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy
| | - Jacobus J Arts
- Department Orthopaedic Biomechanics, Faculty Biomedical Engineering, Eindhoven University of Technology TU/e, Eindhoven, Netherlands
- Department Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Fabio Pessina
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Mattia Carminati
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Giovanni Zatti
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy
| | - Laura De Rosa
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy
| | - Marco Bigoni
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
| |
Collapse
|
2
|
Turati M, Rigamonti L, Giulivi A, Gaddi D, Accadbled F, Zanchi N, Bremond N, Catalano M, Gorla M, Omeljaniuk RJ, Zatti G, Piatti M, Bigoni M. Management of anterior cruciate ligament tears in Tanner stage 1 and 2 children: a narrative review and treatment algorithm guided by ACL tear location. J Sports Med Phys Fitness 2023; 63:1218-1226. [PMID: 34609098 DOI: 10.23736/s0022-4707.21.12783-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The incidence of anterior cruciate ligament (ACL) tears in skeletally immature patients has acutely increased over the last 20 years, yet there is no consensus on a single "best treatment." Selection of an optimal treatment is critical and based on individual circumstances; consequently, we propose a treatment-selection algorithm based on skeletal development, ACL tear location, type, and quality, as well as parental perspective in order to facilitate the decision-making process. We combined our surgical group's extensive case histories of ACL tear management in Tanner Stage 1 and 2 patients with those in the literature to form a consolidated data base. For each case the diagnostic phase, communication with patient and parents, treatment choice(s), selected surgical techniques and rehabilitation schedule were critically analyzed and compared for patient outcomes. MRI-imaging and intraoperative tissue quality assessment were preeminent in importance for selection of the optimal treatment strategy. Considerations for selecting an optimal treatment included: associated lesions, the child/patient and parent(s)' well-informed and counseled consent, biological potential, and the potential for successful ACL preservative surgery. Complete ACL tears were evaluated according to tear-location. In type I and II ACL tears with remaining good tissue quality, we propose primary ACL repair. In type III and IV ACL tears we propose physeal-sparing reconstruction with an iliotibial band graft. Finally, in the case of a type V ACL tear, we propose that the best treatment be based on the Meyers-McKeever classification. We present a facile decision-making algorithm for ACL management in pediatric patients based on specific elements of tissue damage and status.
Collapse
Affiliation(s)
- Marco Turati
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy -
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy -
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy -
- Couple Enfant Hospital, Grenoble, France -
- Department of Pediatric Orthopedic Surgery, Couple Enfant Hospital, Grenoble Alpes University, Grenoble, France -
| | - Luca Rigamonti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andrea Giulivi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Diego Gaddi
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Franck Accadbled
- Department of Orthopedics, Children's Hospital, CHU de Toulouse, Toulouse, France
| | - Nicolò Zanchi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Nicolas Bremond
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
- Department of Pediatric Orthopedic Surgery, Couple Enfant Hospital, Grenoble Alpes University, Grenoble, France
| | - Marcello Catalano
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Massimo Gorla
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Robert J Omeljaniuk
- Department of Orthopedics, Children's Hospital, CHU de Toulouse, Toulouse, France
- Department of Biology, Lakehead University, Thunder Bay, ON, Canada
| | - Giovanni Zatti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Massimiliano Piatti
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Marco Bigoni
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| |
Collapse
|
3
|
Gandossi CM, Zambon A, Ferrara MC, Tassistro E, Castoldi G, Colombo F, Mussi C, Martini E, Sergi G, Coin A, Zatti G, Trevisan C, Volpato S, Ungar A, Bellelli G. Frailty and post-operative delirium influence on functional status in patients with hip fracture: the GIOG 2.0 study. Aging Clin Exp Res 2023; 35:2499-2506. [PMID: 37542601 PMCID: PMC10628048 DOI: 10.1007/s40520-023-02522-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND This study analyzes the effect of frailty and Post-Operative Delirium (POD) on the functional status at hospital discharge and at 4-month follow-up in patients with hip fracture (HF). METHODS Multicenter prospective observational study of older patients with HF admitted to 12 Italian Orthogeriatric centers (July 2019-August 2022). POD was assessed using the 4AT. A 26-item Frailty Index (FI) was created using data collected on admission. The outcome measures were Cumulated Ambulation Score (CAS) ≤ 2 at discharge and a telephone-administered CAS ≤ 2 after 4 months. Poisson regression models were used to assess the effect of frailty and POD on outcomes. RESULTS 984 patients (median age 84 years, IQR = 79-89) were recruited: 480 (48.7%) were frail at admission, 311 (31.6%) developed POD, and 158 (15.6%) had both frailty and POD. In a robust Poisson regression, frailty alone (Relative Risk, RR = 1.56, 95% Confidence Intervals, CI 1.19-2.04, p = 0.001) and its combination with POD (RR = 2.57, 95% CI 2.02-3.26, p < 0.001) were associated with poor functional status at discharge. At 4-month follow-up, the combination of frailty with POD (RR 3.65, 95% CI 1.85-7.2, p < 0.001) increased the risk of poor outcome more than frailty alone (RR 2.38, 95% CI 1.21-4.66, p < 0.001). CONCLUSIONS POD development exacerbates the negative effect that frailty exerts on functional outcomes in HF patients.
Collapse
Affiliation(s)
| | - Antonella Zambon
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy
- Biostatistics Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Elena Tassistro
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Centre), School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Giuseppe Castoldi
- Orthopedic Unit, Carate Brianza Hospital, ASST Brianza, Vimercate, MB, Italy
| | - Francesca Colombo
- Orthopedic Unit, Carate Brianza Hospital, ASST Brianza, Vimercate, MB, Italy
| | - Chiara Mussi
- Orthogeriatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Emilio Martini
- Orthogeriatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Sergi
- Department of Medicine, Geriatrics Unit, University of Padua, Padua, Italy
| | - Alessandra Coin
- Department of Medicine, Geriatrics Unit, University of Padua, Padua, Italy
| | - Giovanni Zatti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Orthopedic Unit, IRCCS S. Gerardo Hospital, Monza, Italy
| | - Caterina Trevisan
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Orthogeriatric Unit, Arcispedale S. Anna, University Hospital of Ferrara, Ferrara, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Orthogeriatric Unit, Arcispedale S. Anna, University Hospital of Ferrara, Ferrara, Italy
| | - Andrea Ungar
- Geriatrics and Intensive Care Unit, University of Florence and AOU Careggi, Florence, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.
- Orthogeriatric Unit, IRCCS San Gerardo Hospital, Monza, Italy.
| |
Collapse
|
4
|
Turati M, Franchi S, Crippa M, Rizzi L, Rigamonti L, Sacerdote P, Gatti SD, Piatti M, Galimberti G, Munegato D, Amodeo G, Omeljaniuk RJ, Zatti G, Torsello A, Bigoni M. Prokineticin 2 and Cytokine Content in the Synovial Fluid of Knee Osteoarthritis and Traumatic Meniscal Tear Patients: Preliminary Results. J Clin Med 2023; 12:4330. [PMID: 37445367 DOI: 10.3390/jcm12134330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/15/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Knee osteoarthritis (OA) is a chronic degenerative inflammatory-based condition caused by a cascade of different intra-articular molecules including several cytokines. Among the cytokines, prokineticins (PKs) have recently been identified as important mediators of inflammation and pain. This observational study examined the potential involvement of PK2 in degenerative or traumatic knee disease. Fifteen patients presenting knee osteoarthritis (OA group) and 15 patients presenting a traumatic meniscal tear (TM group) were studied. Synovial fluid samples from affected knees were assessed for PK2, IL-10, and TNF-α using the ELISA method. At a long-term follow-up (minimum 5 years, mean = 6.1 years), patients in the TM group underwent clinical re-evaluation with PROMs (Tegner Activity Scale, IKDC, Lysholm, SKV); in addition, X-ray visualization was used to assess the presence of secondary OA. PK2 was detected in synovial fluids of both TM and OA patients and the levels were comparable between the two groups, while IL-10 levels were significantly greater in the OA group than those in TM patients. PK2 levels correlated with those of IL-10. PK2 levels were greater in blood effusions compared to clear samples, did not differ significantly between sexes, nor were they related to differences in weight, height, or injury (meniscal laterality, time since dosing). No correlation was found between PROMs and radiological classifications in patients in the TM group at final follow-up. These data are the first observations of PK2 in synovial fluid following traumatic meniscus injury. These findings suggest possible further prognostic indices and therapeutic targets to limit the development of secondary OA.
Collapse
Affiliation(s)
- Marco Turati
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Paediatric Orthopedic Surgery, Hospital Couple Enfants, Grenoble Alpes University, 38400 Grenoble, France
| | - Silvia Franchi
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20129 Milan, Italy
| | - Marco Crippa
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Laura Rizzi
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Luca Rigamonti
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Orthopedic Surgery, Policlinico San Pietro, 24036 Ponte San Pietro, Italy
| | - Paola Sacerdote
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20129 Milan, Italy
| | - Simone Daniel Gatti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Massimiliano Piatti
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Orthopedic Surgery, Policlinico San Pietro, 24036 Ponte San Pietro, Italy
| | - Giulia Galimberti
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20129 Milan, Italy
| | - Daniele Munegato
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Giada Amodeo
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20129 Milan, Italy
| | | | - Giovanni Zatti
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Antonio Torsello
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Marco Bigoni
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Orthopedic Surgery, Policlinico San Pietro, 24036 Ponte San Pietro, Italy
| |
Collapse
|
5
|
Castoldi G, Carletti R, Ippolito S, Colzani M, Pelucchi S, Zerbini G, Perseghin G, Zatti G, di Gioia CRT. Cardioprotective Effects of Sodium Glucose Cotransporter 2 Inhibition in Angiotensin II-Dependent Hypertension Are Mediated by the Local Reduction of Sympathetic Activity and Inflammation. Int J Mol Sci 2023; 24:10710. [PMID: 37445888 DOI: 10.3390/ijms241310710] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The cardioprotective effects of sodium glucose cotrasponter 2 (SGLT2) inhibitors seem to be independent from the effects on glycemic control, through little-known mechanisms. In this study, we investigate whether the cardioprotective effects of empagliflozin, a SGLT2 inhibitor, may be associated with myocardial sympathetic activity and inflammatory cell infiltration in an experimental model of angiotensin II-dependent hypertension. Angiotensin II (Ang II), Ang II plus Empagliflozin, physiological saline, or physiological saline plus empagliflozin were administered to Sprague Dawley rats for two weeks. Blood pressure was measured by plethysmographic method. Myocardial hypertrophy and fibrosis were analysed by histomorphometry, and inflammatory cell infiltration and tyrosine hydroxylase expression, implemented as a marker of sympathetic activity, were evaluated by immunohistochemistry. Ang II increased blood pressure, myocardial hypertrophy, fibrosis, inflammatory infiltrates and tyrosine hydroxylase expression, as compared to the control group. Empagliflozin administration prevented the development of myocardial hypertrophy, fibrosis, inflammatory infiltrates and tyrosine hydroxylase overexpression in Ang II-treated rats, without affecting blood glucose and the Ang II-dependent increase in blood pressure. These data demonstrate that the cardioprotective effects of SGLT2 inhibition in Ang II-dependent hypertension may result from the myocardial reduction of sympathetic activity and inflammation and are independent of the modulation of blood pressure and blood glucose levels.
Collapse
Affiliation(s)
- Giovanna Castoldi
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, 20900 Monza, Italy
| | - Raffaella Carletti
- Dipartimento di Medicina Traslazionale e di Precisione, Sapienza Università di Roma, 00185 Rome, Italy
| | - Silvia Ippolito
- Laboratorio Analisi Chimico Cliniche, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Massimiliano Colzani
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, 20900 Monza, Italy
| | - Sara Pelucchi
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, 20900 Monza, Italy
| | - Gianpaolo Zerbini
- Unita' Complicanze del Diabete, IRCCS Istituto Scientifico San Raffaele, 20132 Milano, Italy
| | - Gianluca Perseghin
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, 20900 Monza, Italy
- Dipartimento di Medicina Interna e Riabilitazione, Policlinico di Monza, 20900 Monza, Italy
| | - Giovanni Zatti
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, 20900 Monza, Italy
- Clinica Ortopedica, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Cira R T di Gioia
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Istituto di Anatomia Patologica, Sapienza Università di Roma, 00185 Rome, Italy
| |
Collapse
|
6
|
Turati M, Boerci L, Piatti M, Russo L, Rigamonti L, Buonanotte F, Courvoisier A, Zatti G, Piscitelli D, Bigoni M. Meniscal Allograft Transplants in Skeletally Immature Patients: A Systematic Review of Indications and Outcomes. Healthcare (Basel) 2023; 11:healthcare11091312. [PMID: 37174854 PMCID: PMC10178226 DOI: 10.3390/healthcare11091312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/22/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Meniscal lesions in skeletally immature patients can lead to joint degradation and knee instability. Meniscal allograft transplant (MAT) surgery is a solution to maintain knee stability. There is a lack of consensus on MAT surgery outcomes in pediatric patients. A systematic review was conducted according to the PRISMA guidelines. PubMed, Scopus and EMBASE databases were searched from 1965 to June 2022. Studies were evaluated using the Newcastle-Ottawa Scale (NOS). Three studies were selected, and 58 patients were included (mean age 15.9 years) in total. The lateral meniscus was involved in 82.8% of all MAT surgeries. Post-meniscectomy syndrome and discoid meniscus were the main indications for MAT surgery. All studies reported improved subjective clinical scores and levels of sport after the surgery. The complication rate was 27.5%. Partial meniscectomy, meniscus knot removal, chondral defect treatment and lysis of adhesions were the most frequent procedures performed during reoperation. MAT surgery can improve clinical outcomes in pediatric patients with strictly selected indications. MAT surgery is safe when there are no limb asymmetries or malalignments, but it remains a challenging procedure with a high complication rate. Long-term follow-up is needed for definitive statements on the use of MAT in skeletally immature patients.
Collapse
Affiliation(s)
- Marco Turati
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Paediatric Orthopedic Surgery, Hopital Couple Enfants, Grenoble Alpes University, 38700 Grenoble, France
| | - Linda Boerci
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy
| | - Massimiliano Piatti
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Orthopaedic and Trauma, Policlinico San Pietro Hospital, 24036 Ponte San Pietro, Italy
| | - Laura Russo
- Department of Biotechnology and Biosciences, University of Milano Bicocca, 20126 Milano, Italy
| | - Luca Rigamonti
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Orthopaedic and Trauma, Policlinico San Pietro Hospital, 24036 Ponte San Pietro, Italy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55902, USA
| | - Francesco Buonanotte
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy
| | - Aurelien Courvoisier
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Paediatric Orthopedic Surgery, Hopital Couple Enfants, Grenoble Alpes University, 38700 Grenoble, France
| | - Giovanni Zatti
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Marco Bigoni
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Orthopaedic and Trauma, Policlinico San Pietro Hospital, 24036 Ponte San Pietro, Italy
| |
Collapse
|
7
|
Turati M, Boerci L, Piatti M, Zanchi N, Zatti G, Accadbled F, Bigoni M. Updates on etiopathogenesis of musculoskeletal injuries in adolescent athletes. Minerva Pediatr (Torino) 2023; 75:133-135. [PMID: 33107275 DOI: 10.23736/s2724-5276.20.05944-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- Marco Turati
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy - .,Hospital Couple Enfant, Grenoble, France - .,Department of Orthopedics, San Gerardo Hospital, University of Milano-Bicocca, Monza, Monza-Brianza, Italy - .,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy - .,Department of Pediatric Orthopedic Surgery, Couple Enfant Hospital, Grenoble Alpes University, Grenoble, France -
| | - Linda Boerci
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
| | - Massimiliano Piatti
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy.,Department of Orthopedics, San Gerardo Hospital, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
| | - Nicolò Zanchi
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
| | - Giovanni Zatti
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy.,Department of Orthopedics, San Gerardo Hospital, University of Milano-Bicocca, Monza, Monza-Brianza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
| | - Franck Accadbled
- Department of Orthopedics, Children's Hospital, Centre Hospitalier Universitaire (CHU), Toulouse, France
| | - Marco Bigoni
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy.,Department of Orthopedics, San Gerardo Hospital, University of Milano-Bicocca, Monza, Monza-Brianza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
| |
Collapse
|
8
|
Gaddi D, Gatti SD, Piatti M, Poli A, De Rosa L, Riganti A, Zatti G, Bigoni M, Turati M. Non-Union Scoring System (NUSS): Is It Enough in Clinical Practice? Indian J Orthop 2022; 57:137-145. [PMID: 36655209 PMCID: PMC9789216 DOI: 10.1007/s43465-022-00767-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Bone consolidation defects represent a real orthopedic challenge because of the absence of validated treatment guidelines that can assist the surgeon in his choices. The aim of this study is to evaluate the appropriateness of the Non-Union Scoring System NUSS treatment protocol in the management of long bone non-unions by comparing it to the experience-based therapeutic approach carried out in our facility. MATERIALS AND METHODS We conducted a comparative outcome study of a retrospective series of 89 patients surgically treated for long bone non-union in our facility vs. clinical results reported by Calori et al. obtained following the NUSS treatment protocol. RESULTS Radiographic healing was reached in 13/13 non-unions (100%) in group NUSS 1, in 58/62 (93.5%) in group NUSS 2, and in 13/14 (92.9%) in group NUSS 3. The mean time to radiographic healing was 5.69 ± 2.09 months in group 1, 7.38 ± 3.81 months in group 2 and 9.23 ± 2.31 months in group 3. 91% of patients in group I, 69% in group II and 48% in group III received what would be considered by the NUSS treatment protocol an "overtreatment", especially from a biological stand point. The comparative outcome analysis shows that our case series achieved significantly higher global healing rates (p value = 0.017) and shorter radiological healing times in groups NUSS 1 and 2 (p value < 0.001). CONCLUSION From the results obtained, we can assume that the NUSS treatment protocol might underestimate the necessary therapies, particularly from a biological point of view.
Collapse
Affiliation(s)
- Diego Gaddi
- Department of Orthopedic Surgery, Policlinico San Pietro, Strada Statale 18, 23826 IT Mandello del Lario, LC Italy
| | - Simone D. Gatti
- School of Medicine and Surgery, University of Milano-Bicocca, Via Rismondo 62, Seregno, 20831 IT Monza, MB Italy
| | - Massimiliano Piatti
- Department of Orthopedic Surgery, Policlinico San Pietro, Strada Statale 18, 23826 IT Mandello del Lario, LC Italy
| | - Andrea Poli
- Orthopedic Department, Carate Brianza Hospital, Via Don Luigi Monza 14/B Carate B.Za, 23900 IT Lecco, LC Italy
| | - Laura De Rosa
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy ,School of Medicine and Surgery, University of Milano-Bicocca, Via Rismondo 62, Seregno, 20831 IT Monza, MB Italy
| | - Andrea Riganti
- Department of Economics, Management and Quantitative Methods, University of Milano Statale, Via Speri Della Chiesa 28, 21100 IT Milan, VA Italy
| | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy ,School of Medicine and Surgery, University of Milano-Bicocca, Via Rismondo 62, Seregno, 20831 IT Monza, MB Italy
| | - Marco Bigoni
- School of Medicine and Surgery, University of Milano-Bicocca, Via Rismondo 62, Seregno, 20831 IT Monza, MB Italy ,Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Hospital Couple Enfant, Via Marcona 15, 20100 IT Grenoble, MI France ,Department of Orthopedic Surgery, Policlinico San Pietro, Strada Statale 18, 23826 IT Mandello del Lario, LC Italy
| | - Marco Turati
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy ,Department of Paediatric Orthopedic Surgery, Hospital Couple Enfants, Grenoble Alpes University, Via Filzi 34, Giussano, 20833 IT Grenoble, MB France ,School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| |
Collapse
|
9
|
Turati M, Caliandro M, Gaddi D, Piatti M, Rigamonti L, Zanchi N, Di Benedetto P, Boerci L, Catalano M, Zatti G, Ollivier M, Bigoni M. Clinical outcomes and complications after anterior cruciate ligament reconstruction with bone-patellar tendon-bone in patient Tanner 3 and 4: a systematic review. Eur J Orthop Surg Traumatol 2022:10.1007/s00590-022-03402-z. [PMID: 36307618 PMCID: PMC10368545 DOI: 10.1007/s00590-022-03402-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Clinical outcomes and potential complications associated with Bone-Patellar Tendon-Bone (BPTB) graft in skeletally immature ACL reconstruction (ACLR) are poorly defined. Considering that in Tanner 1-2 patients this kind of graft is not recommended, we focused our systematic review on the evaluation of all the studies in the literature that reported clinical outcomes and rate of complications of the ACLR using BPTB graft in Tanner 3-4 patients. METHODS This review was conducted in accordance with the PRISMA statement. PubMed, Cochrane Library, EMBASE and Scopus were examined from 1965 to 2020 using different combinations of the following keywords: "ACL reconstruction", "skeletally immature", "young", "patellar tendon" and "BPTB". The database search yielded 742 studies, on which we performed a primary evaluation. After carrying out a full-text evaluation for the inclusion criteria, 4 studies were included in the final review and assessed using the Newcastle-Ottawa scale. Ninety-six cases with mean age of 14.2 years were reported. RESULTS Good stability and functional outcomes were reported with a mean follow-up of 49.5 months. Return to sport rate ranged from 91.7% to 100%. A KT-1000 side-to-side difference higher than 5 mm was observed in five patients (5.2%). No lower limb length discrepancy and angulation were reported. Graft rupture rate was 5.2%. CONCLUSION According to these results, BTPB graft could be a good choice in Tanner 3-4 patients who want to achieve their preinjury sport level with a low risk of growth disturbances and graft failure. Further investigations in a wider population are needed.
Collapse
Affiliation(s)
- Marco Turati
- Orthopedic Department, San Gerardo Hospital, Monza, Italy.
- School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy.
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France.
- Department of Paediatric Orthopedic Surgery, Hospital Couple Enfants, Grenoble Alpes University, Grenoble, France.
| | - Marco Caliandro
- School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
| | - Diego Gaddi
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Department of Orthopaedic and Trauma, Policlinico San Pietro Hospital, Ponte San Pietro, Bg, Italy
| | - Massimiliano Piatti
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Department of Orthopaedic and Trauma, Policlinico San Pietro Hospital, Ponte San Pietro, Bg, Italy
| | - Luca Rigamonti
- School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nicolò Zanchi
- School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Department of Orthopaedics & Rehabilitation, College of Medicine, The Pennsylvania State University, University Park, PA, USA
| | - Paolo Di Benedetto
- Medical Department (DAME), University of Udine, Udine, Italy
- Clinic of Orthopaedics, Friuli Centrale Healthcare and University Trust (ASUFC), Udine, Italy
| | - Linda Boerci
- School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
| | - Marcello Catalano
- School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Department of Orthopedics and Traumatology, Clinica Ars Medica, Gravesano, Ticino, Switzerland
| | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
| | - Matthieu Ollivier
- Department of Orthopedics and Traumatology, St. Marguerite Hospital, APHM, CNRS, ISM, Institute of Movement and Locomotion, Aix Marseille University, Marseille, France
| | - Marco Bigoni
- School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Department of Orthopaedic and Trauma, Policlinico San Pietro Hospital, Ponte San Pietro, Bg, Italy
| |
Collapse
|
10
|
Gaddi D, Mosca A, Piatti M, Munegato D, Catalano M, Di Lorenzo G, Turati M, Zanchi N, Piscitelli D, Chui K, Zatti G, Bigoni M. Acute Ankle Sprain Management: An Umbrella Review of Systematic Reviews. Front Med (Lausanne) 2022; 9:868474. [PMID: 35872766 PMCID: PMC9301067 DOI: 10.3389/fmed.2022.868474] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/27/2022] [Indexed: 12/26/2022] Open
Abstract
Even though ankle sprains are among the most frequent musculoskeletal injuries seen in emergency departments, management of these injuries continues to lack standardization. Our objective was to carry out an umbrella review of systematic reviews to collect the most effective evidence-based treatments and to point out the state-of-the-art management for this injury. PubMed, Scopus, Web of Science, and the Cochrane library were searched from January 2000 to September 2020. After removing duplicates and applying the eligibility criteria, based on titles and abstracts, 32 studies were screened. At the end of the process, 24 articles were included in this umbrella review with a mean score of 7.7/11 on the AMSTAR quality assessment tool. We found evidence supporting the effectiveness of non-surgical treatment in managing acute ankle sprain; moreover, functional treatment seems to be preferable to immobilization. We also found evidence supporting the use of paracetamol or opioids as effective alternatives to non-steroidal anti-inflammatory drugs to reduce pain. Furthermore, we found evidence supporting the effectiveness of manipulative and supervised exercise therapy to prevent re-injury and restore ankle dorsiflexion.
Collapse
Affiliation(s)
- Diego Gaddi
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Angelo Mosca
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Massimiliano Piatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Daniele Munegato
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Marcello Catalano
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giorgia Di Lorenzo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Turati
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Paediatric Orthopedic Surgery, University Hospital Grenoble-Alpes, University Grenoble-Alpes, Grenoble, France
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Hospital Couple Enfant, Grenoble, France
- *Correspondence: Marco Turati
| | - Nicolò Zanchi
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Daniele Piscitelli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States
| | - Kevin Chui
- Department of Physical Therapy, Waldron College of Health and Human Services, Radford University, Roanoke, VA, United States
| | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Hospital Couple Enfant, Grenoble, France
| | - Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Hospital Couple Enfant, Grenoble, France
| |
Collapse
|
11
|
Hall AJ, Clement ND, Ojeda-Thies C, MacLullich AMJ, Toro G, Johansen A, White TO, Duckworth AD, Abdul-Jabar H, Abu-Rajab R, Abugarja A, Adam K, Aguado Hernández HJ, Améstica Lazcano G, Anderson S, Ansar M, Antrobus J, Aragón Achig EJ, Archunan M, Arrieta Salinas M, Ashford-Wilson S, Assens Gibert C, Athanasopoulou K, Awadelkarim M, Baird S, Bajada S, Balakrishnan S, Balasubramanian S, Ballantyne JA, Bárcena Goitiandia L, Barkham B, Barmpagianni C, Barres-Carsi M, Barrett S, Baskaran D, Bell J, Bell K, Bell S, Bellelli G, Benchimol JA, Boietti BR, Boswell S, Braile A, Brennan C, Brent L, Brooke B, Bruno G, Burahee A, Burns S, Calabrò G, Campbell L, Carabelli GS, Carnegie C, Carretero Cristobal G, Caruana E, Cassinello Ogea MC, Castellanos Robles J, Castillon P, Chakrabarti A, Cecere AB, Chen P, Clarke JV, Collins G, Corrales Cardenal JE, Corsi M, Cózar Adelantado GM, Craxford S, Crooks M, Cuarental-García J, Cuthbert R, Dall G, Daskalakis I, De Cicco A, Diana DLFDD, Demaria P, Dereix J, Díaz Jiménez J, Dinamarca Montecinos JL, Do Le HP, Donoso Coppa JP, Drosos G, Duffy A, East J, Eastwood D, Elbahari H, Elias de Molins Peña C, Elmamoun M, Emmerson B, Escobar Sánchez D, Faimali M, Farré-Mercadé MV, Farrow L, Fayez A, Fell A, Fenner C, Ferguson D, Finlayson L, Flores Gómez A, Freeman N, French J, Gabardo Calvo S, Gagliardo N, Garcia Albiñana J, García Cruz G, García de Cortázar Antolín U, García Virto V, Gealy S, Gil Caballero SM, Gill M, González González MS, Gopireddy R, Guntley D, Gurung B, Guzmán Rosales G, Haddad N, Hafeez M, Haller P, Halligan E, Hardie J, Hawker I, Helal A, Herrera Cruz M, Herreros Ruiz-Valdepeñas R, Horton J, Howells S, Howieson A, Hughes L, Hünicken Torrez FL, Hurtado Ortega A, Huxley P, Hamid HK, Ilahi N, Iliadis A, Inman D, Jadhao P, Jandoo R, Jawad L, Jayatilaka MLT, Jenkins PJ, Jeyapalan R, Johnson D, Johnston A, Joseph S, Kapoor S, Karagiannidis G, Karanam KS, Kattakayam F, Konarski A, Kontakis G, Labrador Hernández G, Lancaster V, Landi G, Le B, Liew I, Logishetty K, Lopez Marquez ACD, Lopez J, Lum J, Macpherson GJ, Madan S, Mahroof S, Malik-Tabassum K, Mallina R, Maqsood A, Marson B, Martin Legorburo MJ, Martin-Perez E, Martínez Jiménez T, Martinez Martin J, Mayne A, Mayor A, McAlinden G, McLean L, McDonald L, McIntyre J, McKay P, McKean G, McShane H, Medici A, Meeke C, Meldrum E, Mendez M, Mercer S, Merino Perez J, Mesa-Lampré MP, Mighton S, Milne K, Mohamed Yaseen M, Moppett I, Mora J, Morales-Zumel S, Moreno Fenoll IB, Mousa A, Murray AW, Murray EV, Nair R, Neary F, Negri G, Negus O, Newham-Harvey F, Ng N, Nightingale J, Noor Mohamed Anver S, Nunag P, O'Hare M, Ollivere B, Ortés Gómez R, Owens A, Page S, Palloni V, Panagiotopoulos A, Panagiotopoulos E, Panesar P, Papadopoulos A, Spyridon P, Pareja Sierra T, Park C, Parwaiz H, Paterson-Byrne P, Patton S, Pearce J, Porter M, Pellegrino A, Pèrez Cuellar A, Pezzella R, Phadnis A, Pinder C, Piper D, Powell-Bowns M, Prieto Martín R, Probert A, Ramesh A, Ramírez de Arellano MVM, Renton D, Rickman S, Robertson A, Roche Albero A, Rodrigo Verguizas JA, Rodríguez Couso M, Rooney J, Sáez-López P, Saldaña-Díaz A, Santulli A, Sanz Pérez MI, Sarraf KM, Scarsbrook C, Scott CE, Scott J, Shah S, Sharaf S, Sharma S, Shirley D, Siano A, Simpson J, Singh A, Singh A, Sinnett T, Sisodia G, Smith P, Sophena Bert E, Steel M, Stewart A, Stewart C, Sugand K, Sullivan N, Sweeting L, Symes M, Tan DJH, Tancredi F, Tatani I, Thomas P, Thomson F, Toner NS, Tong A, Toro A, Tosounidis T, Tottas S, Trinidad Leo A, Tucker D, Vemulapalli K, Ventura Garces D, Vernon OK, Viveros Garcia JC, Ward A, Ward K, Watson K, Weerasuriya T, Wickramanayake U, Wilkinson H, Windley J, Wood J, Wynell-Mayow W, Zatti G, Zeiton M, Zurrón Lobato M. IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit. Lessons from an international multicentre study of 7,090 patients conducted in 14 nations during the COVID-19 pandemic. Surgeon 2022; 20:e429-e446. [PMID: 35430111 PMCID: PMC8958101 DOI: 10.1016/j.surge.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/06/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022]
Abstract
Aims This international study aimed to assess: 1) the prevalence of preoperative and postoperative COVID-19 among patients with hip fracture, 2) the effect on 30-day mortality, and 3) clinical factors associated with the infection and with mortality in COVID-19-positive patients. Methods A multicentre collaboration among 112 centres in 14 countries collected data on all patients presenting with a hip fracture between 1st March-31st May 2020. Demographics, residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, management, ASA grade, length of stay, COVID-19 and 30-day mortality status were recorded. Results A total of 7090 patients were included, with a mean age of 82.2 (range 50–104) years and 4959 (69.9%) being female. Of 651 (9.2%) patients diagnosed with COVID-19, 225 (34.6%) were positive at presentation and 426 (65.4%) were positive postoperatively. Positive COVID-19 status was independently associated with male sex (odds ratio (OR) 1.38, p = 0.001), residential care (OR 2.15, p < 0.001), inpatient fall (OR 2.23, p = 0.003), cancer (OR 0.63, p = 0.009), ASA grades 4 (OR 1.59, p = 0.008) or 5 (OR 8.28, p < 0.001), and longer admission (OR 1.06 for each increasing day, p < 0.001). Patients with COVID-19 at any time had a significantly lower chance of 30-day survival versus those without COVID-19 (72.7% versus 92.6%, p < 0.001). COVID-19 was independently associated with an increased 30-day mortality risk (hazard ratio (HR) 2.83, p < 0.001). Increasing age (HR 1.03, p = 0.028), male sex (HR 2.35, p < 0.001), renal disease (HR 1.53, p = 0.017), and pulmonary disease (HR 1.45, p = 0.039) were independently associated with a higher 30-day mortality risk in patients with COVID-19 when adjusting for confounders. Conclusion The prevalence of COVID-19 in hip fracture patients during the first wave of the pandemic was 9%, and was independently associated with a three-fold increased 30-day mortality risk. Among COVID-19-positive patients, those who were older, male, with renal or pulmonary disease had a significantly higher 30-day mortality risk.
Collapse
|
12
|
Castoldi G, Carletti R, Ippolito S, Stella A, Zerbini G, Pelucchi S, Zatti G, di Gioia CRT. Angiotensin Type 2 and Mas Receptor Activation Prevents Myocardial Fibrosis and Hypertrophy through the Reduction of Inflammatory Cell Infiltration and Local Sympathetic Activity in Angiotensin II-Dependent Hypertension. Int J Mol Sci 2021; 22:ijms222413678. [PMID: 34948475 PMCID: PMC8708804 DOI: 10.3390/ijms222413678] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 12/29/2022] Open
Abstract
Compound 21 (C21), an AT2 receptor agonist, and Angiotensin 1-7 (Ang 1-7), through Mas receptor, play an important role in the modulation of the protective arm of the renin-angiotensin system. The aim of this study was to investigate in an experimental model of angiotensin II-dependent hypertension whether the activation of the potentially protective arm of the renin-angiotensin system, through AT2 or Mas receptor stimulation, counteracts the onset of myocardial fibrosis and hypertrophy, and whether these effects are mediated by inflammatory mechanism and/or sympathetic activation. Sprague Dawley rats (n = 67) were treated for 1 (n = 25) and 4 (n = 42) weeks and divided in the following groups: (a) Angiotensin II (Ang II, 200 ng/kg/min, osmotic minipumps, sub cutis); (b) Ang II+Compound 21 (C21, 0.3 mg/kg/day, intraperitoneal); (c) Ang II+Ang 1-7 (576 µg/kg/day, intraperitoneal); (d) Ang II+Losartan (50 mg/kg/day, per os); (e) control group (physiological saline, sub cutis). Systolic blood pressure was measured by tail cuff method and, at the end of the experimental period, the rats were euthanized and the heart was excised to evaluate myocardial fibrosis, hypertrophy, inflammatory cell infiltration and tyrosine hydroxylase expression, used as marker of sympathetic activity. Ang II caused a significant increase of blood pressure, myocardial interstitial and perivascular fibrosis and myocardial hypertrophy, as compared to control groups. C21 or Ang 1-7 administration did not modify the increase in blood pressure in Ang II treated rats, but both prevented the development of myocardial fibrosis and hypertrophy. Treatment with losartan blocked the onset of hypertension and myocardial fibrosis and hypertrophy in Ang II treated rats. Activation of AT2 receptors or Mas receptors prevents the onset of myocardial fibrosis and hypertrophy in Ang II-dependent hypertension through the reduction of myocardial inflammatory cell infiltration and tyrosine hydroxylase expression. Unlike what happens in case of treatment with losartan, the antifibrotic and antihypertrophic effects that follow the activation of the AT2 or Mas receptors are independent on the modulation of blood pressure.
Collapse
Affiliation(s)
- Giovanna Castoldi
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, 20900 Monza, Italy; (A.S.); (S.P.); (G.Z.)
- Correspondence: ; Tel.: +39-2-64488058
| | - Raffaella Carletti
- Dipartimento di Medicina Traslazionale e di Precisione, Sapienza Universita’ di Roma, 00161 Rome, Italy;
| | - Silvia Ippolito
- Laboratorio Analisi Chimico Cliniche, Ospedale San Gerardo, ASST Monza, 20900 Monza, Italy;
| | - Andrea Stella
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, 20900 Monza, Italy; (A.S.); (S.P.); (G.Z.)
| | - Gianpaolo Zerbini
- Unita Complicanze del Diabete, IRCCS Istituto Scientifico San Raffaele, 20132 Milan, Italy;
| | - Sara Pelucchi
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, 20900 Monza, Italy; (A.S.); (S.P.); (G.Z.)
| | - Giovanni Zatti
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, 20900 Monza, Italy; (A.S.); (S.P.); (G.Z.)
- Clinica Ortopedica, Ospedale San Gerardo, ASST Monza, 20900 Monza, Italy
| | - Cira R. T. di Gioia
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Istituto di Anatomia Patologica, Sapienza Universita’ di Roma, 00161 Rome, Italy;
| |
Collapse
|
13
|
Gamberale R, D'Orlando C, Brunelli S, Meneveri R, Mazzola P, Foti G, Bellani G, Zatti G, Munegato D, Volpato S, Zurlo A, Caruso G, Andreano A, Valsecchi MG, Bellelli G. Study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery. BMC Geriatr 2021; 21:633. [PMID: 34736422 PMCID: PMC8567587 DOI: 10.1186/s12877-021-02584-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a common complication of older people undergoing hip fracture surgery, which negatively affects clinical- and healthcare-related outcomes. Unfortunately, POD pathophysiology is still largely unknown, despite previous studies showing that neuroinflammation, neuroendocrine dysfunction, increased reactive oxidative stress (ROS), and endothelial dysfunctions may be involved. There is also evidence that many of the pathophysiological mechanisms which are involved in delirium are involved in sarcopenia too. This article describes the protocol of a pilot study to evaluate the feasibility of a larger one that will explore the pathophysiological mechanisms correlating POD with sarcopenia. We will analyse whether various biomarkers reflecting neuroinflammation, ROS, neuroendocrine disorders, and microvasculature lesions will be simultaneously expressed in in the blood, cerebrospinal fluid (CSF), and muscles of patients developing POD. METHODS Two centres will be involved in this study, each recruiting a convenient sample of ten older patients with hip fracture. All of them will undergo a baseline Comprehensive Geriatric Assessment, which will be used to construct a Rockwood-based Frailty Index (FI). Blood samples will be collected for each patient on the day of surgery and 1 day before. Additionally, CSF and muscle fragments will be taken and given to a biologist for subsequent analyses. The presence of POD will be assessed in each patient every morning until hospital discharge using the 4AT. Delirium subtypes and severity will be assessed using the Delirium Motor Subtype Scale-4 and the Delirium-O-Meter, respectively. We will also evaluate the patient's functional status at discharge, using the Cumulated Ambulation Score. DISCUSSION This study will be the first to correlate biomarkers of blood, CSF, and muscle in older patients with hip fracture.
Collapse
Affiliation(s)
- R Gamberale
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - C D'Orlando
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - S Brunelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - R Meneveri
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - P Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - G Foti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - G Bellani
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - G Zatti
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - D Munegato
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - S Volpato
- Orthogeriatric Unit, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - A Zurlo
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - G Caruso
- Department of Biomedical and Surgical Specialist Sciences, University of Ferrara, Ferrara, Italy
| | - A Andreano
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - M G Valsecchi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - G Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy.
| |
Collapse
|
14
|
Gandossi CM, Zambon A, Oliveri G, Codognola M, Szabo H, Cazzulani I, Ferrara MC, Mottadelli C, Galeazzi M, Amoroso I, Zarcone C, Principato G, Corsi M, Mazzola P, Zatti G, Foti G, Bellelli G. Frailty, post-operative delirium and functional status at discharge in patients with hip fracture. Int J Geriatr Psychiatry 2021; 36:1524-1530. [PMID: 33908103 PMCID: PMC8518900 DOI: 10.1002/gps.5561] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/17/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To explore the effect of frailty, alone and in combination with post-operative delirium (POD), on the risk of poor function at discharge in patients with hip fracture (HF). METHODS This is a prospective cohort study of patients with HF admitted to an Orthogeriatric Unit (OGU) between October 1, 2011 and March 15, 2019. POD was assessed using the 4AT and the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5-edition criteria. A 22-items Frailty Index (FI) was created using the data collected on admission. The outcome measure was the Cumulated Ambulation Score (CAS) score at discharge. A log-binomial regression model was used to assess the effect of frailty and POD on CAS. RESULTS A total of 988 patients (median age = 84.9 years, Interquartile range = 80.6-89.2) were included: 360 patients (36.4%) were frail and 411 (42%) developed POD. Poor functional status at discharge (CAS score ≤2) was more common in frail than non-frail patients (68.3% vs. 53.8%, p < 0.001) In a regression adjusted for confounders, frailty alone (Relative Risk, RR = 1.33, 95% Confidence Intervals, CI = 1.14-1.55) and POD alone (RR 1.38, 95% CI = 1.2-1.59) were associated with poor functional status at discharge; when combined, frailty and POD had an interaction, yielding a mild increase in the risk of poor outcome (RR 1.47, 95% CI = 1.28-1.69). CONCLUSIONS In older patients undergoing HF surgery, frailty, POD and their combination, are associated with poor functional status at discharge.
Collapse
Affiliation(s)
| | - Antonella Zambon
- Department of Statistics and Quantitative MethodsUnit of BiostatisticsEpidemiology and Public HealthUniversity of Milano‐ BicoccaMilanItaly
| | | | | | - Hajnalka Szabo
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly
| | - Ilaria Cazzulani
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly
| | | | | | | | - Isabella Amoroso
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly
| | - Cristina Zarcone
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly
| | | | - Maurizio Corsi
- Acute Geriatric and Orthogeriatric UnitSan Gerardo HospitalMonzaItaly
| | - Paolo Mazzola
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly,Acute Geriatric and Orthogeriatric UnitSan Gerardo HospitalMonzaItaly
| | - Giovanni Zatti
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly,Orthopedic DepartmentSan Gerardo HospitalMonzaItaly
| | - Giuseppe Foti
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly,Department of Anesthesia and Intensive CareSan Gerardo HospitalMonzaItaly
| | - Giuseppe Bellelli
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly,Acute Geriatric and Orthogeriatric UnitSan Gerardo HospitalMonzaItaly
| |
Collapse
|
15
|
Castoldi G, Carletti R, Ippolito S, Colzani M, Barzaghi F, Stella A, Zerbini G, Perseghin G, Zatti G, di Gioia CRT. Sodium-glucose cotransporter 2 inhibition prevents renal fibrosis in cyclosporine nephropathy. Acta Diabetol 2021; 58:1059-1070. [PMID: 33760995 PMCID: PMC8272713 DOI: 10.1007/s00592-021-01681-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/25/2021] [Indexed: 01/06/2023]
Abstract
AIMS Sodium-glucose cotransporter 2 (SGLT2) inhibitors, a new class of antidiabetic drugs, are nephroprotective in case of diabetes, but whether a similar beneficial effect may be detectable also in case of chronic non-diabetic kidney diseases remains still unknown. The aim of this study was to evaluate the effects of empagliflozin, a SGLT-2 inhibitor, on the progression of cyclosporine nephropathy, in the absence of diabetes. METHODS Sprague Dawley rats (n = 27) have been fed with low-salt diet starting 10 days before the beginning and finished at the end of the experimental period. Cyclosporine-A (CsA, 15 mg/kg/day, intraperitoneal injection, n = 8) and CsA plus empagliflozin (Empa, 10 mg/kg/day, per os, n = 7) were administered for 4 weeks. The control groups were treated with placebo (Control, n = 7) or empagliflozin (Control + Empa, n = 5). Blood pressure (plethysmographic method) was measured at the beginning and at the end of the experimental period. At the end of the experimental protocol, the kidneys were excised for histomorphometric analysis of renal fibrosis and for immunohistochemical evaluation of inflammatory infiltrates (monocytes/macrophages), type I and type IV collagen expression, and tyrosine hydroxylase expression, used as marker of sympathetic nerve activity. RESULTS CsA-treated rats showed a significant increase (p < 0.01) in blood pressure, which was reduced by administration of empagliflozin (p < 0.05). CsA administration caused an increase in glomerular and tubulo-interstitial fibrosis (p < 0.05), renal inflammatory infiltrates (p < 0.05), type I and type IV collagen expression (p < 0.01), and tyrosine hydroxylase expression (p < 0.01) as compared to the control rats and control + Empa-treated rats. Treatment with empagliflozin in CsA-treated rats reduced glomerular (p < 0.01) and tubulo-interstitial fibrosis (p < 0.05), type I and type IV collagen expression (p < 0.01), inflammatory cell infiltration (p < 0.01) and tyrosine hydroxylase expression (p < 0.05), as compared to rats treated with CsA. CONCLUSION Empagliflozin administration caused a reduction in blood pressure in CsA-treated rats and showed a protective effect on CsA nephropathy by decreasing renal fibrosis, type I and type IV collagen expression, macrophage infiltration and tyrosine hydroxylase expression. These data suggest that empagliflozin promotes nephroprotection also in non-diabetic kidney disease.
Collapse
Affiliation(s)
- Giovanna Castoldi
- Dipartimento Di Medicina E Chirugia, Università Degli Studi Di Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.
| | - Raffaella Carletti
- Dipartimento Di Scienze Radiologiche, Oncologiche E Anatomopatologiche, Istituto Di Anatomia Patologica Sapienza Universita' Di Roma, Roma, Italy
| | - Silvia Ippolito
- Laboratorio Analisi Chimico Cliniche, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Massimiliano Colzani
- Dipartimento Di Medicina E Chirugia, Università Degli Studi Di Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Francesca Barzaghi
- Dipartimento Di Medicina E Chirugia, Università Degli Studi Di Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Andrea Stella
- Dipartimento Di Medicina E Chirugia, Università Degli Studi Di Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Gianpaolo Zerbini
- Unita' Complicanze del Diabete, Diabetes Research Institute, IRCCS Istituto Scientifico San Raffaele, Milano, Italy
| | - Gianluca Perseghin
- Dipartimento Di Medicina E Chirugia, Università Degli Studi Di Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
- Dipartimento Di Medicina Interna E Riabilitazione, Policlinico Di Monza, Monza, Italy
| | - Giovanni Zatti
- Dipartimento Di Medicina E Chirugia, Università Degli Studi Di Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
- Clinica Ortopedica, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Cira R T di Gioia
- Dipartimento Di Scienze Radiologiche, Oncologiche E Anatomopatologiche, Istituto Di Anatomia Patologica Sapienza Universita' Di Roma, Roma, Italy
| |
Collapse
|
16
|
Zagra L, D'Apolito R, Guindani N, Zatti G, Rivera F, Ravasi F, Mosconi M, Momoli A, Massè A, Franceschini M, D'Angelo F, Dallari D, Catani F, Casiraghi A, Bove F, Castelli CC. Do standards of care and early outcomes of periprosthetic fractures change during the COVID-19 pandemic? A multicentre study. J Orthop Traumatol 2021; 22:22. [PMID: 34128114 PMCID: PMC8202961 DOI: 10.1186/s10195-021-00584-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/20/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. MATERIALS AND METHODS Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type of operation and anaesthesia, in-hospital and early complications (Clavien-Dindo Classification, CDC), and length of stay (LOS). Data were analysed by means of descriptive statistics. Out of 1390 patients treated for any reason, 38 PPFs were included. RESULTS Median age was 81 years (range 70-96 years). Twenty-three patients (60.5%) were swabbed on admission, and two of them (5.3%) tested positive; in three patients (7.9%), the diagnosis of COVID-19 was established on a clinical and radiological basis. Two more patients tested positive post-operatively, and one of them died due to COVID-19. Thirty-three patients (86.8%) presented a proximal femoral PPF. Median ASA Score was 3 (range, 1-4), median VAS score on admission was 3 (range, 0-6), median CFS was 4 (range, 1-8), median EQ-5D-5L Score was 3 in each one of the categories (range, 1-5). Twenty-three patients (60.5%) developed post-operative complications, and median CDC grade was 3 (range, 1-5). The median LOS was 12.8 days (range 2-36 days), and 21 patients (55.3%) were discharged home. CONCLUSIONS The incidence of PPFs did not seem to change during the lockdown. Patients were mainly elderly with comorbidities, and complications were frequently recorded post-operatively. Despite the difficult period for the healthcare system, hospitals were able to provide effective conventional surgical treatments for PPFs, which were not negatively influenced by the reorganisation. Continued efforts are required to optimise the treatment of these frail patients in the period of the pandemic, minimising the risk of contamination, and to limit the incidence of PPFs in the future. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Rocco D'Apolito
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy
| | - Nicola Guindani
- Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Giovanni Zatti
- Department of Orthopaedic Surgery ASST Di Monza, Università Milano Bicocca, Via Pergolesi 33, 20900, Monza, Italy
| | - Fabrizio Rivera
- Department of Orthopaedic Surgery, Ospedale SS Annunziata, Via Ospedali 14, 12038, Savigliano, Italy
| | - Flavio Ravasi
- Department of Orthopaedic Surgery, ASST Melegnano Martesana- Ospedale Di Vizzolo Predabissi, Via Pandina 1, 20077, Vizzolo Predabissi, Italy
| | - Mario Mosconi
- Department of Orthopaedic Surgery, IRCCS Policlinico San Matteo Di Pavia, Viale C. Golgi 19, 27100, Pavia, Italy
| | - Alberto Momoli
- Department of Orthopaedic Surgery, Ospedale San Bortolo, Viale F. Rodolfi 37, 36100, Vicenza, Italy
| | - Alessandro Massè
- Department of Orthopaedic Surgery, Ospedale Città Della Salute E Della Scienza Università Di Torino, Via G. Zuretti 29, 10126, Turin, Italy
| | | | - Fabio D'Angelo
- Division of Orthopaedics and Traumatology, ASST Dei Sette Laghi, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Viale L. Borri 57, 21100, Varese, Italy
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques-Musculoskeletal Tissue Bank IRCCS Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Policlinico Universitario Di Modena, Via del Pozzo 71, 41124, Modena, Italy
| | - Alessandro Casiraghi
- Department of Orthopaedic Surgery, ASST Degli Spedali Civili Di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Federico Bove
- Department of Orthopaedic Surgery, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Claudio Carlo Castelli
- Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| |
Collapse
|
17
|
Turati M, Franchi S, Leone G, Piatti M, Zanchi N, Gandolla M, Rigamonti L, Sacerdote P, Rizzi L, Pedrocchi A, Omeljaniuk RJ, Zatti G, Torsello A, Bigoni M. Resolvin E1 and Cytokines Environment in Skeletally Immature and Adult ACL Tears. Front Med (Lausanne) 2021; 8:610866. [PMID: 34150787 PMCID: PMC8208028 DOI: 10.3389/fmed.2021.610866] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 04/22/2021] [Indexed: 01/25/2023] Open
Abstract
The intra-articular synovial fluid environment in skeletally immature patients following an ACL tear is complex and remains undefined. Levels of inflammatory and anti-inflammatory cytokines change significantly in response to trauma and collectively define the inflammatory environment. Of these factors the resolvins, with their inherent anti-inflammatory, reparative, and analgesic properties, have become prominent. This study examined the levels of resolvins and other cytokines after ACL tears in skeletally immature and adult patients in order to determine if skeletal maturity affects the inflammatory pattern. Skeletally immature and adult patients with an anterior cruciate ligament injury and meniscal tears were prospectively enrolled over a 5-month period. Synovial fluid samples were obtained before surgery quantifying Resolvin E1, IL-1β, TNF-α, and IL-10 by ELISA. Comparisons between skeletally immature patients and adults, the influence of meniscal tear, growth plate maturity and time from trauma were analyzed. Skeletally immature patients had significantly greater levels of Resolvin E1 and IL-10 compared with adults with an isolated anterior cruciate ligament lesion. Among the injured skeletally immature patients Resolvin E1 levels were greater in the open growth plate group compared with those with closing growth plates. Moreover, levels of Resolvin E1 and IL-10 appeared to decrease with time. Our results suggest that skeletally immature patients have a stronger activation of the Resolvin pattern compared to adult patients and that synovial fluid Resolvins could play an antinflammatory role in the knee after anterior cruciate ligament lesion and that its activity may be synergistic with that of IL-10.
Collapse
Affiliation(s)
- Marco Turati
- Orthopedic Department, San Gerardo Hospital, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza, Italy.,Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Grenoble, France.,Department of Pediatric Orthopedic Surgery, Hopital Couple Enfants, Grenoble Alpes University, Grenoble, France
| | - Silvia Franchi
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Giulio Leone
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza, Italy.,Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Grenoble, France
| | - Massimiliano Piatti
- Orthopedic Department, San Gerardo Hospital, Monza, Italy.,Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza, Italy.,Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Grenoble, France
| | - Nicolò Zanchi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza, Italy.,Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Grenoble, France
| | - Marta Gandolla
- NearLab, Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Luca Rigamonti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Paola Sacerdote
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Laura Rizzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alessandra Pedrocchi
- NearLab, Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza, Italy.,Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Grenoble, France
| | - Antonio Torsello
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza, Italy.,Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Grenoble, France
| |
Collapse
|
18
|
Turati M, Anghilieri FM, Accadbled F, Piatti M, Di Benedetto P, Moltrasio F, Zatti G, Zanchi N, Bigoni M. Discoid meniscus in human fetuses: A systematic review. Knee 2021; 30:205-213. [PMID: 33945980 DOI: 10.1016/j.knee.2021.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/02/2020] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Discoid meniscus (DM) is a rare variant of regular knee anatomy. Compared to standard meniscus it is thicker and abnormal in shape; these characteristics make it more prone to tear. It is a congenital defect whose correct etiology is still debated and far from being clarified. The purpose of this systematic review is to evaluate evidences of DM in human fetuses in order to assess whether embryological development may have a role. METHODS A systematic review was performed on PubMed, Scopus, and Embase with different combinations of the keywords "discoid meniscus", "embryology", "fetus", "neonatal". Search yielded 1013 studies, on which we performed a primary evaluation. RESULTS Seven studies were considered including a total of 1378 fetal menisci specimens, from 396 different fetuses. Discoid shape was not found represented as a normal stage of prenatal development. From 782 lateral menisci analyzed, only 86 (10.86%) were discoid (13 complete, 73 incomplete type). None of medial menisci was found to be discoid. Lateral meniscus was observed to cover a larger surface of tibial plateau than medial one until 28th gestational week. CONCLUSION Lateral meniscus seems to be more prone to discoid shape for its natural tendency of covering a larger surface of the tibial plateau during fetal stages. However the fact that a discoid shape was not found in the majority of fetuses suggests that it is not a normal stage of fetal development. To support a single etiological factor it will be appropriate to have further morphological and morphometric studies.
Collapse
Affiliation(s)
- Marco Turati
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Paediatric Orthopaedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France.
| | | | - Franck Accadbled
- Department of Orthopedics, Children's Hospital, Toulouse University Hospital, France
| | - Massimiliano Piatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
| | - Paolo Di Benedetto
- Medical Departement (DAME) - University of Udine, Italy; Clinic of Orthopaedics, Friuli Centrale Healthcare and University Trust (ASUFC), Udine, Italy
| | | | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nicolò Zanchi
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
19
|
Aprato A, Guindani N, Massè A, Castelli CC, Cipolla A, Antognazza D, Benazzo F, Bove F, Casiraghi A, Catani F, Dallari D, D’Apolito R, Franceschini M, Momoli A, Ravasi F, Rivera F, Zagra L, Zatti G, D’Angelo F. Clinical Activities, Contaminations of Surgeons and Cooperation with Health Authorities in 14 Orthopedic Departments in North Italy during the Most Acute Phase of Covid-19 Pandemic. Int J Environ Res Public Health 2021; 18:5340. [PMID: 34067826 PMCID: PMC8156362 DOI: 10.3390/ijerph18105340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022]
Abstract
Background: From 10 March up until 3 May 2020 in Northern Italy, the SARS-CoV-2 spread was not contained; disaster triage was adopted. The aim of the present study is to assess the impact of the COVID-19-pandemic on the Orthopedic and Trauma departments, focusing on: hospital reorganization (flexibility, workload, prevalence of COVID-19/SARS-CoV-2, standards of care); effects on staff; subjective orthopedic perception of the pandemic. Material and Methods: Data regarding 1390 patients and 323 surgeons were retrieved from a retrospective multicentric database, involving 14 major hospitals. The subjective directors' viewpoints regarding the economic consequences, communication with the government, hospital administration and other departments were collected. Results: Surgical procedures dropped by 73%, compared to 2019, elective surgery was interrupted. Forty percent of patients were screened for SARS-CoV-2: 7% with positive results. Seven percent of the patients received medical therapy for COVID-19, and only 48% of these treated patients had positive swab tests. Eleven percent of surgeons developed COVID-19 and 6% were contaminated. Fourteen percent of the staff were redirected daily to COVID units. Communication with the Government was perceived as adequate, whilst communication with medical Authorities was considered barely sufficient. Conclusions: Activity reduction was mandatory; the screening of carriers did not seem to be reliable and urgent activities were performed with a shortage of workers and a slower workflow. A trauma network and dedicated in-hospital paths for COVID-19-patients were created. This experience provided evidence for coordinated responses in order to avoid the propagation of errors.
Collapse
Affiliation(s)
- Alessandro Aprato
- Azienda Ospedaliera CTO-CRF Maria Adelaide, Università degli Studi di Torino, 10126 Turin, Italy; (A.A.); (A.M.); (A.C.)
| | - Nicola Guindani
- Regional Health Care and Social Agency Papa Giovanni XXIII, 25127 Bergamo, Italy;
| | - Alessandro Massè
- Azienda Ospedaliera CTO-CRF Maria Adelaide, Università degli Studi di Torino, 10126 Turin, Italy; (A.A.); (A.M.); (A.C.)
| | - Claudio C. Castelli
- Regional Health Care and Social Agency Papa Giovanni XXIII, 25127 Bergamo, Italy;
| | - Alessandra Cipolla
- Azienda Ospedaliera CTO-CRF Maria Adelaide, Università degli Studi di Torino, 10126 Turin, Italy; (A.A.); (A.M.); (A.C.)
| | - Delia Antognazza
- Department of Biotechnology and Life Sciences (DBSV), Università degli Studi dell’Insubria, 21100 Varese, Italy; (D.A.); (F.D.)
| | - Francesco Benazzo
- Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy;
| | - Federico Bove
- Azienda Ospedaliera Niguarda Ca’ Granda, 20162 Milano, Italy;
| | | | - Fabio Catani
- Orthopaedics and Traumatology, Modena University Hospital, Università degli Studi di Modena e Reggio Emilia, 41121 Modena, Italy;
| | - Dante Dallari
- IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Rocco D’Apolito
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy; (R.D.); (L.Z.)
| | | | - Alberto Momoli
- Orthopaedics and Traumatology, San Bortolo Hospital, 36100 Vicenza, Italy;
| | - Flavio Ravasi
- ASST-Melegnano-Martesana, Ortopedia di Cernusco sul Naviglio, 20070 Vizzolo Predabissi, Italy;
| | | | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy; (R.D.); (L.Z.)
| | - Giovanni Zatti
- Orthopaedics and Traumatology, University of Milano–Bicocca, 20900 Monza, Italy;
| | - Fabio D’Angelo
- Department of Biotechnology and Life Sciences (DBSV), Università degli Studi dell’Insubria, 21100 Varese, Italy; (D.A.); (F.D.)
| |
Collapse
|
20
|
Dallari D, Zagra L, Cimatti P, Guindani N, D'Apolito R, Bove F, Casiraghi A, Catani F, D'Angelo F, Franceschini M, Massè A, Momoli A, Mosconi M, Ravasi F, Rivera F, Zatti G, Castelli CC. Early mortality in hip fracture patients admitted during first wave of the COVID-19 pandemic in Northern Italy: a multicentre study. J Orthop Traumatol 2021; 22:15. [PMID: 33818650 PMCID: PMC8020826 DOI: 10.1186/s10195-021-00577-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1 month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1 month on the basis of type of fracture and type of surgical treatment. MATERIALS AND METHODS For this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+ group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C- group) were asymptomatic and tested negative for SARS-CoV-2. The two groups were compared for differences in time to surgery, survival rate and complications rate. The follow-up period was 1 month. RESULTS Of the 1390 patients admitted for acute care for any reason, 477 had a proximal femur fracture; 53 were C+ but only 12/53 were diagnosed as such at admission. The mean age was > 80 years, and the mean American Society of Anesthesiologists (ASA) score was 3 in both groups. There was no substantial difference in time to surgery (on average, 2.3 days for the C+ group and 2.8 for the C- group). As expected, a higher mortality rate was recorded for the C+ group but not associated with the type of hip fracture or treatment. No correlation was found between early treatment (< 48 h to surgery) and better outcome in the C+ group. CONCLUSIONS Hip fracture in COVID-19-positive patients accounted for 11% of the total. On average, the time to surgery was > 48 h, which reflects the difficulty of maintaining normal workflow during a medical emergency such as the present pandemic and notwithstanding the suspension of non-urgent procedures. Hip fracture was associated with a higher 30-day mortality rate in COVID-19-positive patients than in COVID-19-negative patients. This fact should be considered when communicating with patients and/or their family. Our data suggest no substantial difference in hip fracture management between patients with or without COVID-19 infection. In this sample, the COVID-19-positive patients were generally asymptomatic at admission; therefore, routine screening is recommended. LEVEL OF EVIDENCE Therapeutic study, level 4.
Collapse
Affiliation(s)
- Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques-Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Pietro Cimatti
- Reconstructive Orthopaedic Surgery and Innovative Techniques-Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Nicola Guindani
- Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Rocco D'Apolito
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy
| | - Federico Bove
- Department of Orthopaedic Surgery, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Alessandro Casiraghi
- Department of Orthopaedic Surgery, ASST Degli Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Policlinico Universitario di Modena, Via del Pozzo 71, 41124, Modena, Italy
| | - Fabio D'Angelo
- Division of Orthopaedics and Traumatology, ASST Dei Sette Laghi, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Viale L. Borri 57, 21100, Varese, Italy
| | | | - Alessandro Massè
- Department of Orthopaedic Surgery Ospedale Città Della Salute e Della Scienza, Università di Torino, Via G. Zuretti 29, 10126, Turin, Italy
| | - Alberto Momoli
- Department of Orthopaedic Surgery Ospedale San Bortolo, Viale F. Rodolfi 37, 36100, Vicenza, Italy
| | - Mario Mosconi
- Department of Orthopaedic Surgery, IRCCS Policlinico San Matteo di Pavia, Viale C. Golgi 19, 27100, Pavia, Italy
| | - Flavio Ravasi
- Department of Orthopaedic Surgery, ASST Melegnano Martesana-Ospedale di Vizzolo Predabissi, Via Pandina 1, 20077, Vizzolo Predabissi, Italy
| | - Fabrizio Rivera
- Department of Orthopaedic Surgery Ospedale SS Annunziata, Via Ospedali 14, 12038, Savigliano, Italy
| | - Giovanni Zatti
- Department of Orthopaedic Surgery ASST di Monza, Università Milano Bicocca, Via Pergolesi 33, 20900, Monza, Italy
| | - Claudio Carlo Castelli
- Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| |
Collapse
|
21
|
Monticone M, Portoghese I, Cazzaniga D, Liquori V, Marongiu G, Capone A, Campagna M, Zatti G. Task-oriented exercises improve disability of working patients with surgically-treated proximal humeral fractures. A randomized controlled trial with one-year follow-up. BMC Musculoskelet Disord 2021; 22:293. [PMID: 33743670 PMCID: PMC7981858 DOI: 10.1186/s12891-021-04140-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 02/28/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND General physiotherapy is a common means of rehabilitation after surgery for proximal humeral fracture (PHF). Better-targeted exercises seem worthy of investigation and the aim of this study was to assess the efficacy of a rehabilitation program including task-oriented exercises in improving disability, pain, and quality of life in patients after a PHF. METHODS By means of a randomized controlled trial with one-year follow-up, 70 working patients (mean age of 49 ± 11 years; 41 females), who were selected for open reduction and internal fixation with plates caused by PHF, were randomized to be included in an experimental (n = 35) or control group (n = 35). There was a permuted-block randomization plan, and a list of program codes was previously created; subsequently, an automatic assignment system was used to conceal the allocation. The first group underwent a supervised rehabilitation program of task-oriented exercises based on patients' specific job activities, and occupational therapy. The second group underwent general physiotherapy, including supervised mobility, strengthening and stretching exercises. Both groups individually followed programs of 60-min session three times per week for 12 weeks in the outpatient setting. The Disability Arm Shoulder Hand questionnaire (DASH; scores range from 0 to 100; primary outcome), a Pain intensity Numerical Rating Scale (scores range 0 to 10; secondary outcomes), and the Short-Form Health Survey (scores range from 0 to 100; secondary outcomes) assessed the interventions. Participants were evaluated before surgery, before and after rehabilitation (primary endpoint), and at the one-year follow-up (secondary endpoint). A linear mixed model analysis for repeated measures was carried out for each outcome measure (p < 0.05). RESULTS Time, group and time by group showed significant effects for all outcome measures in favour of the experimental group. The DASH and the DASH work achieved clinically important between-group differences of 16.0 points (95% confidence interval [C.I.] 7.3 to 24.7) and 19.7 (95% C.I. 9.0 to 30.5) at follow-up, respectively. The NRS achieved a between-group difference of 2.9 (95% C.I. 1.0 to 3.9) at follow-up. As for SF-36, there were between-group differences ranging from 17.9 to 37.0 at follow-up. CONCLUSIONS A rehabilitation program based on task-oriented exercises was useful in improving disability, pain, and quality of life in working patients after PHFs. Improvements lasted for at least 12 months. TRIAL REGISTRATION On 16/12/2019, the trial was retrospectively registered in the ISRCTN registry with the ID number 17996552 .
Collapse
Affiliation(s)
- Marco Monticone
- Department Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria, Strada Statale, 554 - Monserrato, Cagliari, Italy
- Neurorehabilitation Unit, Department Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy
| | - Igor Portoghese
- Department Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria, Strada Statale, 554 - Monserrato, Cagliari, Italy
| | | | | | - Giuseppe Marongiu
- Orthopaedic and Trauma Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Antonio Capone
- Orthopaedic and Trauma Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Marcello Campagna
- Department Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria, Strada Statale, 554 - Monserrato, Cagliari, Italy.
| | - Giovanni Zatti
- Bicocca University of Milan, Milan, Italy
- Orthopaedics Unit, San Gerardo Hospital, Brianza, Monza, Italy
| |
Collapse
|
22
|
Munegato D, Caminita AD, Sotiri R, Rossi A, Bigoni M, Zatti G. Femoral revision in periprosthetic fractures using a titanium modular fluted tapered stem: mortality and clinical and radiological outcomes. Hip Int 2020; 30:101-107. [PMID: 33267693 DOI: 10.1177/1120700020971313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of the study was to evaluate the mortality and the outcomes of femoral revision in periprosthetic femoral fractures (PFF) using a titanium modular fluted tapered stem. METHODS We retrospectively reviewed femoral revisions performed for PFF with a titanium modular fluted tapered stem in 25 patients. The average age was 74.32 years. In 21 patients the type of fracture was Vancouver B2 and type B3 in 4 cases. The mean follow-up was 29.16 (0.83-104.1) months SD ± 29.49. RESULTS The 30-day and 1-year mortality were 8% and 12% respectively. The mean value of the Charlson Comorbidity Index was 4.8 and the mean value of ASA score was 2.4. The average time to surgery from admittance was 5.45 days with 20% of patients operated on within 48 hours. A significant correlation was found between ASA score and mortality. The mean HHS was 76 points; good-excellent results were recorded in 56% of patients. 72% had no pain and 28% had slight pain (VAS 1-3). 52% of patients were able to walk without pain, limp or aids. The mean implant subsidence was 1.57 mm and superior to 5 mm in 2 cases. As complications we recorded 4 implant dislocations (16%) and 2 infections. Reoperation rate was 12%. CONCLUSIONS Femoral revision with a modular fluted tapered stem in patients with periprosthetic fractures results in good clinical and radiological outcomes. However, mortality remains high and, despite the modularity design, dislocation is the most frequent complication.
Collapse
Affiliation(s)
- Daniele Munegato
- Orthopaedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Romeo Sotiri
- Orthopaedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Andrea Rossi
- Orthopaedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Marco Bigoni
- Orthopaedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giovanni Zatti
- Orthopaedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
23
|
Turati M, Boerci L, Piatti M, Zanchi N, Zatti G, Accadbled F, Bigoni M. What's new about etiopathogenesis of musculoskeletal injuries in adolescent athletes? Minerva Pediatr 2020:S0026-4946.20.05944-7. [PMID: 33107275 DOI: 10.23736/s0026-4946.20.05944-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marco Turati
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy - .,Hospital Couple Enfant, Grenoble, France - .,Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy - .,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy - .,Department of Paediatric Orthopaedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France -
| | - Linda Boerci
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Hospital Couple Enfant, Grenoble, France.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Massimiliano Piatti
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Hospital Couple Enfant, Grenoble, France.,Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Nicolò Zanchi
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Hospital Couple Enfant, Grenoble, France.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giovanni Zatti
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Hospital Couple Enfant, Grenoble, France.,Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Franck Accadbled
- Department of Orthopaedics, Children's Hospital, CHU de Toulouse, Toulouse, France
| | - Marco Bigoni
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Hospital Couple Enfant, Grenoble, France.,Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
24
|
Bigoni M, Turati M, Zanchi N, Lombardo AS, Graci J, Omeljaniuk RJ, Zatti G, Gaddi D. Clinical applications of Bioactive glass S53P4 in bone infections: a systematic review. Eur Rev Med Pharmacol Sci 2020; 23:240-251. [PMID: 30977891 DOI: 10.26355/eurrev_201904_17498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Treatment of osteomyelitis, in of itself, is challenging but is further complicated by attendant bone infections. The management of bone infection, and bone rebuilding may be assisted by the use of bioactive glasses (BAGs) which have antimicrobial and osteo-stimulative proprieties. However, this clinical application and potential complications associated with BAGs (e.g., BAG S53P4), are poorly defined. The aim of this study is to review the results of clinical research using BAG S53P4 in the treatment of human bone infections. MATERIALS AND METHODS This review was conducted in accordance with the PRISMA statement. The following databases were searched: PubMed, Cochrane Library, EMBASE, and Scopus. We examined electronic databases from 1965 to 2018 using different combinations of the following keywords: "S53P4", "BonAlive", "infection" and "osteomyelitis". RESULTS Eight studies were considered which included a total of 276 cases (mean age of 49.3 years). The most frequent pathogen isolated was Staphylococcus aureus. A one-step surgical procedure was performed in 89.85% of cases. Good clinical and radiological outcomes were reported with a mean follow-up of 21.5 months. Twenty-three complications (8.3% of total cases) were described with the recurrence of bone infection as the most common complication (6.15% of total cases). CONCLUSIONS BAG-S53P4 seems to be a useful bone filler in orthopaedic surgery for osteomyelitis treatment. The attendant clinical results and associated rate of complications associated with BAG S53P4 use are comparable with those of other techniques in the short term. However, long-term follow-up studies are required in order to confirm the longevity of this treatment.
Collapse
Affiliation(s)
- M Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Bigoni M, Zanchi N, Omeljaniuk RJ, Zatti G, Locatelli V, Torsello A, Turati M. Role of interleukin-10 in the synovial fluid of the anterior cruciate ligament injured knee. Eur Rev Med Pharmacol Sci 2020; 23:932-940. [PMID: 30779058 DOI: 10.26355/eurrev_201902_16979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This review assesses the roles of IL-10 in post ACL reconstruction OA, and highlights the potential therapeutic effects of this cytokine. MATERIALS AND METHODS We conducted a systematic review of the literature in order to consolidate evidence of IL10 profiles in synovial fluid (SF) of patients with ACL tears. The review was conducted in accordance with the PRISMA statement. In total, 10 studies were found to be pertinent and were considered in depth. Seven studies reported on trends in IL-10 concentrations after an ACL tear; in addition, three studies described IL-10 concentrations after ACL reconstruction. In all studies, IL-10 levels were assessed using enzyme-linked immunosorbent assay. RESULTS IL-10 levels in SF were higher after ACL injury and ACL reconstruction compared to control knees. IL-10 levels were most elevated shortly after injury, but, decreased to more normal levels in chronic lesions. In contrast, the inflammatory cytokine TNF-α remained higher than controls immediately subsequent to, and, even 5 years post-injury. CONCLUSIONS IL-10 is a modulatory cytokine with an active role in antagonizing TNF-α in the knee joint environment. Consideration of the role of IL-10 in the knee has now shifted from simply a key biomarker to having active therapeutic potential in the prevention of OA after ACL injury.
Collapse
Affiliation(s)
- M Bigoni
- Orthopedic Department, San Gerardo Hospital, Monza, Italy.
| | | | | | | | | | | | | |
Collapse
|
26
|
Turati M, Leone G, Zanchi N, Omeljaniuk RJ, Brahim L, Zatti G, Courvoisier A, Bigoni M. Clinical presentation and surgical treatment of distal fibular non-union with talus chondral lesions in a pediatric patient: a case report. BMC Surg 2020; 20:125. [PMID: 32517685 PMCID: PMC7285572 DOI: 10.1186/s12893-020-00782-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 05/24/2020] [Indexed: 11/30/2022] Open
Abstract
Background In children, fracture non-union is uncommon yet, curiously, non-union of distal fibula fractures are rarely reported. Historically, the most common treatment of a lateral malleolus fracture after an ankle sprain is conservative, which usually leads to fracture union. However, even in clinically stable ankles, subsequent pain arising from fracture site could suggest non-union, thereby necessitating reexamination and possible secondary treatment. Case presentation We report the case of an 8-year-old girl with an epiphyseal distal fibula fracture complicated with a symptomatic non-union associated with the chondral flap of the talar dome after conservative treatment. Surgical excision of the fragment and chondroplasty was performed and resulted in an excellent clinical outcome. Conclusion This case report illustrates the necessity of particularly meticulous evaluation of pediatric post-traumatic ankle pain. Surgical treatment as well as talar chondral evaluation should be taken into consideration in the treatment of pediatric distal fibular nonunion.
Collapse
Affiliation(s)
- Marco Turati
- Department of Paediatric Orthopedic Surgery, University Hospital Grenoble-Alpes, University Grenoble-Alpes, Grenoble, France. .,Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy. .,Department of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy.
| | - Giulio Leone
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Nicolò Zanchi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | | | - Lilia Brahim
- Department of Paediatric Orthopedic Surgery, University Hospital Grenoble-Alpes, University Grenoble-Alpes, Grenoble, France
| | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Aurélien Courvoisier
- Department of Paediatric Orthopedic Surgery, University Hospital Grenoble-Alpes, University Grenoble-Alpes, Grenoble, France
| | - Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| |
Collapse
|
27
|
Castoldi G, Carletti R, Ippolito S, Colzani M, Barzaghi F, Stella A, Zerbini G, Perseghin G, Zatti G, Di Gioia C. P0984SGLT2 INHIBITION PREVENTS RENAL FIBROSIS IN CYCLOSPORINE NEPHROPATHY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Sodium glucose cotransporter 2 (SGLT2) inhibitors, a new class of antidiabetic drugs, showed nephroprotection in type 2 diabetic patients. The mechanisms underlying nephroprotection are not completely known and it is unclear whether the nephroprotective effects are present also in non-diabetic nephropathy. The aim of this study was to evaluate the effects of empagliflozin, a SGLT-2 inhibitor, in cyclosporine nephropathy in the absence of diabetes.
Method
Ten days before the beginning and then during the entire experimental periods, low-salt diet (Teklad 7034) was administered to Sprague Dawley rats. Cyclosporine-A (CsA, 15 mg/kg/day, intraperitoneal injection; n=6) and CsA plus empagliflozin (Empa, 10 mg/kg /day, per os; n=6) were administered for 4 weeks. Control group was treated with placebo (n=6). Blood pressure was measured by plethysmographic method at the beginning and at the end of the experimental period. At the end of the protocol, the kidneys were excised for histomorphometric analysis of renal fibrosis and for immunohistochemical evaluation of inflammatory infiltrates and tyrosine hydroxylase expression, used as marker of symphatetic nerve activity.
Results
The rats treated with CsA showed a significant increase (p <0.01) in blood pressure, which was slightly reduced by administration of empagliflozin. CsA administration caused an increase in glomerular and tubulo-interstitial fibrosis (p <0.05), renal inflammatory infiltrates (p <0.05) and tyrosine hydroxylase expression (p <0.01) as compared to the control rats. Treatment with empagliflozin reduced glomerular and tubulo-interstitial fibrosis (p <0.05), inflammatory cell infiltration (p <0.01) and tyrosine hydroxylase expression (p <0.01), as compared to CsA-treated rats.
Conclusion
Empagliflozin administration showed protective effects on cyclosporine nephropathy, decreasing renal fibrosis, macrophage infiltration and tyrosine hydroxylase expression. These data suggest that the nephroprotective role of empagliflozin could not be restricted only to diabetic nephropathy.
Collapse
Affiliation(s)
- Giovanna Castoldi
- Dipartimento di Medicina e Chirurgia, Universita' degli Studi di Milano-Bicocca, Monza, Italy
| | - Raffaella Carletti
- Dip. Scienze Radiol., Oncol., Anatomopatologiche. Istituto Anatomia Patologica, Sapienza Universita' di Roma, Rome, Italy
| | - Silvia Ippolito
- Laboratorio Analisi Chimico Cliniche, Ospedale San Gerardo. ASST Monza, Monza, Italy
| | - Massimiliano Colzani
- Dipartimento di Medicina e Chirurgia, Universita' degli Studi di Milano-Bicocca, Monza, Italy
| | - Francesca Barzaghi
- Dipartimento di Medicina e Chirurgia, Universita' degli Studi di Milano-Bicocca, Monza, Italy
| | - Andrea Stella
- Dipartimento di Medicina e Chirurgia, Universita' degli Studi di Milano-Bicocca, Monza, Italy
| | - Gianpaolo Zerbini
- Unita' Complicanze del Diabete., IRCCS Istituto Scientifico San Raffaele, Milano, Italy
| | - Gianluca Perseghin
- Dipartimento di Medicina e Chirurgia, Universita' degli Studi di Milano-Bicocca, Monza, Italy
- Dip. Medicina Interna e Riabilitazione, Policlinico di Monza, Monza, Italy
| | - Giovanni Zatti
- Dipartimento di Medicina e Chirurgia, Universita' degli Studi di Milano-Bicocca, Monza, Italy
- Clinica Ortopedica, Ospedale San Gerardo. ASST Monza., Monza, Italy
| | - Cira Di Gioia
- Dip. Scienze Radiol., Oncol., Anatomopatologiche. Istituto Anatomia Patologica, Sapienza Universita' di Roma, Rome, Italy
| |
Collapse
|
28
|
Morandi A, Zambon A, Di Santo SG, Mazzone A, Cherubini A, Mossello E, Bo M, Marengoni A, Bellelli G, Rispoli V, Malara A, Spadea F, Di Cello S, Ceravolo F, Fabiano F, Chiaradia G, Gabriele A, Lenino P, Andrea T, Settembrini V, Capomolla D, Citrino A, Scriva A, Bruno I, Secchi R, De Martino E, Muccinelli R, Lupi G, Paonessa P, Fabbri A, Passuti MT, Castellari S, Po A, Gaggioli G, Varesi M, Moneti P, Capurso S, Latini V, Ghidotti S, Riccardelli F, Macchi M, Rigo R, Claudio P, Angelo B, Flavio C, Benedetta B, Boffelli S, Cassinadri A, Franzoni S, Spazzini E, Andretto D, Tonini G, Andreani L, Coralli M, Balotta A, Cancelliere R, Ballardini G, Simoncelli M, Mancini A, Strazzacapa M, Fabio S, De Filippi F, Giudice C, Dentizzi C, Azzini M, Cazzadori M, Mastroeni V, Bertassello P, Claudia Benati HS, Nesta E, Tobaldini C, Guerini F, Elena T, Mombelloni P, Fontanini F, Gabriella L, Pizzorni C, Oliverio M, Del Grosso LL, Giavedoni C, Bidoli G, Mazzei B, Corsonello A, Fusco S, Vena S, De Vuono T, Maiuri G, Luca FF, Andrea A, Giovanni S, Rossella N, Castegnaro E, De Rosa S, Sechi RB, Benvenuti E, Del Lungo I, Giardini S, Giulietti C, Mauro DB, Eleonora B, Roberto F, Paolo B, DuranteMangoni E, Testoni M, Fabio DS, Loredana S, Valeria S, Fabiano M, Annabella DG, Salvatore DC, Martina P, Greco A, Grazia D, Daniele S, Gianluca R, Renzo G, Sergio M, Morena B, Vitali M, Marina P, Paolo DC, Irene F, Cristina S, Alessandra F, Orlandini F, La Regina M, Desirée A, Mirella F, Marco F, Mario B, Paola P, Giuliana B, Riccardo B, Michela T, Eleonora C, Padulo F, Cristina M, Dario R, Giancarla M, Guido R, Elena M, Prete C, Marileda N, Federica S, Igor B, Nicole B, Elena R, Paolillo C, Riccardi A, Claudia B, Barbara R, Francesca M, Silvia V, Chiara C, Ilaria DL, Oliver B, Mauro C, Eleonora M, Giuseppe P, Rosaria T, Maria C, Davide D, Stefania C, Marco C, Massimo P, Bertoletti E, Luca S, Martina DF, Paola V, Lia S, Sandro C, Valentina DS, Erminia B, Paola C, Romina R, Minisola S, D'Amico F, Luciano C, Pasquale A, Ilaria L, Francesca C, Guglielmo S, Marco E, Sara R, Paola A, Claudio A, Francesco R, Caronzolo F, Alessandro C, Simona M, Lara F, Paola R, Simonetta C, Antonella C, Generoso U, Fernando G, Giuliano C, Emanuela S, Grippa A, Mariolina S, Alessandro D, Chiara P, Giulia L, Alessandro G, Famularo S, Sandini M, Pinotti E, Gianotti L, Antonella B, Lombardo G, Giulia P, Sante G, Rossi A, Rubele S, Sant S, Marco V, Danila C, Fabio R, Bandirali MP, Nicoletta C, Pipicella T, Laura B, Paolo T, Luciano T, Leonello A, Margherita S, Stefania DN, Pierluigi DS, Laura R, Fabiana T, Giovanna C, Antonino S, Antonino A, Felice C, Giuseppe B, Danilo F, Giovanna DB, Francesco L, Salini S, Angela BM, De Filippi F, Giorgetta C, Francesco C, Giovanni G, Paola C, Gerardo B, Silvio R, Letizia S, Sabrina P, Davide B, Rosaria RM, Maria DA, Raffaele P, Valeria PG, Palmieri VO, Palasciano G, Belfiore A, Portincasa P, Carlo S, Vincenzo S, Alessia D, Valiani V, Carolina B, Tiziana C, Daniela L, Giuseppe M, Francesca C, Giordano C, Roberto S, Paola T, Ugo P, Federica R, Giacomo P, Castellano M, Anna G, Domenico C, Elisa C, Federica C, Antonietta CM, Luigi M, Fabio L, Salvatore B, Giuseppe M, Gelosa G, Viviana AT, Piras V, Giorgio B, Andrea C, Alessandra B, Coen D, Magliola R, Milanesio D, Muzzulini CL, Paolo F, Marinella T, Sofia CM, Marta B, March A, Siano P, Capo G, Napoletano R, Cecilia P, Mancini C, Del Buono C, De Bartolomeo G, Addolorata M, Carmen C, Roberto C, Nitti MT, Giovanni VA, Moschettini G, Franco M, Daniela R, D'Amico G, Mirella P, Endrizzi C, Trotta L, Ciarambino T, Orazio Z, Felici A, Emanuela T, Marta S, Thomas F, Giacomo T, Ignazio DF, Andrea B, Giuseppe O, Emanuela F, Serena A, Elena D, Pavan S, Anna C, Serena B, Erika N, Roberto S, Elena S, Manuela P, Francesca A, Angelo T, Piazzani F, Lunelli A, Dimori S, Margotta A, Soglia T, Postacchini D, Brunelli R, Santini S, Francavilla M, Macchiati I, Sorvillo F, Giuli C, Mecocci P, Longo A, Perticone F, Addesi D, Rosa PC, Bencardino G, Falbo T, Grillo N, Marco F, Mirella F, Fantò F, Isaia G, Pezzilli S, Bergamo D, Furno E, Rrodhe S, Lucarini S, Dijk B, Dall'Acqua F, Cappelletto F, Calvani D, Becheri D, Giuseppe M, Costanza M, Vito A, Francesca B, Magherini L, Novella M, Franca B, Lucia Gambardella PM, Valente C, Ilaria B, Alice F, Bo M, Porrino P, Ceci G, Giuliana B, Michela T, Eleonora C, Ettore E, Camellini C, Servello A, Grassi A, Rozzini R, Tironi S, Grassi MG, Troisi E, Carlo C, Simona Gabriella DS, Flaminia F, Federica R, Beatrice P, Sofia T, Gabutto A, Quazzo L, Rosatello A, Suraci D, Tagliabue B, Perrone C, Ferrara L, Castagna A, Tremolada ML, Giuseppe C, Stefano B, Davide O, Piano S, Serviddio G, Lo Buglio A, Gurrera T, Merlo V, Rovai C, Cotroneo AM, Carlucci R, Abbaldo A, Monzani F, Qasem AA, Bini G, Tafuto S, Galli G, Bruni AC, Mancuso G, Mancuso G, Calipari D, Giuseppe Massimiliano DL, Bernardini B, Corsini C, Michele C, Sara DF, Cagnin A, Fragiacomo F, Pompanin S, Piero A, Marco C, Zurlo A, Guerra G, Pala M, Menozzi L, Gatti CD, Magon S, Roberto M, Alfredo DG, Fabio F, Ruana T, Elisa M, Benedetta B, Christian M, Marco P, Massimo G, Di Francesco V, Faccioli S, Pellizzari L, Giorgia F, Barbagallo G, Lunardelli ML, Martini E, Ferrari E, Macchiarulo M, Corneli M, Bacci M, Battaglia G, Anastasio L, Lo Storto MS, Seresin C, Simonato M, Loreggian M, Cestonaro F, Durando M, Latella R, Mazzoleni M, Russo G, Ponte M, Valchera A, Salustri G, Petritola D, Costa A, Sinforiani E, Cotta MR, Piano S, Pizio RN, Cester A, Formilan M, Pietro B, Carbone P, Cazzaniga I, Appollonio I, Cereda D, Stabile A, Xhani R, Acampora R, Tremolizzo L, Federico P, Antonio C, Valerio P, Cesare B, Zhirajr M, Giovanni V, Maria A, Mariaelena S, Bottacchi E, Bucciantini E, Di Giovanni M, Franchi F, Lucchetti L, Mariani C, Grande G, Rapazzini P, Marco M, Romanelli G, Marengoni A, Franco N, Alessio M, Stefano B, Nicola L, Laura P, Nazario P, Carlo C, Chiara G, Soccorso P, Andrea S, Luca B, Francesca S, Roberto A, Marco F, Anna C, Francesco C, Anna C, Fugazza L, Guerrini C, De Paduanis G, Iallonardo L, Palumbo P, Zuliani G, Ortolani B, Capatti E, Soavi C, Bianchi L, Francesconi D, Miselli A, Gloria B, Tommaso R, Chiara P, Agata MM, Marco D, Luca M, Gianluca G, Suardi T, Mazzone A, Zaccarini C, Manuela R, Mirra G, Muti E, Bottura R, Gianpaolo M, Secreto P, Bisio E, Cecchettani M, Naldi T, Pallavicino A, Pugliese M, Iozzo RC, Grassi G, Michele B, Raffaella D, Fosca QT, Giorgio GC, Giovanni P, Ernesto C, Soccorso P, Mannironi A, Giorli E, Oberti S, Fierro B, Piccoli T, Giacalone F, Mandas A, Serchisu L, Costaggiu D, Pinna E, Orrù F, Mannai M, Cordioli Z, Pelizzari L, Turcato E, Arduini P, Cacace C, Chiloiro R, Cimino R, Ruberto C, Giovanni R, Pietro G, Laura G, Alberto C, Pietro G, Carmen R, Santo PD, Andriolli A, Burattin G, Rossi L, Andreolli Antonino CG, Giuseppe C, Tezza F, Maddalena P, Laura S, Crippa P, Aloisio P, Di Monda T, Malighetti A, Galbassini G, Salutis D, Ivaldi C, Russo AM, Bennati E, Pino E, Zavarise G, Pesci A, Suigo G, Faverio P, Andrea G, Sabrina P, Zanasi M, Moniello G, Rostagno C, Cartei A, Polidori G, Ungar A, Melis MR, Martellini E, Enrico M, Monica T, Antonella G, Giovanna L, Migliorini M, Caramelli F, Battiston B, Berardino M, Cavallo S, Alessandro M, Anna S, Lombardi B, D'Ippolito P, Furini A, Villani D, Clara R, Guarneri M, Paolucci S, Bassi A, Coiro P, De Angelis D, Morone G, Venturiero V, Palleschi L, Raganato P, Di Niro G, Rosa CA, Loredana B, Imoscopi A, Isaia G, Tibaldi V, Bottignole G G, Calvi E, Clementi C, Zanocchi M, Agosta L, Nortarelli A, Provenzano G, Mari D, Romano FY, Rosini F, Mansi M, Rossi S, Geriatria AR, Inzaghi L, Bonini G, Rossi P, Potena A, Lichii M, Candiani T, Grimaldi W, Bertani E, Alessandra P, Calogero P, Pinto D, Bernardi R, Nicolino F, Galetti C, Gianstefani A, Giulia C, Lorenzo M, Odetti P, Monacelli F, Prefumo M, Fiammetta M, Canepa M, Minaglia C, Paolisso G, Rizzo MR, Prestano R, Dalise AM, Barra D, Bosco LD, Asprinio V, Dallape L, Perina E, Incalzi RA, Bartoli IR, Pluderi A, Maina A, Pecoraro E, Sciarra M, Prudente A, Paola M, Francesca M, Manuel V, Luisella C, Maria PL, Tina S, Benini L, Levato F, Mhiuta V, Alius F, Davidoaia D, Giardini V, Garancini M, Bellamoli C, Terranova L, Bozzini C, Tosoni P, Provoli E, Cascone L, Dioli A, Ferrarin G, Gabutto A, Bucci A, Bua G, Fenu S, Bianchi G, Casella S, Romano V, Maurizio P, Mascherona I, Belotti G, Cavaliere S, Cuni E, Merciuc N, Oberti R, Veneziani S, Capoferri E, De Bernardi E, Colombo K, Bravi M, Nicoletta N, D'Arcangelo P, Montenegro N, Galli G, Montanari R, Lamanna P, Gasperini B, Isabella M, Stefania D, Gaia A, Filippo C, Palamà C, Di Emidio C, Scarpini E, Arighi A, Fumagalli G, Basilico P, De Amicis Margherita M, Marta M, Diletta M, D'Amico F, Granata A, Rostagno C, Ranalli C, Cammilli A, Cavallini MC, Tricca M, Natella D, Gabbani L, Tesi F, Martella L, Gurrera T, Imbrici R, Guerrini G, Scotuzzi AM, Sozzi F, Valenti L, Chiarello A, Monia M, Pilotto A, Prete C, Senesi B, Meta AC, Pendenza E, Monzani F, Pasqualetti G, Polini A, Tognini S, Ballino E, Cherubini A, Dell'Aquila G, Gasparrini PM, Marotti E, Migale M, Scrimieri A, Falsetti L, Salvi A, Toigo G, Ceschia G, Rosso A, Tongiorgi C, Scarpa C, Maurizio P, De Dominicis L, Pucci E, Renzi S, Cartechini E, Tomassini PF, Del Gobbo M, Ugenti F, Romeo P, Nardelli A, Lauretani F, Visioli S, Montanari I, Ermini F, Giordano A, Pigato G, Simeone E, Barbujani M, Giampieri M, Amoruso R, Piccinini M, Ferrari C, Gambetti C, Sfrappini M, Semeraro L, Striuli R, Mariani C, Pelliccioni G, Marinelli D, Fabi K, Rossi T, Pesallaccia M, Sabbatini D, Gobbi B, Cerqua R, Tagliani G, Schlauser E, Caser L, Caramello E, Sandigliano F, Rosso G, Ferrari A, Bendini C, Luisa DM, Casella M, Prampolini R, Scevola M, Vitale E, Roberto B, Carlo F, Sergio F, Alberto S, Daniela Z, Giulia B, Serena G, Michele B, Maugeri D, Sorace R, Anzaldi M, De Gesu R, Morrone G, Davolio F, Fabbo A, Palmieri M, Barbagallo G, Zoli M, Forti P, Pirazzoli L, Fabbri E, Terenzi L, Bergolari F, Wenter C, Ruffini I, Insam M, Abraham E, Kirchlechner C, Cucinotta D, Antonino L, Basile G, Grazia AM, Parise P, Boccali A, Amici S, Gambacorta M, Ferrari A, Lasagni A, Lovati R, Giovinazzo F, Kimak E, Zappa P, Medici F, Lo Castro M, Mauro F, De Luca A, Sancesario G, Martorana A, Scaricamazza B, Toniolo S, Di Lorenzo F, Liguori C, Lasco A, Basile G, Vita N, Giomi M, Dimori S, Forte F, Padovani A, Rozzini L, Ceraso A, Salvatore C, Padovani A, Cottino M, Vitali S, Marelli E, Tripi G, Miceli S, Urso G, Grioni G, Vezzadini G, Misaggi G, Forlani C, Avanzi S, Serena S, Claudia C, Marilena V, Alberto L, Diego G, Alessandro G, Iemolo F, Giordano A, Sanzaro E, D'Asta G, Proietto M, Carnemolla A, Razza G, Spadaro D, Bertolotti M, Mussi C, Neviani F, Roberto C, Valentina G, Linda M, Francesca V, Tarozzi A, Balestri F, Monica T, Mannarino G, Tesi F, Bigolari M, Natale A, Grassi S, Bottaro C, Stefanelli S, Bovone U, Tortorolo U, Quadri R, Leone G, Ponzetto M, Frasson P, Annoni G, Bellelli G, Bruni A, Confalonieri R, Corsi M, Moretti D, Teruzzi F, Umidi S, Mazzola P, Perego S, Persico I, Olivieri G, Bonfanti A, Hajnalka S, Galeazzi M, Massariello F, Anzuini A, Caffarra P, Barocco F, Spallazzi M, Paolo CG, Simonetta M, Andrea A, Chioatto P, Bortolamei S, Soattin L, Ruotolo G, Beneamino B, Pietro G, Giuseppe B, Carmen R, Castagna A, Bertazzoli M, Rota E, Adobati A, Scarpa A, Granziera S, Zuccher P, Fabbro AD, Zara D, Lo Nigro A, Franchetti L, Toniolo M, Marcuzzo C, Piano S, Rollone M, Guerriero F, Sgarlata C, Massè A, Berardino M, Cavallo S, Anna S, Zatti G, Piatti M, Graci J, Benati G, Boschi F, Biondi M, Fiumi N, Erika T, Locatelli SM, Mauri S, Beretta M, Margheritis L, Desideri G, Liberatore E, Carucci AC, Bonino P, Caput M, Antonietti MP, Polistena G, De la Pierre F, Mari M, Massignani P, Tombesi F, Selvaggio F, Verbo B, Bodoni P, Marchionni N, Mossello E, Cavallini MC, Sabatini T, Mussio E, Magni E, Bianchetti A, Crucitti A, Titoldini G, Cossu B, Fascendini S, Licini C, Tomasoni A, Calderazzo M, Daniela T, Valentina L, Ferrari A, Prampolini R, Melotti RM, Lilli A, Buda S, Adversi M, Noro G, Turco R, Ubezio MC, Mantovani AR, Viola MC, Serrati C, Pretta S, Infante M, Gentile S, Morandi A, D'Ambrosio V, Mazzanti P, Brambilla C, Sportelli S, Platto C, Faraci B, Quattrocchi D, Pernigotti LM, Pisu C, Sicuro F, Oliverio M, Del Grosso LL, Zagnoni P, Ghiglia S, Mosca M, Corazzin I, Deola M, Biagini CA, Bencini F, Cantini C, Tonon E, Pierinelli S, Onofrj M, Thomas A, Filomena B, Bonanni L, Gabriella C, Comi G, Magnani G, Santangelo R, Mazzeo S, Giuseppe M, Francesca C, Giordano C, Roberto S, Barbieri C, Giroldi L, Davolio F, Bandini F, Masina M, Malservisi S, Cicognani A, Ricca L, Ricca L, Piccininni M, Ferrari C, Gambetti C, Tassinari T, Brogi D, Sugo A, Alessandra F, Sonia M, Valerio V, Andrea UC, Enrico C, Vera RF, Assunta S, Gianmaria Z, Mauro P, Pietro B, Roberto M, Salvatore C, Barone A, Razzano M, Giuseppe I, Angela B, Francesco S, Valeria D, Federico G, Lucia P, Antonella V, Elisabetta DC, Cristina R, Nadia C, Maria S, Luciano A, Chiara C, Bini P, Pignata M, Enrico B, Maria V, Giovanni C, Giorgio C, Andrea T, Marco M, Anna C, Piera R, Alberto Z, Ceccon A, Magrin L, Marin S, Barbara S, Marco M, Laura G, Matteo M, Marco P, Caterina PM, Carla R, Federica G, Clara T, Melania C, Giampaolo B, Stefano G, Valeria G, Lucia M, Giovambattista D, Ester L, Cecilia CA, Maurizio T, Alessandra F, Vera RF, Nadia B, Grillo A, Arenare F, Tonino M, David K, Giorgio VP, Ubaldo B, Vincenzo S, Stefano M, Marino F, Busonera Flavio MT, Paolo A, Monica M, Francesco B. Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia. J Am Med Dir Assoc 2020; 21:486-492.e7. [DOI: 10.1016/j.jamda.2020.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 02/15/2020] [Accepted: 02/19/2020] [Indexed: 12/12/2022]
|
29
|
Cossio A, Graci J, Lombardo AS, Turati M, Melzi ML, Bigoni M, Zatti G. Bilateral tibial Brodie's abscess in a young patient treated with BAG-S53P4: case report. Ital J Pediatr 2019; 45:91. [PMID: 31349859 PMCID: PMC6660657 DOI: 10.1186/s13052-019-0685-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/19/2019] [Indexed: 11/18/2022] Open
Abstract
Background Brodie’s abscess is a form of chronic pyogenic osteomyelitis that usually affects the cancellous part of the long bones in children. Its treatment is represented by antibiotic therapy alone or in association with surgical procedures. Case presentation A 12-years-old male affected by a Brodie’s abscess of the tibia involving the distal growth plate was admitted to the Pediatric Department for a conservative treatment. After several attempts of antibiotic therapy interrupted for intolerance manifestations he was surgically treated with bioactive glass BAG-S53P4 (BonAlive, BonAlive Biomaterials Ltd., Biolinja, Finland), with excellent results. Conclusions In our experience BAG-S53P4 has proven to be an effective bone substitute without side effects even in the pediatric population. In our case it eradicated the infection without interfere with the growth; neither epiphysiodesis nor other disorders were found during the follow-up. For the publication of this case report we followed the CARE guidelines for good clinical case reports; the parents gave consent for publication.
Collapse
Affiliation(s)
- Andrea Cossio
- Orthopedic Department, San Gerardo Hospital, University of Milano - Bicocca, Monza, Italy
| | - Jole Graci
- Orthopedic Department, San Gerardo Hospital, University of Milano - Bicocca, Monza, Italy. .,Department of Paediatric Orthopaedics, Saint Joseph Hospital, Marseille, France.
| | | | - Marco Turati
- Orthopedic Department, San Gerardo Hospital, University of Milano - Bicocca, Monza, Italy
| | - Maria Luisa Melzi
- Pediatrics Department, San Gerardo Hospital, University of Milan - Bicocca, Monza, Italy
| | - Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano - Bicocca, Monza, Italy.,School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano - Bicocca, Monza, Italy.,School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| |
Collapse
|
30
|
Bigoni M, Turati M, Arnoldi M, Omeljaniuk RJ, Peri Di Caprio A, Del Bene M, Zatti G, Gaddi D. Distal humeral septic non-union treated with debridement and vascularized fibular transfer: case report and review of the literature. Eur Rev Med Pharmacol Sci 2019; 23:12-18. [PMID: 30977866 DOI: 10.26355/eurrev_201904_17469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Clinical management of a septic non-union of the distal humerus is challenging and is complicated by the diversity of potential treatments which are variably successful. We report a novel and very successful treatment of a 58-year-old man presenting an infected non-union of the right distal humerus, secondary to a closed fracture initially treated with two anatomic plates. After hardware removal, a two-stage reconstruction was performed. Bone and soft-tissue debridement was performed, followed by vascularized fibular transfer and free iliac bone crest chips fixed with plates and screws. Consolidation was achieved within three months, and a very good elbow function was presented two years thereafter. This technique shows great promise for improved management of large segmental infected bone defects of complete articular distal humeral fractures, above many currently recognized treatments.
Collapse
Affiliation(s)
- M Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Bigoni M, Zanchi N, Turati M, Pirovano G, Zatti G, Munegato D. Short-term differences in anterior knee pain and clinical outcomes between rotating and fixed platform posterior stabilized total knee arthroplasty with a new femoral component design. World J Orthop 2019; 10:128-136. [PMID: 30918796 PMCID: PMC6428999 DOI: 10.5312/wjo.v10.i3.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/16/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare rotating versus fixed-bearing Press-Fit Condylar (PFC) Sigma posterior stabilized (PS) total knee arthroplasty (TKA) with the new “J curve” femoral design in terms of clinical outcomes and anterior knee pain.
METHODS We retrospectively analyzed 39 patients who underwent primary total knee replacement surgery for knee osteoarthritis using the PFC Sigma PS TKA with either fixed (FP group, 20 cases) or rotating platform (RP group, 19 cases) treated between 2009 and 2013 by the same surgeon. The two groups were homogeneous for age, gender, weight, American Society of Anesthesiologists status, pre-operative clinical and functional scores, and prosthetic alignment at two years after surgery. We analyzed clinical outcomes score at two years follow-up using Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Performance Score, Short Form (SF) 36, and anterior knee pain assessed by the Hospital for Special Surgery (HSS) patellar score.
RESULTS No differences were found in KSS, Knee Performance Score, and SF-36 outcome scores. A statistically significant difference was found in the HSS Patella score objective (FP: 22.36; RP: 28.75; P < 0.05), HSS Patella score total (FP: 73.68; RP: 86.50; P < 0.05), and KOOS symptoms (FP: 73.49; RP: 86.44; P < 0.05).
CONCLUSION Rotating platform in PFC Sigma PS TKA appears to reduce the short-term incidence of anterior knee pain compared to the fixed platform.
Collapse
Affiliation(s)
- Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Nicolò Zanchi
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
| | - Marco Turati
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
- Department of Paediatric Orthopedic Surgery, University Hospital Grenoble-Alpes, Grenoble-Alpes University, Grenoble 38043, France
| | - Gabriele Pirovano
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
| | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Daniele Munegato
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
| |
Collapse
|
32
|
Munegato D, Gridavilla G, Guerrasio S, Turati M, Cazzaniga C, Zanchi N, Zatti G, Bigoni M. Mini open versus open repair techniques in Achilles tendon rupture: clinical and isokinetic evaluation. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.03.2017.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- D. Munegato
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - G. Gridavilla
- Department of Orthopedic Surgery and Traumatology, Manzoni General Hospital, Lecco, Italy
| | - S. Guerrasio
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - M. Turati
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
- Department of Paediatric Orthopedic Surgery, Hopital Couple Enfants, Grenoble Alpes University, Grenoble, France
| | - C. Cazzaniga
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - N. Zanchi
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - G. Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - M. Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
33
|
Fadini GP, Solini A, Manca ML, Zatti G, Karamouzis I, Di Benedetto A, Frittitta L, Avogaro A. Phenotyping normal kidney function in elderly patients with type 2 diabetes: a cross-sectional multicentre study. Acta Diabetol 2018; 55:1121-1129. [PMID: 30090961 DOI: 10.1007/s00592-018-1194-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/17/2018] [Indexed: 12/26/2022]
Abstract
AIMS Type 2 diabetes (T2D) accelerates the decline in glomerular function; however, some individuals do not develop chronic kidney disease despite advanced age and long-lasting T2D. We aimed to phenotype patients with T2D aged 80 years or older who presented with a fully preserved kidney function. METHODS From an Italian population of 281,217 T2D outpatients, we collected data on demographics, anthropometrics, diabetes duration, HbA1c, fasting plasma glucose, lipids, liver enzymes, estimated glomerular filtration rate (eGFR), albumin excretion rate (AER), chronic complications, and medication use. We primarily compared patients with a fully preserved kidney function (eGFR > 90 ml/min/1.73 m2 and AER < 30 mg/24 h, or G1A1) with those with mild kidney impairment (eGFR 60-90 ml/min/1.73 m2 and AER < 30 mg/24 h, or G2A1). RESULTS N = 113,860 had available data for eGFR and AER, 21,648 of whom were aged ≥ 80. G1A1 (n = 278) and G2A1 (n = 6647) patients represented 1.3 and 30.7% of aged T2D patients, respectively, with an average diabetes duration of 16 years. Differences between the G1A1 and G2A1 groups were entered in a multiple logistic regression analysis with and without imputation of missing data. After adjustment and in both imputed and non-imputed datasets, younger age, lower BMI and lower triglycerides were associated with fully preserved versus mildly impaired kidney function. The comparison between G1A1 and G1A2/3 yielded different results. CONCLUSIONS In a rare population of patients with a fully preserved kidney function despite old age and long-lasting diabetes, lower BMI and triglycerides suggest that protection from lipotoxicity may preserve kidney function over time.
Collapse
Affiliation(s)
- G P Fadini
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
| | - A Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - M L Manca
- Department of Mathematics, University of Pisa, Pisa, Italy
| | - G Zatti
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - I Karamouzis
- Ospedale Maggiore di Novara, 28100, Novara, Italy
| | - A Di Benedetto
- Department of Clinical and Experimental Medicine, University of Messina, 98122, Messina, Italy
| | - L Frittitta
- Department of Internal and Special Medicine, University of Catania, 95122, Catania, Italy
| | - A Avogaro
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| |
Collapse
|
34
|
Munegato D, Bigoni M, Sotiri R, Bruschetta A, Omeljaniuk RJ, Turati M, Andrea R, Zatti G. Clinical and radiological outcomes of acetabular revision with the Delta Revision TT cup. Hip Int 2018; 28:54-60. [PMID: 30755123 DOI: 10.1177/1120700018813224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION: This study evaluates mid-term results of acetabular revision using a hemispherical acetabular cup in Trabecular Titanium with a cage construct. METHODS: We reviewed 36 acetabular revisions performed with the Delta Revision TT cup in 34 patients (mean age = 75, range: 45-92 years). Acetabular defect types (Paprosky classification) included (1) 2B ( n = 5), (2) 2C ( n = 7), (3) 3A ( n = 15), and (4) 3B ( n = 9). Morcellised bone allografts were used in 24 cases, and synthetic bone used in 11. Outcomes were evaluated using the Harris Hip Score (HHS), and the Verbal Rating Scale (VRS) for pain measurement. X-ray visualisation of cup position was used to discern signs of mobilisation and bone graft incorporation. Survivorship at post-revision follow-up (mean = 39.8; range 12-91.5 months) was calculated. RESULTS: HHS increased from 40.5 to 87 ( p < 0.01). 68% of cases were pain free; by comparison, 32% had an average VRS score of 1.9 (range 1-3). The average cup inclination angle was 40.8° (30-52°) postoperatively, compared with 41.2° (30-52°) at follow-up; there were no signs of loosening or mobilisation. Centre of rotation was fully restored in 21 (58.3%) hips. According to Gie classification; bone graft incorporation grades were (1) 3 ( n = 21), (2) 2 ( n = 12) and (3) 1 ( n = 2). The survival rate was 100% for aseptic loosening and 91.7% for any cause of revision. CONCLUSIONS: The Delta Revision TT cup promises good clinical and radiographic results at short- to mid-term follow-up, with high rates of survival rate and bone integration.
Collapse
Affiliation(s)
- Daniele Munegato
- 1 Orthopaedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Marco Bigoni
- 1 Orthopaedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.,2 Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Romeo Sotiri
- 1 Orthopaedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | | | - Marco Turati
- 1 Orthopaedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Rossi Andrea
- 1 Orthopaedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giovanni Zatti
- 1 Orthopaedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.,2 Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
35
|
Munegato D, Gridavilla G, Guerrasio S, Turati M, Cazzaniga C, Zanchi N, Zatti G, Bigoni M. Mini open versus open repair techniques in Achilles tendon rupture: clinical and isokinetic evaluation. Muscles Ligaments Tendons J 2018; 7:554-561. [PMID: 29387651 DOI: 10.11138/mltj/2017.7.3.554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The aim of the study was to compare the mini-open to the classic open repair techniques for Achilles tendon ruptures. Methods We retrospectively evaluated at a minimum of 2 years follow-up 32 subcutaneous Achilles tendon ruptures; 17 underwent mini-open surgery (Group A) and 15 the open technique (Group B). Results No difference in Achilles Tendon Total Rupture Score and in modified Leppillahti score was observed. With respect to the contralateral side the width of the operated Achilles tendon was 4.07 mm thicker in Group A and 7.67 mm in Group B (p<.05); the calf circumference reduction was respectively 10 mm and 23.75 mm (p<.05). Iso-kinetic peak force measurement of the calf muscle strength showed a loss of 8.21% in Group A versus 17.25% in Group B (p <.05). The mean Patient Satisfaction Score was 96.76 in Group A and 88.67 in Group B (p<.01); respectively 82.3% vs 66.7% of patients were able to return to previous levels of sporting activity. There were two post-operative complications in Group B and one in Group A. Conclusion Mini-open technique minimizes the risk of complications, leads to an improved tendon healing process and functional recovery with higher patient satisfaction. Level of evidence IV.
Collapse
Affiliation(s)
- Daniele Munegato
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giulia Gridavilla
- Department of Orthopedic Surgery and Traumatology, Manzoni General Hospital, Lecco, Italy
| | - Stefano Guerrasio
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Marco Turati
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.,Department of Paediatric Orthopedic Surgery, Hopital Couple Enfants, Grenoble Alpes University, Grenoble, France
| | - Carlo Cazzaniga
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Nicolò Zanchi
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
36
|
Fadini GP, Zatti G, Consoli A, Bonora E, Sesti G, Avogaro A. Rationale and design of the DARWIN-T2D (DApagliflozin Real World evIdeNce in Type 2 Diabetes): A multicenter retrospective nationwide Italian study and crowdsourcing opportunity. Nutr Metab Cardiovasc Dis 2017; 27:1089-1097. [PMID: 28967594 DOI: 10.1016/j.numecd.2017.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/26/2017] [Accepted: 08/01/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Randomized controlled trials (RCTs) in the field of diabetes have limitations inherent to the fact that design, setting, and patient characteristics may be poorly transferrable to clinical practice. Thus, evidence from studies using routinely accumulated clinical data are increasingly valued. AIMS We herein describe rationale and design of the DARWIN-T2D (DApagliflozin Real World evIdeNce in Type 2 Diabetes), a multicenter retrospective nationwide study conducted at 50 specialist outpatient clinics in Italy and promoted by the Italian Diabetes Society. DATA SYNTHESIS The primary objective of the study is to describe the baseline clinical characteristics (particularly HbA1c) of patients initiated on dapagliflozin from marketing authorization approval to the end of 2016. Secondary and exploratory objectives will evaluate the changes in glycaemic and extraglycaemic efficacy parameters after initiation of dapagliflozin or after initiation of comparator glucose lowering medications (DPP-4 inhibitors, gliclazide extended release, and long-acting GLP-1 receptor agonists). An automated software will extract relevant data from the same electronic chart system at all centres, thereby minimizing data treatment and human intervention. CONCLUSION The study is expected to collect an enormous dataset of information on dapagliflozin- and comparator-using patients. After study completion, the Italian Diabetes Society will launch an open crowdsourcing call on the DARWIN-T2D database, challenging diabetes researchers to apply their ideas and approaches to address new unmet needs and knowledge gaps in diabetes. We believe this will move DARWIN-T2D to the next generation of real world studies.
Collapse
Affiliation(s)
- G P Fadini
- Department of Medicine, University of Padova, 35128 Padova, Italy.
| | - G Zatti
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | - A Consoli
- Department of Medicine and Aging Science, "G. D'Annunzio" University of Chieti, 68100 Chieti, Italy
| | - E Bonora
- Department of Medicine, University of Verona, 37154 Verona, Italy
| | - G Sesti
- Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | - A Avogaro
- Department of Medicine, University of Padova, 35128 Padova, Italy
| |
Collapse
|
37
|
Bigoni M, Zatti G, Zanchi N, Anghilieri FM, Riva MA. Treatment of hip fracture of Pope Innocent XII by Marcello Malpighi with bed rest. Int Orthop 2017; 42:437-440. [PMID: 29119295 DOI: 10.1007/s00264-017-3669-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 10/09/2017] [Indexed: 11/24/2022]
Abstract
Marcello Malpighi (1628-1694), who is referred to as the father of microscopical anatomy, histology, physiology and embryology was an Italian biologist and physician, well known for his discoveries on microscopical anatomy of kidney, circulating and lymphatic systems. As well as being a brilliant anatomist, Malpighi was also a valued physician so far as to became the personal physician of Pope Innocent XII (1615-1700). On 23 August 1691, one month after his election, the Pope fell to the ground hitting his left hip. Malpighi, as his personal physician, was immediately called and diagnosed a hip fracture. At that time fractures were generally treated by surgeons, barbers and sawbones, while physicians were mainly concerned with internal diseases. Despite that, Marcello Malpighi cured Pope Innocent XII's hip fracture by applying some modern traumatologic concepts. This article analyses how Malpighi treated this hip fracture, comparing it with the current approach.
Collapse
Affiliation(s)
- Marco Bigoni
- School of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900, Monza, Italy.,Orthopaedics Clinic, San Gerardo Hospital, Monza, Italy
| | - Giovanni Zatti
- School of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900, Monza, Italy.,Orthopaedics Clinic, San Gerardo Hospital, Monza, Italy
| | - Nicolò Zanchi
- School of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900, Monza, Italy.,Orthopaedics Clinic, San Gerardo Hospital, Monza, Italy
| | - Filippo Maria Anghilieri
- School of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900, Monza, Italy
| | - Michele A Riva
- School of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900, Monza, Italy.
| |
Collapse
|
38
|
Monticone M, Ambrosini E, Brunati R, Capone A, Pagliari G, Secci C, Zatti G, Ferrante S. How balance task-specific training contributes to improving physical function in older subjects undergoing rehabilitation following hip fracture: a randomized controlled trial. Clin Rehabil 2017; 32:340-351. [PMID: 28805094 DOI: 10.1177/0269215517724851] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the efficacy of a rehabilitation programme including balance task-specific training in improving physical function, pain, activities of daily living (ADL), balance and quality of life in subjects after a hip fracture. DESIGN Randomized controlled trial. SUBJECTS A total of 52 older subjects selected for internal fixation due to extra-capsular hip fracture were randomized to be included in an experimental ( n = 26) and control group ( n = 26). INTERVENTIONS The experimental group underwent a rehabilitation programme based on balance task-specific training. The control group underwent general physiotherapy, including open kinetic chain exercises and walking training. Both groups individually followed programmes of 90-minute sessions five times/week for three weeks. OUTCOME MEASURES The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a Pain Numerical Rating Scale, the Berg Balance Scale, the Functional Independence Measure and the 36-item Short-Form Health Survey. The participants were evaluated before and after training, and after 12 months. RESULTS Significant effects of time, group and time × group were found for all outcome measures in favour of the experimental group. A clinically important between-group difference of 25 points was achieved after training and at follow-up in terms of the primary outcome (WOMAC function before treatment, after treatment and at follow-up was 84.8 (3.7), 39.8 (4.9) and 35.7 (6.2) for the experimental group and 80.9 (5.7), 65.2 (7.1) and 61.0 (11.1) for the control group). CONCLUSION An inpatient rehabilitation programme based on balance task-specific training is useful in improving physical function, pain, ADL and quality of life in older patients after hip fracture.
Collapse
Affiliation(s)
- Marco Monticone
- 1 Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,2 Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Clinical and Scientific Institutes Maugeri, Institute of Care and Research (IRCCS), Lissone, Italy
| | - Emilia Ambrosini
- 3 Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Roberto Brunati
- 2 Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Clinical and Scientific Institutes Maugeri, Institute of Care and Research (IRCCS), Lissone, Italy
| | - Antonio Capone
- 4 Orthopaedic Unit, Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Giulia Pagliari
- 2 Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Clinical and Scientific Institutes Maugeri, Institute of Care and Research (IRCCS), Lissone, Italy
| | - Claudio Secci
- 5 Physical Medicine and Rehabilitation School, University of Cagliari, Cagliari, Italy
| | - Giovanni Zatti
- 6 University of Milano-Bicocca, Milan, Italy.,7 Orthopaedics Unit, San Gerardo Hospital, Monza, Italy
| | - Simona Ferrante
- 3 Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| |
Collapse
|
39
|
Zanchi N, Zatti G, Munegato D, Riva MA. Pulcinella's secret. Further hypotheses on the etiology of the double hump in an Italian 16th-century mask. Eur J Intern Med 2016; 35:e34-e35. [PMID: 27212449 DOI: 10.1016/j.ejim.2016.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 11/21/2022]
Affiliation(s)
- Nicolò Zanchi
- Orthopedics Clinic, San Gerardo Hospital, Monza, Italy
| | - Giovanni Zatti
- Orthopedics Clinic, San Gerardo Hospital, Monza, Italy; School of Medicine and Surgery, University of Milano Bicocca, via Cadore, 48, IT-20900 Monza, Italy
| | | | - Michele Augusto Riva
- School of Medicine and Surgery, University of Milano Bicocca, via Cadore, 48, IT-20900 Monza, Italy.
| |
Collapse
|
40
|
Munegato D, Bigoni M, Gridavilla G, Olmi S, Cesana G, Zatti G. Sports hernia and femoroacetabular impingement in athletes: A systematic review. World J Clin Cases 2015; 3:823-830. [PMID: 26380829 PMCID: PMC4568531 DOI: 10.12998/wjcc.v3.i9.823] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 04/02/2015] [Accepted: 07/08/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the association between sports hernias and femoroacetabular impingement (FAI) in athletes.
METHODS: PubMed, MEDLINE, CINAHL, Embase, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched for articles relating to sports hernia, athletic pubalgia, groin pain, long-standing adductor-related groin pain, Gilmore groin, adductor pain syndrome, and FAI. The initial search identified 196 studies, of which only articles reporting on the association of sports hernia and FAI or laparoscopic treatment of sports hernia were selected for systematic review. Finally, 24 studies were reviewed to evaluate the prevalence of FAI in cases of sports hernia and examine treatment outcomes and evidence for a common underlying pathogenic mechanism.
RESULTS: FAI has been reported in as few as 12% to as high as 94% of patients with sports hernias, athletic pubalgia or adductor-related groin pain. Cam-type impingement is proposed to lead to increased symphyseal motion with overload on the surrounding extra-articular structures and muscle, which can result in the development of sports hernia and athletic pubalgia. Laparoscopic repair of sports hernias, via either the transabdominal preperitoneal or extraperitoneal approach, has a high success rate and earlier recovery of full sports activity compared to open surgery or conservative treatment. For patients with FAI and sports hernia, the surgical management of both pathologies is more effective than sports pubalgia treatment or hip arthroscopy alone (89% vs 33% of cases). As sports hernias and FAI are typically treated by general and orthopedic surgeons, respectively, a multidisciplinary approach for diagnosis and treatment is recommended for optimal treatment of patients with these injuries.
CONCLUSION: The restriction in range of motion due to FAI likely contributes to sports hernias; therefore, surgical treatment of both pathologies represents an optimal therapy.
Collapse
|
41
|
Mazzola P, Anzuini A, Picone D, De Filippi F, Dubner L, Bellelli G, Zatti G, Pasinetti GM, Annoni G. Simultaneous bilateral femoral neck fracture and end-stage renal disease in a 76-year-old woman: a case report. Aging Clin Exp Res 2015; 27:555-9. [PMID: 25576255 DOI: 10.1007/s40520-014-0312-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/29/2014] [Indexed: 11/30/2022]
Abstract
Hip fracture is a common occurrence in the elderly. Due to the growing demand for the specific care of these patients, we established the Orthogeriatric Unit (OGU) at San Gerardo University Hospital (Italy) in 2007. However, simultaneous bilateral femoral neck fractures among the geriatric population (those aged ≥65 years) are rarely reported in the literature. Reporting the rare case of a frail 76-year-old woman admitted with bilateral hip fracture and end-stage renal disease, we explain the important role played by the OGU and its flexible multidisciplinary approach for providing comprehensive care to patients with multimorbidity and clinical complexity. The team of geriatricians, orthopedic surgeons, anesthesiologists, and, in this case, a nephrologist, helped in the careful planning and timing of the single-step surgical repair, decided the appropriate type of anesthesia, and optimized outcomes. After a prompt evaluation of the patient, the OGU approach can achieve clinical stabilization prior to intervention. Along with a strict follow-up in the postoperative phase, this could result in a significant reduction of complications and mortality rates and an early start to a tailored rehabilitation process. We strongly suggest employing facilities with multidisciplinary teams for cases involving complex patients at short-term high risk for poor clinical outcomes. Indeed, the usual single-specialist model of care is gradually being abandoned worldwide.
Collapse
Affiliation(s)
- Paolo Mazzola
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA,
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Mazzola P, Perego S, Picone D, Corsi M, Tsiantouli E, De Filippi F, Castoldi G, Bellelli G, Zatti G, Annon G. Hip fracture in centenarians: Retrospective analysis of an orthogeriatric unit reveals the limitations of the current research. ACTA ACUST UNITED AC 2015. [DOI: 10.15761/gapm.1000118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
43
|
Bellelli G, Mazzola P, Morandi A, Bruni A, Carnevali L, Corsi M, Zatti G, Zambon A, Corrao G, Olofsson B, Gustafson Y, Annoni G. Duration of Postoperative Delirium Is an Independent Predictor of 6-Month Mortality in Older Adults After Hip Fracture. J Am Geriatr Soc 2014; 62:1335-40. [DOI: 10.1111/jgs.12885] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Giuseppe Bellelli
- Department of Health Sciences; University of Milano-Bicocca; Milan Italy
- Geriatric Unit; S. Gerardo Hospital; Monza Italy
- Geriatric Research Group; Brescia Italy
| | - Paolo Mazzola
- Department of Health Sciences; University of Milano-Bicocca; Milan Italy
| | - Alessandro Morandi
- Geriatric Research Group; Brescia Italy
- Department of Rehabilitation and Aged Care; Ancelle Hospital; Cremona Italy
| | | | - Lucio Carnevali
- Department of Health Sciences; University of Milano-Bicocca; Milan Italy
| | | | - Giovanni Zatti
- Department of Surgery; University of Milano-Bicocca; Milan Italy
- Orthopaedic Unit; S. Gerardo Hospital; Monza Italy
| | - Antonella Zambon
- Unit of Biostatistics, Epidemiology and Public Health; Department of Statistics and Quantitative Methods; University of Milano-Bicocca; Milan Italy
| | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health; Department of Statistics and Quantitative Methods; University of Milano-Bicocca; Milan Italy
| | | | - Yngve Gustafson
- Division of Geriatric Medicine; Department of Community Medicine and Rehabilitation; Umeå University; Umeå Sweden
| | - Giorgio Annoni
- Department of Health Sciences; University of Milano-Bicocca; Milan Italy
| |
Collapse
|
44
|
Monticone M, Ambrosini E, Rocca B, Lorenzon C, Ferrante S, Zatti G. Task-oriented exercises and early full weight-bearing contribute to improving disability after total hip replacement: a randomized controlled trial. Clin Rehabil 2014; 28:658-68. [DOI: 10.1177/0269215513519342] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 12/14/2013] [Indexed: 01/22/2023]
Abstract
Objective: To evaluate the efficacy of an in-hospital programme based on task-oriented exercises associated with early full weight-bearing in patients with multiple comorbidities undergoing total hip replacement. Design: Randomized controlled trial. Setting: Specialised rehabilitation centre. Subjects: A total of 100 patients (mean age of 69 (8) years; 40 males, 60 females). Interventions: The experimental group underwent task-oriented exercises and was encouraged to abandon any walking aids by the end of their in-hospital stay. The control group underwent open chain kinetic exercises, and was recommended to use partial weight-bearing and walking aids until three months after surgery. Both groups individually followed programmes of 90-minute sessions five times a week for three weeks. Outcome measures: Western Ontario and McMaster Universities Osteoarthritis Index, Pain Numerical Rating Scale, Functional Independence Measure, and Short-Form Health Survey. The participants were evaluated before, after training, and after a further 12 months. Results: There were no significant between-group differences at baseline. After training, a between-group difference of 12 points was found for the Western Ontario and McMaster Universities Osteoarthritis Index – functional subscale, indicating a clinically tangible treatment effect on disability. The Functional Independence Measure increased by 31 and 15 points in the experimental and control group, respectively. A linear mixed model revealed significant effects of time, group, and time by group interaction on disability, pain, activities of daily living, and most of the physical quality of life domains. Conclusion: Task-oriented exercises associated with early full weight-bearing improve disability, pain, activities of daily living, and quality of life after total hip replacement.
Collapse
Affiliation(s)
- Marco Monticone
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone Salvatore Maugeri Foundation IRCCS, Monza Brianza, Italy
| | - Emilia Ambrosini
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone Salvatore Maugeri Foundation IRCCS, Monza Brianza, Italy
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information, and Bioengineering Politecnico di Milano, Milan, Italy
| | - Barbara Rocca
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone Salvatore Maugeri Foundation IRCCS, Monza Brianza, Italy
| | - Chiara Lorenzon
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone Salvatore Maugeri Foundation IRCCS, Monza Brianza, Italy
| | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information, and Bioengineering Politecnico di Milano, Milan, Italy
| | - Giovanni Zatti
- Bicocca University of Milan, Milan, Italy
- Orthopaedics Unit, San Gerardo Hospital, Monza Brianza, Italy
| |
Collapse
|
45
|
Abstract
Osseointegration is a term that refers to the formation of a direct interface between an implant and bone without intervening soft tissue. Cementless femoral fixation in total hip arthroplasty is dependent on mechanical and biological factors that affect implant stability and long-term outcome. Osteoporosis leads to morphological and biological alterations in the proximal femur that adversely affect both mechanical stability of implant and biological response of bone, making it more challenging to achieve a valid osseointegration.
Collapse
Affiliation(s)
- G Piarulli
- Azienda Ospedaliera San Gerardo, Università degli Studi di Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, Italy,
| | | | | |
Collapse
|
46
|
Mazzola P, Broggini V, Anzuini A, Corsi M, Berruti D, Bonaiuti D, Zatti G, Bellelli G, Annoni G. Postoperative delirium and pre-fracture disability predict 6-month mortality among the oldest old orthogeriatric patients. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
47
|
Cattoni A, Cazzaniga G, Perseghin P, Zatti G, Gaddi D, Cossio A, Biondi A, Corti P, Masera N. An Attempt to Induce Transient Immunosuppression Pre-erythrocytapheresis in a Girl With Sickle Cell Disease, a History of Severe Delayed Hemolytic Transfusion Reactions and Need for Hip Prosthesis. Hematol Rep 2013; 5:36-8. [PMID: 23888247 PMCID: PMC3719100 DOI: 10.4081/hr.2013.e11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/19/2013] [Accepted: 06/21/2013] [Indexed: 11/25/2022] Open
Abstract
Abstract We report on a case of delayed hemolytic transfusion reaction (DHTR) occurred 7 days after an erythrocytapheresis or eritroexchange procedure (EEX) treated with rituximab and glucocorticoids in a 15-years old patient with sickle cell disease. EEX was performed despite a previous diagnosis of alloimmunization, in order to reduce hemoglobin S rate before a major surgery for avascular necrosis of the femoral head. A first dose of rituximab was administered before EEX. However, rituximab couldn’t prevent DHTR that occurred with acute hemolysis, hemoglobinuria and hyperbilirubinemia. A further dose of rituximab and three boli of methylprednisolone were given after the onset of the reaction. It is likely that the combined use of rituximab and steroids managed to gradually improve both patient’s general conditions and hemoglobin levels. Nor early or late side effects were registered in a 33-months follow-up period. This report suggests the potential effectiveness and safety of rituximab in combination with steroids in managing and mitigating the symptoms of delayed post-transfusional hemolytic reactions in alloimmunized patients affected by sickle cell disease with absolute need for erythrocytapheresis.
Collapse
|
48
|
D'Angelo F, Negri L, Binda T, Zatti G, Cherubino P. The use of a preformed spacer in two-stage revision of infected hip arthroplasties. Musculoskelet Surg 2011; 95:115-120. [PMID: 21479729 DOI: 10.1007/s12306-011-0128-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 03/24/2011] [Indexed: 05/30/2023]
Abstract
Two-stage revision with the use of an antibiotic-loaded cement spacer has spread widely as a successful treatment for THA infection. Between 1999 and 2008, 28 patients with infected THA were treated with two-stage implant revision using a preformed spacer. The spacer was left in situ for 5.5 months (range 1-13 months), and the patients were allowed to walk with partial weight bearing. At a mean follow-up of 53 months (range 18-106 months), recurrence of infection was observed in only one patient. Complications were observed in five patients: three spacer dislocations, one distal femoral fracture occurred during stem removal, and one femoral artery pseudo-aneurysm. The mean HHS increased from 43 points (range 13-77) to 82 points (range 35-96). Though small prospective studies are reported in literature, good eradication rate and good functional outcomes encourage for the use of an antibiotic-loaded cement spacer. The industrial production ensures procedure standardization, well-defined physical and chemical properties to the device and eliminates time necessary to intraoperatory manufacturing.
Collapse
Affiliation(s)
- F D'Angelo
- Department of Orthopaedic and Traumatologic Sciences, University of Insubria, Varese, Italy.
| | | | | | | | | |
Collapse
|
49
|
D'Angelo F, Murena L, Vulcano E, Zatti G, Cherubino P. Seven to twelve year results with Versys ET cementless stem. A retrospective study of 225 cases. Hip Int 2010; 20:81-6. [PMID: 20235069 DOI: 10.1177/112070001002000112] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2009] [Indexed: 02/04/2023]
Abstract
A retrospective review was conducted to evaluate the mid-term results (8.5 years follow-up) of the Versys ET stem (Zimmer, Warsaw, Indiana, USA). From 1995 to 2000, 225 total hip arthroplasties (THA) were performed using this device. All patients were evaluated clinically by the Harris Hip Score, and radiographically. The Hip Score increased from 54 preoperatively to 97 points postoperatively. The stem displayed a varus alignment between 5 degrees and 10 degrees in 17 cases without any clinical consequences (HHS 96.8). We recorded one case of septic loosening and one case of aseptic loosening. The stability of the stem was radiographically evaluated according to Engh's criteria, confirming bone ongrowth in all other cases.
Collapse
Affiliation(s)
- Fabio D'Angelo
- Department of Orthopaedics and Traumatology "M. Boni", Università dell'Insubria, Varese, Italy.
| | | | | | | | | |
Collapse
|
50
|
Salvadè A, Della Mina P, Gaddi D, Gatto F, Villa A, Bigoni M, Perseghin P, Serafini M, Zatti G, Biondi A, Biagi E. Characterization of platelet lysate cultured mesenchymal stromal cells and their potential use in tissue-engineered osteogenic devices for the treatment of bone defects. Tissue Eng Part C Methods 2010; 16:201-14. [PMID: 19469694 DOI: 10.1089/ten.tec.2008.0572] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Mesenchymal stromal cells (MSCs), seeded onto a scaffold and associated with platelet-gel, may represent an innovative treatment to improve bone repair. The preparation of MSCs for clinical use requires the fulfillment of Good Manufacturing Practice indications. The aim of this study was to validate a Good Manufacturing Practice-grade protocol of tissue engineering for bone regeneration, seeding platelet lysate (PL)-cultured MSCs onto an hydroxyapatite clinical-grade scaffold. Six large-scale experiments were performed. MSC expansions were performed comparing fetal bovine serum 10% and PL 5%. We demonstrated that PL lots contain high levels of growth factors possibly responsible of accelerated growth rate, since the number of colony-forming unit-fibroblast and population doublings were always significantly higher in PL cultures. MSCs were characterized for their phenotype and multilineage differentiation capacity, demonstrating appropriate features for both conditions. Gene expression analysis revealed higher expression of typical osteogenic genes of PL-cultured MSCs, when compared to fetal bovine serum MSCs. Cell transformation was excluded by analysis of karyotype, absence of growth without anchorage, and p53/c-myc gene expression. Scaffolds were precoated with retronectin before MSC seeding. MSC adhesion, distribution, and proliferation were demonstrated through the whole surface of the scaffold by scanning electron microscopy analysis or by immunofluorescence and MSC osteogenic differentiation through quantitative reverse transcriptase-polymerase chain reaction of typical osteogenic genes. The present report offers a model of an MSC-based bioengineered device, using an hydroxyapatite clinical-grade scaffold, and supports its potential use in tissue engineering to repair bone defects.
Collapse
Affiliation(s)
- Agnese Salvadè
- Laboratory of Cell Therapy Stefano Verri, Pediatric Department, Matilde Tettamanti Research Center, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|