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Aprato A, Branca Vergano L, Casiraghi A, Liuzza F, Mezzadri U, Balagna A, Prandoni L, Rohayem M, Sacchi L, Smakaj A, Arduini M, Are A, Battiato C, Berlusconi M, Bove F, Cattaneo S, Cavanna M, Chiodini F, Commessatti M, Addevico F, Erasmo R, Ferreli A, Galante C, Giorgi PD, Lamponi F, Moghnie A, Oransky M, Panella A, Pascarella R, Santolini F, Schiro GR, Stella M, Zoccola K, Massé A. Consensus for management of sacral fractures: from the diagnosis to the treatment, with a focus on the role of decompression in sacral fractures. J Orthop Traumatol 2023; 24:46. [PMID: 37665518 PMCID: PMC10477162 DOI: 10.1186/s10195-023-00726-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND There is no evidence in the current literature about the best treatment option in sacral fracture with or without neurological impairment. MATERIALS AND METHODS The Italian Pelvic Trauma Association (A.I.P.) decided to organize a consensus to define the best treatment for traumatic and insufficiency fractures according to neurological impairment. RESULTS Consensus has been reached for the following statements: When complete neurological examination cannot be performed, pelvic X-rays, CT scan, hip and pelvis MRI, lumbosacral MRI, and lower extremities evoked potentials are useful. Lower extremities EMG should not be used in an acute setting; a patient with cauda equina syndrome associated with a sacral fracture represents an absolute indication for sacral reduction and the correct timing for reduction is "as early as possible". An isolated and incomplete radicular neurological deficit of the lower limbs does not represent an indication for laminectomy after reduction in the case of a displaced sacral fracture in a high-energy trauma, while a worsening and progressive radicular neurological deficit represents an indication. In the case of a displaced sacral fracture and neurological deficit with imaging showing no evidence of nerve root compression, a laminectomy after reduction is not indicated. In a patient who was not initially investigated from a neurological point of view, if a clinical investigation conducted after 72 h identifies a neurological deficit in the presence of a displaced sacral fracture with nerve compression on MRI, a laminectomy after reduction may be indicated. In the case of an indication to perform a sacral decompression, a first attempt with closed reduction through external manoeuvres is not mandatory. Transcondylar traction does not represent a valid method for performing a closed decompression. Following a sacral decompression, a sacral fixation (e.g. sacroiliac screw, triangular osteosynthesis, lumbopelvic fixation) should be performed. An isolated and complete radicular neurological deficit of the lower limbs represents an indication for laminectomy after reduction in the case of a displaced sacral fracture in a low-energy trauma associated with imaging suggestive of root compression. An isolated and incomplete radicular neurological deficit of the lower limbs does not represent an absolute indication. A worsening and progressive radicular neurological deficit of the lower limbs represents an indication for laminectomy after reduction in the case of a displaced sacral fracture in a low-energy trauma associated with imaging suggestive of root compression. In the case of a displaced sacral fracture and neurological deficit in a low-energy trauma, sacral decompression followed by surgical fixation is indicated. CONCLUSIONS This consensus collects expert opinion about this topic and may guide the surgeon in choosing the best treatment for these patients. LEVEL OF EVIDENCE IV. TRIAL REGISTRATION not applicable (consensus paper).
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Affiliation(s)
- Alessandro Aprato
- Università degli studi di Torino, Viale 25 Aprile 137 Int 6, 10133, Turin, Italy.
| | | | | | | | - Umberto Mezzadri
- ASST Grande Ospedale Metropolitano Niguarda di Milano, Milan, Italy
| | - Alberto Balagna
- Università degli studi di Torino, Viale 25 Aprile 137 Int 6, 10133, Turin, Italy
| | | | | | | | | | | | | | | | | | - Federico Bove
- ASST Grande Ospedale Metropolitano Niguarda di Milano, Milan, Italy
| | | | | | | | | | | | - Rocco Erasmo
- Ospedale Civile Santo Spirito di Pescara, Pescara, Italy
| | | | | | | | | | | | - Michel Oransky
- Università degli studi di Roma, ASST degli spedali Civili di Brescia, Brescia, Italy
| | | | | | | | | | | | | | - Alessandro Massé
- Università degli studi di Torino, Viale 25 Aprile 137 Int 6, 10133, Turin, Italy
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Aprato A, Cipolla A, D'Amelio A, Branca Vergano L, Giaretta S, Massè A. Isolated greater trochanter fractures. Acta Biomed 2023; 94:e2023094. [PMID: 37366186 DOI: 10.23750/abm.v94is2.13815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/16/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Isolated fractures of the greater trochanter (GT) in adults are rare injuries and traditionally treated without surgery. The present systematic review was designed to examine the treatment protocol for isolated GT fractures and to discover if innovative surgical techniques, such as arthroscopy or suture anchors, can be used to improve outcomes in young active patients. METHODS A systematic review was conducted including all full-text articles suited our inclusion criteria from January 2000 describing treatment protocols of isolated great trochanter fractures confirmed at MRI in adults. RESULTS The searches identified a total of 247 patients from 20 studies with a mean age 56.1 years and mean follow-up 13,7 months. Only 4 case report treated 4 patients with not unique surgical strategy. The rest of the patients were treated conservatively. DISCUSSION Most trochanteric fractures can heal without surgical intervention with good results However, the patient must not immediately bear full weight and the abductor's function could decrease. Displaced GT fragments more than 2 cm or athletes, young, demanding patients may benefit from surgical fixation to regain abductor function and strength. Evidence-based surgical strategies could be provided by arthroplasty and periprosthetic literature. CONCLUSION The grade of fracture displacement and the physical demands of the athlete can be important factors in the decision process for or against surgery. By now, no evidence-based guideline exists for the ideal treatment method in demanding patients. It is necessary use a "patient-specific" treatment strategy.
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Aprato A, Nardi M, Arduini M, Bove F, Branca Vergano L, Capitani D, Casiraghi A, Cavanna M, Cominetti G, Commessatti M, Favuto M, Ferreli A, Fino A, Gulli S, Lamponi F, Massè A, Mezzadri U, Monesi M, Oransky M, Pannella A, Santolini F, Stella M, Tigani D, Zoccola K, Rocca G. Italian Consensus Conference on Guidelines for preoperative treatment in acetabular fractures. Acta Biomed 2021; 92:e2021290. [PMID: 34487106 PMCID: PMC8477087 DOI: 10.23750/abm.v92i4.9856] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/30/2020] [Indexed: 11/25/2022]
Abstract
Preoperative management of acetabular fracture is a major problem and no consensus has been reached in literature on the optimal treatment of this problem. We present the results of the First Italian Consensus Conference on Acetabular fracture. An extensive review of the literature has been undertaken by the organizing committee and forwarded to the panel. Members were appointed by surgical experience with acetabular fractures. From November 2017 to January 2018, the organizing committee undertook the critical revision and prepared the presentation to the Panel on the day of the Conference. Then 11 recommendations were presented according to the 11 submitted questions. The Panel voted the recommendations after discussion and amendments with the audience. Later on, a second debate took place in September 2018 to reach a unanimous consent. We present results of the following questions: does hip dislocation require reduction? Should hip reduction be performed as soon as possible? In case of unsuccessful reduction of the dislocation after attempts in the emergency department, how should it be treated? If there is any tendency toward renewed dislocation, how should it be treated? Should Computed Tomography (CT) scan be performed before reduction? Should traction be used? How can we treat the pain? Is preoperative ultrasound exam to rule out vein thrombosis always necessary? Is tranexamic acid intravenous (IV) preoperatively recommended? Which antibiotic prophylactic protocols should be used? Is any preoperative heterotopic ossification prophylaxis suggested? In this article we present the indications of the First Italian Consensus Conference: a hip dislocation should be reduced as soon as possible. If unsuccessful, surgeon may repeat the attempts optimizing the technique. Preoperative CT scan is not mandatory before reduction. Skeletal traction is not indicated in most of the acetabular fracture. Standard pain and antibiotic prophylactic protocols for trauma patient should be used. Preoperative ultrasound exam is not recommended in all acetabular fracture. Tranexamic acid should be preoperatively used. There is no indication for preoperative heterotopic ossification.
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Affiliation(s)
| | - Michele Nardi
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino.
| | - Mario Arduini
- Policlinico Tor Vergata, Viale Oxford, 81, 00133, Roma.
| | | | | | | | | | | | - Gabriele Cominetti
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino.
| | | | - Marco Favuto
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino.
| | | | - Alberto Fino
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino.
| | | | | | - Alessandro Massè
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino.
| | | | | | | | | | | | | | | | - Kristijan Zoccola
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino.
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Branca Vergano L, Prezioso V, Monesi M. Intramedullary cortical fragment in tibial nailing: push it, remove it or ignore it? Acta Biomed 2021; 92:e2021012. [PMID: 34313669 PMCID: PMC8420818 DOI: 10.23750/abm.v92is3.11714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022]
Abstract
Intramedullary nailing of long bones is a safe procedure, with excellent long-term results. Even in apparently simple fractures, many complications may arise. Incarceration of a cortical fragment in the medullary canal is a fearsome situation, which may lead to severe complications and, consequently, poor outcomes. The surgeon should be aware of this risk and, after careful analysis of the pre-operative imaging, must remove or, at least, disengage the fragment from the medullary canal. (www.actabiomedica.it)
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Di Bari S, Bisulli M, Russo E, Bissoni L, Martino C, Branca Vergano L, Santonastaso DP, Ranieri VM, Agnoletti V. Preoperative vena cava filter placement in recurrent cerebral fat embolism following traumatic multiple fractures. Scand J Trauma Resusc Emerg Med 2021; 29:86. [PMID: 34193211 PMCID: PMC8243467 DOI: 10.1186/s13049-021-00906-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Silvia Di Bari
- Anesthesia and Intensive Care Department, Alma Mater Studiorum - Università di Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti, 9, 40138, Bologna, Italy.
| | - Marcello Bisulli
- Interventional Radiology Department, AUSL Romagna Trauma Center "Maurizio Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Emanuele Russo
- Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center "Maurizio Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Luca Bissoni
- Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center "Maurizio Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Costanza Martino
- Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center "Maurizio Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Luigi Branca Vergano
- Orthopedics and Traumatology Department, AUSL Romagna Trauma Center "Maurizio Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Domenico Pietro Santonastaso
- Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center "Maurizio Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Vito Marco Ranieri
- Anesthesia and Intensive Care Department, Alma Mater Studiorum - Università di Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti, 9, 40138, Bologna, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center "Maurizio Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
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Cacciola G, Aprato A, Branca Vergano L, Sallam A, Masse A. Is non-operative management of acetabular fracture a viable option for older patients? A systematic review of the literature for indication, treatments, complications and outcome. Acta Biomed 2021; 92:e2021555. [PMID: 35604268 PMCID: PMC9437683 DOI: 10.23750/abm.v92is3.12544] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/02/2021] [Indexed: 11/26/2022]
Abstract
There is no consensus about the best treatment for acetabular fracture in older patients. The purpose of this study was to review the current literature looking for indication, perioperative information and outcome of nonoperative management for acetabular fractures in elderly.A systematic review of literature was performed on different research database by using various combination of the keywords "acetabular fracture", "elderly patients", "60 years", "nonoperative", "nonsurgical" and "conservative treatment".Six articles met our inclusion criteria, 315 patients aged 60 or more treated nonoperatively for acetabular fracture were included in the analysis. The average age was 78.1 years, the average follow-up length was 48.7 months. The main criteria for indication of nonoperative management for acetabular fractures were, old age (75 years or more), two or more important medical comorbidities, and minimally or undisplaced fracture. The most frequent fracture pattern was anterior column in 25.3% of cases. Fall from standard height was the most frequent causative mechanism in 80% of patients. A conversion total hip arthroplasty was performed after 8.3% of cases. A 1-year mortality of 18% was reported, an overall mortality of 33.1% at last follow-up was reported.The management of acetabular fractur in elderly is a challenging problem and there is no consensus about the best treatment. Currently, multiple treatment options have been suggested, depending on fracture pattern and patients' general conditions. Although operatively treatment allow for an early recovery, there is not an high level of evidence about the superiority in terms or complications and mortality rate compared to nonoperative treatment.
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Affiliation(s)
- Giorgio Cacciola
- University of Turin, Department of Orthopaedic Surgery, C.T.O., Turin, Italy
| | - Alessandro Aprato
- University of Turin, Department of Orthopaedic Surgery, C.T.O., Turin, Italy
| | | | - Adel Sallam
- University of Turin, Department of Orthopaedic Surgery, C.T.O., Turin, Italy
| | - Alessandro Masse
- University of Turin, Department of Orthopaedic Surgery, C.T.O., Turin, Italy
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Branca Vergano L, Florio EF, Prezioso V, Monesi M, Landi S. Suprapatellar nail removal after suprapatellar nailing of the tibia: it could work! Acta Biomed 2021; 92:e2021559. [PMID: 35604263 PMCID: PMC9437694 DOI: 10.23750/abm.v92is3.12548] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Intramedullary nailing is a fundamental tool for the treatment of meta-diaphyseal tibia fractures. While, in the past, the infrapatellar approach was the only one available, over the last few years, an alternative approach has been developed: the suprapatellar tibial nailing. This technique has shown some advantages over the other one. However, as the most recent method has become increasingly more common, concerns have been put forward about the possibility to remove the nail using only the infrapatellar approach, thus incising the previously unviolated patellar tendon. The aim of our study is to describe the technique and the results of a suprapatellar approach to remove the nail. METHODS We describe the surgical technique used to remove the tibial nail via the suprapatellar approach. We analyze a small case series of 12 patients who underwent the operation of nail removal, analyzing operation time, intraoperative and/or postoperative complications and clinical outcomes. RESULTS The mean duration of the operation was 39.8 minutes. The difference between the two values of the Lysholm score (pre- and postoperative) in each patient was not statistically significant, ranging between -2 to +4 points. We did not observe any intraoperative or postoperative complications. CONCLUSIONS After suprapatellar nailing of the tibia, it is possible to remove the nail using the same suprapatellar approach with a safe, easy and reproducible technique. The clinical results observed in our case series show excellent outcomes in terms of absence of complications and good functional knee score.
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Affiliation(s)
- Luigi Branca Vergano
- Department of Orthopaedics and Traumatology, Santa Chiara Hospital, Trento (TN), Italy
| | | | - Vito Prezioso
- Department of Orthopaedics and Traumatology, Bufalini Hospital, Cesena (FC), Italy
| | - Mauro Monesi
- Department of Orthopaedics and Traumatology, Bufalini Hospital, Cesena (FC), Italy
| | - Stefano Landi
- Department of Orthopaedics and Traumatology, Infermi Hospital, Rimini (RN); Italy
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Branca Vergano L, Coviello G, Monesi M. Rotational malalignment in femoral nailing: prevention, diagnosis and surgical correction. Acta Biomed 2020; 91:e2020003. [PMID: 33559631 PMCID: PMC7944689 DOI: 10.23750/abm.v91i14-s.10725] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/19/2020] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: to review and discuss the literature about rotational malalignment during and after femoral nailing. Methods: analysis of the literature on prevention and evaluation of rotation during femoral nailing, clinical and subjective consequences of malrotation and techniques used to correct the deformity, both in the acute and chronic phase. Results: malrotation is very common after femoral nailing. The exact definition of a malrotated femur is controversial, but it is widely agreed that a rotational malalignment <10° is considered normal while >30° is a deformity which requires correction. The complaints of the patients with a malrotated femur can be various and can involve the hip, the knee or below the knee. The ability to compensate for the deformity while standing and walking may decrease the symptoms. Surgical correction is feasible with many techniques and devices: the procedure involving derotation, changing the locking screws and maintaining the nail is safe, reproducible and relatively easy. Conclusions: prevention of malrotation during femoral nailing is the cornerstone of successful operation outcomes. If rotational malalignment is suspected, prompt diagnosis and adequate surgical treatment are mandatory to overcome this common complication. (www.actabiomedica.it)
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Coccolini F, Improta M, Picetti E, Vergano LB, Catena F, de ’Angelis N, Bertolucci A, Kirkpatrick AW, Sartelli M, Fugazzola P, Tartaglia D, Chiarugi M. Timing of surgical intervention for compartment syndrome in different body region: systematic review of the literature. World J Emerg Surg 2020; 15:60. [PMID: 33087153 PMCID: PMC7579897 DOI: 10.1186/s13017-020-00339-8] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/07/2020] [Indexed: 12/28/2022] Open
Abstract
Compartment syndrome can occur in many body regions and may range from homeostasis asymptomatic alterations to severe, life-threatening conditions. Surgical intervention to decompress affected organs or area of the body is often the only effective treatment, although evidences to assess the best timing of intervention are lacking. Present paper systematically reviewed the literature stratifying timings according to the compartmental syndromes which may beneficiate from immediate, early, delayed, or prophylactic surgical decompression. Timing of decompression have been stratified into four categories: (1) immediate decompression for those compartmental syndromes whose missed therapy would rapidly lead to patient death or extreme disability, (2) early decompression with the time burden of 3-12 h and in any case before clinical signs of irreversible deterioration, (3) delayed decompression identified with decompression performed after 12 h or after signs of clinical deterioration has occurred, and (4) prophylactic decompression in those situations where high incidence of compartment syndrome is expected after a specific causative event.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100 Pisa, Italy
| | - Mario Improta
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | | | - Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Nicola de ’Angelis
- Unit of Digestive and Hepato-biliary-pancreatic Surgery, Henri Mondor Hospital and University Paris-Est Créteil (UPEC), Créteil, France
| | - Andrea Bertolucci
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100 Pisa, Italy
| | - Andrew W. Kirkpatrick
- Departments of Surgery and Critical Care Medicine, Foothills Medical Centre, Calgary, Canada
| | | | - Paola Fugazzola
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Dario Tartaglia
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100 Pisa, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100 Pisa, Italy
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Branca Vergano L, Corsini G, Monesi M. Long head of biceps in proximal fractures of the humerus: an underestimated problem? Acta Biomed 2020; 91:69-78. [PMID: 32555078 PMCID: PMC7944844 DOI: 10.23750/abm.v91i4-s.9634] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 11/25/2022]
Abstract
Background and aim of the work: The long head of biceps (LHB) is one of the tendons of the rotator cuff that runs strictly close to the humeral head. In case of pathology, it can be responsible for pain and shoulder impairment: in such cases, surgical options include tenotomy or tenodesis. The management of LHB along with surgery of the rotator cuff or during shoulder prosthetic replacement has been widely discussed in the literature. Conversely, the possibility of acute impingement and incarceration of LHB in proximal humerus fractures, as well as its role in shoulder pain in outcomes of these fractures, has been poorly considered. Methods: The following aspects in the literature on LHB and proximal humerus fractures have been analysed: its management during fixation of fractures, the possibility of interference of the tendon with reduction of fractures or dislocations of the shoulder and its possible role in chronic pain after fixation of proximal humerus fractures. Results: LHB can be an obstacle in the reduction of fractures, dislocations and fracture-dislocations. Only a few papers take into account acute surgery to LHB (tenotomy or tenodesis); most of the studies on fixation of proximal humerus fractures simply ignore the problem of LHB. The tendon can be a source of pain and a cause of disability in sequelae of these fractures. Conclusions: LHB should be taken into consideration both in the acute phase of fractures of the proximal humerus and in the outcomes. Other studies are needed to better understand its optimal management during fracture surgery. (www.actabiomedica.it)
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Affiliation(s)
| | | | - Mauro Monesi
- Ortopedia e traumatologia Ospedale M. Bufalini, Cesena (FC).
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Abstract
BACKGROUND AND AIM OF THE WORK To describe a valid option for the treatment of locked posterior fracture-dislocation of the shoulder (LPFDS) and to compare it to the literature about this topic. METHODS We present a small case series (3 patients), with a medium follow up at 4 years and 5 months. We accurately describe our surgical strategies, underlining the choice of approach, reduction and fixation. RESULTS The three patients showed excellent functional and radiological results at the follow up examinations, with a full range of shoulder movements and complete regain of pre-trauma activities. A lateral approach (standard or minimally invasive), a reduction technique with a Shantz pin in the head and in the humeral shaft, and fixation with a locking plate were used in the three patients. CONCLUSION LPFDS is a challenging lesion, hard to recognize and to treat. Our suggested method of treatment is highly reproducible and has revealed itself to be very effective in achieving good results.
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Aprato A, Olivero M, Branca Vergano L, Massè A. Outcome of cages in revision arthroplasty of the acetabulum: a systematic review. Acta Biomed 2019; 90:24-31. [PMID: 30714995 PMCID: PMC6503392 DOI: 10.23750/abm.v90i1-s.8081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIM OF THE WORK To investigate the clinical, radiological and functional outcomes of acetabular revisions with acetabular reinforcement rings and cages. METHODS A comprehensive literature study of international databases was performed. Inclusion criteria were cementless revisions, use of reinforcement rings, radiological and clinical follow-up, availability of full text in English, publication between January 1990 and July 2018. In a second further analysis, we selected only studies describing patients with more severe acetabular defects (AAOS 3, AAOS 4, Paprosky III). Data extracted included mean follow-up period, radiographic follow-up, functional scores, implant failures and survival rate. RESULTS We included in our review 1327 acetabular revisions described in 28 articles. The most commonly used reinforcement rings were Burch-Schneider ring, the Muller ring and the Ganz ring. Mean follow-up for all patients together was 8.8 years. Clinical or radiological signs of loosening were reported in 191 patients, 83 patients needed further acetabular revision for aseptic loosening and 41 patients received additional surgeries for septic loosening. The mean value of the Harris Hip Score reported at the last follow-up was 76.3. Nineteen articles fulfilled the criteria for further analysis about high-grade acetabular bone defects. We analyzed 649 revisions with mean follow-up period of 8.2 years. Clinical or radiological loosening was reported in 90 patients, additional acetabular revision was performed in 39 patients and 25 patients needed further surgeries for deep infection. CONCLUSION Acetabular revisions with cages are characterized by good survival rates and functional scores with a mean follow-up period of 8 years.
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Branca Vergano L, Monesi M. Scapulothoracic dissociation: a devastating "floating shoulder" injury. Acta Biomed 2018; 90:150-153. [PMID: 30715015 PMCID: PMC6503390 DOI: 10.23750/abm.v90i1-s.7857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 11/23/2022]
Abstract
Background and aim of the work The term "floating shoulder" was used in a previous paper to describe lesions of at least two components of the SSSC (superior shoulder suspensory complex), a bony-ligamentous structure of the shoulder girdle. Following this article other types of floating shoulder were described, including scapulothoracic dissociation (STD), a rare lesion with potentially devastating consequences, with detachment of the scapular body from the thoracic wall, with following lateralization of the scapula, fracture of the clavicle or injury of the adiacent sterno-clavear or acromion-clavicular joints. Prognosis and outcome are also negatively influenced by secondary vascular and neurologic injuries. Methods We review the literature on this lesion and we describe two patients with STD, their treatment and outcome. Results Reviewing the literature and analysing our cases, we point out that the STD is often associated with serious general lesions and is indicative of an high-energy trauma. The consequences can be disabling for the upper limb (20% amputation, 50% flail limb) or for the general status of the patient (10% mortality). Conclusions STD must be timely recognized and subsequently properly treated, to avoid the associated general and local injuries (vascular) and subsequently the musculoskeletal lesions.
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Massari L, Benazzo F, Falez F, Cadossi R, Perugia D, Pietrogrande L, Aloj DC, Capone A, D'Arienzo M, Cadossi M, Lorusso V, Caruso G, Ghiara M, Ciolli L, La Cava F, Guidi M, Castoldi F, Marongiu G, La Gattuta A, Dell'Omo D, Scaglione M, Giannini S, Fortina M, Riva A, De Palma PL, Gigante AP, Moretti B, Solarino G, Lijoi F, Giordano G, Londini PG, Castellano D, Sessa G, Costarella L, Barile A, Borrelli M, Rota A, Fontana R, Momoli A, Micaglio A, Bassi G, Cornacchia RS, Castelli C, Giudici M, Monesi M, Branca Vergano L, Maniscalco P, Bulabula M, Zottola V, Caraffa A, Antinolfi P, Catani F, Severino C, Castaman E, Scialabba C, Tovaglia V, Corsi P, Friemel P, Ranellucci M, Caiaffa V, Maraglino G, Rossi R, Pastrone A, Caldora P, Cusumano C, Squarzina PB, Baschieri U, Demattè E, Gherardi S, De Roberto C, Belluati A, Giannini A, Villani C, Persiani P, Demitri S, Di Maggio B, Abate G, De Terlizzi F, Setti S. Can Clinical and Surgical Parameters Be Combined to Predict How Long It Will Take a Tibia Fracture to Heal? A Prospective Multicentre Observational Study: The FRACTING Study. Biomed Res Int 2018; 2018:1809091. [PMID: 29854729 PMCID: PMC5952440 DOI: 10.1155/2018/1809091] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/22/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. METHODS The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. RESULTS 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r = 0.63 (p < 0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. CONCLUSIONS This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings.
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Affiliation(s)
- Leo Massari
- Orthopaedic and Traumatology Department, “S. Anna” Hospital, University of Ferrara, Ferrara, Italy
| | - Francesco Benazzo
- Orthopaedic and Traumatology Department, IRCCS Foundation “San Matteo” Hospital, University of Pavia, Pavia, Italy
| | - Francesco Falez
- Orthopaedic and Traumatology Department, “Santo Spirito in Sassia” Hospital, Rome, Italy
| | - Ruggero Cadossi
- Research and Development, IGEA Clinical Biophysics, Carpi, Modena, Italy
| | - Dario Perugia
- Orthopaedic and Traumatology Department, “Sant'Andrea” Hospital, Rome, Italy
| | - Luca Pietrogrande
- Health Sciences Department, Operative Unit of Orthopaedics and Traumatology, “San Paolo” Hospital, University of Milan, Milan, Italy
| | - Domenico Costantino Aloj
- Orthopaedic, Traumatology and Rehabilitation Department, II Orthopaedics Clinic, CTO Hospital, Torino, Italy
| | - Antonio Capone
- Orthopaedic Department, University of Cagliari, Cagliari, Italy
| | - Michele D'Arienzo
- Orthopaedic and Traumatology Department, “Paolo Giaccone” Hospital, University of Palermo, Palermo, Italy
| | - Matteo Cadossi
- Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
| | - Vincenzo Lorusso
- Orthopaedic and Traumatology Department, “S. Anna” Hospital, University of Ferrara, Ferrara, Italy
| | - Gaetano Caruso
- Orthopaedic and Traumatology Department, “S. Anna” Hospital, University of Ferrara, Ferrara, Italy
| | - Matteo Ghiara
- Orthopaedic and Traumatology Department, IRCCS Foundation “San Matteo” Hospital, University of Pavia, Pavia, Italy
| | - Luigi Ciolli
- Orthopaedic and Traumatology Department, “Santo Spirito in Sassia” Hospital, Rome, Italy
| | - Filippo La Cava
- Orthopaedic and Traumatology Department, “Santo Spirito in Sassia” Hospital, Rome, Italy
| | - Marco Guidi
- Orthopaedic and Traumatology Department, “Sant'Andrea” Hospital, Rome, Italy
| | - Filippo Castoldi
- Orthopaedic, Traumatology and Rehabilitation Department, II Orthopaedics Clinic, CTO Hospital, Torino, Italy
| | | | - Alessandra La Gattuta
- Orthopaedic and Traumatology Department, “Paolo Giaccone” Hospital, University of Palermo, Palermo, Italy
| | - Dario Dell'Omo
- Translational Research on New Surgical and Medical Technologies Department, Orthopaedics and Traumatology II°, University of Pisa, Pisa, Italy
| | - Michelangelo Scaglione
- Translational Research on New Surgical and Medical Technologies Department, Orthopaedics and Traumatology II°, University of Pisa, Pisa, Italy
| | - Sandro Giannini
- Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
| | - Mattia Fortina
- Orthopaedics and Traumatology Clinic, “S. M. alle Scotte” Hospital, University of Siena, Siena, Italy
| | - Alberto Riva
- Orthopaedics and Traumatology Clinic, “S. M. alle Scotte” Hospital, University of Siena, Siena, Italy
| | - Pier Luigi De Palma
- Clinical and Molecular Science Department, Faculty of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Antonio Pompilio Gigante
- Clinical and Molecular Science Department, Faculty of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Biagio Moretti
- Basic Medical Science, Neurosciences and Sensory Organs Department, University of Bari, Bari, Italy
| | - Giuseppe Solarino
- Basic Medical Science, Neurosciences and Sensory Organs Department, University of Bari, Bari, Italy
| | - Francesco Lijoi
- Orthopaedic and Trauma Department, “Morgagni-Pierantoni” Hospital, Forlì, Italy
| | - Giovanni Giordano
- Orthopaedic and Trauma Department, “Morgagni-Pierantoni” Hospital, Forlì, Italy
| | - Pier Giorgio Londini
- Orthopaedic and Traumatology Department, “Misericordia” Hospital ASL 9, Grosseto, Italy
| | - Danilo Castellano
- Orthopaedic and Traumatology Department, “Misericordia” Hospital ASL 9, Grosseto, Italy
| | - Giuseppe Sessa
- Surgery Department, “Vittorio Emanuele” Hospital, University of Catania, Catania, Italy
| | - Luciano Costarella
- Surgery Department, “Vittorio Emanuele” Hospital, University of Catania, Catania, Italy
| | - Antonio Barile
- Orthopaedic and Trauma Department, “San Michele” Nursing Home Hospital, Maddaloni, Caserta, Italy
| | - Mariano Borrelli
- Orthopaedic and Trauma Department, “San Michele” Nursing Home Hospital, Maddaloni, Caserta, Italy
| | - Attilio Rota
- Orthopaedic and Traumatology Department, “Sandro Pertini” Hospital, ASL RMB, Rome, Italy
| | - Raffaele Fontana
- Orthopaedic and Traumatology Department, “Sandro Pertini” Hospital, ASL RMB, Rome, Italy
| | - Alberto Momoli
- Orthopaedic and Traumatology Department, “San Bortolo” Hospital, Vicenza, Italy
| | - Andrea Micaglio
- Orthopaedic and Traumatology Department, “San Bortolo” Hospital, Vicenza, Italy
| | - Guido Bassi
- Orthopaedic and Traumatology Department, A.O. Pavia Voghera Hospital, Pavia, Italy
| | | | - Claudio Castelli
- Orthopaedics and Trauma Department, “Papa Giovanni XXIII” Hospital, Bergamo, Italy
| | - Michele Giudici
- Orthopaedics and Trauma Department, “Papa Giovanni XXIII” Hospital, Bergamo, Italy
| | - Mauro Monesi
- Orthopaedic and Traumatology Department, “M. Bufalini” Hospital, Cesena, Italy
| | | | - Pietro Maniscalco
- Orthopaedic and Traumatology Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy
| | - M'Putu Bulabula
- Orthopaedic and Traumatology Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy
| | - Vincenzo Zottola
- Traumatology and Reconstructive Surgery Functional Department, “S. Anna” Hospital, Como, Italy
| | - Auro Caraffa
- Orthopaedics and Traumatology Clinic, “S. M. Misericordia” Hospital, University of Perugia, Perugia, Italy
| | - Pierluigi Antinolfi
- Orthopaedics and Traumatology Clinic, “S. M. Misericordia” Hospital, University of Perugia, Perugia, Italy
| | - Fabio Catani
- Orthopaedic Surgery Department, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudio Severino
- Orthopaedic Surgery Department, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Castaman
- Orthopaedic and Traumatology Department, Montecchio Maggiore Hospital, Vicenza, Italy
| | - Carmelo Scialabba
- Orthopaedic and Traumatology Department, Montecchio Maggiore Hospital, Vicenza, Italy
| | - Venceslao Tovaglia
- Orthopaedic and Traumatology Department, CTO Hospital ASL RM “C”, Rome, Italy
| | - Pietro Corsi
- Orthopaedic and Traumatology Department, CTO Hospital ASL RM “C”, Rome, Italy
| | - Paolo Friemel
- Orthopaedic and Traumatology Department, Regione Veneto Azienda ULSS 18, Rovigo, Italy
| | - Marco Ranellucci
- Orthopaedic and Traumatology Department, Regione Veneto Azienda ULSS 18, Rovigo, Italy
| | - Vincenzo Caiaffa
- Orthopaedics and Traumatology Department, “Di Venere” Hospital, Bari, Italy
| | - Giovanni Maraglino
- Orthopaedics and Traumatology Department, “SS. Annunziata” Hospital, Taranto, Italy
| | - Roberto Rossi
- Orthopaedic and Traumatology SCDU Department, “Mauriziano Umberto I” Hospital, University of Torino, Torino, Italy
| | - Antonio Pastrone
- Orthopaedic and Traumatology SCDU Department, “Mauriziano Umberto I” Hospital, University of Torino, Torino, Italy
| | - Patrizio Caldora
- Orthopaedic and Traumatology Surgery Department, “San Donato” Hospital, Arezzo, Italy
| | - Claudio Cusumano
- Orthopaedic and Traumatology Surgery Department, “San Donato” Hospital, Arezzo, Italy
| | | | - Ugo Baschieri
- Orthopaedics Department, NOCSAE Hospital, Modena, Italy
| | - Ettore Demattè
- Orthopaedics and Traumatology Department, “Santa Chiara” Hospital, Trento, Italy
| | - Stefano Gherardi
- Orthopaedics and Traumatology Department, “Santa Chiara” Hospital, Trento, Italy
| | - Carlo De Roberto
- Orthopaedics Unit, “Santa Maria di Loreto Mare” Hospital, Loreto Mare, Napoli, Italy
| | - Alberto Belluati
- Specialized Surgery Department, “S. Maria delle Croci” Hospital, Ravenna, Italy
| | - Antonio Giannini
- Specialized Surgery Department, “S. Maria delle Croci” Hospital, Ravenna, Italy
| | - Ciro Villani
- Orthopaedic Department, Sapienza University of Rome, Rome, Italy
| | - Pietro Persiani
- Orthopaedic Department, Sapienza University of Rome, Rome, Italy
| | - Silvio Demitri
- Orthopaedic and Trauma Department, “Santa Maria della Misericordia” Hospital, AOUD Udine, Udine, Italy
| | - Bruno Di Maggio
- Orthopaedics and Traumatology Unit, Piedimonte Matese Hospital, Caserta, Italy
| | - Guglielmo Abate
- Orthopaedics and Traumatology Unit, Piedimonte Matese Hospital, Caserta, Italy
| | | | - Stefania Setti
- Research and Development, IGEA Clinical Biophysics, Carpi, Modena, Italy
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