Surgical treatment of acute fingernail injuries

The fingernail has an important role in hand function, facilitating the pinch and increasing the sensitivity of the fingertip. Therefore, immediate and proper strategy in treating fingernail injuries is essential to avoid aesthetic and functional impairment. Nail-bed and fingertip injuries are considered in this review, including subungual hematoma, wounds, simple lacerations of the nail bed and/or matrix, stellate lacerations, avulsion of the nail bed, ungual matrix defect, nail-bed injuries associated with fractures of the distal phalanx, and associated fingertip injuries. All these injuries require careful initial evaluation and adequate treatment, which is often performed under magnification. Delayed and secondary procedures of fingernail sequelae are possible, but final results are often unpredictable

Are suprapectineal quadrilateral surface buttressing plates performances superior to traditional fixation? A finite element analysis

Acetabular fractures have a high impact on patient’s quality of life, and because acetabular fractures are high energy injuries, they often co-occur with other pathologies such as damage to cartilage that could increase related morbidity; thus, it appears of primary importance developing reliable treatments for this disease. This work aims at the evaluation of the biomechanical performances of non-conservative treatments of acetabular fractures through a finite element approach. Two pelvic plates models (the standard suprapectineal plate—SPP, and a suprapectineal quadrilateral surface buttressing plate—SQBP) were analyzed when implanted on transverse or T-shaped fractures. The plates geometries were adapted to the specific hemipelvis, mimicking the bending action that the surgeon performs on the plate intraoperatively. Implemented models were tested in a single leg stance condition. The obtained results show that using the SQBP plate in transverse and T-shaped acetabular fractures generates lower bone stress if compared to the SPP plate. Interfragmentary movement analysis shows that the SQBP plate guarantees greater stability in transverse fractures. In conclusion, the SQBP plate seems worthy of further clinical analysis, having resulted as a promising option in the treatment of transverse and T-shaped acetabular fractures, able to reduce bone stress values and to get performances comparable, and in some cases superior, to traditional fixation

Surgical treatment of equinus deformity in cerebral palsy by aponeurosis lengthening and Z-lengthening

Abstract Surgical treatment of equi- nus defomiity in cerebral palsy can be carried out successfully by Achilles tendon lengthening and gas- trocnemius aponeurosis lengthening. From 1993 to 1998, we performed 59 operations in 37 cerebral palsied patients with equinus deformity using Z-lengthening in 30 cases and a mod• ified Baker’s procedure in 29 cases. The operations, associated with other hip and knee procedures in 65% of patients, were followed by postopera- tive use of casts and by a 12-month intensive kinesitherapeutic protocol. On preoperative evaluation, besides pattem deformity and the condition of proximal joints, we considered also age, clinical diagnosis, nature of tone and muscle strength. In most cases, the retrospective analysis showed the correction of deformity and a functional improvement. We observed 9 recurrences in six of the younger patients without relationship with topographic pattem of cerebral palsy. Overcorrection of equinus deformity occurred in one diplegic ch.ild who had phasic hypertonia and low muscle strength. We believe that the evaluation of patients, the preop- erative planning and the effective kinesitherapeutic program are neces- sary to reduce the risk of complica- tions related to surgery

Botulin toxin type A in the treatment of dynamic equinus in cerebral palsy

Nei pazienti affetti da paralisi cerebrale infantile, llequinismo e il tipo di deformita piu co- mune a carico del piede. Il trattamento conservativo dellequinismo dinamico ha incluso tmdizionalmente l’impieg0 della kinesiterapia, delle ortesi e del gessi. Tuttavia, negli ultimi anni un ruolo sempre piu im- portante e stato assunto dalla tossina botulinica A (BTX-A), Un efficace trattamento conservativo del- equinismo permette di ritardare il momento del trat- tamento chirurgico riducendo i rischi di recidiva, che sono inversamente proporzionali all’eta dell’inter- vento

Biological mechanisms of stroke prevention by physical activity in type 2 diabetes

The principal modifiable risk factors for stroke are hypertension, diabetes mellitus, hypercholesterolaemia, hyperhomocysteinaemia, smoking and limited physical activity. However, it is not clear whether physical inactivity is a risk factor per se, or because it predisposes to pathological conditions that are risk factors for stroke. The limited availability of effective therapeutic approaches for stroke emphasizes the crucial role of prevention of risk factors. The global burden associated with type 2 diabetes is large and continues to grow. Convincing epidemiologic data support the role of physical activity in preventing type 2 diabetes. The increasing evidence of physical activity in preventing diabetic complications, including stroke, has generated interest in the molecular basis underlying these beneficial effects. The aim of the present review is to discuss the biological mechanisms underlying the effect of physical activity in preventing stroke in type 2 diabetes

Heterotopic ossification after hip surgery in cerebral palsy

Abstract Heterotopic ossification is a post-surgery compli- cation occasionally observed in patients with in- fantile cerebral palsy. In the majority of the cases such lesions are found at the hip after surgery on the skeleton and the soft tissues. At our Institute in the last five years, this com- plication has been observed four times, in 39 pa- tients, who underwent mainly soft tissue releas- es because of flexion and adduction contracture of the hip, In these cases, as in a further patient with myelomeningocele, the periarticular heterotopic ossification appeared in the hip after tenotomy of the ilio-psoas at the lesser tronchater associat- ed to other surgical procedures. Conversely, no cases of ossification have been found after tenotomy of the adductors or the gracilis or selective tenotomy of the psoas at the pelvic brim. The exact causes of this complication are still un- clear, but after an analysis of the literature and patient history it can be hypothesised that it may be related to the surgical procedures carried out