Hip joint hydatidosis after prosthesis replacement

Summary Hydatidosis is a rare parasitic disease caused by the Echinococcus tapeworm, which only occasionally affects the musculoskeletal tissues. In this article we describe the case of a patient who underwent a total hip replacement procedure for a pathological fracture of the femur neck. At the next histological examination it was shown to be a consequence of secondary bone hydatidosis. This clinical case is exceptional in that the infection spread to the cotyloid and femoral prosthesis components and, in the following years, caused repeated episodes of joint dislocation

Frequency of hypertension in hospitalized population with osteoporotic fractures: Epidemiological retrospective analysis of Hospital Discharge Data in the Apulian database for the period 2006–2010

Osteoporosis and hypertension are two widespread diseases, which share many of the same risk factors such as advanced age, early menopause, smoking, and physical inactivity. The aim of this study is to examine the association between fragility fractures, anti-hypertensive drugs (subgroup C02, according to the Anatomical Therapeutic Chemical classification system [ATC]), diuretics (subgroup C03), b-blocker (subgroup C07), calcium antagonist (subgroup C08) and renin-angiotensin-aldosterone system regulator (subC09), and drugs administration for osteoporosis among the osteoporotic population of a region of Southern Italy. We retrospectively studied “Hospital Discharge Data” (HDD) in the Apulian database for the period 2006–2010 to find fragility fractures treated with hospitalization in men aged over 65 years and in women aged over 50 years. We then checked the database for drug prescriptions to identify those patients who had taken at least one osteoporosis drug. Within this latter group, based on hospital admissions and prescription records, we identified the patients affected with hypertension. We observed that, between 2006 and 2010, in Apulia, 177,639 patients were hospitalized and diagnosed as having fragility fractures. The prevalence of hypertension patients in Apulia in this period was estimated at 44.3%. In the same region and period, the prevalence of patients with fragility fracture, who also had hypertension, was 80.9%. The percentage of fracture was lowest in the female population aged 50–59 years (52.5%), while the highest was in women aged > 80 years (92.5%). We observed that in hypertensive patients the most frequent site of fracture was the femur (43,638 cases), while the least frequent were the tarsus and metatarsus (742 cases combined). The patients who took angiotensin-converting enzyme (ACE) inhibitor and diuretic drugs presented a higher number of fragility fractures, while the calcium antagonists, beta-blockers, and ATC anti-hypertensive drugs were linked to a reduced incidence of lesions. Hypertension is associated with increased fracture risk in the Apulia population. The bone demineralization effect of this disease should be taken into account during the management of these patients. The different distribution of fragility fractures in relation to anti-hypertensive treatment warrants further investigatio

Femoral tunnel placement in anterior cruciate ligament reconstruction: rationale of the two incision technique

Endoscopic anterior cruciate ligament (ACL) reconstruction can be performed through one-incision or two-incision technique. The current one-incision endoscopic ACL single bundle reconstruction techniques attempt to perform an isometric repair placing the graft along the roof of the intercondylar notch, anterior and superior to the native ACL insertion. However the ACL isometry is a theoretical condition, and has not stood up to detailed testing and investigation. Moreover this type of reconstruction results in a vertically oriented non-anatomic graft, which is able to control anterior tibial translation but not the rotational component of the instability. Femoral tunnel obliquity has a great effect on rotational stability. To improve the obliquity of graft, an anatomical ACL reconstruction should be attempt. Anatomical insertion of ACL on the femur lies very low in the notch, spreading between 11 and 9–8 o'clock position and the center lies lower than at 11 o'clock position. Femoral aiming devices through the tibial tunnel aim at an isometric placement, and they do not aim at an anatomic position of the graft. Also, a placement of tunnel in a position of 11 o'clock is unable to restore rotational stability. The two-incision technique, with the possibility to position femoral tunnel independently by tibial tunnel, allows us to place femoral tunnel entrance in a position of 10 'clock that can most accurately reproduce the anatomic behaviour of the ACL and can potentially improve the response of the graft to rotatory loads. This positioning results in a more oblique graft placement, avoiding problem related to PCL impingement during knee flexion. Further studies are required to understand if this kind of reconstruction can ameliorate proprioception as well as clinical outcome at a long-term follow-up

“Open-book” pelvic fracture with soft tissue serious damage in a child

Open-book fractures of the pelvis are uncommon during childhood and require urgent treatment from the association with other abdominal, vascular or nervous injuries. The case discussed is an open-book fracture (type B1, Tile classification) associated with triradiate cartilage injury (type I, Salter–Harris classification) in an 11-year-old female. Surgical treatment was delayed for 2 months due to an associated extensive cutaneous lesion which required an adequate treatment. The delayed intervention did not affect the radiological and clinical healing of the fracture

Methylsulfonylmethane and boswellic acids versus glucosamine sulfate in the treatment of knee arthritis: Randomized trial

Until now glucosamine sulfate (GS) has been the most widely used supplement and has been shown to be efficacious in the treatment of osteoarthritis (OA). Methylsulfonylmethane (MSM) and boswellic acids (BA) are new effective supplements for the management of inflammation and joint degeneration, according to previous experimental studies. The aim of our study is to test the effectiveness of association of MSM and BA in comparison with GS in knee arthritis.In this prospective randomized clinical trial, MEBAGA (Methylsulfonylmethane and Boswellic Acids versus Glucosamine sulfate in the treatment of knee Arthritis), 120 participants affected by arthritis of the knee were randomly assigned to an experimental group (MB group) or a control group (GS group) treated for 60 days with 5 g of MSM and 7.2 mg of BA or with 1500 mg of GS daily, respectively. At the 2-month (T1) and 6-months (T2) follow-up , the efficacy of these two nutraceuticals was assessed using the visual analog pain scale (VAS) and the Lequesne Index (LI) for joint function, along with the use of anti-inflammatory drugs (non-steroidal anti-inflammatory drugs and anti-cyclooxygenase-2).The repeated measures ANOVA analysis shows that for VAS, LI, and the use of anti-inflammatory drugs scores there are improvements due to the time in the two groups (respectively, F=26.0; P<0.0001; F=4.15; P=0.02; F=3.38; P=0.04), with a tendency to better values for the MB group at T2.On the basis of these preliminary data, we could support the efficacy of the MSM in association with BA in the treatment of OA. These results are consistent with the anti-inflammatory and chondroprotective effects previously occurred in experimental studies. This new combination of integration (MSM and BS) has presented good results and satisfactory in comparison with GS, until now the cornerstone of the treatment of arthritis in according to guidelines

The management of neuropathic ulcers of the foot in diabetes by shock wave therapy

<p>Abstract</p> <p>Background</p> <p>Diabetes is becoming one of the most common chronic diseases, and ulcers are its most serious complication. Beginning with neuropathy, the subsequent foot wounds frequently lead to lower extremity amputation, even in the absence of critical limb ischemia. In recent years, some researchers have studied external shock wave therapy (ESWT) as a new approach to soft tissue wound healing. The rationale of this study was to evaluate if ESWT is effective in the management of neuropathic diabetic foot ulcers.</p> <p>Methods</p> <p>We designed a randomized, prospective, controlled study in which we recruited 30 patients affected by neuropathic diabetic foot ulcers and then divided them into two groups based on different management strategies. One group was treated with standard care and shock wave therapy. The other group was treated with only standard care. The healing of the ulcers was evaluated over 20 weeks by the rate of re-epithelization.</p> <p>Results</p> <p>After 20 weeks of treatment, 53.33% of the ESWT-treated patients had complete wound closure compared with 33.33% of the control patients, and the healing times were 60.8 and 82.2 days, respectively (p < 0.001). Significant differences in the index of the re-epithelization were observed between the two groups, with values of 2.97 mm²/die in the ESWT-group and 1.30 mm²/die in the control group (p < 0.001).</p> <p>Conclusion</p> <p>Therefore, ESWT may be a useful adjunct in the management of diabetic foot ulceration.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN21800909</p

Medium-energy shock wave therapy in the treatment of rotator cuff calcifying tendinitis

To evaluate the results of the treatment with medium-energy extracorporeal shock wave therapy (ESWT) in rotator cuff calcifying tendinitis. Fifty-four non-consecutive patients, who were referred to our institute for rotator cuff calcifying tendinitis, were managed with a standardized protocol in four sessions of medium-energy (0.11mJ/mm2) ESWT administered with an electromagnetic lithotriptor. Pain was evaluated at the end of each session, functional state of shoulder was assessed at 1 and 6months after the end of procedure. All patients underwent radiographs and sonography imaging. No systemic or local complications. Thirty-eight patients (70%) reported satisfactory functional results. Radiographs and sonographs showed a disappearance of calcium deposit in 29 patients (54%) and in 19 patients (35%) it appeared to be reduced more than a half. A correlation was found between residual calcium deposit and the clinical outcome, but some patients showed a reduced pain without modification of calcium deposit. These results were unmodified at 6months follow-up. Our protocol of medium-energy ESWT provides good results overall about pain modulatio

Plasma Technology Reduces Blood Loss in Adolescent Idiopathic Scoliosis Surgery: A Prospective Randomized Clinical Trial

Study Design: Prospective randomized clinical trial. Objectives: To assess the effectiveness of PEAK Plasmablade (PPB), compared with bipolar sealer and standard electrocautery, in the posterior spinal instrumentation and fusion (PSF) surgery performed for adolescent idiopathic scoliosis (AIS). Methods: Ninety-three patients undergoing PSF surgery for AIS were randomized in 2 groups: group-A patients (n = 45) underwent PSF surgery using PPB; group-B patients (n = 48) were treated with bipolar sealer and standard electrocautery. Demographic and surgical data was recorded. All the patients underwent serial blood tests on the day before surgery (T0) and at 24 (T1), 48 (T2), 72 (T3), and 96 (T4) hours postoperatively. Visual analogue scale for pain (VAS) score, the percentage of paracetamol assumption, and the blood transfusion rate were recorded in the time-lapse T1 to T4. Intergroup variability was assessed. Pearson correlation test was performed. A P value <.05 was considered significant. Results: In group A, a significantly shorter total operative time ( P = .0087), a significantly lower total intraoperative blood loss (TBL) ( P = .001), and a higher postoperative hemoglobin (Hb) ( P = .01) were recorded. A significant higher mean Hb concentration and mean albumin value was recorded in group A at 24 and 48 hours postoperatively. A significant correlation between TBL and hospital stay was recorded in both groups (group A, P = .00 001; group B, P = .00 006); moreover, in both groups, a significant correlation was observed between TBL and mean VAS at 72 hours postoperatively (group A, P = .0009; group B, P = .0001) and at 96 hours postoperatively (group A, P = .000 044; group B, P = .00 001). Conclusions: PPB reduces the intraoperative blood loss in PSF performed for AIS, thus allowing a patient's faster recovery

Common Clinical Practice for Low Back Pain Treatment: A Modified Delphi Study

Low back pain (LBP) is a common reason for adults to seek medical care and is associated with important functional limitation and patient burden. Yet, heterogeneity in the causes and presentation of LBP and a lack of standardization in its management impede effective prevention and treatment