The repair of the Achilles tendon rupture: comparison of two percutaneous techniques

This study proposes a comparison between two percutaneous techniques of subcutaneous Achilles tendon rupture by evaluating the risk of lesion developing, the morbidity of the surgical technique adopted and the effectiveness of each technique. Sixty patients were operated at Padua Orthopaedic Clinic by using the two different procedures: (1) Ma and Griffith in 30 cases and (2) Tenolig in 30 cases. Risk of rupture developing has been evaluated in relation to sex, age, side, kind of trauma, work and presence of preoperative risk factors. The Morbidity of surgical technique has been evaluated in with respect to surgical time, hospital permanence, immobilization, active nonweight-bearing mobilization, assisted weight bearing until the full one, number of early and late complications before and after hospital discharge. Effectiveness has been evaluated in relation to return time to common life, work and sport; anatomical and functional features have been evaluated using McComis score, rating results as: very good (from 80 to 70), good (from 69 to 60), fair (from 59 to 50) and poor (<50). Tenolig group shows shorter average time from hospital admission and operation, hospital permanence and immobilization (P < 0.05), and it results in an easier and quicker execution and functionally stimulates the tendon healing in a short time. Effectiveness was the same for both techniques because average McComis score was good (P = 0.35), and there was no significant differences in common life returning time (P = 0.12). Tenolig technique seems to be preferable to Ma and Griffith

Bilateral synovial chondromatosis of the first metatarsophalangeal joint: a report case

Synovial chondromatosis is a rare pathology of unknown aetiology. It originates from the chondroid metaplasia of the connective tissue of the synovial membrane. Consequently, cartilaginous nodules develop in the affected joints, first calcifying and then ossifying. The bursae mucosae, the vaginae tendinis and the para-articular connective tissue are less frequently affected. The most common locations of this pathology are the knee, the hip, the shoulder, the elbow and the ankle. The small articulations are rarely affected, even less the bilateral involving of joints, above all of hand or foot, is exceptional. In a clinical and radiological valuation, it is difficult to distinguish synovial chondromatosis from arthrosis and from degenerative arthopathies in general. A sure diagnosis can be obtained only by means of a histological examination. We here report a case of synovial chondromatosis bilaterally located on the first metatarsophalangeal joint. Clinical and radiological features were analogous to those of hallux rigidus, a typical and peculiar metatarsophalangeal joint pathology. The diagnostic suspicion that it was a synovial chondromatosis arose during surgical surgery, and was subsequently confirmed by histological examination. During the following visits, the patient did not present any painful symptomatology

Peri-Operative Management of Patients Undergoing Fenestrated-Branched Endovascular Repair for Juxtarenal, Pararenal and Thoracoabdominal Aortic Aneurysms: Preventing, Recognizing and Treating Complications to Improve Clinical Outcomes

The advent and refinement of complex endovascular techniques in the last two decades has revolutionized the field of vascular surgery. This has allowed an effective minimally invasive treatment of extensive disease involving the pararenal and the thoracoabdominal aorta. Fenestrated-branched EVAR (F/BEVAR) now represents a feasible technical solution to address these complex diseases, moving the proximal sealing zone above the renal-visceral vessels take-off and preserving their patency. The aim of this paper was to provide a narrative review on the peri-operative management of patients undergoing F/BEVAR procedures for juxtarenal abdominal aortic aneurysm (JAAA), pararenal abdominal aortic aneurysm (PRAA) or thoracoabdominal aortic aneurism (TAAA). It will focus on how to prevent, diagnose, and manage the complications ensuing from these complex interventions, in order to improve clinical outcomes. Indeed, F/BEVAR remains a technically, physiologically, and mentally demanding procedure. Intraoperative adverse events often require prolonged or additional procedures and complications may significantly impact a patient’s quality of life, health status, and overall cost of care. The presence of standardized preoperative, perioperative, and postoperative pathways of care, together with surgeons and teams with significant experience in aortic surgery, should be considered as crucial points to improve clinical outcomes. Aggressive prevention, prompt diagnosis and timely rescue of any major adverse events following the procedure remain paramount clinical needs

Rare causes of scoliosis and spine deformity: experience and particular features

<p>Abstract</p> <p>Background</p> <p>Spine deformity can be idiopathic (more than 80% of cases), neuromuscular, congenital or neurofibromatosis-related. However, there are many disorders that may also be involved. We present our experience treating patients with scoliosis or other spine deformities related to rare clinical entities.</p> <p>Methods</p> <p>A retrospective study of the records of a school-screening study in North-West Greece was performed, covering a 10-year period (1992–2002). The records were searched for patients with deformities related to rare disorders. These patients were reviewed as regards to characteristics of underlying disorder and spine deformity, treatment and results, complications, intraoperative and anaesthesiologic difficulties particular to each case.</p> <p>Results</p> <p>In 13 cases, the spine deformity presented in relation to rare disorders. The underlying disorder was rare neurological disease in 2 cases (Rett syndrome, progressive hemidystonia), muscular disorders (facioscapulohumeral muscular dystrophy, arthrogryposis) in 2 patients, osteogenesis imperfecta in 2 cases, Marfan syndrome, osteopetrosis tarda, spondyloepiphyseal dysplasia congenita, cleidocranial dysplasia and Noonan syndrome in 1 case each. In 2 cases scoliosis was related to other congenital anomalies (phocomelia, blindness). Nine of these patients were surgically treated. Surgery was avoided in 3 patients.</p> <p>Conclusion</p> <p>This study illustrates the fact that different disorders are related with curves with different characteristics, different accompanying problems and possible complications. Investigation and understanding of the underlying pathology is an essential part of the clinical evaluation and preoperative work-up, as clinical experience at any specific center is limited.</p

Profiling Insulin Like Factor 3 (INSL3) Signaling in Human Osteoblasts

Abstract BACKGROUND: Young men with mutations in the gene for the INSL3 receptor (Relaxin family peptide 2, RXFP2) are at risk of reduced bone mass and osteoporosis. Consistent with the human phenotype, bone analyses of Rxfp2(-/-) mice showed decreased bone volume, alterations of the trabecular bone, reduced mineralizing surface, bone formation, and osteoclast surface. The aim of this study was to elucidate the INSL3/RXFP2 signaling pathways and targets in human osteoblasts. METHODOLOGY/PRINCIPAL FINDINGS: Alkaline phosphatase (ALP) production, protein phosphorylation, intracellular calcium, gene expression, and mineralization studies have been performed. INSL3 induced a significant increase in ALP production, and Western blot and ELISA analyses of multiple intracellular signaling pathway molecules and their phosphorylation status revealed that the MAPK was the major pathway influenced by INSL3, whereas it does not modify intracellular calcium concentration. Quantitative Real Time PCR and Western blotting showed that INSL3 regulates the expression of different osteoblast markers. Alizarin red-S staining confirmed that INSL3-stimulated osteoblasts are fully differentiated and able to mineralize the extracellular matrix. CONCLUSIONS/SIGNIFICANCE: Together with previous findings, this study demonstrates that the INSL3/RXFP2 system is involved in bone metabolism by acting on the MAPK cascade and stimulating transcription of important genes of osteoblast maturation/differentiation and osteoclastogenesis

The tantalum screw for treating femoral head necrosis: rationale and results

Femoral head necrosis (FHN) is a progressive pathology due to the failure of blood supply to the proximal femoral epiphysis, with consequent necrosis of the sub-chondral bone and collapse of the articular cartilage and loss of congruity between the head and the acetabulum. Borrowing the biological and mechanical principles from the vascularized fibular graft technique for the femoral neck, the tantalum screws have been introduced. They show an extraordinary porosity, osteoconductivity, biocompatibility and very good osteoinductivity. Vitreous tantalum can be processed to take the form of a screw, with a round medial extremity and a 25 mm threaded lateral extremity that can be inserted into the neck of the femur, thereby supporting the articular cartilage, stimulating the repair process, interrupting the interface between necrotic and healthy tissue and favoring local vascularization. We have drawn up a treatment protocol for early-stage FHN, based on the insertion of a tantalum screw into the femoral neck. The implant has a cylindrical shape, with a 10 mm diameter in the smooth part and 15 mm in the threaded part. It is available in different sizes from 70 to 130 mm, with 5 mm increments. The aim of the study is to describe the clinical and instrumental results of the tantalum screw for FHN. From June 2004 to June 2006 we performed 15 implants. The tantalum screw was inserted with an incision on the trochanteric region with traction and under X-ray control. For the clinical evaluation of the hip, we used the Harris hip score (HHS). For diagnosis and staging we used standard X-rays in two views and/or MRI, using the Steinberg classification (J Bone Joint Surg Br 77:34–41, 1995) and CT. In all cases, the osteonecrosis extended to not more than 30% of the joint surface and the cartilage was intact with no collapse. To assess the results, we compared the pre-operative and the post-operative HHS, calculated the percentage differences between the two. We then compared X-rays, CT scans and MRI before and some time after the operation to assess whether the problem had been addressed, taking into account the intracancellous edema and the possible extension of necrosis. After an average follow-up period of 15.43 ± 5.41 months, ten implants (seven patients out of ten) were examined and all but one patient showed a marked improvement in HHS (the average increase was 127.9%), with no further progression of the disease. We believe that this procedure can be suitable for young patients with limited first or second stage osteonecrosis. The objective for the foreseeable future is to resolve the pain, improve the quality of life and prevent or at least postpone arthroplasty

Osteochondritis dissecans of the talus. A report on 7 cases

The clinical and radiological findings in 7 cases of osteochondritis dissecans of the talus indicate that this is a potentially progressive condition. Surgical treatment was carried out in 4 cases while the remaining 3 were treated conservatively. Surgery produced good clinical and radiological results. The conservative treatment consisted of immobilisation and abstention from weight-bearing. This was unsuccessful in 2 adult patients but in a 9 year old girl it led to a virtually complete recovery in 3 months