Effect of platelet-rich plasma and microfracture reparative technique combined in chondral lesions treatment

The microfracture surgery introduced by Stedman despite limitations still represents the most common procedure to repair chondral defects. In recent years other regeneration techniques, such as the implantation of platelet-rich plasma (PRP), have been adopted in combination to boost and promote successful outcomes. This study aimed at evaluating clinical and functional results in 60 patients affected by chondral lesions and treated only using the microfracture procedure or in combination with intra-articular PRP infiltration. Patients were sub-divided in 2 groups: 30 were treated with microfracture reparative technique and the remaining 30 microfractures were treated with 3 platelet-rich plasma intra-articular injections. All patients were postoperatively evaluated based on the visual along scale, International Knee Documentation Committee, subjective knee function, and Lysholm knee scoring scale. The evaluation results for each follow-up showed an improvement of all evaluation scores compared to the preoperative phase and a variable and progressive deterioration registered at 24, 36 and 48-month follow-up visits, more pronounced in patients treated with microfracture alone. Instead, more successful outcomes in terms of pain symptomatology and functional recovery were reported during all follow-up visits and based on all scoring scales for the 30 patients treated with a combination of both techniques. The combination of the micro fracture reparative technique and the platelet-rich plasma implantation favoured a faster resolution of pain symptomatology and a quicker functional recovery with favourable results maintained over time

Cauda equina syndrome secondary to idiopathic spinal epidural lipomatosis

Study Design. Three cases of idiopathic epidural lipomatosis are reported. Objectives. Description of the relationship between spinal pathologic overgrowth of fat tissue and neurologic symptoms. Summary of Background Data. Idiopathic epidural lipomatosis is a very rare condition; it is usually secondary to chronic steroid therapy or endocrinopathic diseases. Methods. Three men with a mean age of 58.5 years, who experienced intermittent claudication, bilateral radicular pain in both legs, and urinary dysfunction with hypoesthesia in the perineal region, were evaluated by plain radiography and magnetic resonance imaging, the results of which demonstrated a pathologic overgrowth of fat tissue in the spinal canal with a marked impingement of the dural sac. Obesity, endocrinopathic diseases, and chronic steroid therapy were excluded for all patients. Surgical treatment was performed by wide multilevel laminectomies, fat debulking, and instrumented posterolateral fusion. Results. After surgery there was a gradual improvement in symptoms and signs so that 2 years later the patients returned to daily activities and were neurologically normal. Conclusions. Spinal epidural lipomatosis can be a cause of back pain but rarely radicular impingement. Magnetic resonance imaging is the procedure of choice. The treatment must be performed early by wide surgical decompression

Cesarean Section and Right Femur Fracture: A Rare but Possible Complication for Breech Presentation

Background. The breech extraction of the fetus through the vagina has a greater risk of hip fracture compared with the extraction by abdominal route. Case. A 2390 g female infant was delivered at 39 weeks by elective cesarean section for breech presentation. The newborn sustained a fracture of the right femur. A simple immobilization of the limb in extension led to a complete healing of the fracture without sequelae. Conclusion. Caesarean delivery reduces the risk of causing a traumatic injury of the newborn compared to vaginal delivery, especially with breech presentation but does not eliminate this possible accidental complication

Clinical evaluation of sodium hyaluronate in the treatment of patients with sopraspinatus tendinosis under echographic guide: experimental study of periarticular injections

Purpose. The purpose of this study was to examine the effect of periarticular injection of hyaluronate into shoulders with supraspinatus tendinosis under echographic guide. Methods and materials. The subjects were 56 patients with clinical, echographic and magnetic resonance diagnosis of supraspinatus tendinosis. They were divided in two groups by random sampling; 28 patients were assigned in SH group (sodium hyaluronate) and 28 patients in SC group (sodium chloride). The test drug was 20 mg sodium hyaluronate (2 ml, Hyalgan®, Fidia SpA, Abano T., P.M. 500–700.000, 20 mg/2 ml). Results. Preliminary results showed that sodium hyaluronate presented the highest efficacy in the improvement of clinical symptoms and recovery of functional status in patients with supraspinatus tendinosis in fact the mean V.A.S. score (Visual Analogue Scale) at 1 month after the end of the infiltrative cycle was 8.0 in the SC group vs. 2.8 in SH group and these numerical data were substantially unchanged also after 3 and 4 months. Conclusion. Hyaluronate injection under echographic guide should be use not only as a lubricant but also to prevent articular cartilage degeneration and cover and protect the articular cartilage; indeed sodium hyaluronate can decrease inflammatory joint process.<br/