The treatment of intertrochanteric fractures of the femur with Endovis nail

n/

Bisphosphonate-associated femoral fracture: implication for management

Studies carried out on individuals being treated long term with bisphosphonates have provoked considerable interest and perplexity about the effect that these drugs have on bone turnover in the long run. In fact the experiences reported by numerous researchers tend to highlight how treatment with high doses of bisphosphonates over many years, of individuals with osteoporosis complicated by or secondary to neoplastic pathologies, causes a suppression of bone turnover that over time predisposes the bone to the accumulation of micro damage that can then result in complicated fractures, as in the case described here

A case of bilateral luxatio erecta

Luxatio erecta is an uncommon form of glenohumeral dislocation. Cases of bilateral inferior shoulder dislocation (luxatio erecta) are very rare, and only ten cases have been described in literature. We describe a case of a woman with bilateral luxatio erecta of the shoulders treated with close reduction, immobilization and rehabilitation. The patient had fallen downstairs while clinging to both lateral banisters

Simultaneous chronic rupture of quadriceps tendon and contra-lateral patellar tendon in a patient affected by tertiary hyperparatiroidism

Spontaneous ruptures of the extensor mechanism of the knee are very rare. They tend to increase considerably in patients with metabolic diseases such as chronic renal failure, hyperparathyroidism, diabetes, gout, and systemic lupus erythematosus. The reported case regards a 48-year-old man with chronic, spontaneous and simultaneous quadriceps, and contra-lateral patellar tendon rupture. The patient suffered from chronic renal failure and for the past year from tertiary hyperparathyroidism. Ruptured tendons were repaired and both knee were evaluated monthly for the next 12 months. Good functional recovery was achieved on both knees without relapse. This case emphasizes the importance of long-term high parathyroid hormone level in the etiology of tendons ruptures

Emergency free flaps for the reconstruction of open injuries of the upper limb: a review

Debridement of all necrotic and contaminated tissues followed by immediate soft: tissue coverage in order to obtain primary healing is nowadays the standard approach to all open injuries of the extremities. In 1977 Foucher et al. introduced for the first time the concept of immediate treatment at one time of all injured tissues in complex traumas of the upper limb. The final goal of this therapeutic approach is early postoperative mobilization of the hand and of the whole upper extremity. Any delay in treatment will lead to higher risk of infection, to granulation tissue formation and extended fibrosis, reduced flap survival rate, longer hospital stay, late rehabilitation and eventually to poor function. The advantages of an emergency free-flap reconstruction are salvage of exposed vital structures, reduction of bacterial colonization and immediate reconstruction of all damaged structures in the first surgical procedure, allowing for early rehabilitation and eventually leading to better functional recovery. In the absence of life-threatening injuries the absolute indication for an emergency free flap is exposure of a reconstructed vessel and/or of the main artery of the limb. Other absolute indications are salvage free flaps harvested from non replantable amputated parts and the flow-through flaps used for limb revascularization. The golden period for free-tissue transfer is the first 24 hours after injury. In the literature there is evidence that three days and even five days are of no detriment to final outcome if debridement is accurate and bacterial load low. Longer delays are consistently associated with higher infection rate, flap failure, multiple secondary procedures, longer hospital stay and eventually poor function. Disadvantages are the need for a well experienced surgeon capable, first of all, of a careful assessment of the general condition of the patient and of the remaining function of the affected limb. Further critical points are the extent of the debridement and the choice of the receiving vessels. Only when a surgically clean wound is obtained should a definitive closure be undertaken. In our opinion there are multiple methods available to close a complex wound of the extremities and the surgeon should choose the technique that offers the best chance of success at the lowest risk for the patient

Metodi geofisici per la ricerca di cavità: caso di studio alle Cave di Marsala (TP)

Many engineering and environmental projects require geophysical exploration to minimize the geological risk connected with the presence of natural or artificial tunnels and cavities (air and/or water filled). In this paper we like to confirm the reliability of combined geophysical methodologies (GPR and ERT) and relative modelling to detect and locate cavities in a particular site (Marsala Western Sicily) where underground dug structures exist. These structures may be used as real artificial physical models, very useful for testing geophysical methodologies. These shallow sandstone caves have, in general, a rectangular shape and are interconnected by tunnels. Most of these structures can be inspected from the inside, due to easy access points. The studies site, a well known area in which abandoned and active caves are presents, due to massive extractive historical and recent activity, seem to be suitable for many kinds of tests. In fact, the area presents relative homogeneity of materials, flat topography and presence of cavities having shapes regular enough, differing only for size and depth. The possibility to inspect cavity and their regular shape allowed us modelling the subsoil to compare synthetic data with experimental data. GPR and Resistivity modelling evidenced the most favourable configuration parameters for the selected acquisition techniques. An air-filled void generally provides a strong dielectric contrast with the surrounding rocks, so that the detectability using GPR is relatively high, but in our case the result seem to bee particularly unambiguous, allowing us recognizing the tops of the cavities. The apparent resistivity data have been processed by a robust constrained inversion technique and compared whit synthetic simulation. Also in this case, the detention of the cavity and its geometry seem to be very clear. GPR data shoved that these underground cavities can be detected also considering diffraction phenomena, which increase the vertical resolution. The used ERT technique seem to be able to recognize correct shapes and dimensions of cavities if their depth is comparable witch their dimensions. The integration of GPR and ERT seem to be very appropriate for cavities detections. In fact, the two techniques are complementary in detecting underground discontinuities (GPR) and volume anomalies (ERT) regarding electrical (resistivity) and electromagnetic (velocity) parameters of the rocks and air, which are generally well correlated