“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

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

Effects of training on postural stability in young basketball players

BACKGROUND: in basketball, balance ability is important to reduce non-contact injuries. The purpose of the present study was to investigate the effect of training on balance. METHODS: thirty-two healthy male volunteers were recruited from amateur basketball teams. They were asked to perform the Balance Error Scoring System BESS test in order to measure the number of stability errors in six conditions. The test was performed at the beginning of the season (T0) and after 12 weeks (T1). In both cases the test was carried out before (pre-session) and after a training session (post-session). RESULTS: the comparison of the total BESS scores both pre- and post-session showed a statistically significant increase of stability errors at both T0 and T1 (T0: pre-session 8.6±6.1 errors, post-session 10.7±6.3 errors; t=-4.03; p=0.002) (T1: pre-session 7.2±3.8 errors, post-session 9.1±5.4 errors; t=-1.93; p=0.03). Between T0 and T1 we noticed a reduction of errors which reached a statistical significance during the pre-session time (t=2.75; p=0.0049). CONCLUSION: stability improved after 12 weeks of training, even for those conditions for which no specific training was done to improve, such as on the soft surface and feet aligned in a tandem stance

Comparison of pain perception between open and minimally invasive surgery in total knee arthroplasty

Total knee arthroplasty (TKA) was a well-established procedure that had shown excellent long-term results in terms of reduced pain and increased mobility. Pain was one of the most important outcome measures that contributed to patient dissatisfaction after TKA. After a computerized search of the Medline and Embase databases, we considered articles from January 1st, 1997 to October 31st, 2009 that underlined the impact on patient pain perception of either standard open total knee arthroplasty or minimally invasive total knee arthroplasty. We included articles that used the visual analog scale (VAS), Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), Knee Score, Hospital for Special Surgery Score (HSS), Oxford Knee Score (OKS) as postoperative pain indicators, and we included studies with a minimum follow-up period of two months. We excluded studies that monitored only functional postoperative knee activities. It was shown that TKA with the open technique was a better treatment for knees with a positive effect on pain and function than the minimally invasive technique

Improved mental representation of space in beginner orienteers.

The purpose of the present study was to monitor any improvement in orienteering skills attributable to acquiring a better mental representation of space. Two groups were examined: the experimental group, who attended 6 mo. of orienteering lessons, versus the control group, who did jogging training instead. Each group, consisting of 20 children, was tested on the Corsi Block-tapping Test, run Forward and Backward, and the Star-Butterfly Test. Pre- and post-tests were administered. In the experimental group, scores increased in mean complexity from pre- to post-test on the Forward and the Backward Corsi tests, while on the Star-Butterfly Test both time and mistakes had decreased after the training. In the control group, mean complexity and Star-Butterfly Test scores were unchanged from pre- to post-test. These results showed that after continual training in orienteering techniques, the orienteering group was able to remember and repeat sequences of events with greater precision than before the training, while these skills were unchanged in the control group after training in jogging

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

Returning to sport after anterior cruciate ligament reconstruction in amateur sports men: a retrospective study.

BACKGROUND: According to the literature, 95% of professional athletes return to their sport after anterior cruciate ligament (ACL) reconstruction surgery. The main objective of this study was to verify the return to sport after ACL reconstruction in a homogenous group of amateur sportsmen and sportswomen in a series of Italian patients. MATERIALS AND METHODS: We designed a retrospective study in which we analyzed the amateur sports patients operated for ACL reconstruction. We verified whether they had returned to sporting activities by comparing the pre- and post-operative Tegner activity scores. We then analyzed the average time to restart the sporting activity and the Lysholm and International Knee Documenting Committee (IKDC) scores. RESULTS: We analyzed 80 subjects: 47.5% restarted a sports activity, on average after eight months, with a significant reduction of their competitive level or physical commitment, as expressed by the Tegner activity score (pre-operative: 6.9; post-operative: 3.9; p&lt;0.01). The functional knee recovery was good, as expressed by the average score of the Lyshom Knee Scoring Scale (93.5) and the IKDC (74.7). CONCLUSIONS: In the literature, a return to sport for international case studies and amateur sports is higher than our data. In our population we found the lack of information provided by the medical staff at discharge and follow-up. The assessment at a short-term follow up allowed us to verify that at the end of the post-surgical rehabilitation program the patients were uninformed about the timing and the ability to resume a sporting activity. An efficacious relationship between orthopedic doctor, physiotherapist and a doctor in motorial science may ensure proper treatment the patient after ACL reconstruction. It is important to guarantee the restarting of the sports activity to have a better quality of life in amateur sports. Level of evidence: V

New Variant of the Treatment of Acromion-Clavicular Dislocation with TightRope®System in a Mini - Open Approach: A Preliminary Clinical Study

Background: Many different surgical techniques have been described to stabilize the acromion-clavicular (AC) dislocations. So far many of these procedures are performed only in arthroscopy. Objectives: In this study, we describe a new technique that utilizes the tightrope with a mini-invasive open approach for the acute stabilization of the acromion-clavicular joint (ACJ) dislocation. Patients and Methods: We set an prospective study aimed to verify the efficacy of this new surgical technique. We treated 28 patients with acute ACJ dislocation with ACJ TightRope ® System with dual mini access. We retrospectively reviewed the data of 34 patients treated with arthroscopic technique. They were considered as the control group. Results: At 6 month’s follow-up, all the 28 patients showed a stable joint during clinical examination and obtained an average Constant score of 98.62/100, with a complete recovery of ROM and strength in abduction. The mean operation time was of 33.7 minutes. The mean recovery duration was 102.8 days. No significant difference was found between the experimental and control groups (P &gt; 0.05). Conclusions: Results of this trial suggest the effectiveness of this new mini-invasive surgical technique in producing clinical and functional recovery in patients with ACJ dislocations