Three-dimension-printed custom-made prosthetic reconstructions: from revision surgery to oncologic reconstructions

Background The use of custom-made 3D-printed prostheses for reconstruction of severe bone defects in selected cases is increasing. The aims of this study were to evaluate (1) the feasibility of surgical reconstruction with these prostheses in oncologic and non-oncologic settings and (2) the functional results, complications, and outcomes at short-term follow-up. Methods We analyzed 13 prospectively collected patients treated between June 2016 and January 2018. Diagnoses were primary bone tumour (7 patients), metastasis (3 patients), and revision of total hip arthroplasty (3 patients). Pelvis was the most frequent site of reconstruction (7 cases). Functional results were assessed with MSTS score and complications according to Henderson et al. Statistical analysis was performed using Kaplan-Meier and log-rank test curves. Results At a mean follow-up of 13.7 months (range, 6 \u2013 26 months), all patients except one were alive. Oncologic outcomes show seven patients NED (no evidence of disease), one NED after treatment of metastasis, one patient died of disease, and another one was alive with disease. Overall survival was 100% and 80% at one and two years, respectively. Seven complications occurred in five patients (38.5%). Survival to all complications was 62% at two years of follow-up. Functional outcome was good or excellent in all cases with a mean score of 80.3%. Conclusion 3D-printed custom-made prostheses represent a promising reconstructive technique in musculoskeletal oncology and challenging revision surgery. Preliminary results were satisfactory. Further studies are needed to evaluate prosthetic design, fixation methods, and stability of the implants at long-ter

Post-tsunami primary Scedosporium apiospermum osteomyelitis of the knee in an immunocompetent patient

SummaryScedosporium apiospermum is a filamentous fungus present in soil and polluted waters that may cause infection by direct inoculation. Osteomyelitis represents a challenge both for diagnosis and treatment. We report a case of post-tsunami primary S. apiospermum osteomyelitis of the knee in an immunocompetent patient

Instabilities in two flavor quark matter

I discuss briefly the instabilities of two flavor quark matter, paying attention to the gradient instability which develops in the g2SC phase in the Goldstone $U(1)_A$ sector.Comment: 6 pages. Talk given at QCD@Work07, Martina Franca (Italy). Some typos corrected, one reference adde

Instabilities in two flavor quark matter

I discuss briefly the instabilities of two flavor quark matter, paying attention to the gradient instability which develops in the g2SC phase in the Goldstone $U(1)_A$ sector.Comment: 6 pages. Talk given at QCD@Work07, Martina Franca (Italy). Some typos corrected, one reference adde

Long-term radiographic and clinical-functional outcomes of isolated, displaced, closed talar neck and body fractures treated by ORIF: the timing of surgical management

Background: The main purpose of this retrospective case series study was to evaluate long-term radiographic and clinical outcomes of a consecutive series of patients diagnosed with isolated, displaced, closed talar neck or body fractures treated by open reduction and internal fixation (ORIF). Secondly, the aim was to verify the influence of the location of talar fractures on the outcomes, the prognostic value of the Hawkins sign, whether operative delays promote avascular necrosis (AVN) and if the fractures require emergent surgical management. Methods: From January 2007 to December 2012, at our institution, 31 patients underwent ORIF through the use of screws. On the basis of Inokuchi criteria, the injuries were divided between neck and body fractures, which were classified according to Hawkins and Sneppen, respectively. The patients included were divided into two groups in relation to fracture location and complexity. Radiographic assessment focused on reduction quality, bone healing, the Hawkins sign and post-traumatic arthritis (PTA) development. For the clinical evaluation, clinical-functional scores (AOFAS Ankle-Hindfoot Score; MFS; FFI-17; SF-36) and VAS were determined, and statistical analysis was performed. Results: 27 patients, 19 males and 8 females, mean age 38.3 years, were included with an average follow-up period of 83.2 months (range 49\u2013119). There were 9 neck and 19 body fractures; their reduction was anatomical or nearly anatomical in 22 cases, and all reached radiographic consolidation after a mean period of 3.4 months (range 1.7\u20137). The Hawkins sign was observed in 9 cases, in which necrosis did not develop. With a 0\u201311 day surgical timing interval, more than 60% of the patients obtained good or fair results with different scores, while 18 (66.7%) were completely satisfied (VAS: 9\u201310). The early complications included malunions (21.4%) and wound problems (25%); the late complications involved AVN (25%) and PTA (78.6%). Conclusions: Despite a high rate of long-term complications, satisfactory clinical results were achieved. Talar fracture location did not influence the outcomes, the Hawkins sign was confirmed as a positive prognostic factor, and operation timing did not influence AVN development. Hence, these injuries do not require emergent surgical management by ORIF

Medium-Long-Term Clinical and Radiographic Outcomes of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Central Primary Metatarsalgia: Do Maestro Criteria Have a Predictive Value in the Preoperative Planning for This Percutaneous Technique?

The purpose of this prospective study was first to evaluate the safety and effectiveness of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) in treating central metatarsalgia, identifying possible contraindications. The second objective was to verify the potential of DMMO to restore a harmonious forefoot morphotype according to Maestro criteria. Methods. A consecutive series of patients with metatarsalgia was consecutively enrolled and treated by DMMO. According to Maestro criteria, preoperative planning was carried out by both clinical and radiological assessment. Patient demographic data, AOFAS scores, 17-FFI, MOXFQ, SF-36, VAS, and complications were recorded. Maestro parameters, relative morphotypes, and bone callus formation were assessed. Statistical analysis was carried out (p<0.05). Results. Ninety-three patients (93 feet) with a mean age of 62.4 (31-87) years were evaluated. At mean follow-up of 58.7 (36-96) months, all of the clinical scores improved significantly (p<0.0001). Most of the osteotomies (76.3%) had healed by 3-month follow-up, while ideal harmonious morphotype was restored only in a few feet (3.2%). Clinical and radiological outcomes were not different based on principal demographic parameters. Long-term complications were recorded in 12 cases (12.9%). Conclusion. DMMO is a safe and effective method for the treatment of metatarsalgia. Although Maestro criteria were useful to calculate the metatarsal bones to be shortened and a significant clinical improvement of all scores was achieved, the ideal harmonious morphotype was restored only in a few feet. Hence, our data show that Maestro criteria did not have a predictive value in clinical outcomes of DMM

Medium-Long-Term Radiographic and Clinical Outcomes after Surgical Treatment of Intra-Articular Tibial Pilon Fractures by Three Different Techniques

The goal of this retrospective, observational, case series study was to evaluate the medium-long-term clinical and radiographic results of the three most common surgical osteosynthesis techniques used for the treatment of articular tibial pilon fractures: ORIF, MIPO, and EF. Materials and Methods. A consecutive series of patients with articular pilon fractures who underwent surgery at our institution were enrolled in this study. Fractures were classified according to the M\ufcller AO classification system. Overall outcomes took the following into account: radiographic quality of reduction, evaluated using Ovadia and Beals\u2019 criteria; clinical assessment, evaluated using the AOFAS questionnaire; and general health, evaluated with the SF36-v2 Health Survey. Results. A total of 94 articular pilon fractures (34 type 43-B and 60 43-C) were evaluated with a mean follow-up of 56.34 months (range 33\u2013101). The techniques used were ORIF, MIPO, and EF in 63 (67%), 17 (18.9%), and 14 cases (14.1%), respectively. According to Ovadia and Beals\u2019 criteria, good, fair, and poor results were reported in 61 (64.89%), 26 (27.66%), and 7 (7.45%) cases, respectively. The mean AOFAS score was 82.41 for MIPO, 79.83 for ORIF, and 50.57 for EF, respectively. Thirty-nine patients (41.49%) presented early and/or late complications. Conclusion. Satisfactory outcomes using the three different techniques were reported. In particular, the radiographic outcomes were inversely proportional to the fracture comminutions and statistically different between internal and external osteosynthesis, but comparable between ORIF and MIPO techniques. On the other hand, the clinical outcomes were closely related to the soft tissue conditions and the anatomical reconstruction of the joint

Predictability of Big Five Traits in high school teacher burnout. Detailed study through the disillusionment dimension

This research aimed to investigate the theme of burnout syndrome in high school teachers. In particular, the objective was to verify if the five personality traits can be considered predictors of the four dimensions of burnout. The sample consisted of 171 teachers, 49 males and 122 females. For the burnout measurement, the Link Burnout Questionnaire (LBQ) was used, and for the personality measure, the Big Five Questionnaire (BFQ) was used. As predictive factors for the development of the negative polarity of Psychophysical Exhaustion, the results identify both Energy and Emotional Stability. For Relational Deterioration, the same traits emerge due to the dimension of Professional Inefficiency. For the LBM’s Disillusion dimension, there was no corresponding predictive BFM trait, but by reducing the statistical error via analysis of regression with fixed effects, Agreeableness and Emotional Stability were predictive. The research confirms the relationship between personality and burnout, but future studies should both analyse the influence exerted by the contextual factors on the onset of the syndrome and deepen the research on the mental model

Functional outcome and complications after treatment of comminuted tibial fractures or deformities using Ilizarov bone transport: a single-center study at 15- to 30-year follow-up

Introduction - The aim of this retrospective study was to evaluate long-term outcomes and complications of a single-center and single-surgeon patient series of isolated and comminuted tibial fractures with bone defects or tibial deformities treated by Ilizarov bone transport. Materials and methods - Data from a consecutive series of patients with isolated comminuted tibial fractures (Fracture Group: FG) or deformities (Deformity Group: DG) treated between 1987 and 2002 were included. For clinical assessment, the Lower Extremities Functional Scale was used; complications were recorded according to the Dindo classification and statistical analysis was performed. Results - Overall, 72 patients were enrolled with a mean follow-up of 21.6 years (range 15\u201330) a mean LEFS of 36.4 (range 0\u2013100). In the FG, the mean LEFS was 21.3 (range 0\u201398.75), and the external fixation time (EFT) lasted 7.6 months (range 3\u201318 months) months. In the DG, the mean LEFS was 76.7 (range 55\u2013100), and the EFT was 10.6 months (range 3\u201320 months). Between the two groups, the clinical evaluation was significantly different, while the EFT was not (p = 0.14). In the FG, the worst results were obtained in the cases of open fractures with a higher percentage of complications and the need for further surgical procedures. The cumulative rate of complications was 55.6% during the first 36 months and 66.7% at the minimum follow-up of 180 months. Conclusions - Ilizarov bone transport, even at a long follow-up period, proved to be an effective technique for both definitive treatment of comminuted tibial fractures with bone defects or tibial deformities. Although our functional outcomes were lower in patients with exposed fractures, they were in line with the literature, but not influenced by the EFT when properly managed. Most complications occurred during the first 3 years; however, they could also arise much later, even until almost 30 years

Palliative embolization arteries or veins for a recurrent pelvic chondrosarcoma

Chondrosarcoma is a malignant bone tumor characterized by the formation of cartilage structures of varying degrees of ma-turity. They account for approximately 20 % of malignant skele-tal tumors. Chondrosarcoma most often affects the pelvis (iliac bone), the proximal femur and humerus, ribs. The chondrosar-coma of the pelvis has a low response to chemo- and radiation therapy, so they are usually resected by standard hemipelvec-tomy. New surgical reconstructive techniques allow surgeons to perform major reconstructions, thereby improving patients' quality of life. Clinical case: male, 64 years old, with complains of the left thigh pain for 6 months. The patient was made a com-prehensive examination \u2014 standard X-rays, MRI and CT scan of the pelvis, biopsy of the pathological formation. Diagnosis: chondrosarcoma II clinical group, stage IIB. Primary sur-gery \u2014 wide-field excision and reconstruction with a massive bone allograft was performed and bipolar hip replacement. Two major local recurrences were detected in 3 years. Due to inef-ficiency of chemo- and radiation therapy, refusal of the patient from amputation, high degree of tumor vascularization, arterial embolization was applied. A selective study of both the medial and lateral femoral arteries was performed using a uroangio-graphic contrast medium. The achievement of complete devas-cularization of the greatest lesion was confirmed angiographi-cally. After 20 days due to partial revascularization, re-emboli-zation of the lateral circular femoral artery was made. The final embolization of all arterial branches that fed the tumor was performed after 3 months with acrylic (n-butyl 2-cyanoacrylate) glue for larger-sized vessels and microparticles of polyvinyl al-cohol (150\u2013 250 \u3bcm) for the smallest branches. Conclusion: em-bolization can be effectively used as a palliative treatment for highly vascularized pelvic chondrosarcoma. Key words: chond-rosarcoma, pelvis, embolization, palliative, polyvinyl alcohol microparticles