Bone Marrow Concentrate in the Treatment of Aneurysmal Bone Cysts: A Case Series Study

Introduction. A recent attractive option regarding mesenchymal stem cells (MSC) application is the treatment of bone cystic lesions and in particular aneurysmal bone cysts (ABC), in order to stimulate intrinsic healing. We performed a retrospective evaluation of the results obtained at our institution.Methods. The study group consisted of 46 cases with an average follow-up of 33 months. Forty-two patients underwent percutaneous treatment as the first approach; four patients had curettage as first treatment. In all cases, autologous bone marrow concentrate (BMC) was associated too. The healing status was followed up through a plain radiograph 45 days and 2 months after the procedure.Results and Conclusions.At the final follow-up, thirty-six patients healed with a Neer type II aspect, nine healed with a type I aspect, and one patient was not classified having total hip arthroplasty. Bone marrow concentrate is easy to obtain and to manipulate and can be immediately available in a clinical setting. We can assert that the use of BMC must be encouraged being harmless and having an unquestionable high osteogenic and healing potential in bone def

Surgical management of villonodular-pigmented synovitis of knee: decisional algorithm

Pigmented villonodular synovitis (PVNS) of knee is an uncommon disease defined as benign despite presenting local aggressiveness and high propensity to recurrence. Etiology is still not completely understood. It seems to be a chronic inflammation process involving synovial membranes characterized by hemosiderin deposition which leads to pain, limitation of range of motion and, if not treated, bone erosion and osteoarthritis of knee. The gold standard for treatment is surgical excision; other adjuvant or alternative therapies are described, too. We present a case series of PVNS of the knee treated with surgical excision at our institution. Functionality was assessed using the Muscoloskeletal Tumor Society (MSTS) Score for lower limbs and Oxford Knee Score (OKS). Statistical analysis were performed. At the latest follow-up, our patients' mean MSTS score was 26.4 (30-18): 27.4 for those treated with posterior approach and 26.1 for the anterior ones. Only 5% of patients suffered local complications and 15% had a local recurrence of the disease. Adequate pre-operative study and careful surgical excision, that should be tailored to each patient are the key to obtain a low recurrence rate

Unstable lateral femoral fractures: elements predictable of failure. Analysis of critical aspects related to the fracture pattern and nailing in order to obtain healing

Objective. Lateral femoral fractures are common events, especially in old frail patients. They can be stable or unstable on the basis of specific features. Optimal treatment requires preoperative evaluation of the fracture pattern and appropriate choice of implant and surgical technique. The aim of this study was to detect variables related to fixation failure in unstable lateral femoral fracture. Methods. We retrospectively evaluated 136 patients treated with intramedullary proximal femur nail (PFN) between January 2016 and December 2017 at our hospital. All fractures were classified according to the AO/OTA classification; the type and length of nail, nail collodiaphyseal angle, type of distal locking and use of steel wire cerclage were recorded. These variables were statistically analysed to evaluate any correlation with the onset of complications, i.e., biological and/or mechanical failure. Results. At the first follow-up at three months, we found 13 failures (9.6%). At 6 months, 38 patients were lost to follow-up and we identified 3 failures as pseudoartrosis. Statistical analysis showed a significant correlation between the type of fracture and failure. No significant differences were detected for the other parameters. Conclusions. When treating a lateral unstable femoral fracture with proximal femoral nail, the only variable significantly related to failure seems to be the fracture pattern. Thorough knowledge of the implant still remains essential to obtain a good result

Cisti ossee aneurismatiche: inquadramento diagnostico e trattamenti

Il trattamento ottimale delle cisti aneurismatiche dell’osso rimane tuttora controverso, sebbene siano passati quasi ottant’anni da quando queste lesioni sono state descritte per la prima volta. Nella seguente tesi vieni presentata la casistica raccolta presso la II Clinica Ortopedica di Pisa negli ultimi quattro anni con trattamenti e risultati ottenuti; per ogni opzione terapeutica è stato anche effettuato un confronto con la letteratura, dai primi lavori a quelli più recenti. Queste lesioni, tipiche del giovane, sono benigne ma talvolta possono presentare dei caratteri destruenti e localmente aggressivi, mimando patologie oncologiche di carattere ben più grave. Esse meritano, pertanto, un tempestivo e attento inquadramento diagnostico ed un trattamento altrettanto mirato

Bilateral transient osteoporosis of the hip with unilateral fracture in a 40 years old pregnant woman

Purpose: Some physiological events in women’s life such as pregnancy and lactation can be associated to a condition known as Transient Osteoporosis of the Hip (TOH); if not promptly diagnosed it can lead to significant consequences such as femoral neck fracture. In this paper we describe a case of bilateral TOH, focusing on the importance of early treatment and how it influenced the outcome. Methods: A 40 years old post-delivery woman came to our attention for hip pain and a left femoral neck fracture was diagnosed. Magnetic resonance (MRI) showed bilateral edema of the femoral head. She underwent total hip replacement on the left side; toe-touch weight bearing and pharmacological therapy were prescribed for the right hip. Results: MRI at nine months showed complete regression of the femoral head and neck edema; the patient was clinically asymptomatic. Conclusion: If not promptly diagnosed and treated, TOH can potentially evolve in fracture. Many therapeutic strategies have been suggested since now; we believe that avoiding weight bearing on the involved hip as early as possible is the key to recovery

First metatarsophalangeal fusion with dorsal plate: clinical outcomes

Abstract Background First metatarsophalangeal joint (MTPJ) fusion is the most effective technique for the treatment of MTPJ primary arthritis, severe hallux valgus and failure of primary corrective surgery of these conditions. It can be achieved through different techniques. We evaluated the outcomes in a cohort of patients treated with dorsal plate arthrodesis. Materials and methods We treated 30 feet for 28 patients; the mean follow-up was 35 months. For each foot, we collected radiological and clinical assessment, with the visual analogue scale (VAS) for pain and the Manchester and Oxford Foot questionnaire (MOFQ). The technique consisted in a cup and cone arthrodesis with the application of a low profile dorsal plate. Patients were allowed for immediate weight bearing. Results Consolidation was achieved in all cases; in 29 cases, radiographic union was recorded within 6 months from surgery, in one case after 9 months. Comparison between the preoperative and postoperative of VAS and MOXFQ values showed a statistically significant difference (p < 0.05). Only one case developed wound dehiscence as complication. Conclusions Even if there is still a debate regarding the best system for MTPJ fusion, we believe cup and cone fusion with dorsal plating is an effective method. Moreover, the stability of the osteosynthesis obtained allows for immediate post-operative weight bearing, making patients able to return soon to their normal life. Trial registration We present a retrospective study; all patients enrolled were retrospectively registered

Surgical approach to rare case of recurrent pheochromocytoma and bones metastatic paraganglioma

Background. Paraganglioma/Pheochromocytoma (PGL/PCC) are neuroendocrine tumors characterized by association of paraganglioma and pheochromocytoma. PGLPCC are caused by mutations in a series of genes involved in cell metabolism. These genetic conditions can be both sporadics or less frequently hereditaries, usually diagnosed in younger patients. PCC-PGL incidence is about 1 in 300,000. PGL type 4 represents 5% of all PCC-PGL, it's related to SDHB mutations and has higher risk for malignancy than the other types. Malignancy is defined by presence of metastases that arise in sites devoid of chromaffin tissue such as bone. Malignant PGLs are extremely rare. Case presentation. The patient is a 37-year-old-female affected by paraganglioma in left paravertebral region and pheochromocytoma in the left adrenal gland (PPGL type 4). Pheocromocytoma was suspected after sporadic episode of hypertensive crisis and in 2012 a diagnosis was obtained. Genetic analysis were performed and showed mutation of SDHB gene. The patient underwent a left adrenalectomy to remove left pheochromocytoma. In October 2016 laboratory tests and instrumental exams showed recurrence of pheochromocytoma in left adrenal loggia, a metastases involving D10 and other small osteolytic areas spread in vertebral column and other bones. Meantime the patient complained lumbar and intercostal pain, blood pressure was always in normal range. A surgical intervention of nerve decompression was needed urgently. Our intervention consisted in metastasis excision with apposition of bone cement and stabilization of column through polyaxial pedicle screw and bar. Outcomes. After surgery the patient showed improvement of symptoms, after two months was reported a regression of pain. Discussion. Our case report is a rare example of malignant PGLPCC with pheochromocytoma recurrence and paraganglioma metastatic lesions spread in bones (specially in vertebral column) and other organs whereas PGL4 is generally benignant. Few are similar cases described in literature. In particular our report is exceptional for the multiples metastatic lesions spread in bones like sternum, right femurs, iliac wings and vertebras. This case confirmed that the surgery plays a significant role in the management of malignant PGLPCC. Our case remarks the need to carefully follow this kind of patients after diagnosis both to identify recurrence and/or secondary localizations of disease. Strict control of a set of markers in the blood flow is cost-effective and primary. Our case confirm the need, in these rare cases, to perform MIBG scintigraphy and PET total body in addition to standard imaging techniques to improve our ability to recognize recurrences when suspected. We recommend a multidisciplinar approach to ensure rapid recognition of disease and to choose the most appropriate treatment. For this reason it is demanding to report these cases to better understand this rare disease and all its multiple forms. © 2018 CIC Edizioni Internazionali s.r.l.. All rights reserved. SciVal Topic Prominenc