A NEW MECHANICAL DEVICE USEFUL TO INSERT THE DISTAL SCREWS IN INTRAMEDULLARY NAILS

The development and introduction of the closed locked intramedullary nail into clinical practice has revolutionized the treatment of fractures of long bone. The most difficult and technically demanding part of the procedure is often the insertion of the distal interlocking screws. A lot of efforts have been made during the past years to make it easier. In according with Whatling and Nokes, we can divide the different approaches to this issue in four main groups: Free-hand (FH) technique; Mechanical targeting devices mounted on image intensifier; Mechanical targeting devices mounted onto nail handle; Computer-assisted techniques. In addition of these, recently it has been proposed a navigational system using electromagnetic field. The main disadvantages of the FH technique, are prolonged exposure to radiation and results depend mostly on the dexterity of the surgeons. FH technique is however the most popular technique. Our targeting device is included into the mounted on image intensifier group. It consists of 2 radio-opaque rods at right angle to each over: one of this is fixed on the c-arm, whereas, the other is a sliding rod with a sleeve for the drill bit, which is the targeting guide itself. In the realization of this device, we have been inspired by the modification of the FH technique suggested by Kelley et al. To identify the distal holes we used the method described by Medoff (perfect circle). Once that the distal hole is seen as a perfect circle, with the C-arm in later view, the targeting guide is roughly positioned onto this and the drilling and the screwing operations are performed without the need for image intensifier. We used the device in bone models and in 9 clinical cases. In spite of authors demonstrated that the electromagnetic targeting device significantly reduced radiation exposure during placement of distal interlocking screws and was equivalent in accuracy when compared with the FH technique, the latter is the most used technique. Indeed, although all the studies have reported that the radiation exposure to orthopedic surgeon has been below the maximum allowable doses in all cases, there is still the risk of cumulative lifetime radiation exposure. From this point of view, namely the reduction of cumulative lifetime radiation exposure, we think that, paradoxically, our device could be more effective than electromagnetic targeting device, because it can be used in all the orthopedic operations that required a targeting device

Pregnancy-associated osteoporosis with seven vertebral compression fractures, a case treated with strontium ranelate

This paper shows a case of pregnancy-associated osteoporosis (PAO) with seven vertebral compression fractures treated with strontium ranelate and supplementation of calcium and cholecalciferol. Clinical evaluation, laboratory and radiological results are analyzed in the case-report to demonstrate that strontium ranelate is a good option to restore quickly the value of bone mineral density in the treatment of a case of PAO. KEYWORDS

Cobalt, chromium and molybdenum ions kinetics in the human body: data gained from a total hip replacement with massive third body wear of the head and neuropathy by cobalt intoxication.

6openopenPazzaglia, U; Apostoli, P; Congiu, T; Catalani, S; Marchese, M; Zarattini, G.Pazzaglia, Ugo; Apostoli, Pietro; Congiu, T; Catalani, S; Marchese, M; Zarattini, Guid

Fin systems comparative anatomy in model Batoidea Raja asterias and Torpedo marmorata: Insights and relatioships between musculo-skeletal layout, locomotion and morphology

The macroscopic and microscopic morphology of the appendicular skeleton was studied in the two species Raja asterias (order Rajiformes) and Torpedo marmorata (Order Torpediniformes), comparing the organization and structural layout of pectoral, pelvic, and tail fin systems. The shape, surface area and portance of the T. marmorata pectoral fin system (hydrodynamic lift) were conditioned by the presence of the two electric organs in the disk central part, which reduced the pectoral fin surface area, suggesting a lower efficiency of the "flapping effectors" than those of R. asterias. Otherwise, radials' rays alignment, morphology and calcification pattern showed in both species the same structural layout characterized in the fin medial zone by stiffly paired columns of calcified tiles in the perpendicular plane to the flat batoid body, then revolving and in the horizontal plane to continue as separate mono-columnar rays in the fin lateral zone with a morphology suggesting fin stiffness variance between medial/lateral zone. Pelvic fins morphology was alike in the two species, however with different calcified tiles patterns of the 1st compound radial and pterygia in respect to the fin-rays articulating perpendicularly to the latter, whose tile rows lay-out was also different from that of the pectoral fins radials. The T. marmorata tail-caudal fin showed a muscular and connective scaffold capable of a significant oscillatory forward thrust. On the contrary, the R. asterias dorsal tail fins were stiffened by a scaffold of radials-like calcified segments. Histomorphology, heat-deproteination technique and morphometry provided new data on the wing-fins structural layout which can be correlated to the mechanics of the Batoid swimming behavior and suggested a cartilage-calcification process combining interstitial cartilage growth (as that of all vertebrates anlagen) and a mineral deposition with accretion of individual centers (the tiles). The resulting layout showed scattered zones of un-mineralized matrix within the calcified mass and a less compact texture of the matrix calcified fibers suggesting a possible way of fluid diffusion throughout the mineralized tissue. These observations could explain the survival of the embedded chondrocytes in absence of a canalicular system as that of the cortical bone

Analisi predittive del comportamento idro-meccanico di un modello di argine fluviale in condizioni di flusso transitorio

Il frequente manifestarsi di eventi alluvionali per collasso di opere in terra costituisce un problema di particolare rilevanza nella valutazione del rischio idrogeologico e della pianificazione territoriale. In questo contesto risulta cruciale un’accurata stima delle condizioni di stabilità che tenga conto dello stato di parziale saturazione dei terreni costituenti il rilevato. Altrettanto importante è tenere conto delle condizioni di flusso transitorio che si instaurano negli argini e nei terreni di fondazione a seguito delle continue variazioni del livello idrometrico dei corsi d’acqua. Tutto ciò influenza notevolmente la risposta idro-meccanica delle opere in parola. In tale prospettiva la nota illustra uno studio numerico, basato sull’approccio agli elementi finiti e sul metodo dell’Equilibrio Limite, per l’analisi del comportamento di un argine fluviale rappresentativo delle opere di difesa idraulica degli affluenti alpini e appenninici del fiume Po. Lo studio proposto tiene debito conto delle condizioni di parziale saturazione del corpo arginale interessato da un moto di filtrazione in regime transitorio. Le analisi numeriche proposte costituiscono parte integrante della progettazione di una prova in centrifuga geotecnica su un modello fisico in scala ridotta, finalizzata a investigare la vulnerabilità delle infrastrutture arginali nei confronti di eventi di piena

Modellazione fisica in centrifuga di un argine fluviale soggetto a forzanti idrauliche

In questo lavoro sono riportati i risultati sperimentali di una prova in centrifuga su un modello di argine fluviale soggetto ad una progressiva sollecitazione idraulica. Le misure di pressioni neutre e di suzione nell’argine mostrano che il fronte di saturazione raggiunge il lato campagna attingendo la condizione stazionaria solo dopo una persistenza irrealistica dell'evento di piena simulato. Pertanto svolgere la progettazione o la valutazione delle condizioni di sicurezza di un argine fluviale con proprietà simili a quello testato nel presente lavoro, assumendo l'ipotesi semplificata di un regime stazionario di filtrazione potrebbe risultare in molti casi un approccio eccessivamente conservativo e, comunque, poco significativo

The incidence of hip, forearm, humeral, ankle, and vertebral fragility fractures in Italy: results from a 3-year multicenter study

INTRODUCTION: We aimed to assess the incidence and hospitalization rate of hip and "minor" fragility fractures in the Italian population. METHODS: We carried out a 3-year survey at 10 major Italian emergency departments to evaluate the hospitalization rate of hip, forearm, humeral, ankle, and vertebral fragility fractures in people 45 years or older between 2004 and 2006, both men and women. These data were compared with those recorded in the national hospitalizations database (SDO) to assess the overall incidence of fragility fractures occurring at hip and other sites, including also those events not resulting in hospital admissions. RESULTS: We observed 29,017 fractures across 3 years, with hospitalization rates of 93.0% for hip fractures, 36.3% for humeral fractures, 31.3% for ankle fractures, 22.6% for forearm/wrist fractures, and 27.6% for clinical vertebral fractures. According to the analyses performed with the Italian hospitalization database in year 2006, we estimated an annual incidence of 87,000 hip, 48,000 humeral, 36,000 ankle, 85,000 wrist, and 155,000 vertebral fragility fractures in people aged 45 years or older (thus resulting in almost 410,000 new fractures per year). Clinical vertebral fractures were recorded in 47,000 events per year. CONCLUSIONS: The burden of fragility fractures in the Italian population is very high and calls for effective preventive strategies

A Multicentric, Open-Label, Randomized, Comparative Clinical Trial of Two Different Doses of Expanded hBM-MSCs Plus Biomaterial versus Iliac Crest Autograft, for Bone Healing in Nonunions after Long Bone Fractures: Study Protocol

ORTHOUNION is a multicentre, open, comparative, three-arm, randomized clinical trial (EudraCT number 2015-000431-32) to compare the efficacy, at one and two years, of autologous human bone marrow-derived expanded mesenchymal stromal cell (hBM-MSC) treatments versus iliac crest autograft (ICA) to enhance bone healing in patients with diaphyseal and/or metaphysodiaphyseal fracture (femur, tibia, and humerus) status of atrophic or oligotrophic nonunion (more than 9 months after the acute fracture, including recalcitrant cases after failed treatments). The primary objective is to determine if the treatment with hBM-MSCs combined with biomaterial is superior to ICA in obtaining bone healing. If confirmed, a secondary objective is set to determine if the dose of 100 × 106 hBM-MSCs is noninferior to that of 200 × 106 hBM-MSCs. The participants (n = 108) will be randomly assigned to either the experimental low dose (n = 36), the experimental high dose (n = 36), or the comparator arm (n = 36) using a central randomization service. The trial will be conducted in 20 clinical centres in Spain, France, Germany, and Italy under the same clinical protocol. The confirmation of superiority for the proposed ATMP in nonunions may foster the future of bone regenerative medicine in this indication. On the contrary, absence of superiority may underline its limitations in clinical use

Ascending Tonic Clonic Seizure Syndrome after Percutaneous Vertebroplasty

Background Context. Cement leakage is not a rare complication of vertebroplasty, but ascending tonic clonic seizure syndrome is exceptionally rare. We herein report the first case to our knowledge of this complication related to vertebroplasty. Purpose. We herein report the first case of ascending tonic clonic seizure syndrome following epidural cement leakage after percutaneous vertebroplasty in a patient with multiple osteoporotic compression fractures. Study Design. Case report. Methods. A 64-year-old woman with T8, T10, L2, and L4 osteoporotic compression fractures underwent percutaneous vertebroplasty using polymethylmethacrylate. 40 minutes after the procedure the patient started suffering back and leg pain, having repetitive myoclonic jerks lasting 15 seconds of the lower extremities, spasm of the back, dyspnea, sinus tachycardia, hypoxemia, and metabolic acidosis. Results. The patient recovered completely due to a combination of early effective resuscitation and considered definitive management. Conclusions. Percutaneous vertebroplasty with polymethylmethacrylate is relatively safe but has few dangerous complications, which should be prevented by a meticulous technique and excellent image quality