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Limb lengthening with PRECICE magnetic nail in pediatric patients: A systematic review

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World Journal of Orthopedics 2021年第8期12卷 575-583页

作者： Giulia Masci Osvaldo Palmacci Raffaele Vitiello Nadia Bonfiglio Maria Beatrice Bocchi Valerio Cipolloni Giulio Maccauro enrico pola Department of Orthopaedics and Traumatology Fondazione Policlinico Universitario A.Gemelli IRCCSRome 00168Italy Policlinico di Napoli University Hospital Universitàdella Campania Luigi Vanvitelli School of MedicineNapoli 80100Italy

BACKGROUND Limb lengthening techniques play an increasingly important role in the pediatric orthopedic *** principles of the osteogenesis distraction bonded traditionally with external fixators;however,the recent deployment of fully implantable systems has been able to overcome severities related to external *** PRECICE®is an implantable limb lengthening intramedullary nail system that is remotely controlled and magnetically *** To review the current literature available on this matter in order to assess the PRECICE clinical and radiological outcomes and its possible complications in a population of pediatric patients undergoing limb *** Only five studies met the inclusion criteria and were consequently included in the review for a total of 131 patients and 135 *** clinical and radiological outcomes of interest were:the main lengthening obtained,the distraction rate,the period of time to full weight bearing,the consolidation index,and the Association for the Study and Application of Methods of Ilizarov *** In conclusion,data collected from the articles under investigation were comparable with the exception of the consolidation ***,the study population was too small and the patients’follow-up was too short to make definitive *** This review shows that the PRECICE Nail System is still a therapeutic challenge in limb lengthening for pediatric orthopedic surgeons;however,careful preoperative planning and an accurate surgical technique could allow the correction of more complex deformities with a low rate of complications.

关键词： Limbs lengthening PRECICE Nail Pediatric Dysmetria Deformities

Pain management in acute musculoskeletal injury: Effect of opioid vs nonopioid medications

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World Journal of Orthopedics 2024年第9期15卷 882-890页

作者： Marco Fiore Luigi Aurelio Nasto Eleni McCaffery Fannia Barletta Angela Visconti Francesca Gargano enrico pola Maria Caterina Pace Department of Women Child and General and Specialized SurgeryUniversity of Campania“Luigi Vanvitelli”Naples 80138Italy Department of Orthopaedics University of Campania“Luigi Vanvitelli”Naples 80138Italy Department of Emergency Medicine New York Presbyterian-Brooklyn Methodist HospitalNew YorkNY 11215United States Department of Anesthesia and Intensive Care “San Carlo”HospitalPotenza 85100Italy Department of Anaesthesia “San Giuliano”HospitalGiugliano 80014Italy Unit of Anesthesia and Intensive Care The Fondazione Policlinico Universitario Campus Bio-MedicoRome 00128Italy

BACKGROUND The use of opioids for pain is linked to an increased risk of developing opioid use disorder,and has resulted in the emergence of the opioid crisis over the last few *** The systematic review question is“How does the use of opioid medications in pain management,compared with non-opioid medications,affect pain intensity over the short,intermediate,and long-term in adults with acute traumatic pain?”.METHODS The protocol was prospectively registered on the International Prospective Re-gister of Systematic Reviews:*** and Google Scholar were electronically searched for controlled peer-reviewed studies published in full,with the PICO framework:P:Adult patients with traumatic injuries,I:Opioid medications,C:Non-opioid medi-cations,O:A minimum clinically important difference(MCID)in *** After full-text screening,we included 14 studies in the qualitative *** these 14 studies,12 were rando-mized clinical trials(RCTs)and 2 were pseudo-RCTs with a total of 2347 patients *** was heteroge-neity in both medication utilized and outcome in these studies;only two studies were homogeneous regarding the type of study conducted,the opioid used,its comparator,and the outcome *** MCID was evaluated in 8 studies,while in 6 studies,any measured pain reduction was considered as an *** 11 cases,the setting of care was the Emergency Department;in 2 cases,care occurred out-of-hospital;and in one case,the setting was not *** included studies were found to have a low-moderate risk of *** Non-opioids can be considered an alternative to opioids for short-term pain management of acute musculoskeletal *** ketamine may cause more adverse events than other routes of administration.

关键词： Acute musculoskeletal injury Acute traumatic pain Non-opioid analgesia Non-opioid pain control Opioid-sparing analgesia Opioid crisis Opioid disorder Systematic review

Distal femur complex fractures in elderly patients treated with megaprosthesis:Results in a case series of 11 patients

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World Journal of Orthopedics 2022年第5期13卷 454-464页

作者： Fabio Zanchini Antonio Piscopo Valerio Cipolloni Federico Fusini Stefano Cacciapuoti Davide Piscopo Charlotte Pripp Luigi Aurelio Nasto enrico pola Orthopaedics and Traumatology Division Multidisciplinary Department of Medical-Surgical and Dental SpecialtiesUniversity of Campania"Luigi Vanvitelli"School of MedicineNaples 80138Italy Department of Orthopedics and Traumatology Sacro Cuore di GesùFatebenefratelli HospitalBenevento 82100Italy Spine Division Department of Orthopaedics and TraumatologyA.Gemelli IRCCS University HospitalCatholic University of RomeRome 00168Italy Department of Orthopaedic and Traumatology Regina Montis Regalis HospitalMondovì12084Italy Service de Geriatrie et réaaptation HUG H?pital de Bellerive ChemGenève 1205Switzerland

BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is *** and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for early walking and rapid restoration of function and also pose significant obstacles to achievement of satisfactory results with standard fixation ***,several authors have suggested that primary arthroplasty could be a viable alternative option to standard fixation techniques in selected patients with complex distal femur *** To present our experience with 11 cases of distal femur fractures treated with knee arthroplasty and large femoral resection in a population of patients over the age of *** Data from 11 consecutive patients(10 females,1 male)presenting with acute intra-articular supracondylar or intercondylar distal femur fractures and with pre-existent primary osteoarthritis who were treated with primary knee arthroplasty were *** collected standard demographic data,comorbidities and patient reported outcomes including Visual Analogical Scale(VAS),Oxford Knee Score(OKS)and Barthel’s ***-operative joint range of motion(ROM)and standard radiographic data were also *** At a mean follow-up of 23.2 mo,all of the implants were well-positioned and ***,all the patients were alive and walking either independently or with walking *** was a marked improvement in pain(VAS 4.5 postop vs 1.9 at the last follow-up),OKS score(29.5 postop vs 36.81 at the last follow-up),ROM(96.2°postop vs 102°at the last follow-up)and restoration of pre-injury ambulatory status(average Barthel Index 77.3).The radiographic evaluations showed good restoration of the articular *** deaths and no complications were *** In conclusion,we believe that knee megaprosthesis in the case of complex fractures of the distal femur is a valid surgical *** is particularly true in

关键词： Knee Joint replacement Megaprosthesis Elderly Distal femur fracture

Allergy in total knee replacement surgery:Is it a real problem?

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World Journal of Orthopedics 2019年第2期10卷 63-70页

作者： Maristella F Saccomanno Giuseppe Sircana Giulia Masci Gianpiero Cazzato Michela Florio Luigi Capasso Marco Passiatore Giovanni Autore Giulio Maccauro enrico pola Department of Orthopaedics and Traumatology Fondazione Policlinico Universitario A.Gemelli IRCCS

Total knee arthroplasty is a common procedure, with extremely good clinical results. Despite this success, it produces 20% unsatisfactory results. Among the causes of these failures is metal hypersensitivity. Metal sensitization is higher in patients with a knee arthroplasty than in the general population and is even higher in patients undergoing revision surgery. However, a clear correlation between metal sensitization and symptomatic knee after surgery has not been ascertained. Surely, patients with a clear history of metal allergy must be carefully examined through dermatological and laboratory testing before surgery. There is no globally accepted diagnostic algorithm or laboratory test to diagnose metal hypersensitivity or metal reactions. The patch test is the most common test to determine metal hypersensitivity, though presenting some limitations. Several laboratory assays have been developed, with a higher sensitivity compared to patch testing, yet their clinical availability is not widespread, due to high costs and technical complexity. Symptoms of a reaction to metal implants present across a wide spectrum, ranging from pain and cutaneous dermatitis to aseptic loosening of the arthroplasty. However, although cutaneous and systemic hypersensitivity reactions to metals have arisen, thereby increasing concern after joint arthroplasties, allergies against implant materials remain quite rare and not a well-known problem. The aim of the following paper is to provide an overview on diagnosis and management of metal hypersensitivity in patients who undergo a total knee arthroplasty in order clarify its real importance.

关键词： Knee arthroplasty Total knee arthroplasty Metal hypersensitivity Metal allergy Non-allergenic implants