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Two-stage surgical treatment for septic non-union of the forearm

World Journal of Orthopedics 2017年第6期8卷 471-477页

作者： Fabrizio Perna Federico Pilla Matteo Nanni Lisa Berti Giada Lullini Francesco Traina Cesare Faldini istituto ortopedico rizzoli

AIM To investigate the effectiveness of a two-stage surgical procedure for the treatment of septic forearm *** Septic non-unions are rare complications of forearm fractures. When they occur, they modify the relationship between forearm bones leading to a severe functional impairment. Treatment is challenging and surgery and antibiotic therapy are required to achieve infection resolution. It is even harder to obtain non-union healing with good functional results. The aim of this study is to present a two stages surgical treatment for septic forearm non-union with revision and temporary stabilization of the non-union until infection has cleared and subsequently perform a new synthesis with plate, opposite bone graft strut and intercalary graft. We retrospectively reviewed 18 patients with a mean age at the time of primary injury of 34.5 years(19-57 years) and a mean follow-up of 6 years(2-10 years). All patients presented an atrophic nonunion with a mean length of the bone defect of 1.8 cm(1.2-4 cm). Complications and clinical results after surgical treatment were recorded. RESULTS Mean time to resolution of the infectious process was 8.2 wk(range 4-20 wk) after the first surgery and specific antibiotic therapy. All the non-union healed with an average time of 5 mo(range 2-10 mo) after the second step surgery. Cultures on intraoperative samples werepositive in all cases. No major intraoperative complications occurred. Two patients developed minor complications and one needed a second surgical debridement for infection resolution. At the last follow-up functional results were excellent in 5(27.8%) patients, satisfactory in 10(55.5%) and unsatisfactory in 3(16.7%) patients. No activities of daily living(ADLs) limitations were reported by 12(66.6%) patients, slight by 3(16.6%) and severe limitation by 3(16.6%) patients. Mean visual analog scale at the last follow-up was 1(0-3).CONCLUSION The two-step technique has proven to be effective to achieve resolutio

关键词： Forearm fractures Non-union Delayed union Infection Open fracture External fixation Bone graft

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Primary malignant tumors of bone surface:a review with emphasis in differential diagnosis

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Journal of Cancer Metastasis and Treatment 2020年第1期6卷 632-646页

作者： Marina Pacheco Alberto Righi Department of Pathology IRCCS Istituto Ortopedico RizzoliBologna 40136Italy

Surface tumors of the bone are broadly defined as a diverse group of osteogenic and chondrogenic benign and malignant neoplasms that arise adjacent to the outer surface of cortical *** may be a cause of diagnostic difficulty due to a degree of histological overlap,rarity,and *** this review we summarize the different histological types of primary malignant tumors of bone surface,namely,secondary peripheral chondrosarcoma,periosteal chondrosarcoma,parosteal osteosarcoma,dedifferentiated parosteal osteosarcoma,periosteal osteosarcoma,and high-grade surface *** provide a comprehensive updated review of their pathogenesis and highlight radiological,macroscopic,and histopathological features and recently available ancillary diagnostic tools that may aid in the differential diagnosis.

关键词： Secondary peripheral chondrosarcoma periosteal chondrosarcoma parosteal osteosarcoma periosteal osteosarcoma high-grade surface osteosarcoma

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Preoperative and postoperative risk factors for periprosthetic joint infection in primary total hip arthroplasty:A 1-year experience

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World Journal of Orthopedics 2022年第10期13卷 903-910页

作者： Giuseppe Ferdinando Tella Cesare Donadono Francesco Castagnini Barbara Bordini Monica Cosentino Michele Di Liddo Francesco Traina Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio IRCCS Istituto Ortopedico RizzoliBologna 40125Italy Laboratorio di Tecnologia Medica IRCCS Istituto Ortopedico RizzoliBologna 40125Italy

BACKGROUND Periprosthetic joint infection(PJI)in primary total hip replacement(THR)is one of the most important threats in orthopedic surgery,so one important surgeon’s target is to avoid or early diagnose a *** the incidence of PJI is very low(0.69%)in our department,with an average follow-up of 595 d,this infection poses a serious threat due to the difficulties of treatment and the lower functional outcomes after *** To study the incidence of PJI in all operations occurring in the year 2016 in our department to look for predictive signs of potential *** We counted 583 THR for 578 patients and observed only 4 cases of infection(0.69%)with a mean follow-up of 596 d(min 30,max 1451).We reviewed all medical records to collect the data:duration and time of the surgery,presence,type and duration of the antibiotic therapy,preoperative diagnosis,blood values before and after surgery,transfusions,presence of preoperative drugs(in particularly anticoagulants and antiaggregant,corticosteroids and immunosuppressants),presence of some comorbidities(high body mass index,blood hypertension,chronic obstructive pulmonary disease,cardiac ischemia,diabetes,rheumatological conditions,previous local infections).RESULTS No preoperative,intraoperative,or postoperative analysis showed a higher incidence of *** did not find any class with evident major odds of *** our study,we did not find any border value to predict PJI and all patients had similar values in both groups(non-PJI and PJI).Only some categories,such as female patients,showed more frequency of PJI,but this difference related to sex was not statistically *** We did not find any category with a higher risk of PJI in THR,probably due to the lack of few cases of infection.

关键词： Primary total hip replacement Periprosthetic joint infection Preoperative risk factors Postoperative risk factors Preoperative and postoperative blood value Total hip arthroplasty

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Use of MSC in the Treatment of the Congenital Pseudoarthrosis in Children

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Surgical Science 2014年第12期5卷 555-561页

作者： Marina Magnani Costantina Racano Caterina Novella Abati Donatella Granchi Valentina de Vescovi Stefano Stilli istituto ortopedico rizzoli (IRCCS) Bologna Italy

Congenital pseudoatrhrosis of the tibia is one of the most frustrating conditions encountered in paediatric orthopaedic surgery because of the difficulty in achieving healing;There are different methods of treatment the most commonly used are: External fixator according Ilizarov’s technique, vascularised fibular grafting, bone grafting with intramedullary fixation, Boyd’s double bone grafting and also after several operation go bad and a significant shortening of the leg even the amputation has to be considered [1] [2]. Numerous treatment options have been explored with several degree of success. In this paper we show a combinated surgical technique using autogenous mesenchymal stem cells (MSC) by precursor of osteogenic differensation at the same time as adjuvant to the surgical stabilization by an external fixator or an intramedullary nailing. We used these combined technique in tibia congenital pseudoarthrosis with and without neurofibromatosis in children. In fact Bone Marrow has been shown to contain a population of rare mesenchymal stem cells that are capable of forming bone, cartilage and other connective tissues enhancing bone repair and regeneration.

关键词： Pseudoarthrosis Mesenchimal Stem Cells Children

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Magnetic resonance imaging after anterior cruciate ligament reconstruction:A practical guide

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World Journal of Orthopedics 2016年第10期7卷 638-649页

作者： Alberto Grassi James R Bailey Cecilia Signorelli Giuseppe Carbone Andy Tchonang Wakam Gian Andrea Lucidi Stefano Zaffagnini Laboratorio di Biomeccanica ed Innovazione Tecnologica Istituto Ortopedico Rizzoli Department of Orthopaedic Surgery Duke Sports Sciences Institute Duke University Medical Center Unita’ Operativa di Ortopedia Dipartimento Rizzoli-Sicilia

Anterior cruciate ligament(ACL) reconstruction is one of the most common orthopedic procedures performed worldwide. In this regard, magnetic resonance imaging(MRI) represents a useful pre-operative tool to confirm a disruption of the ACL and to assess for potential associated injuries. However, MRI is also valuable postoperatively, as it is able to identify, in a non-invasive way, a number of aspects and situations that could suggest potential problems to clinicians. Graft signal and integrity, correct tunnel placement, tunnel widening, and problems with fixation devices or the donor site could all compromise the surgical outcomes and potentially predict the failure of the ACL reconstruction. Furthermore, several anatomical features of the knee could be associated to worst outcomes or higher risk of failure. This review provides a practical guide for the clinician to evaluate the post-surgical ACL through MRI, and to analyze all the parameters and features directly or indirectly related to ACL reconstruction, in order to assess for normal or pathologic conditions.

关键词： Anterior cruciate ligament reconstruction Magnetic resonance imaging Graft Tunnel Failures Complications Anatomic

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Biomechanical modeling of metal screw loadings on the human vertebra

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Acta Mechanica Sinica 2021年第2期37卷 307-320页

作者： Leonardo Molinari Cristina Falcinelli Alessio Gizzi Alberto Di Martino Department of Engineering Campus Bio-Medico University of RomeVia A.del Portillo 21Rome 00128Italy Department of Biomedical and Neuromotor Science DIBINEM University of BolognaBolognaItaly 1st Orthopaedic and Traumatologic Clinic IRCCS Istituto Ortopedico RizzoliBolognaItaly

During spinal fusion surgery,angled screw insertion can provide a more favorable stress distribution reducing failure events(screw breakage and loosening).Finite element(FE)analysis can be employed for identifying the optimal insertion path,preventing stress concentrations,and ensuring a lower failure *** this work,a patient-specific FE model of L4 vertebra,virtually implanted with two pedicle screws,was obtained from diagnostic images and numerically *** elastic,inhomogeneous,and isotropic material properties were assigned to bone based on density distributions reconstructed from the medical *** mechanical response of the screws-vertebra system was analyzed through a progressive damage procedure,considering a stress-based *** screws insertion angles were simulated,as well as physiological loading *** each loading case,screw orientation influences the fracture mechanism(i.e.,brittle or ductile one),as well as the fracture pattern and ***,stresses in trabecular bone and pedicle screws are significantly affected by the screw *** caudomedial trajectory indicates the most safe case,significantly reducing the stress concentrations in both trabecular bone and *** findings aim to furnish a useful indication to surgeons regarding the screws insertion angle,further reducing the failure risk and improving the clinical outcome of the fixation procedure.

关键词： Fracture mechanics Patient-specific FE modeling Vertebra mechanics Screw orientation Stress analysis

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Patient-specific instrumentation in total ankle arthroplasty

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World Journal of Orthopedics 2022年第3期13卷 230-237页

作者： Antonio Mazzotti Alberto Arceri Simone Zielli Simone Bonelli Valentina Viglione Cesare Faldini The First Orthopaedics and Traumatologic Clinic IRCCS Istituto Ortopedico RIzzoliBologna 40136Italy Department of Biomedical and Neuromotor Sciences Alma Mater Studiorum University of BolognaBologna 40136Italy

The recent increase in the adoption of total ankle arthroplasty(TAA)reflects the improvements in implant designs and surgical techniques,including the use of preoperative navigation system and patient-specific instrumentation(PSI),such as custom-made cutting *** guides are customized with respect to each patient's anatomy based on preoperative ankle computed tomography scans,and they drive the saw intra-operatively to improve the accuracy of bone resection and implant *** some promising results,the main queries in the literature are whether PSI improves the reliability of achieving neutral ankle alignment and more accurate implant sizing,whether it is actually superior over standard techniques,and whether it is cost ***,the advantages of PSI in clinical outcomes are still theoretical because the current literature does not allow to confirm its *** purpose of this review article is therefore to assess the current literature on PSI in TAA with regard to current implants with PSI,templating and preoperative planning strategies,alignment and sizing,clinical outcomes,cost analysis,and comparison with standard techniques.

关键词： Total ankle arthroplasty Total ankle replacement Patient-specific instrumentation Ankle computer navigation system Preoperative navigation Prophecy Infinity INBONE II

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Biosynthetic scaffolds for partial meniscal loss:A systematic review from animal models to clinical practice

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Bioactive Materials 2021年第11期6卷 3782-3800页

作者： F.Veronesi B.Di Matteo N.D.Vitale G.Filardo A.Visani E.Kon M.Fini Complex Structure of Surgical Sciences and Technologies IRCCS Istituto Ortopedico RizzoliBolognaItaly Humanitas University Department of Biomedical SciencesVia Rita Levi Montalcini 420090Pieve EmanueleMilanItaly IRCCS Humanitas Research Hospital Via Manzoni 5620089RozzanoMilanItaly Applied and Translational Research Center IRCCS Istituto Ortopedico RizzoliBolognaItaly Orthopaedic and Traumatology Unit Ospedale Regionale di LuganoEOCLuganoSwitzerland Faculty of Biomedical Sciences Universit`a della Svizzera ItalianaLuganoSwitzerland First Moscow State Medical University-Sechenov University Bol’shaya Pirogovskaya Ulitsa19c1119146MoscowRussia

Acute or degenerative meniscus tears are the most common knee *** provides symptomatic relief and functional recovery only in the short-to mid-term follow-up but significantly increases the risk of *** this reason,preserving the meniscus is key,although it remains a *** transplants present many disadvantages,so during the last 20 years preclinical and clinical research focused on developing and investigating meniscal *** aim of this systematic review was to collect and evaluate all the available evidence on biosynthetic scaffolds for meniscus regeneration both in vivo and in clinical *** databases were searched:46 in vivo preclinical studies and 30 clinical ones were *** natural,15 synthetic,and 15 hybrid scaffolds were studied in *** them,only 2 were translated into clinic:the Collagen Meniscus Implant,used in 11 studies,and the polyurethane-based scaffold Actifit®,applied in 19 *** positive outcomes were described in the short-to mid-term,the number of concurrent procedures and the lack of randomized trials are the major limitations of the available clinical *** in vivo studies also combined the use of cells or growth factors,but these augmentation strategies have not been applied in the clinical practice *** solutions offer a significant but incomplete clinical improvement,and the regeneration potential is still *** upon the overall positive results of these“old”technologies to address partial meniscal loss,further innovation is urgently needed in this field to provide patients better joint sparing treatment options.

关键词： Meniscal scaffold Meniscectomy Osteoarthritis Regenerative medicine Collagen Polyurethane

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Incidental vertebral compression fractures in imaging studies:Lessons not learned by radiologists

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World Journal of Radiology 2010年第10期2卷 399-404页

作者： Tommaso Bartalena Maria Francesca Rinaldi Cecilia Modolon Lucia Braccaioli Nicola Sverzellati Giuseppe Rossi Eugenio Rimondi Maurizio Busacca Ugo Albisinni Donald Resnick Department of Radiologiy Poliambulatorio Privato Zappi Bartalena Department of Radiology Policlinico S.Orsola-Malpighi Department of Radiology Ospedale Ceccarini Department of Clinical Sciences Radiology SectionUniversityof Parma Department of Angiographic Interventional Radiology Istituto Ortopedico Rizzoli Department of Radiology Istituto Ortopedico Rizzoli Department of Musculoskeletal Radiology VA Medical Center

AIM:To assess radiologists reporting rates of incidental vertebral compression fractures in imaging studies. METHODS:We performed a review of the current literature on the prevalence and reporting rates of incidental vertebral compression fractures in radiologic examinations. RESULTS:The bibliographic search revealed 12 studies:7 studies using conventional radiology and 5 using multidetector computed tomography(MDCT).The lossof height cut-off to define a vertebral fracture varied from 15%to 25%.Fracture prevalence was high (mean 21.1%;range 9.5%-35%)in both radiographic and MDCT studies(mean 21.6%and 20.2%,respectively).Reporting rates were low with a mean value of 27.4%(range 0%-66.3%)and were significantly lower in MDCT than in radiographic studies(mean 8.1%vs 41.1%).Notably,recent studies showed lower reporting rates than older studies. CONCLUSION:Many scientific studies have confirmed a high prevalence of vertebral compression fractures as incidental findings on imaging ***,the underreporting of these fractures,as determined in our study,may negatively affect patient care.

关键词： Vertebral compression fractures Spine Osteoporosis Multidetector computed tomography X-rays

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Ionized jet deposition of antimicrobial and stem cell friendly silver-substituted tricalcium phosphate nanocoatings on titanium alloy

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Bioactive Materials 2021年第8期6卷 2629-2642页

作者： Gabriela Graziani Katia Barbaro Inna V.Fadeeva Daniele Ghezzi Marco Fosca Enrico Sassoni Gianluca Vadalà Martina Cappelletti Francesco Valle Nicola Baldini Julietta V.Rau ircss istituto ortopedico rizzoli Laboratory of NanoBiotechnologyvia di Barbiano 1/1040136BolognaItaly istituto Zooprofilattico Sperimentale Lazio e Toscana“M.Aleandri” Via Appia Nuova 1411-00178RomeItaly A.A.Baikov Institute of Metallurgy and Materials Science Russian Academy of SciencesLeninsky prospect 49119334MoscowRussia istituto di Struttura della Materia Consiglio Nazionale delle Ricerche(ISM-CNR)Via del Fosso del Cavaliere100-00133RomeItaly University of Bologna Department of CivilChemicalEnvironmental and Materials Engineeringvia Terracini 2840131BolognaItaly UniversitàCampus Bio-Medico di Roma Research Unit of Orthopaedic SurgeryFaculty of Medicine and SurgeryVia Alvaro del Portillo 2100128RomeItaly University of Bologna Department of Pharmacy and Biotechnologyvia Irnerio 4240126BolognaItaly Institute of Nanostructured Materials National Research Council(ISMN-CNR)Via Piero Gobetti10140129BolognaItaly ircss istituto ortopedico rizzoli BST Biomedical Science and Technologies Labvia di Barbiano 1/1040136BolognaItaly University of Bologna Department of Biomedical and Neuromotor SciencesVia Massarenti940128BolognaItaly Sechenov First Moscow State Medical University Institute of PharmacyDepartment of AnalyticalPhysical and Colloid ChemistryTrubetskaya 8build.2119991MoscowRussia

Orthopedic infections pose severe societal and economic burden and interfere with the capability of the implanted devices to integrate in the host bone,thus significantly increasing implants failure *** address infection and promote integration,here nanostructured antibacterial and bioactive thin films are proposed,obtained,for the first time,by Ionized Jet Deposition(IJD)of silver-substituted tricalcium phosphate(Ag-TCP)targets on *** morphology,composition and mechanical properties are characterized and proof-of-concept of biocompatibility is *** efficacy is investigated against four Gram positive and Gram negative bacterial strains and against *** fungus,by investigating the modifications in planktonic bacterial growth in the absence and presence of ***,for all bacterial strains,the capability of the film to inhibit bacterial adhesion is also *** indicate that IJD permits a fine control over films composition and morphology and deposition of films with suitable mechanical *** studies show a good efficacy against Escherichia coli,Staphylococcus aureus,Pseudomonas aeruginosa,Enterococcus faecalis and against fungus Candida albicans,with evidences of efficacy against planktonic growth and significant reduction of bacterial cell *** cytotoxic effects are evidenced for equine adipose tissue derived mesenchymal stem cells(ADMSCs),as no reductions are caused to cells viability and no interference is assessed in cells differentiation towards osteogenic lineage,in the presence of ***,thanks to nanostructuration and biomimetic composition,tricalcium phosphate(TCP)coatings favor cells viability,also when *** findings show that silver-substituted nanostructured coatings are promising for orthopedic implant applications.

关键词： Tricalcium phosphate Silver Nanostructured coatings Antibacterial coatings Orthopedics Antibacterial ceramics

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