Research Interests:
Nonunion of the first metatarsal after hallux valgus surgery is a rare complication that often results in significant pain and disability requiring surgical management. We report the case of a 42-year-old woman who developed a... more
Nonunion of the first metatarsal after hallux valgus surgery is a rare complication that often results in significant pain and disability requiring surgical management. We report the case of a 42-year-old woman who developed a pseudarthrosis of the first metatarsal after percutaneous retrocapital distal osteotomy of the first metatarsal for a mild hallux valgus deformity. The operative treatment consisted of debridement of fibrous nonunion with plating followed by application of pulsed electromagnetic fields (PEMF) with an external device.
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In this paper, the authors perform microtensile tests of single trabeculae excised from a human femur head. One of the main issues of this work is to establish some experimental procedures for preparing and testing the specimens. The use... more
In this paper, the authors perform microtensile tests of single trabeculae excised from a human femur head. One of the main issues of this work is to establish some experimental procedures for preparing and testing the specimens. The use of a well-characterized microtensile apparatus allows for a low intraspecimen dispersion of the measured stiffness. Tensile/compressive tests were chosen because they appear less sensitive to errors in the cross-sectional area measurements with respect to bending tests. By these considerations, some tensile/compressive tests of plate-like trabecular specimens have been carried out. Typical stiffness values are 74.2+/-0.7Nmm(-1) for tensile tests, and 58.9+/-0.6Nmm(-1) for compressive test. Another compressive test performed on a shorter specimen yielded a stiffness value of 148.3+/-5.3Nmm(-1). The maximum applied load was about 0.5N. Rough measurements of specimens sizes yielded a Young's modulus value ranging from 1.41 to 1.89GPa.
Research Interests:
Periarticular osteoid osteoma of the knee is a diagnostic and therapeutic challenge. This article presents a patient with a juxta-articular osteoid osteoma localized in the patella beneath the cartilage joint level and describes a simple... more
Periarticular osteoid osteoma of the knee is a diagnostic and therapeutic challenge. This article presents a patient with a juxta-articular osteoid osteoma localized in the patella beneath the cartilage joint level and describes a simple and effective technique of arthroscopic computed tomography-guided en-bloc retrograde resection. The association of computed tomography and arthroscopy achieved a complete and minimally invasive removal of the lesion. This technique prevented damage to the proximal structures while permitting examination of the lesion and filling of the bony defect with the harvest removed from the proximal metaphysis of the tibia. Postoperative followup also was accomplished with arthroscopy and computed tomography.
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Von Hippel-Lindau disease is a rare autosomic dominant hereditary tumoral syndrome characterized by mutation of the VHL gene. Here follows the first reported case of a patient (20 year old male) affected by Von Hippel-Lindau (VHL)... more
Von Hippel-Lindau disease is a rare autosomic dominant hereditary tumoral syndrome characterized by mutation of the VHL gene. Here follows the first reported case of a patient (20 year old male) affected by Von Hippel-Lindau (VHL) disease, was referred to our Department because of the occurrence of a hard lump at the right aspect of the pelvis, who presented a primary mildly differentiated chondrosarcoma of the right iliac wing (confirmed by CT scan). Chondrosarcoma of the iliac wing, treated by surgical resection and reconstruction of the pelvis with appropriately shaped bone allograft fixed with plates and screws. At one year follow-up, the patient shows no signs of recurrence. Conventional treatment for chondrosarcoma of the iliac wing would be either wide or radical resection (hemipelvectomy), or amputation. The described treatment is unusual in that it is dependent on patient's choice to privilege quality of life due to the awareness of being affected by a genetic disease w...
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Object of this work is to evaluate activity and tolerance of Celecoxib in out-patient's department practice. In this study we enlisted 46 patients, affected by pain of inflammatory or degenerative origin; any of them ever did... more
Object of this work is to evaluate activity and tolerance of Celecoxib in out-patient's department practice. In this study we enlisted 46 patients, affected by pain of inflammatory or degenerative origin; any of them ever did continued therapy with NSAIDs before. We administered 200 mg daily dose of Celecoxib for at least three months. Each patient has been evaluated by the Visual Analogic Score (VAS) Scale before and after the therapy. The data We obtained agree with those of multicenter studies like CLASS. Celecoxib had similar efficacy respect with traditional NSAIDs, with good control of pain in both osteoarthrosic and arthritic pain (p < 0.000). Not good results were obtained for control of acute-onset pain. In our population We didn't find side-effects different from those included in the technical-form of the drug. The only patient who complained of epigastric pain did not stop the treatment, because the symptom resolved with assumption of the drug during meals. By...
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Micro-CT analysis is a powerful technique for a non-invasive evaluation of the morphometric parameters of trabecular bone samples. This elaboration requires a previous binarization of the images. A problem which arises from the... more
Micro-CT analysis is a powerful technique for a non-invasive evaluation of the morphometric parameters of trabecular bone samples. This elaboration requires a previous binarization of the images. A problem which arises from the binarization process is the partial volume artifact. Voxels at the external surface of the sample can contain both bone and air so thresholding operates an incorrect estimation of volume occupied by the two materials. The aim of this study is the extraction of bone volumetric information directly from the image histograms, by fitting them with a suitable set of functions. Nineteen trabecular bone samples were extracted from femoral heads of eight patients subject to a hip arthroplasty surgery. Trabecular bone samples were acquired using micro-CT Scanner. Hystograms of the acquired images were computed and fitted by Gaussian-like functions accounting for: a) gray levels produced by the bone x-ray absorption, b) the portions of the image occupied by air and c) ...
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Morphometric and architectural bone parameters change in diseases such as osteoarthritis and osteoporosis. The mechanical strength of bone is primarily influenced by bone quantity and quality. Bone quality is defined by parameters such as... more
Morphometric and architectural bone parameters change in diseases such as osteoarthritis and osteoporosis. The mechanical strength of bone is primarily influenced by bone quantity and quality. Bone quality is defined by parameters such as trabecular thickness, trabecular separation, trabecular density and degree of anisotropy that describe the micro-architectural structure of bone. Recently, many studies have validated microtomography as a valuable investigative technique to assess bone morphometry, thanks to micro-CT non-destructive, non-invasive and reliability features, in comparison to traditional techniques such as histology. The aim of this study is the analysis by micro-computed tomography of six specimens, extracted from patients affected by osteoarthritis and osteoporosis, in order to observe the tridimensional structure and calculate several morphometric parameters.
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ABSTRACT
The subscapularis muscle is the largest and strongest muscle of the rotator cuff. It plays an essential role in the stability and function of the shoulder. Tears of the subscapularis tendon are more frequent than previously estimated. The... more
The subscapularis muscle is the largest and strongest muscle of the rotator cuff. It plays an essential role in the stability and function of the shoulder. Tears of the subscapularis tendon are more frequent than previously estimated. The worldwide use of arthroscopy in rotator cuff surgery has allowed to recognize the true prevalence of subscapularis lesions, as it permits to visualize the articular side where partial tears are usually localized. Subscapularis tears are generally non-traumatic, arising from intrinsic degeneration, subcoracoid and/or anterosuperior impingement. Clinical presentation is usually characterized by history of pain, typically located anteriorly, and difficulty in lifting movements across the chest, or twisting inwards that hinders activities of daily life. Special tests for the diagnosis of subscapularis tears include the lift-off, belly-press, and bear-hug tests. Imaging of the subscapularis tendon may involve plain radiography, magnetic resonance and ultrasound scanning, but MRI better characterizes subscapular tears and coexistent shoulder pathology. The management of subscapularis tears is aimed at restoring the integral role of this muscle in the shoulder. Operative management is indicated for most patients because it is the only one to allow restoration of subscapularis function. Arthroscopic repair can be safely and successfully performed. It requires tendon mobilization to reach the lesser tuberosity. If this is not possible, its footprint can be medialized up to 5-7 mm. Arthroscopic results are encouraging. At intermediate follow-up, improvement in functional scores and patient satisfaction has been reported. Outcomes are comparable to that of open repair, with a very low complication rate and no major intraoperative complications.
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We firstly measured the swelling of single trabeculae from human femur heads during water imbibition. Since the swelling is caused by water diffusing from external surfaces to the core of the sample, by measuring the sample swelling over... more
We firstly measured the swelling of single trabeculae from human femur heads during water imbibition. Since the swelling is caused by water diffusing from external surfaces to the core of the sample, by measuring the sample swelling over time, we obtained direct information about the transport of fluids through the intimate constituents of bone, where the mineralization process takes place. We developed an apparatus to measure the free expansion of the tissue during the imbibition. In particular, we measured the swelling along three natural axes (length L, width W, and thickness T) of plate-like trabeculae. For this aim, we developed a 3D analytical model of the water uptake by the sample that was performed according to Fickian transport mechanism. The results were then utilized to predict the swelling over time along the three sample directions (L, W, T) and the apparent diffusion coefficients D T, D W, and D L.
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The swelling of air-dried single trabeculae from human femur heads was obtained by complete immersion in water and the dimensional changes of the samples were measured over time. The experimental results were analyzed under the viewpoint... more
The swelling of air-dried single trabeculae from human femur heads was obtained by complete immersion in water and the dimensional changes of the samples were measured over time. The experimental results were analyzed under the viewpoint of the diffusion through a porous material. The dimensional changes of the single trabeculae were 0.26 ± 0.15 percent (length), 0.45 ± 0.25 percent (width) and 1.86 ± 0.97 percent (thickness). The diffusion coefficients were then calculated from the swelling recorded over time and a value of (4.12 ± 0.8) x 10(-10)(m (2)s(-1)) (mean ± standard deviation) was found. Since the dimensional variations of the specimens is due to the swelling of the collagen bone matrix, this technique could offer new insights for (1) a selective characterization of bone microstructure at the collagen matrix level and (2) the dynamics of diffusion through bone tissue.
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ABSTRACT
Osteonecrosis of the first metatarsal head after distal metatarsal osteotomy is a rare condition. Latter stages with complete destruction of the metatarsophalangeal joint often required arthrodesis in order to relieve pain and improve... more
Osteonecrosis of the first metatarsal head after distal metatarsal osteotomy is a rare condition. Latter stages with complete destruction of the metatarsophalangeal joint often required arthrodesis in order to relieve pain and improve function. We present a case of a 50-years old woman who developed osteonecrosis of the first metatarsal head after distal chevron osteotomy which was successfully treated with hemiarthroplasty of the proximal phalanx. Although longer follow-up and larger number of patients is needed to draw valid conclusions, the current result is encouraging and can be suggested in similar cases.
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The purpose of this study was to translate the Oxford Hip Score (OHS) into Italian and to evaluate the psychometric properties by testing the feasibility, internal consistency, reproducibility, construct validity, and responsiveness in... more
The purpose of this study was to translate the Oxford Hip Score (OHS) into Italian and to evaluate the psychometric properties by testing the feasibility, internal consistency, reproducibility, construct validity, and responsiveness in patients with hip osteoarthritis (OA). The OHS Italian version was developed and evaluated in Italian-speaking patients with hip OA. The psychometric properties assessed were feasibility with floor and ceiling effect; internal consistency with Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Alpha; reproducibility with intraclass correlation coefficient (ICC); construct validity with evaluating correlation with the SF-36 and visual analogue scale (VAS) for pain; responsiveness to intra-articular hyaluronate injections. The standardized effect size (ES) and standardized response mean (SRM) were also evaluated. A total of 96 patients were recruited (mean age 62.7 ± 5.8 years, range 49-77). No floor or ceiling effect was observed prior to or after treatment with HA injections. Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha value was 0.85 at baseline and 0.89 after treatment. The reproducibility was good with an ICC of 0.89. A strong correlation was found between OHS, VAS, and some SF-36 subscales, indicating good cross-sectional and longitudinal construct validity. The mean OHS improved from 16.4 ± 5.8 to 28.0 ± 9.0 after hyaluronate injections (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). The ES and SRM values were 1.98 and 1.12, respectively. The Italian OHS questionnaire is valid, reliable, and responsive for use in Italian patients with symptomatic hip OA receiving hyaluronate injections.
Research Interests: Psychometrics, Quality of life, Osteoarthritis, Activities of Daily Living, Italy, and 19 moreCross-Cultural Comparison, Humans, Effect size, Female, Feasibility Studies, Construct Validity, Male, Psychometric Properties, Health Status, Visual Analogue Scale, Aged, Middle Aged, Hyaluronic Acid, Intraclass Correlation Coefficient, Cross Section, Public health systems and services research, Reproducibility of Results, Quality Life, and Pain Measurement
Research Interests: Psychometrics, Social Interaction, Translations, Italy, Humans, and 18 moreFemale, Construct Validity, Male, STEM (short form), Aged, Middle Aged, Validity and Reliability, Intraclass Correlation Coefficient, Questionnaires, Adult, Public health systems and services research, Reproducibility of Results, Quality Life, Hallux Valgus, Health Survey, Rank Correlation, Functional Status, and Sickness Impact Profile
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Triplanar distal osteotomy is a safe procedure for mild-to-moderate hallux valgus deformity. It allows shortening and plantar displacement of the first metatarsal while correcting the intermetatarsal angle. However, complications such as... more
Triplanar distal osteotomy is a safe procedure for mild-to-moderate hallux valgus deformity. It allows shortening and plantar displacement of the first metatarsal while correcting the intermetatarsal angle. However, complications such as dorsiflexion and excessive shortening of the first metatarsal have been associated with distal osteotomy. We describe a new device, designed by one of the authors (P.R.), that enables precise positioning of the Kirschner guide wire for the osteotomy cuts.
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Metatarsus adductus is a structural foot deformity that is rarely associated with hallux valgus deformity. Surgical treatment is challenging, and multiple osteotomies are often required to correct both deformities. However, surgical... more
Metatarsus adductus is a structural foot deformity that is rarely associated with hallux valgus deformity. Surgical treatment is challenging, and multiple osteotomies are often required to correct both deformities. However, surgical impact must be considered, especially in elderly patients. We present a clinical case of a 76-year-old woman affected by hallux valgus and metatarsus adductus deformity. Multiple distal oblique osteotomies were performed on the first, second, and third metatarsals, coupled with Z-lengthening of the extensor digitorum longus tendons.
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We report the clinical features, radiographic findings, management, and results of a patient with bilateral hallux valgus and associated bilateral tibial hallux sesamoid agenesis and fibular hallux sesamoid hypoplasia. Our patient was... more
We report the clinical features, radiographic findings, management, and results of a patient with bilateral hallux valgus and associated bilateral tibial hallux sesamoid agenesis and fibular hallux sesamoid hypoplasia. Our patient was managed operatively with good clinical results. Combined tibial sesamoid agenesis and fibular sesamoid hypoplasia do not seem to negatively influence the management of hallux valgus.
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Nonunion of the first metatarsal after hallux valgus surgery is a rare complication that often results in significant pain and disability requiring surgical management. We report the case of a 42-year-old woman who developed a... more
Nonunion of the first metatarsal after hallux valgus surgery is a rare complication that often results in significant pain and disability requiring surgical management. We report the case of a 42-year-old woman who developed a pseudarthrosis of the first metatarsal after percutaneous retrocapital distal osteotomy of the first metatarsal for a mild hallux valgus deformity. The operative treatment consisted of debridement of fibrous nonunion with plating followed by application of pulsed electromagnetic fields (PEMF) with an external device.
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In this paper, the authors perform microtensile tests of single trabeculae excised from a human femur head. One of the main issues of this work is to establish some experimental procedures for preparing and testing the specimens. The use... more
In this paper, the authors perform microtensile tests of single trabeculae excised from a human femur head. One of the main issues of this work is to establish some experimental procedures for preparing and testing the specimens. The use of a well-characterized microtensile apparatus allows for a low intraspecimen dispersion of the measured stiffness. Tensile/compressive tests were chosen because they appear less sensitive to errors in the cross-sectional area measurements with respect to bending tests. By these considerations, some tensile/compressive tests of plate-like trabecular specimens have been carried out. Typical stiffness values are 74.2+/-0.7Nmm(-1) for tensile tests, and 58.9+/-0.6Nmm(-1) for compressive test. Another compressive test performed on a shorter specimen yielded a stiffness value of 148.3+/-5.3Nmm(-1). The maximum applied load was about 0.5N. Rough measurements of specimens sizes yielded a Young&amp;amp;amp;amp;amp;amp;amp;amp;#39;s modulus value ranging from 1.41 to 1.89GPa.
Research Interests:
Previous studies reported the effect of flatfoot deformity on tibiotalar joint contact characteristics. The lateral shift of the load which occurred in flatfeet may be responsible for degenerative changes in the ankle joint. The purpose... more
Previous studies reported the effect of flatfoot deformity on tibiotalar joint contact characteristics. The lateral shift of the load which occurred in flatfeet may be responsible for degenerative changes in the ankle joint. The purpose was to assess the pattern of joint contact stress of the tibiotalar joint in intact, flat, and corrected specimens with subtalar arthroereisis. Seven fresh-frozen cadaver specimens were studied in the intact and flat-footed condition after transection of ligaments which support the medial arch. Ankle joint contact stress and plantar pressure patterns were determined from a capacitive pressure sensor inserted in the tibiotalar joint and a pressure distribution platform when the specimens were axially loaded in simulated mid-stance. Contact pressure was also assessed after subtalar arthroereisis with a 12 mm Kalix implant for correction of the flatfoot deformity. A maximum contact pressure of 1414.2±319.2 kPa was recorded in the middle-medial region in intact specimens. Flatfoot caused a lateral shift in the pressure distribution (p&lt;0.05). In the flat specimens, the maximum contact pressure of 1394.7 8±470.5 kPa was in the anterior-central region. After subtalar arthroereisis with the Kalix implant for correction of the flatfoot deformity a maximum contact pressure of 1323.3±497.5 kPa was observed in the middle-lateral region. In a cadaver model, subtalar arthroereisis with Kalix implant failed to restore a normal intraarticular ankle joint pressure pattern. Further interventions should be considered to restore a normal pressure pattern.
Research Interests: Mechanical Engineering, Biomedical Engineering, Biomechanics, Humans, Tibia, and 8 moreFemale, Male, Cadaver, Aged, Pressure, Ankle Joint, Flatfoot, and Talus
We performed 60 microtensile tests on 6 single trabeculae excised from a human femur head at various maximum tensile loads. The obtained results show a clear dependence of the calculated stress-strain behaviour from the applied load and... more
We performed 60 microtensile tests on 6 single trabeculae excised from a human femur head at various maximum tensile loads. The obtained results show a clear dependence of the calculated stress-strain behaviour from the applied load and thus from the mean stress over the cross section of the trabecula. The pooled data were found in good agreement with a combination of both the model of the nonlinear stress-strain behaviour of collagen fibrils and that for the modulus of elasticity of staggered mineralized collagen. This circumstance could also suggest a realistic explanation of the extreme variability found in literature for the elastic modulus of the trabecular material. In particular, when the trabeculae are solicited with relatively low stresses, their mechanical properties are mainly affected by the entropic elasticity of collagen molecules. This work offers both experimental data and a reasonable interpretation of the behaviour of fully mineralized tissue at low strains, that is up to about 0.1%.
Research Interests: Mechanical Engineering, Biomedical Engineering, Biomechanics, Modeling, Entropy, and 18 moreElasticity, Humans, Collagen, Femur, Male, Arthritis, Aged, Pressure, Theoretical Models, Mechanical Stress, Cross Section, Elastic Modulus, Tensile Strength, Experimental Data, Weight Bearing, Tensile Stress, Bone and Bones, and Modulus of Elasticity
The purpose of this study was to assess the safety and preliminary clinical results of platelet-rich plasma (PRP) injections for treating chronic plantar fasciitis. Fourteen consecutive patients with chronic plantar fasciitis receiving... more
The purpose of this study was to assess the safety and preliminary clinical results of platelet-rich plasma (PRP) injections for treating chronic plantar fasciitis. Fourteen consecutive patients with chronic plantar fasciitis receiving three injections of PRP into the plantar fascia were assessed 12 months after the procedure. The modified Roles and Maudsley score and a visual analogue scale (VAS) for pain were used to evaluate the clinical results. According to criteria of the Roles and Maudsley score, at 12 months of follow-up, results were rated as excellent in nine (64.3 %), good in two (14.3 %), acceptable in two (14.3 %) and poor in one (7.1 %) patient. VAS for pain was significantly decreased from 7.1 ± 1.1 before treatment to 1.9 ± 1.5 at the last follow-up (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). In this single-centre, uncontrolled, prospective, preliminary study, results indicate that treating chronic plantar fasciitis with PRP injections is safe and has the potential to reduce pain.
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In a retrospective study, we evaluated the effect of the addition of a decompressive osteotomy to hemiarthroplasty of the great toe in terms of clinical and radiographic outcomes. Twenty-one consecutive patients affected by Grade III... more
In a retrospective study, we evaluated the effect of the addition of a decompressive osteotomy to hemiarthroplasty of the great toe in terms of clinical and radiographic outcomes. Twenty-one consecutive patients affected by Grade III hallux rigidus underwent distal oblique osteotomy of the first metatarsal and hemiarthroplasty of the hallux metatarsophalageal joint. Clinical evaluation included the American Orthopaedic Foot and Ankle Society scoring system (AOFAS) and the Short Form 36 questionnaire (SF-36), preoperatively and at followup visits. Standard weightbearing radiographs were performed to assess implant alignment, loosening, and bone loss. The mean followup was 26.4 (range, 16 to 29) months. The mean AOFAS score improved from 47.5 ± 11.5 preoperatively to 76.0 ± 15.5 postoperatively (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). At the last followup the SF-36 subscales Physical functioning, Bodily pain and Emotional role scores were increased from baseline. At the last followup, six patients (28.5%) were very satisfied with the outcome, ten patients (47.6%) were satisfied and five patients (23.8%) were dissatisfied. In the dissatisfied group, two patients had persistent joint pain with stiffness and subluxation of the prosthesis. Dorsal subsidence of the implant was present in ten patients at the last radiographic followup. Hemiarthroplasty of the proximal phalanx and distal oblique metatarsal osteotomy for Grade III hallux rigidus at 2-years followup yielded mixed patient satisfaction and unsatisfactory radiographic outcome.
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Boc&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s modification of the Austin procedure is a triplane distal osteotomy that achieves shortening and plantarflexion of the... more
Boc&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s modification of the Austin procedure is a triplane distal osteotomy that achieves shortening and plantarflexion of the first metatarsal with a lateral translation of the metatarsal head. The clinical results and influence of the Austin and Boc osteotomies on plantar pressure have been compared retrospectively. The patients were divided into two groups: 30 Austin and 30 Boc osteotomies were performed with a mean followup of 37 (range, 29 to 56) months. Sixty patients with mild hallux valgus deformities and central metatarsalgia, took part in the study. Pressure measurements were performed with a Diagnostic Support system footplate. The average postoperative American Orthopaedic Foot and Ankle Society score of the Austin group was 81.9 and 86.4 for the Boc group. The pressure distributions under the fourth and fifth metatarsal head were comparable in both groups (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). The Austin group showed decreased load bearing under the hallux and the first metatarsal head (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01), consistent with a persistent overloading of the second and third metatarsal head (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). The Boc group showed decreased weightbearing under the hallux with better load distribution beneath the second and the third metatarsal head (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Correlation of the American Orthopaedic Foot and Ankle Society scores and pressure variables confirmed a significant negative correlation with altered hallux and central metatarsal head loading (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). The Boc triplane osteotomy seems to restore more physiologic loading of the forefoot in comparison to the Austin procedure, reducing the incidence of painful callus under the second and third metatarsal head.
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Due to the nature of articular cartilage of being poorly vascularized the capabilities of self repair are limited. Mesenchymal stem cells transplantation is a modern technique which has been developed after the high success rates obtained... more
Due to the nature of articular cartilage of being poorly vascularized the capabilities of self repair are limited. Mesenchymal stem cells transplantation is a modern technique which has been developed after the high success rates obtained by microfracturing and drilling techniques which promote the release of growth factors and the infiltration of bone marrow derived cells in the lesion. In order to increase the concentration of bone marrow derived cells appropriate devices, the scaffolds, are necessary. These three dimensional constructs mimic the physiological ambient of chondrogenesis.The race for new scaffold materials, which will show high biocompatibility to prevent inflammatory response, high cellular adhesion properties with three dimensional architecture, high bioactivity to deliver growth factor appropriately and possibly high biodegrability has just begun. New studies will concentrate on the role, on the interaction and on the temporal sequence of growth factors to improve ostheocondral differentiation, but the necessity to increase the number of clinical studies with more patients and longer follow ups seems mandatory. The aim of this review is to update and summarise the evidence-based knowledge of treatment of talus chondral defect with new tissue engineering techniques.
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The treatment of cervical spine osteoblastomas requires complex therapeutic and reconstructive strategies depending on the... more
The treatment of cervical spine osteoblastomas requires complex therapeutic and reconstructive strategies depending on the tumor&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s location, local aggressiveness, and proximity to the surrounding neurovascular structures. Despite careful removal, lesions recur in as much as 10% of patients. Preoperative embolization is useful to minimize intraoperative bleeding and decrease the relapse of vascular tumors, but its role in osteoblastoma surgery is yet to be defined. We asked whether preoperative embolization with marginal resection would lead to osteoblastoma recurrence, and whether marginal excision with reconstruction would improve neurologic symptoms. We retrospectively analyzed a consecutive series of patients with cervical spine osteoblastoma, treated by one surgeon with a combined approach of preoperative embolization, marginal excision, and spinal reconstruction. One of nine patients presented with a monoradiculopathy, whereas only two patients presented with symptomatic spinal cord compression. At followup, all patients showed neurologic improvement, no tumor relapse, and adequate bony healing. Followup imaging studies showed cervical alignment was maintained. Although we report only a small uncontrolled cohort, the data suggest preoperative embolization and a tumor-free margin are consistent with a prolonged disease-free interval or complete tumor eradication.
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The widespread of hallux valgus surgery in a day care setting enhanced the role of regional anaesthesia in the last few years. Sciatic nerve block at popliteal fossa has been shown to provide safe and effective analgesia. Our purpose was... more
The widespread of hallux valgus surgery in a day care setting enhanced the role of regional anaesthesia in the last few years. Sciatic nerve block at popliteal fossa has been shown to provide safe and effective analgesia. Our purpose was to compare the success rate and performance time of popliteal block during resident&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s training for regional anaesthesia by using nerve stimulation (NS) or combined nerve stimulation and ultrasound (NS + US). 70 adult patients undergoing hallux valgus surgery were randomly assigned to receive sciatic nerve block at popliteal fossa with US+NS or NS alone with a double injection technique for peroneal and tibial branches, respectively. Two residents experienced with nerve stimulator performed the procedures after a learning phase concerning ultrasonography. A local anaesthetic solution, containing 10 mL of 0.75% ropivacaine and 10 mL of 2% lidocaine was used: 12 mL were infiltrated close the tibial nerve, and 8mL were infiltrated close the common peroneal nerve. Block success rate, sensory block onset time, block performance time were evaluated. Recourse to general anaesthesia was considered as failure. No differences were detected in success rate and onset time of sensory block between the two groups (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). The time to block tibial nerve and the overall block time were significantly faster in US+NS group (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Ultrasound guidance for popliteal nerve block resulted in similar success rate with a faster procedure time when compared with nerve stimulator, thus providing a possible effect on resident education and operating room efficiency.
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Research Interests:
Research Interests:
Osteoid osteoma is a benign tumour in young adults. The clinical manifestations are generally typical nocturnal pain that prevents sleep and that is alleviated with aspirin. When the typical clinical and radiological features are present,... more
Osteoid osteoma is a benign tumour in young adults. The clinical manifestations are generally typical nocturnal pain that prevents sleep and that is alleviated with aspirin. When the typical clinical and radiological features are present, diagnosis is not difficult. Problems in the differential diagnosis may arise in connection with an unusual location. We report on the clinical features, radiographic and histopathological findings, treatment, and results of four patients who were managed for an intra- or juxta-articular osteoid osteoma at our medical centre between 2000 and 2002 and in whom the initial diagnosis was erroneous and delayed from 1 to 10 years. In order to remove these lesions, we performed a CT-guided en block retrograde resection under arthroscopic control for juxta-articular osteoid osteomas (knee) and an arthroscopy-assisted en block antegrade resection in two cases of intra-articular osteoid osteoma (elbow and shoulder). None of the osteoid osteomas recurred in the follow-up period, and each patient got relief from pain.
Research Interests:
With advances in arthroscopic surgery, many techniques have been developed to increase the tendon-bone contact area, reconstituting a more anatomic configuration of the rotator cuff footprint and providing a better environment for tendon... more
With advances in arthroscopic surgery, many techniques have been developed to increase the tendon-bone contact area, reconstituting a more anatomic configuration of the rotator cuff footprint and providing a better environment for tendon healing. We present a low-profile arthroscopic rotator cuff repair technique which uses suture bridges to optimize rotator cuff tendon-footprint contact area and mean pressure. A 5.5 mm Bio-Corkscrew suture anchor (Arthrex, Naples, FL, USA), double-loaded with No. 2 FiberWire sutures (Arthrex, Naples, FL, USA), is placed in the anteromedial aspect of the footprint. Two suture limbs from a single suture are both passed through a single anterior point in the rotator cuff. One suture limb is retrieved from the cannula. The second suture limb is passed through a single posterior point in the rotator cuff producing two points of fixation in the tendon, with a tendon bridge between them. The same suture limb is retrieved through the lateral portal, and then inserted into the bone by means of a Pushlock (Arthrex, Naples, FL, USA), placed approximately 1.5-2 cm posterior to the first anchor. This second suture is passed again in the posterior aspect of the cuff. The limbs of the first suture are pulled to compress the tendon in the medial aspect of the footprint. The two free suture limbs are used to produce suture bridges over the tendon by means of a Pushlock (Arthrex, Naples, FL, USA), placed 1 cm distal to the lateral edge of the footprint relative to the medially placed suture anchors anterior to posterior. This technique allows us to perform a low-profile (single pulley-suture bridges) repair for knotless double-row repair of the rotator cuff.