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Stress fractures mainly occur in the lower limb as a result of cyclic submaximal stresses. Most commonly affected by this specific type of fractures are young athletes, military or elderly subjects with metabolic bone diseases like... more
Stress fractures mainly occur in the lower limb as a result of cyclic submaximal stresses. Most commonly affected by this specific type of fractures are young athletes, military or elderly subjects with metabolic bone diseases like osteoporosis. In consideration of the heterogeneity of affected patients is presumable that there are different pathogenic mechanisms. In young person bone tissue, although metabolically intact, is not able to withstand the stresses to which it is chronically subjected, also because of muscle fatigue. This leads to a macrostructural failure and to the development of "fatigue" fractures. Instead, in elderly patients, there are numerous physiological conditions that determine a bone metabolism alteration. This is the main reason for the structural changes in trabecular and cortical bone, which is reflected in reduced biomechanical strength. In addition, muscular situation, such as muscle fiber atrophy, is unable to correctly support bone tissue, leading to the development of insufficiency fractures.
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Introduction Leg fractures may occur frequently in sport injuries but it is very rare to find this kind of injury associated with interosseous membrane synostosis. This case report describes a unique case of 42 B1.2 fracture of the leg... more
Introduction Leg fractures may occur frequently in sport injuries but it is very rare to find this kind of injury associated with interosseous membrane synostosis. This case report describes a unique case of 42 B1.2 fracture of the leg associated with an interosseous membrane synostosis and literature review on Pubmed, Google scholar and Medscape. Case Presentation A 26 year old male amateur soccer player came to our attention at the emergency room after a fall while he was running without any direct trauma following a referred ankle sprain. X-ray and CT scan of the left leg showed a comminuted displaced fracture of the lower middle third of tibial and peroneus diaphysis, and moreover, a fracture of peroneal malleolus associated with a bone bridge between the tibia and fibula. The patient was treated with a surgical osteosynthesis the day after trauma. Conclusion We think that the interosseous membrane plays an important role in biomechanics of the leg even during running. To our kn...
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Research Interests: Medicine and Osteoporosis
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Introduction: clinical guidelines recommend to identify and treat people at high risk of fracture. Methods: we have carried out a simulation concerning pharmaco-economic issues in the treatment of severe osteoporosis and particularly... more
Introduction: clinical guidelines recommend to identify and treat people at high risk of fracture. Methods: we have carried out a simulation concerning pharmaco-economic issues in the treatment of severe osteoporosis and particularly those people with previous femoral fragility fractures, assuming that only 13.1% of hip fractured patients had started a proper antifracture therapy, as shown by the analysis of the Tuscany regional database. Results: Annual costs sustained by the Italian healthcare system for treating hip fractured patients all over Italy have been estimated to range from 2 560 000 in year 2000 to 3 291 750 in year 2005, representing only 0,3% of the overall costs sustained because of hip fractures in Italy. Conclusions: Sixty percent of the pharmacological costs can be considered as ineffective from a therapeutic point of view because patients were assuming their drugs only for 6 months. There is a need for specific codification of osteoporotic fragility fractures at hospital admissions and for implementing regional strategies aimed to reduce hip re-fractures by increasing the number of patients on treatment and incrementing adherence to treatment.
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Research Interests: Materials Science, Humans, Cancellous bone, Female, Male, and 15 moreFracture Healing, Cyclic Loading, Clinical Sciences, Adult, Bone Substitutes, Durapatite, Knee Joint, Experimental Method, Calcium Sulfate, Injections, Internal Fixation, Biomechanical Phenomena, Combined Modality Therapy, Bone Transplantation, and Drug combinations
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Research Interests: Epigenetics and Genes
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The progressive aging of the population inevitably leads to an increase in all age-related diseases, with osteoporosis arising as a health and social priority. Fragility fractures, resulting by Osteoporosis, may have important... more
The progressive aging of the population inevitably leads to an increase in all age-related diseases, with osteoporosis arising as a health and social priority. Fragility fractures, resulting by Osteoporosis, may have important consequences such as hospitalizations with long periods of immobility, need of surgery, increased risk of disability and partial or complete loss of autonomy in the ordinary activities of daily life and related economical burden. It is therefore essential to implement immediately a tertiary prevention to reduce the risk of further fractures through a diagnostic-therapeutic evidence-based pathway. So, starting from the fracture, the orthopaedic surgeon is meant to play an essential role in the management of osteoporotic patients, both to reduce the risk of further fractures and improve long-term outcome in these people, thus lowering the health and life quality downward spiral that often results in fractures in the elderly.
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A correct fracture healing depends on the synergy between biomechanical, molecular and cellular factors. Focusing on different stages, fracture hematoma represents the starting point of the inflammatory process, with a critical role in... more
A correct fracture healing depends on the synergy between biomechanical, molecular and cellular factors. Focusing on different stages, fracture hematoma represents the starting point of the inflammatory process, with a critical role in triggering the process of fracture healing. The essential factors for bone repair are the activation of mesenchymal stem cells and the release of growth and regulatory factors. Moreover, the efficacy of fracture healing is determined by three ideal conditions: adequate blood supply, good contact between bone fragments and good stability. It is remarkable how the implant choice influences fracture healing after surgical treatment. In osteoporosis, bone quality adversely affects the tissue structural competence, increasing the risk of a complicated fracture healing. The qualitative and quantitative alterations established at the cellular level during osteoporosis explain the progressive deterioration of bone tissue healing ability.
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ABSTRACT Objectives: We aimed to evaluate hospitalization rate of femoral neck fractures in the elderly Italian population over ten years. Methods: We analyzed national hospitalizations records collected at central level by Ministry of... more
ABSTRACT Objectives: We aimed to evaluate hospitalization rate of femoral neck fractures in the elderly Italian population over ten years. Methods: We analyzed national hospitalizations records collected at central level by Ministry of Health from 2000 to 2009. Age- and sex-specific rates of fractures occurred at femoral neck in people ≥65 years old. We performed a sub-analysis over a 3-year period (2007–2009), presenting data per five-year age groups, in order to evaluate the incidence of the hip fracture in the oldest population. Results: We estimated a total of 839 008 hospitalizations due to femoral neck fractures between 2000 and 2009 in people ≥65, with an overall increase of 29.8% over 10 years. The incidence per 10000 inhabitants remarkably increased in people ≥75, passing from 158.5 to 166.8 (+5.2%) and from 72.6 to 77.5 (+6.8%) over the ten-year period in women and men, respectively. The oldest age group (people >85 years old) accounted only for more than 42% of total hospital admissions in 2009 (n=39 000), despite representing 2.5% of the Italian population. Particularly, women aged >85 accounted for 30.8% of total fractures, although they represented only 1.8% of the general population. The results of this analysis indicate that femoral neck fractures progressively increased from 2000 to 2009, but a reduction can be observed for the first time in the number of fractures suffered by women ≤75 (−6.5%, between 2004 and 2009). Conclusion: Hospitalizations for hip fractures in Italy are continuously increasing, although women aged 65–74 years old start showing a decreasing trend.
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Research Interests: Biochemistry, Thermodynamics, Chemistry, Inorganic Chemistry, Kinetics, and 15 moreMedicine, Humans, Circular Dichroism, Triple Helix, Biological, Fibroblast, Active site, Matrix Metalloproteinases, Recombinant Proteins, Enzymatic Activity, Collagenase, Biochemistry and cell biology, Matrix Metalloproteinase, Gelatinase, and Collagen type I
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Osteosarcopenia (OS) is a newly defined condition represented by the simultaneous presence of osteopenia/osteoporosis and sarcopenia, the main age-related diseases. The simultaneous coexistence of the two phenotypes derives from the close... more
Osteosarcopenia (OS) is a newly defined condition represented by the simultaneous presence of osteopenia/osteoporosis and sarcopenia, the main age-related diseases. The simultaneous coexistence of the two phenotypes derives from the close connection of the main target tissues involved in their pathogenesis: bone and muscle. These two actors constitute the bone–muscle unit, which communicates through a biochemical and mechanical crosstalk which involves multiple factors. Altered pattern of molecular pathways leads to an impairment of both the functionality of the tissue itself and the communication with the complementary tissue, composing the OS pathogenesis. Recent advances in the genetics field have provided the opportunity to delve deeper into the complex biological and molecular mechanisms underlying OS. Unfortunately, there are still many gaps in our understanding of these pathways, but it has proven essential to apply strategies such as exercise and nutritional intervention to ...
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Hip fractures in elderly patients are an arising problem due to aging of population and still represent a controversial challenge for orthopedic surgeon who should help achieve the best functional recovery in the shortest time.... more
Hip fractures in elderly patients are an arising problem due to aging of population and still represent a controversial challenge for orthopedic surgeon who should help achieve the best functional recovery in the shortest time. Cementation in hip replacement plays an important role, but it should be carefully planned considering the possible risks. According to the literature, there are still no certainties regarding the superiority of an uncemented implant compared to a cemented one. The purpose of this work is to conduct an overview of the scientific literature that can clarify the advantages and disadvantages of cemented and non-cemented implants from a biological and biomechanical point of view.
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The prevention of femoral head collapse and the maintenance of hip function would represent a substantial achievement in the treatment of osteonecrosis of the femoral head; however it is difficult to identify appropriate treatment... more
The prevention of femoral head collapse and the maintenance of hip function would represent a substantial achievement in the treatment of osteonecrosis of the femoral head; however it is difficult to identify appropriate treatment protocols to manage patients with pre-collapse avascular necrosis in order to obtain a successful outcome in joint preserving procedures. Conservative treatments, including pharmacological management and biophysical modalities, are not supported by any evidence and require further investigation. The appropriate therapeutic approach has not been identified. The choice of surgical procedures is based on patient clinical conditions and anatomopathological features; preservation of the femoral head by core decompression may be attempted in younger patients without head collapse. Biological factors, such as bone morphogenetic proteins and bone marrow stem cells, would improve the outcome of core decompression. Another surgical procedure proposed for the treatme...
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Clusterin (CLU) is a secreted heterodimeric glycoprotein expressed in all organism fluids as well as in the intracellular matrix that plays key roles in several pathological processes. Its recent involvement in muscle degeneration of... more
Clusterin (CLU) is a secreted heterodimeric glycoprotein expressed in all organism fluids as well as in the intracellular matrix that plays key roles in several pathological processes. Its recent involvement in muscle degeneration of osteoporotic patients led to investigation of the role of CLU in bone metabolism, given the biochemical and biomechanical crosstalk of the bone–muscle unit. Quantitative real time-polymerase chain reaction (qRT-PCR) analysis of CLU expression was performed in both osteoblasts and Peripheral Blood Mononuclear Cells (PBMCs) from osteoporotic patients (OP) and healthy individuals (CTR). Furthermore, immunohistochemical analysis on femoral head tissues and enzyme-linked immunosorbent assay (ELISA) in plasma samples were performed to investigate CLU expression pattern. Finally, genotyping of CLU rs11136000 polymorphism has also been performed by qRT-PCR assays to explore a possible association with CLU expression levels. Data obtained showed a significantly ...
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The term “Bone Marrow Lesions” (BMLs) identifies a pathological state characterized by a structural degeneration of the osteochondral unit (OCU) and by an alteration of the biochemical balance existing between articular cartilage and... more
The term “Bone Marrow Lesions” (BMLs) identifies a pathological state characterized by a structural degeneration of the osteochondral unit (OCU) and by an alteration of the biochemical balance existing between articular cartilage and subchondral bone. These lesions, if they do not resolve spontaneously and if not adequately treated, can give rise to chronic degenerative diseases such as osteoarthritis and, in the most serious cases, evolve into stress fractures. The technique considered to be the gold standard for the detection of BMLs is Magnetic Resonance Imaging (MRI), to which BMLs appear as an area of ill-defined hyperintensity (high signal) in subchondral bone in fat-suppressed T2-weighted sequences, and hypointense areas (low signal) in T1-weighted sequences. There are several pharmacological intervention strategies for the treatment of BMLs, primarily the administration of bisphosphonates, but in recent years Iloprost treatment is also proving to be an effective therapeutic ...
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Several scientific evidence have shown that exposure to microgravity has a significant impact on the health of the musculoskeletal system by altering the expression of proteins and molecules involved in bone–muscle crosstalk, which is... more
Several scientific evidence have shown that exposure to microgravity has a significant impact on the health of the musculoskeletal system by altering the expression of proteins and molecules involved in bone–muscle crosstalk, which is also observed in the research of microgravity effect simulation. Among these, the expression pattern of myostatin appears to play a key role in both load-free muscle damage and the progression of age-related musculoskeletal disorders, such as osteoporosis and sarcopenia. Based on this evidence, we here investigated the efficacy of treatment with anti-myostatin (anti-MSTN) antibodies on primary cultures of human satellite cells exposed to 72 h of random positioning machine (RPM). Cell cultures were obtained from muscle biopsies taken from a total of 30 patients (controls, osteoarthritic, and osteoporotic) during hip arthroplasty. The Pax7 expression by immunofluorescence was carried out for the characterization of satellite cells. We then performed morp...