[Benigh epiphysial chondroblastoma].
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Adolescent↗
Biomedical subjects
A Giunti
Publications and source records attributed to A Giunti.
Diabetes as pro-infective risk factor in total hip replacement.
It is widely accepted that diabetic patients, above all poorly controlled ones, are more susceptible to infection. To verify whether diabetes might be considered a pro-infective risk factor in total hip replacement, 1,042 patients, who from 1969 to 1979 underwent an operation for arthropros thesis of the hip, were studied. The patients were subdivided into two groups according to whether they were diabetic or not. The diabetic patients, though well controlled by diet or by diet plus oral hypoglycemic agents, received insulin for at least two days before surgery. In the early post-operative phase they showed transient worsening of glycemic control rapidly corrected by increased insulin dosage. The patients of both groups were operated in low air exchange operating theaters, by the same staff and using standardized surgical techniques, and all received antibiotic coverage as preventive treatment against infections for a week after surgery. Infection and suppuration occurred in 11% of diabetic patients and only in 2% of non-diabetic patients (p less than 0.001); in these cases the prostheses were removed after unsuccessful antimicrobial treatment. Our study indicates that diabetes mellitus must be considered a proinfective risk factor in patients who undergo an operation for total hip replacement and suggests that a conservative approach is required in diabetic patients.
Aged↗
Direct cortisone injection in eosinophilic granuloma of bone: a preliminary report on 11 patients.
Eleven patients, between 3 and 16 years of age (average 6.5 years), with eosinophilic granuloma of bone were treated with direct injection of methylprednisolone acetate. Methylprednisolone acetate was used at the dilution of 40 mg/ml. Each single injected dose varied from 1 to 4 ml, depending on the sizes of the radiolucent defect and the soft tissue mass. One patient had four separate injections, one had three injections, five had two injections, and four had a single injection. All 11 patients healed without complications. This method of management is recommended.
Adolescent↗
Changes in the femoral cortex as related to prosthetic stem.
The need to improve the features of resistance and duration of prosthetic implants, based on the constant increase in the number per year of total hip substitutions has encouraged the study of the causes of aseptic loosening of implants, in particular, any relationship between femoral morphology, features of the implanted prosthesis (size and coating), degree of contact between the latter and the host bone, and the occurrence of changes in bone trophism. The documentation relative to 143 patients, corresponding to 149 primary hip arthroplasties, was evaluated clinically (according to Merle d'Aubigné modified by Charnley) and radiographically, using a computerized radiographic evaluation system devised by our group. In particular, on x-rays (anteroposterior view) obtained in the area corresponding to the upper and lower margins of the smaller trochanter and of the femoral isthmus, measurements relative to femoral diameters, to the distance between them, and to the corresponding flare indexes were obtained; bone thickness, degree of bone-prosthesis correspondence and any changes in bone trophism caused by stress-shielding and stress-concentration were also measured. An analysis of the data was carried out using non-parametric statistical tests, that allowed us to reveal the surgeon's good standardization in preparation of the femur; the tendency for the cortex to thicken for prostheses of the short type, and the narrowing of the standard type prostheses, the influence of the degree of fit of the prosthesis on trophism of the femoral cortex.
Femur Head↗
[Prevention and treatment of infections in orthopedic surgery. The role of antibiotic-loaded cements].
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Anti-Bacterial Agents↗
Hip arthroplasty after femoral osteotomy.
The authors report the results of 56 prosthetic implants on previous femoral osteotomy. The cases submitted to surgery, some time after the operation, present with clinical-radiographic results (movement and risk of loosening) that are worse than those cases that had not undergone osteotomy. Among complications, a higher incidence of intraoperative fractures and nerve paralysis were observed. Fractures always occurred when instrumentation was removed during the same prosthetic implantation procedure.
Adolescent↗
The treatment of anterior recurrent dislocation of the shoulder: the Bankart-Delitala procedure.
The authors report the results of 110 shoulder capsulorrhaphies performed according to the Bankart-Delitala technique. After a mean period of 104 months +/- 63 the clinical results, evaluated on the basis of the Rowe method were excellent-good in 94.6% of cases, and fair-poor in 5.4%. In 83.6% of cases there was no deficit in motility of the shoulder submitted to surgery, in 16.4%, the shoulder presented deficit in extrarotation (exceeding 15 degrees in only 1 case, equal to 0.9%).
Adolescent↗
Preventive cobalt therapy in heterotopic ossification consequent to prosthetic hip reimplantation.
Prosthetic hip reimplantation is considered to be a procedure at risk for the development of periprosthetic heterotopic ossification, which may be responsible for functional limitations of the hip operated on. Preventive treatment may be carried out with radiation or drug therapy. The authors report the results of 54 cases submitted to prosthetic reimplantation and treated by cobalt therapy, as compared to the results of 76 reimplantations (control group) that did not undergo any kind of treatment: the occurrence of high grade ossification (exceeding Brooker grade III) was 2% in cases treated, as compared to 9% in those not treated. Males were more at risk for the development of ossification.
Adult↗
Osteoid osteoma: diagnostic problems in joint and periarticular localizations.
The diagnosis of osteoid osteoma is usually not difficult. In typical forms of the disease, with diaphyseal localization, the clinical course and radiographic findings are so typical that diagnosis may be considered certain even when there is no histological confirmation. In some localizations, nonetheless, such as in the cancellous or short bones, or when the lesion involves a joint, diagnosis may be difficult, uncertain and late. Between January 1991 and April 1997 a total of 91 patients who had been diagnosed as having osteoid osteoma were submitted to computed tomography. Of these patients, there were 34 females, and 57 males, and age ranged from a minimum of 2 to a maximum of 69 years. Localizations are reported in Table I. For the purposes of our study, several cases with atypical features have been selected from these. We found it interesting to emphasize the importance of a correct diagnostic procedure with the purpose of accurately identifying the lesion.
Adolescent↗
The use of the carbon-fiber reinforced modular implant for the reconstruction of the anterior column of the spine. A clinical and experimental study conducted on 42 cases.
The conservative treatment of neoplasms of the locomotor apparatus means the production of bone defects that may be filled with prostheses, bone grafts, systems of osteosynthesis. In the vertebral column, reconstruction of the resected elements--in the case of total vertebrectomy--requires the combination of anterior and posterior implants. It is the purpose of this study to analyze a group of 42 patients who, after accurate and uniform oncological (Enneking) and surgical (Weinstein-Boriani-Biagini) staging, were submitted to excision of one or more vertebral bodies for the treatment of neoplastic pathology, with reconstruction by prosthetic carbon fiber modular implant in order to obtain immediate stability, and to stimulate solid intervertebral fusion by bone grafts introduced inside the prosthesis. Thirty of the 42 patients presented with primary malignant tumor, 3 with benign tumor, 6 with solitary metastases, and 3 with plasmacytoma. In 32 cases, en bloc resection of the vertebral body was carried out (vertebrectomy) with combined anterior and posterior access in 29 patients (69.0%), and by posterior approach alone in 3 cases (7.1%). Ten intralesional corporectomies were carried out, 8 by anterior approach, 2 by posterior approach. The carbon prosthesis was filled with cortical and cancellous bone grafts in 38 cases. At a mean clinical and instrumental follow-up obtained 26 months after surgery for all of the patients, the use of a carbon prosthesis did not cause short- or long-term mechanical complications. The results of our study tend to affirm that the use of a carbon fiber modular implant may fill any loss of bone substance of the vertebral column, that it allows for immediate weight-bearing, and that if favors bone fusion. Some particular features of the carbon prosthesis favorably adapt to the surgical method of vertebrectomy: 1. The various components of the prosthesis may adapt to any type of bone resection of the vertebral body, even in unexpected situations; 2. Connection to posterior instrumentation in total vertebrectomies avoids the use of an anterior plate, thus reducing the time required for reconstruction of the anterior column, eliminating necessary surgical procedures in the segmental vascular structures. Finally, the radiolucency of the prosthesis allows for an easy evaluation of the formation of bone within and around the implant up to definitive anterior fusion and, of no less importance, early diagnosis of any local recurrence.
Adolescent↗
The treatment of post-traumatic stiffness of the elbow.
The authors present the results observed in 12 patients affected with post-traumatic stiffness of the elbow treated by an external fixator in distraction to obtain functional recovery of range of movement; in all of the cases anterior and posterior release and resection of the apex of the olecranon was carried out, while in 2 cases interposition arthroplasty with freeze-dried dura madre was associated. The series includes 12 cases with a long-term follow-up that ranges from 8 to 33 months after surgery. The mean arch of movement during the preoperative phase was 35 degrees (minimum 0 degree-maximum 90 degrees) in flexion extension and 80 degrees (minimum 0 degree-maximum 150 degrees) in pronosupination. Recovery of mean joint excursion in flexion-extension was 91 degrees and in pronosupination it was 127 degrees. Complications included loosening of the nails in 2 cases, breakage of the nails in 1 case, and transitory deficit of the ulnar nerve in 4 cases. A total of 11 patients (91.66%) declared that they were satisfied with the considerable improvement in their ability to do daily activities. The results of arthroplasty in distraction in the elbow are satisfactory even if much attention must be paid to the selection of the patients because of the intense collaboration that is required during postoperative rehabilitation.
Adolescent↗
Cementless hip arthroplasty with a modular neck.
The authors report the preliminary results obtained in 347 prosthetic implants with hip arthroplasty with a modular neck. The advantages to using this method are related to the chance to adapt to different anatomical conditions: in particular, in primary arthroplasty a straight neck was used in the majority of cases (83%), while in dysplastic hips a straight neck was used in 47.5% of cases and a retroverse neck (8 degrees or 15 degrees) overall in 40% of cases.
Adolescent↗
Free microvascular flaps in oncological surgery of the limbs.
Surgery plays a role of primary importance in the treatment of sarcomas of the soft tissues. The first objective of surgical treatment is the local control of the disease. Local recurrence is a serious event, that often requires amputation, and favors metastatic progression of the disease. Currently, except in very rare cases, conservative treatment is the treatment of choice, as it has by now been demonstrated that its results are equivalent to those obtained when demolitive surgery is used. In the distal sites of the limbs, superficial localization of the tendons, ligaments, and joints, the absence of anatomical compartments, make it difficult to perform wide conservative surgery. To this must be added that patients are often sent to see a specialist after a previous inadequate operation, and the presence of a contaminated surgical scar often requires exeresis of a wide area of the skin, sufficient to obstruct healing by primary intention. The use of revascularized free flaps allows for oncologically adequate conservative surgery to be performed, even in anatomical sites where amputation alone traditionally provided a safe surgical margin.
Adult↗
Infected nonunion of the femur.
From 1988 to 2000, 21 patients with infected nonunion were treated by wide resection of the nonunion site and fixation with Ilizarov's external ring fixator. Of the 21 cases, 2 are still under treatment. 18 cases resolved. In two cases iterative fracture occurred, which was successfully treated by internal fixation. One case treated by external fixator failed; any further attempts at surgery were abandoned, and the patient was put in a brace. The ring fixator enabled a sufficiently wide resection to remove the infection. It also provided stability for long periods of time, unrestricted weight bearing, and, after resolution, the same set up was used to restore the femur to its original length by corticotomy and distraction according to Ilizarov.
Adult↗
Radiographic and therapeutic aspects of neurogenic arthropathy.
The authors describe the typical radiographic aspects of neurogenic arthropathy based on an examination of 127 cases observed at the Rizzoli Orthopaedic Institute. Surgical indications for the various joints affected are discussed, and the results obtained after treatment are reported.
Adult↗
Considerations on ceramic prosthesis explants.
The authors report data obtained for 11 cases of explants of prostheses having ceramic joint surfaces. The wear phenomena observed in 9 prostheses, including 1 case with breakage of the ceramic head, was moderate: 20-22,000 debris per mu 2. In 2 cases the wear was massive, with a concentration of debris in the peri-implant tissues 5-10 times greater (100,000-218,000 debris per mu 2). An explanation for the trigger mechanism of wear phenomena is proposed: the cases of massive wear are related to loosening of the acetabulum. A histological examination of the bone tissue surrounding a stem covered with alumina (Al2O3) carried out in three cases allowed us to observe an area of demineralization measuring approximately 500 mu of tissue in contact with the ceramic coating. The osteomalacia could be caused by the diffusion of alumina ions.
Bone Cements↗
Radiographic evaluation of HDPE cemented and cementless Lord and An.C.A. screwed acetabular models.
A total of 187 alumina screwed porous-ceramic coated sockets (An.C.A.), 48 screwed smooth-surfaced Lord sockets, and 251 cemented polyethylene sockets were radiographically evaluated at an average follow-up of 30, 51 and 96 months respectively. After 6 years the Lord prostheses revealed a 38% incidence of loosening, similar to that observed for cemented sockets 10-12 years after surgery. The An.C.A. prostheses revealed radiographic loosening equal to 12% (6 cases) in the first 50 implants, and only 0.7% in the remaining 137 cases: overall, the An.C.A. acetabular prosthesis revealed an index of radiographic loosening equal to 3.3% (7/187). To guarantee "osteointegration" of the porous coating of An.C.A. sockets optimal stability must be obtained when the prosthesis is screwed in. Because the mid-term follow-up for this clinical experience is relatively short (30 months), an opinion on the reliability of the screwed "porous" sockets must await confirmation.
Acetabulum↗
Femoral bone remodeling: clinical experience with cemented and cementless total hip arthroplasty.
A radiographic study of femoral bone tissue remodeling around hip arthroplasty was carried out simultaneously in two series totalling 224 cementless and 77 cemented prostheses. Remodeling was analyzed by detailed visual evaluation of the radiographic assessment. The results show that the phenomenon of bone remodeling is still evolving more than 5 years after surgery. Bone demineralization of the proximal femur is more evident in cementless prostheses than in those stabilized with acrylic cement (24% vs. 12%). The preoperative state of mineralization significantly influences bone remodeling.
Bone Cements↗