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Biomedical subjects

A Miniaci

Publications and source records attributed to A Miniaci.

At least 37 records · Page 2Linked to original sources
PubMed1993

Impingement in the athlete.

There is no doubt that the understanding of shoulder mechanics and pathology will continue to evolve. It is not appropriate to consider that all patients, especially young athletes, who have shoulder pain have "impingement." Rather, a careful evaluation will result in the correct diagnosis and the institution of the appropriate treatment. A step-by-step assessment and management scheme is necessary for each health care professional dealing with athletes. If surgery is deemed necessary, the correction of the anatomic abnormality with minimal disruption of normal anatomy will be the key to allowing the athlete to return to his or her chosen sport.

Arthroscopy↗
PubMed1992

Release of the subscapularis for internal rotation contracture and pain after anterior repair for recurrent anterior dislocation of the shoulder.

Ten patients who had an internal rotation contracture and pain after an anterior repair for recurrent dislocation of the shoulder were treated by release of the subscapularis muscle. For six of the patients, radiographs demonstrated severe osteoarthrotic changes in the shoulder as well. The release was done an average of eleven years after the original procedure, which, for most patients, had been a Putti-Platt repair. After release of the subscapularis, each patient had less pain in the shoulder and an average increase of 27 degrees of external rotation. Release of the subscapularis can offer relief of pain and of functional limitations associated with the symptoms caused by an internal rotation contracture after an anterior repair of the shoulder.

Adult↗
PubMed1991

Four-part valgus impacted fractures of the proximal humerus.

There is a specific type of displaced four-part fracture of the proximal humerus which consists of valgus impaction of the head fragment; this deserves special consideration because the rate of avascular necrosis is lower than that of other displaced four-part fractures. Using either closed reduction or limited open reduction and minimal internal fixation, 74% satisfactory results can be achieved in this injury.

Adult↗
PubMed1991

Open surgical techniques in the athlete's shoulder.

Treatment of the athlete's shoulder is one of the greatest challenges facing the orthopedic specialist. Surgical procedures, and in particular, the open surgical techniques presented in this article, are always a last resort of treatment. The primary treatment is always nonoperative with a particular emphasis toward physiotherapy. In selected instances in which patients have failed rehabilitation, the techniques that are presented can achieve a relatively high degree of success if particular attention is paid to the specific indications, approaches, and details of each technique. Open surgical techniques for rotator cuff tendonitis, instability, and unusual problems in the athlete's shoulder are presented.

Arthroscopy↗
PubMed1990

Analysis of radionuclide arthrograms, radiographic arthrograms, and sequential plain radiographs in the assessment of painful hip arthroplasty.

An analysis of sequential plain radiographs (XR), radionuclide arthrography, (RNA), and radiographic arthrography (RGA) was performed to determine the efficacy and usefulness of each study in the diagnosis of loosening of prosthetic hip components. Over a 2-year-period, 65 hip prostheses were assessed before operation using each type of study; these results were compared to the intraoperative assessment of the status of the components. Of the three studies, sequential plain radiographs were overall the most accurate, sensitive, and specific. Radionuclide arthrography was of no use on the acetabular side but quite useful on the femoral side, especially in cases with only minimal femoral component loosening. Radiographic arthrography was overall the least accurate or sensitive of the three studies performed.

Aged↗
PubMed1989

A compression pinning system for osteochondritis dissecans of the knee.

A new pinning technique for fixation of osteochondritis dissecans of the knee is presented. The system consists of hooked wires, anchoring screws, and bolts, which provide compression to the osteochondral fragments and prevent pin migration. In 10 patients followed for 4 (3-5) years, all the knees had normal, painless function, with complete healing of all but one of the fragments: the exception was a small chondral fragment, which was removed arthroscopically.

Adolescent↗
PubMed1989

Proximal tibial osteotomy. A new fixation device.

A new internal fixation device was applied to 41 proximal tibial osteotomies to ensure against loss of postoperative correction. An oblique osteotomy was stabilized by two screws and a five-hole one-half tubular plate. Thirty-six patients with 41 proximal tibial osteotomies were reviewed for an average roentgenographic follow-up time of 22.6 months (range, six to 48 months) with no loss of correction. In addition, 16 patients with 19 osteotomies and a minimum clinical follow-up time of two years were reviewed using the Hospital for Special Surgery knee scoring system; these early results demonstrated a similar outcome to previously published series. The new fixation device is simple to use, permits early postoperative motion, and maintains the exact correction obtained at the time of surgery.

Arthritis↗
PubMed1989

Anterolateral compression fracture of the thoracolumbar spine. A seat belt injury.

A thoracolumbar injury is reported in four patients who were involved in motor vehicle accidents while wearing shoulder-lap belt assemblies. These injuries consisted of anterolateral wedge compression of a thoracolumbar vertebra with lateral compression occurring on the side opposite the restrained shoulder. The posterior elements were disrupted contralateral to the anterolateral body compression. There was no translation in any of these fractures, and there were no neurological injuries. All fractures united without significant late disability. Although there was no gross clinical instability in these fractures, two of the three columns of the spine are disrupted, suggesting potential instability. The postulated mechanism of injury, referred to as the roll-out phenomenon, is flexion and rotation about the axis of the shoulder strap.

Adolescent↗
PubMed1988

Longitudinal stress fracture of the tibia: case report.

Stress fractures usually present with vague clinical features and delayed radiographic findings. A patient with a longitudinal stress fracture of the tibia is described here. Computed tomographic images, perpendicular to the fracture, were diagnostic while plain radiographs and scintigraphy showed nondiagnostic changes due to an unexpected fracture pattern.

Cumulative Trauma Disorders↗
PubMed1988

Healing of extra-articular angulated apex volar fractures of the distal radius.

Healed extra-articular angulated apex volar fractures of the distal radius are a relatively common orthopedic finding. The functional end-results of treatment of this injury are controversial. Twenty-nine patients with 34 fractures were reviewed by subjective and objective assessment, as well as radiologic examination. Some had unsatisfactory results. These poor results were associated with older age, poor anatomical reduction and, in some, the presence of a midcarpal instability pattern.

Adult↗
PubMed1987

Tibialis anterior muscle hernia: a rationale for treatment.

Tibialis anterior muscle hernia is an orthopedic problem that should be dealt with carefully since the potential complications of treatment are serious. The literature is reviewed to provide a better understanding of the natural history, incidence, classification and treatment of muscle hernias. Guidelines are proposed for a rational treatment plan for tibialis anterior muscle hernias. Asymptomatic hernias need no treatment. Longitudinal fasciotomies are recommended as the treatment of choice in symptomatic tibialis anterior muscle hernias that are refractory to conservative treatment.

Hernia↗
PubMedDate not supplied

Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder.

Our purpose was to compare the effectiveness of traditional treatment with immediate arthroscopic stabilization in young patients who have sustained a first traumatic anterior dislocation of the shoulder. Forty skeletally mature patients younger than 30 years of age were randomly allocated to immobilization for 3 weeks followed by rehabilitation (group T) or arthroscopic stabilization (within 4 weeks of injury) followed by an identical immobilization and rehabilitation protocol (group S). A blinded research assistant performed all follow-up evaluations. The dominant arm was involved in 35% of subjects. The injury occurred in a sporting event in 70% of subjects. At 24 months, there was a statistically significant difference in the rate of redislocation (T = 47%, S = 15.9%, P = .03). An intention-to-treat analysis comparing disease-specific quality of life using the validated Western Ontario Shoulder Instability (WOSI) index showed statistically significantly better results in the surgically treated group at the 33 months (T = 633.93 v S = 287.1, P = .03) and no significant difference in range of motion. At an average 32 months follow-up, a significant reduction in redislocation and improvement in disease-specific quality of life is afforded by early arthroscopic stabilization in patients less than 30 year of age with a first, traumatic, anterior dislocation of the shoulder.

Adolescent↗
PubMedDate not supplied

Arthroscopic mosaic arthroplasty in the equine third carpal bone.

OBJECTIVE: To investigate survival and function of autogenous heterotopic osteochondral grafts in a site where injuries are common. STUDY DESIGN: Three osteochondral grafts were harvested arthroscopically from the femoropatellar joint and transplanted to the third carpal bone (C(3)). Nine months later, histologic, histomorphometric, and biochemical comparisons were made between the transplanted grafts in C(3) and tissue adjacent to the recipient site, the opposing radial carpal bone (C(r)), the donor site in the femoropatellar joint, and the sham-operated contralateral C(3). ANIMALS: One mixed-breed pony and 5 Standardbred horses aged 3 to 8 years old. METHODS: Using instruments modified for equine use, four 4.5-mm-diameter osteochondral grafts were harvested arthroscopically from the distal aspect of the lateral trochlea of the right femur and inserted into the radial facet of the right third carpal bone. The fourth graft was kept as a donor-site control sample. Three months later, regular exercise was started and at 6 months, repeat arthroscopy was conducted to evaluate healing. The horses were euthanatized 9 months after transplantation, and comparisons were made between the grafts, opposing radial carpal bone, and contralateral third carpal bone. The assessment criteria included paravital staining, a modified Mankin scoring system, and biochemical analyses for collagen type, total collagen content, and sulfated glycosaminoglycan concentration. RESULTS: All horses were sound 21 days' postoperatively. At 6 months, all 18 grafts were intact but somewhat soft and opaque compared with surrounding carpal cartilage. Nine months' postoperatively, the bony portions of the grafts were well integrated with the recipient sites, but 6 grafts had histologic evidence of cartilage degeneration. From biochemical analysis of grafts, there was little or no new repair tissue invading the experimental sites, but sulfated glycosaminoglycan (proteoglycan) loss from the transplanted cartilage was marked. CONCLUSIONS: Heterotopic transfer of osteochondral grafts from the distal aspect of the lateral femoral trochlea to the third carpal bone is feasible with minor modifications of human mosaic arthroplasty instruments. The bony portion of the osteochondral grafts was quickly remodeled to provide subchondral support to the transplanted articular cartilage. The loss of proteoglycan from the transplanted cartilage indicates that the grafts might have been injured during harvesting or insertion, or, more likely, did not remodel to meet the demands of a new biomechanical environment. CLINICAL RELEVANCE: These findings suggest that arthroscopic resurfacing of focal osteoarticular defects will not be successful in the long term unless donor and recipient sites can be matched with respect to cartilage thickness, biochemical constituents, and physical properties. Mosaic arthroplasty may be indicated in selected cases in which no other options exist to create a confluent cartilage-covered surface.

Animals↗
PubMedDate not supplied

Analgesic effects of low-dose ropivacaine for interscalene brachial plexus block for outpatient shoulder surgery-a dose-finding study.

BACKGROUND AND OBJECTIVES: Interscalene brachial plexus block (ISB) with low-dose bupivacaine provides effective postoperative shoulder analgesia in outpatients. The analgesic effect of low-dose ropivacaine for ISB is unknown. METHODS: In this double-blind study, 66 outpatients scheduled to undergo arthroscopic shoulder surgery were randomly assigned to receive an ISB with 10 mL of 0.125%, 0.25%, or 0.5% ropivacaine before surgery. Postoperative verbal pain rating score, analgesic consumption, and the extent of motor and sensory block was assessed for 120 minutes after surgery. RESULTS: The degree of shoulder analgesia was dose dependent. Postoperative pain scores were lowest with 0.5% ropivacaine, and analgesic was not required in the hospital in 70% of the patients who received 0.25% and 0.5% ropivacaine, compared to 30% with 0.125% ropivacaine (P < .03). In the patients who required no analgesic in the hospital, the time to first oral analgesic at home was approximately 10 hours irrespective of ropivacaine concentration. Motor and sensory block distal to the elbow was detected in 25% of the patients in the 0.5% group but none in the 0.125% group. CONCLUSIONS: Interscalene brachial plexus block with low-dose ropivacaine, 10 mL of 0.25% and 0.5%, provides effective long-lasting shoulder analgesia in a majority of patients after arthroscopic surgery.

Adult↗
PubMedDate not supplied

Magnetic resonance imaging evaluation of the rotator cuff tendons in the asymptomatic shoulder.

Thirty shoulders in 20 volunteers (average age, 29 years; range, 17 to 49) with no shoulder symptoms or known abnormalities were scanned using magnetic resonance imaging. All scans were interpreted by one radiologist who was blinded to clinical data. Appearance of rotator cuff tendons on the images was graded. Grade 0 was normal, homogeneous low signal intensity structure. Grade 1 lesion was focal, linear, or diffuse intermediate signal through the tendon. Grade 2 lesion was high signal intensity within the tendon and less than full thickness. Grade 3 was high signal intensity through full thickness of the tendon. No supraspinatus or infraspinatus tendons were grade 0 (normal); all supraspinatus and infraspinatus tendons had grade 1 changes through the tendons; and 7 of 30 (23%) of the tendons had grade 2 changes. None of the 30 shoulders had grade 3 changes in the rotator cuff tendons. There is a wide array of abnormal magnetic resonance imaging signals in shoulders of young asymptomatic individuals, but they do not have full-thickness rotator cuff tears (grade 3 lesion). Nonenhanced magnetic resonance imaging may be of limited value in defining rotator cuff injury in a patient with shoulder pain unless a full-thickness rotator cuff tear is suspected clinically.

Adolescent↗