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Biomedical subjects

N Maffulli

Publications and source records attributed to N Maffulli.

At least 181 records · Page 10Linked to original sources
PubMed1994

Radiographic features of limb lengthening in children.

We report our experience in radiographic imaging in limb lengthening procedures using callotasis for limb lengthening discrepancy with the Orthofix dynamic monoaxial external fixator. Seventeen patients (average age at operation 10.8 years) completed 22 bone segments (7 femora, 11 tibiae, 4 ulnae) lengthening procedures. The average time for formation of good medullary bridging was over 6 months. The commonest radiographic abnormality was a periosteal reaction around the pin sites seen in 14 patients, while evidence of pin loosening was present in 10. All patients with pin loosening also showed periosteal reaction which pre-dated the loosening in 5 of 12 patients by an average of 47 days. Angulation was detected in 9 patients in the a.p. plane, and in 6 in the lateral plane. Six patients developed a ragged radiolucent region through the newly forming bone at an average of 95 days from the corticotomy but with uneventful healing.

Adolescent↗
PubMed1994

Radiological measurements in patellofemoral disorders. A review.

This paper analyzes some of the radiologic measurements used in the diagnosis and management of patellofemoral disorders. Measurements such as condylar width and height and patellar height from the true lateral view are helpful to determine the type and severity of intercondylar dysplasia. Skyline views provide information on the type and degree of patellar subluxation and dysplasia, especially of the medial aspect of the trochlear groove. In asymptomatic subjects, the trochlear angle does not exceed 140 degrees, and the lateral medial intercondylar ratio in dysplasia is > 1.7. Scanograms specifically assess the longitudinal axis of the lower limb. Computed tomography (CT) measurements for patellar subluxation do not provide significant additional information over that provided by skyline views. The average distance between the anterior tibial tuberosity and the trochlear groove is normally 13 mm, and a distance > 20 mm associated with knee pain should probably warrant surgery. Because of multiplanar facilities and exposure to nonionizing radiations, magnetic resonance imaging is progressively replacing CT scanning for quantitative and qualitative measurements, at least in a research environment. Its use in routine clinical practice is not yet warranted, given its high costs.

Femur↗
PubMed1994

Molded arthroplasty and transfer of the extensor hallucis brevis tendon. A modification of the Keller-Lelievre operation.

The Keller-Lelievre technique for hallux valgus correction was modified by detaching the extensor hallucis brevis tendon from the proximal phalanx, and reattaching it on the medial sesamoid. Thirty-five consecutive patients were assigned randomly to 1 of 2 groups. Patients in Group 1 received the modified operation, and the original Keller-Lelievre technique was used for the control group. The only significant radiographic difference at 6 months was the distance between the first and the fifth metatarsal heads. There were only slightly significant differences in function and in pain relief between the 2 groups at the 6th postoperative month. At 3 years, these differences were greater, with the group treated by the modification described herein, retaining significant correction and showing better functional results.

Aged↗
PubMed1994

Imaging in bone lengthening. A review.

Limb lengthening using callotasis needs careful preoperative planning and great care during the lengthening period. The most common method used to monitor limb lengthening is plain radiography, but the time of frame removal is still left to the judgment of the surgeon. This paper reviews some of the methods used experimentally and clinically to monitor the process, outlining their possible advantages and disadvantages for application in routine clinical practice. Considering availability, cost, and safety, an imaging protocol could involve preoperative assessment with computed tomography scan; immediate postoperative anteroposterior (AP) and lateral radiographs; weekly ultrasound scanning for the 1st 8 weeks; and monthly AP and lateral radiographs during the lengthening phase and if there is any clinical suspicion of complication during the consolidation phase. If available, dual energy bone densitometry can be performed every 2 to 4 weeks from 8 weeks, until removal of the fixator.

Absorptiometry, Photon↗
PubMed1994

Biomechanics of radiotransparent circular external fixators.

The mechanical and biomechanical characteristics of an external fixation system determine the biologic environment of the treated site. Traditionally, the Ilizarov system uses steel rings, which are heavy and can interfere with radiographic imaging. Biomechanical comparison of the traditional Ilizarov steel rings with rings made of oriented carbon fibers shows that the mechanical characteristics of the carbon fiber rings are comparable with those exhibited by traditional steel rings, being elastically rigid over the whole range of loads applied (147 N, 441 N, 735 N, 1029 N, 1110.34 N, 1192.7 N, 1274 N, 1355.3 N, 1437.7 N, 1519 N, and 1600.4 N). The plastic deformation exhibited by steel rings at high loads thus is avoided. In a clinical situation, such a deformation in response to loading would alter the biomechanics of the fracture site, possibly affecting the healing process.

Biomechanical Phenomena↗
PubMed1994

Proteases and antiproteases in cartilage homeostasis. A brief review.

Among other factors, articular cartilage degeneration is caused by proteolytic enzymes. Different cell types of the synovial fluid and/or the synovial membrane and cartilage release specific proteases. Normally, these are finely tuned with their inhibitors. When this balance is altered, the proteolytic action may prevail, producing tissue damage, cartilage disruption, and ultimately a full osteoarthritic picture. The protease antiprotease mechanism opens new perspectives in the diagnosis and pharmacologic management of osteoarthritis. Early diagnosis and improved monitoring of the evolution of the disease are made possible, and a more rational therapy against cartilage disruption becomes feasible.

Cartilage, Articular↗
PubMed1994

Tibial tuberosity avulsion associated with patellar tendon avulsion.

We report an adolescent boy with avulsion of the tibial tuberosity associated with avulsion of the patellar tendon. He underwent open reduction and internal fixation of his bone injury, and the patellar tendon was successfully reattached. The boy experienced a full recovery.

Adolescent↗
PubMed1994

Tibial tuberosity avulsion associated with patellar tendon avulsion.

We report an adolescent boy with avulsion of the tibial tuberosity associated with avulsion of the patellar tendon. He underwent open reduction and internal fixation of his bone injury and the patellar tendon was successfully reattached. The boy experienced a full recovery.

Adolescent↗
PubMed1993

Patterns of meniscal tears associated with anterior cruciate ligament lesions in athletes.

In this study, 400 clinically anterior cruciate ligament (ACL) deficient knees were arthroscoped and studied prospectively in the period January 1986 to April 1992. An ACL tear was always confirmed, and 41 per cent of these patients did not have an associated meniscal tear. In 30.25 per cent the lateral meniscus was torn; in 21.25 per cent the ACL tear was associated with a medial meniscus tear, and in the remaining 7 per cent both menisci were torn. The most frequently associated meniscal injury was the bucket handle tear of the medial meniscus (9 per cent), followed by the posterior horn tear of the lateral meniscus, which showed the same frequency as the ragged (or degenerated) tear of the lateral meniscus (6 per cent). The horizontal tear of the posterior part of the lateral meniscus showed a prevalence of 4.3 per cent. This picture is probably dependent on a secondary referral nature of the centre surveyed, in which the average time between injury and arthroscopy was 23.3 months.

Adolescent↗
PubMed1993

Low injury rates in elite athletes.

A group of 453 elite young athletes (231 boys, 222 girls) in five two year age groups from 8-16 years of age was followed up for two years in order to identify self reported injuries over that period. Four sports were studied, namely football (soccer), gymnastics, tennis, and swimming. The injury rate was low with just over half the children suffering one or more injuries per year, with the majority of those injured sustaining one injury only. Over the two year period of intensive sporting activity this amounted to less than one injury per 1000 hours of training. The highest risk of injuries was in football (67%) and the lowest in swimming (37%). Most injuries (70%) were acute and of a minor nature, although overuse injuries did require longer periods off training and competition than acute injuries (20 v 13 days). Footballers appeared to sustain more significant injuries than other sports as judged by the time required to resume training and/or competition (16 days after acute and 57 after overuse). No significant associations were found between injury rate, injury severity, sex, and pubertal status with the single exception of female gymnasts in whom more injuries occurred in the latter stages of puberty. Only four of the 453 athletes reported injury as a reason for retiring from their chosen sports. Most injuries in elite young athletes are minor, their prevalence is low and, at least in the short to medium term, do not constitute a significant health problem.

Adolescent↗
PubMed1993

Chevron or Wilson metatarsal osteotomy for hallux valgus. A prospective randomised trial.

We compared the chevron and the Wilson metatarsal osteotomy for hallux valgus in a prospective randomised trial on 87 feet in 51 patients, reviewed at averages of 5.5 and 38 months after operation. The patients in the chevron group returned to work earlier and mobilised faster, but, at the later review, those in the Wilson group had better functional results and were more satisfied with the appearance of the foot. Correction of the hallux valgus angle was better maintained in patients in the Wilson group and they had a better range of motion at the metatarsophalangeal joint; fewer complained of metatarsalgia.

Adult↗
PubMed1993

Acute haemarthrosis of the knee in athletes. A prospective study of 106 cases.

We made a prospective arthroscopic study of 106 skeletally mature male sportsmen with an average age of 28.35 years (16.8 to 44) who presented with an acute haemarthrosis of the knee due to sporting activities. We excluded those with patellar dislocations, radiographic bone injuries, extra-articular ligamentous lesions or a previous injury to the same joint. The anterior cruciate ligament (ACL) was intact in 35 patients, partially disrupted in 28 and completely ruptured in 43. In the patients with an ACL lesion, associated injuries included meniscal tears (17 patients), cartilaginous loose bodies (6), and minimal osteochondral fractures of the patella (2), the tibial plateau (3) or the femoral condyle (9). We found no age-related trend in the pattern of ACL injuries. Isolated injuries included one small osteochondral fracture of the patella, and one partial and one total disruption of the posterior cruciate ligament. Three patients had cartilaginous loose bodies, and no injury was detected in five. Acute traumatic haemarthrosis indicates a serious ligament injury until proved otherwise, and arthroscopy is needed to complement careful history and clinical examination. All cases with a tense effusion developing within 12 hours of injury should have an aspiration. If haemarthrosis is confirmed, urgent admission and arthroscopy are indicated.

Acute Disease↗
PubMed1993

Use of a tourniquet in the internal fixation of fractures of the distal part of the fibula. A prospective, randomized trial.

A prospective, randomized trial was undertaken to determine the rate of complications after the use of a tourniquet during open reduction and internal fixation of simple, closed fractures of the distal part of the fibula. Forty patients were operated on with use of a tourniquet (Group 1) and forty patients, without use of a tourniquet (Group 2). The average duration of the operation was significantly different between the two groups (41 +/- 9 minutes for Group 1 compared with 53 +/- 12 minutes for Group 2 [p = 0.026]). There were more complications in the patients in Group 1, two of whom had an isolated deep-vein thrombosis of the calf. The wound was possibly infected in eleven patients (seven in Group 1 and four in Group 2 [p < 0.05]) and frankly infected in three patients, all in Group 1 (p < 0.05). The plaster-of-Paris cast needed to be changed in three patients from Group 1. The patients in Group 1 returned to work an average of one week later than those in Group 2. The mean duration of follow-up was eighteen months (range, nine to thirty-two months). Given the lower prevalence of postoperative complications and the shorter time to recovery for the patients in Group 2, we believe that it is justified not to use a tourniquet in the operative treatment of simple, isolated fibular fractures.

Adult↗
PubMed1993

Post-viral fatigue syndrome. A longitudinal assessment in varsity athletes.

Maximal oxygen uptake, anaerobic threshold (AT), isometric strength of the elbow flexor and knee extensor muscles, isometric strength endurance exhaustion time (prolonged contraction at 66% of maximal isometric strength), uphill sprinting exhaustion time were longitudinally studied in eight varsity endurance runners with post-viral fatigue syndrome (PVFS). Prolonged impairment of exercise performance is evident during the course of PVFS. Although maximal oxygen uptake (VO2max) had returned to pre-infection values 13 months after the viral illness (4.160 vs 4.0 L.min-1), AT was still significantly reduced [52 ml.kg-1.min-1, 18.6 km.hr-1, 176 bpm, and 82% of VO2max vs. 49.1 ml.kg-1.min-1 (p < 0.05), 175 bpm (NS), 17.2 km.hr-1 (p < 0.01) and 79% of VO2max (NS)]. Maximal isometric contraction strength of the upper limb remained constant (282 N vs. 274 N), while knee extensor muscles strength decreased significantly (730 N vs. 701 N, p < 0.05). Strength endurance was still significantly reduced by the end of the study (arm average pre-infection: 46.2 sec; end of study: 29.3 sec, p < 0.001; leg average pre-infection: 66.4 sec; end of study: 49.1 sec, p < 0.01). Up hill sprinting time was similarly reduced by the end of the study period (29.3 sec vs. 16.2 sec, p < 0.01). Both aerobic and anaerobic exercise variables are seriously affected by post-viral fatigue syndrome, and one year may not be sufficient to fully recover.

Adult↗
PubMed1993

Mediopatellar synovial plica of the knee in athletes: results of arthroscopic treatment.

The long-term results (9-87 months) of the arthroscopic treatment of unilateral mediopatellar synovial plica of the knee in 102 athletes are reported. In all patients a large and/or fibrotic inflamed mediopatellar plica impinging on the femoral condyle on knee flexion was identified and trimmed. Chondromalacia patellae was detected in 38 patients. The impingement lesion was seen in 13 knees. In one patient, a minor tear of the lateral meniscus was trimmed, and one patient was found to suffer from a clinically asymptomatic partial tear of the anterior cruciate ligament. Isometric strength testing of the quadriceps revealed marked decrease at the second postoperative week, with subsequent gradual recovery. The results obtained justify arthroscopic treatment in a young, extremely active population.

Adolescent↗
PubMed1993

Ultrasonographic appearance of regenerate bone in limb lengthening.

The appearance of regenerate bone during the process of limb lengthening using a mono-axial device was studied using radiographs and ultrasound scanning in nine patients. The corticotomy site initially appeared as a sonolucent area. Poorly organized echogenic foci were detectable 2 weeks after the distraction was begun. After 4 weeks, these areas became aligned. At 7-8 weeks, a clear impression of a new cortical margin was seen. The formation of a medullary canal started at this point, progressing to a radiographically evident canal. Ultrasound scanning can reduce considerably exposure to ionising radiation in patients undergoing limb lengthening. Accurate measurements are possible in the early stages, and ossification can be monitored. Axial deviation can be seen but not evaluated. The maturity of the regenerate bone still has to be assessed clinically.

Bone Lengthening↗