Search PubMed⌕ Search

Biomedical subjects

R Pascarella

Publications and source records attributed to R Pascarella.

35 records · Page 2Linked to original sources
PubMedDate not supplied

The surgical treatment of inveterate hip dislocation in children affected with cerebral palsy: a preliminary report.

The incidence of hip dislocation in patients affected with cerebral palsy is directly correlated with the degree of neurologic deficit. Surgical treatment aimed at stabilization of the coxofemoral joint relieves pain and avoids the occurrence of changes in the static of the pelvis and vertebral column. The authors report their experience with procedures for the recovery of joint congruency (release of the adductors and psoas, surgical reduction of the dislocated epiphysis, femoral shortening associated with varus-derotation at the osteotomy level, acetabuloplasty) performed in one or more surgical stages, and operations with a purely anthalgic purpose (innominate osteotomy according to Chiari), specifying relative indications in relation to age.

Adolescent↗
PubMedDate not supplied

The surgical treatment of nonunion of the proximal metaphysis of the femur.

Nonunion of the proximal femur is a severe pathology, often provoked by the inopportune or improper use of a therapeutic aid: nonsurgical (primary nonunion), surgical (secondary nonunion). Surgical treatment of this nonunion may thus be characterized by different degrees of difficulty, depending on whether or not it is the sequela of surgery or of nonsurgical treatment. In lax nonunion, with atrophy of the segments and regions of necrotic bone interposed, modeling resection is required to correct the functional axes. The condylar blade-plate may be opposed by a cortical graft--to improve stability of the assembly--protecting the medial wall and providing the screws with excellent hold.

Adult↗
PubMedDate not supplied

Aseptic nonunion of the humeral shaft.

A total of 78 cases of aseptic nonunion of the humeral shaft treated at the third division of the Rizzoli Orthopaedic Institute between 1980 and 1997 were evaluated. There was a mean time of 19 months between trauma and definitive treatment. Surgical treatment consisted in osteosynthesis with a plate and bone grafting in 75 cases, and synthesis with screwed bone grafting alone in 3 cases. Consolidation was obtained in 96% of cases. The bone graft used (homo- or autoplastic) encountered complete osteointegration in a maximum time of 8 months. Postoperative motility of the shoulder and elbow were comparable to the preoperative findings.

Adolescent↗
PubMedDate not supplied

Valgus-lateralization osteotomy: notes on surgery.

There are specific forms of nonunion secondary to per-inter-subtrochanteric fractures that make surgical planning a critical phase. In cases such as these, it may be useful to transform the center of the nonunion into an osteotomy plane. Because of the anatomotopographical features, course and progression of the lesion, cases such as these constitute a pathology that is difficult to define in terms of a therapeutic protocol. The authors report the surgical technique used in 4 cases of nonunion of the proximal metaphysis of the femur.

Adult↗
PubMedDate not supplied

Rigid fixation with plate and bone graft in failures of intramedullary osteosynthesis for the treatment of diaphyseal nonunion of the femur.

Fractures and diaphyseal nonunion of the femur are normally treated by intramedullary nailing. In cases in which nailing fails, nonunion is treated by reaming of the canal and substitution of the nail with one of a more adequate caliber. Rarely, however, due to unfavorable mechanical conditions or in cases of atrophic nonunion or with scarce vascularization the biological conditions for healing are absent. In cases such as these, nonunion must be treated by rigid internal fixation with a plate, aided by the use of cortical graft on the opposite side. The authors present 7 cases of diaphyseal nonunion of the femur treated between 1994 and 1996 using rigid fixation (plate and graft) as a salvage method, as a result of numerous previous failures in surgery. The results were favorable in all of the cases without complications.

Adult↗
PubMedDate not supplied

Infected nonunion of the humerus.

Eight patients with infected nonunion of the humerus were treated surgically by removal of the instrumentation, surgical debridement or wide resection of the fracture site and stabilization in compression with an external fixator. A monoaxial external fixator was used in 5 patients, a circular external one in 3. The amount of time between trauma and treatment described was a mean of 13 months. Consolidation occurred in all of the patients after an average of 5.5 months. Long-term follow-up was obtained after a mean of 18 months (minimum 14, maximum 35). There was postoperative paralysis of the radial nerve in 2 of the cases, with complete recovery after 3 months. One case consolidated despite the persistence of a fistula.

Adult↗
PubMedDate not supplied

Dislocation of the proximal femoral epiphysis in acetabular fractures.

Acetabular fractures are often associated with dislocation of the proximal femoral epiphysis. The dislocation may be of three types, based on the type of fracture to which it is associated: anterior, central, posterior. In anterior and in central dislocation epiphyseal necrosis of the proximal femur has never been observed, while in posterior dislocation necrosis has been observed in 23% of cases. Diagnosis of posterior dislocation is of essential importance so that it may be reduced immediately, decreasing the risk of necrosis. The authors report a review of 192 fractures of the acetabulum to which dislocation of the femoral epiphysis was associated, treated between 1980 and 1996 at the IIIrd Division of the Rizzoli Orthopaedic Institute.

Acetabulum↗
PubMedDate not supplied

Fractures of the humerus treated by elastic nailing.

The Marchetti-Vicenzi elastic nail was used in the osteosynthesis of 15 diaphyseal or metadiaphyseal fractures of the humerus, 14 cases achieved consolidation, 1 resulted in nonunion. Surgical approach was always distal, transtricipital and the nail was always locked distally. In the cases that healed, the mean radiographic consolidation time was 90 days. There were no immediate postoperative complications.

Adolescent↗
PubMedDate not supplied

Locked nailing in subtrochanteric fractures of the femur in the elderly patient.

Subtrochanteric fractures are a typical pathology in the elderly patient, they are not very common and they are difficult to treat. The general conditions of these patients, often at the limit of operability, are further compromised by surgery and time spent in bed, leading to the death of the patient in a high percentage of cases. The fracture is often spyroid, it has multiple fragments, with interruption of the medial cortical bone. The quality of the bone, because of the marked osteoporosis, does not guarantee the good hold of the means of fixation used. The use of intramedullary nailing is a safe method, that allows for stabilization of the fracture without excessive blood loss, it allows for early partial weight-bearing and it has a lower number of complications as compared to other methods. Between 1-1-97 and 31-12-00 a total of 59 persubtrochanteric fractures were treated; there were 15 males and 44 females. A Gamma Long nail was used in 46 cases, a Gamma Standard in 13. Eleven of the patients died within 6 months. A total of 27 patients aged an average of 78 years (minimum 65, maximum 87) were evaluated at a mean follow-up of 10 months (minimum 7, maximum 27). A Gamma Long nail had been used in 18 cases, and Gamma Standard in 8. Partial weight-bearing was allowed after a mean of 20 days (minimum 10, maximum 35), total weight-bearing after a mean of 60 days (minimum 40, maximum 75). Consolidation was obtained after a mean of 4 months (minimum 3, maximum 7). There were no significant complications.

Age Factors↗
PubMedDate not supplied

Conjoined fracture-dislocation of the forearm at the elbow.

Conjoined fracture-dislocation of the elbow were first described by Marotte in 1982. In this study, a total of 41 patients treated between 1975 and 1995 at the Rizzoli Orthopaedic Institute and 4 patients treated between 1997 and 2000 at the Division of Orthopaedics at the Maggiore Hospital are evaluated. Based on the Marotte classification, the patients are divided into 4 groups, by site of dislocation of the radial capitellum and amount of comminution of the fracture of the ulna. A clinical and radiographic evaluation was made after a mean follow-up of 5.3 years based on Anderson criteria. The results obtained were excellent in 17 patients (37.8%) satisfactory in 13 (28.9%), dissatisfactory in 12 (26.7%); 3 patients were considered to be failures (6.7%), the best results were obtained in type I anterior dislocations.

Adolescent↗
PubMedDate not supplied

The Fixion nail in the lower limb. Preliminary results.

The Fixion nail is an intramedullary nail made of stainless steel, that may be used to treat fractures of the humerus and in the lower limb. This nail is made up of a cylinder that has 4 longitudinal bars which, once inserted in the bone segment, expands via a pressure hydraulic system using physiological solution. The nail may be introduced without reaming and after its expansion it adheres to the bone walls producing stabilization of the fracture. In order to guarantee good stability, the apex of the nail must exceed the fracture line by 5 cm. Indications were initially limited to type 32 and 42 A1-2-3 fractures of the mid third of the lower limb, to then be expanded to type B1 fractures in the AO system. A total of 20 nails were used in 19 patients, with an average time of 7 days for partial weight-bearing and 40 days for total weight-bearing, achieving consolidation on day 18 after an average of 5 months in the femur and 4 months in the tibia. Reaming of the intramedullary canal was carried out in all of the cases.

Adolescent↗
PubMedDate not supplied

Subtrochanteric nonunion of the femur.

Nonunion of the subtrochanteric region is usually secondary to incorrect surgical treatment. The main cause of failed osteosynthesis is related to interruption of the medial cortex of the femur. Either a closed method, with intramedullary nailing, or an open method, using cortical osteosynthesis and opposing bone graft, may be used to treat the pathology. Surgery differs depending on the instrumentation used for the initial treatment of the fracture. A total of 8 cases of intra- and subtrochanteric nonunion with intramedullary nailing and cortical osteosynthesis are reported.

Aged↗
PubMedDate not supplied

Distal diaphyseal fractures of the tibia treated by modified Grosse-Kempf nail.

Fractures of the distal fourth of tibia are difficult to treat because of the possible involvement of the joint, the comminution of the fragments, the local skin conditions and the surgical method required. There are many methods of osteosynthesis, and these range from external fixation to use of a plate to combined methods. Intramedullary nailing is generally not indicated in the treatment of such fractures, but if the correct technical procedure is used, indications may be widened, and the method may even be used in cases such as these. It is necessary to saw the tip of the nail so that the distal holes go beyond the fracture line. A total of 30 cases of fracture of the distal fourth of the tibia treated by Grosse-Kempf nailing sawed distally are reported.

Adult↗
PubMedDate not supplied

Revision of the femoral prosthetic component according to the Wagner technique.

The authors report the preliminary results they obtained using the Wagner technique for revision of the prosthetic stem by transfemoral access. Between January 1992 and June 1993 a total of 20 patients were treated by reimplantation of the prosthetic stem according to the Wagner technique. At minimum 12-month follow-up, based on the Harris Score System, results were excellent, good and fair in 16 cases. Results were not satisfactory in 4 cases after sinking of the prosthesis exceeding 2 cm or due to mid-distal pain with loading.

Aged↗
PubMedDate not supplied

The external fixator for the treatment of wrist fractures.

The authors present 15 unstable fractures of the wrist treated by external fixation. The fractures were classified based on the AO system, while results were evaluated clinically (Gartland and Werley method modified by Sarmientio) and radiographically. In two cases stabilization with metal wiring was used in addition to external fixation. Results were excellent in 4 cases, good in 9, unsatisfactory in 2 (1 fair, 1 poor). Intraoperative complications included a compound fracture of the second metacarpus, and late complications included a case of algodystrophy.

Aged↗