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Biomedical subjects

S Boriani

Publications and source records attributed to S Boriani.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

The Gamma nail, sliding-compression plate. A comparison between the long-term results obtained in two similar series.

The authors report the results they obtained in a retrospective comparative study conducted on two systems of osteosynthesis used to treat trochanteric fractures: the sliding-compression screw-plate (CHS), and the Gamma nail. Two series were included in the study, each of which was made up of 50 cases; these were comparable in terms of fracture type, age of the patients, associated pathologies, and minimum follow-ups of 6 months. The parameters compared were: surgical trauma, average amount of time before a standing position could be resumed, resumption of motor activity previous to trauma, mechanical behavior of the instrumentation. The results show that both of the means of synthesis are capable of effectively stabilizing pertrochanteric fractures, avoiding the mechanical complications instead observed when more dated instrumentation, such as the screw-plate or nail-plate, are used, systems which are not characterized by a sliding cervico-cephalic screw. The amount of time before walking is resumed is quicker when the Gamma nail is used. There was no significant difference in terms of resumption of motor activity. Surgical trauma was the same in both series when the instrumentation was applied after reduction of the fracture in closed surgery, while blood loss was greater when fracture reduction required by application of the plate was performed in open surgery.

Adult↗
PubMedDate not supplied

Fractures and dislocations of the lower cervical spine: surgical treatment. A review of 83 cases.

The authors examine 83 consecutive cases of fracture and dislocation of the lower cervical spine submitted to surgery over a period of 5 years. Sixty-five patients were monitored with minimum 5-months follow-up, 5 died, 13 could not be traced. Lesions were classified based on the method proposed by Argenson3 with the purpose of identifying guidelines for surgical treatment. Thus, different methods are proposed based on the type of lesion and on any neurologic deficit. Intersomatic fusion with anterior approach is the method of choice in most lesions. The exception to this is monoarticular dislocations that cannot be reduced, so that reduction by posterior approach associated with discectomy and anterior fusion are recommended. Circumferential fusion is proposed for traumatic spondylolistheses, complete dislocations with unsatisfactory anterior reduction, in lesions in flexion-extension and rotation associated with complete spinal cord injury, in order to favor functional rehabilitation free from ortheses. The need to review many cases of traumatic lesions of the lower cervical spine (LCS) collected over a relatively short period of time derives from the need to identify guidelines that will help the surgeon in his or her choice of the type of surgery to perform on the patient with emergency injury. The basic premise, as for other sites of traumatic injury, resides in an efficient classification (corresponding to the anatomic injury and of immediate and intuitive application) to which options for treatment may be related. In particular, an evaluation of the type of approach (anterior, posterior, combined) and of the sequence of surgical stages is essential to obtaining effective results with an acceptable complication rate. Finally, treatment must be definitive, and in cases of severe spinal cord injury it must allow for rapid rehabilitation and freedom from the use of ortheses.

Adult↗
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

Spinal metastases: treatment evaluation algorithm.

Spinal metastases are only apparently similar lesions, considering the large varieties of istotypes and the spread of the primary tumor. These metastases develop early and are not terminal events, they have to be considered as severe complications because, when possible, surgical treatment can improve the history of the patient in terms of life expectancy and quality of life. The approach to these lesions should be multidisciplinary in collaboration with oncologists and radiotherapists, in fact the average of survival of these patients has increased in recent years. The evolution of anesthaesiological techniques that permit surgical treatments that were once considered prohibitive. The application of new adjuvant therapy increases the effectiveness for surgical treatment. Controversy exist over the most appropriate treatment for patients with metastatic disease of the vertebral column. The purpose of this article was to determine the best sequential process to arrive at the most appropriate treatment considering the individual general conditions and the parameters of the metastases. We review 269 cases in 182 patients suffering from spinal metastases from a solid tumour treated between 1996 and 2002. As the number of treatment options for metastatic spinal disease has grown, it has become clear that effective implementation of these treatments can only be achieved by multidisciplinary approach.

Adolescent↗
PubMedDate not supplied

Retrograde intramedullary osteosynthesis of femoral fracture: preliminary results of Maggiore Hospital.

The Distal Femoral Nail (DFN), Mathys Medical Ltd. Switzerland) was used in our division for the treatment of fractures of the distal metaepiphysis, and in some cases of the diaphysis, of the femur. A total of 16 cases treated over 30 months, between October 2000 and March 2003 (minimum 6, maximum 61 months), were analyzed retrospectively. A total of 11 metaepiphyseal fractures (65%) and 6 diaphyseal fractures (35%) were treated. Consolidation of the fracture was observed in 15 cases out of 16 (equal to 93.8%) with a mean time of 140 days (minimum 120 days, maximum 240 days) after surgery. Mean flexion of the knee equal to 90 degrees and 3 cases of stiffness with lower mobility at 45 degrees were observed: in 2 cases stiffness was of extra-articular origin caused by exuberant bone callus. There were no iatrogenic complications of the vascular type, nor were there infections, or cases of implant loosening. Shortening (1 cm) in a type B2 fracture (based on the AO classification) was observed. The results we obtained suggest that DFN represents a valid alternative to the open treatment of fractures of the distal metaphysis of the femur; in cases of patients with multiple trauma or in elderly patients where invasiveness is reduced, importance is awarded to less blood loss, a shorter amount of time required for surgery, and early mobilization and weight-bearing.

Adolescent↗
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Clinical features, diagnostic and therapeutic approaches to haematogenous vertebral osteomyelitis.

This article review the clinical features and the diagnostic approach to haematogenous vertebral osteomyelitis in order to optimise treatment strategies and follow-up assessment. Haematogenous spread is considered to be the most important route: the lumbar spine is the most common site of involvement for pyogenic infection and the thoracic spine for tuberculosis infection. The risk factors for developing haematogenous vertebral osteomyelitis are different among old people, adults and children: the literature reports that the incidence seems to be increasing in older patients. The source of infection in the elderly has been related to the use of intravenous access devices and the asymptomatic urinary infections. In young patients the increase has been correlated with the growing number of intravenous drug abusers, with endocarditis and with immigrants from areas where tuberculosis is still endemic. The onset of symptoms is typically insidious with neck or back pain often underestimated by the patient. Fever is present in 10-45% of patients. Spinal infections may cause severe neurological compromise in few cases, but mild neurological deficit, limited to one or two nerve roots, was detected in 28-35% of patients. The diagnosis of haematogenous vertebral osteomyelitis may be very difficult, as the symptoms can be sometimes not specific, vague or almost absent. The usual delay in diagnosis has been reported to be two to four months, despite the use of imaging techniques: in the early diagnosis of vertebral ostemyelitis is important the role of bone scintigraphy. The general principles for the management of spine infections are non operative, consisting of external immobilization and intravenous antibiotics, followed by oral antibiotics. Indications for surgery should be given in case of absence of clinical improvement after 2-3 weeks of intravenous antibiotics, persistent back pain and systemic effects of chronic infection and with presence or progression of neurological deficit in elderly or in cervical infection. Chronic ostemyelitis may require surgery in case of a development of biomechanical instability and/or a vertebral collapse with progressive deformity.

Anti-Bacterial Agents↗
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Giant cell tumor of the upper cervical spine: transmandibular-translingual access. Clinical case.

The authors describe the clinical case of a patient aged 18 years affected with giant cell tumor (GCT) at C3 who came to the surgical unit of Orthopaedics and Traumatology at the Ospedale Maggiore in Bologna after being treated by surgery elsewhere. Particular attention is paid to surgical access by means of median transmandibuloglossotomy used in order to obtain a sufficiently wide surgical field that can adequately expose the vertebral segment affected by neoplastic disease. In particular, possible complications that may be observed postsurgery can be compared to other surgical approaches to the upper cervical spine and above all that there are no permanent clinical sequelae.

Adolescent↗
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Solitary plasmacytoma of the spine: a 22 years follow-up case report.

BACKGROUND AND OBJECTIVES: Plasmacytoma is a systemic malignancy and it is the most frequent primary tumor affecting the skeleton. Progression from solitary plasmacytoma to systemic diffusion is reported to be 65-100% in 15 years. A case report of a rare 22-year follow-up of a thoracic solitary plasmacytoma is here presented. MATERIAL AND METHODS: Clinical case analysis, radiographs, magnetic resonance images and histological sections of the lesion are discussed. Repeated surgical interventions were required due to progression and local recurrence of disease. RESULTS: Although the inadequate surgical treatment, low response to chemotherapy and radiation therapy, and many local recurrences, no systemic diffusion of the disease was observed in 22 years. DISCUSSION: Aggressive surgery may be indicated in young patients with isolated lesion and good prognostic factors. Palliative surgery remains necessary in order to decompress the cord and to stabilize the spine.

Adult↗
PubMedDate not supplied

Selective arterial embolization in the treatment of lesions of the musculoskeletal apparatus.

The authors describe 42 cases of lesions of the musculoskeletal apparatus (traumatic, pseudoneoplastic or tumorous) in which selective arterial transcatheter percutaneous embolization (SAE) was indicated. In 3 patients SAE was not performed because the angiography had shown it to be too dangerous for the spinal cord. Out of 39 patients 2 were embolized in order to stop unrestrainable hemorrhaging (1 post-traumatic and 1 post-bioptic), 7 in order to reduce intraoperative bleeding, while in 7 cases (aneurysmal bone cyst, angioma of bone) the aim was curative. In the remaining 23 patients SAE was performed for adjuvant (8) or palliative (15) purposes in association with radio-and/or chemotherapy (11). In these last 15 cases the clinical results obtained were good in 67% of the cases, with partial or total regression of pain. Healing was obtained in 100% of the patients treated for curative purposes.

Adolescent↗
PubMedDate not supplied

The Lefevre ulnar nail.

The Lefevre nail applies the principles of locked intramedullary nailing in the treatment of fractures of the ulna. It is made up of two segments which slide telescopically, so that assembly may be in compression, distraction or neutral. Fixation at the two ends of the ulna is guaranteed by two transverse screws. It may be used in pseudarthrosis and osteotomies for lengthening and shortening, as well as in simple or complex fractures. The cases presented provide an overview of the use of the nail at the Brest Center, where the nail was invented and developed, and at the Rizzoli Institute. The study includes 22 fractures, 1 pseudarthrosis and 1 osteotomy. Consolidation was obtained in all of the cases after an average of 2.5 months. Immobilization in plaster was required only in cases with associated lesion of radius. The functional results obtained were satisfactory.

Adolescent↗
PubMedDate not supplied

Vertebral histiocytosis.

Thirty-five cases of vertebral histiocytosis are examined for a total of 52 vertebrae affected. The study is conducted on the radiographic picture at the onset and at long-term follow-up in 32 cases (24-223 months, average 45). Diagnosis may be based on radiology only in typical cases, otherwise there may be errors in differential diagnosis with malignant neoplastic lesions. Radiotherapy does not seem to influence the volumetric reconstruction of the vertebral body, which is inversely proportional to age. In those cases submitted to chemotherapy, the morphological results, in the absence of other types of local treatment, are often excellent. Orthesic or surgical treatment must be chosen based on the extent of the lesion and on its ability to progress; CT scan may be useful to this purpose, but initial orientation may be suggested by multiple adjacent lesions or by radiographic images such as osteolysis of the pedicles.

Adolescent↗
PubMedDate not supplied

The Gamma nail. A preliminary note.

The Gamma nail is a new device used in the treatment of pertrochanteric fractures in the elderly in which the principles of locked intramedullary nailing are applied. It is constituted by an intramedullary nail crossed in the proximal segment by a cervico-cephalic screw, by which compression of the fracture segments may be obtained. It is furthermore possible to obtain distal locking by means of two screws, such as for Grosse-Kempf nailing. It constitutes an alternative to Ender nailing, screw-plate, and nail-plate. Our experience with 31 cases did not reveal any differences as compared to what occurs with Ender nailing with regard to surgical stress. Instead, a shorter amount of time seems to be required for functional recovery, as the stability of the assembly allows for early weight-bearing.

Age Factors↗
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Grosse-Kempf nailing in the elderly.

The authors report on 30 fractures of the femur and tibia treated with the Grosse-Kempf locked nail in patients aged more than 60 years. Neither nonunion nor severe complications were observed; surgical trauma was well sustained. Functional results were particularly satisfactory; most patients began walking within the first week after fixation.

Age Factors↗