tesi sperimentale sull'utilizzo di nanoparticelle magnetiche per incentivare la rigenerazione... more tesi sperimentale sull'utilizzo di nanoparticelle magnetiche per incentivare la rigenerazione nervosa in lesioni di nervo mediano di ratto
La lesione del plesso brachiale da trauma ostetrico rappresenta la causa di una condizione di dis... more La lesione del plesso brachiale da trauma ostetrico rappresenta la causa di una condizione di disabilità anche permanente dell’arto superiore ben conosciuta e studiata sia in ambito ostetrico che ortopedico. Oggigiorno grazie all’evoluzione delle tecniche di diagnosi prenatale che permettono di individuare i feti a rischio e grazie alla diffusione del parto cesareo, l’incidenza delle paralisi ostetriche risulta fortemente ridotta, aggirandosi secondo recenti studi intorno a 1.2-1.3 su 1,000 nati negli Stati Uniti. Allo stesso tempo la comprensione sempre più profonda dell’anatomia dei nervi, e nello specifico del plesso brachiale, e lo sviluppo delle nuove tecniche di microchirurgia hanno condotto a nuove soluzioni terapeutiche per i bambini affetti da paralisi ostetrica. Il recente sviluppo della chirurgia nervosa primaria e secondaria del plesso brachiale del bambino ha dato a questi pazienti la possibilità di recuperare almeno parzialmente le funzionalità dell’arto leso, evitando...
Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adul... more Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2–13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14–44). Three patients died after a mean of 19.3 months postoperatively—two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%...
Background: the purpose is to gather and analyze the statistical datas of wrist and hand injuries... more Background: the purpose is to gather and analyze the statistical datas of wrist and hand injuries admitted to the Hand and Reconstructive Microsurgery and Replantation Hub center of Careggi Hospital, Florence during the first two months of COVID-19 epidemic in Italy. The Authors investigated how the drastic changes in daily activities modified the epidemiology of hand trauma lesions. Methods: The Authors analyzed the characteristics of hand and wrist traumatic disorders during the months of February and March comparing 2019 to 2020. Collected data included age distribution, traumatic etiology, diagnosis and type of surgical procedures. Results: The total number of orthopedic and trauma patients significantly decrease in 2020 compared to 2019 (3360 vs 1470). The number of hand and wrist injuries didn't show a significant difference between 2019 and 2020 instead (192 vs 131). The overall number of patients hospitalized and surgically treated at our Operative Unit (OU) was 168 in 2019 and 120 in 2020. Male patients resulted prevalent (60,7 M vs 39,3F/2019; 63,2 M vs 36,8F/2020). In terms of patient age, in 2020 we registered a significant reduction of cases in the 20-35-year-old age group and a significant increase in the 51e65 and 66-80-year-old age groups. Traffic-related, sport-related and fortuitous injuries significantly decreased in 2020, while the number of domestic accidents significantly increased. Analyzing the Hospital Discharge Records (HDR), we found a significant increase in the number of proximal and middle phalanx fractures; no significant differences were found for other kinds of discharge diagnosis. As for the choice of surgical treatment options, no differences were found between 2019 and 2020. Conclusion: Even during drastic movement restrictions and the prolonged suspension of work and leisure activities secondary to COVID-19 epidemic in 2020, hand and wrist traumas rate remained almost the same compared to the same period of the previous year. Nevertheless, a significant change in the etiology and patient age was registered. In fact, sport and traffic-related traumas decreased respect to domestic traumas, while the previous prevalent involvement of young adults was surpassed by accidental hand traumas in the elderly and active adults.
Background Aim of this paper is to validate a procedure for correcting elbow flexion contracture ... more Background Aim of this paper is to validate a procedure for correcting elbow flexion contracture in patients suffering from brachial plexus neonatal palsy sequelae during their teens. Elbow flexion contracture represents an unsolved problem in the natural history of obstetric brachial plexus palsy (OBPP) because of the consistent deformity recurrence. Following a previous paper, in which an original technique was proposed in a small sample of patients, the authors show the possible correction of the deformity in a larger group of patients. Methods The procedure includes a combination of a posterior approach to the elbow with olecranon tip section and an anterior one with capsulotomy and soft tissue release to improve elbow range of motion. A series of 26 patients, who underwent the procedure, were checked out in medium and long term. Collected data were age, type of brachial plexus palsy, length of hospitalization, duration of surgery, preoperative and postoperative elbow range of motion, preoperative and postoperative DASH scores and satisfaction scores. Explaining further details about the procedure, the Authors report their results, including a statistical analysis. Results At the final follow-up, the mean increase of elbow extension was about 22°. Functional outcomes were successful as well, with a mean increase of 10 points of DASH score. Over 75% of patients were fully satisfied with their outcome. Conclusions The outcome has confirmed the good efficacy of the procedure in increasing elbow extension but also in improving cosmetic appearance in adolescents suffering from flexed elbow in OBPP sequelae.
Introduction: Femoral nerve compression caused by iliopsoas hematoma is a rare complication after... more Introduction: Femoral nerve compression caused by iliopsoas hematoma is a rare complication after hip surgery. To the best of our knowledge, this is the first case after hemiarthroplasty. In this case, iliacus hematoma resulted from spontaneous bleeding favored by anticoagulant therapy. Case Report: A 78-year-old female developed left groin pain associated with typical symptoms of femoral nerve palsy about 2weeks after left hip hemiarthroplasty[1, 2, 3]. Computed tomography revealed the presence of a left iliopsoas hematoma that was surgically drained. Inguinal pain was immediately relieved, while nerve palsy recovered only partially, but the quality of life drastically improved and she was able to walk using a walker without pain. Conclusion: Even if it is a rare condition, the formation of a hematoma of iliopsoas muscle should be considered in patients that present symptoms of femoral nerve palsy, especially if treated with heparin or other anticoagulant drugs. Surgical drainage o...
Purpose: The purpose of this bibliometric study was to summarize European orthopedic literature p... more Purpose: The purpose of this bibliometric study was to summarize European orthopedic literature produced by EFORT memberships between 2009 and 2019 and to identify the 100 most cited articles, analyzing the characteristics that made them so interesting for the orthopedic scientific world. Method: A search of the literature was conducted using Clarivate Analytics Web of Science in the subject category “orthopaedics”; then the results were summarized using Web of Science tools. Results: A total of 160.375 articles were found: most of these were produced by England. In particular the most prolific institution was the University of London. Analyzing in detail the 100 most cited publications emerged that most of them were review published in journal with high impact factor (Q1). The University of Oxford was the institution with the greatest number of contributions (13%). The most cited topics were osteoarthritis (24%), followed by orthopedic basic science (22%). Bio-materials was the mos...
Phalangeal (P) and metacarpal (MC) fractures are very common injuries, with potentially disabling... more Phalangeal (P) and metacarpal (MC) fractures are very common injuries, with potentially disabling, residual impairment, deformities or stiffness. Conservative treatment represents the strategy of choice in most cases, but in unstable fractures and/or high-demanding patients, surgical fixation could be required. Ideally, the best treatment choice will be the intramedullary fixation systems, if possible without the implant protruding from the skin. Intramedullary headless screw fixation could be the reliable option to achieve a primary fixation, allowing an early active movement, with regard to the fractures site. The Authors analyzed the results achieved after 56 extra-articular unstable fractures (31 phalangeal fracture and 25 metacarpal fracture) treated with intramedullary headless compression screws. After surgery, patients underwent early mobilization without splinting. The results of the study suggest that this technique could be a reliable therapeutic option in order to obtain...
Background: Ulnar nerve lesions represent a rare complication of wrist fracture. The present manu... more Background: Ulnar nerve lesions represent a rare complication of wrist fracture. The present manuscript describes the case of a particular traumatic mechanism in which the nerve resulted crushed between radial fracture fragments. Case presentation: A 47-year-old man suffered a subtotal lesion of the ulnar nerve following an open displaced distal radius fracture. Symptoms of ulnar nerve deficiency worsened after reduction and temporary stabilization were performed. Further surgery was performed to achieve definitive stabilization and ulnar nerve neurolysis. The ulnar nerve was found to be jammed inside the fracture side, and so was repaired with a direct suture. Progressive recovery was observed in the following months. Conclusions: Given the paucity of reports of ulnar nerve injury in the literature, clear recommendations for treatment of nerve lesions after wrist fractures have not yet been defined. Nevertheless, in our experience, peripheral nerve function should be assessed before and after fracture reduction, as a worsening of symptoms
The purpose was to establish a ranking of the 50 most cited articles about wrist surgery and anal... more The purpose was to establish a ranking of the 50 most cited articles about wrist surgery and analyse their features. Science Citation Index Expanded was used to identify the 50 most frequently cited orthopaedic journal articles written in English, searching for the topic “wrist surgery” in the subject category ‘‘Orthopaedics’’. Then, we analysed the number of citations, citation density, authorship, article institution, the year of publication, the country of origin of the article, name and impact factor of the journal, and publication type of the article. The 50 most cited articles were published in only 6 of the 74 journals included under the category “orthopaedics”. Citation count ranged from 256 for the first one to 67 for the 50th article. Most of them were written by American authors. These articles were published between 1991 and 2011. “Distal Radius Fractures” was the most common issue. This type of bibliographic analysis could be particularly useful for other young Authors ...
Anterior dislocation of a prosthetic knee is a rare event. Only few episodes have been described ... more Anterior dislocation of a prosthetic knee is a rare event. Only few episodes have been described in the past and have never been linked with neurovascular injury. This could lead orthopaedic surgeons to focus on the implant instability factors and underrate other complications. The authors report a case of a patient who experienced popliteal artery dissection 80 hours after traumatic anterior knee dislocation of a previously well-functioning total knee arthroplasty. Given that there is a lack of clinical cases that have established guidelines for management of this problem, the authors have focused on the importance of performing computed tomography angiography in the management of an anterior traumatic knee dislocation of a prosthetic knee.
Metacarpal fractures constitute 7.8% of the upper extremity fractures. The common treatments rema... more Metacarpal fractures constitute 7.8% of the upper extremity fractures. The common treatments remain nonsurgical procedure, but high-demanding patients or unstable fractures require fixation with Kirschner wire (K-wires), plate, and screws. However, these approaches may cause scarring and adhesion with poor functional results. From 2014 to 2015, the authors used an intramedullary headless screw to treat 25 patients (24 men, 1 woman) with metacarpal bones fractures (20 V, 3 IV, 1 III, and 1 II). The fractures patterns were 23 fractures of distal third of metacarpal bone (16 oblique, 5 comminute configurations, and 2 transverse), 1 fracture of the base of the II metacarpal bone. One case presented a multiple metacarpal and phalangeal facture associated. The authors used anesthesia (bupivacaine-epinephrine 1:100,000) and intramedullary titanium headless screw fixation percutaneously inserted (CCS Medartis and HCS Synthes 3 mm of diameter). No open reduction was needed. Early active mobi...
Total hip arthroplasty is one of the most performed procedures in orthopaedic surgery. Implantati... more Total hip arthroplasty is one of the most performed procedures in orthopaedic surgery. Implantation of a prosthesis determines changes in the distribution of loads on the host bone, and this phenomenon, known as stress shielding, is related to the biomechanical characteristics of the implant. Usually stress shielding involves the proximal portion of the femur by reducing the mechanical strength and ability to withstand the transmitted loads. The aim of our study is to demonstrate how the use of a short hip stem reduces the stress shielding phenomenon to the proximal femur. The study analyzed 20 patients undergoing hip prosthesis surgery with a short stem (Metha<, B. Braun Medical, Inc., Bethlehem, Pennsylvania) at the Ist Orthopaedic Division of Pisa University (between December 2008 and January 2010). Each patient was subjected to analysis of periprosthetic bone mineral density by a bone densitometry (dual emission X-ray absorptiometry [DEXA] with the metal removal software) at ...
Currently, the gold standard to repair large nerve defects is the autologous nerve graft. These s... more Currently, the gold standard to repair large nerve defects is the autologous nerve graft. These solutions offer a mechanical support, adhesion substrates, and, with Schwann cells (SC), a source of neurotropic factors for axonal growth. The technical limits are the donor side damage, multiple surgical accesses, and the unavailability of large amounts of grafts. In recent years, several researchers focused their attention on the interaction between cells (nervous and glial) and physic-chemical cues that arise from the extracellular milieu. Nanotechnologies produce surfaces that mimic the topographical signals (physical stimuli) that arise from enterprise content management (ECM) to modulate the forces acting during axonal elongation. The use of magnetic nanoparticles (MNPs) seems to be able to guide and to boost the nerve regeneration. Both research areas could be improved through surfaces functionalization by biological molecules (proteins/peptides, growth factors, etc.). In the futu...
Strategies in Trauma and Limb Reconstruction, 2008
Pseudoaneurysms of the profunda femoris artery have been reported following different types of tr... more Pseudoaneurysms of the profunda femoris artery have been reported following different types of trauma and from orthopedic procedures performed in the proximal femur. Two cases of profunda femoris artery pseudoaneurysm with two rare causes are presented. The first one is a core decompression of femoral head for osteonecrosis and the second one is a proximal femur fracture nailing. Awareness and careful follow-up are the key issues for the early diagnosis.
Introduction Septic arthritis of the hip is a rare condition in adults and its treatment depends ... more Introduction Septic arthritis of the hip is a rare condition in adults and its treatment depends on symptoms duration: early onset of infection can be treated with open or arthroscopic debridement, while more aggressive surgery is required when articular damage takes place such as articular resection or total hip replacement (THA). Presentation of case We report a case of a 30 year old man affect by septic arthritis of the hip after an intramuscular injection of diclofenac successfully treated with a two-steps THA. Discussion In literature there aren’t many cases of septic arthritis of the hip developed after intramuscular injections. Early onset of infection can be treated with an accurate articular debridement, while chronic conditions are traditionally treated by resection arthroplasty. However resection arhtroplasty gives to the patients a significant leg length discrepancy and, especially in young adults, a two-steps surgery with the implant of THA can lead to good results, as ...
Surgical reconstruction after humeral resection represents a challenging issue in orthopaedic onc... more Surgical reconstruction after humeral resection represents a challenging issue in orthopaedic oncology. Particularly in paediatric patients, the main concerns are maintaining limb function and reconstruction longevity. We describe a novel strategy of humeral reconstruction based on the use of a three-dimensional-printed custom-made prosthesis in a 13-year-old patient diagnosed with osteosarcoma. The implant was specifically designed to sustain the native head, which was spared, as it was not involved by the neoplastic tissue. The mechanical support the prosthesis provided was associated with the biological stimulus of a free vascularised fibular graft to obtain an anatomic, functional and stable construct. This solution has had good longevity, and after 3 years of follow-up, the patient still shows excellent limb function and personal satisfaction.
tesi sperimentale sull'utilizzo di nanoparticelle magnetiche per incentivare la rigenerazione... more tesi sperimentale sull'utilizzo di nanoparticelle magnetiche per incentivare la rigenerazione nervosa in lesioni di nervo mediano di ratto
La lesione del plesso brachiale da trauma ostetrico rappresenta la causa di una condizione di dis... more La lesione del plesso brachiale da trauma ostetrico rappresenta la causa di una condizione di disabilità anche permanente dell’arto superiore ben conosciuta e studiata sia in ambito ostetrico che ortopedico. Oggigiorno grazie all’evoluzione delle tecniche di diagnosi prenatale che permettono di individuare i feti a rischio e grazie alla diffusione del parto cesareo, l’incidenza delle paralisi ostetriche risulta fortemente ridotta, aggirandosi secondo recenti studi intorno a 1.2-1.3 su 1,000 nati negli Stati Uniti. Allo stesso tempo la comprensione sempre più profonda dell’anatomia dei nervi, e nello specifico del plesso brachiale, e lo sviluppo delle nuove tecniche di microchirurgia hanno condotto a nuove soluzioni terapeutiche per i bambini affetti da paralisi ostetrica. Il recente sviluppo della chirurgia nervosa primaria e secondaria del plesso brachiale del bambino ha dato a questi pazienti la possibilità di recuperare almeno parzialmente le funzionalità dell’arto leso, evitando...
Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adul... more Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2–13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14–44). Three patients died after a mean of 19.3 months postoperatively—two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%...
Background: the purpose is to gather and analyze the statistical datas of wrist and hand injuries... more Background: the purpose is to gather and analyze the statistical datas of wrist and hand injuries admitted to the Hand and Reconstructive Microsurgery and Replantation Hub center of Careggi Hospital, Florence during the first two months of COVID-19 epidemic in Italy. The Authors investigated how the drastic changes in daily activities modified the epidemiology of hand trauma lesions. Methods: The Authors analyzed the characteristics of hand and wrist traumatic disorders during the months of February and March comparing 2019 to 2020. Collected data included age distribution, traumatic etiology, diagnosis and type of surgical procedures. Results: The total number of orthopedic and trauma patients significantly decrease in 2020 compared to 2019 (3360 vs 1470). The number of hand and wrist injuries didn't show a significant difference between 2019 and 2020 instead (192 vs 131). The overall number of patients hospitalized and surgically treated at our Operative Unit (OU) was 168 in 2019 and 120 in 2020. Male patients resulted prevalent (60,7 M vs 39,3F/2019; 63,2 M vs 36,8F/2020). In terms of patient age, in 2020 we registered a significant reduction of cases in the 20-35-year-old age group and a significant increase in the 51e65 and 66-80-year-old age groups. Traffic-related, sport-related and fortuitous injuries significantly decreased in 2020, while the number of domestic accidents significantly increased. Analyzing the Hospital Discharge Records (HDR), we found a significant increase in the number of proximal and middle phalanx fractures; no significant differences were found for other kinds of discharge diagnosis. As for the choice of surgical treatment options, no differences were found between 2019 and 2020. Conclusion: Even during drastic movement restrictions and the prolonged suspension of work and leisure activities secondary to COVID-19 epidemic in 2020, hand and wrist traumas rate remained almost the same compared to the same period of the previous year. Nevertheless, a significant change in the etiology and patient age was registered. In fact, sport and traffic-related traumas decreased respect to domestic traumas, while the previous prevalent involvement of young adults was surpassed by accidental hand traumas in the elderly and active adults.
Background Aim of this paper is to validate a procedure for correcting elbow flexion contracture ... more Background Aim of this paper is to validate a procedure for correcting elbow flexion contracture in patients suffering from brachial plexus neonatal palsy sequelae during their teens. Elbow flexion contracture represents an unsolved problem in the natural history of obstetric brachial plexus palsy (OBPP) because of the consistent deformity recurrence. Following a previous paper, in which an original technique was proposed in a small sample of patients, the authors show the possible correction of the deformity in a larger group of patients. Methods The procedure includes a combination of a posterior approach to the elbow with olecranon tip section and an anterior one with capsulotomy and soft tissue release to improve elbow range of motion. A series of 26 patients, who underwent the procedure, were checked out in medium and long term. Collected data were age, type of brachial plexus palsy, length of hospitalization, duration of surgery, preoperative and postoperative elbow range of motion, preoperative and postoperative DASH scores and satisfaction scores. Explaining further details about the procedure, the Authors report their results, including a statistical analysis. Results At the final follow-up, the mean increase of elbow extension was about 22°. Functional outcomes were successful as well, with a mean increase of 10 points of DASH score. Over 75% of patients were fully satisfied with their outcome. Conclusions The outcome has confirmed the good efficacy of the procedure in increasing elbow extension but also in improving cosmetic appearance in adolescents suffering from flexed elbow in OBPP sequelae.
Introduction: Femoral nerve compression caused by iliopsoas hematoma is a rare complication after... more Introduction: Femoral nerve compression caused by iliopsoas hematoma is a rare complication after hip surgery. To the best of our knowledge, this is the first case after hemiarthroplasty. In this case, iliacus hematoma resulted from spontaneous bleeding favored by anticoagulant therapy. Case Report: A 78-year-old female developed left groin pain associated with typical symptoms of femoral nerve palsy about 2weeks after left hip hemiarthroplasty[1, 2, 3]. Computed tomography revealed the presence of a left iliopsoas hematoma that was surgically drained. Inguinal pain was immediately relieved, while nerve palsy recovered only partially, but the quality of life drastically improved and she was able to walk using a walker without pain. Conclusion: Even if it is a rare condition, the formation of a hematoma of iliopsoas muscle should be considered in patients that present symptoms of femoral nerve palsy, especially if treated with heparin or other anticoagulant drugs. Surgical drainage o...
Purpose: The purpose of this bibliometric study was to summarize European orthopedic literature p... more Purpose: The purpose of this bibliometric study was to summarize European orthopedic literature produced by EFORT memberships between 2009 and 2019 and to identify the 100 most cited articles, analyzing the characteristics that made them so interesting for the orthopedic scientific world. Method: A search of the literature was conducted using Clarivate Analytics Web of Science in the subject category “orthopaedics”; then the results were summarized using Web of Science tools. Results: A total of 160.375 articles were found: most of these were produced by England. In particular the most prolific institution was the University of London. Analyzing in detail the 100 most cited publications emerged that most of them were review published in journal with high impact factor (Q1). The University of Oxford was the institution with the greatest number of contributions (13%). The most cited topics were osteoarthritis (24%), followed by orthopedic basic science (22%). Bio-materials was the mos...
Phalangeal (P) and metacarpal (MC) fractures are very common injuries, with potentially disabling... more Phalangeal (P) and metacarpal (MC) fractures are very common injuries, with potentially disabling, residual impairment, deformities or stiffness. Conservative treatment represents the strategy of choice in most cases, but in unstable fractures and/or high-demanding patients, surgical fixation could be required. Ideally, the best treatment choice will be the intramedullary fixation systems, if possible without the implant protruding from the skin. Intramedullary headless screw fixation could be the reliable option to achieve a primary fixation, allowing an early active movement, with regard to the fractures site. The Authors analyzed the results achieved after 56 extra-articular unstable fractures (31 phalangeal fracture and 25 metacarpal fracture) treated with intramedullary headless compression screws. After surgery, patients underwent early mobilization without splinting. The results of the study suggest that this technique could be a reliable therapeutic option in order to obtain...
Background: Ulnar nerve lesions represent a rare complication of wrist fracture. The present manu... more Background: Ulnar nerve lesions represent a rare complication of wrist fracture. The present manuscript describes the case of a particular traumatic mechanism in which the nerve resulted crushed between radial fracture fragments. Case presentation: A 47-year-old man suffered a subtotal lesion of the ulnar nerve following an open displaced distal radius fracture. Symptoms of ulnar nerve deficiency worsened after reduction and temporary stabilization were performed. Further surgery was performed to achieve definitive stabilization and ulnar nerve neurolysis. The ulnar nerve was found to be jammed inside the fracture side, and so was repaired with a direct suture. Progressive recovery was observed in the following months. Conclusions: Given the paucity of reports of ulnar nerve injury in the literature, clear recommendations for treatment of nerve lesions after wrist fractures have not yet been defined. Nevertheless, in our experience, peripheral nerve function should be assessed before and after fracture reduction, as a worsening of symptoms
The purpose was to establish a ranking of the 50 most cited articles about wrist surgery and anal... more The purpose was to establish a ranking of the 50 most cited articles about wrist surgery and analyse their features. Science Citation Index Expanded was used to identify the 50 most frequently cited orthopaedic journal articles written in English, searching for the topic “wrist surgery” in the subject category ‘‘Orthopaedics’’. Then, we analysed the number of citations, citation density, authorship, article institution, the year of publication, the country of origin of the article, name and impact factor of the journal, and publication type of the article. The 50 most cited articles were published in only 6 of the 74 journals included under the category “orthopaedics”. Citation count ranged from 256 for the first one to 67 for the 50th article. Most of them were written by American authors. These articles were published between 1991 and 2011. “Distal Radius Fractures” was the most common issue. This type of bibliographic analysis could be particularly useful for other young Authors ...
Anterior dislocation of a prosthetic knee is a rare event. Only few episodes have been described ... more Anterior dislocation of a prosthetic knee is a rare event. Only few episodes have been described in the past and have never been linked with neurovascular injury. This could lead orthopaedic surgeons to focus on the implant instability factors and underrate other complications. The authors report a case of a patient who experienced popliteal artery dissection 80 hours after traumatic anterior knee dislocation of a previously well-functioning total knee arthroplasty. Given that there is a lack of clinical cases that have established guidelines for management of this problem, the authors have focused on the importance of performing computed tomography angiography in the management of an anterior traumatic knee dislocation of a prosthetic knee.
Metacarpal fractures constitute 7.8% of the upper extremity fractures. The common treatments rema... more Metacarpal fractures constitute 7.8% of the upper extremity fractures. The common treatments remain nonsurgical procedure, but high-demanding patients or unstable fractures require fixation with Kirschner wire (K-wires), plate, and screws. However, these approaches may cause scarring and adhesion with poor functional results. From 2014 to 2015, the authors used an intramedullary headless screw to treat 25 patients (24 men, 1 woman) with metacarpal bones fractures (20 V, 3 IV, 1 III, and 1 II). The fractures patterns were 23 fractures of distal third of metacarpal bone (16 oblique, 5 comminute configurations, and 2 transverse), 1 fracture of the base of the II metacarpal bone. One case presented a multiple metacarpal and phalangeal facture associated. The authors used anesthesia (bupivacaine-epinephrine 1:100,000) and intramedullary titanium headless screw fixation percutaneously inserted (CCS Medartis and HCS Synthes 3 mm of diameter). No open reduction was needed. Early active mobi...
Total hip arthroplasty is one of the most performed procedures in orthopaedic surgery. Implantati... more Total hip arthroplasty is one of the most performed procedures in orthopaedic surgery. Implantation of a prosthesis determines changes in the distribution of loads on the host bone, and this phenomenon, known as stress shielding, is related to the biomechanical characteristics of the implant. Usually stress shielding involves the proximal portion of the femur by reducing the mechanical strength and ability to withstand the transmitted loads. The aim of our study is to demonstrate how the use of a short hip stem reduces the stress shielding phenomenon to the proximal femur. The study analyzed 20 patients undergoing hip prosthesis surgery with a short stem (Metha<, B. Braun Medical, Inc., Bethlehem, Pennsylvania) at the Ist Orthopaedic Division of Pisa University (between December 2008 and January 2010). Each patient was subjected to analysis of periprosthetic bone mineral density by a bone densitometry (dual emission X-ray absorptiometry [DEXA] with the metal removal software) at ...
Currently, the gold standard to repair large nerve defects is the autologous nerve graft. These s... more Currently, the gold standard to repair large nerve defects is the autologous nerve graft. These solutions offer a mechanical support, adhesion substrates, and, with Schwann cells (SC), a source of neurotropic factors for axonal growth. The technical limits are the donor side damage, multiple surgical accesses, and the unavailability of large amounts of grafts. In recent years, several researchers focused their attention on the interaction between cells (nervous and glial) and physic-chemical cues that arise from the extracellular milieu. Nanotechnologies produce surfaces that mimic the topographical signals (physical stimuli) that arise from enterprise content management (ECM) to modulate the forces acting during axonal elongation. The use of magnetic nanoparticles (MNPs) seems to be able to guide and to boost the nerve regeneration. Both research areas could be improved through surfaces functionalization by biological molecules (proteins/peptides, growth factors, etc.). In the futu...
Strategies in Trauma and Limb Reconstruction, 2008
Pseudoaneurysms of the profunda femoris artery have been reported following different types of tr... more Pseudoaneurysms of the profunda femoris artery have been reported following different types of trauma and from orthopedic procedures performed in the proximal femur. Two cases of profunda femoris artery pseudoaneurysm with two rare causes are presented. The first one is a core decompression of femoral head for osteonecrosis and the second one is a proximal femur fracture nailing. Awareness and careful follow-up are the key issues for the early diagnosis.
Introduction Septic arthritis of the hip is a rare condition in adults and its treatment depends ... more Introduction Septic arthritis of the hip is a rare condition in adults and its treatment depends on symptoms duration: early onset of infection can be treated with open or arthroscopic debridement, while more aggressive surgery is required when articular damage takes place such as articular resection or total hip replacement (THA). Presentation of case We report a case of a 30 year old man affect by septic arthritis of the hip after an intramuscular injection of diclofenac successfully treated with a two-steps THA. Discussion In literature there aren’t many cases of septic arthritis of the hip developed after intramuscular injections. Early onset of infection can be treated with an accurate articular debridement, while chronic conditions are traditionally treated by resection arthroplasty. However resection arhtroplasty gives to the patients a significant leg length discrepancy and, especially in young adults, a two-steps surgery with the implant of THA can lead to good results, as ...
Surgical reconstruction after humeral resection represents a challenging issue in orthopaedic onc... more Surgical reconstruction after humeral resection represents a challenging issue in orthopaedic oncology. Particularly in paediatric patients, the main concerns are maintaining limb function and reconstruction longevity. We describe a novel strategy of humeral reconstruction based on the use of a three-dimensional-printed custom-made prosthesis in a 13-year-old patient diagnosed with osteosarcoma. The implant was specifically designed to sustain the native head, which was spared, as it was not involved by the neoplastic tissue. The mechanical support the prosthesis provided was associated with the biological stimulus of a free vascularised fibular graft to obtain an anatomic, functional and stable construct. This solution has had good longevity, and after 3 years of follow-up, the patient still shows excellent limb function and personal satisfaction.
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Papers by Anna Nucci