Papers by Michele F Surace
Journal of Bone and Joint Surgery-british Volume, Mar 1, 2017
BACKGROUND Early dislocation is a foremost complication of total hip arthroplasty through a poste... more BACKGROUND Early dislocation is a foremost complication of total hip arthroplasty through a postero-lateral approach. The extra-articular impingement of the anterior part of the great trochanter with ileum bone, with or without soft tissue interposition is a well recognized but underestimated etiopathogenetic cause reported in literature. In this retrospective study through the assessment of clinical and radiographic follow-up at a minimum of six months, the effectiveness of an antero- longitudinal osteotomy of the great trochanter for early dislocation prevention is evaluated. MATERIALS AND METHODS 209 patients (48.3% males and 51,7% females) underwent a total hip arthroplasty from June 2011 to September 2015, with surgery being performed by the same surgeon. A modified posterolateral approach was used according to the tissue-sparing criteria, in all the cases an anterior longitudinal osteotomy of the great trochanter has been performed at 90\ub0 to the antiversion angle of the implant and aligned posteriorly with the prosthesis. All the patients underwent a clinical and radiological follow up at one, three, and six months. RESULTS In this study, only one patient reported dislocation of THA. One patient suffered from a wound infection which was subsequently treated with antibiotics and had complete remission. All patients demonstrated a fast recovery of ROM and walking, starting from pre-op Harris Hip Score 42.24pts and obtaining a score of 81.52pts at three months, and 92.03 at six months post-op. After surgery and during the follow up period, there were no trochanteric fractures detected. DISCUSSION The correct positioning of the implants, the head diameter, offset, soft tissues repair, absence of impingement, and patients compliance are all elements that define the prosthetic stability. Literature shows and incidence of primary total hip arthroplasty dislocation between 0.80% to 10%. The incidence of dislocation reported in a preliminary study in our Institute is 0.48%, demonstrating the effectiveness of the trochanteric osteotomy. CONCLUSIONS The osteotomy of the great trochanter is an effective surgical technique used to decrease the anterior impingement and early dislocation incidence. It is particularly effective on patients with good compliance and correctly implanted prosthetic components
Journal of Orthopaedics and Traumatology, 2011
PubMed, Sep 25, 2001
It is the purpose of this retrospective study to analyze factors capable of influencing clinical-... more It is the purpose of this retrospective study to analyze factors capable of influencing clinical-functional and radiographic results, such as type of fracture, age of the patients, type of trauma, delay in treatment, associated lesions. A total of 33 fractures treated by open reduction and internal stabilization for fractures of the proximal tibia classified according to the AO were re-evaluated. Clinical and radiographic evaluation were obtained by assessing arthrosis, axis, and sinking of the tibial plateau. The clinical and functional results were satisfactory in 72.2% of cases, and radiographic ones were satisfactory in 63.6% for gonarthrosis, in 81.6% for axis, and in 84.8% for sinking. In conclusion, factors capable of influencing the results, such as type of fracture, age of the patient, and type of trauma, in addition to variables that the surgeon must monitor, such as reconstruction of the joint, alignment, synthesis, treatment of meniscal lesions, were observed.
World journal of orthopedics, May 18, 2021
BACKGROUND Talar fractures are exceedingly rare in childhood. There are very few studies on the c... more BACKGROUND Talar fractures are exceedingly rare in childhood. There are very few studies on the clinical aspects, the long-term outcomes and the appropriate treatment of these fractures in pediatric patients. The mechanism of trauma consists of the application of a sudden dorsiflexion force on a fully plantar-flexed foot. Traumatic mechanism, symptoms and imaging of injuries of the talar head are similar to transitional fractures that are normally described at the distal epiphysis of the tibia: the so-called transitional fracture is defined as an epiphyseal injury when the growth plate has already started to close. CASE SUMMARY A thirteen-year-old girl reported a high-energy trauma to her right foot, due to falling from her horse. X-rays at the Emergency Department were negative. Because of persistent pain, the patient was assessed by an orthopedic surgeon after two weeks and computed tomography scans revealed a misdiagnosed displaced shear-type fracture of the talar head. Hence, surgical open reduction and fixation with two headless screws was performed. The girl was assessed regularly, and plain films at follow-up revealed complete healing of the fracture. Within six months after surgery, the patient returned to pre-injury sport activities reporting no complications. CONCLUSION Injuries of the talar head in childhood should be considered as transitional fractures. Open reduction with internal fixation aims to reduce malalignment and osteoarthritis. Computed tomography scans are recommended in these cases.
Knee, Jun 1, 2020
The aim of this study was to describe a new, closed, arthroscopically-assisted reduction of poste... more The aim of this study was to describe a new, closed, arthroscopically-assisted reduction of posterolateral tibial plateau fractures with minimally invasive plate osteosynthesis using a plate pre-contoured over a 3D-model based on a CT-scan of the injured tibial plateau and positioned by using a minimal anterolateral approach. Methods: A five to six centimeter long curvilinear incision was made over the Gerdy's tubercle. After subcutaneous dissection, the fascia was incised, the ileo-tibial band was split, and the dissection was extended posteriorly. The knee was flexed to 90°and the space between the fibular collateral ligament and the posterolateral plateau rim (para-FCL space) was created. A variable-angle locking compression plate contoured on a 3D-model was inserted flush to the tibial plateau rim. Two cortical screws were placed to ensure support under the area of depression as far posteriorly as possible. Two additional screws were implanted, and a cortical screw was used for the most anterior screw hole. The custom pre-contoured plate based on a personspecific 3D-model, associated with arthroscopy reduction, provides a supporting and containing effect to the posterolateral periarticular fragments and allows a minimally invasive plate osteosynthesis fixation to be performed. This guarantees a proper reduction and fixation without the described limitations and risks associated with the classic approaches. Conclusions: This approach should be considered to treat fractures of the posterolateral plateau, isolated or associated with medial tibial plateau fractures, as it could improve the outcome in terms of lower associated risks, better reduction and fixation, and faster and improved patient recovery.
Hip International, Apr 1, 1993
It has been a matter of debate as to when a hip prosthesis can be said to have failed. Pain, limp... more It has been a matter of debate as to when a hip prosthesis can be said to have failed. Pain, limp and functional impairment are considered clinical signs of failure while radiolucent lines, subside, bone reabsorption and gross mobilitation are considered radiological sing. But many times, the patients without signs, free of pain and well functioning, show radiological signs of failure and the patients without radiological signs show clinical signs of failure. In the revision of 613 hip arthroplasties performed since 1983, the authors have pointed out 19 failures of their patients and 36 failures of the implants done in other hospitals. Moreover, they have observed on 15 cases radiological signs of failure without clinical sings.
Introduzione: Le fratture del radio distale rappresentano circa un sesto delle fratture trattate ... more Introduzione: Le fratture del radio distale rappresentano circa un sesto delle fratture trattate chirurgicamente. Negli ultimi anni il trattamento pi\uf9 frequentemente utilizzato \ue8 stato la riduzione aperta e fissazione interna mediante placche e viti (ORIF), ottenendo cos\uec un rapido recupero funzionale. L\u2019utilizzo dei fili di Kirschner e fissatore esterno (CREF) \ue8 un trattamento meno cruento, rapido ed economico, che la letteratura ha comunque dimostrato come efficace. Scopo dello studio \ue8 stato verificare i risultati a medio termine dei trattamenti proposti. Materiali e Metodi: 35 pazienti con frattura di radio distale sono stati trattati nell\u2019arco di un anno: 16 mediante CREF e 19 mediante ORIF. I pazienti sono stati valutati clinicamente e con questionari dedicati. I parametri radiografici analizzati sono stati: tilt volare, tilt ulnare, altezza del radio, varianza ulnare e segni di degenerazione artrosica. Eventuali complicazioni sono state documentate. L\u2019analisi dei dati \ue8 stata eseguita con software dedicato. Risultati: Al follow-up a medio termine, 4 anni in media, dal confronto tra i trattamenti proposti non sono state evidenziate differenze significative dei valori di forza di presa della mano, dell\u2019articolarit\ue0 residua e dei parametri radiografici. Una corrispondenza significativa, invece, \ue8 emersa tra i valori DASH e PRWE; DASH e VAS; PRWE e VAS. Un\u2019incidenza maggiore di complicanze \ue8 emersa nel gruppo dei pazienti con CREF, seppur non statisticamente significativa. Discussione: Nel trattamento delle fratture di polso negli ultimi anni la prevalenza di ORIF \ue8 aumentata. Le indicazioni all\u2019utilizzo di CREF sono l\u2019esposizione della frattura e la comminuzione articolare. La superiorit\ue0 del trattamento con ORIF a breve termine, dimostrata in diversi studi, si riduce nel tempo. A medio termine non si evidenziano differenze significative cliniche e radiografiche. Il tasso di complicazioni \ue8 maggiore nel gruppo CREF, probabilmente correlato ad un\u2019eccessiva distrazione del fissatore esterno e al passaggio per cutaneo dei mezzi di sintesi. Conclusioni: Il trattamento delle fratture di radio distale con ORIF o CREF garantisce in entrambi i casi, ottimi risultati clinici e radiografici. Nei primi mesi dalla procedura, i risultati clinici del trattamento ORIF sembrano migliori, ma a lungo termine non vi sono differenze significative tra i due trattamenti
European Spine Journal, Mar 20, 2012
The purpose of this study is to report clinical outcome and imaging changes of percutaneous Aperi... more The purpose of this study is to report clinical outcome and imaging changes of percutaneous Aperius stand-alone implant in patients with degenerative lumbar spinal stenosis and neurogenic intermittent claudication, which did not respond to conservative treatment. Method Between January 2008 and July 2010, 37 patients (20 males and 17 females) with mean age of 64.3 years underwent surgery for the onset of claudicatio spinalis with Aperius PercLID interspinous device (Medtronic). In all patients, the diagnosis was: foraminal stenosis, in one case (2.7 %) it was associated to a degenerative anterior listhesis (I grade), in three cases (8.1 %) it was associated to an intraforaminal disc herniation. The mean follow-up was of 18 months (range 2-35 months). The patients were evaluated through the Oswestry disability index, Zurich Claudication Questionnaire (ZCQ), VAS scales. In all cases were obtained preoperative and in postoperative radiographs and magnetic resonance imaging. Results The VAS score decreased significantly after surgery: the patients presented a mean VAS of seven preoperatively and two postoperatively (p \ 0.001). The ZCQ score significantly decreased postoperatively, with an average reduction of 21.89 % (p \ 0.001). The ODI score as well showed a significant reduction postoperatively of an average 26.09 % (p \ 0.001). Conclusion Despite of the brief follow up, the preliminary results are encouraging, showing a significantly decrease of the disability parameters, a marked improvement of the function with the vanishing of the claudicatio spinalis and the following increase of the free interval during the walk. Aperius PercLID system seems to offer an alternative to the traditional decompression surgery.
A case of shoulder periprosthetic fracture in elderly patient. The patient underwent a minimally ... more A case of shoulder periprosthetic fracture in elderly patient. The patient underwent a minimally invasive osteosynthesis and "off-label" treatment with teriparatide. An 80-year-old woman patient following an accidental fall reported a transverse displaced diaphyseal fracture of the right humerus, distal to the stem of the inverse prosthesis. The patient suffering from severe osteoporosis and chronic ischaemic heart disease. The patient underwent fracture osteosynthesis surgery using a Hoffmann III mono-axial external fixator. Teriparatide administered at a dosage of 20 micrograms/day, for four months. At six months from the beginning of th e hybrid treatment, a complete healing of the fracture was observed radiologically and clinically. It is possible to affirm that the use of teriparatide off-label has a positive and additive effect in promoting the healing of fractures.
La Pediatria medica e chirurgica : Medical and surgical pediatrics, Oct 28, 2022
A successful and minimally invasive treatment for adolescent flexible flatfoot is subtalar arthro... more A successful and minimally invasive treatment for adolescent flexible flatfoot is subtalar arthroeresis. This study examines the short-term results of subtalar arthroereisis with a new PEEK device (Pit'Stop®); additional research will be required to determine the device's true potential, but the preliminary findings are very encouraging, with a high success rate and a low complication rate (0.08).
PubMed, Dec 13, 2016
Background: Dislocation of primary THA (total hip arthroplasty) is one of the most undesirable co... more Background: Dislocation of primary THA (total hip arthroplasty) is one of the most undesirable complications with an incidence ranging from 2% to 5%. Several risk factors are described, related to the patient, surgery, or prosthetic design. The aim of the study was to assess risk factors and their potential influence on dislocation. Materials and methods: 387 primary THA were performed between September 2005 to December 2008 at our institute (Varese, Italy) through a modified posterior-lateral approach. Clinical evaluation was based on range of motion (ROM) and Harris Hip Score; femoral offset, acetabular inclination, and anteversion were measured on plain radiograms. Data were analyzed by SPSS software (SPSS, Inc., Chicago, Illinois). Results: Excellent ROM and Harris Hip Scores were achieved in more than 95% of patients (p<0.05). The offset was restored in all patients. Most of the cases had their cup positioned in the "safe zone" (both inclination and anteversion). Six dislocations (1.87%) occurred: significant correlation was found between dislocation and preoperative diagnosis of femoral neck fracture. Conclusions: THA dislocation rate appears not to be related to patient biometric parameters and prosthesis design. Femoral neck fracture is reported as the major risk factor for this complication, probably caused by higher preoperative activity and lesser compliance of the patient.
World journal of orthopedics, Nov 18, 2020
BACKGROUND Müller-Weiss disease (MWD) is an idiopathic foot condition characterized by spontaneou... more BACKGROUND Müller-Weiss disease (MWD) is an idiopathic foot condition characterized by spontaneous tarsal “scaphoiditis” in adults. Frequently bilateral and affecting females during the 4th-6th decades of life, the pathogenesis of MWD remains unclear: It has been traditionally considered a spontaneous osteonecrosis of the navicular. The typical presentation of MWD is a long period of subtle discomfort followed by prolonged standing, atraumatic, disabling pain. Currently, there is no gold standard for the treatment of patients with MWD. Most support initial conservative therapy. Operative treatment should be considered for failure of conservative therapies longer than 6 months. The indication for surgery is severity of symptoms rather than severity of deformities. Operative treatment options include core decompression, internal fixation of the tarsal navicular, open or arthroscopic triple fusion, talo-navicular or talo-navicular-cuneiform arthrodesis, and navicular excision with reconstruction of the medial column. CASE SUMMARY In this study, we report four patients affected by MWD. Clinical and radiographic assessment, follow-up and treatment are reported. CONCLUSION As it is frequently misdiagnosed, MWD is challenging for orthopedic surgeons. Early diagnosis and effective treatment are mandatory to avoid sequelae.
Hip International, Jul 1, 1993
The Authors have re-evaluated 84 cementless total hip arthroprostheses out of 700 hip arthroplast... more The Authors have re-evaluated 84 cementless total hip arthroprostheses out of 700 hip arthroplasties carried out in their department from January 1982 to December 1992. The aim was to find a correlation between the radio-lucent line and the clinical signs of prosthetic loosening. On the basis of the results of this study and reports in the literature, the Authors conclude that a very poor correlation exists.
Introduzione: L\u2019incidenza delle fratture periprotesiche d\u2019anca \ue8 in aumento per l\u2... more Introduzione: L\u2019incidenza delle fratture periprotesiche d\u2019anca \ue8 in aumento per l\u2019invecchiamento della popolazione e l\u2019aumento del numero di impianti protesici. L\u2019adeguatezza del trattamento e della gestione sono fondamentali per migliorare i risultati. L\u2019obiettivo di questo studio \ue8 di valutare gli out-comes, la sopravvivenza e l\u2019accuratezza della classificazione di Vancouver. Materiali e Metodi: Sono stati rivalutati 58 pazienti trattati tra il 2010 e il 2016. Le fratture sono state suddivise secondo la classificazione di Vancouver. Il tempo d\u2019attesa, il tasso di sopravvivenza, le complicanze e score funzionali sono stati registrati. L\u2019analisi statistica dei dati \ue8 stata eseguita mediante software dedicato con livello di significativit\ue0 per p < 0,05. Risultati: La sopravvivenza \ue8 stata del 78,8% e del 66,7% ad uno e due anni. Un\u2019attesa all\u2019intervento maggiore di due giorni \ue8 associate ad un aumento del rischio di decesso. In dieci pazienti si \ue8 verificata una complicanza. I pazienti con osteosintesi hanno avuto risultati funzionali peggiori. La regressione lineare ha evidenziato un peggioramento dei risultati all\u2019aumentare dell\u2019et\ue0 e delle classi di Vancouver. Discussione: La classificazione di Vancouver \ue8 la pi\uf9 utilizzata nel processo decisionale terapeutico, ove la stabilit\ue0 dell\u2019impianto \ue8 discriminante. In alcune fratture B2, l\u2019osteosintesi \ue8 tuttavia possibile ove per caratteristiche dello stelo si possa ottenere una nuova stabilit\ue0 primaria. La revisione dello stelo negli anziani garantisce risultati funzionali migliori con limitato allettamento a discapito di un maggior rischio di complicanze. Le fratture periprotesiche possono esser equiparate alle fratture di femore prossimale, in cui un aumento dei giorni d\u2019attesa \ue8 gravato da una riduzione della sopravvivenza. Pertanto fondamentale al fine di migliorare l\u2019out-come sar\ue0 la corretta gestione perioperatoria. Conclusioni: L\u2019appropriatezza del trattamento e la corretta gestione perioperatoria dei pazienti con fratture periprotesiche \ue8 fondamentale al fine di migliorare l\u2019out-come clinico e ridurre il rischio di complicanze. Nei pazienti anziani il tasso di sopravvivenza \ue8 correlato ai giorni d\u2019attesa all\u2019intervento
In: Salvi V., La patologia non traumatica della colonna vertebrale, CD Stryker Spin
In: AA.VV., Le Fratture vertebrali, CD Stryker Italia, Education Progra
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Papers by Michele F Surace