Alessio Pedrazzini

Management and effect of platelet-rich plasma on wound healing: small reality of Oglio Po Hospital

Abstract Platelet Rich Plasma (PRP) represents a relatively new approach in regenerative medicine. Its use is increasing in the treatment of a variety of orthopedic conditions, such as the management of acute wounds, chronic non-healing lesions, acceleration of bone formation, tendinopathy and chondropathy. The Orthopaedic Unit at Oglio Po Hospital uses PRP Gel in wound care since 2008. More than 70 patients have been treated with this procedure. The aim of this study is to show our patients outcome. We present 3 cases of severe traumatic wound treated with our PRP protocol. The patients had complete healing of the lesion with good aesthetic results.

Complex lesion of the third metacarpophalangeal joint: complete tear of the radial collateral and deep transverse metacarpal ligament

Total knee replacement is a common treatment for advanced knee osteoarthritis. The most common and widespread method is cemented arthroplasty. As in the prosthetic hip a gradual transition from cemented to uncemented fixation techniques occurred over time, increasing interest is growing also around cementless knee fixation, with the theoretical advantages of preserving the bone stock and obtaining a biological fixation avoiding cement fragmentation. On the basis of the actual knowledge, the uncemented knee prosthesis represents an interesting alternative especially for the patient under 65 years of age, with viable bone quality, in which a biological bone-prosthesis fixation is desirable, while avoiding the drawbacks of cement fragmentation and of the possible future revision of a cemented implant. However the weak link remains the tibial fixation, so that technical tips are important to avoid micromovements with subsequent lack of osteointegration. In our experience, gap balancing, mobile bearings and no haemostatic tourniquet well combine with this kind of implant.Injuries of collateral ligaments of MCPs joints are often underdiagnosed but have to be considered serious traumas of the hand. In many cases they concern thumb and rarely long fingers. Closed rupture of the deep transverse metacarpal ligament (DTML) is an unusual parallel injury. Both lesions present similar symptoms included local pain, swelling, ecchymosis and deviation of the finger in flexion and can be misdiagnosed. We describe the treatment of a 34 years old woman who sustained a complex lesion of the soft tissues of third metacarpophalangeal joint with complete close tear of the radial collateral and deep transverse metacarpal ligament following a fall during a walk thus leading to a multiplanar instability. Surgery consisted in mini anchor repair or the collateral ligament tear, direct resorbable suture of DTML and a double k-wire stabilization. Follow up at 11 months has shown excellent functional outcomes.

Injuries of the trochanteric region: can analysis of radiographic indices help in prediction of recurrent osteoporotic hip fractures?

Total knee replacement is a common treatment for advanced knee osteoarthritis. The most common and widespread method is cemented arthroplasty. As in the prosthetic hip a gradual transition from cemented to uncemented fixation techniques occurred over time, increasing interest is growing also around cementless knee fixation, with the theoretical advantages of preserving the bone stock and obtaining a biological fixation avoiding cement fragmentation. On the basis of the actual knowledge, the uncemented knee prosthesis represents an interesting alternative especially for the patient under 65 years of age, with viable bone quality, in which a biological bone-prosthesis fixation is desirable, while avoiding the drawbacks of cement fragmentation and of the possible future revision of a cemented implant. However the weak link remains the tibial fixation, so that technical tips are important to avoid micromovements with subsequent lack of osteointegration. In our experience, gap balancing, mobile bearings and no haemostatic tourniquet well combine with this kind of implant.Injuries of collateral ligaments of MCPs joints are often underdiagnosed but have to be considered serious traumas of the hand. In many cases they concern thumb and rarely long fingers. Closed rupture of the deep transverse metacarpal ligament (DTML) is an unusual parallel injury. Both lesions present similar symptoms included local pain, swelling, ecchymosis and deviation of the finger in flexion and can be misdiagnosed. We describe the treatment of a 34 years old woman who sustained a complex lesion of the soft tissues of third metacarpophalangeal joint with complete close tear of the radial collateral and deep transverse metacarpal ligament following a fall during a walk thus leading to a multiplanar instability. Surgery consisted in mini anchor repair or the collateral ligament tear, direct resorbable suture of DTML and a double k-wire stabilization. Follow up at 11 months has shown excellent functional outcomes.

Pectoralis major tendon rupture in a weight lifter: a rare case.

Pectoralis major tendon (PMT) rupture is a rare event, and it was originally described by Patisser in 1822. The PMT is a thick lamina, which has two origins, one from the clavicle and the other from the ribcage sternum. PMT lesions are classified according to 3 levels of severity: Type 1 is contusions and strains, Type 2 is a partial tear and Type 3 is a complete tear. Diagnosis is made through a clinical examination which comprises a positive response to pain upon pressure over the axilla recess, the presence of bruising and limited motion, and is completed with an MRI. Type 3 injuries are treated exclusively through surgery, while Type 1 and 2 lesions are treated conservatively. In this article, we describe a rare case of PMT rupture in a 39-year-old weight lifter, the surgical treatment that was carried out through an open access at the Pectoralis and Deltoid junction and anchor suture, the post-surgical rehabilitation program and a 1-year follow-up assessment at which point return to sport was achieved. (www.actabiomedica.it)