Angelo Gabriele Aulisa

Association between IL-6 and MMP-3 gene polymorphisms and adolescent idiopathic scoliosis : A case-control study

Study Design. Case-control study. Objective. As inflammation plays a key role in the etiology of intervertebral disc degeneration, we suggest a possible contribution of pro-inflammatory gene polymorphisms in the pathogenesis of adolescent idiopathic scoliosis (AIS). Summary of Background Data. The nucleus pulposus of scoliotic discs responds to exogenous stimuli by secreting interleukin-6 (IL-6) and other inflammatory cytokines. The association between matrix metalloproteinases (MMPs) and disc degeneration has been reported by several investigators. A human MMP-3 promoter 5A/6A gene polymorphism regulates MMP-3 genes expression, while the G/C polymorphism of the promoter region of IL-6 gene influences levels and functional activity of the IL-6 protein. Methods. We conducted a case-control study to investigate whether the 5A/6A polymorphism of the MMP-3 gene and the G/C polymorphism of the promoter region of IL-6 gene were associated with susceptibility to AIS. Results. The frequency of the 5A/5A genotype of MMP-3 gene polymorphism in patients with scoliosis was almost 3 times higher than in controls (30.2% vs. 11.2%, p 0.001), and the frequency of the G/G genotype of IL-6 gene polymorphism in patients with scoliosis was almost 2 times higher than in controls (52.8% vs. 26.2%, P < 0.001). 5A/5A genotype of MMP-3 gene polymorphism and G/G genotype of IL-6 gene polymorphism are independently associated with a higher risk of scoliosis (odds ratio, respectively, 3.34 and 10.54). Conclusion. This is the first study that has evaluated the possibility that gene variants of IL-6 and MMPs might be associated with scoliosis and suggests that MMP-3 and IL-6 promoter polymorphisms constitute important factors for the genetic predisposition to scoliosis.

Patellar dislocation in skeletally immature patients: semitendinosous and gracilis augmentation for combined medial patellofemoral and medial patellotibial ligament reconstruction.

PurposePatellar instability is a frequent condition in children and adolescents. The problem can be associated with malalignment resulting from different anatomical abnormalities. Several surgical procedures have been suggested for recurrent patellar dislocation consequent to failed conservative treatment.MethodsWe present an original surgical procedure for reconstructing both the medial patellofemoral (MPFL) and medial patellotibial ligaments (MPTL) by semitendinosus (ST) tendon with gracilis (G) autograft augmentation in skeletally immature patients with recurrent patellar dislocation.ResultsThis technique is effective and permits satisfactory patellar congruency documented by static and dynamic CT.ConclusionsThe operation is associated with optimal functional results and is minimally invasive, causing no growth disturbance.Level of evidence Expert opinion, Level V.

Radial Neck Fractures in Children: Results When Open Reduction Is Indicated

Background: Radial neck fractures in children are rare, representing 5% of all elbow pediatric fractures. Most are minimally displaced or nondisplaced. Severely displaced or angulated radial neck fractures often have poor outcomes, even after open reduction, and case series reported in literature are limited. The aim of the study is to analyze the outcomes of patients with a completely displaced and angulated fracture who underwent open reduction when closed reduction failed. Methods: Between 2000 and 2009, 195 patients with radial neck fractures were treated in our institute. Twenty-four cases satisfied all the inclusion criteria and were evaluated clinically and radiologically at a mean follow-up of 7 years. At follow-up, the carrying angle in full elbow extension and the range of motion of the elbow and forearm were measured bilaterally. We recorded clinical results as good, fair, or poor according to the range of movement and the presence of pain. Radiographic evaluation documented the size of the radial head, the presence of avascular necrosis, premature physeal closure, and cubitus valgus. Results: Statistical analysis showed that fair and poor results are directly correlated with loss of pronation-supination (P=0.001), reduction of elbow flexion-extension (P=0.001), increase of elbow valgus angle (P=0.002), necrosis of the radial head (P=0.001), premature physeal closure (P=0.01), and associated lesions (olecranon fracture with or without dislocation of the elbow) (P=0.002). Discussion: In our cases, residual radial head deformity due to premature closure of the growth plate and avascular necrosis were correlated with a functional deficit. Associated elbow injury was coupled with a negative prognosis. In our series, about 25% of patients had fair and 20% had poor results. Outcomes were good in 55% and felt to represent a better outcome than if the fracture remained nonanatomically reduced with residual angulation and/or displacement of the radial head. This study reports the largest series of these fractures with a combination of significant angulation and displacement of the fracture requiring open reduction. We feel that open reduction is indicated when the head of the radius is completely displaced and without contact with the rim of the metaphysis.

Treatment of lumbar curves in scoliotic adolescent females with progressive action short brace: a case series based on the Scoliosis Research Society Committee Criteria.

Study Design. A prospective interventional study. Objective. To determine the outcomes of adolescents affected by idiopathic lumbar scoliosis treated with a progressive action short brace (PASB). Summary of Background Data. The efficacy of conservative treatment of scoliosis is still debated. In a recent study, we showed that the PASB was effective in correcting deformities in adolescents with idiopathic thoracolumbar scoliosis. The purpose of the present study was to extend our preliminary findings by determining the results of PASB treatment in scoliotic adolescents with lumbar curves. Methods. Patients were 40 adolescent girls (age [mean ± SD] = 11.6 ± 0.7 yr]) with lumbar curves and a pretreatment Risser score between 0 and 2. All patients were prescribed with a full-time PASB. The minimum duration of follow-up was 24 months (mean ± SD = 41.6 ± 34.5 mo). Anteroposterior radiographs were used to estimate the curve magnitude (CM) and the torsion of the apical vertebra (TA) at 5 time points: beginning of treatment (t1), 1 year after the beginning of treatment (t2), intermediate time between t1 and t4 (t3), end of weaning (t4), and 2-year minimum follow-up from t4 (t5). Three outcomes were distinguished: curve correction, curve stabilization, and curve progression. Results. A significant reduction in CM was achieved from t1 (Cobb angle [mean ± SD] = 26.4° ± 2.8) to t5 (Cobb angle [mean ± SD] = 13.8° ± 7.9; P < 0.001). Likewise, the PASB reduced TA from Perdriolle rotation angles of 10.8° (SD = 3.7) at t1 to 7.9° (SD = 4.2) at t5 (P < 0.05). Curve correction was accomplished in 82.5% of patients, whereas curve stabilization was obtained in 17.5% of patients. None of the patients experienced curve progression. Conclusion. The PASB allows a complete curve correction in most cases. No patients exhibited curve progression.

Imaging of Lumbar Spondylolysis

This article reviews the imaging findings in spondylolysis, which represents a stress fracture of the pars interarticularis that is secondary to chronic low-grade trauma. The incidence of spondylolysis in the general population is approximately 6%, but it reaches 63% in those engaging in certain spo

Advantages of a two-step procedure for school-based scoliosis screening

PurposeTo verify if a “two step” school-based scoliosis screening procedure could reduce childhood radiation exposure and, if so, to estimate the subsequent reduction in radiogenic cancer fatalities and in socio-economic burden.Material and methodsData from two different scoliosis screening programs (A and B) performed on a total of 8,995 children (age range 9–14) were examined. Children in program A (5,731 children) were screened using a “two-step” procedure in which school physicians performed the first clinical examination and uncertain cases were referred to an orthopaedist. The school physicians were previously instructed by orthopaedists in the recognition of a number of simple clinical signs. Children in program B (3,264 children) were screened using a “one-step” procedure in which the initial clinical examination was performed directly by an orthopedist. In both programs, suspected cases of scoliosis were then ascertained by the orthopaedist with Radiography. To evaluate the lifetime attributable risk of cancer mortality the guidelines of the International Commission on Radiological Protection Publication 60 were followed. The economic cost of the performed X-ray examination was calculated assuming the current National Health Service’s reimbursement to hospitals of euro 35 per X-Ray exam. The statistic significance of the difference in these estimates between the two programs was assessed using the proportions z-test. The issues of the relative sensitivity and specificity of the two programs were also examined.ResultsIn programs A and B, 86 (1.5 %) and 95 (2.91 %) X-ray examinations were performed respectively (z=4.452, p<0.001). Based on these observations, a screening of 10,000 children directly performed by orthopaedists would result in 291 X-ray exams (2.91 %). A screening of the same number of children using a two-step procedure would result in 150 X-ray exams (1.5 %), with a savings of euro 4,935 for the National Health Care System, a reduction of 0.283 Sv of collective dose, and an estimated 50% reduction in the number of radiogenic malignant tumours.ConclusionsUsing a two-step scoliosis screening procedure provides reasonable sensitivity and specificity while reducing costs and radiation exposure to children.RiassuntoObiettivoVerificare se il ricorso ad un metodo di screening scolastico per la scoliosi “a due tappe” riduce l’esposizione a radiazioni ionizzanti e, se è così, determinare la conseguente riduzione del rischio di cancro radio-indotto e del costo economico.Materiali e metodiAbbiamo esaminato i dati relativi a due programmi di screening (A e B) attuati su 8995 ragazzi (range di età, 9–14 anni). I ragazzi del gruppo A (5731 ragazzi) sono stati sottoposti ad un programma “a due tappe”. I medici scolastici, dopo essere stati istruiti da ortopedici sulla semeiotica clinica elementare, hanno effettuato la prima valutazione clinica ed hanno inviato allo specialista tutti i casi dubbi. Per i ragazzi del gruppo B (3264 ragazzi) è stato utilizzato un programma “ad una sola tappa”, cioè, la valutazione clinica è stata effettuata direttamente dall’ortopedico. In entrambi i programmi, soltanto l’ortopedico ha richiesto gli esami radiografici. Per valutare il successivo rischio di mortalità per cancro, sono state seguite le linee guida della Pubblicazione 60 della Commissione Internazionale sulla Protezione Radiologica. Per calcolare il costo economico degli esami radiografici effettuati, ci si è basati sull’attuale rimborso del Servizio Sanitario Nazionale agli ospedali che è di 35 euro ad esame. La significatività statistica delle differenze tra i due programmi, è stato calcolata con lo z test per le proporzioni. Inoltre, è stata considerata la sensibilità e specificità dei due metodi.RisultatiNei programmi A e B sono stati eseguiti rispettivamente 86 (1,5%) e 95 (2,91%) esami radiografici (z=4,452, p<0,001). Sulla base di queste osservazioni, uno screening di 10000 bambini effettuato direttamente dall’ortopedico, comporterebbe 291 esami radiografici (2,91%). Lo screening di uno stesso numero di ragazzi, utilizzando il programma “a due tappe”, comporterebbe invece 150 esami radiografici con un risparmio di 4935 euro per il Sistema Sanitario Nazionale, una riduzione della dose collettiva di 0,283 Sv ed una riduzione stimata del 50% del numero di tumori maligni radio-indotti.ConclusioniIl ricorso al programma di screening “a due tappe” presenta una buona sensibilità e specificità, riduce i costi e, soprattutto, l’esposizione a radiazioni dei ragazzi.

Repeatability of the Aesthetic Index for adolescent scoliosis idiopathic evaluation

Study design Since many years in our Institute we have used a clinical tool to evaluate the aesthetics of the trunks posteriorly. This is based on a three point scale for asymmetry (0 absent, 1 slight, 2 important) of the shoulders, scapulae and flanks; the sum of these sub-scores gives the AI. One hundred sixty posterior anterior photographs of the trunk of adolescent idiopathic scoliosis patients were scored two times independently by three observers. We used the Kappa statistics [1]: 0–0.2 poor, 0.2–0.4 fair, 0.4–0.6 moderate, 0.6–0.8 good, 0.8–1.0 very good. The 95% level of agreement was used to identify the minimum clinically significant change to be considered between two different clinical examinations. Results See Table 1.

The association between IL-6 and MMP-3 gene polymorphisms and adolescent idiopathic scoliosis: a case-control study

STUDY DESIGN Case-control study. OBJECTIVE As inflammation plays a key role in the etiology of intervertebral disc degeneration, we suggest a possible contribution of pro-inflammatory gene polymorphisms in the pathogenesis of adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA The nucleus pulposus of scoliotic discs responds to exogenous stimuli by secreting interleukin-6 (IL-6) and other inflammatory cytokines. The association between matrix metalloproteinases (MMPs) and disc degeneration has been reported by several investigators. A human MMP-3 promoter 5A/6A gene polymorphism regulates MMP-3 genes expression, while the G/C polymorphism of the promoter region of IL-6 gene influences levels and functional activity of the IL-6 protein. METHODS We conducted a case-control study to investigate whether the 5A/6A polymorphism of the MMP-3 gene and the G/C polymorphism of the promoter region of IL-6 gene were associated with susceptibility to AIS. RESULTS The frequency of the 5A/5A genotype of MMP-3 gene polymorphism in patients with scoliosis was almost 3 times higher than in controls (30.2% vs. 11.2%, p 0.001), and the frequency of the G/G genotype of IL-6 gene polymorphism in patients with scoliosis was almost 2 times higher than in controls (52.8% vs. 26.2%, P < 0.001). 5A/5A genotype of MMP-3 gene polymorphism and G/G genotype of IL-6 gene polymorphism are independently associated with a higher risk of scoliosis (odds ratio, respectively, 3.34 and 10.54). CONCLUSION This is the first study that has evaluated the possibility that gene variants of IL-6 and MMPs might be associated with scoliosis and suggests that MMP-3 and IL-6 promoter polymorphisms constitute important factors for the genetic predisposition to scoliosis.

Conservative treatment in adolescent idiopathic scoliosis with curves over 45°: is the measurement in Cobb degrees the only parameter to be considered?

Methods The study including idiopathic scoliosis with 45° or more, Risser 0-4, who had utterly deny any surgical intervention. Fulfill the inclusion criteria 160 patients. Of these, 104 patients has definite outcome, 28 abandoned treatment and 28 are currently under treatment. The minimum duration of follow-up was 24 months. Xrays was used to to obtain Cobb degrees and torsion of the apical vertebra (Perdriolle’s method). Three outcomes were distinguished in agreement with SRS criteria: curve correction, curve stabilization and curve progression. We have divided the sample in subgroup according to Risser (0-2; 3-4), to rotation ( 25) and to type of Curve. The Kruskal Wallis and Spearman Rank Correlation tests have been used as statistical tests.

Le lussazioni dell’arto superiore in età evolutiva

Children have a high propensity to injure their upper limbs. Younger children use their hands to discover and get to know the world around them, while older ones and the teenagers are increasingly dealing with recreational physical activities and agonistic sports events. Upper extremity lesions may occur from the shoulder to the fingers. As regards the biomechanical features in the developing skeleton, bones and physes are usually involved while, on the other hand, dislocations and subluxations of the upper extremities are uncommon in children, because of the relative weakness of the epiphyseal plates. Correct diagnostic procedures and consequent therapeutic treatments are fundamental to achieve the best possible outcome.