Antonio Sanfilippo

Monitoring of fracture calluses with color Doppler sonography.

Fracture callus formation is closely associated with vascular invasion, and the use of color Doppler sonography has been suggested as a means to monitor, earlier than gray‐scale sonography, the first stages of the healing process. We report the findings in a series of patients with tibial fractures in whom both gray‐scale sonography and color Doppler imaging were employed to monitor new bone formation at the fracture site.

Intramuscular tramadol versus ketorolac in patients with orthopedic and traumatologic postoperative pain: a comparative multicenter trial

This 3-day, multicenter, open-label, randomized, controlled trial was undertaken to assess the postoperative analgesic effect and therapeutic safety of intramuscular tramadol compared with intramuscular ketorolac in 48 patients undergoing orthopedic surgery and having postoperative pain assessed as 75 mm or more on a 100-mm visual analogue scale. Tramadol (100 mg/2 mL ampules) was administered as needed to a maximum of 400 mg/d, and ketorolac (30 mg/1 mL ampules) was given as needed up to 90 mg/d. Nine patients who received tramadol and six who received ketorolac needed only one dose of medication to achieve satisfactory analgesia. Tramadol had a more pronounced analgesic effect than did ketorolac. After 1 and 2 hours, respectively, 41.7% and 52.5% of the patients who received tramadol experienced relief, compared with 33.9% and 42.1% of the patients who received ketorolac. No adverse reactions were observed in either group, and the investigators final opinion was positive (ie, effective analgesia in 19 patients [79.2%] who received tramadol and in 14 patients [58.3%] who received ketorolac). Intramuscular tramadol therefore appeared to be as effective as ketorolac against orthopedic postoperative pain and was well tolerated.

Greater Trochanteric Pain Syndrome: What is this Meaning?

Greater trochanteric pain syndrome (GTPS) is a common cause of lower extremity pain. This is frequently attributed to trochanteric bursitis and distension of the subgluteal bursae. Patients are suffering from pain radiating to the posterolateral aspect of the thigh, paraesthesiae in the legs, and tenderness over the iliotibial tract. Often the symptoms are mild, with the patient treating himself successfully through activity modification and other conservative measures. including relative rest, ice, compression, elevation, anti-inflammatory medication and treatment modalities such as ultrasound and electrical stimulation, combined with a structured rehabilitation program. Patients whose symptoms persist despite conservative therapy are likely to benefit from an injection of corticosteroid and anaesthetic into the inflamed bursa. More invasive surgical interventions have anecdotally been reported to provide pain relief when previous treatment modalities fail. In this article, we review the pathogenesis, common initial symptoms, diagnostic approach, and treatment options for trochanteric bursitis.

The effectiveness of intra-articular injections of Hyalubrix combined with exercise therapy in the treatment of hip osteoarthritis

Purpose Osteoarthritis (OA) is the most common joint disorder in the elderly, causing significant pain which negatively affects mobility and quality of life. The aim of the study was to assess the effectiveness of ultrasound image-guided intra-articular injections of Hyalubrix® combined with exercise therapy in the treatment of hip osteoarthritis. Methods This was a single site, prospective, open-label, Investigator-initiated study. Forty patients were enrolled and received three ultrasound image-guided injections of Hyalubrix®, 45 days apart, combined with three sessions a week of physical therapy (proprioceptive rehabilitation of the lower limbs; gait training; balance training) up to a total of 30 sessions (10 weeks), starting from one week after the first injection. Results The primary objective was to achieve a lasting reduction in OA symptoms related to pain during activity. During the course of the study the pain perceived by the patient during activity dropped from a mean value of 6.94 cm to a mean value of 1.46 cm and showed a statistically significant decrease from visit 1 compared to baseline (p < 0.05) which was confirmed at all the subsequent time points. Significant improvements were also observed in the evaluation of the secondary objectives: hip disability; OA-related pain at rest; daily functioning and NSAIDs intake. Conclusions Results from this study including 40 patients for a total of 65 treated hips demonstrate a significant improvement in OA-related pain, hip disability, and patients daily functioning as well as a reduction in NSAIDs intake. Patients suffering from hip OA seem to benefit from the treatment with Hyalubrix® injections plus exercise therapy.

Neck Pain Rehabilitation

Neck pain is par excellence one of the most common disorders of the musculoskeletal system, second only to low back pain. It constitutes 40 % of all backache. The International Association for the Study of Pain (IASP) defines pain of cervical origin coming from an area between the nuchal line and another imagi-nary line that passes through the lower end of the spinous process of the first thoracic vertebra and the sagittal plans tangent to the side edges of the neck. This definition considers therefore posterior pain which in turn can be divided into high pain, up to C3, and lower pain, down from C4. Also, as all diseases, it can be divided into acute and chronic neck pain, merely according to the time of onset: it lasts more than 3 months in the first case and for longer in the second case. The painful perception depends on the nociceptive elicitation of the major structures innervated in the neck region, such as cervical muscles, ligaments, facet joints and nerve roots.