Claudio Iacobellis

Bone transport using the Ilizarov method: a review of complications in 100 consecutive cases.

We present the results of treatment of 100 patients (72 men, 28 women) by the Ilizarov method of bone transport using circular (55) and monolateral external fixators (45). A total of 26 femurs (18 monolateral, 8 circular) and 74 tibias (49 circular, 25 monolateral) was examined. There were no significant differences between the circular fixator and the monolateral fixator with regard to treatment time, complications in the treated bone segments or compliance with the presence of the fixator. The main complications (pseudoarthrosis at bone contact points after transport, insufficient ossification of lengthened bone, knee stiffness) were resolved with further treatment for all patients with the exception of one case which continued with repeated infections. The circular fixator allows for deformity corrections during bone transport but the monolateral fixator is tolerated better by patients, especially in those with femoral defects.

In vitro response of osteoarthritic chondrocytes and fibroblast-like synoviocytes to a 500–730 kDa hyaluronan amide derivative†

The aim of this study was to compare the effects of native hyaluronan (HA) with that of its hexadecylamide derivative (HYADD) on proliferation of fibroblast-like synoviocytes (FLS) and chondrocytes. The production of inflammatory and anti-inflammatory cytokines was also analyzed in FLS cultures. The proliferation of osteoarthritis (OA) chondrocytes was enhanced when cells were treated with 0.5-1.5 mg mL(-1) of HA or HYADD®4-G. This effect was completely suppressed by the anti-CD44 antibody. At 0.5 to 1 mg mL(-1) , HA and HYADD®4-G did not influence the proliferation of normal or pathological FLS; however, at the higher concentration (1.5 mg mL(-1) ), HYADD®4-G did significantly inhibit cell proliferation. As to effects on inflammation, a significant increase in the expression of the IL-10 gene was observed when FLS were pretreated with tumor necrosis factor alpha and then cultured in the presence of 0.5 mg mL(-1) HYADD® 4-G or HA. The effects of HA derivatives on FLS proliferation and production of anti-inflammatory cytokines indicate that they may be of therapeutic benefit in OA. The longer residence time in the joint cavity, the increased viscoelasticity, and the anti-inflammatory potential of HYADD®4-G make it a better candidate than native HA for OA therapy.

Infrapatellar fat pad features in osteoarthritis: a histopathological and molecular study

Objective The infrapatellar fat pad (IFP) is considered a local producer of adipocytokines, suggesting a potential role in OA. The objective of this study was to evaluate the histopathological and molecular characteristics of OA IFPs compared with controls. Methods The histopathological characteristics of IFPs were evaluated in patients undergoing total knee replacements and in control patients (without OA), considering the following parameters: presence of inflammatory cells, vascularization, adipose lobules dimension and thickness of the interlobular septa. Immunohistochemistry was performed to evaluate VEGF, monocyte chemotactic protein 1 (MCP-1) and IL-6 proteins. Quantitative real time PCR was performed to evaluate the expression levels of adipocytokines in the OA IFPs. Results OA IFPs showed an increase in inflammatory infiltration, vascularization and thickness of the interlobular septa compared with controls. VEGF, MCP-1 and IL-6 proteins were higher in OA IFPs compared with in controls. Inflammatory infiltration, hyperplasia, vascularization and fibrosis were increased in OA IFP synovial membranes compared with in those of controls. VEGF protein levels were associated with an increased number of vessels in the OA IFPs, while MCP-1 and IL-6 protein levels were associated with higher grades of inflammatory infiltration. Leptin levels were positively correlated with adiponectin and MCP-1expression, while adiponectin positively correlated with peroxisome proliferative activated receptor gamma, MCP-1 and IFP vascularity. MCP-1 showed a positive correlation with peroxisome proliferative activated receptor gamma. IFP lobules dimensions were positively correlated with IL-6 expression and negatively with thickness of interlobular septa. VEGF mRNA levels were positively correlated with increased synovial vascularity. Conclusions OA IFPs and synovial membranes are more inflamed, vascularized and fibrous compared with those of control patients (without OA).

Intramedullary nailing in femoral shaft fractures. Evaluation of a group of 101 cases

The Authors analyse the results of intramedullary nailing in a group of 101 femoral shaft fractures. Used nails: Universal Synthes (62 cases), Russel-Taylor (14), Gamma long (10), uncannulated femoral nail (9), cannulated femoral nail (4) and proximal femoral nail (2). Stabilisation of the femoral shaft fracture was possible using a reamed technique in 91 cases, unreamed in 10. All nails were locked. Dynamisation was performed in 35 cases and was not in 66. The fracture heal was faster with the reaming and dynamisation technique. Ten fractures were open (5 Gustilo I, 5 Gustilo II) and stabilisation with Universal Synthes nail (8 cases), Russel-Taylor nail (1) and Gamma long nail (1) was performed. No infection was detected. Lung embolism (6) and deep vein thrombosis (3) occurred only in the case of reamed nails. All results confirm the locking nail system as the best treatment in the shaft fractures, especially with new-generation nails.

The ultrasound scan in monitoring regenerated bone

Abstract The aim of this work was to delimit the diagnostic possibilities of the ultrasound scan in the evaluation of regenerated bone produced in bone lengthenings and transports. The study is based on 56 ultrasound scans of regenerated bone regarding 4 lengthenings and 18 bone transports. X-ray examinations were taken in 13 patients contemporarily with the ultrasound scans and a comparative and qualitative evaluation between the radiographic gap and the ultrasound one was made. The ultrasound scans allowed us to distinguish 3 kinds of regenerated bone: normal, cystic and hypertrophic. In 7 cases, at the proximal third of the tibia, a cyst in the regenerated bone was noticed on ultrasonography. The evaluation of these cysts after the slowing down of the distraction speed was satisfactory in the sense that they disappeared in the following examinations, their volume did not change and they did not interact with the following maturation and corticalization of the regenerated bone. In one case, at the proximal third of the tibia, we noticed two cysts that disappeared after regenerated bone compression while, after a new distraction made at a lower speed, a cyst appeared again maintaining its unchanged volume. The presence of one or more cysts indicates an initial crisis of the regenerated bone which could develop into a dangerous hypotrophy if the distraction speed remained unchanged. In 5 cases with a hypertrophic regenerated bone, a gap less than 10 mm was noticed. It was treated by accelerating the distraction speed. The ultrasound examination can offer a precise monitoring of distractional osteogenesis.

CT evaluation of regenerated osseous segments following bone transport

A morphological analysis using radiography and computed tomography was performed in a total of 17 bone segments following single or double bone transport in 11 and 3 patients, respectively. All bone transports involved the tibia, with the exception of 2 single bone transports, which were femoral. The following parameters were measured: cortical wall thickness, sectional area of the medullary canal, and density of the cortical bone and medullary canal in Hounsfield units (HU). The regenerated segments showed a cortical thickness and density that were less than the contralateral portion, with an enlargement of the medullary canal and an increase in density due to the presence of cancellous bone in the medullary area. Successive controls showed an increase in thickness and density of the cortical bone and a small reduction in the diameter of the medullary canal and its cancellous bone. The variations in the cortical and the medullary canal appeared to be independent of the length of the regenerated segment. In the 3 tibia treated by double bone transport, the anatomical variations in the distal regenerated portion varied less from normal values than the proximal portion of the same segment. In the 2 femurs examined, enlargement of the regenerated section was smaller with respect to cases involving regeneration of the proximal tibia. These differences are presumably dependent on the fact that in the latter case, a more vascularized segment is produced after osteotomy in spongy bone, with respect to those involving the distal tibia or femur. Double transport is preferable due to the reduced treatment times.

Normalization of chromium and cobalt values after femoral head replacement.

Highlights • A patient with MoM THA presented ARMD with worsening paresthesias.• Elevated Cr–Co values, worsening clinical picture, prosthetic revision was considered.• Acetabular cup and femoral stem were found correctly osteointegrated.• Only prosthetic metallic head was replaced with a polyethylene one.• Cr and Co decreased and normalized 3 months after surgery.

Minimally invasive plate osteosynthesis in type B fibular fractures versus open surgery

Introduction Distal radial fractures represent 17% of fractures in the Italian E.R. At the University Hospital ‘‘Policlinico Umberto I’’ of Rome E.R. we have started treating these fractures with a new fixation system designed by us: the CASLAU. This system provides a nonbridging external fixation. The synthesis is guaranteed by two or more K-wires which can be intramedullary or x-crossing the cortex and/or inter-fragmentary. These K-wires are connected with two radial pins by an external bar. This radial to radial system gives stability to the fracture and allows the patient to move the wrist immediately. We remove this fixation system after 40 days. Materials and methods From July 2008 to July 2010 we treated 127 distal radial fractures. Evaluation outcomes are presented only for the 101 patients that, at the present time, have a follow-up longer than 8 months. Clinical assessment was performed every 7 days until removal of external fixation system, then at 2, 3, 6 and 12 months. Radiographic assessment was performed at 30 and 40 days, consequently at 2, 3, 6 and 12 months. Outcome was measured on the basis of range of motion, grip and pinch strength, DASH and PRWE scores. A questionnaire was used to determine patient satisfaction, and a detailed analysis of complications was carried out. Results All patients had excellent or good results and were satisfied with the clinical outcome. At 60 days after surgery 94% of patients showed complete clinical and functional recovery. After 3 months 100% of patients showed complete clinical and functional recovery. After 6 and 12 months no modification of the obtained result was detected. Discussion Considering the immediate movement recovery and the minimal invasive system CASLAU non bridging external fixator is on our opinion a useful tool for DRF’s treatment. Conclusions On our series, at an average 14-month follow-up, the CASLAU system showed good to excellent results.External fixation is commonly practiced for pelvic ring fractures management. Many parameters influence mechanical performances of external fixators. Prior literature shows that the state of the art in pelvic fixator modelling has been mostly based on analysis of real prototypes made of either synthetic bone or other materials, or on cadaver specimens. Those works, although well performed, intrinsically lack in mechanical reliability due to many simplified assumptions. This study proposes a virtual 3D model of the pelvic ring with an external fixator in a 4 pins and 4 bars configuration, on which finite elements method (FEM) analysis was run. Our virtual 3D model of the pelvic ring introduces the advantage of differentiating the mechanical properties of cortical and cancellous bone along with the complex boundary conditions of major ligaments

Ludloff’s anteromedial approach in disorders other than congenital hip dislocation

We report our results obtained using Ludloff’s anteromedial approach in 17 patients affected by disorders other than congenital dislocation of the hip. These disorders were all localized on the anteromedial aspect of the hip joint and the proximal part of the femur (6 heterotopic ossifications, 3 osteoid osteomas, 2 osteochondromas, 1 aspecific coxofemoral synovitis, 1 chronic epiphysiolysis of the hip, 3 fractures of the femoral head, and 1 malignant fibrous histiocytoma). The treated group comprised 10 males and 7 females with a mean age of 33 years (range, 11–72 years). The anteromedial approach allowed for complete or almost complete removal of the pathological masses, withdrawal of synovial tissue for biopsy purposes, the reduction and fixation of femoral head fractures and even a corrective femoral neck osteotomy. The suitability of this treatment for skeletal disorders has been confirmed by clinical and radiographic controls carried out after a mean period of 7 years (range, 2–10 years).