Francesco Muratori

Percutaneous acetabuloplasty for metastatic acetabular lesions

BackgroundOsteolytic metastases around the acetabulum are frequent in tumour patients, and may cause intense and drug-resistant pain of the hip. These lesions also cause structural weakening of the pelvis, limping, and poor quality of life. Percutaneous acetabuloplasty is a mini-invasive procedure for the management of metastatic lesions due to carcinoma of the acetabulum performed in patients who cannot tolerate major surgery, or in patients towards whom radiotherapy had already proved ineffective.MethodsWe report a retrospective study in 25 such patients (30 acetabuli) who were evaluated before and after percutaneous acetabuloplasty, with regard to pain, mobility of the hip joint, use of analgesics, by means of evaluation forms: Visual Analog Scale, Harris Hip Score, Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC), Eastern Cooperative Oncology Group (ECOG). The results obtained were analysed using the χ2 Test and Fishers exact test. Significance was sent at P < 0.05.ResultsMarked clinical improvement was observed in all patients during the first six post-operative months, with gradual a worsening thereafter from deterioration of their general condition.Complete pain relief was achieved in 15 of our 25 (59%) of patients, and pain reduction was achieved in the remaining 10 (41%) patients. The mean duration of pain relief was 7.3 months. Pain recurred in three patients (12%) between 2 weeks to 3 months. No major complications occurred. There was transient local pain in most cases, and 2 cases of venous injection of cement without clinical consequences.ConclusionPercutaneous acetabuloplasty is effective in improving the quality of life of patients with osteolytic bone tumours, even though the improvement is observed during the first 6 months only. It can be an effective aid to chemo- and radiotherapy in the management of acetabular metastases.

Elastofibroma dorsi: 8 case reports and a literature review

A series of 8 cases of elastofibroma is reported, and the clinical, pathological and imaging features and different therapeutic modalities are reviewed. On this basis, we suggest an algorithm for the diagnosis and treatment of elastofibroma. Briefly, marginal excision is the treatment of choice in symptomatic patients, while followup appears to be a good solution in asymptomatic ones.

An overview about biomedical applications of micron and nano size tantalum.

Tantalum is obtained from the minerals colombite, tantalite and euxenite. It is greyish silver, heavy and very hard. Tantalum does not react with body fluids and is used to make surgical equipment. Tantalum also does not irritate the body and is used to make surgical sutures as well as implants, such as artificial joints and cranial plates. Bone growth around tantalum covered by calcium phosphate is described by in vitro experimentations. in vivo. Bioactive properties of porous tantalum have been recently developed. Porous tantalum consists of an interconnected porous structure with an average porosity diameter of approximately 400 microm. Hollow spheres with nanometre-to-micrometer dimensions are widely used in different range of applications such as drug delivery carriers and bioreactors. Porous tantalum metal is currently used in orthopaedic for manufacturing of structural component for primary and revision total hip and knee replacements and, more recently, in spine surgery. Good clinical outcomes have been achieved especially in hip revision surgery, using tantalum implants, and promising short term follow up have been reported for knee revision surgery. Some patents for tantalum biomedical applications have been obtained and this article reviews various recent patents on this material. Many patents are developed on tantalum for biomedical application. This paper review some of them with particular interested for biomedical applications in orthopaedic and dentistry.

Infection following bone tumor resection and reconstruction with tumoral prostheses: a literature review.

Bone resection is the choice treatment of malignant bone tumors. Tumor prosthesis is one of the most common solutions of reconstruction following resection of bone tumor located to the metaphysis of long bones. Periprosthetic infections are a frequent complication of limb-salvage surgery which is largely due to prolonged and repeated surgeries, as well as to the immunocompromised condition of these patients due to neoplastic treatment. Furthermore, the large exposure of tissues during this type of surgery and the dissection across vascular distributions also contributes to the high risk of infection. The authors reviewed the literature discussing the incidence of infections of tumor prosthesis implanted following resection of bone tumors, taking into account the different sites of implantation. In the English literature, the highest risk of infection which led to limb amputation was observed after proximal tibia resection and this difference was considered to be due to the poor condition of soft tissue and also after pelvic resection due to huge dead space after sarcoma resection not filled by implant. Independent of the location, the management of infected prosthesis is similar. That is, after one or more attempts at debridement and antibiotic therapy, it consists of implant removal and insertion of a new implant in a one- or two-stage procedure, with a decreased risk of failure with the two-stage procedure.

In vivo characterization of Zirconia Toughened Alumina material: a comparative animal study.

The development of a new chromia-doped Zirconia Toughened Alumina (ZTA) material was previously reported as displaying mechanical properties suitable for implants with load bearing applications, such as orthopaedic and dental implants. This type of biomaterial is expected to be in contact with living tissues for a long period of time and its long-term toxicity must be carefully evaluated. In this study the suitability of this ZTA material as a candidate biomaterial for orthopaedic implants and dental devices was further investigated in vivo in comparison to alumina and zirconia, which are currently used in orthopaedic and dental surgery. Cylinders of the materials were implanted in vivo in white rabbits, and local and systemic tissue reactions were analyzed at different time intervals after surgery. Radiologic examinations displayed the absence of radiolucence around cylinders and no signs of implant loosening up to twelve months. No tumours developed in the animals either locally (at the site of implantation), or systemically in the peripheral organs. The results obtained suggest that this new ZTA material does not display any long term pathogenic effect in vivo. These findings extend our previous observations on the biocompatibility and the absence of any long-term carcinogenic effect in vitro of this material which displays interesting properties for biomedical applications. In conclusion, we report the in vivo characterization of a new chromia-doped ZTA material and confirm its suitability as a candidate biomaterial for orthopaedic implants and dental devices since it does not give any local nor systemic toxicity even after a long period of time after implantation.

Tubercular Osteomyelitis of the Second Metatarsal: A Case Report

A number of studies have described the osteoarticular involvement of tuberculosis, but very few cases of tubercular osteomyelitis of the foot have been reported. We describe a case of spina ventosa affecting the second metatarsal, with a review of the literature and description of the clinical manifestations, diagnostic images, and treatment of skeletal tuberculosis.

Morphological Modifications in Osteoarthritis: A Scanning Electron Microscopy Study

The chondrocyte, the only cellular component of adult articular cartilage, plays a key role in the pathogenesis of osteoarthritis (OA). The evolution of this process is very slow: the first changes involve the cell-matrix morphofunctional unit known as chondron. In this study we analyzed the cartilage of 10 patients with primary osteoarthritis. The cartilage was retrieved during total knee replacement (TKR) and maxillofacial surgery procedures. All patients presented an osteoarthritis of at least grade III. The preparation of the specimens was made by taking cartilage from both well-preserved and macroscopically degenerated areas. Specimens underwent histological evaluation with conventional staining and ultrastructural analysis. Age appeared to be a high risk factor in the development of articular cartilage damages. Depth of injury was also found to be age-related as more extensive lesions were found in the elderly, either in the knee or in the mandibular condyle. Whatever the cause of possible damage, Scanning Electron Microscopy (SEM) observations showed that at the beginning most degenerative changes in articular cartilage involved the chondron unit, a concept first introduced by Benninghoff. These changes generally go through three phases. During OA progression all degenerative changes begin from the chondron, which is why it is extremely important to understand the molecular anatomy and physiology of this pericellular microenvironment and its form, function and failure in adult articular cartilage. It is also fundamental to understand the mechanism of adaptation of the cartilage and bone disruptions, given the physiological relationship between these tissues, essential to maintain normal joint structure and function.

A report of a very rare localization of bone metastasis to the talus

A very rare case of a bone metastasis to the talus as a primary symptom of the disease is described in a 64-year-old female. Staging revealed that the primary lesion was a transitional carcinoma localized in the kidney basin. The surgical treatment consisted of bone curettage, reconstruction with PMMA and an arthrodesis of the ankle joint with two screws. Postoperatively a radiotherapy was performed with 45 gray.RésuméUn cas très rare de métastase osseuse du talus comme symptôme primaire de la maladie est décrit chez une femme de 64 ans. L’analyse a indiqué que la lésion primaire était un carcinome transitionnel localisé dans le bassinet du rein. Le traitement chirurgical a consisté en curettage osseux, en reconstruction avec PMMA et en une arthrodèse de cheville avec deux vis. En post opératoirement une radiothérapie à 45 gray a été ajoutée.

Whiteside line as the reliable surgical landmark for femoral rotation in total knee arthroplasty. Radiological validation

BackgroundThe authors report a series of 20 cases of total knee replacement (TKR), where the proper rotational femoral alignment was defined intraoperatively according to the Whiteside line (AP axis) to avoid patello-femoral and femoro-tibial problems. The aim of this study was to evaluate the validity of Whiteside line used intraoperatively with a X-ray projection to asses the twist angle, obtained by the trans-epicondylar line and the posterior condylar axis.MethodsPostoperatively, all patients executed a new X-ray projection to assess the twist angle, obtained by the trans-epicondylar line and the posterior condylar axis, for the effective rotational alignment of the femoral component.ResultsThe range of value of the twist angle resulted in 0–3° of external rotation.ConclusionThe results confirm the validity of the Whiteside line used intraoperatively as a reliable landmark to asses the femoral rotation.RésuméElémentsLes auteurs rapportent une série de 20 cas d’arthroplasties totales du genou (PTG) pour lesquelles le bon positionnement correct en rotation a été défini en per-opératoire selon la ligne de Whiteside (axe antéro-postérieur) afin d’éviter des problèmes fémoro-patellaires et fémoro-tibiaux. Le but de cette étude a été d’évaluer la validité de l’utilisation per-opératoire de la ligne de Whiteside grâce à un cliché radiographique pour définir l’angle de torsion, obtenue par la ligne trans-épicondylaire et l’axe condylien postérieur.MéthodesEn postopératoire tous les patients ont eu un nouveau contrôle radiographique pour définir l’angle de torsion, obtenue par la ligne trans-épicondylaire et l’axe condylien postérieur.RésultatsLes valeurs extremes de l’angle de torsion étaient entre 0 et 3° de rotation externe.ConclusionLes resultants conferment la pertinence de l’utilisation per-opératoire de la ligne de Whuteside pour definer la rotation fémorale.

A PARTICULAR SOLUTION IN THE TREATMENT OF PRIMITIVE NEOPLASMS OF THE DISTAL THIRD OF THE TIBIA. PRESENTATION OF A CLINICAL CASE AND REVIEW OF THE LITERATURE

Primitive malignant neoplasms affecting the distal third of the tibia are altogether rare, and their treatment is considerably controversial. The authors describe the diagnostic procedure and a particular surgical strategy of limb salvage in a case of malignant fibrous histiocytoma located at the distal third of the tibia, in particular pointing out the difficulties in restoring the continuity of the skeletal tissues and of the muscle, and with a review of the relevant literature.