Lodovico Renzi Brivio

Percutaneous CT-Guided Vertebroplasty in the Management of Osteoporotic Fractures and Dorsolumbar Metastases

Percutaneous vertebroplasty (PVP) is a minimally invasive, image-guided procedure consisting of an injection of acrylic cement into a vertebral body to reinforce the compressed segment and achieve pain relief. The use of PVP is a minimally invasive option in the treatment of osteoporotic or metastatic vertebral collapses. Our personal experience, using a CT-guided technique, confirms the efficacy and safety of PVP with a lower risk for complications compared with conventional fluoroscopic approaches because of a precise placement of the instruments in the vertebral body and an early detection of small cement leakages.

Treatment of non-union of the humerus using the Orthofix® external fixator

An Orthofix monolateral axial external fixator was used to treat 31 patients with non-union of the humeral shaft, 30 of whom had been previously treated surgically. In seven cases the non-union was hypertrophic and one of these cases had been treated by simple fixation anol compression, the others by fixation, bone grafting and decortication; in 20 cases the non-union was hypotrophic and had been treated by fixation and decortication with bone grafting. The remaining four cases had septic non-union, treated by debridement of the focus of infection and fixation, followed in three cases by a bone graft and osteomuscular decortication once the infection had been eradicated. The fracture site consolidated in all patients in a mean time of 4.9 months. Five patients required further surgery: three in the group with infected non-union and two who had had a new bone graft and application of the external fixator, one because of a refracture (the patient was receiving chronic treatment with antimitotic agents) and one because of persistent non-union. There were no major complications (e.g. radial nerve palsy, joint stiffness, deep infection), and only six cases of pin track infection (5% of the screws implanted). The authors believe that this method is reliable, effective and low risk provided that the patient is cooperative; furthermore, the monolateral axial external fixator is tolerated well and allows movement of the shoulder and elbow throughout the period of treatment.

Biomechanical factors in designing screws for the Orthofix system.

In a monolateral external fixation system, bone grip is achieved optimally using half pins. This article reports the mathematical modeling used to design the screws and the drills of the Orthofix system. The diameter of the shank must be such that there is no risk of fracture at the screw entry point. It must also provide high strength under weight-bearing deformation stresses. The shape of the threaded part must allow the highest possible bone-gripping strength while minimizing slackening in relation to external and internal loads. The thermal effects of drilling and screw insertion must be considered to minimize necrotic damage that may stimulate reabsorption phenomena around the screw. The design of the different components of the pins must vary according to all the above factors to ensure optimal interaction between the fixator, screw, and bone.

Return to Sport After Ankle Lesions

Ankle postoperative rehabilitation treatment must be customized according to the surgical procedure and the patient’s characteristics.