Nicola Lollino

Bone Mineral Density and Singh Index Predict Bone Mechanical Properties of Human Femur

The aim of our study was to assess the predictive value of the Singh index (SI), which estimates bone architecture, and bone density (BMD) when dealing with the mechanical competence of bone and to analze possible differences in bone properties between gender in humans. The relationship between SI, BMD, and mechanical competence was analyzed in 106 bone cylinders from 37 human femoral heads obtained during hip-joint replacement surgery for low energy fracture or for osteoarthritis. Bones from osteoporotic patients are less dense and more brittle compared with bones from osteoarthritic patients, as expected. Among osteoporotic patients female bones were more brittle than those from males, although BMD was similar. In osteoarthritic patients there were no significant differences among sexes. Bone mechanical competence varies according to BMD and to SI categories. Thus, our study suggests that bone strength is predicted by both BMD and bone architecture.

Non-orthopaedic causes of shoulder pain: what the shoulder expert must remember

Aim of this review is to underline some specific patterns of shoulder pain that are not related to musculoskeletal diseases but are manifestations of gastrointestinal, neurological, cardiological or rheumatological diseases. The most important pathologies (like gallstones, myocardial ischaemia and Parsonage-Turner syndrome…) that can manifest with shoulder pain will be presented by specialty doctors and elements for differential diagnosis will be discussed. Orthopaedic shoulder surgeons should always suspect other causes of pain, different from those related to bone, tendons and joint. If there is something unfair, patients should be referred to family doctor for further investigations in order to exclude major systemic diseases.

Correlation between radiographic risk for glenoid component loosening and clinical scores in shoulder arthroplasty

Glenoid component loosening is the weak point in the failure of total shoulder arthroplasty (TSA). In this study we analyse the radiographic risk factors observed on 86 cemented polyethylene glenoid components and their relationship with clinical signs at a mean follow-up of 5.8 years. Clinical assessment included Simple Shoulder Test (SST) and Constant-Murley score. Radiograms were taken to detect periprosthetic radiolucency, tilt, medial displacement and polyethylene thinning. Pearson’s correlation coefficient and Spearman’s rank correlation coefficient were calculated for statistical analysis. In 61 patients (71%) lucent lines were less than 2 mm wide (grade 2) and in 6 cases (7%) they were ≥2 mm wide (grade 3 and 4). Thinning of the polyethylene was found in 11 cases (13%), glenoid tilt in 6 cases (7%) and medial migration of the component in 5 cases (6%). Complete glenoid prosthetic loosening was found in 3 cases (3.5%) associated with polyethylene wear and glenoid bone loss. The Constant-Murley score associated with radiolucency grade 3 and 4 was less than 45% (38.39 ± 8.9) (p < 0.05), while a score less than 56% (30.72 ± 8.7) was found in patients with glenoid tilt and medial migration (p < 0.01). The mean SST score was 4.8 ± 2.8 in case of glenoid tilt and migration of the component (p < 0.01). Removal of the glenoid component and conversion to hemiarthroplasty or reverse prostheses is suggested in painful glenoid loosening. An exhaustive analysis of radiograms is essential to detect early and late complications or risk factors of glenoid loosening.

Reverse shoulder prosthesis as revision surgery after fractures of the proximal humerus, treated initially by internal fixation or hemiarthroplasty

Complex (3–4 fragments) fractures of the proximal humerus often have a bad outcome, whatever treatment is performed. When revision surgery is required, reverse shoulder prosthesis can improve function and reduce pain in these patients. We analysed whether the choice of the first treatment (hemiarthroplasty vs. reduction and fixation) can influence the outcome of revision surgery. Our data demonstrate that results are not significantly dependent on the choice of the first implant, even though there is a tendency for patients with previous hemiarthroplasty to have a worse outcome.

Informed consent in shoulder surgery

Informed consent is an essential tool for diagnosis and therapy in medicine, and is of fundamental importance in surgery, where it underpins the operation itself. Its origins can be traced back to US forensic medicine but is now incorporated into the Italian legal system, with different consequences depending on the context in which it is applied. This article describes our experiences in shoulder surgery, with suitable references to legislation and analysis of the literature studies in this area.

Importance of neurological evaluation before reverse shoulder arthroplasty in patients with previous poliomyelitis

We present a case report of a patient, affected by post-polio syndrome and cuff tear arthropathy of his right shoulder, who underwent reverse shoulder arthroplasty. A previous radial deficiency was unmasked in the post-operative follow-up, with passive elbow bending when the forearm was put in an antigravitational position. A precise preoperative neurological evaluation is mandatory in shoulder replacement in order to estimate the functional outcome after surgery.

Subacromial widening osteotomy of the scapular spine: surgical technique and literature review.

Scapular fractures are usually treated non-operatively with short-term sling immobilisation and early active motion. However, some patterns of fracture require surgical reduction and internal fixation with plates and screws. These fracture patterns are rare, and there are few reports regarding long-term outcome of non-operative treatment or the management of the severe malunion which may follow. The definition of malunion is related to fracture type (spine, glenoid neck). We have found no relevant epidemiological data in the literature. In this paperwe have focused on fractures of the lateral scapular spine (type III) that tend to heal with a downwards malalignment of the acromial fragment. This malunion reduces the subacromial space and alters the normal kinematics of the acromioclavicular and scapulothoracic joints, presenting clinically as a pseudo scapular winging related to the deformity (the lateral fragment is often anteriorly rotated). This anatomical situation can give rise to considerable pain, disability and weakness, with dysfunction of the rotator cuff, trapezius, deltoid and rhomboid muscles and consequent loss of normal range of movement of the shoulder. Clavicular involvement (clavicular malunion or acromioclavicular dislocation) may be also be present and can lead to discomfort and instability. We report on a technique for subacromial opening osteotomy of the scapular spine, which raises the acromion and restores anatomical geometry after varus malunion of the acromion.

Salter-Harris type II proximal humerus injuries: our experience with a new external fixator.

Proximal humeral fractures in the pediatric population are commonly treated conservatively. When there is an indication for surgery, percutaneous pinning is considered to be the elective choice. We report our experience with a new external fixator that reduces the risk of pin migration and permits an early rehabilitation. The range of motion was completely restored in all patients and no pain or discomfort was detected at follow-up. According to the literature, a small varus malunion at the first x-ray control can be tolerated in the pediatric population because of the remodeling ability of the bone. We conclude that this system provides a good stability and healing of Salter-Harris type II proximal humerus injuries.