Treatment of unstable spinopelvic fractures: outcome of three surgical techniques-a retrospective single-center case series.

PURPOSE: The aim of our retrospective study is to analyze how spinopelvic dissociations (SPDs) were treated in a single center trying to better understand how to improve surgical and non-surgical options. METHODS: Twenty patients of a single center surgically treated for SPDs between 2013 and 2021 were retrospectively included in this study. Three surgical techniques have been used: modified triangular stabilization, triangular stabilization and double iliac screws stabilization. Follow-up was assessed for up to 11.6 ± 9.9 months through ODI, MRS, NRS, IIEF or FSFI, a CT scan and whole spine X-ray examination. RESULTS: Twenty patients were admitted to our ER for traumatic spinopelvic dissociation. Surgical treatment for spinopelvic dissociation has been performed on average 11.5 ± 6.7 days after the trauma event. Eighteen fractures were C3 type and two C2 types. Neurological examination showed nerve root injury (N2) in 5 patients, incomplete spinal cord injury (N3) in 4 patients and cauda equina syndrome in two patients (N4). In case of neurologic deficits, routinary nerve decompression was performed. Three different surgical techniques have been used: 8 triangular fixations (Group 1), 6 modified triangular stabilization (Group 2) and 6 double iliac screws triangular fixation (Group 3). CONCLUSION: In patients with post-traumatic neurological deficit, decompression surgery and fracture reduction seem to be associated with clinical improvement; however, sexual disorders seem to be less responsive to the treatment. Some open stabilization techniques, such as the double iliac screw, could help in restoring the sagittal balance in case of severe deformities.

Complications and survival of megaprostheses after resection of bone metastases.

Treatment of bone metastases is often palliative, aiming at pain control and stabilization or prevention of pathological fractures. However, a complete resection with healing purposes can be performed in selected cases. The aim of our work was to evaluate the survival of megaprostheses used for reconstruction after bone metastases. Between January 2001 and March 2015, we implanted 169 Megasystem-C® (Waldemar LINK® GmbH & Co. KG, Hamburg, Germany) after bone metastasis resection. Patients, 95 females and 74 males, were operated at an average age of 61 (12-87) years for proximal femoral resection in 135 (79.9%) cases, distal femur in 24 (14.2%), proximal tibia in 6 (3.6%), total femur in 3 (1.8%) and intercalary femur in 1 (0.6%). Mostly, breast cancer metastases (30.8%), kidney (17.8%) and lung (14.2%) were treated. At an average follow-up of 21 (1-150) months, we found a 99.4% overall limb salvage and a 96.1% overall survival rate at 1 year, 92.8% at 2 years, and 86.8% at 5 and 10 years. We found 9 (5.3%) mobilization cases of the proximal femoral implant, 3 needed surgical reduction; 2 (1.2%) cases of aseptic loosening of the prosthetic stem; 2 (1.2%) periprotetic infection cases, one requiring a 2-stage revision. Few literature studies have evaluated the survival of megaprosthetic implant in the treatment of bone metastases. Our data show how in this specific context the rate of complications is significantly lower than expected in general orthopedic orthopedic surgery. The use of modular prostheses is a valid reconstructive strategy after bone metastasis resection in selected patients. The rate of short-term complications is exceptionally low; further studies will have to confirm this in the longer term.

Scaffolds combined with stem cells and growth factors in healing of pseudotumoral lesions of bone.

Reconstructions of large lesions or defects often require a bone graft or a bone substitute to promote healing. In common practice the reconstruction of a bone defect is dependent on the site and size of the lesion: in long bones intercalary defects may be managed with Ilizarov technique of bone transport and distraction osteogenesis or the use of a free or pedicled vascularized bone graft, or with Masquelet technique. For cavitary defects the available surgical options include autograft, allograft or xenograft or the use of synthetic scaffolds to promote bone regeneration. In order to promote a faster bone healing tissue engineering proposed the application of enriched graft to fill bone defects. The employment of enriched bone graft has been our choice in the last years to fill contained defects following curettage of a pseudotumoral lesion of bone. We report our clinical experience in terms of safety and success of these procedures at a long-term follow up.

[Minimally invasive techniques for treatment of metastatic cancer]. / Minimal-invasive Techniken zur Behandlung metastasierter Karzinome.

Many percutaneous image-guided ablative techniques have been used in the treatment of cancer-related bone metastases. These techniques are rapidly becoming a focus in the palliative and curative treatment of patients with both benign and malignant bone cancer.In this article we will briefly review the principles of radiofrequency ablation and our experience with this technique, including its use in combination with surgery; we will also discuss other minimally invasive techniques such as cryoablation and osteoplasty in the treatment of bone metastases.

Application of bone morphogenetic proteins to femoral non-unions: a 4-year multicentre experience.

Fracture non-unions often complicate orthopaedic trauma. BMPs (bone morphogenetic proteins) are currently considered the most appealing osteoinductive agents. Applications of BMP-7 since January 2004 were prospectively recorded in a multicentre registry of aseptic femoral non-unions. The study included 30 patients who had undergone a median of 1 revision operation before BMP-7 application and who were followed up for a median 24 months. In 23/30 cases the application of BMP-7 was combined with revision of the fixation, and in 12 it was combined also with autograft. Non-union healing was verified in 26/30 cases in a median period of 6 months. No adverse events were associated with BMP-7 application. Our case series supports the safety and efficacy of BMP-7 in femoral non-unions. Multicentre networks and systematic, long-term follow-up of patients may improve understanding of this promising osteoinductive bone substitute.

A comparison of clinical and radiological parameters with two arthroscopic techniques for anterior cruciate ligament reconstruction.

We performed a comparative study of two series of 25 patellar tendon arthroscopic reconstructions of isolated chronic anterior cruciate ligament injuries, alternating between a double-incision (using a rear-entry guide) or single-incision technique (using a transtibial approach). The patients were reviewed to assess the clinical, KT-2000 and radiological differences at an average follow-up of 14 months (range 8-18 months). For the clinical evaluation the International Knee Documentation Committee Form was used. The following radiographic parameters were measured: (1) the direction of the femoral and tibial tunnels in the antero-posterior (AP) and lateral (LL) views; (2) the location of the anterior border of the intra-articular exit hole of the femoral tunnel in the LL radiologic view; (3) femoral interference screw divergence with the bone block. An extension loss < or = 5 degrees was detected in 40% of the double-incision and 36% of the single-incision patients (NS). A flexion loss < or = 10 degrees was present in 8% of the double-incision and 16% of single-incision group (NS). There were no differences in terms of pivot shift test between the two groups (pivot glide in 12% of both groups). The average side-to-side KT-2000 differences at the manual maximum test were 1.98 mm in the double-incision and 2.64 mm in the single-incision group. With the double-incision technique the femoral and tibial tunnels were divergent in the AP plane and crossed the joint at an angle of 37 degrees and 72 degrees, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical treatment of recurrent dislocation of the patella.

Sixty-seven patients (69 knees) with recurrent patellar dislocation underwent either a lateral release (20 knees), a proximal realignment (14 knees), a distal realignment (16 knees), or a combined realignment (19 knees) procedure. Average respective followup was 8, 8, 6, and 4 years. Patients undergoing lateral release experienced a 40% recurrence of patellar dislocation. After a realignment procedure, redislocation was uncommon (4%), but pain and swelling were reported by 12% of the patients. Significant patellofemoral crepitation was present in 35% of the realignments. The congruence angle was corrected satisfactorily in the proximal realignments, but it remained abnormal in 25% of the distal realignments. The distance from the tuberosity to the sulcus was restored to normal by transposition of the tibial tuberosity, but remained abnormal in 36% of the proximal realignments. However, it did not preclude a good clinical result. Lateral release cannot be recommended for knees with severe dysplasia of the extensor mechanism. Proximal, distal, and combined realignments yielded similar clinical results. Retensioning of the medial structures and lateral release are effective in reducing the patella within the sulcus. Although transposition of the tuberosity is appealing, clinical advantages are less evident.

A comparison between medial meniscus repair, partial meniscectomy, and normal meniscus in anterior cruciate ligament reconstructed knees.

A clinical, radiographic, and scintigraphic comparative study was performed on 57 consecutive successful patellar tendon anterior cruciate ligament reconstructions for chronic laxity. Patients were divided into 3 matched groups according to the medial meniscal treatment. Group A included 18 patients with medial meniscal repairs; Group B, 19 patients with partial medial meniscectomies; and Group C, 20 patients with normal menisci (controls). The average followup was 55 months. At clinical examination, patients in Group B had more activity-related pain than those in Group C (p = 0.04). The anteroposterior weight-bearing views in extension showed more degenerative changes in the medial compartment in Group B than in the other 2 groups (Group A versus B, p = 0.01; Group C versus B, p < 0.001). Scintigraphy showed an increased uptake in the operated knee as compared with the normal side (11%), but no differences among the 3 study groups. The patients with partial meniscectomies had more pain and degenerative radiographically evident changes than the control group. Medial meniscal repair offers a better chance than partial meniscectomy to preserve the articular cartilage of the medial compartment. Bone homeostasis, as detected by bone scanning, remains slightly altered in successful reconstructions as compared with the opposite normal side.

Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction.

The results of intraarticular anterior cruciate ligament reconstruction with either the patellar tendon or the semitendinosus and gracilis tendons (four strands) were prospectively compared in a consecutive series of 60 patients with chronic injuries. A single surgeon performed arthroscopically assisted reconstructions in an alternating sequence. Preoperative and operative data revealed no significant differences between the two groups. After 28 months of followup there were no significant differences in the incidence of symptoms, and recurrent giving way was present in only one knee with semitendinosus and gracilis tendon graft. Return to sport participation was more frequent in the patellar tendon group (80% versus 43%, P < 0.01). A minor extension loss (< or = 3 degrees) was more frequent in the patellar tendon group (47% versus 3%, P < 0.001). Other differences between the two groups were not significant. KT-2000 arthrometer side-to-side difference of anterior displacement > 5 mm at 30 pounds was present in 13% of the knees with patellar tendon grafts and in 20% of those with semitendinosus and gracilis; a patellofemoral crepitation developed in 17% and 3% of the two groups, respectively. Based on these data we routinely use patellar tendon grafts. Semitendinosus and gracilis tendons are preferred in selected cases: older patients, patients with preexisting patellofemoral problems, and those with failed patellar tendon grafts.

Recurrent dislocation of patella: three kinds of surgical treatment.

The authors compare three surgical techniques for treatment of recurrent dislocation of patella. The best results, even in the correction of lateral patellar displacement, were achieved with proximal realignment, while the worst results occurred when lateral retinacular release was used alone. In distal realignment, the degree of correction necessary must be ascertained by thorough preoperative assessment of both patellar height and malalignment between femoral groove and tibial tubercle. If the medial retinacular structures are weakened, it may be necessary to perform proximal realignment. We believe that a single surgical option is insufficient, and that the best solution for each individual case should be chosen according to precise indications. The choices include proximal realignment, distal realignment, or a combination of both, while lateral release should always be used in combination with another technique.