A comparison between ilioinguinal and modified Stoppa approach in anterior column acetabular fractures.

INTRODUCTION: Pelvis fractures are among the most difficult fractures to manage and treat for Orthopedic surgeons. Anatomic reduction is the main goal to reach in the acetabular fractures' treatment. The following study compares clinical outcomes and complications of Ilioinguinal versus modified Stoppa approach in Open Reduction and Internal Fixation (ORIF) of anterior column acetabulum fractures. MATERIALS AND METHODS: A comparative analysis on 90 patients undergoing ORIF on acetabular fracture has been performed. Patients have been divided into two groups. The first group was treated by Ilioinguinal approach (n = 48), the second group by modified Stoppa approach (n = 42). The following parameters have been compareted: quality of fragment reduction; operative time; peri­ and post-operative blood loss; complications; clinical and radiographic outcomes. RESULTS: The modified Stoppa approach has shown a shorter mean operative time (146 min vs 175 min), fewer complications (14/48 vs 6/42), less blood loss both in the perio-operative phase (0.8 Hb pt vs 1.3 Hb pt) than in postoperative one (1.1 Hb pt vs 1.5 Hb pt), a lower rate of nerve, infections and critical complications. On the other hand, the ilioinguinal approach has showed better results in terms of quality of fracture reduction (43/48 patiens with anatomical or near anatomical reduction vs. 37/42). No significant differences concerning vascular lesions, clinical and functional outcomes have been found between the two groups. CONCLUSIONS: The modified Stoppa approach results in shorter operative time, less intra-operative blood loss and fewer complications than the ilioinguinal one. Greater anatomic reduction is achieved by Ilioinguinal approach; however, this does not necessarily translate into better clinical and functional outcomes which, overall, are comparable in the two analysed approaches. In conclusion, the modified Stoppa approach is deemed to be a better alternative in treating these fractures.

Chlamydia pneumoniae and osteoporosis-associated bone loss: a new risk factor?

UNLABELLED: We found an association between the presence of Chlamydia pneumoniae DNA both in osteoporotic bone tissue and peripheral blood mononuclear cells (PBMCs) and the increase in circulating resorptive cytokines. INTRODUCTION: Our study was designed to determine whether C. pneumoniae infection may be involved in osteoporosis-associated bone loss. METHODS: The study included 59 women undergoing hip joint replacement surgery for femoral neck fracture: 32 with osteoporosis and 27 with osteoarthritis. A total of 118 tissue specimens (59 bone tissues, 59 PBMCs) were examined for C. pneumoniae DNA by real-time polymerase chain reaction (PCR). Serum levels of soluble receptor activator of nuclear factor kappa B ligand (sRANKL), osteoprotegerin (OPG), interleukin (IL)-1ß, tumor necrosis factor-α, and IL-6 were also measured. RESULTS: C. pneumoniae DNA was detected in osteoporotic bone tissue whereas it was not found in non-osteoporotic bone tissue (p < 0.05). A significantly higher rate of C. pneumoniae DNA (p < 0.05) was found in PBMCs of osteoporotic patients than in those of osteoarthritis patients. Among osteoporotic patients, serum sRANKL, IL-1, and IL-6 concentrations as well as sRANKL/OPG ratio significantly differ between patients with bone tissue and PBMCs positive to C. pneumoniae and C. pneumoniae-negative patients. CONCLUSION: The association between the presence of C. pneumoniae DNA, both in bone tissue and PBMCs, and the increase in sRANKL/OPG ratio as well as in IL-1ß and IL-6 levels observed in osteoporotic patients suggests C. pneumoniae infection as a new risk factor for osteoporosis.

[Impact of an integrated treatment approach of the severely injured patients (ISS =/> 16) on hospital mortality and quality of care]. / Impatto di un modello di gestione integrata dei pazienti con trauma grave (ISS >/= 16) sulla qualità del trattamento ospedaliero e sulla mortalità ospedaliera.

BACKGROUND: Outcome of severely injured patients is sharply influenced by the level of prehospital and hospital organization. OBJECTIVE: To evaluate the impact of the re-organization of the trauma care process on the quality of care and final outcome of major trauma (ISS =/< 16) victims. SETTING: the Emergency Department (ED) of a 1600 bedded tertiary care hospital. INTERVENTION: a standardized approach to major trauma patients (MT) was implemented: Written protocols were established and trauma teams were organized. All anesthesiologists and trauma surgeons involved in trauma care were enrolled in an educational program including ATLS Courses and the Italian Resuscitation Council Prehospital Trauma Care Course. One of the targets was to assure the early orthopedic stabilization of limb and pelvis fractures. METHODS: Data of all major trauma victims admitted to the ED during 3 comparable periods of time: before (Jan-May 1998), during (Jan-May 1999) and after (Jan-May 2000) the implementation of the process, were retrospectively and prospectively collected and analyzed. RESULTS: MT patients admitted to the hospital increased from 39 in 1998 to 106 in 2000. For similar ISS (30.2 +/- 11.3 in 1998, 29.6 +/- 13.7 in 1999 and 30.5 +/- 12.9 in 2000) hospital mortality dropped from 42% in 1998 to 20.8%. The mean time from hospital admission to surgical orthopedic stabilization was 12 days in 1998, 4.6 in 1999 and 1.3 in 2000. In 2000, 86% of the patients with limbs fractures who required surgical stabilization, were treated within 36 hours from admission vs 11% in 1998. CONCLUSIONS: The implementation of written protocols for trauma care, the organization of trauma teams, educational programs including ATLS and PTC-IRC Courses and a strategy of early stabilization of limb fractures are associated with a dramatic decrease in hospital mortality for major trauma.

[Chordoma (a review of 11 cases)]. / Cordoma (rassegna di 11 casi).

Eleven cases of chordoma, localized at sacrum (3 cases), lumbar spine (6 cases), cervical spine (2 cases), are reported. Authors describe clinical and pathological findings of the tumor and underline peculiarity of spinal localization and difficulty of diagnosis, often delayed, particularly in sacral spine localizations. Radiotherapy and chemotherapy give poor results while surgery can be employed in the treatment on account of the slow evolution and of the not very frequent aptitude of the tumor to give metastases. However peculiar localization into the sacral spine allows to remove the whole tumor if only it is localized below the 2nd sacral vertebra; authors present such a case treated by means of subtotal resection of sacrum and coccyx. In proximal sacral localizations and in other spinal localizations, surgery is a palliative procedure and can only slow down the evolution of the tumor; recurrence is a rule, even in association with radiotherapy. However surgical treatment must be often performed because of myeloradicular involvement.

[Multiple exostoses disease (observations in 21 reported cases)]. / La malattia delle esostosi multiple (osservazioni su una rassegna di 21 casi).

With reference to 21 cases the authors describe the clinical, radiological and anatomo-pathological findings of multiple exostoses disease. The indications for the surgical treatment are discussed; they are, however, the same to the solitary osteochondroma.

Current trends in the treatment of Ewing's sarcoma.

The authors analyse the results obtained in the treatment of Ewing's sarcoma by comparing the period previous to the use of chemotherapy with the more recent one involving the use of antiblastic drugs. Thirty-one patients with Ewing's sarcoma were divided into three groups according to the type of treatment used. The first group included 11 patients treated either by surgery or high dosage radiation (7000-8000 rads); the second group included 9 patients treated by radiation plus polychemotherapy; finally, the third group included 11 patients treated by surgery (excision in 5 localizations and segmental resection in the remaining 6), associated with polychemotherapy and low dosage radiotherapy. The results in the first group were discouraging as none of the patients survived five years; there was a low survival rate (33%) for the second group, partly due to the fact that there were 4 localizations in the pelvis, a site with a notoriously unfavourable prognosis; the third group had the highest percentage (55%) of long-term disease-free patients. Thus, in agreement with what is reported in the literature, the most radical surgery possible, associated with polychemotherapy and low-dose radiotherapy, currently seems to be the best treatment.

Primary reticulosarcoma of bone (non-Hodgkin's lymphoma). A study of 12 cases.

Reticulosarcoma, nowadays usually referred to as non-Hodgkin's malignant lymphoma, is a particularly rare primary bone tumour. This study includes 12 cases observed over more than 15 years. The favourable clinical course of the tumour, and the use of complementary therapy justify a more extensive use of surgical treatment. Five cases were submitted to surgery plus complementary chemotherapy; two resections of the tibia, one of the humerus, one scapulectomy and one disarticulation of the hip. The remaining 7 cases were treated by radiation therapy. The overall prognosis of the disease is not very favourable (25% survival rate) although its slow progress gives a favourable clinical impression. Treatment may, however, influence the prognosis; much better results are obtained by radical surgery with complementary chemotherapy. In one resection of the tibial diaphysis and one radical scapulectomy there was no local recurrence or metastases at 3 and 4 years follow-up, whereas cases treated previously by less radical surgery and inadequate chemotherapy, although showing no local recurrence, did result in systemic diffusion of the disease.