The "Cascade" membrane: a new PRP device for tendon ruptures. Description and case report on rotator cuff tendon.

Rotator cuff tears are common soft-tissue injuries that often require surgical treatment. Initial efforts to better tendon healing centered on improving the strength of repair. More recent studies have focused on abiologic enhancement of the healing process. Platelet rich plasma (PRP) is a fraction of plasma that has been isolated and used to enhance regeneration in bone and soft tissues. The healing potential of PRP has been attributed to the release of multiple growth factors from the highly concentrated platelets. The "Cascade" membrane is a thin layer of autologous fibrine that is very rich in platelets and is obtained by high speed centrifugation of a small quantity of PRP. The Authors present the case of C.U., a right-handed 53 year-old male that came to our attention complaining of severe right shoulder pain and ROM reduction. The MRI showed a thick tear of the sovraspinatus tendon with retraction of the muscle. The patient underwent surgical repair with arthroscopy and mini-open approach with acromionplasty, subacromial decompression, cuff repair by trans-bone suture and application of the "Cascade" membrane (A.T. Grade Milano, Italy) that was sutured side-to-side to close the 10 mm tear. A standard rehabilitation protocol for rotator cuff tears was performed. A MRI 6 months after surgical repair showed the complete integrity of the cuff under the membrane. Currently no widely accepted treatment for massive, irreparable rotator cuff tears is available. Allograft reconstruction to span the remaining defect in massive rotator cuff tears will lead to increase functional results; we believe that further studies are needed to describe and evaluate its potential in tendon healing; multiple MRI studies will demonstrate healing of the tendon with the graft.

Retroperitoneal hematoma due to spontaneous lumbar artery rupture during fondaparinux treatment. Case report and review of the literature.

We present the case of a 78 year-old man who developed a spontaneous rupture of the lumbar artery leading to a retroperitoneal hematoma while receiving fondaparinux therapy after a total hip replacement. A selective angiographic embolization stopped the bleeding. Fondaparinux was discontinuated and the patient presented a complete resolution of his medical status. Spontaneous hematomas has been well described during low molecular weight heparin (LMWH) treatment, expecially in elderly patients, but there are no previous reports of hematomas induced by fondaparinux. We reviewed the literature to identify the possible risk-factors of bleeding. Our review shows that even if many works suggest that fondaparinux is a safe and effective alternative to LMWH in the prevention of venous thromboembolism following major orthopaedic surgery, it should carefully be used in elderly people and patients with renal disfunction.

Recovery of physical function and patient's satisfaction after total hip replacement (THR) surgery supported by a tailored guide-book.

BACKGROUND AND AIM OF THE WORK: The purpose of this prospective study was to give a customized guide, describing the hospitalization period and the postoperative exercise program, to patients scheduled for total hip arthroplasty (THA) and to show its effectiveness on functional recovery and on patient's satisfaction with the rehabilitation care and with the in-hospital discharge planning after surgery. METHODS: This trial included 365 consecutive subjects with osteoarthritis who underwent THA at the Orthopaedic and Traumatology Clinic of Siena (Italy). The Harris Hip Score (HHS), a disease specific measure, was determined before and after surgery. Postoperative evaluations, associated with a Satisfaction Questionnaire, were carried out at the time of discharge and after 3 months. RESULTS: The overall satisfaction level was very high, both at discharge (81+/-28) and at follow-up (90+/-17). The HHS results showed a significant (p< or =0.05) improvement over time in patients with higher scores 3 months after surgery in comparison with baseline. CONCLUSIONS: Patients reported high levels of satisfaction at the 3 month postoperative follow-up and good levels at discharge. After surgery, the highest improvements were shown in bodly pain and physical function scores. The current study showed that a customized guide was well accepted by patients with THA and satisfie their need of information. It was also effective in improving patient's satisfaction and early recovery of physical function after surgery.

Metallosis due to impingement between the socket and the femoral head in a total hip prosthesis. A case report.

Metallosis is usually defined as aseptic fibrosis, local necrosis, or loosening of a device secondary to metallic corrosion and release of wear debris. It is an occasional but characteristic clinical finding in patients who have a metal-on-metal design of total hip replacement, or when metal surfaces contact after a failure or erosion of the polyethylene component. We report the case of a patient who had severe metallosis caused by wear of the femoral head with the titanium socket, after the complete erosion and destruction of the polyethylene cup, with failure of the accetabular component. Breakage of the acetabular cup constitutes one of the possible long-term complications occurring as a result of a total hip replacement. This extremely rare complication can occur at any time postoperatively and may not be associated with symptoms or other problems for a long time.

Healing of fresh tibial fractures with OP-1. A preliminary report.

Osteogenic proteins (OP) are elements of a class of natural growth factors called Bone Morphogenetic Proteins (BMP). A specific member of this class is OP-1, a human recombinant protein that has osteogenic properties. The osteoinductive and osteoconductive properties of OP-1, with its specific collagen matrix, promote the generation of new functionally active, biologically and biomechanically mature bone. We carried out a clinical study to verify the potential of this protein in fresh tibial closed fractures, using OP-1 associated with osteosynthesis by means of a monolateral external fixator.

Low-velocity gunshot fractures of the tibia.

A gunshot-related fracture is a unique type of open fracture. Bullet-induced fractures of the tibia may be encountered in any urban or rural setting as a result of hunting or cleaning mishaps or, perhaps more frequently, of criminal activity. For surgeons with limited experience, there is a bewildering range of apparently contradictory advice concerning their management. This article reports a case of a 53-year-old man with a highly comminuted bullet-induced shaft fracture of the tibia received during hunting activity. The patient was treated with a unilateral external fixator and vascularized flap for skin reconstruction. Six months after surgery, the external fixator was removed at clinical and radiological evidence of healing. At 1 year follow-up, the patient obtained complete healing and returned to normal activity.