Profunda Femoris Artery Pseudoaneurysm after Intramedullary Fixation for a Pertrochanteric Hip Fracture.

INTRODUCTION: Vascular complications after femoral fixation are rare and not only easy to recognize but also potentially life-threatening. The aim of this case report is to describe how a pseudoaneurysm of the deep femoral artery can complicate an intramedullary nailing after a pertrochanteric fracture and how it can be treated. CASE REPORT: We report the case of a 90-year-old female who developed a pseudoaneurysm of the profunda femoris artery 16 days after intramedullary femoral nailing for a pertrochanteric hip fracture. Stenting of the artery was urgently performed with a consequent resolution of the symptoms. CONCLUSION: Diagnosis of vascular complications after hip surgery may be very challenging because symptoms are often nonspecific. Despite their rarity, it is important to know this type of complications to address the diagnostic pathway in the right direction and to treat them promptly.

How to Direct the Neuronal Growth Process in Peripheral Nerve Regeneration: Future Strategies for Nanosurfaces Scaffold and Magnetic Nanoparticles.

Currently, the gold standard to repair large nerve defects is the autologous nerve graft. These solutions offer a mechanical support, adhesion substrates, and, with Schwann cells (SC), a source of neurotropic factors for axonal growth. The technical limits are the donor side damage, multiple surgical accesses, and the unavailability of large amounts of grafts. In recent years, several researchers focused their attention on the interaction between cells (nervous and glial) and physic-chemical cues that arise from the extracellular milieu. Nanotechnologies produce surfaces that mimic the topographical signals (physical stimuli) that arise from enterprise content management (ECM) to modulate the forces acting during axonal elongation. The use of magnetic nanoparticles (MNPs) seems to be able to guide and to boost the nerve regeneration. Both research areas could be improved through surfaces functionalization by biological molecules (proteins/peptides, growth factors, etc.). In the future, the aim will be to help recovery after peripheral nerve lesion by producing a tridimensional structured conduit, then repeat the ECM architecture and take advantage of MNPs internalized by cells and guide them through tension forces by external magnetic fields to stimulate and direct axon growing. The aims of this review were to evaluate the findings of studies that used physical stimuli (nanoscaffold surfaces and MNPs) used for peripheral nerve regeneration support. The future trends in the field of peripheral nerve regeneration continue to produce a wide variety of new techniques to improve the opportunity for advances to treat peripheral nerve injuries.

Magnetic Nanoparticles for Efficient Delivery of Growth Factors: Stimulation of Peripheral Nerve Regeneration.

The only clinically approved alternative to autografts for treating large peripheral nerve injuries is the use of synthetic nerve guidance conduits (NGCs), which provide physical guidance to the regenerating stump and limit scar tissue infiltration at the injury site. Several lines of evidence suggest that a potential future strategy is to combine NGCs with cellular or molecular therapies to deliver growth factors that sustain the regeneration process. However, growth factors are expensive and have a very short half-life; thus, the combination approach has not been successful. In the present paper, we proposed the immobilization of growth factors (GFs) on magnetic nanoparticles (MNPs) for the time- and space-controlled release of GFs inside the NGC. We tested the particles in a rat model of a peripheral nerve lesion. Our results revealed that the injection of a cocktail of MNPs functionalized with nerve growth factor (NGF) and with vascular endothelial growth factor (VEGF) strongly accelerate the regeneration process and the recovery of motor function compared to that obtained using the free factors. Additionally, we found that injecting MNPs in the NGC is safe and does not impair the regeneration process, and the MNPs remain in the conduit for weeks.

Nanoparticles for Tendon Healing and Regeneration: Literature Review.

Tendon injuries are commonly met in the emergency department. Unfortunately, tendon tissue has limited regeneration potential and usually the consequent formation of scar tissue causes inferior mechanical properties. Nanoparticles could be used in different way to improve tendon healing and regeneration, ranging from scaffolds manufacturing (increasing the strength and endurance or anti-adhesions, anti-microbial, and anti-inflammatory properties) to gene therapy. This paper aims to summarize the most relevant studies showing the potential application of nanoparticles for tendon tissue regeneration.

Treatment of Scaphoid Waist Nonunion Using Olecranon Bone Graft and Stryker Asnis Micro Cannulated Screw: A Retrospective Study-80 Case Studies and 6 Years of Follow-Up.

Background Screw fixation and bone grafting are the gold standard for scaphoid waist nonunion without avascular necrosis. Question/Purpose Assesses the scaphoid waist nonunion healing rate with use of an uncommon cancellous bone graft (olecranon) and an unusual fixation system (Asnis Micro Cannulated Screw System; Stryker Inc., Kalamazoo, MI, USA). Material and Methods A series of 102 consecutive patients were treated for scaphoid waist nonunion (without deformity). Of these, 80 patients subjected to clinical (Modified Mayo Wrist Score (MMWS), Jamar hydraulic dynamometer) and radiographic examination before and after surgery were evaluated. Ipsilateral olecranon cancellous bone graft and the ASNIS Micro 3.0-mm diameter screw, were used. The average follow up was 6 years (min 3; max 10). Results Radiographic consolidation was achieved in 90% of patients; dorsal intercalated segment instability (DISI) deformities were corrected in 71.4% of cases. Ninety percent improved the range of motion of the wrist and grip strength. All patients showed a significant reduction of peak force in the operated hand. In 6.25% we observed clinical and radiographic screw head-trapezium impingement. Twenty-six patients developed a degenerative wrist sign. The MMWS yielded 68 optimal, 8 good, and 4 bad results. Conclusions To treat scaphoid waist nonunions without misalignment, low-profile headed screw and olecranon bone graft allowed a high consolidation rate with positive results to long-term follow-up. The Asnis Micro 3.0 mm diameter screw may be a suitable option for treating scaphoid waist nonunion. Level of Evidence IV.