An Italian experience with mechanochemical ablation of the saphenous vein since 2012.

OBJECTIVE: Mechanochemical endovenous ablation is a nonthermal method to ablate superficial incompetent veins. The aim of this paper was to assess short-term complications and 5-year follow-up outcomes. METHODS: This is a retrospective single-center study of data collected prospectively. We treated, in an outpatient setting, 395 primary, symptomatic, unilateral, incompetent varicose saphenous veins. No patients were treated bilaterally in the same session. The majority were great saphenous veins (92.3%), and the others were small saphenous veins. Procedures were performed with a mechanochemical endovenous occlusion catheter (ClariVein endovenous occlusion catheter; Merit Medical, South Jordan, Utah) and polidocanol 2% in liquid form. RESULTS: Follow-up was available for 329 patients treated between September 2012 and September 2017 with a mean follow-up time of 20 ± 18 months (range, 6-60 months). Technical success was achieved in 99.5%; in two patients, we were unable to complete the procedures because of vein spasm leading to catheter damage and inability to infuse the sclerosant. Follow-up was performed with clinical evaluation and duplex ultrasound scan at 1 week, 1 month, 6 months, and 1 year and then once every year. The overall survival rate free from recanalization was 92.4%. Anatomic success is 94% at 1 year, 91% at 2 years, 88% at 3 years, 88% at 4 years, and 84% at 5 years. The follow-up at 5 years includes 23 patients, 5 of whom presented with recanalization; moreover, in this series, in 36% of cases, the veins completely disappeared on duplex ultrasound scan. CONCLUSIONS: The ClariVein catheter is associated with a good occlusion rate, comparable with other techniques including thermal techniques, without major complications.

Effectiveness of the Dynamic Internal Fixator System in Metaphyseal and Epiphyseal Femoral Fractures: 10 Years of Experience and Future Expectations.

Angular stability plates are largely used for treating complex fractures, but the incidence of nonunion is high. The innovative dynamic internal fixator (DIF) system is comprised of a plate with angular stability that combines the principles of internal fixator with dynamic device. In this study, we evaluate the feasibility of surgical reconstruction using the DIF in adult patients with epiphyseal-metaphyseal femur fractures and examine complications and outcomes at long-term follow-up. We retrospectively analyze 26 patients (14 females and 12 males), with a mean age of 64 yr, who were treated for femoral fractures between 2008 and 2017. Primary fractures were stratified according to the Muller AO Classification of fractures (mostly types 33-A3 and 31-A3). One patient was treated for a periprosthetic fracture and another for the early breakage of a conventional plate. Mean overall follow-up was 4.3 yr. Fracture healing with complete bony consolidation was achieved in 25 of 26 patients (96%). Two patients experienced complete union after revision surgery. The mean time to bridging callus formation was 58 d (range, 41 d to 4 mo) and to radiographic union was 4.6 mo (range, 1.2 to 12.5 mo). Dynamization of the system was performed in 16 cases. The following major complications occurred in 15% of cases: wound dehiscence (1), nonunion (2), and deep infection (1). No implant breakdowns were observed. The DIF system merged the advantages of angular stability plates with the possibility of dynamization, increasing fracture site compression to modulate and guarantee the healing process.

Intramedullary nailing versus external fixation in Gustilo type III open tibial shaft fractures: a meta-analysis of randomised controlled trials.

Open tibial shaft fractures are the most common of long-bone open fractures. Management of the fracture is either by intramedullary nailing (IMN) or by external fixation (EF). Since the literature does not indicate clearly which is more effective, a meta-analysis was conducted to establish which approach is more suitable to treat Gustilo type III fractures. MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE and CINAHL databases were searched for randomised controlled trials (RCT) describing IMN and EF treatment of Gustilo type III fractures. As of 15 November 2012, five RCT involving 239 patients had been published; the outcomes examined in this study are their surgical complications. Data analysis led complications to be grouped into infection, fracture healing problems (non-union, malunion) and "other complications" (vascular injury, revision surgery, soft tissue damage, mechanical failure and tibial malalignment). IMN was associated with lower rates of infection and fracture healing problems; the differences between the two approaches for "other complications" were not significant. The data indicate that IMN is the treatment of choice for Gustilo type III fractures.

Oral chondroprotection with nutraceuticals made of chondroitin sulphate plus glucosamine sulphate in osteoarthritis.

Oral supplementation of chondroitin sulphate plus glucosamine helps repair the articular surface in osteoarthritis. Chondroitin-S reduces the concentration of the pro-inflammatory cytokines and transcription factor involved in inflammation. GlcN.S enhances cartilage specific matrix components and prevents collagen degeneration in chondrocytes by inhibiting hydrolytic enzymes, and preventing the oxidation of lipids and proteins. Chondroitin-S plus GlcN.S are slow-acting drugs that alleviate pain and partly restore joint function in OA patients. Orally administered pharmaceutical-grade chondroitin-S plus GlcN.S stabilize the joint space narrowing and significantly decrease the number of patients with new erosive OA. They are safe and no adverse events have ever been reported; they are recommended by EULAR and OARSI. The cost/effectiveness of the oral chondroitin-S plus GlcN.S therapy derives from the reduction of costs for physiotherapy, and for gastroprotective and non-steroidal drugs. The synergistic association of these two world-widely preferred nutraceuticals is a step forward in the management of OA.