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PURPOSE: Floating hip fractures are severe and rare injuries with high complication rate and lack of standard management. The purpose of this retrospective study was to review the outcomes of a case series of polytraumatized patients with floating hip injuries, in order to describe the relationship between complication rate and floating hip injury type, the pathomechanism of injury, and the surgical treatment strategy. METHODS: Forty-five patients with floating hip injuries were analyzed. Complication rate, mechanism of injury, and surgical strategy (damage control orthopedics, stages of internal fixation) were recorded. Fractures were classified using the Mueller system for floating hips and AO/OTA system for the other fractures. RESULTS: Of the 45 patients with floating hip injuries, 23 (51.1%) developed complications. The results revealed that the complication rate was associated with the instability and type of the pelvic or acetabular fracture (61-C AO/OTA pelvic fracture [73.3%; p = 0.04], 62-B AO/OTA acetabular fracture [88.8%; p = 0.03]). Vertical shear (VS) pelvic fractures were related to middle-distal femoral fractures and lateral compression/anteroposterior compression (LC/APC) pelvic lesions were associated to proximal femoral fractures (p = 0.012). CONCLUSIONS: Complications were associated with the severity and instability of the pelvic and acetabular type of fractures. The pathomechanism causing Mueller type B and C floating hip injuries was illustrated. A two-stage "femur first" surgical approach was the preferred one for definite internal fixation of fractures.
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Fracturas del Fémur , Huesos Pélvicos , Acetábulo/lesiones , Acetábulo/cirugía , Fracturas del Fémur/cirugía , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Humanos , Huesos Pélvicos/lesiones , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Inaccurate projection on standard pelvic radiographs leads to the underestimation of femoral offset-a critical determinant of postoperative hip function-during total hip arthroplasty (THA) templating. We noted that the posteromedial facet of the greater trochanter and piriformis fossa form a double contour on radiographs, which may be valuable in determining the risk of underestimating femoral offset. We evaluate whether projection errors can be predicted based on the double contour width. METHODS: Plain anteroposterior (AP) pelvic radiographs and magnetic resonance images (MRIs) of 64 adult hips were evaluated retrospectively. Apparent femoral offset, apparent femoral head diameter and double contour widths were evaluated from the radiographs. X-ray projection errors were estimated by comparison to the true neck length measured on MRIs after calibration to the femoral heads. Multivariate analysis with backward elimination was used to detect associations between the double contour width and radiographic projection errors. Femoral offset underestimation below 10% was considered acceptable for templating. RESULTS: The narrowest width of the double line between the femoral neck and piriformis fossa is significantly associated with projection error. When double line widths exceed 5 mm, the risk of projection error greater than 10% is significantly increased compared to narrower double lines, and the acceptability rate for templating drops below 80% (p = 0.02). CONCLUSION: The double contour width is a potential landmark for excluding pelvic AP radiographs unsuitable for THA templating due to inaccurate femoral rotation.
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Artroplastia de Reemplazo de Cadera , Articulación de la Cadera , Adulto , Fémur/diagnóstico por imagen , Fémur/cirugía , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Humanos , Estudios Retrospectivos , Tomografía Computarizada por Rayos XAsunto(s)
Osteoartritis de la Cadera , Femenino , Cadera , Articulación de la Cadera/diagnóstico por imagen , Humanos , Masculino , Debilidad Muscular/diagnóstico , Debilidad Muscular/epidemiología , Debilidad Muscular/etiología , Osteoartritis de la Cadera/diagnóstico , Osteoartritis de la Cadera/epidemiologíaRESUMEN
INTRODUCTION: Hip magnetic resonance arthrography (MRA) is the pre-operative imaging modality of choice in patients with labral damage, with several classifications of labral tears having been reported based on MRA findings. Nevertheless, none of the available classification systems allows the surgeon to predict before surgery how a labral tear could be treated. Our purpose was to develop a new MRA-based scoring system of labral tears to predict before surgery the treatment option more suitable for labral tears. MATERIALS AND METHODS: Forty-seven patients (29 males and 18 females; mean age: 35.9 ± 12.4) performed hip MRA for suspicious of femoroacetabular impingement and were afterwards subjected to arthroscopic treatment. Two musculoskeletal radiologists reviewed all pre-operative examinations and provided the Extension-Thickness-Damage score for each patient, based on Extension of tear, Thickness of labrum, and type of Damage. Chondral lesions grading was based on the arthroscopic findings according to Konan classification. For statistical purposes, patients were divided into two groups, depending on the type of treatment: labral repair or debridement. Mann-Whitney U, Chi-square, receiver operator curves, and Cohen kappa statistics were used. RESULTS: 35/47 underwent repair, while 12/47 were debrided. In both groups, the median chondral damage was grade III, with no significant differences (p = 0.439). The median Extension-Thickness-Damage score in the repair group (6) was significantly lower (p < 0.001) than that in the debridement group (8). The highest diagnostic performance (area under the curve) of Extension-Thickness-Damage was 0.819. The inter-observer agreement was substantial in the evaluation of Extension (k = 0.626) and Thickness (k = 0.771), and almost perfect for Damage (k = 0.827). Higher scores of Extension and Thickness were more frequently associated with debridement (p < 0.001; p = 0.0016, respectively), with no significant differences on the basis of Damage parameter (p = 0.284). CONCLUSIONS: The MRA-based Extension-Thickness-Damage score could represent a helpful pre-operative tool, expressing the extent of the damage and its reparability before arthroscopy.
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Artrografía/métodos , Pinzamiento Femoroacetabular/diagnóstico por imagen , Lesiones de la Cadera/diagnóstico por imagen , Articulación de la Cadera/diagnóstico por imagen , Imagen por Resonancia Magnética , Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Adolescente , Adulto , Artroscopía , Desbridamiento , Femenino , Pinzamiento Femoroacetabular/clasificación , Pinzamiento Femoroacetabular/cirugía , Fibrocartílago/diagnóstico por imagen , Fibrocartílago/lesiones , Fibrocartílago/cirugía , Lesiones de la Cadera/clasificación , Articulación de la Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Rotura , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
BACKGROUND: Greater Trochanter Pain Syndrome (GTPS) is the main reason for recalcitrant lateral hip pain. Gluteus medius and minimus tendinopathy plays a key role in this setting. An injectable medical compound containing collagen type I (MD-Tissue, Guna) has been produced with the aim to counteract the physiological and pathological degeneration of tendons. In this study we aimed at characterizing the effect of this medical compound on cultured human gluteal tenocytes, focusing on the collagen turnover pathways, in order to understand how this medical compound could influence tendon biology and healing. METHODS: Tenocytes were obtained from gluteal tendon fragments collected in eight patients without any gluteal tendon pathology undergoing total hip replacement through an anterior approach. Cell proliferation and migration were investigated by growth curves and wound healing assay, respectively. The expression of genes and proteins involved in collagen turnover were analysed by real-time PCR, Slot blot and SDS-zymography. RESULTS: Our data show that tenocytes cultured on MD-Tissue, compared to controls, have increased proliferation rate and migration potential. MD-Tissue induced collagen type I (COL-I) secretion and mRNA levels of tissue inhibitor of matrix metalloproteinases (MMP)-1 (TIMP-1). Meanwhile, lysyl hydroxylase 2b and matrix metalloproteinases (MMP)-1 and -2, involved, respectively, in collagen maturation and degradation, were not affected. CONCLUSIONS: Considered as a whole, our results suggest that MD-Tissue could induce in tenocytes an anabolic phenotype by stimulating tenocyte proliferation and migration and COL-I synthesis, maturation, and secretion, thus favouring tendon repair. In particular, based on its effect on gluteal tenocytes, MD-Tissue could be effective in the discouraging treatment of GTPS. From now a rigorous clinical investigation is desirable to understand the real clinical potentials of this compound.
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The correct management of acute, subacute and overuse-related elbow pathologies represents a challenging diagnostic and therapeutic problem. While major trauma frequently requires a rapid surgical intervention, subluxation and minor trauma allow taking more time for diagnostics and planning the correct elective treatment after careful clinical and radiological investigation. In these conditions, communication between orthopaedic surgeon and radiologist allow to create a detailed radiology report, tailored to the patient's and surgeon's needs and optimal to plan proper management. Imaging technique as X-Ray, CT, US, MRI, CTA and MRA all belong to the radiologist's portfolio in elbow diagnostics. Detailed knowledge of elbow pathology and its classification and of the possibilities and limits of each imaging technique is of crucial importance to reach the correct diagnosis efficiently. The aim of this review is to present the most frequent elbow pathologies and suggest a suitable diagnostic approach for each of them.
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Trastornos de Traumas Acumulados/diagnóstico por imagen , Lesiones de Codo , Articulación del Codo/diagnóstico por imagen , Diagnóstico por Imagen/métodos , Fracturas Óseas/diagnóstico por imagen , Humanos , Luxaciones Articulares/diagnóstico por imagen , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/terapia , Codo de Tenista/diagnóstico por imagenRESUMEN
There is still no "gold standard" for the diagnosis and prognosis of post-operative periprosthetic joint infection (PJI). Among serum biomarkers, an emerging molecule is presepsin, the soluble fraction of CD14, recently described in other settings as a powerful diagnostic tool to detect sepsis at different degrees of severity. The aim of this study was to investigate the diagnostic and prognostic value of presepsin in PJI. A total of 30 patients with PJI and 30 patients without PJI were enrolled. Presepsin, C-reactive protein (CRP), serum interleukin (IL)-6, triggering receptor expressed on myeloid cells 1 (TREM-1), CCL2, matrix metalloproteinase 9 (MMP-9), CD163, osteopontin (OPN), and toll-like receptor 2 (TLR2) were measured at different times after surgery. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were analyzed for each biomarker. Presepsin showed greater diagnostic value than CRP and IL-6; CD163, TREM-1, and MMP-9 had very low diagnostic potential. Presepsin, OPN, CCL2, suPAR, and TLR2 all decreased significantly with increasing time of recovery after surgery in PJI patients. Presepsin can be considered a useful tool for the diagnosis and clinical monitoring of PJI and can be backed by a panel of new inflammatory markers involved in monocyte-/macrophage-mediated inflammatory responses, such as OPN, CCL2, TLR2, and suPAR.
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Receptores de Lipopolisacáridos/metabolismo , Fragmentos de Péptidos/metabolismo , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/metabolismo , Adolescente , Antígenos CD/metabolismo , Antígenos de Diferenciación Mielomonocítica/metabolismo , Área Bajo la Curva , Biomarcadores/metabolismo , Proteína C-Reactiva/metabolismo , Quimiocina CCL2/metabolismo , Femenino , Humanos , Inflamación/metabolismo , Interleucina-6/metabolismo , Masculino , Metaloproteinasa 9 de la Matriz/metabolismo , Osteopontina/metabolismo , Pronóstico , Infecciones Relacionadas con Prótesis/patología , Curva ROC , Receptores de Superficie Celular/metabolismo , Sepsis/metabolismo , Receptor Toll-Like 2/metabolismo , Receptor Activador Expresado en Células Mieloides 1/metabolismoRESUMEN
BACKGROUND: Fluid samples obtained from an affected joint still play a central role in the diagnosis of periprosthetic joint infection (PJI). It is the only preoperative test able to discover the causative microbiological agent. In the hip, fluid aspiration can be performed through fluoroscopy, ultrasound, or, less commonly, computed tomography. However, there is still a lack of consensus on which method is preferable in terms of efficacy and costbenefit. PURPOSES: We, therefore, asked whether (1) the benefits in terms of sensitivity and specificity and (2) the costs were comparable between fluoroscopy- and ultrasound-guided joint aspirations in a suspicious of hip PJI. METHODS: Between 2013 and 2016, 52 hip aspirations were performed on 49 patients with clinical, radiological, or serological suspicion of PJI, waiting for a revision surgery. The patients were divided in two groups: fluoroscopy- (n = 26) vs ultrasound-guided hip aspiration group (n = 26). These groups were also divided in control and infected patients. The criteria of MusculoSkeletal Infection Society (MSIS) were used, as gold standard, to define PJI. RESULTS: (1) Ultrasound-guided aspiration revealed valid sensitivity (89% vs 60%) and specificity (94% vs 81%) in comparison with fluoroscopic-guided aspiration. (2) The cost analysis was also in favor of ultrasound-guided aspiration (125.30) than fluoroscopic-guided aspiration (343.58). CONCLUSIONS: We concluded that ultrasound-guided hip aspiration could represent a valid, safe, and less expensive diagnostic alternative to fluoroscopic-guided aspiration in hip PJI.
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Fluoroscopía , Prótesis de Cadera , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/cirugía , Succión/métodos , Cirugía Asistida por Computador , Ultrasonografía , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Costos y Análisis de Costo , Femenino , Fluoroscopía/economía , Prótesis de Cadera/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/etiología , Estudios Retrospectivos , Sensibilidad y Especificidad , Succión/economía , Cirugía Asistida por Computador/economía , Ultrasonografía/economíaRESUMEN
BACKGROUND: The demand for decorative tattoos is steadily growing worldwide, and in the US it is estimated that up to 24% of adults has one or more tattoos. Subsequently, the number of tattoo-related complications is increasing. Among these, lymphoproliferative disorders play a minor but important role. The aim of this article is to arouse the awareness of plastic surgeons and dermatologists about this rare but serious complication and to stimulate stricter clinical control of their tattooed patients. METHODS: We report a new case of tattoo-related cutaneous pseudolymphoma (CPL) and perform a review of the last 30 years of literature on the topic in PubMed. RESULTS: Apart from this new case, only 18 cases of CPL have been reported in PubMed so far. In contrast to the classic knowledge, the T cell was the predominant phenotype in 68% of cases. Red is confirmed to be the most involved ink. Topical and intralesional steroids, laser therapy, and surgery were used for treatment of CPL. CONCLUSIONS: Even if CPL is a very rare and benign complication, we should not forget that in rare cases pseudolymphoma may evolve into a true lymphoma. Diagnosis is still difficult and is based on anamnestic, clinical, and histopathological data. From the review of the literature, the T cell predominance suggests a reclassification of tattoo-induced CPL and there is not a gold standard treatment yet. Finally, once a pseudolymphoma is diagnosed, there must be a long follow-up because of the possibility to transform into a malignancy. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Colorantes/efectos adversos , Tinta , Seudolinfoma/inducido químicamente , Enfermedades de la Piel/inducido químicamente , Tatuaje/efectos adversos , Adulto , Biopsia con Aguja , Procedimientos Quirúrgicos Dermatologicos/métodos , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Masculino , Seudolinfoma/patología , Seudolinfoma/cirugía , Enfermedades Raras , Medición de Riesgo , Enfermedades de la Piel/patología , Enfermedades de la Piel/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine malignancy that usually grows rapidly at the head and neck. Giant forms at the lower limbs are rarely reported and usually affect patients in the eighth decade or older. METHODS: We report the case of a 60-year-old man who presented with a giant MCC on his right thigh. We managed this case by applying the 2012 updated guidelines and reviewed all cases of giant MCC of the lower limbs reported in the literature. RESULTS: At the 4-month follow-up, the patient showed complete remission. CONCLUSION: Giant forms of MCC are still treated as typical cases of MCC, when these patients show a very poor prognosis. In young and adult people, such as our case, wide surgical excisions, sentinel lymph node biopsy in clinically negative node cases, radiotherapy of the regional drain area, and a strict follow-up should be routinely performed to improve patients' survival.
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Carcinoma de Células de Merkel/patología , Neoplasias Cutáneas/patología , Carcinoma de Células de Merkel/terapia , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Cutáneas/terapia , MusloRESUMEN
A isquemia mesentérica aguda é uma emergência vascular com alto índice de mortalidade e sua incidência vem aumentando nas últimas décadas. Determinar a necessidade de ressecar a alça intestinal, qual segmento preservar e avaliar a viabilidade do segmento preservado continua sendo um desafio para o cirurgião, o qual se vale, quase que exclusivamente, de critérios clínicos intra-operatórios para decidir a conduta. Diversos métodos experimentais estão sendo estudados para avaliar a viabilidade intestinal. Realizou-se revisão da literatura do período de 1975 a 2007 sobre a utilização da imagem infravermelha na avaliação intra-operatória da viabilidade intestinal. Concluiu-se que a imagem infravermelha poderá ser um método sensível, rápido e confiável para a avaliação intra-operatória da viabilidade intestinal.