RESUMEN
PURPOSE: Anterior cruciate ligament (ACL) rupture is the most common complete ligamentous injury in the knee. Many studies explored ACL graft integration and maturation, but only a few assessed the application of platelet rich fibrin matrix (PRFM) as augmentation for ACL reconstruction. The main aim of this study was to test the PRFM augmentation in terms of graft-bone integration and knee stability. The secondary aim was to investigate patient-reported functional status. METHODS: Prospective evaluation has been done in two consecutive series of patients who underwent ACL reconstruction with semitendinosus and gracilis (STG) grafts: 14 patients were operated with PRFM augmentation and 14 patients without PRFM augmentation. Objective clinical evaluation (Rolimeter) and MRI evaluation were performed at 1 year from surgery. Subjective evaluation (IKDC) was performed pre-operatively and at 6 months, 1 and 2 years from surgery. RESULTS: A statistically significant difference was not detected between the two groups in terms of MRI and objective clinical evaluation, although PRFM-augmented patients showed a statistically significant higher clinical improvement. CONCLUSIONS: The procedure described for PRFM augmentation in ACL STG reconstruction does not improve radiologic graft integration and knee stability after 1 year and should not be used by clinicians to this purpose. However, it may result in a short-term improvement of patient-reported knee function, and future research should focus on further developing PRP treatment to optimize ACL clinical outcome. LEVEL OF EVIDENCE: III.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior/métodos , Ligamento Cruzado Anterior/cirugía , Fibrina , Traumatismos de la Rodilla/cirugía , Plasma Rico en Plaquetas , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/fisiopatología , Articulación de la Rodilla/patología , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Prospectivos , RoturaRESUMEN
Leishmaniasis is a group of diseases caused by the protozoa Leishmania, endemic in the Mediterranean countries. Clinical manifestations can be divided into three different forms: cutaneous leishmaniasis, mucosal leishmaniasis and the visceral leishmaniasis, the most severe form which is potentially lethal if untreated. Immunology and pathogenesis are complex: many different aspects of immune response, resistance and susceptibility to Leishmania have been studied but many others remain to be clarified. The gold standard in diagnosis of visceral Leishmaniasis is the presence of amastigotes in bone marrow or tissue sections. Patients can be initially misdiagnosed as having an autoimmune disease because it may mimic diseases like systemic lupus erythematosus, autoimmune hepatitis, dermatomyositis or others disorders. As in pediatric age the risk of life-threatening complications is very high, leishmaniasis, must be kept in mind to the clinician, in order to avoid wrong diagnosis and an inappropriate immunosuppressive therapy.
Asunto(s)
Enfermedades Autoinmunes/inmunología , Leishmaniasis/inmunología , Niño , Interacciones Huésped-Parásitos , Humanos , Leishmaniasis/epidemiología , Leishmaniasis/terapiaRESUMEN
BACKGROUND: Posterior wall fracture is the most common acetabular fracture. Comminuted fractures with an impacted segment represent a subtype of this injury. The subchondral bone of the articular zone is compressed and causes a bone defect. The impacted fragment should be isolated, mobilized, and then reduced. A bone graft should be used to fill the gap. The other fragments are fixed following the reduction of the impacted segment. MATERIALS AND METHODS: Ten patients with comminuted fractures and impacted segments with bone defects were enrolled in our study, from January 2010 to July 2012. Autogenous bone grafts from the greater trochanter were used to fill the gap in all patients. The reduction was achieved through the insertion of the graft above the impacted fracture, and plate fixation was performed subsequently. Merle d'Aubigne and Postel scoring, modified by Matta, was applied to evaluate the patients during follow-up. The mean follow-up was 12 months. RESULTS: The clinical results included one "excellent", four "very good", four "good" and one "poor". Pain in the zone of graft harvesting was not detected in any patient. Femoral head necrosis was observed in one case. No other severe complications were detected. CONCLUSIONS: Using an autogenous bone graft to fill the bone defect supplies excellent mechanical stability without any severe complications at the donor site. This surgical technique seems to be effective and safe in treating a comminuted fracture of the posterior wall in association with an impacted segment. LEVEL OF EVIDENCE: Level IV.
Asunto(s)
Acetábulo/lesiones , Trasplante Óseo , Fémur/trasplante , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Fracturas Conminutas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Placas Óseas , Femenino , Fracturas Conminutas/complicaciones , Luxación de la Cadera/complicaciones , Luxación de la Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
INTRODUCTION: Multifocal humeral fractures are extremely rare. These may affect the neck and the shaft, the shaft alone, or the diaphysis and the distal humerus. There is no classification of these fractures in the literature. MATERIALS AND METHODS: From 2004 to 2010, 717 patients with humeral fracture were treated surgically at our department. Thirty-five patients presented with an associated fracture of the proximal and diaphyseal humerus: synthesis was performed with plate and screws in 34 patients, and the remaining patient had an open fracture that was treated with an external fixator. RESULTS: Mean follow-up was 3 years and 3 months. A classification is proposed in which type A fractures are those affecting the proximal and the humeral shaft, type B the diaphysis alone, and type C the diaphysis in association with the distal humerus. Type A fractures are then divided into three subgroups: A-I, undisplaced fracture of the proximal humerus and displaced shaft fracture; A-II: displaced fracture of the proximal and humeral shaft; and A-III: multifragmentary fracture affecting the proximal humerus and extending to the diaphysis. DISCUSSION: Multifocal humeral fractures are very rare and little described in the literature, both for classification and treatment. The AO classification describes bifocal fracture of the humeral diaphysis, type B and C. The classification suggested in this article mainly concerns fractures involving the proximal and humeral shaft. CONCLUSIONS: A simple classification of multifocal fractures is suggested to help the surgeon choose the most suitable type of synthesis for surgical treatment.
Asunto(s)
Diáfisis/cirugía , Fijadores Externos , Fijación Intramedular de Fracturas , Fracturas del Húmero/cirugía , Húmero/cirugía , Nervio Radial/lesiones , Neuropatía Radial/cirugía , Placas Óseas , Diáfisis/fisiopatología , Diseño de Equipo , Femenino , Estudios de Seguimiento , Curación de Fractura , Humanos , Fracturas del Húmero/clasificación , Fracturas del Húmero/fisiopatología , Húmero/fisiopatología , Masculino , Guías de Práctica Clínica como Asunto , Neuropatía Radial/fisiopatología , Rango del Movimiento Articular , Recuperación de la FunciónRESUMEN
Even though muscle injuries are very common, few scientific data on their effective treatment exist. Growth Factors (GFs) may have a role in accelerating muscle repair processes and a currently available strategy for their delivery into the lesion site is the use of autologous platelet-rich plasma (PRP). The present study is focused on the use of Platelet Rich Fibrin Matrix (PRFM), as a source of GFs. Bilateral muscular lesions were created on the longissimus dorsi muscle of Wistar rats. One side of the lesion was filled with a PRFM while the contralateral was left untreated (controls). Animals were sacrificed at 5, 10, 40 and 60 days from surgery. Histological, immunohistochemical and histomorphometric analyses were performed to evaluate muscle regeneration, neovascularization, fibrosis and inflammation. The presence of metaplasia zones, calcifications and heterotopic ossification were also assessed. PRFM treated muscles exhibited an improved muscular regeneration, an increase in neovascularization, and a slight reduction of fibrosis compared with controls. No differences were detected for inflammation. Metaplasia, ossification and heterotopic calcification were not detected. This preliminary morphological experimental study shows that PRFM use can improve muscle regeneration and long-term vascularization. Since autologous blood products are safe, PRFM may be a useful and handy product in clinical treatment of muscle injuries.
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Fibrina/farmacología , Músculo Esquelético/lesiones , Neovascularización Fisiológica/efectos de los fármacos , Plasma Rico en Plaquetas , Regeneración/efectos de los fármacos , Animales , Masculino , Músculo Esquelético/patología , Ratas , Ratas WistarAsunto(s)
Artritis Juvenil/diagnóstico por imagen , Enfermedad de Hodgkin/diagnóstico por imagen , Artritis Juvenil/patología , Biopsia , Médula Ósea/patología , Niño , Diagnóstico Diferencial , Femenino , Enfermedad de Hodgkin/patología , Humanos , Esplenomegalia/diagnóstico por imagen , UltrasonografíaRESUMEN
There is no agreement on the ideal type of surgical management for Achilles tendon rupture. The present randomized prospective study was performed to compare outcome data of open and percutaneous repair in the treatment of Achilles tendon rupture. Forty consecutive patients with acute rupture of Achilles tendon were recruited. Patients were randomized to receive open (group A) or percutaneous repair with Tenolig (group B). All patients followed the same rehabilitation protocol except for slight differences in the duration of immobilization. Follow-up included objective evaluation (at 4 and 12 months), subjective evaluation using the SF-12 questionnaire (at 24 months), and bilateral ultrasound scanning and isokinetic testing (at 12 months). The differences in the parameters evaluated clinically were not significant except for ankle circumference, which was significantly greater in group B. There were two minor complications in the open repair group and one case of failed repair in the percutaneous group. SF-12 questionnaire, ultrasound and isokinetic test data did not show significant differences between the groups. The present study demonstrates that the open and the percutaneous technique are both safe and effective in repairing the ruptured Achilles tendon and that both afford the same degree of restoration of clinical, ultrasound and isokinetic patterns. Medium-term results were substantially comparable. Percutaneous repair is performed on a day-surgery basis, it reduces cutaneous complications and operation times, and enables faster recovery, enhancing overall patient compliance. To us, these characteristics make it preferable to open repair in managing subcutaneous ruptures of Achilles tendon in non-professional sports practicing adults.
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Tendón Calcáneo/lesiones , Tendón Calcáneo/cirugía , Procedimientos Ortopédicos/métodos , Tendón Calcáneo/diagnóstico por imagen , Adulto , Anestesia Local , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Rotura/cirugía , Anclas para Sutura , Suturas , Resultado del Tratamiento , UltrasonografíaRESUMEN
The histologic features of bone callus after a traumatic fracture in a patient with osteopetrosis are presented. The fracture callus develops in stages that are apparently normal. The tissue is initially rich in bone-forming cells and vessels. One year later, however, unlike mature osteopetrotic bone, the tissue shows no Haversian organization.
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Callo Óseo/citología , Fracturas del Fémur/patología , Fracturas de Cadera/patología , Osteopetrosis/patología , Adulto , Humanos , Masculino , Osteopetrosis/complicacionesRESUMEN
A case of intravascular papillary endothelial hyperplasia in the hypothenar eminence of a 23-year-old female fencer is described. Differential diagnosis with other similar benign and malignant lesions was made using histopathology and immunohistochemistry. The possible post-traumatic proliferative histogenesis is discussed. The non-malignant nature of the mass was confirmed after a three year follow-up.