Antonio Medici - Academia.edu (original) (raw)

Papers by Antonio Medici

Research paper thumbnail of Treatment of vasospastic angina pectoris at rest with nitroglycerin ointment: A short-term controlled study in the coronary care unit

The American Journal of Cardiology, 1981

Research paper thumbnail of Treatment of angina at rest with nifedipine: A short-term controlled study

The American Journal of Cardiology, 1980

The effectiveness of nifedipine in treating angina pectoris at rest was evaluated in 14 patients ... more The effectiveness of nifedipine in treating angina pectoris at rest was evaluated in 14 patients with frequent ischemic episodes associated with S-T segment elevation or depression. The trial consisted of (1) a 48 hour control period; (2) a placebo period and a period of treatment with nifedipine of 48 hours each; and (3) a second placebo period and a second period of treatment with nifedipine of 24 hours each. The efficacy of treatment was evaluated by continuous electrocardiographic recording to detect painless ischemic episodes. During coronary angiography coronary spasm was demonstrated in five patients. The ergonovine maleate test was positive in seven of eight patients. No statistically significant difference was found in the mean daily number of ischemic episodes between the control period and the first placebo period, or between the control and the second placebo periods. Nifedipine produced a highly significant reduction in the mean daily number of episodes compared with the response to placebo during the first as well as the second period. Nifedipine is effective in angina at rest caused by coronary arterial spasm. The prevention of ischemia may be related to the ability of nifedipine to decrease calcium-dependent coronary muscle tone and to prevent coronary spasm.

Research paper thumbnail of Major trauma, definitive treatment of the lower limbs

Lo Scalpello - Otodi Educational

Multifocal fractures of the femur in modern traumatology are becoming more frequent and often pos... more Multifocal fractures of the femur in modern traumatology are becoming more frequent and often pose difficult problems for treatment. These fractures are frequently associated with other comorbidities, necessitating thorough trauma life support assessment and interdisciplinary care. Associated ipsilateral femoral neck fractures have been reported to occur in 1% to 9% of femoral shaft fractures. The associated femoral neck fracture is often nondisplaced, and diagnosis is delayed or missed in up to one-third of cases. It is essential to carefully evaluate the femoral neck in all patients sustaining high-energy femoral shaft fractures. No consensus exists regarding the timing of surgery, sequence of fixation, or the optimal implant choice in the treatment of ipsilateral femoral neck and shaft fractures because these fractures are relatively rare, and patients often present with concomitant multi-system injuries. Fixation of these combined injury patterns is challenging, and multiple treatment options exist. Treatment goals should include anatomic reduction and adequate fixation of the femoral neck fracture, as well as restoration of the length, alignment, and rotation of the femoral shaft fracture. While most authors recommend surgical fixation within 24 hours, if possible, and to give priority to anatomic reduction and optimal stabilization of the femoral neck fracture because nonunion, malunion, or avascular necrosis of this injury is more difficult to successfully treat, other studies demonstrate that the use of separate implants can lead to a better result.

Research paper thumbnail of Periprosthetic Knee Fracture with the Left Floating Total Knee and Left Bimalleolar Fracture: A Case Report

Research paper thumbnail of The Exchange Reamed Nailing technique in the treatment of aseptic tibial nonunion. A literature review of 371 cases

Lo Scalpello - Otodi Educational, 2021

The persistence of pain at the fracture site and the absence of bone callus at X-ray controls are... more The persistence of pain at the fracture site and the absence of bone callus at X-ray controls are the univocal criteria for diagnosis of nonunion. When this failure befalls, the healing process has stopped and the fracture is no longer able to consolidate without surgery. The aim of this review is to investigate the use and outcomes of the Exchange Reamed Nailing (ERN) technique for aseptic tibial shaft nonunion. Replacement surgery with an oversized reamed nail showed 91% success. After a tibial fracture, nonunion is to be expected in 17% of cases, with a majority of the hypertrophic type (82%). To avoid further failures, the following is essential: to increase the mechanical stability by implanting an oversize nail and lock it with 2 distal static screws and a proximal dynamic screw; to ream the canal to promote vascularisation with osteoinductive and osteoconductive effects; to ensure the absence of a latent infection, which can lead to osteomyelitis in 18% of failures. Autologous bone grafting and fibula osteotomy are useful in specific cases.

Research paper thumbnail of Indicazioni e limiti dell'inchiodamento retrogrado dinamico nel trattamento delle fratture di femore diafisarie e del III distale nel giovane adulto Indications and limitations of retrograde dynamic nailing in the treatment of shaft and distal femoral fractures in young adult Articolo originAle 174

Giornale Italiano di Ortopedia e Traumatologia 2016;42:174-181 Riassunto Background. Nei pazienti... more Giornale Italiano di Ortopedia e Traumatologia 2016;42:174-181 Riassunto Background. Nei pazienti giovani le fratture diafisarie (FDF) e del III distale di femore (3DF) sono più comuni di quelle del III prossimale perché causate da traumi ad alta energia. L'inchiodamento retrogrado può essere una soluzione per il trattamento di queste fratture. Obiettivo. Lo scopo di questo studio è di comprendere le indicazioni e i limiti dell'inchiodamento retrogrado non bloccato prossimalmente nel trattamento delle FDF e 3DF. Materiali e metodi. Dal Giugno 2008 al Dicembre 2014 abbiamo trattato presso l'U.O.C. Orto-pedia e Traumatologia dell'A.O.R.N. G. Rummo di Benevento: 16 FDF e 21 3DF. L'età media dei pazienti è stata di 33,65 anni (range 16-45), 32 maschi e solo 5 femmine. La classificazione usata per caratterizzare le lesioni è stata quella dell'AO. I pazienti erano tutti politraumi dovuti a traumi ad alta energia cinetica. Tutti i pazienti sono stati trattati con il...

Research paper thumbnail of The management of pin-care in external fixation technique: Povidone-Iodine versus sodium hypochlorite 0,05% (Amukina-Med®) medications

Currently, there is no universal approach to pin-site care for preventing infection. The medicati... more Currently, there is no universal approach to pin-site care for preventing infection. The medication of these pins is essential for obtaining good external fixation results. The purpose of this study is to evaluate the results obtained after pins were medicated with two different disinfectants: povidone-iodine (10%) and sodium hypochlorite 0,05% (Amukina-med®). Methods: 237 pins of 40 patients treated with Hoffmann II external fixation have been analyzed in our study. The average age was 41.3 (ranging from 19-71). All pins were inserted by hand pre-drilling together with continuous irrigation with cold saline to reduce the risk of thermal necrosis. Patients were divided into 2 groups consisting of 20 patients each: in group A, 109 pins were medicated with povidone-iodine and in group B, 128 pins were medicated with sodium hypochlorite 0,05%. Results: 24 pins (22%) medicated with povidone-iodine became infected, as well as 13 pins (10,1%) medicated with sodium hypochlorite. A few pins mobilized: 13 in group A and 6 in group B. In all cases, infections were resolved with oral antibiotic therapy. Conclusions: Our study showed that medication with sodium hypochlorite 0,05% reduced the percentage of pin-tract infection and mobilization with respect to povidone-iodine, demonstrated by significant statistical evidence (Chi-square's test: p<0.05).

Research paper thumbnail of Indicazioni e limiti dell’inchiodamento retrogrado dinamico nel trattamento delle fratture di femore diafisarie e del III distale nel giovane adulto

Indicazioni e limiti dell'inchiodamento retrogrado dinamico nel trattamento delle fratture di fem... more Indicazioni e limiti dell'inchiodamento retrogrado dinamico nel trattamento delle fratture di femore diafisarie e del III distale nel giovane adulto Indications and limitations of retrograde dynamic nailing in the treatment of shaft and distal femoral fractures in young adult Articolo originAle

Research paper thumbnail of The treatment of intertrochanteric fracture: a survey on the preferred treatment used by orthopedic surgeons in Campania

Lo Scalpello - Otodi Educational, 2021

Hip fragility fractures incidence is constantly increasing, and outcomes are mostly poor in terms... more Hip fragility fractures incidence is constantly increasing, and outcomes are mostly poor in terms of both morbidity and mortality. Surgery is the treatment of choice for most hip fractures, but the choice between the various fixation devices is difficult. We conducted a survey on the treatment of trochanteric fractures among orthopedic surgeons in Campania using a Google form questionnaire. The preferred treatment was cephalomedullary distal locked nailing for most fractures, while sliding hip screws and hip replacement were limited to 31 A1.2 and 31.B2 fractures.

Research paper thumbnail of Fractures around Trochanteric Nails: The “Vergilius Classification System”

Advances in Orthopedics, 2021

Introduction. The fractures that occurred around trochanteric nails (perinail fractures, PNFs) ar... more Introduction. The fractures that occurred around trochanteric nails (perinail fractures, PNFs) are becoming a huge challenge for the orthopaedic surgeon. Although presenting some specific critical issues (i.e., patients’ outcomes and treatment strategies), these fractures are commonly described within peri-implant ones and their treatment was based on periprosthetic fracture recommendations. The knowledge gap about PNFs leads us to convene a research group with the aim to propose a specific classification system to guide the orthopaedic surgeon in the management of these fractures. Materials and Methods. A steering committee, identified by two Italian associations of orthopaedic surgeons, conducted a comprehensive literature review on PNFs to identify the unmet needs about this topic. Subsequently, a panel of experts was involved in a consensus meeting proposing a specific classification system and formulated treatment statements for PNFs. Results and Discussion. The research group ...

Research paper thumbnail of The challenge of total knee arthroplasty periprosthetic fracture: a comprehensive review

Lo Scalpello - Otodi Educational, 2020

Total knee arthroplasty (TKA) is a common procedure in orthopeadic surgery. It has been estimated... more Total knee arthroplasty (TKA) is a common procedure in orthopeadic surgery. It has been estimated that the incidence of periprosthetic fractures after TKA ranged between 0.3 to 2.5%, but increases to 38% when considering revision TKA. Patient-related risk factors for TKA periprosthetic fracture (TKAPF) include osteoporosis, age, female gender, revision arthroplasty and osteolysis. The choice of the most appropriate fixation device of TKAPF is a matter of debate, considering that locking plates and retrograde intramedullary are both associated with good outcomes in terms of fracture union and joint function. In case of prosthetic component instability, severe comminution or metaphyseal extension of the fracture that precludes fixation, failure of previous treatments, and severe malalignment of the TKA, revision TKA (RTKA) should be considered. Severe bone loss is another issue of concern, that might be addressed using both megaprosthesis or allograft-prosthesis composite. Considering the variability of the clinical scenario of TKAPF, a comprehensive approach based on both fracture fixation and/or revision arthroplashty is needed.

Research paper thumbnail of The orthopaedic and traumatology scenario during Covid-19 outbreak in Italy: chronicles of a silent war

International Orthopaedics, 2020

Background From February 21, the day of hospitalisation in ICU of the first diagnosed case of Cov... more Background From February 21, the day of hospitalisation in ICU of the first diagnosed case of Covid-19, the social situation and the hospitals' organisation throughout Italy dramatically changed. Methods The CIO (Club Italiano dell'Osteosintesi) is an Italian society devoted to the study of traumatology that counts members spread in public and private hospitals throughout the country. Fifteen members of the CIO, Chairmen of 15 Orthopaedic and Trauma Units of level 1 or 2 trauma centres in Italy, have been involved in the study. They were asked to record data about surgical, outpatients clinics and ER activity from the 23rd of February to the 4th of April 2020. The data collected were compared with the data of the same timeframe of the previous year (2019). Results Comparing with last year, overall outpatient activity reduced up to 75%, overall Emergency Room (ER) trauma consultations up to 71%, elective surgical activity reduced up to 100% within two weeks and trauma surgery excluding femoral neck fractures up to 50%. The surgical treatment of femoral neck fractures showed a stable reduction from 15 to 20% without a significant variation during the timeframe. Conclusions Covid-19 outbreak showed a tremendous impact on all orthopaedic trauma activities throughout the country except for the surgical treatment of femoral neck fractures, which, although reduced, did not change in percentage within the analysed timeframe.

Research paper thumbnail of Bilateral fractures of acetabulum in a young girl with osteogenesis imperfecta and epilepsy

Trauma Case Reports, 2020

We report a case of bilateral displaced acetabular fractures including both columns fractures wit... more We report a case of bilateral displaced acetabular fractures including both columns fractures with protrusio acetabuli in a female patient, aged 15 years, with osteogenesis imperfecta (OI) (Sillence Type I), epilepsy, blue sclera and bilateral ipoacusia. Since OI is a rare genetic disorder characterized by an increased propensity to osteopenia, intraoperative fracture risks and hemorrhagic diathesis, we opted for the open reduction and internal fixation of the acetabula in two surgical steps and using two different approaches. Although the clinical outcomes are not excellent in this report (HHS 45/100), the authors suggest that chances of a good outcome with reconstruction of the acetabulum must be balanced against the benefits of early or late total hip arthroplasty. The goal was to delay a joint replacement as long as possible due to the patient's young age. Level of evidence: V, case report.

Research paper thumbnail of Foot Loading and Gait Analysis Evaluation of Nonarticular Tibial Pilon Fracture: A Comparison of Three Surgical Techniques

The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, Jan 15, 2018

The aim of our study was to investigate which technique among hybrid external fixation, plate and... more The aim of our study was to investigate which technique among hybrid external fixation, plate and screws, and intramedullary nailing produces better outcomes in foot loading when treating type 43.A1, 43.A2, and 43.A3 fractures, according to the AO classification. From November 2011 to December 2014, 34 patients, including 25 (73.5%) males and 9 (26.5%) females with an average age of 32.3 (range 16 to 67) years, with a type A tibia fracture were treated with intramedullary nailing, plate and screws, or hybrid external fixation. The patients were divided into 3 groups: 16 (47%) received hybrid external fixation, 10 (29.4%) received plate and screw fixation, and 8 (23.5%) received intramedullary nailing fixation. The follow-up protocol included clinical and radiologic evaluations performed at 15 days, 1 month, 3 months, 6 months, and 12 months after surgery. The selected outcome parameters for the 3 groups were as follows: visual analog scale for pain of the traumatized tibia, interval...

Research paper thumbnail of Nail or plate in the management of distal extra-articular tibial fracture, what is better? Valutation of outcomes

SICOT-J, 2018

Distal tibial fractures are the most common long bone fractures. Several studies focusing on the ... more Distal tibial fractures are the most common long bone fractures. Several studies focusing on the methods of treatment of displaced distal tibial fractures have been published. To date, locked plates, intramedullary nails and external fixation are the three most used techniques. The aim of our study was to compare intramedullary nail (IMN) and locked plate (LP) for treatment of this kind of fracture. We collected data on 81 patients with distal tibial fractures (distance from the joint between 40 and 100 mm) and we divided into two groups: IMN and LP. We compared in the 2 groups the mean operation time, the mean union time, the infection rate the rate of malunion and nonunion, the full weight bearing time. No patient in the two groups developed a nonunion. None of the patients obtained a fair or poor outcome. Overall 52 patients obtained an excellent result (69.3%) and 23 obtained a good result (30.6%). Our study results indicate a superiority of IMN over LP in terms of lower rates o...

Research paper thumbnail of Does routine carpal tunnel release during fixation of distal radius fractures improve outcomes?

Injury, 2017

This case-control study was designed to test the hypothesis whether carpal tunnel release (CTR) d... more This case-control study was designed to test the hypothesis whether carpal tunnel release (CTR) during fixation of distal radius 23-C2 AO fractures improves outcomes. Thirty-five consecutive patients who sustained distal radius fractures of the dominant hand participated in this study. Patients were allocated into two groups: (a) The ORIF + CTR (16 patients (11 males and 5 females)); (b) the ORIF and NOT CTR 19 patients (12 males and 7 females). Patient assessment included visual analogic scale of pain (VAS), the subjective Mayo Wrist Score (MWS), electromyograms (EMG) at 3 month and 6 months from the day of injury and complications. All patients had the same physiotherapy treatment algorithm following surgery. Patient follow up took place at 1 month, 3, 6, and 12 months. A the T12 month follow up point the VAS average was 0.8 (range 0-3) in ORIF + CTR group compared to 1.2 (range 0-3) in the ORIF and NOT CTR. The MWS average was 98.7 (range 95-100) in ORIF + CTR group versus 97.6 (...

Research paper thumbnail of Tibial Intercondylar Eminence Fracture

Scripta Medica, 2016

Introduction: Tibial intercondylar eminence fractures are uncommon injuries, occurring mainly in ... more Introduction: Tibial intercondylar eminence fractures are uncommon injuries, occurring mainly in adolescents and young adults. When necessary, regardless of patient age, anatomic reduction and stable internal fixation are mandatory for fracture healing and accurate restoration of normal knee biomechanics. There are various arthroscopically assisted fixation methods (sutures, anchors, wires, or screws). We present a case, in which we reduced the fracture using fiber wire suture, fixing it with EndoButton® on the medial tibial tuberosity, with a clinical and radiological follow-up of three months.

Research paper thumbnail of Treatment of acute proximal humeral fractures in children with modular external fixator

Journal of Acute Disease, 2016

To evaluate the follow-up of the fractures treated by external fixator. Methods: A total of 31 ch... more To evaluate the follow-up of the fractures treated by external fixator. Methods: A total of 31 children aged 6-15 years with proximal humeral fractures Grade IV according to Neer-Horowitz classification were treated. The medium follow-up was 24 months. Results: In all cases, a good stability of the fracture and a quick healing process were obtained. The mean time of follow-up was 24 months. The external fixation was removed after 6 weeks (5-8 weeks) on average. Constant shoulder score was proposed to all patients and the average result was 97.5 (84-100). Conclusions: Advantages of the external fixation are rapid mobilization of the joint, low invasiveness, a single surgery and the possibility to correct any secondary displacement. It is important to underline that the positioning of external fixator should be implanted by expert surgeons and that the patients must cooperate during the entire process up to the time of the removal of the fixator.

Research paper thumbnail of Prelom interkondilarne eminencije tibije

Research paper thumbnail of Dynamic corset versus three-point brace in the treatment of osteoporotic compression fractures of the thoracic and lumbar spine: a prospective, comparative study

Aging Clinical and Experimental Research, 2016

Background The three-point orthosis is the most commonly used brace in the conservative treatment... more Background The three-point orthosis is the most commonly used brace in the conservative treatment of osteoporotic vertebral fractures. The Spinomed dynamic orthosis represents an alternative. AQ1 Aims We compared efficacy and safety of these two types of brace in treating osteoporotic vertebral fractures. Methods One hundred forty patients, aged 65-93 years, sustaining osteoporotic vertebral fracture were consecutively recruited and divided into two groups, and treated with either three-point orthosis or dynamic corset. Patients were evaluated with Visual Analogue Scale, Oswestry Low Back Pain Disability Questionnaire, and measurement of forced expiratory volume in the first second. Regional kyphosis angle, Delmas Index, and height of the fractured vertebral body were also measured on full-spine X-rays. Follow-up intervals were 1, 3, and 6 months after trauma. The complications encountered during the 6-month follow-up were recorded. AQ2 Results At the 3-and 6-month follow-ups, there was a significant difference (p < 0.05) in pain, disability, and respiration in favor of the dynamic orthosis group. At 6-month follow-up, there was no significant difference (p > 0.05) in all the radiological parameters between groups. Complications were reported for 28 patients in the three-point orthosis group, and for eight patients in the dynamic corset group (p < 0.05).

Research paper thumbnail of Treatment of vasospastic angina pectoris at rest with nitroglycerin ointment: A short-term controlled study in the coronary care unit

The American Journal of Cardiology, 1981

Research paper thumbnail of Treatment of angina at rest with nifedipine: A short-term controlled study

The American Journal of Cardiology, 1980

The effectiveness of nifedipine in treating angina pectoris at rest was evaluated in 14 patients ... more The effectiveness of nifedipine in treating angina pectoris at rest was evaluated in 14 patients with frequent ischemic episodes associated with S-T segment elevation or depression. The trial consisted of (1) a 48 hour control period; (2) a placebo period and a period of treatment with nifedipine of 48 hours each; and (3) a second placebo period and a second period of treatment with nifedipine of 24 hours each. The efficacy of treatment was evaluated by continuous electrocardiographic recording to detect painless ischemic episodes. During coronary angiography coronary spasm was demonstrated in five patients. The ergonovine maleate test was positive in seven of eight patients. No statistically significant difference was found in the mean daily number of ischemic episodes between the control period and the first placebo period, or between the control and the second placebo periods. Nifedipine produced a highly significant reduction in the mean daily number of episodes compared with the response to placebo during the first as well as the second period. Nifedipine is effective in angina at rest caused by coronary arterial spasm. The prevention of ischemia may be related to the ability of nifedipine to decrease calcium-dependent coronary muscle tone and to prevent coronary spasm.

Research paper thumbnail of Major trauma, definitive treatment of the lower limbs

Lo Scalpello - Otodi Educational

Multifocal fractures of the femur in modern traumatology are becoming more frequent and often pos... more Multifocal fractures of the femur in modern traumatology are becoming more frequent and often pose difficult problems for treatment. These fractures are frequently associated with other comorbidities, necessitating thorough trauma life support assessment and interdisciplinary care. Associated ipsilateral femoral neck fractures have been reported to occur in 1% to 9% of femoral shaft fractures. The associated femoral neck fracture is often nondisplaced, and diagnosis is delayed or missed in up to one-third of cases. It is essential to carefully evaluate the femoral neck in all patients sustaining high-energy femoral shaft fractures. No consensus exists regarding the timing of surgery, sequence of fixation, or the optimal implant choice in the treatment of ipsilateral femoral neck and shaft fractures because these fractures are relatively rare, and patients often present with concomitant multi-system injuries. Fixation of these combined injury patterns is challenging, and multiple treatment options exist. Treatment goals should include anatomic reduction and adequate fixation of the femoral neck fracture, as well as restoration of the length, alignment, and rotation of the femoral shaft fracture. While most authors recommend surgical fixation within 24 hours, if possible, and to give priority to anatomic reduction and optimal stabilization of the femoral neck fracture because nonunion, malunion, or avascular necrosis of this injury is more difficult to successfully treat, other studies demonstrate that the use of separate implants can lead to a better result.

Research paper thumbnail of Periprosthetic Knee Fracture with the Left Floating Total Knee and Left Bimalleolar Fracture: A Case Report

Research paper thumbnail of The Exchange Reamed Nailing technique in the treatment of aseptic tibial nonunion. A literature review of 371 cases

Lo Scalpello - Otodi Educational, 2021

The persistence of pain at the fracture site and the absence of bone callus at X-ray controls are... more The persistence of pain at the fracture site and the absence of bone callus at X-ray controls are the univocal criteria for diagnosis of nonunion. When this failure befalls, the healing process has stopped and the fracture is no longer able to consolidate without surgery. The aim of this review is to investigate the use and outcomes of the Exchange Reamed Nailing (ERN) technique for aseptic tibial shaft nonunion. Replacement surgery with an oversized reamed nail showed 91% success. After a tibial fracture, nonunion is to be expected in 17% of cases, with a majority of the hypertrophic type (82%). To avoid further failures, the following is essential: to increase the mechanical stability by implanting an oversize nail and lock it with 2 distal static screws and a proximal dynamic screw; to ream the canal to promote vascularisation with osteoinductive and osteoconductive effects; to ensure the absence of a latent infection, which can lead to osteomyelitis in 18% of failures. Autologous bone grafting and fibula osteotomy are useful in specific cases.

Research paper thumbnail of Indicazioni e limiti dell'inchiodamento retrogrado dinamico nel trattamento delle fratture di femore diafisarie e del III distale nel giovane adulto Indications and limitations of retrograde dynamic nailing in the treatment of shaft and distal femoral fractures in young adult Articolo originAle 174

Giornale Italiano di Ortopedia e Traumatologia 2016;42:174-181 Riassunto Background. Nei pazienti... more Giornale Italiano di Ortopedia e Traumatologia 2016;42:174-181 Riassunto Background. Nei pazienti giovani le fratture diafisarie (FDF) e del III distale di femore (3DF) sono più comuni di quelle del III prossimale perché causate da traumi ad alta energia. L'inchiodamento retrogrado può essere una soluzione per il trattamento di queste fratture. Obiettivo. Lo scopo di questo studio è di comprendere le indicazioni e i limiti dell'inchiodamento retrogrado non bloccato prossimalmente nel trattamento delle FDF e 3DF. Materiali e metodi. Dal Giugno 2008 al Dicembre 2014 abbiamo trattato presso l'U.O.C. Orto-pedia e Traumatologia dell'A.O.R.N. G. Rummo di Benevento: 16 FDF e 21 3DF. L'età media dei pazienti è stata di 33,65 anni (range 16-45), 32 maschi e solo 5 femmine. La classificazione usata per caratterizzare le lesioni è stata quella dell'AO. I pazienti erano tutti politraumi dovuti a traumi ad alta energia cinetica. Tutti i pazienti sono stati trattati con il...

Research paper thumbnail of The management of pin-care in external fixation technique: Povidone-Iodine versus sodium hypochlorite 0,05% (Amukina-Med®) medications

Currently, there is no universal approach to pin-site care for preventing infection. The medicati... more Currently, there is no universal approach to pin-site care for preventing infection. The medication of these pins is essential for obtaining good external fixation results. The purpose of this study is to evaluate the results obtained after pins were medicated with two different disinfectants: povidone-iodine (10%) and sodium hypochlorite 0,05% (Amukina-med®). Methods: 237 pins of 40 patients treated with Hoffmann II external fixation have been analyzed in our study. The average age was 41.3 (ranging from 19-71). All pins were inserted by hand pre-drilling together with continuous irrigation with cold saline to reduce the risk of thermal necrosis. Patients were divided into 2 groups consisting of 20 patients each: in group A, 109 pins were medicated with povidone-iodine and in group B, 128 pins were medicated with sodium hypochlorite 0,05%. Results: 24 pins (22%) medicated with povidone-iodine became infected, as well as 13 pins (10,1%) medicated with sodium hypochlorite. A few pins mobilized: 13 in group A and 6 in group B. In all cases, infections were resolved with oral antibiotic therapy. Conclusions: Our study showed that medication with sodium hypochlorite 0,05% reduced the percentage of pin-tract infection and mobilization with respect to povidone-iodine, demonstrated by significant statistical evidence (Chi-square's test: p<0.05).

Research paper thumbnail of Indicazioni e limiti dell’inchiodamento retrogrado dinamico nel trattamento delle fratture di femore diafisarie e del III distale nel giovane adulto

Indicazioni e limiti dell'inchiodamento retrogrado dinamico nel trattamento delle fratture di fem... more Indicazioni e limiti dell'inchiodamento retrogrado dinamico nel trattamento delle fratture di femore diafisarie e del III distale nel giovane adulto Indications and limitations of retrograde dynamic nailing in the treatment of shaft and distal femoral fractures in young adult Articolo originAle

Research paper thumbnail of The treatment of intertrochanteric fracture: a survey on the preferred treatment used by orthopedic surgeons in Campania

Lo Scalpello - Otodi Educational, 2021

Hip fragility fractures incidence is constantly increasing, and outcomes are mostly poor in terms... more Hip fragility fractures incidence is constantly increasing, and outcomes are mostly poor in terms of both morbidity and mortality. Surgery is the treatment of choice for most hip fractures, but the choice between the various fixation devices is difficult. We conducted a survey on the treatment of trochanteric fractures among orthopedic surgeons in Campania using a Google form questionnaire. The preferred treatment was cephalomedullary distal locked nailing for most fractures, while sliding hip screws and hip replacement were limited to 31 A1.2 and 31.B2 fractures.

Research paper thumbnail of Fractures around Trochanteric Nails: The “Vergilius Classification System”

Advances in Orthopedics, 2021

Introduction. The fractures that occurred around trochanteric nails (perinail fractures, PNFs) ar... more Introduction. The fractures that occurred around trochanteric nails (perinail fractures, PNFs) are becoming a huge challenge for the orthopaedic surgeon. Although presenting some specific critical issues (i.e., patients’ outcomes and treatment strategies), these fractures are commonly described within peri-implant ones and their treatment was based on periprosthetic fracture recommendations. The knowledge gap about PNFs leads us to convene a research group with the aim to propose a specific classification system to guide the orthopaedic surgeon in the management of these fractures. Materials and Methods. A steering committee, identified by two Italian associations of orthopaedic surgeons, conducted a comprehensive literature review on PNFs to identify the unmet needs about this topic. Subsequently, a panel of experts was involved in a consensus meeting proposing a specific classification system and formulated treatment statements for PNFs. Results and Discussion. The research group ...

Research paper thumbnail of The challenge of total knee arthroplasty periprosthetic fracture: a comprehensive review

Lo Scalpello - Otodi Educational, 2020

Total knee arthroplasty (TKA) is a common procedure in orthopeadic surgery. It has been estimated... more Total knee arthroplasty (TKA) is a common procedure in orthopeadic surgery. It has been estimated that the incidence of periprosthetic fractures after TKA ranged between 0.3 to 2.5%, but increases to 38% when considering revision TKA. Patient-related risk factors for TKA periprosthetic fracture (TKAPF) include osteoporosis, age, female gender, revision arthroplasty and osteolysis. The choice of the most appropriate fixation device of TKAPF is a matter of debate, considering that locking plates and retrograde intramedullary are both associated with good outcomes in terms of fracture union and joint function. In case of prosthetic component instability, severe comminution or metaphyseal extension of the fracture that precludes fixation, failure of previous treatments, and severe malalignment of the TKA, revision TKA (RTKA) should be considered. Severe bone loss is another issue of concern, that might be addressed using both megaprosthesis or allograft-prosthesis composite. Considering the variability of the clinical scenario of TKAPF, a comprehensive approach based on both fracture fixation and/or revision arthroplashty is needed.

Research paper thumbnail of The orthopaedic and traumatology scenario during Covid-19 outbreak in Italy: chronicles of a silent war

International Orthopaedics, 2020

Background From February 21, the day of hospitalisation in ICU of the first diagnosed case of Cov... more Background From February 21, the day of hospitalisation in ICU of the first diagnosed case of Covid-19, the social situation and the hospitals' organisation throughout Italy dramatically changed. Methods The CIO (Club Italiano dell'Osteosintesi) is an Italian society devoted to the study of traumatology that counts members spread in public and private hospitals throughout the country. Fifteen members of the CIO, Chairmen of 15 Orthopaedic and Trauma Units of level 1 or 2 trauma centres in Italy, have been involved in the study. They were asked to record data about surgical, outpatients clinics and ER activity from the 23rd of February to the 4th of April 2020. The data collected were compared with the data of the same timeframe of the previous year (2019). Results Comparing with last year, overall outpatient activity reduced up to 75%, overall Emergency Room (ER) trauma consultations up to 71%, elective surgical activity reduced up to 100% within two weeks and trauma surgery excluding femoral neck fractures up to 50%. The surgical treatment of femoral neck fractures showed a stable reduction from 15 to 20% without a significant variation during the timeframe. Conclusions Covid-19 outbreak showed a tremendous impact on all orthopaedic trauma activities throughout the country except for the surgical treatment of femoral neck fractures, which, although reduced, did not change in percentage within the analysed timeframe.

Research paper thumbnail of Bilateral fractures of acetabulum in a young girl with osteogenesis imperfecta and epilepsy

Trauma Case Reports, 2020

We report a case of bilateral displaced acetabular fractures including both columns fractures wit... more We report a case of bilateral displaced acetabular fractures including both columns fractures with protrusio acetabuli in a female patient, aged 15 years, with osteogenesis imperfecta (OI) (Sillence Type I), epilepsy, blue sclera and bilateral ipoacusia. Since OI is a rare genetic disorder characterized by an increased propensity to osteopenia, intraoperative fracture risks and hemorrhagic diathesis, we opted for the open reduction and internal fixation of the acetabula in two surgical steps and using two different approaches. Although the clinical outcomes are not excellent in this report (HHS 45/100), the authors suggest that chances of a good outcome with reconstruction of the acetabulum must be balanced against the benefits of early or late total hip arthroplasty. The goal was to delay a joint replacement as long as possible due to the patient's young age. Level of evidence: V, case report.

Research paper thumbnail of Foot Loading and Gait Analysis Evaluation of Nonarticular Tibial Pilon Fracture: A Comparison of Three Surgical Techniques

The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, Jan 15, 2018

The aim of our study was to investigate which technique among hybrid external fixation, plate and... more The aim of our study was to investigate which technique among hybrid external fixation, plate and screws, and intramedullary nailing produces better outcomes in foot loading when treating type 43.A1, 43.A2, and 43.A3 fractures, according to the AO classification. From November 2011 to December 2014, 34 patients, including 25 (73.5%) males and 9 (26.5%) females with an average age of 32.3 (range 16 to 67) years, with a type A tibia fracture were treated with intramedullary nailing, plate and screws, or hybrid external fixation. The patients were divided into 3 groups: 16 (47%) received hybrid external fixation, 10 (29.4%) received plate and screw fixation, and 8 (23.5%) received intramedullary nailing fixation. The follow-up protocol included clinical and radiologic evaluations performed at 15 days, 1 month, 3 months, 6 months, and 12 months after surgery. The selected outcome parameters for the 3 groups were as follows: visual analog scale for pain of the traumatized tibia, interval...

Research paper thumbnail of Nail or plate in the management of distal extra-articular tibial fracture, what is better? Valutation of outcomes

SICOT-J, 2018

Distal tibial fractures are the most common long bone fractures. Several studies focusing on the ... more Distal tibial fractures are the most common long bone fractures. Several studies focusing on the methods of treatment of displaced distal tibial fractures have been published. To date, locked plates, intramedullary nails and external fixation are the three most used techniques. The aim of our study was to compare intramedullary nail (IMN) and locked plate (LP) for treatment of this kind of fracture. We collected data on 81 patients with distal tibial fractures (distance from the joint between 40 and 100 mm) and we divided into two groups: IMN and LP. We compared in the 2 groups the mean operation time, the mean union time, the infection rate the rate of malunion and nonunion, the full weight bearing time. No patient in the two groups developed a nonunion. None of the patients obtained a fair or poor outcome. Overall 52 patients obtained an excellent result (69.3%) and 23 obtained a good result (30.6%). Our study results indicate a superiority of IMN over LP in terms of lower rates o...

Research paper thumbnail of Does routine carpal tunnel release during fixation of distal radius fractures improve outcomes?

Injury, 2017

This case-control study was designed to test the hypothesis whether carpal tunnel release (CTR) d... more This case-control study was designed to test the hypothesis whether carpal tunnel release (CTR) during fixation of distal radius 23-C2 AO fractures improves outcomes. Thirty-five consecutive patients who sustained distal radius fractures of the dominant hand participated in this study. Patients were allocated into two groups: (a) The ORIF + CTR (16 patients (11 males and 5 females)); (b) the ORIF and NOT CTR 19 patients (12 males and 7 females). Patient assessment included visual analogic scale of pain (VAS), the subjective Mayo Wrist Score (MWS), electromyograms (EMG) at 3 month and 6 months from the day of injury and complications. All patients had the same physiotherapy treatment algorithm following surgery. Patient follow up took place at 1 month, 3, 6, and 12 months. A the T12 month follow up point the VAS average was 0.8 (range 0-3) in ORIF + CTR group compared to 1.2 (range 0-3) in the ORIF and NOT CTR. The MWS average was 98.7 (range 95-100) in ORIF + CTR group versus 97.6 (...

Research paper thumbnail of Tibial Intercondylar Eminence Fracture

Scripta Medica, 2016

Introduction: Tibial intercondylar eminence fractures are uncommon injuries, occurring mainly in ... more Introduction: Tibial intercondylar eminence fractures are uncommon injuries, occurring mainly in adolescents and young adults. When necessary, regardless of patient age, anatomic reduction and stable internal fixation are mandatory for fracture healing and accurate restoration of normal knee biomechanics. There are various arthroscopically assisted fixation methods (sutures, anchors, wires, or screws). We present a case, in which we reduced the fracture using fiber wire suture, fixing it with EndoButton® on the medial tibial tuberosity, with a clinical and radiological follow-up of three months.

Research paper thumbnail of Treatment of acute proximal humeral fractures in children with modular external fixator

Journal of Acute Disease, 2016

To evaluate the follow-up of the fractures treated by external fixator. Methods: A total of 31 ch... more To evaluate the follow-up of the fractures treated by external fixator. Methods: A total of 31 children aged 6-15 years with proximal humeral fractures Grade IV according to Neer-Horowitz classification were treated. The medium follow-up was 24 months. Results: In all cases, a good stability of the fracture and a quick healing process were obtained. The mean time of follow-up was 24 months. The external fixation was removed after 6 weeks (5-8 weeks) on average. Constant shoulder score was proposed to all patients and the average result was 97.5 (84-100). Conclusions: Advantages of the external fixation are rapid mobilization of the joint, low invasiveness, a single surgery and the possibility to correct any secondary displacement. It is important to underline that the positioning of external fixator should be implanted by expert surgeons and that the patients must cooperate during the entire process up to the time of the removal of the fixator.

Research paper thumbnail of Prelom interkondilarne eminencije tibije

Research paper thumbnail of Dynamic corset versus three-point brace in the treatment of osteoporotic compression fractures of the thoracic and lumbar spine: a prospective, comparative study

Aging Clinical and Experimental Research, 2016

Background The three-point orthosis is the most commonly used brace in the conservative treatment... more Background The three-point orthosis is the most commonly used brace in the conservative treatment of osteoporotic vertebral fractures. The Spinomed dynamic orthosis represents an alternative. AQ1 Aims We compared efficacy and safety of these two types of brace in treating osteoporotic vertebral fractures. Methods One hundred forty patients, aged 65-93 years, sustaining osteoporotic vertebral fracture were consecutively recruited and divided into two groups, and treated with either three-point orthosis or dynamic corset. Patients were evaluated with Visual Analogue Scale, Oswestry Low Back Pain Disability Questionnaire, and measurement of forced expiratory volume in the first second. Regional kyphosis angle, Delmas Index, and height of the fractured vertebral body were also measured on full-spine X-rays. Follow-up intervals were 1, 3, and 6 months after trauma. The complications encountered during the 6-month follow-up were recorded. AQ2 Results At the 3-and 6-month follow-ups, there was a significant difference (p < 0.05) in pain, disability, and respiration in favor of the dynamic orthosis group. At 6-month follow-up, there was no significant difference (p > 0.05) in all the radiological parameters between groups. Complications were reported for 28 patients in the three-point orthosis group, and for eight patients in the dynamic corset group (p < 0.05).