Giuseppe Bosco - Academia.edu (original) (raw)

Papers by Giuseppe Bosco

le complicazioni nella stabilizzazione percutanea delle fratture del rachide toracico e lombare: ... more le complicazioni nella stabilizzazione percutanea delle fratture del rachide toracico e lombare: analisi di 101 pazienti con follow-up minimo di 1 anno complications in minimal invasive percutaneous fixation of thoracic and lumbar fractures: analysis of 101 patients with 1-year minimum follow-up riassunto Introduzione. L'osteosintesi percutanea mininvasiva delle fratture vertebrali amieliche toraciche e lombari rappresenta una valida alternativa al trattamento incruento. Obiettivi. Valutazione dei limiti e delle complicazioni di questa tecnica chirurgica in rapporto al trattamento incruento e all'artrodesi vertebrale con tecnica open Materiale e metodi. Da maggio 2005 a maggio 2010 sono state stabilizzate 133 fratture vertebrali del tratto toracico e lombare in 101 pazienti. La localizzazione più frequente è stata al passaggio toraco-lombare. Tutte le fratture sono state classificate secondo la classificazione AO di Magerl. Risultati. Le complicazioni sono state suddivise secondo un ordine temporale di comparsa in intraoperatorie e postoperatorie. Queste ultime si dividono a loro volta in precoci e tardive. A seconda della gravità sono suddivise in maggiori e minori.Abbiamo avuto 12 complicazioni (12%) suddivise in 4 intraoperatorie (4%), 6 postoperatorie precoci (6%) e 2 postoperatorie tardive (2%). Quattro complicazioni sono risultate minori (4%), e 8 maggiori (8%). Conclusioni. L'osteosintesi percutanea mininvasiva risulta essere una tecnica chirurgica sicura con una bassa percentuali di complicazioni, anche se potenzialmente severe per il paziente, a fronte di un rapido e completo recupero funzionale con ripresa dell'attività lavorativa in tempi brevi.

Minimally Invasive Surgery, 2012

We studied 122 patients with 163 fractures of the thoracic and lumbar spine undergoing the surgic... more We studied 122 patients with 163 fractures of the thoracic and lumbar spine undergoing the surgical treatment by percutaneous transpedicular fixation and stabilization with minimally invasive technique. Patient followup ranged from 6 to 72 months (mean 38 months), and the patients were assessed by clinical and radiographic evaluation. The results show that percutaneous transpedicular fixation and stabilization with minimally invasive technique is an adequate and satisfactory procedure to be used in specific type of the thoracolumbar and lumbar spine fractures.

Orthopedics, 2009

Adamantinoma is a rare tumor with an indolent course that occurs most commonly in the tibia. It i... more Adamantinoma is a rare tumor with an indolent course that occurs most commonly in the tibia. It is locally aggressive, and local recurrences are described after resection. Pain is the most common symptom. Since the lesion is typically slow growing, the pain can be present for many years before the patient seeks medical attention. Microscopically, adamantinoma consists of islands of epithelial cells in a fibrous stroma. Nuclear atypia is minimal, and mitotic figures are rare. The most common radiographic appearance is that of multiple sharply demarcated radiolucent lesions surrounded by areas of dense, sclerotic bone. This tumor most often affects the tibial diaphysis and produces lytic lesions that can cause fractures. A 31-year-old man presented with a rapidly growing lytic lesion of the distal tibia. On histological examination, many areas of epithelial cells in a fibrous stroma were identified. Diagnosis of adamantinoma was performed. The lesion was treated with en bloc resection and reconstruction with distal tibia allograft and ankle arthrodesis with retrograde nail. At 2-year follow-up, there were no clinical or radiological signs of recurrence of disease.

$Research paper thumbnail of Complications in minimally invasive percutaneous fixation of thoracic and lumbar spine fractures and tumors$

European Spine Journal, 2013

Full article available online at Healio.com/Orthopedics. Search: 20130523-16 Minimally invasive s... more Full article available online at Healio.com/Orthopedics. Search: 20130523-16 Minimally invasive stabilization of thoracic and lumbar fractures without neurologic involvement is becoming a more frequent alternative to open fusion and conservative treatment. The authors analyzed the complication rate and limits of this technique in a consecutive series of 99 patients (127 thoracolumbar vertebral fractures) who underwent this technique between May 2005 and November 2009. Eighty-three patients had only spine injuries, whereas 16 had polytrauma injuries (mean Injury Severity Score, 25.2). In these 16 patients, percutaneous fixation was performed as a damage control procedure. The most frequent construct was monosegmental: 1 level above and 1 level below the fractured vertebra. In the remaining 21 patients, multilevel construction was performed for multiple injuries. Complications were analyzed according to the period of onset (intra-and postoperative) and the severity (major and minor). Twelve (12%) complications were recorded: 4 (4%) were intraoperative, 6 (6%) were early postoperative, and 2 (2%) were late postoperative; 4 (4%) were minor and 8 (8%) were major. Mean follow-up was 52 months (range; 36-90 months). All patients except 1 were considered healed after 6-month follow-up. The failed patient had an initial kyphosis greater than 20°, and a posterior open reduction and fusion would have been more appropriate. Minimally invasive stabilization of selected spine injuries is a safe technique with a low complication rate. The main goal of this approach is a fast recovery time, so any complication leading to an extended length of stay should be considered severe. An adequate learning curve is important to minimize complications.

European Spine Journal, 2012

Purpose Pre-curved peek rods to support posterior lumbar fusion have been available in the market... more Purpose Pre-curved peek rods to support posterior lumbar fusion have been available in the market since 4 years. Potential advantages using this new technology are increased load sharing on the anterior column promoting interbody fusion, reduced stress on bone-screw interface decreasing the rate of screw mobilization and, in the long term, reduced incidence of adjacent level disc degeneration. Methods The authors retrospectively reviewed 30 cases in which posterior fusion was supported by peek rods, analyzing early complications, rate of fusion and clinical outcome. Results At an average follow-up of 18 months, both clinical and radiographic results were satisfactory with only one case requiring surgical revision for a mechanical complication. Conclusions The semi-rigid systems can now be considered a viable option in the lumbar degenerative disease, although clinical evaluations are necessary in the longer term.

European Spine Journal, 2013

Introduction Surgical management of upper cervical spine (UCS) unstable injuries may be challengi... more Introduction Surgical management of upper cervical spine (UCS) unstable injuries may be challenging as the number of cases requiring this surgery collected in every single center is small. This retrospective study was conducted to analyze the radiographic and clinical results in 12 patients undergoing a posterior occipito-cervical fusion by a polyaxial screws-rod-plate system. Methods There were eight male and four female patients with a mean age of 73.7 years (range 32-89 years). Six patients presented neurologic deficits at admission. Six patients had sustained major trauma. The remaining six patients had suffered a minor trauma. Results Two patients died postoperatively in Intensive Care Unit. All surviving patients achieved solid fusion at 6 months. No surviving patient had neurological deterioration postoperatively. There were no instrumentation failures or revision required. Two patients suffered from superficial occipital wound infection. Conclusions Although the indication to occipito-cervical fusion decreased since the new C1-C2 posterior fixation techniques were described, it remains a valid and reliable option in UCS post-traumatic instability to be applied even in emergency especially in the elderly.

$Research paper thumbnail of Results in treatment of distal femur fractures using polyaxial locking plate$

Strategies in trauma and limb reconstruction (Online), 2014

Indications and techniques of locked plate fixation for the treatment of challenging fractures co... more Indications and techniques of locked plate fixation for the treatment of challenging fractures continue to evolve. As design variant of classic locked plates, the polyaxial locked plate has the ability to alter the screw angle and thereby, enhance fracture fixation. The aim of this observational study was to evaluate clinical and radiographic results in 89 patients with 90 fractures of the distal femur treated, between June 2006 and November 2011, with such a polyaxial locked plating system (Polyax™ Locked Plating System, DePuy, Warsaw, IN, USA). Seventy-seven fractures formed the report of this study. These cases were followed up until complete fracture healing or for a mean time of 77 weeks. At the time of last follow-up, 58 of 77 fractures (75.3 %) progressed to union without complication and radiographic healing occurred at a mean time of 16.3 weeks. Complications occurred in ten fractures that did not affect the healing and in nine fractures that showed delayed or non-union. Th...

ABSTRACT Rehabilitation is a crucial issue in the management of spinal cord injuries (SCI) but, i... more ABSTRACT Rehabilitation is a crucial issue in the management of spinal cord injuries (SCI) but, in these patients, the primary treatment can bias the outcome of recovery protocols. Purpose of this paper is to review our case load in the treatment of surgical failures and to define the role of surgery in thoraco-lumbar injuries rehabilitation. Between 2000 and 2009 seventy patients with post-traumatic paraplegia were referred to Surgical Department as rehabilitation was unfeasible due to inadequate spine injury treatment. Forty-six had had surgery, 24 were treated conservatively Twenty-five patients had a thoracic lesion, 9 a lumbar lesion and 36 a lesion of the thoraco-lumbar junction. A total of 44 surgical procedures were performed (by anterior, posterior or anterior-posterior). On postoperative imaging sagittal alignment was found good in 93% of cases and acceptable in 7%. All patients regained the sitting position within 5 days after surgery. Wound healing problems requiring revision were observed in 4 cases. Major complications were a cerebro spinal fluid (CSF) leakage and a massive pulmonary embolism case in the early post-op. Wrong primary treatment frequently leads to demanding revision procedures with increased risks for the patient and more than double costs for the health care system. Whatever the technique a stable spine is the target in surgery of SCI allowing a quick and effective rehabilitation without external orthosis.

Minimally Invasive Surgery, 2012

Orthopedics, 2009

LO SCALPELLO-OTODI Educational, 2009

... Successivamente, nel 1958 e nel 1962, Küntscher propose evoluzioni del-la sua idea originale ... more ... Successivamente, nel 1958 e nel 1962, Küntscher propose evoluzioni del-la sua idea originale con altri due chiodi endo-midollari, il Double Nail e una nuova versione del chiodo a Y. Dovettero però passare diver-si anni da quegli esperimenti prima che un chio-do ...

Journal of Surgical Oncology, 2010

Background and Objectives: The aim of the present study was to review the long-term results in pa... more Background and Objectives: The aim of the present study was to review the long-term results in patients who had undergone modular prosthetic reconstruction of the knee, following a failed arthrodesis performed after the resection of bone tumors. Methods: We reviewed 16 desarthrodeses and prosthetic reconstructions of the knee following a failed artificial arthrodesis after bone tumor resection. Desarthrodeses and subsequent knee megaprosthesis were performed after breakage of the arthrodesis implant in 11 cases and following presumed eradication of infection in five cases. Results: The mean follow-up was 15.9 years. The mean post-operative range of knee flexion was 708, but only four patients had active extension of the knee. Functional results, according to the MSTS system, were satisfactory in 11 patients. Complications included deep infections in five patients, aseptic loosening in three patients, breakage of the joint hinge in one patient, and patellar tendon avulsion in one patient. Despite a high rate of complications, all but two patients were satisfied. Conclusion: Our findings indicate that conversion of oncological knee arthrodesis to total knee arthroplasty should be taken into consideration only after giving the patient extensive information about the high risk of serious complications.

Journal of Pediatric Orthopaedics, 2012

Previous case reports and small series have reported on the treatment of eosinophilic granuloma o... more Previous case reports and small series have reported on the treatment of eosinophilic granuloma of bone. We present our long experience in a large group of children and teenagers with symptomatic eosinophilic granuloma of the appendicular skeleton to evaluate clinical and imaging outcome after methylprednisolone injection. Sixty-six patients with symptomatic solitary eosinophilic granuloma of the appendicular skeleton treated by incisional or percutaneous biopsy and methylprednisolone injection were retrospectively studied. There were 38 boys and 28 girls (mean age, 7.2 y). The mean follow-up was 10.7 years (median, 11.2 y; range, 3 to 15 y). All patients presented with symptomatic lesions including pain or tenderness and fever and had 1 intralesional injection of methylprednisolone acetate after biopsy: 52 patients had incisional biopsy and 14 patients had percutaneous computed tomography-guided biopsy. Complete resolution of symptoms was observed in 58 patients (92%) at 48 to 72 hours (50 patients) and in 7 days (8 patients) after the procedure. Complete imaging reconstitution of bone was observed in 60 patients (95.2%) at 1 to 2 years after the procedure. No patient had recurrence. Multifocal disease was diagnosed in 7 patients (11%) at 3 months to 6 years. Complications occurred in 2 patients: one patient with a clavicular lesion had a pathologic fracture after open direct methylprednisolone injection and the second patient developed trochanteric bursitis after computed tomography-guided methylprednisolone injection. Biopsy and direct intralesional methylprednisolone injection is safe for symptomatic eosinophilic granulomas of the appendicular skeleton in children with effective clinical and imaging resolution of the lesions.

European Spine Journal, 2013

Surgical management of upper cervical spine (UCS) unstable injuries may be challenging as the num... more Surgical management of upper cervical spine (UCS) unstable injuries may be challenging as the number of cases requiring this surgery collected in every single center is small. This retrospective study was conducted to analyze the radiographic and clinical results in 12 patients undergoing a posterior occipito-cervical fusion by a polyaxial screws-rod-plate system. There were eight male and four female patients with a mean age of 73.7 years (range 32-89 years). Six patients presented neurologic deficits at admission. Six patients had sustained major trauma. The remaining six patients had suffered a minor trauma. Two patients died postoperatively in Intensive Care Unit. All surviving patients achieved solid fusion at 6 months. No surviving patient had neurological deterioration postoperatively. There were no instrumentation failures or revision required. Two patients suffered from superficial occipital wound infection. Although the indication to occipito-cervical fusion decreased since the new C1-C2 posterior fixation techniques were described, it remains a valid and reliable option in UCS post-traumatic instability to be applied even in emergency especially in the elderly.

$Research paper thumbnail of Complications in minimally invasive percutaneous fixation of thoracic and lumbar spine fractures and tumors$

European Spine Journal, 2013

Purpose We propose to evaluate the complication rate in minimally invasive stabilization (MIS) fo... more Purpose We propose to evaluate the complication rate in minimally invasive stabilization (MIS) for spine fractures and tumors, as a common alternative to open fusion and conservative treatment. Methods From 2000 to 2010, 187 patients were treated by minimally invasive percutaneous fixation in 133 traumatic fractures and 54 primitive and/or secondary spine tumors. Complications were classified, according to the period of onset as intraoperative and postoperative, and according to the severity, as major and minor. Results A total of 15 complications (8 %) were recorded: 5 intraoperative (3 %), 6 early postoperative (3 %) and 4 late postoperative (2 %); 6 were minor complications (3 %) and 9 were major complications (5 %). Conclusions Minimally invasive stabilization of selected spine pathologies appears to be a safe technique with low complication rate and high patient satisfaction. MIS reduces hospitalization and allows a fast functional recovery improving the quality of life.

Clinical Orthopaedics and Related Research®, 2010

Background The choices of treatment for patients with extensive tumors of the femur include total... more Background The choices of treatment for patients with extensive tumors of the femur include total femur megaprosthesis or large allograft-prosthetic composites. Previous reports suggest variable survival ranging from 60-70% at 1 to 2 years. However, these studies described earlier prostheses and techniques. Questions/purposes To confirm previous reports we determined (1) risk of local recurrence; (2) overall survivorship; and (3) function in patients with total femur reconstructions for tumors. Methods We retrospectively reviewed 23 patients with total femur megaprostheses implanted between 1987 and 2006 after resection of bone tumors. Two patients lost at followup were excluded; the remaining 21 included 15 males and six females with a mean age of 21 years. The mean followup was 48 months (range, 1 month 17 years). Function was assessed according to the MSTS System II. Results No patient developed a local recurrence during followup. At last followup, six patients were continuously disease-free at a mean of 148 months, one patient had no evidence of disease after treatment of a recurrence, one patient was alive with disease, and 13 patients died of their disease at a mean time of 17 months. In 15 patients evaluated with the MSTS score, the mean score was 66%; four patients had over 75%, eight from 51% to 75%, three from 26% to 50%. Four patients (19%) had complications requiring further surgery in absence of trauma. A fifth patient had a posttraumatic periprosthetic fracture. Conclusions A total femur prosthesis allows a limbpreserving procedure in tumors with extensive femoral involvement or in the presence of a skip lesion along the femur. The prognosis of these tumors is poor, but this reconstruction provides function with a relatively low rate of major complications.

$Research paper thumbnail of Inramedullary nailing in proximal femural fractures$