Enrico Gozzi | Università di Bologna (original) (raw)

Papers by Enrico Gozzi

La Chirurgia degli Organi di Movimento

La Chirurgia degli Organi di Movimento

La Chirurgia degli Organi di Movimento

La Chirurgia degli organi di movimento

Bone grafting procedures are widely used to repair large defects successfully in humans, but new ... more Bone grafting procedures are widely used to repair large defects successfully in humans, but new surgical therapies can be designed to improve allograft integration. The objective of this study was to investigate the best surgical procedure to study bone graft integration in a large animal model. An osteoperiosteal defect of 3 cm in the tibia or in the metatarsal was made in 15 adult crossbreed sheep to investigate osteo-integration of a homologous bone graft in an intercalary critical defect. DCP plates, alone or in association with Scotchcast or external fixator were used as fixation devices. The Scotchcast as was applied after surgery and left for 2 months to avoid torsion stress of the limb during the stand up movement. Metatarsal defect fixed with 7-hole DCP plate and protected with Scotchcast was the best surgical approach to avoid early or late implant failures, and provided good radiographic results after 4 months.

La Chirurgia degli organi di movimento

Conjoined fracture-dislocation of the elbow were first described by Marotte in 1982. In this stud... more Conjoined fracture-dislocation of the elbow were first described by Marotte in 1982. In this study, a total of 41 patients treated between 1975 and 1995 at the Rizzoli Orthopaedic Institute and 4 patients treated between 1997 and 2000 at the Division of Orthopaedics at the Maggiore Hospital are evaluated. Based on the Marotte classification, the patients are divided into 4 groups, by site of dislocation of the radial capitellum and amount of comminution of the fracture of the ulna. A clinical and radiographic evaluation was made after a mean follow-up of 5.3 years based on Anderson criteria. The results obtained were excellent in 17 patients (37.8%) satisfactory in 13 (28.9%), dissatisfactory in 12 (26.7%); 3 patients were considered to be failures (6.7%), the best results were obtained in type I anterior dislocations.

La Chirurgia degli organi di movimento

Subtrochanteric fractures are a typical pathology in the elderly patient, they are not very commo... more Subtrochanteric fractures are a typical pathology in the elderly patient, they are not very common and they are difficult to treat. The general conditions of these patients, often at the limit of operability, are further compromised by surgery and time spent in bed, leading to the death of the patient in a high percentage of cases. The fracture is often spyroid, it has multiple fragments, with interruption of the medial cortical bone. The quality of the bone, because of the marked osteoporosis, does not guarantee the good hold of the means of fixation used. The use of intramedullary nailing is a safe method, that allows for stabilization of the fracture without excessive blood loss, it allows for early partial weight-bearing and it has a lower number of complications as compared to other methods. Between 1-1-97 and 31-12-00 a total of 59 persubtrochanteric fractures were treated; there were 15 males and 44 females. A Gamma Long nail was used in 46 cases, a Gamma Standard in 13. Elev...

La Chirurgia degli organi di movimento

One-hundred patients affected with non-metastatic osteosarcoma of the limbs were treated accordin... more One-hundred patients affected with non-metastatic osteosarcoma of the limbs were treated according to a new adjuvant chemotherapy protocol. Preoperative treatment consisted in high doses of methotrexate (i.v.), followed after one week by cisplatin continuous intra-arterial infusion for 72 hours and adriamycin in intravenous infusion for 8 hours. There was good clinical and radiographic response in all of the cases, and conservative treatment was used in 86 cases (86%). A postsurgery histological examination of the segment showed "good" necrosis (greater than 90%) in 75 patients (75%). The incidence of "good" necroses obtained with this protocol was significantly higher as compared to that observed previously at our Center when a preoperative chemotherapy scheme was used, which involved methotrexate and cisplatin alone. Up until now, patients with a good histological response to preoperative chemotherapy have always had an excellent prognosis. Thus, it is our beli...

Advances in Tissue Banking, 2000

La Chirurgia degli Organi di Movimento, 2008

Femoral neck fractures are progressively increasing, due to higher survival rates, particularly a... more Femoral neck fractures are progressively increasing, due to higher survival rates, particularly among the female population. The gamma nail was created to treat intertrochanteric fracture types 31-A1, 31-A2 and 31-A3 and in some cases basicervical fractures of type 31-B2-1. Complications can be classified as intraoperative and postoperative. The intraoperative might be related to the nail's introduction site, lag and distal locking screw positions. Postoperative complications depend mostly on an incorrect surgical technique, which can lead to an inaccurate nail position and consequent implant failure. We rarely observe failures caused by severe bone osteoporosis.

The Journal of Bone and Joint Surgery, 2001

W e describe 25 patients who were treated for a tumour of the proximal femur by resection and rep... more W e describe 25 patients who were treated for a tumour of the proximal femur by resection and replacement with an uncemented, bipolar, modular prosthesis. When followed up after more than ten years four prostheses (16%) had required revision. Two joints showed wear and another necrosis of the acetabulum. One patient with loosening of the stem had been treated by radiotherapy to the femur. Articular cartilage seemed to be a reliable barrier to acetabular wear. Very few signs of the formation of particulate debris were observed. The most obvious feature in the bone-stem relationship was stress shielding, seen as osteoporosis of the proximal part of the femur around the stem in 68%. Functional activity was satisfactory in 68% of the patients. A better system of reattachment of the soft tissues is needed to avoid pain and a persistent limp.

International Orthopaedics, 2007

Total knee modular megaprosthesis or osteochondral allograft are used to preserve joint movement ... more Total knee modular megaprosthesis or osteochondral allograft are used to preserve joint movement in bone tumours of the proximal tibia. The aim of this study was to compare two groups of patients with total knee modular megaprosthesis and osteochondral allograft through an objective analysis. Eighteen patients, ten treated with prosthesis (TKR group) and eight with osteochondral allografts (AL group), were included in the study. X-ray, muscular strength measurements, and studies of gait analysis including electromyography (EMG) were used to compare functional results of patients. In the TKR group a higher incidence of knee extension lag was found. While the TKR group had a prevalent knee stiff/hyperextension pattern with reduced rectus femoris activity, the AL group had a higher percentage of normal knee pattern. Knee extensor muscular strength was reduced in the TKR group. TKR functional performance during gait is in most cases abnormal, consistent with the weakness of the extensor apparatus and knee extension lag. Although a greater rate of normal walking was found in the AL group, problems related to a short patellar tendon, knee instability, and joint mismatching were considered to be responsible for abnormal knee kinematics. An allograft, when optimal reconstruction is performed, gives better functional results. Résumé Les prothèses totales massives et les allogreffes ostéochondrales sont utilisées pour préserver le mouvement articulaire dans les tumeurs du tibia proximal. Le but de cette étude était de comparer 2 groupes de patients ayant reçus ces traitements. 18 patients étaient inclus dans l'étude, 10 traités par prothèse (groupe TKR) et 8 par allogreffe ostéochondrale (groupe AL). Les radiographies, la mesure de la force musculaire, l'étude de la boiterie incluant l'EMG étaient utilisées pour comparer les résultats fonctionnels. Dans le groupe TKR une plus grande incidence de perte d'extension était notée. Tandis que le groupe TKR avait une réduction de l'activité du Rectus fémorus , le groupe AL avait un plus grand pourcentage de fonction normale. La force musculaire des extenseurs était réduite dans le groupe TKR. La performance fonctionnelle durant la marche des TKR étaient la plupart du temps anormal avec faiblesse de l'appareil extenseur et perte d'extension. Bien qu'un taux plus élevé de marche normale était trouvé dans le groupe AL, les problèmes dû à un tendon rotulien court, une instabilité articulaire et à une articulation mal adaptée étaient supposés responsable d'une cinématique anormale du genou. L'allogreffe, quand une reconstruction optimale était réalisée donnait un meolleur résultat fonctionnel.

European Journal of Surgical Oncology (EJSO), 2004

Aims. To describe the outcomes of a large number of patients with pelvic osteosarcoma, and to def... more Aims. To describe the outcomes of a large number of patients with pelvic osteosarcoma, and to define the guidelines for appropriate treatment. Methods. We reviewed 60 consecutive patients with primary pelvic high-grade osteosarcoma. The tumour involved the whole hemipelvis in 15 cases, while the most common location was the iliac wing in 29 cases (48.3%): 25 of these adjacent to or passing the sacroiliac joint. Results. Thirty patients underwent surgery; there were 16 hindquarter amputations and 14 internal hemipelvectomies. All the patients who presented with metastasis died of their disease. In 18 cases wide margins were achieved, however, eight patients experienced local recurrence. Of the series, only eight patients are still alive. Conclusion. The use of intense chemotherapy and surgical wide margin, hardly seems to achieve local control, however, tumour necrosis was correlated with positive prognosis. When internal hemipelvectomy it is not safe enough, amputation must be considered, particularly for cases with sacrifice of the sciatic nerve roots or for older patients where a shorter surgical procedure can be less risky.

Clinical Orthopaedics and Related Research, 2002

Clinical Orthopaedics and Related Research, 2004

In a proximal humerus resection for a bone tumor, the use of an osteoarticular allograft is consi... more In a proximal humerus resection for a bone tumor, the use of an osteoarticular allograft is considered the best restoration of shoulder function. We retrospectively reviewed the outcomes of 31 patients who had an intraarticular resection of the proximal humerus for a bone tumor. Twenty-three of the allografts were filled with cement. The average followup was 5.3 years. Of the 31 patients with more than 24 months followup, seven had revision surgery or removal of the allograft. Kaplan-Meier analysis showed that the probability of survival of the reconstruction was 78% at 5 years. Fracture was the main complication in 11 patients (37%) of whom seven were in the noncemented group. Four of these patients had successful surgery for conversion to an allograftprosthetic composite, whereas one patient had a new allograft. Allografts that were filled with cement had four fractures (18%); three were subchondral fractures discovered by routine CT scans. None of these patients had pain or needed revision surgery. Osteochondral allograft in proximal humerus replacement is a reliable reconstructive technique if the allograft is augmented by filling the intramedullary space with cement. Moreover, cement augmented allografts are less expensive and technically easier than allograft-prosthetic composites.

Clinical Orthopaedics and Related Research, 2002

Twenty-seven patients who had resection of the proximal femur for bone tumors and reconstruction ... more Twenty-seven patients who had resection of the proximal femur for bone tumors and reconstruction with an allograft prosthesis composite are reported. In most of the patients, the prosthesis was a long-stem revision type, cemented in the allograft and uncemented in the femoral shaft. The abductor muscles and iliopsoas were sutured to the corresponding tendons on the allograft. Implant-related complications and functional results were evaluated and are reported. Twenty-two patients achieved a minimum followup of 36 months (range, 36-126 months; average, 58 months). The implant was removed in two patients (one for infection, one for intraoperative fracture of the allograft). One patient experienced nonunion, whereas in the remaining 24 patients, the allograft eventually united to the host bone. A frequent late complication (17 patients) was fracture of the greater trochanter of the allograft. In the whole series, only four new operations were done for implant-related complications. In 22 patients who could be evaluated, the functional evaluation according to the Musculoskeletal Tumor Society System was excellent in 16 (73%) patients, good in four (18%), and fair in two (9%). These results compare favorably with those of megaprostheses for tumor resection of the proximal femur, where a Trendelenburg gait almost always is present.

La Chirurgia degli organi di movimento

A consecutive series of 57 patients treated by knee resection arthrodesis for malignant or aggres... more A consecutive series of 57 patients treated by knee resection arthrodesis for malignant or aggressive tumor around the knee was reviewed. Infection was present only after repeated surgery for other complications, delayed union or non-union occurred in 50% of the cases that could be evaluated, but were still easy to manage. Fracture incidence was higher than expected (32.6%) even occurring after 10 years; this was difficult to deal with and it often led to failure. The best possible method of fixation is still being debated, but locked nail and allograft cementation is often advised. Several satisfactory functional results were however achieved when surgery was performed in young patients; final results can be less satisfactory when there is leg length discrepancy and poor acceptance on the part of the patient. In recent years this type of surgery has been limited to younger male patients (10 to 14 years of age) in whom extra-articular knee resection was required or when most of the ...

Acta …, 2007

This long-term retrospective study investigated the value of debridement versus debridement and O... more This long-term retrospective study investigated the value of debridement versus debridement and Osteoset T® antibiotic-loaded calcium sulphate pellets in the treatment of adult chronic osteo-myelitis. Sixty-five patients were included in the study. The mean follow-up was 75 ...

La Chirurgia degli Organi di Movimento

La Chirurgia degli Organi di Movimento

La Chirurgia degli Organi di Movimento

La Chirurgia degli organi di movimento

Bone grafting procedures are widely used to repair large defects successfully in humans, but new ... more Bone grafting procedures are widely used to repair large defects successfully in humans, but new surgical therapies can be designed to improve allograft integration. The objective of this study was to investigate the best surgical procedure to study bone graft integration in a large animal model. An osteoperiosteal defect of 3 cm in the tibia or in the metatarsal was made in 15 adult crossbreed sheep to investigate osteo-integration of a homologous bone graft in an intercalary critical defect. DCP plates, alone or in association with Scotchcast or external fixator were used as fixation devices. The Scotchcast as was applied after surgery and left for 2 months to avoid torsion stress of the limb during the stand up movement. Metatarsal defect fixed with 7-hole DCP plate and protected with Scotchcast was the best surgical approach to avoid early or late implant failures, and provided good radiographic results after 4 months.

La Chirurgia degli organi di movimento

Conjoined fracture-dislocation of the elbow were first described by Marotte in 1982. In this stud... more Conjoined fracture-dislocation of the elbow were first described by Marotte in 1982. In this study, a total of 41 patients treated between 1975 and 1995 at the Rizzoli Orthopaedic Institute and 4 patients treated between 1997 and 2000 at the Division of Orthopaedics at the Maggiore Hospital are evaluated. Based on the Marotte classification, the patients are divided into 4 groups, by site of dislocation of the radial capitellum and amount of comminution of the fracture of the ulna. A clinical and radiographic evaluation was made after a mean follow-up of 5.3 years based on Anderson criteria. The results obtained were excellent in 17 patients (37.8%) satisfactory in 13 (28.9%), dissatisfactory in 12 (26.7%); 3 patients were considered to be failures (6.7%), the best results were obtained in type I anterior dislocations.

La Chirurgia degli organi di movimento

Subtrochanteric fractures are a typical pathology in the elderly patient, they are not very commo... more Subtrochanteric fractures are a typical pathology in the elderly patient, they are not very common and they are difficult to treat. The general conditions of these patients, often at the limit of operability, are further compromised by surgery and time spent in bed, leading to the death of the patient in a high percentage of cases. The fracture is often spyroid, it has multiple fragments, with interruption of the medial cortical bone. The quality of the bone, because of the marked osteoporosis, does not guarantee the good hold of the means of fixation used. The use of intramedullary nailing is a safe method, that allows for stabilization of the fracture without excessive blood loss, it allows for early partial weight-bearing and it has a lower number of complications as compared to other methods. Between 1-1-97 and 31-12-00 a total of 59 persubtrochanteric fractures were treated; there were 15 males and 44 females. A Gamma Long nail was used in 46 cases, a Gamma Standard in 13. Elev...

La Chirurgia degli organi di movimento

One-hundred patients affected with non-metastatic osteosarcoma of the limbs were treated accordin... more One-hundred patients affected with non-metastatic osteosarcoma of the limbs were treated according to a new adjuvant chemotherapy protocol. Preoperative treatment consisted in high doses of methotrexate (i.v.), followed after one week by cisplatin continuous intra-arterial infusion for 72 hours and adriamycin in intravenous infusion for 8 hours. There was good clinical and radiographic response in all of the cases, and conservative treatment was used in 86 cases (86%). A postsurgery histological examination of the segment showed "good" necrosis (greater than 90%) in 75 patients (75%). The incidence of "good" necroses obtained with this protocol was significantly higher as compared to that observed previously at our Center when a preoperative chemotherapy scheme was used, which involved methotrexate and cisplatin alone. Up until now, patients with a good histological response to preoperative chemotherapy have always had an excellent prognosis. Thus, it is our beli...

Advances in Tissue Banking, 2000

La Chirurgia degli Organi di Movimento, 2008

Femoral neck fractures are progressively increasing, due to higher survival rates, particularly a... more Femoral neck fractures are progressively increasing, due to higher survival rates, particularly among the female population. The gamma nail was created to treat intertrochanteric fracture types 31-A1, 31-A2 and 31-A3 and in some cases basicervical fractures of type 31-B2-1. Complications can be classified as intraoperative and postoperative. The intraoperative might be related to the nail's introduction site, lag and distal locking screw positions. Postoperative complications depend mostly on an incorrect surgical technique, which can lead to an inaccurate nail position and consequent implant failure. We rarely observe failures caused by severe bone osteoporosis.

The Journal of Bone and Joint Surgery, 2001

W e describe 25 patients who were treated for a tumour of the proximal femur by resection and rep... more W e describe 25 patients who were treated for a tumour of the proximal femur by resection and replacement with an uncemented, bipolar, modular prosthesis. When followed up after more than ten years four prostheses (16%) had required revision. Two joints showed wear and another necrosis of the acetabulum. One patient with loosening of the stem had been treated by radiotherapy to the femur. Articular cartilage seemed to be a reliable barrier to acetabular wear. Very few signs of the formation of particulate debris were observed. The most obvious feature in the bone-stem relationship was stress shielding, seen as osteoporosis of the proximal part of the femur around the stem in 68%. Functional activity was satisfactory in 68% of the patients. A better system of reattachment of the soft tissues is needed to avoid pain and a persistent limp.

International Orthopaedics, 2007

Total knee modular megaprosthesis or osteochondral allograft are used to preserve joint movement ... more Total knee modular megaprosthesis or osteochondral allograft are used to preserve joint movement in bone tumours of the proximal tibia. The aim of this study was to compare two groups of patients with total knee modular megaprosthesis and osteochondral allograft through an objective analysis. Eighteen patients, ten treated with prosthesis (TKR group) and eight with osteochondral allografts (AL group), were included in the study. X-ray, muscular strength measurements, and studies of gait analysis including electromyography (EMG) were used to compare functional results of patients. In the TKR group a higher incidence of knee extension lag was found. While the TKR group had a prevalent knee stiff/hyperextension pattern with reduced rectus femoris activity, the AL group had a higher percentage of normal knee pattern. Knee extensor muscular strength was reduced in the TKR group. TKR functional performance during gait is in most cases abnormal, consistent with the weakness of the extensor apparatus and knee extension lag. Although a greater rate of normal walking was found in the AL group, problems related to a short patellar tendon, knee instability, and joint mismatching were considered to be responsible for abnormal knee kinematics. An allograft, when optimal reconstruction is performed, gives better functional results. Résumé Les prothèses totales massives et les allogreffes ostéochondrales sont utilisées pour préserver le mouvement articulaire dans les tumeurs du tibia proximal. Le but de cette étude était de comparer 2 groupes de patients ayant reçus ces traitements. 18 patients étaient inclus dans l'étude, 10 traités par prothèse (groupe TKR) et 8 par allogreffe ostéochondrale (groupe AL). Les radiographies, la mesure de la force musculaire, l'étude de la boiterie incluant l'EMG étaient utilisées pour comparer les résultats fonctionnels. Dans le groupe TKR une plus grande incidence de perte d'extension était notée. Tandis que le groupe TKR avait une réduction de l'activité du Rectus fémorus , le groupe AL avait un plus grand pourcentage de fonction normale. La force musculaire des extenseurs était réduite dans le groupe TKR. La performance fonctionnelle durant la marche des TKR étaient la plupart du temps anormal avec faiblesse de l'appareil extenseur et perte d'extension. Bien qu'un taux plus élevé de marche normale était trouvé dans le groupe AL, les problèmes dû à un tendon rotulien court, une instabilité articulaire et à une articulation mal adaptée étaient supposés responsable d'une cinématique anormale du genou. L'allogreffe, quand une reconstruction optimale était réalisée donnait un meolleur résultat fonctionnel.

European Journal of Surgical Oncology (EJSO), 2004

Aims. To describe the outcomes of a large number of patients with pelvic osteosarcoma, and to def... more Aims. To describe the outcomes of a large number of patients with pelvic osteosarcoma, and to define the guidelines for appropriate treatment. Methods. We reviewed 60 consecutive patients with primary pelvic high-grade osteosarcoma. The tumour involved the whole hemipelvis in 15 cases, while the most common location was the iliac wing in 29 cases (48.3%): 25 of these adjacent to or passing the sacroiliac joint. Results. Thirty patients underwent surgery; there were 16 hindquarter amputations and 14 internal hemipelvectomies. All the patients who presented with metastasis died of their disease. In 18 cases wide margins were achieved, however, eight patients experienced local recurrence. Of the series, only eight patients are still alive. Conclusion. The use of intense chemotherapy and surgical wide margin, hardly seems to achieve local control, however, tumour necrosis was correlated with positive prognosis. When internal hemipelvectomy it is not safe enough, amputation must be considered, particularly for cases with sacrifice of the sciatic nerve roots or for older patients where a shorter surgical procedure can be less risky.

Clinical Orthopaedics and Related Research, 2002

Clinical Orthopaedics and Related Research, 2004

In a proximal humerus resection for a bone tumor, the use of an osteoarticular allograft is consi... more In a proximal humerus resection for a bone tumor, the use of an osteoarticular allograft is considered the best restoration of shoulder function. We retrospectively reviewed the outcomes of 31 patients who had an intraarticular resection of the proximal humerus for a bone tumor. Twenty-three of the allografts were filled with cement. The average followup was 5.3 years. Of the 31 patients with more than 24 months followup, seven had revision surgery or removal of the allograft. Kaplan-Meier analysis showed that the probability of survival of the reconstruction was 78% at 5 years. Fracture was the main complication in 11 patients (37%) of whom seven were in the noncemented group. Four of these patients had successful surgery for conversion to an allograftprosthetic composite, whereas one patient had a new allograft. Allografts that were filled with cement had four fractures (18%); three were subchondral fractures discovered by routine CT scans. None of these patients had pain or needed revision surgery. Osteochondral allograft in proximal humerus replacement is a reliable reconstructive technique if the allograft is augmented by filling the intramedullary space with cement. Moreover, cement augmented allografts are less expensive and technically easier than allograft-prosthetic composites.

Clinical Orthopaedics and Related Research, 2002

Twenty-seven patients who had resection of the proximal femur for bone tumors and reconstruction ... more Twenty-seven patients who had resection of the proximal femur for bone tumors and reconstruction with an allograft prosthesis composite are reported. In most of the patients, the prosthesis was a long-stem revision type, cemented in the allograft and uncemented in the femoral shaft. The abductor muscles and iliopsoas were sutured to the corresponding tendons on the allograft. Implant-related complications and functional results were evaluated and are reported. Twenty-two patients achieved a minimum followup of 36 months (range, 36-126 months; average, 58 months). The implant was removed in two patients (one for infection, one for intraoperative fracture of the allograft). One patient experienced nonunion, whereas in the remaining 24 patients, the allograft eventually united to the host bone. A frequent late complication (17 patients) was fracture of the greater trochanter of the allograft. In the whole series, only four new operations were done for implant-related complications. In 22 patients who could be evaluated, the functional evaluation according to the Musculoskeletal Tumor Society System was excellent in 16 (73%) patients, good in four (18%), and fair in two (9%). These results compare favorably with those of megaprostheses for tumor resection of the proximal femur, where a Trendelenburg gait almost always is present.

La Chirurgia degli organi di movimento

A consecutive series of 57 patients treated by knee resection arthrodesis for malignant or aggres... more A consecutive series of 57 patients treated by knee resection arthrodesis for malignant or aggressive tumor around the knee was reviewed. Infection was present only after repeated surgery for other complications, delayed union or non-union occurred in 50% of the cases that could be evaluated, but were still easy to manage. Fracture incidence was higher than expected (32.6%) even occurring after 10 years; this was difficult to deal with and it often led to failure. The best possible method of fixation is still being debated, but locked nail and allograft cementation is often advised. Several satisfactory functional results were however achieved when surgery was performed in young patients; final results can be less satisfactory when there is leg length discrepancy and poor acceptance on the part of the patient. In recent years this type of surgery has been limited to younger male patients (10 to 14 years of age) in whom extra-articular knee resection was required or when most of the ...

Acta …, 2007

This long-term retrospective study investigated the value of debridement versus debridement and O... more This long-term retrospective study investigated the value of debridement versus debridement and Osteoset T® antibiotic-loaded calcium sulphate pellets in the treatment of adult chronic osteo-myelitis. Sixty-five patients were included in the study. The mean follow-up was 75 ...