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Papers by MARIA BEATRICE BOCCHI

Journal of clinical medicine, Feb 8, 2024

Background: Ankle arthroscopy is indicated for both diagnosis and treatment of a large spectrum o... more Background: Ankle arthroscopy is indicated for both diagnosis and treatment of a large spectrum of common ankle disorders. It has certain advantages over the open procedure; however, it is important to recognize that there are some complications associated with it. Infections after this procedure are quite uncommon, with an overall estimated incidence of 2%. Given the low incidence of infections after ankle arthroscopy, not a great deal of literature on the topic has been published. The present review aims to provide an overview of the incidence, diagnosis, and treatment of infections after ankle arthroscopy. Methods: A systematic review of the literature indexed in the PubMed, MEDLINE, and Cochrane Library databases using search term "ankle arthroscopy infections" was performed in November 2023. No restrictions were applied concerning the date of publication. The Preferred reporting items for systematic reviews and meta-analyses (PRISMA) were followed. Among all surgical operations for the treatment of ankle and foot pathologies, we included articles with a described superficial or deep infection after ankle arthroscopy. Results: The search resulted in 201 studies. Only 21 studies met our inclusion criteria, and they were included in this systematic review. We evaluated 1706 patients who underwent 1720 arthroscopic tibiotalar procedures at an average age of 42 years old. Out of the 1720 procedures, 41 (2%) were complicated by infection. We divided infectious complications into superficial (68%; 28/41) and deep (32%; 13/41) infections. The most common pathogen isolated was Staphylococcus aureus. Arthroscopic arthrodesis was found to be the most affected by deep infections. Conclusions: Infection after ankle arthroscopy is an uncommon complication. Superficial infections were successfully treated with antibiotics, while surgical debridement, arthroscopic drainage, and intravenous antibiotics were necessary in cases of deep infections. Considering the amount of information on pathogens associated with knee and shoulder infections, there is still a lack of literature on pathogens associated with ankle infections, which makes their management difficulty.

Journal of Clinical Medicine

Background and aim: Cancers are one of the most frequent causes of death and disability in humans... more Background and aim: Cancers are one of the most frequent causes of death and disability in humans. Skeletal involvement has a major impact on the quality of life and prognosis of cancer patients. Electrochemotherapy is a palliative and minimally invasive oncologic treatment that was first used to treat subcutaneous nodules for malignant tumors. The aim of our review is to evaluate the results of electrochemotherapy in the treatment of bone metastases. Methods: A systematic review of the literature indexed in the PubMed MEDLINE and Cochrane Library databases using the search key words “electrochemotherapy” AND (“metastasis” OR “metastases”) was performed. The Preferred Reporting Items for Systematic Reviews and MetaAnalyses was followed. Inclusion criteria were proven involvement of the appendicular skeleton in metastatic carcinoma or melanoma, through at least one percutaneous electrochemotherapy session on the metastatic bone lesion. The exclusion criterion was no skeletal metastat...

Journal of Neurosciences in Rural Practice

Objectives: The treatment options for thoracolumbar junction burst fractures remain a topic of co... more Objectives: The treatment options for thoracolumbar junction burst fractures remain a topic of controversy. Short-segment percutaneous fixation (SSPF) and short-segment open fixation including the fractured level (SSOFIFL) are both viable procedures for managing these fractures. At present, there is a lack of evidence in the literature demonstrating the absolute superiority of one treatment over the other. This study aimed to compare these two surgical strategies with a focus on radiological and clinical outcomes. Materials and Methods: This retrospective case–control multicenter analysis involved patients with A3 and A4 vertebral fractures at the thoracolumbar junction (T11–L2) who underwent surgical treatment with either SSPF or SSOFIFL in the participating centers. Clinical outcomes were measured using the Oswestry Disability Index and visual analogue scale (VAS) both pre- and postoperatively. Radiological outcomes included kyphotic deformity (KD), anterior vertebral body height ...

Journal of biological regulators and homeostatic agents, 2020

In the orthopaedic field the foreign body reaction is well known for therapeutic purposes in the ... more In the orthopaedic field the foreign body reaction is well known for therapeutic purposes in the alleged Masquelet technique consisting of segmental bone loss two-stage reconstruction. The induced membrane creates advantageous local conditions that promote bone graft remodeling and osteointegration. The aim of our study was to describe the first two cases in Literature of induced membrane observed following silver-coated knee megaprosthesis reconstruction. In addition, it was our interest to evaluate their histological features.

Journal of clinical medicine, Apr 25, 2024

Journal of Xiangya Medicine

Background: Pycnodysostosis (PYCD) is a rare genetic disorder causing skeletal dysplasia. It is i... more Background: Pycnodysostosis (PYCD) is a rare genetic disorder causing skeletal dysplasia. It is inherited in an autosomal recessive manner, and it is caused by a gene mutation leading cathepsin K (CTSK) deficiency. PYCD is characterized among many by short-limbed short stature, typical facial appearance and osteosclerosis with increased bone fragility. The altered bone quality typical of this disease cause the bones to be fragile and brittle with the medullary canal present while often narrowed so as a result, these individuals have an increased fracture rate. Methods: A systematic review of the literature indexed in PubMed, MEDLINE, and Cochrane Library databases using as search terms "pycnodysostosis fracture" was performed in January 2022. To be considered for this review at least a section of the population understudy needed to be affected by PYCD, bone fracture and the treatment performed needed to be explicit. Literature focused on maxillofacial manifestations/ surgery were excluded. The methodological quality of the studies was assessed using the modified Coleman methodology score (mCMS). Results: Only 23 studies met the inclusion criteria and were included in the review. The reached population consisted of 36 patients for a total of 57 fractures secondary mainly to low energy trauma (91%). Fractures occurred mainly in long bones, 54% were femur and 26% were tibia. The 60%. Of fractures were treated surgically. Bony union was achieved at an average of 11 months after surgery/trauma. The most frequent complications reported were refracture (19%) and pseudoarthrosis (31%). Six femur "impending fracture" cases have also been reported. Conclusions: Treatments such as intramedullary nailing or internal plate fixation offer continuous support for the delayed bone healing and the high risk of refracture in PYCD which are the most common complications. Prolonged follow-up over time could help these patients with a rare disease to treat and sometimes prevent disease-related events. To date, therefore, there are no standardized guidelines on this matter.

Minerva Orthopedics, 2021

BACKGROUND: The SARS-CoV-2 pandemic produced substantial changes in the organization of the natio... more BACKGROUND: The SARS-CoV-2 pandemic produced substantial changes in the organization of the national health systems. The creation of emergency units dedicated to COVID-19 patients led to a reduction in the resource usage for "clean" emergency rooms. One of the most frequent non-surgical causes of access to the orthopedic emergency room is represented by acute low back pain. The aim of the present investigation was to evaluate the role of semi-rigid corset in the treatment of patients with acute low back pain in terms of pain relief, number of control visit and duration of symptoms during COVID-19 pandemic. METHODS: A retrospective analysis of the institutional databases of low back pain patients was conducted. A total of 127 patients were enrolled in the study. Two groups of patients were obtained based on received treatment (group A: medical therapy;group B: medical therapy and semi-rigid corset) The primary outcome was to evaluate the clinical symptoms and the degree of disability at the end of the treatment. RESULTS: The treatment used in group B produced greater benefits in terms of pain improvement and disability compared to the group A. The overall satisfaction rate was much higher in the group B than group A. CONCLUSIONS: The use of a semi-rigid corset with pharmacological treatment can improve the outcome of acute low back pain compared to pharmacological treatment only. This home therapy option combined with telemedicine follow up allow to minimize the interaction between patients and healthcare workers with an important impact on the spread of the virus.

Medical Research Archives, 2021

As lung cancer is the most common neoplasm worldwide, bone is one of the most metastatic sites of... more As lung cancer is the most common neoplasm worldwide, bone is one of the most metastatic sites of advanced malignant tumors in general. Nearly 50% of patients with advanced lung cancer develop bone metastases. A literature review on this matter was performed. As in recent years the life expectancy of patients with lung cancer increased, symptoms control measures are gaining importance. The early detection of bone metastases is crucial due to prevent skeletal-related events (SREs). The bone metastases management should be discussed in a multidisciplinary setting given the numerous therapeutic options. Treatment is either pharmacological (analgesics, diphosphonates, monoclonal antibodies), non-pharmacological (radiotherapy, interventional radiological techniques, surgery) or even a combination of both. Orthopedic surgery shall be assessed in case of pathological/impending fractures. The orthopedic surgeon challenge is indeed to detect those patients who will take advantage from surger...

Journal of orthopaedics, 2021

Purpose Percutaneous trans-pedicle screws represent a surgical option frequently performed in pat... more Purpose Percutaneous trans-pedicle screws represent a surgical option frequently performed in patients affected by thoracolumbar vertebral burst fractures (A3-A4). The aim of the study was to evaluate the early loss of kyphosis correction and its clinical correlations in a cohort of patients affected by burst spinal fracture treated with percutaneous trans-pedicle screws fixation. Methods The present investigation consists in a retrospective one center analysis. The primary outcome was the evaluation of the early loss of correction. Secondary outcomes were the bi-segmental kyphosis change, the clinical outcome and the correlation between clinical outcome and the loss of correction. Results Among 435 patients 97 were included in the study. A mean 3.3° of early loss of correction was observed between postoperative and 1 month follow-up evaluations. The mean anterior vertebral body height change was 3.8 mm. No statistical differences were found in clinical and functional outcomes betwe...

Background and aim of the work: To report the history and clinical presentation of a 60-year-old ... more Background and aim of the work: To report the history and clinical presentation of a 60-year-old male who developed a rare soft tissue infection of the right leg caused by Bacillus megaterium and to perform a Literature review focusing on clinical manifestations and diagnostic difficulties of the aforementioned bacterium. Methods: Medical history and clinical presentation suggested the infectious etiology, which led to the surgical procedure of fistulectomy and to further histological and microbiological investigations with bacterial cultures. Results: The histological report tested negative for osteomyelitis. Bacterial cultures revealed Bacillus megaterium, which was sensitive to all antibiotics against which it was tested. The oral antibiotic therapy was set for 12 days with benefits. The patient has always been apyretic, inflammation indexes and white cells count have been within normal limits. Conclusions: This was a rare case of soft tissue infection caused by Bacillus megateri...

World Journal of Orthopedics

Journal of Clinical Orthopaedics and Trauma

Orthopedic Reviews

Foot metastasis are rare and often overlooked due to non-specifical symptoms. This often leads to... more Foot metastasis are rare and often overlooked due to non-specifical symptoms. This often leads to misdiagnosis delaying the right diagnosis. Metastatic disease of the foot is rare. Foot pain and swelling may be the presenting symptom of an occult malignancy. If metastatic disease is not kept in the differential diagnosis of foot pain, diagnosis and treatment will be delayed. The purpose of this study was to analyze articles presenting cases of foot metastasis to provide a more accurate incidence of symptomatic foot acrometastasis as well as to review the clinical course and outcomes. Studies were searched on PubMed/Medline from the inception to February 2020. All studies included in the review presented foot metastasis either with or without a known primary tumor. Most of the articles were case reports, to which we added two case reports of foot acrometastasis produced by our Institute. Forty-three studies with a total of 45 patients were included in this review. The literature publ...

Orthopedic Reviews

Osteoma is a benign, slowly growing, asymptomatic, bone-forming tumor arising from cancellous or ... more Osteoma is a benign, slowly growing, asymptomatic, bone-forming tumor arising from cancellous or compact bone. Osteoma usually is a solitary lesion, but in patients with Gardner’s Syndrome it may be multiple. osteoma may rarely have a parosteal localization. Parosteal osteoma has peculiar radiographic, histologic and clinical features. We describe a case report of a 51- years old man with a bifocal parosteal osteoma of the femur in a non-syndromic patient. This is the first described patient with a bifocal lesion. In literature only 24 cases of paraosteal osteoma are found. Our patient underwent surgery and the lesions were fully excised. At one year follow-up there was no evidence of recurrence.

Orthopedic Reviews

The Charcot foot is a condition characterized by a progressive derangement of the foot. The type ... more The Charcot foot is a condition characterized by a progressive derangement of the foot. The type of deformity and patient clinical conditions will lead to the proper surgical approach among exostectomy, arthrodesis (through external and/or internal fixation) and amputation. Many authors report good clinical outcomes performing the arthrodesis in Charcot foot; however, the choice of the most appropriate hardware is still an issue. The aim of this study is to analyze the outcomes of different hardware in midfoot and hindfoot Charcot arthrodesis.

Journal of clinical medicine, Feb 8, 2024

Background: Ankle arthroscopy is indicated for both diagnosis and treatment of a large spectrum o... more Background: Ankle arthroscopy is indicated for both diagnosis and treatment of a large spectrum of common ankle disorders. It has certain advantages over the open procedure; however, it is important to recognize that there are some complications associated with it. Infections after this procedure are quite uncommon, with an overall estimated incidence of 2%. Given the low incidence of infections after ankle arthroscopy, not a great deal of literature on the topic has been published. The present review aims to provide an overview of the incidence, diagnosis, and treatment of infections after ankle arthroscopy. Methods: A systematic review of the literature indexed in the PubMed, MEDLINE, and Cochrane Library databases using search term "ankle arthroscopy infections" was performed in November 2023. No restrictions were applied concerning the date of publication. The Preferred reporting items for systematic reviews and meta-analyses (PRISMA) were followed. Among all surgical operations for the treatment of ankle and foot pathologies, we included articles with a described superficial or deep infection after ankle arthroscopy. Results: The search resulted in 201 studies. Only 21 studies met our inclusion criteria, and they were included in this systematic review. We evaluated 1706 patients who underwent 1720 arthroscopic tibiotalar procedures at an average age of 42 years old. Out of the 1720 procedures, 41 (2%) were complicated by infection. We divided infectious complications into superficial (68%; 28/41) and deep (32%; 13/41) infections. The most common pathogen isolated was Staphylococcus aureus. Arthroscopic arthrodesis was found to be the most affected by deep infections. Conclusions: Infection after ankle arthroscopy is an uncommon complication. Superficial infections were successfully treated with antibiotics, while surgical debridement, arthroscopic drainage, and intravenous antibiotics were necessary in cases of deep infections. Considering the amount of information on pathogens associated with knee and shoulder infections, there is still a lack of literature on pathogens associated with ankle infections, which makes their management difficulty.

Journal of Clinical Medicine

Background and aim: Cancers are one of the most frequent causes of death and disability in humans... more Background and aim: Cancers are one of the most frequent causes of death and disability in humans. Skeletal involvement has a major impact on the quality of life and prognosis of cancer patients. Electrochemotherapy is a palliative and minimally invasive oncologic treatment that was first used to treat subcutaneous nodules for malignant tumors. The aim of our review is to evaluate the results of electrochemotherapy in the treatment of bone metastases. Methods: A systematic review of the literature indexed in the PubMed MEDLINE and Cochrane Library databases using the search key words “electrochemotherapy” AND (“metastasis” OR “metastases”) was performed. The Preferred Reporting Items for Systematic Reviews and MetaAnalyses was followed. Inclusion criteria were proven involvement of the appendicular skeleton in metastatic carcinoma or melanoma, through at least one percutaneous electrochemotherapy session on the metastatic bone lesion. The exclusion criterion was no skeletal metastat...

Journal of Neurosciences in Rural Practice

Objectives: The treatment options for thoracolumbar junction burst fractures remain a topic of co... more Objectives: The treatment options for thoracolumbar junction burst fractures remain a topic of controversy. Short-segment percutaneous fixation (SSPF) and short-segment open fixation including the fractured level (SSOFIFL) are both viable procedures for managing these fractures. At present, there is a lack of evidence in the literature demonstrating the absolute superiority of one treatment over the other. This study aimed to compare these two surgical strategies with a focus on radiological and clinical outcomes. Materials and Methods: This retrospective case–control multicenter analysis involved patients with A3 and A4 vertebral fractures at the thoracolumbar junction (T11–L2) who underwent surgical treatment with either SSPF or SSOFIFL in the participating centers. Clinical outcomes were measured using the Oswestry Disability Index and visual analogue scale (VAS) both pre- and postoperatively. Radiological outcomes included kyphotic deformity (KD), anterior vertebral body height ...

Journal of biological regulators and homeostatic agents, 2020

In the orthopaedic field the foreign body reaction is well known for therapeutic purposes in the ... more In the orthopaedic field the foreign body reaction is well known for therapeutic purposes in the alleged Masquelet technique consisting of segmental bone loss two-stage reconstruction. The induced membrane creates advantageous local conditions that promote bone graft remodeling and osteointegration. The aim of our study was to describe the first two cases in Literature of induced membrane observed following silver-coated knee megaprosthesis reconstruction. In addition, it was our interest to evaluate their histological features.

Journal of clinical medicine, Apr 25, 2024

Journal of Xiangya Medicine

Background: Pycnodysostosis (PYCD) is a rare genetic disorder causing skeletal dysplasia. It is i... more Background: Pycnodysostosis (PYCD) is a rare genetic disorder causing skeletal dysplasia. It is inherited in an autosomal recessive manner, and it is caused by a gene mutation leading cathepsin K (CTSK) deficiency. PYCD is characterized among many by short-limbed short stature, typical facial appearance and osteosclerosis with increased bone fragility. The altered bone quality typical of this disease cause the bones to be fragile and brittle with the medullary canal present while often narrowed so as a result, these individuals have an increased fracture rate. Methods: A systematic review of the literature indexed in PubMed, MEDLINE, and Cochrane Library databases using as search terms "pycnodysostosis fracture" was performed in January 2022. To be considered for this review at least a section of the population understudy needed to be affected by PYCD, bone fracture and the treatment performed needed to be explicit. Literature focused on maxillofacial manifestations/ surgery were excluded. The methodological quality of the studies was assessed using the modified Coleman methodology score (mCMS). Results: Only 23 studies met the inclusion criteria and were included in the review. The reached population consisted of 36 patients for a total of 57 fractures secondary mainly to low energy trauma (91%). Fractures occurred mainly in long bones, 54% were femur and 26% were tibia. The 60%. Of fractures were treated surgically. Bony union was achieved at an average of 11 months after surgery/trauma. The most frequent complications reported were refracture (19%) and pseudoarthrosis (31%). Six femur "impending fracture" cases have also been reported. Conclusions: Treatments such as intramedullary nailing or internal plate fixation offer continuous support for the delayed bone healing and the high risk of refracture in PYCD which are the most common complications. Prolonged follow-up over time could help these patients with a rare disease to treat and sometimes prevent disease-related events. To date, therefore, there are no standardized guidelines on this matter.

Minerva Orthopedics, 2021

BACKGROUND: The SARS-CoV-2 pandemic produced substantial changes in the organization of the natio... more BACKGROUND: The SARS-CoV-2 pandemic produced substantial changes in the organization of the national health systems. The creation of emergency units dedicated to COVID-19 patients led to a reduction in the resource usage for "clean" emergency rooms. One of the most frequent non-surgical causes of access to the orthopedic emergency room is represented by acute low back pain. The aim of the present investigation was to evaluate the role of semi-rigid corset in the treatment of patients with acute low back pain in terms of pain relief, number of control visit and duration of symptoms during COVID-19 pandemic. METHODS: A retrospective analysis of the institutional databases of low back pain patients was conducted. A total of 127 patients were enrolled in the study. Two groups of patients were obtained based on received treatment (group A: medical therapy;group B: medical therapy and semi-rigid corset) The primary outcome was to evaluate the clinical symptoms and the degree of disability at the end of the treatment. RESULTS: The treatment used in group B produced greater benefits in terms of pain improvement and disability compared to the group A. The overall satisfaction rate was much higher in the group B than group A. CONCLUSIONS: The use of a semi-rigid corset with pharmacological treatment can improve the outcome of acute low back pain compared to pharmacological treatment only. This home therapy option combined with telemedicine follow up allow to minimize the interaction between patients and healthcare workers with an important impact on the spread of the virus.

Medical Research Archives, 2021

As lung cancer is the most common neoplasm worldwide, bone is one of the most metastatic sites of... more As lung cancer is the most common neoplasm worldwide, bone is one of the most metastatic sites of advanced malignant tumors in general. Nearly 50% of patients with advanced lung cancer develop bone metastases. A literature review on this matter was performed. As in recent years the life expectancy of patients with lung cancer increased, symptoms control measures are gaining importance. The early detection of bone metastases is crucial due to prevent skeletal-related events (SREs). The bone metastases management should be discussed in a multidisciplinary setting given the numerous therapeutic options. Treatment is either pharmacological (analgesics, diphosphonates, monoclonal antibodies), non-pharmacological (radiotherapy, interventional radiological techniques, surgery) or even a combination of both. Orthopedic surgery shall be assessed in case of pathological/impending fractures. The orthopedic surgeon challenge is indeed to detect those patients who will take advantage from surger...

Journal of orthopaedics, 2021

Purpose Percutaneous trans-pedicle screws represent a surgical option frequently performed in pat... more Purpose Percutaneous trans-pedicle screws represent a surgical option frequently performed in patients affected by thoracolumbar vertebral burst fractures (A3-A4). The aim of the study was to evaluate the early loss of kyphosis correction and its clinical correlations in a cohort of patients affected by burst spinal fracture treated with percutaneous trans-pedicle screws fixation. Methods The present investigation consists in a retrospective one center analysis. The primary outcome was the evaluation of the early loss of correction. Secondary outcomes were the bi-segmental kyphosis change, the clinical outcome and the correlation between clinical outcome and the loss of correction. Results Among 435 patients 97 were included in the study. A mean 3.3° of early loss of correction was observed between postoperative and 1 month follow-up evaluations. The mean anterior vertebral body height change was 3.8 mm. No statistical differences were found in clinical and functional outcomes betwe...

Background and aim of the work: To report the history and clinical presentation of a 60-year-old ... more Background and aim of the work: To report the history and clinical presentation of a 60-year-old male who developed a rare soft tissue infection of the right leg caused by Bacillus megaterium and to perform a Literature review focusing on clinical manifestations and diagnostic difficulties of the aforementioned bacterium. Methods: Medical history and clinical presentation suggested the infectious etiology, which led to the surgical procedure of fistulectomy and to further histological and microbiological investigations with bacterial cultures. Results: The histological report tested negative for osteomyelitis. Bacterial cultures revealed Bacillus megaterium, which was sensitive to all antibiotics against which it was tested. The oral antibiotic therapy was set for 12 days with benefits. The patient has always been apyretic, inflammation indexes and white cells count have been within normal limits. Conclusions: This was a rare case of soft tissue infection caused by Bacillus megateri...

World Journal of Orthopedics

Journal of Clinical Orthopaedics and Trauma

Orthopedic Reviews

Foot metastasis are rare and often overlooked due to non-specifical symptoms. This often leads to... more Foot metastasis are rare and often overlooked due to non-specifical symptoms. This often leads to misdiagnosis delaying the right diagnosis. Metastatic disease of the foot is rare. Foot pain and swelling may be the presenting symptom of an occult malignancy. If metastatic disease is not kept in the differential diagnosis of foot pain, diagnosis and treatment will be delayed. The purpose of this study was to analyze articles presenting cases of foot metastasis to provide a more accurate incidence of symptomatic foot acrometastasis as well as to review the clinical course and outcomes. Studies were searched on PubMed/Medline from the inception to February 2020. All studies included in the review presented foot metastasis either with or without a known primary tumor. Most of the articles were case reports, to which we added two case reports of foot acrometastasis produced by our Institute. Forty-three studies with a total of 45 patients were included in this review. The literature publ...

Orthopedic Reviews

Osteoma is a benign, slowly growing, asymptomatic, bone-forming tumor arising from cancellous or ... more Osteoma is a benign, slowly growing, asymptomatic, bone-forming tumor arising from cancellous or compact bone. Osteoma usually is a solitary lesion, but in patients with Gardner’s Syndrome it may be multiple. osteoma may rarely have a parosteal localization. Parosteal osteoma has peculiar radiographic, histologic and clinical features. We describe a case report of a 51- years old man with a bifocal parosteal osteoma of the femur in a non-syndromic patient. This is the first described patient with a bifocal lesion. In literature only 24 cases of paraosteal osteoma are found. Our patient underwent surgery and the lesions were fully excised. At one year follow-up there was no evidence of recurrence.

Orthopedic Reviews

The Charcot foot is a condition characterized by a progressive derangement of the foot. The type ... more The Charcot foot is a condition characterized by a progressive derangement of the foot. The type of deformity and patient clinical conditions will lead to the proper surgical approach among exostectomy, arthrodesis (through external and/or internal fixation) and amputation. Many authors report good clinical outcomes performing the arthrodesis in Charcot foot; however, the choice of the most appropriate hardware is still an issue. The aim of this study is to analyze the outcomes of different hardware in midfoot and hindfoot Charcot arthrodesis.