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Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_10 | Pages 77 - 77
1 May 2016
Comitini S Tigani D Leonetti D Amendola L Commessatti M
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Introduction

Acute poliomyelitis is a very rare disease in western countries, however the remnant of the pathology can be find among the adult patients. In poliomyelitis, sensation is normal and patients may suffer from painful etiologies. Total knee arthroplasty (TKA) with non-hinged or semi hinged prosthesis systems may be a good options to relief the pain in poliomyelitic patients, however the knee remains unstable. Using the hinged system implant may be the good option to resolve the late. Although the main concern in case of hinged implant usage is the mechanical stress which is directly transferred to the bone surface in contact with the implant. This may leads to implant mobilization and consequently failure.

Methods and Materials

From 2004 to 2014, 14 TKA were performed in poliomyelitic patients with secondary knee pain. All patients were presented with extensor compartment hyposthenia and reduced antigravity function. In all patients a third generation rotating hinged knees (RHK) implant system (Zimmer, Warsaw, IN, USA) was applied. Bilateral TKA was performed in only one case. The mean age at the time of surgery was 56 years (ranged 48–77). Mean follow-up was 60 months (24–112).

Results Due to post-operative infection, one patient underwent knee arthrodesis and excluded from the study. In one case, patellar fracture occurred 3 month following the surgery and treated non-surgically. Pain relief was observed in all patients following the surgery without any major complication. Mean objective score according to knee society knee scoring system was improved from 28 (16–51) preoperatively to 79 (72–88) postoperatively. Mean functional score was improved from 24 (5–35) preoperatively to 66 (50–70) postoperatively. At last follow up the mean range of motion was 90° (75°−100°). Following radiographic control at last follow-up all implants was stable without any sign of failure such as mobilization, radiolucency line or osteolysis.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_III | Pages 250 - 250
1 Sep 2005
Gasbarrini A Bròdano GB Bertoldi E Commessatti M De Iure F Gonella F Mirabile L Russo M Terzi S Boriani S
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Introduction: Purpose of this study is to evaluate retrospectively 61 cases of spinal infections, unrelated to previous spinal surgical treatment. We included patients with drug addiction. Objective of this study is to analyze the results of treatment using a diagnostic and therapeutic algorithm. This procedure may allow a systematic and comprehensive approach to the diagnosis and management of vertebral osteomyelitis. For instance, despite advances in imaging, this pathology is easily missed and treatment is often delayed.

Materials and Methods: We reviewed 61 patients aged 15–83 (average 52y) treated between January 1997 and March 2001. All patients received plain radiographs, gadolinium enhanced magnetic resonance imaging, Ga-67 and Tc-99 scintigraphy. A total of 36 patients underwent CT- guided fine-needle aspiration biopsy: the coltures of spinal specimen were positive in 47% (17/36) of cases. Blood coltures were positive in 65% (13/20).

Results: Staphylococcus Aureus was the main organism followed by Mycobacterium Tubercolosis and Staphylococcus Epidermidis. All patients received intravenous antibiotics. Neurologic impairment was present in 13 (26%) patients who underwent surgery. All patients with paresis recovered completely after surgical decompression (100%). Patients with nonsurgical spondylodiscitis were treated with bed rest and bracing. They reported residual back pain not frequently 22% (8/36) than patients treated surgically 38% (5/13).

Conclusions: the outcome of patients with vertebral osteomyelitis in general is favourable when appropriate treatment is picked even if vertebral osteomyelitis is a rare condition and because of this often overlooked initially. Delay in diagnosis may results in spine impairment, more hospitalisation time and more cost. We suggest diagnostic and therapeutic criteria in order to simplify the treatment.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 301 - 301
1 Mar 2004
Villanueva P Osorio F Commessatti M Sanchez-Sotelo J Munuera L
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Aims: Tension band wiring is a widely accepted method for internal þxation of olecranon fractures. Plate þxation is suggested for the more complex olecranon fractures, but little is known about the speciþc risk factors for failure of tension band wiring. The aim of this study was to analyze the inßuence of fracture comminution, associated elbow instability and fracture extension into the coronoid process on the outcome of tension band wiring for olecranon fractures. Methods: From 1996 to 1998, forty-four olecranon fractures were treated consecutively at out institution using tension band wiring. All patients returned for a clinical and radiographic exam performed by two observers independent of the treating surgeon. Pain and satisfaction were determined using visual-analogue scales (VAS) and clinical results were graded using the Mayo Elbow Performance Score (MEPS) and the DASH questionnaire. Patients were followed for 3 to 6 years. Results: At most recent follow-up, the mean VAS score for pain was 2.0, mean extension was 3.6û and mean ßexion was 137.2û. According to the MEPS the results were graded as good or excellent in 78% of the patients. Five patients were disabled for activities of daily living according to the DASH questionnaire. All but one fracture healed. Fracture comminution did not affect the outcome. Worse results were associated with elbow instability and fracture extension into the coronoid. Conclusions: Tension band wiring provided satisfactory results for the treatment of olecranon fractures in the presence of fracture comminution, but worse results were obtained in the presence of elbow instability and fracture extension into the coronoid.