Publications by authors named "Gianluca Testa"

127 Publications

Forearm Fracture Nonunion with and without Bone Loss: An Overview of Adult and Child Populations.

J Clin Med 2022 Jul 15;11(14). Epub 2022 Jul 15.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico "Rodolico-San Marco", University of Catania, 95123 Catania, Italy.

Nonunion occurs in 2-10% of all forearm fractures due to different mechanical and biological factors, patient characteristics, and surgeon-dependent causes. It is a condition that causes functional and psychosocial disability for the patient because it is a unique anatomical segment in which all the bones and structures involved embody a complex functional unit; therefore, it is a challenge for the orthopedic surgeon. The ultimate goal of the care of these patients is the restoration of function and limitations related to impairment and disability. The aim of this review is to provide an extended description of nonunion forearm fractures, related risk factors, diagnosis, classification systems, and the available evidence for different types of treatment as a tool to better manage this pathology.
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http://dx.doi.org/10.3390/jcm11144106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9319244PMC
July 2022

Hip Fractures and Visual Impairment: Is There a Cause-Consequence Mechanism?

J Clin Med 2022 Jul 6;11(14). Epub 2022 Jul 6.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, 95123 Catania, Italy.

Background: Numerous studies have pointed out how visual impairment relates to falls in the elderly, causing dangerous consequences, such as fractures. The proximal femur fracture is one of the most frequent fracture types related to poor vision. This study investigates the link between fall-related hip fractures and visual impairment.

Methods: The present is an observational monocentric case-control study. We collected the ophthalmologic anamnesis and measured the visual acuity of 88 subjects with femur neck fracture (case group), comparing it with 101 adults without fractures and a recent fall history.

Results: The results showed no statistical difference between the two groups regarding visual acuity, with a -value of 0.08 for the right eye and 0.13 for the left one. One of the major ophthalmologic morbidities found was cataracts, present in 48% of the control group and 30% of the case group.

Conclusions: The data obtained suggest that visual impairment might not be crucial in determining falls in the elderly.
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http://dx.doi.org/10.3390/jcm11143926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9315617PMC
July 2022

Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society.

J Child Orthop 2022 Jun 30;16(3):208-219. Epub 2022 Jun 30.

Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, Lille, France.

Purpose: The purpose of this study was to evaluate the current trends in the treatment of supracondylar humerus fractures as well as the preferred post-operative follow-up protocol among members of the European Paediatric Orthopaedic Society.

Methods: The survey was composed by four main domains and 26 items: (1) surgeon information (3 items); (2) treatment (8 items); (3) post-operative treatment (3 items); and (4) factors influencing the outcome (12 items). All active members of European Paediatric Orthopaedic Society were invited by email to answer an electronic questionnaire.

Results: The survey was submitted to 397 European Paediatric Orthopaedic Society active members; 184 members answered (46.3%) the questionnaire. Among respondents, 64.1% declared >10 years of experience and 55.4% declared to treat >20 supracondylar humerus fractures per year. Closed reduction, percutaneous pinning, and supine position were the preferred treatment option for Gartland type II and III supracondylar humerus fractures by 79.9%, 95.5%, and 84.8% of respondents, respectively. Supracondylar humerus fractures are treated within 24 h from trauma by 33.2% of respondents. Pins are removed 4 weeks from index procedure by 58.2% of respondents. Fracture type (72.3%), surgeon experience, and (71.2%) are of "crucial importance" for expected outcome of supracondylar humerus fractures treatment.

Conclusion: Surgeon experience, type of fracture, treatment modality, and pins configuration were considered the main factors potentially influencing the outcome of supracondylar humerus fractures. European Paediatric Orthopaedic Society members agreed on the treatment modality of Gartland type II and III supracondylar humerus fractures, patient positioning, and timing of hardware removal. Other important issues such as timing of surgery, pins configuration, surgical approach, and post-operative protocol are still debated.

Level Of Evidence: level II.
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http://dx.doi.org/10.1177/18632521221106379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9254020PMC
June 2022

Comparison between Vascular and Non-Vascular Bone Grafting in Scaphoid Nonunion: A Systematic Review.

J Clin Med 2022 Jun 14;11(12). Epub 2022 Jun 14.

Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy.

Background: Scaphoid fractures correspond to 60% of all carpal fractures, with a risk of 10% to progress towards non-union. Furthermore, ~3% present avascular necrosis (AVN) of the proximal pole, which is one of the main complications related to the peculiar vascularization of the bone. Scaphoid non-union can be treated with vascularized and non-vascularized bone grafting. The aim of the study is to evaluate the rates of consolidation of scaphoid non-union treated using two types of grafts.

Methods: A systematic review of two electronic medical databases was carried out by two independent authors, using the following inclusion criteria: non-union of the proximal pole of the scaphoid bone, treated with vascular bone grafting (VBG) or non-vascular bone grafting (NVBG), with or without the use of internal fixation, patients aged ≥ 10 years old, and a minimum of 12 months follow-up. Research of any level of evidence that reports clinical results and regarding non-union scaphoid, either using vascularized or non-vascularized bone grafting, has been included.

Results: A total of 271 articles were identified. At the end of the first screening, 104 eligible articles were selected for the whole reading of the text. Finally, after reading the text and the control of the reference list, we selected 26 articles following the criteria described above.

Conclusions: The choice of the VBG depends mainly on the defect of the scaphoid and on the surgeon's knowledge of the different techniques. Free vascular graft with medial femoral condyle (MFC) seems to be a promising alternative to local vascularized bone grafts in difficult cases.
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http://dx.doi.org/10.3390/jcm11123402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9225170PMC
June 2022

Running Footwear and Impact Peak Differences in Recreational Runners.

Biology (Basel) 2022 May 26;11(6). Epub 2022 May 26.

Human, Histology and Movement Science Section, Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia n°87, 95123 Catania, Italy.

Running is a physical activity and the investigation of its biomechanical aspects is crucial both to avoid injuries and enhance performance. Recreational runners may be liable to increased stress over the body, particularly to lower limb joints. This study investigates the different running patterns of recreational runners by analyzing characteristics of the footwear impact peak, spatiotemporal, and kinematic parameters among those that present with a peak impact and those that do not, with a 3D markerless system. Thirty recreational runners were divided into two groups: impact peak group (IP) ( = 16) and no impact peak group ( = 14) (n-IP). Kinematic and spatiotemporal parameters showed a large Cohen's d effect size between the groups. The mean hip flexion was IP 40.40° versus n-IP 32.30° (d = -0.82). Hip extension was IP 30.20° versus n-IP 27.70° (d = -0.58), and ankle dorsiflexion was IP 20.80°, versus n-IP 13.37° (d = -1.17). Stride length was IP 117.90 cm versus n-IP 105.50 cm (d = -0.84). Steps per minute was IP group 170 spm, versus n-IP 163 spm (d = -0.51). The heel-to-toe drop was mainly 10-12 mm for the IP group and 4-6 mm for the n-IP group. Recreational runners whose hip extension is around 40°, ankle dorsiflexion around 20°, and initial foot contact around 14°, may be predisposed to the presence of an impact peak.
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http://dx.doi.org/10.3390/biology11060818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9219650PMC
May 2022

The Etiology and Risk Factors of Osgood-Schlatter Disease: A Systematic Review.

Children (Basel) 2022 Jun 2;9(6). Epub 2022 Jun 2.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U.P. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy.

The etiology and etiopathogenesis of Osgood-Schlatter Disease (OD) are not fully understood. The aim of this review is to systematically analyze the available literature about the etiology and risk factors of OD. The literature was systematically reviewed using the PRISMA criteria to evaluate all studies published in the last 25 years (between 1996 and 2021) dealing with the etiology of OD. A total of 16 articles were included. The etiology and risk factors of OD are controversial. The main articles focused on muscular factors (mainly tightness of the rectus femoris), alteration of the patellar tendon or extensor mechanism, mechanical factors (repetitive solicitation, trauma, sports), tibial anatomy (tibial slope or tibial torsion), and histological alteration. Associations with ankle kinematic and behavior disorders were also reported. Many theories about the etiology, risk factors, and associated factors of OD have been reported in the literature, but more studies are needed to fully understand the etiopathogenesis of this disorder.
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http://dx.doi.org/10.3390/children9060826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9222097PMC
June 2022

3D-Printed Models versus CT Scan and X-Rays Imaging in the Diagnostic Evaluation of Proximal Humerus Fractures: A Triple-Blind Interobserver Reliability Comparison Study.

Adv Orthop 2022 13;2022:5863813. Epub 2022 Jun 13.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy.

Background: Proximal humerus fractures (PHFs) are one of the most frequent fractures in the elderly and are the third most fractures after those of the hip and wrist. PHFs are assessed clinically through conventionally standard imaging (X-ray and computed tomography (CT) scans). The present study aims to conduct the diagnostic evaluation and therapeutic efficacy of the 3D-printed models (3DPMs) for the PHFs, compared with the standard imaging.

Objectives: In terms of fracture classification and surgical indication, PHFs have poor interobserver agreement between orthopedic surgeons using traditional imaging such as X-rays and CT scan. Our objective is to compare interobserver reliability in diagnostic evaluation of PHFs using 3DPMs compared to traditional imaging.

Methods: The inclusion criteria were elders aged >65 years, fracture classification AO/OTA 11 B and 11 C, and no pathological fractures or polytrauma. In addition, 9 PHFs were assessed by 6 evaluators through a questionnaire and double-blinded administered for each imaging (X-ray and CT scan) and 3DPMs for each fracture. The questionnaire for each method regarded Neer classification, Hertel classification, treatment indication (IT), and surgical technique (ST). Interobserver reliability was calculated through the intraclass correlation coefficient (ICC).

Results: Nine patients with PHF were included in the study (66% female). The Neer and Hertel classifications between imaging types had similar ICC values between raters with no statistical differences. IT reliability using CT scan and 3DPMs (ICC = 1; (=0.116)) assessed better agreement compared with X-rays IT. The ST reliability using 3DPMs (ICC = 0.755; =0.002) was statistically superior to traditional imaging (ST-RX ICC = -0.004 (=0.454); ST-CT ICC = 0.429 (=0.116)).

Conclusion: Classification systems like Neer and Hertel offer poor reliability between operators. The 3DPMs for evaluating diagnostics are comparable to CT images but superior to the surgical technique agreement. The application of 3DPMs is effective for preoperative fracture planning and the modeling of patient-specific hardware.
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http://dx.doi.org/10.1155/2022/5863813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9208975PMC
June 2022

Patellofemoral Pain Syndrome in Young Female Athletes: A Case-Control Study.

Adv Orthop 2022 15;2022:1907975. Epub 2022 Apr 15.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy.

Background: Patellofemoral pain syndrome (PFPS) is the most common cause of anterior knee pain in children and adolescents, and it is characterized by highly limiting, recurrent, frontal pain.

Objectives: The purpose of the study is to assess the incidence and onset of PFPS in the young female athletes and to compare it to healthy individuals.

Methods: Between 2017 and 2019, 51 subjects were reviewed and divided in three groups: rhythmic gymnastics athletes (RG; 21 individuals, mean age: 13.8 ± 3.6 years), basketball athletes (BG; 17 individuals, mean age: 14.2 ± 3.1 years), and control group (CG; 13 individuals, mean age: 14.5 ± 4.3 years). All patients underwent physical examination including patellar glide, tilt, grind and apprehension tests, tiptoe and jack tests, Coleman block, and navicular drop tests. The clinical and functional outcomes of the subjects were assessed using the Kujala patellofemoral score (KPS).

Results: In RG patients were recorded 66.7% of normal footprint (NF), 9.5% of cavus feet (FCF), and 23.8% of flatfeet (FFF); 14.8% patellar positive tests, KS = 98.6 ± 13.7. BG patients had 70.6% of NF, 11.8% FCF, and 17.6% of FFF; 23.5% patellar positive tests, KS = 98.3 ± 12.4. CG patients had 61.5% of NF, 7.7% of FCF and 30.8% of FFF; 15.4% patellar positive tests, KPS = 98,9 ± 15.3. No statistically significance was found between the three cohorts of patients.

Conclusions: PFPS is a common pathology; muscular imbalance and overuse could exacerbate pain and discomfort in young female athletes. Our findings show high type and level of sport activity are not related to increase frequency of clinical symptoms related to PFPS.
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http://dx.doi.org/10.1155/2022/1907975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9033388PMC
April 2022

Is Obesity a Risk Factor for Loss of Reduction in Children with Distal Radius Fractures Treated Conservatively?

Children (Basel) 2022 Mar 17;9(3). Epub 2022 Mar 17.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy.

Background: Obesity in children is a clinical and social burden. The distal radius (DR) is the most common site of fractures in childhood and conservative treatment is widely used. Loss of reduction (LOR) is the major casting complication. The aim of this study is to evaluate obesity as a risk factor for LOR in children with displaced DR fractures (DRF) treated conservatively.

Methods: 189 children under 16 years of age were treated conservatively for DRF. Patients were divided into three groups: normal weight (NW), overweight (OW) and obese (OB). The following radiographic criteria were evaluated in all patients: amount of initial translation (IT); quality of initial reduction; Cast (CI), Padding (PI), Canterbury (CaI), Gap (GI) and Three-Points (3PI) indices and the presence of LOR.

Results: Statistically significant differences were found between the NW and the OB group for number of LOR ( = 0.002), severity (grade) of initial translation ( = 0.008), quality of initial reduction ( = 0.01) as well as CsI and CaI ( < 0.001).

Conclusions: Obese children have a significantly higher rate of LOR compared to NW and OW children. A close follow-up is necessary in this population of patients. Preventive percutaneous pinning could be considered in older obese patients in order to reduce the need for further treatment.
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http://dx.doi.org/10.3390/children9030425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8947058PMC
March 2022

Reliability of fr-AGILE tool to evaluate multidimensional frailty in hospital settings for older adults with COVID-19.

Aging Clin Exp Res 2022 Apr 16;34(4):939-944. Epub 2022 Mar 16.

Covid Internal Medicine Unit, Department of Translational Medical Sciences, AOU Federico II, University of Naples Federico II, Via S. Pansini, 5, 80131, Naples, Italy.

Aims: The study assesses the reliability of fr-AGILE, a validated rapid tool used for the evaluation of multidimensional frailty in older adults hospitalized with COVID-19.

Methods: Two different staff members independently assessed the presence of frailty in 144 patients aged ≥ 65 years affected by COVID-19 using the fr-AGILE tool. The internal consistency of fr-AGILE was evaluated by examining the item-total correlations and the Kuder-Richardson (KR) formula. The inter-rater reliability was evaluated using linear weighted kappa.

Results: Multidimensional frailty severity increases with age and is associated to higher use of non-invasive ventilation (p = 0.025), total severity score on chest tomography (p = 0.001) and in-hospital mortality (p = 0.032). Fr-AGILE showed good internal consistency (KR-20 = 0.742) and excellent inter-rater reliability (weighted kappa = 0.752 and 0.878 for frailty score and frailty degree, respectively).

Conclusions: fr-AGILE tool can quickly identify and quantify multidimensional frailty in hospital settings for older patient affected by COVID-19.
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http://dx.doi.org/10.1007/s40520-022-02101-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8926098PMC
April 2022

Hematopoietic progenitor cell liabilities and alarmins S100A8/A9-related inflammaging associate with frailty and predict poor cardiovascular outcomes in older adults.

Aging Cell 2022 03 15;21(3):e13545. Epub 2022 Feb 15.

IRCCS MultiMedica, Milan, Italy.

Frailty affects the physical, cognitive, and social domains exposing older adults to an increased risk of cardiovascular disease and death. The mechanisms linking frailty and cardiovascular outcomes are mostly unknown. Here, we studied the association of abundance (flow cytometry) and gene expression profile (RNAseq) of stem/progenitor cells (HSPCs) and molecular markers of inflammaging (ELISA) with the cardiorespiratory phenotype and prospective adverse events of individuals classified according to levels of frailty. Two cohorts of older adults were enrolled in the study. In a cohort of pre-frail 35 individuals (average age: 75 years), a physical frailty score above the median identified subjects with initial alterations in cardiorespiratory function. RNA sequencing revealed S100A8/A9 upregulation in HSPCs from the bone marrow (>10-fold) and peripheral blood (>200-fold) of individuals with greater physical frailty. Moreover higher frailty was associated with increased alarmins S100A8/A9 and inflammatory cytokines in peripheral blood. We then studied a cohort of 104 more frail individuals (average age: 81 years) with multidomain health deficits. Reduced levels of circulating HSPCs and increased S100A8/A9 concentrations were independently associated with the frailty index. Remarkably, low HSPCs and high S100A8/A9 simultaneously predicted major adverse cardiovascular events at 1-year follow-up after adjustment for age and frailty index. In conclusion, inflammaging characterized by alarmin and pro-inflammatory cytokines in pre-frail individuals is mirrored by the pauperization of HSPCs in frail older people with comorbidities. S100A8/A9 is upregulated within HSPCs, identifying a phenotype that associates with poor cardiovascular outcomes.
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http://dx.doi.org/10.1111/acel.13545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8920446PMC
March 2022

Benign Bone Tumors: An Overview of What We Know Today.

J Clin Med 2022 Jan 28;11(3). Epub 2022 Jan 28.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy.

Nonmalignant bone tumors represent a wide variety of different entities but maintain many common features. They usually affect young patients, and most can be diagnosed through imaging exams. Often asymptomatic, they can be discovered incidentally. Due to their similarities, these tumors may be challenging to diagnose and differentiate between each other, thus the need for a complete and clear description of their main characteristics. The aim of this review is to give a picture of the benign bone tumors that clinicians can encounter more frequently in their everyday work.
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http://dx.doi.org/10.3390/jcm11030699DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8836463PMC
January 2022

Recent Advances in -Targeting Strategies by Phytochemical Antioxidants, Nanoparticles, and Biocompatible Scaffolds for the Treatment of Diabetic Cardiovascular Complications.

Antioxid Redox Signal 2022 04;36(10-12):707-728

Laboratory of Cardiovascular Physiopathology-Regenerative Medicine, IRCCS MultiMedica, Milan, Italy.

Modulation of nuclear factor (erythroid-derived 2)-like 2 (Nrf2)-mediated antioxidant response is a key aspect in the onset of diabetes-related cardiovascular complications. With this review, we provide an overview of the recent advances made in the development of Nrf2-targeting strategies for the treatment of diabetes, with particular attention toward the activation of Nrf2 by natural antioxidant compounds, nanoparticles, and oxidative stress-modulating biocompatible scaffolds. In the past 30 years, studies addressing the use of antioxidant therapies to treat diabetes have grown exponentially, showing promising but yet inconclusive results. Animal studies and clinical trials on the Nrf2 pathway have shown promising results, suggesting that its activation can delay or reverse some of the cardiovascular impairments in diabetes. Hyperglycemia- and oscillating glucose levels-induced reactive oxygen species (ROS) accumulation is progressively emerging as a central factor in the onset and progression of diabetes-related cardiovascular complications, including endothelial dysfunction, retinopathy, heart failure, stroke, critical limb ischemia, ulcers, and delayed wound healing. In this context, accumulating evidence suggests a central role for Nrf2-mediated antioxidant response, one of the most studied cellular defensive mechanisms against ROS accumulation. Innovative approaches such as tissue engineering and nanotechnology are converging toward targeting oxidative stress in diabetes. 36, 707-728.
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http://dx.doi.org/10.1089/ars.2021.0134DOI Listing
April 2022

Clinical Effects of L-Carnitine Supplementation on Physical Performance in Healthy Subjects, the Key to Success in Rehabilitation: A Systematic Review and Meta-Analysis from the Rehabilitation Point of View.

J Funct Morphol Kinesiol 2021 Nov 4;6(4). Epub 2021 Nov 4.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico "Rodolico-San Marco", University of Catania, 95123 Catania, Italy.

L-carnitine supplementation improves body strength, sports endurance and exercise capacity, as well as delaying the onset of fatigue. The aim of this study was to identify the correct dosage of supplementation to obtain improvements in physical performance and evaluate the changes related to L-carnitine supplementation in specific metabolic parameters, such as serum lactate, VO, serum total and free carnitine at rest and after physical activities, in healthy subjects. The search was conducted on PubMed, EMBASE, Cochrane Library, Scopus and Web of Science and identified 6404 articles with the keywords: "carnitine" AND "exercises" OR "rehabilitation" OR "physical functional performance" OR "physical activity" OR "sports" OR "health" OR "healthy". A total of 30 publications met the inclusion criteria and were included in the systematic review. The meta-analysis did not show any significant differences in serum lactate values at rest and after exercise in healthy subjects who took L-carnitine supplementation ( > 0.05). On the contrary, L-carnitine administration significantly changed maximal oxygen consumption (VO) at rest ( < 0.005), serum free and total carnitine at rest and after exercise ( < 0.001). The dosage of supplementation that obtained a significant change in serum total carnitine was 2 g/dL for 4 weeks at rest, 1 g/dL for 3 weeks after exercise, and in serum free carnitine was 2 g/dL for 3 weeks and 2 g/dL for 4 weeks at rest. Based on our study, serum total and free carnitine at rest and after exercise, and VO at rest could be used to clinically follow individuals during physical activity and rehabilitation programs. Moreover, the supplementation should have a correct dosage to have maximum effect. Other robust trials are needed to find the best dosage to obtain positive results in metabolic parameters and in physical performance.
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http://dx.doi.org/10.3390/jfmk6040093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8628984PMC
November 2021

Immediate Effects of Sforzesco Bracing on Respiratory Function in Adolescents with Idiopathic Scoliosis.

Healthcare (Basel) 2021 Oct 14;9(10). Epub 2021 Oct 14.

Section of Orthopaedics and Traumatology, Department of General Surgery and Medical Surgical Specialties, University Hospital Policlinico "Rodolico-San Marco", University of Catania, 95123 Catania, Italy.

The thoraco-lumbar bracing is an effective management of adolescent idiopathic scoliosis (AIS). Studies have shown that brace wearing reduces lung volume. Whether or not the Sforzesco brace, frequently used in Italy, affects lung volume has not been investigated. We studied the immediate effect of Sforzesco bracing on lung volumes in 11 AIS patients (10 F, 1 M; aged 13.6 ± 1.6 yrs) mean Cobb angle 26 ± 4.49 degrees. Lung function variables and the perceived respiratory effort were recorded twice, before and 5 min after bracing. The one-way analysis of variance repeated measures, and multiple comparison tests, showed that means of unbraced variables were not significantly different from the corresponding means of predicted values, whereas means under brace were significantly lower ( < 0.05) compared to both predicted and baseline values of respiratory variables. In addition, a significant correlation ( < 0.0001) was found between unbraced and braced values, and linear regression equations were calculated. A significant but clinically unimportant increase in perceived effort was observed under the brace. In conclusion, data indicate that lung function is not impaired in moderate AIS and that wearing the Sforzesco brace causes an immediate, predictable reduction of lung volumes. Data also suggest that the respiratory discomfort during brace wearing could not be due to respiratory function defects.
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http://dx.doi.org/10.3390/healthcare9101372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8535408PMC
October 2021

Comparative study between admission, orthopaedic surgery, and economic trends during Covid-19 and non-Covid-19 pandemic in an Italian tertiary hospital: a retrospective review.

J Orthop Surg Res 2021 Oct 15;16(1):601. Epub 2021 Oct 15.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.

Background: The COVID-19 pandemic represents one of the most massive health emergencies in the last century and has caused millions of deaths worldwide and a massive economic and social burden. The aim of this study was to evaluate how the COVID-19 pandemic-during the Italian lockdown period between 8 March and 4 May 2020-influenced orthopaedic access for traumatic events to the Emergency Department (ER).

Methods: A retrospective review of the admission to the emergency room and the discharge of the trauma patients' records was performed during the period between 8 March and 4 May 2020 (block in Italy), compared to the same period of the previous year (2019). Patients accesses, admissions, days of hospitalisation, frequency, fracture site, number and type of surgery, the time between admission and surgery, days of hospitalisation, and treatment cost according to the diagnosis-related group were collected. Chi-Square and ANOVA test were used to compare the groups.

Results: No significant statistical difference was found for the number of emergency room visits and orthopaedic hospitalisations (p < 0.53) between the year 2019 (9.5%) and 2020 (10.81%). The total number of surgeries in 2019 was 119, while in 2020, this was just 48 (p < 0.48). A significant decrease in the mean cost of orthopaedic hospitalisations was detected in 2020 compared (261.431 euros, equal to - 52.07%) relative to the same period in 2019 (p = 0.005). Although all the surgical performances have suffered a major decline, the most frequent surgery in 2020 was intramedullary femoral nailing.

Conclusion: We detected a decrease in traumatic occasions during the lockdown period, with a decrease in fractures in each district and a consequent decrease in the diagnosis-related group (DRG).
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http://dx.doi.org/10.1186/s13018-021-02754-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8517555PMC
October 2021

Use of 3D printing and pre-contouring plate in the surgical planning of acetabular fractures: A systematic review.

Orthop Traumatol Surg Res 2022 04 11;108(2):103111. Epub 2021 Oct 11.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico "Rodolico-San Marco", University of Catania, Via Santa Sofia, 78, 95123 Catania, Italy. Electronic address:

Background: Acetabular fractures are caused by high energy injuries. The treatment aims to reconstruct the articular surface, restoring the anatomical structure. The surgical management of these fractures is difficult because it requires familiarity with the 3D anatomy of the pelvis. With the use of 3D printing technique for planning surgery, this limitation could be overcome.

Hypothesis: Studies examining the use of 3D printing in pre-operative planning of acetabular fractures tend to agree on its usefulness.

Methods: A systematic review of two electronic medical databases was performed by three independent authors, using the following inclusion criteria: any type of acetabular fracture and pre-operative use of 3D printing to plan the surgery.

Results: Among 93 screened articles, following selection criteria, six randomised controlled human trials (hRCT) were eligible for the study; articles compare a group in which a pre-contouring plate was performed through 3D printing with a control group in which the plate was intraoperatively modelled.

Conclusion: This review demonstrates the advantage of 3D printing in terms of surgical time, reduction of blood losses, quality of fracture reduction, and fixation, and reporting best clinical outcomes.

Level Of Evidence: II.
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http://dx.doi.org/10.1016/j.otsr.2021.103111DOI Listing
April 2022

Advanced Technologies to Target Cardiac Cell Fate Plasticity for Heart Regeneration.

Int J Mol Sci 2021 Sep 1;22(17). Epub 2021 Sep 1.

Department of Molecular Medicine and Medical Biotechnology, Federico II University, 80138 Naples, Italy.

The adult human heart can only adapt to heart diseases by starting a myocardial remodeling process to compensate for the loss of functional cardiomyocytes, which ultimately develop into heart failure. In recent decades, the evolution of new strategies to regenerate the injured myocardium based on cellular reprogramming represents a revolutionary new paradigm for cardiac repair by targeting some key signaling molecules governing cardiac cell fate plasticity. While the indirect reprogramming routes require an in vitro engineered 3D tissue to be transplanted in vivo, the direct cardiac reprogramming would allow the administration of reprogramming factors directly in situ, thus holding great potential as in vivo treatment for clinical applications. In this framework, cellular reprogramming in partnership with nanotechnologies and bioengineering will offer new perspectives in the field of cardiovascular research for disease modeling, drug screening, and tissue engineering applications. In this review, we will summarize the recent progress in developing innovative therapeutic strategies based on manipulating cardiac cell fate plasticity in combination with bioengineering and nanotechnology-based approaches for targeting the failing heart.
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http://dx.doi.org/10.3390/ijms22179517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8431232PMC
September 2021

Use of different devices for surgical treatment of proximal humerus fractures in adults: a systematic review.

Acta Biomed 2021 09 2;92(4):e2021198. Epub 2021 Sep 2.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy.

Background And Aim: Proximal humeral fracture is one of the most common osteoporotic fractures in elderly people. The proper treatment choice is controversial. Open reduction and internal fixation (ORIF) with plate and screws is currently the most common treatment for the majority of displaced proximal humeral fractures. The aim of this systematic review is to investigate the surgical treatment outcomes of PHFs, focusing on main used devices and surgical approaches.

Methods: From the earliest record up to 21 July 2020, two independent authors conducted a systematic review of two medical electronic database (PubMed and Science Direct). To achieve the maximum sensitivity of the search strategy, the following terms were combined: "(proximal NOT shaft NOT distal) AND humeral AND fracture AND (plate OR locking plate OR osteosynthesis NOT nail NOT arthroplasty)" as either key words or MeSH terms. The risk of bias of the included studies was assessed, agreeing to the Cochrane Handbook guidelines.

Results: Thirty-four articles were initially noticed after the term string research in the two electronic databases. Finally, after full-text reading and analyzing the reference list, 8 studies were selected. The mean age recorded was 69.5 years (Range 67-72). All the studies included two-, three-, four-fragments fracture. Seven studies investigated PHILOS (Synthes, Bettlach, Switzerland) implants results, while one investigated CFR-PEEK plate (PEEK Power Humeral Fracture Plate; Arthrex, Naples, Florida, USA) outcomes or other plates. Deltopectoral and Transdeltoid approaches were the more common used.

Conclusions: Both deltopectoral and transdeltoid approaches are valid approach in plating after proximal humerus fractures, for these reasons, the surgeon experience is crucial in the choice. The more valid implant is still unclear. The develop of prospective randomized comparative studies is strongly encourages.
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http://dx.doi.org/10.23750/abm.v92i4.11394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477127PMC
September 2021

Interobserver Reliability of Pirani and Dimeglio Scores in the Clinical Evaluation of Idiopathic Congenital Clubfoot.

Children (Basel) 2021 Jul 21;8(8). Epub 2021 Jul 21.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico "Rodolico-San Marco", University of Catania, 95123 Catania, Italy.

Background: Dimeglio (DimS) and Pirani (PirS) scores are the most common scores used in congenital talipes equinovarus (CTEV) clinical practice. The aim of this study was to evaluate the interobserver reliability of these scores and how clinical practice can influence the clinical outcome of clubfoot through the DimS and Pirs.

Methods: Fifty-four feet were assessed by six trained independent observers through the DimS and PirS: three consultants (OS), and three residents (RS) divided into three pediatric orthopaedic surgeons (PeO) and three non-pediatric orthopaedic surgeons (NPeO).

Results: The PirS and DimS Scores were strongly correlated. In the same way, OS and RS, PirS, and DimS scores were strongly correlated, and the interobserver reliability ranked "good" in the comparison between PeO and NPeO. In fully trained paediatric orthopaedic surgeons, an "excellent" interobserver reliability was found but was only "good" in the NPeO cohort.

Conclusions: In conclusion, after careful preparation, at least six months of observation of children with CTEV, PirS and DimS proved to be valid in terms of clinical evaluation. However, more experience with CTEV leads to a better clinical evaluation.
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http://dx.doi.org/10.3390/children8080618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8392791PMC
July 2021

From Codivilla to Ponseti: historical narrative review on clubfoot treatment in Italy.

Ann Transl Med 2021 Jul;9(13):1108

Pediatric Orthopedic Surgery Department, "Buzzi" Children's Hospital, Milano, Italy.

Objective: This narrative review aims to summarize the historical steps of clubfoot treatment in Italy, identifying the centuries-old historical advancement in the deformity management and the most influent involved people.

Background: Clubfoot, also referred to as congenital talipes equinovarus, is a relatively common deformity that has significative consequences in the child if it is left untreated. Effective and early treatment of clubfoot has been praised as one of the most successful practice of modern pediatric orthopedics and both surgical and conservative techniques have been proposed over the decades. As an example, Codivilla's posteromedial release (PMR) has been known internationally as one of the milestones of surgical treatment.

Methods: The narrative review includes clinical studies and reviews concerning clubfoot that were written in English, German and Italian. As an historical review, no limits of years were considered. The search was performed using PubMed, Google Scholar, Scopus, Medline and Cochrane Library databases up to January 2021. A combination of search terms including 'history', 'clubfoot', 'conservative management', 'Codivilla', 'Ponseti method', 'relapse' was utilized. Particular attention was given to papers written by Italian authors.

Conclusions: Current clubfoot treatment arises from several studies and clinical research over the centuries. Many surgeons, starting from mid-16th century, have studied the deformity trying to find a successful and effective technique to achieve full correction. Italian scientists, surgeons and prestigious institutions surely took part in this process.
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http://dx.doi.org/10.21037/atm-20-7956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339829PMC
July 2021

Arthroereisis in juvenile flexible flatfoot: Which device should we implant? A systematic review of literature published in the last 5 years.

World J Orthop 2021 Jun 18;12(6):433-444. Epub 2021 Jun 18.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania 95123, Italy.

Background: Flexible flatfoot (FFF) is a very common condition in children, characterized by the loss of the medial arch and by an increase in the support base with valgus of the hindfoot. Arthroereisis (AR) procedures are widely performed corrective surgeries and are classified as subtalar AR and calcaneo-stop (CS).

Aim: We investigated the literature published in the last 5 years with the aim of providing an update on the evidence related to AR treatment in FFF patients. We report the principal findings of subtalar AR and CS procedures concerning clinical and radiological outcomes and complication rates in the general population, young athletes, and obese people according to material device.

Methods: Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of studies published in the past 5 years and included the PubMed and Science Direct databases was performed on May 6, 2020. The research string used was (pediatric OR children OR Juvenile NOT adult) AND (flexible NOT rigid) AND (flat foot OR pes planus) AND (calcaneo-Stop OR arthroereisis OR subtalar extra-articular screw OR SESA OR subtalar arthroereisis OR endosinotarsal). The risk of bias assessment was performed using the Dutch checklist form for prognosis.

Results: A total of 47 articles were found. Ultimately, after reading the full text and checking reference lists, we selected 17 articles that met the inclusion and exclusion criteria. A total of 1864 FFFs were identified. Eight studies concerned the subtalar AR (47.1%) and nine concerning CS (52.9%). The average age of patients at start of treatment was 11.8 years, the average follow-up of the studies was 71.9 mo (range 29.1-130). Globally, complications occurred in 153 of the 1864 FFF treated, with a rate of 8.2%.

Conclusion: Both AR procedures are valid surgical techniques for treating FFF. Surgeon experience, implant cost, and cosmetic correction are the most common considerations included in the orthopedic device decision-making process. In obese patients, the subtalar AR is not recommended. In adolescents who need to improve sports performance, the CS screw had better results compared with other implants.
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http://dx.doi.org/10.5312/wjo.v12.i6.433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223720PMC
June 2021

Results of the Italian Pediatric Orthopedics Society juvenile flexible flatfoot survey: diagnosis and treatment options.

J Pediatr Orthop B 2022 Jan;31(1):e17-e23

Pediatric Orthopedic and Traumatology Unit, San Raffaele Hospital, Milan, Italy.

The objectives of this study were to collect and analyze current diagnosis and treatment options of symptomatic flexible flatfoot (FFF), as well as to identify treatment expectations, among the members of the Italian Pediatric Orthopedics Society (SITOP). Diagnosis and treatment preferences were recorded according to a web-based survey. The survey was divided into six main sections: (1) general clinical parameters; (2) foot aspects; (3) X-ray angles (or lines); (4) expectations; (5) standard clinical assessment; (6) treatment options. One hundred and ten out of 248 SITOP members answered to the questionnaire. Age (85.5%), pain at the level of the plantar arch or fascia (61.8%), fatigue (59.1%) were the clinical parameters of crucial importance. Heel valgus (85.4%), flexibility (61.8%) and forefoot supination (47.3%) were identified as the most important foot aspects. Ninety-two responders (83.6%) identified the 'improved ability to walk longer without symptoms or discomfort' as the principal treatment expectation. Pain evaluated through the visual analog scale (VAS) was considered crucial in 31.8% of cases. All respondents confirmed they also treat patients with FFF surgically; in particular, 97.3% of SITOP affiliates declare to perform arthroereisis followed by lateral column lengthening (29.1%) and medializing calcaneal osteotomy (9.1%). Although in this survey heterogeneous findings for diagnosis and treatment of patients with symptomatic FFF within SITOP members were found, a large preference for age, heel valgus, flexibility as clinical aspects and parameters, as well as nonoperative treatment and arthroereisis, was reported.
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http://dx.doi.org/10.1097/BPB.0000000000000881DOI Listing
January 2022

Locked Intramedullary Nailing versus Compression Plating for Stable Ulna Fractures: A Comparative Study.

J Funct Morphol Kinesiol 2021 May 26;6(2). Epub 2021 May 26.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico "Rodolico-San Marco", University of Catania, 95123 Catania, Italy.

Background: Isolated ulna shaft fractures (USFs) are a relatively uncommon, but significant, injury. For unstable USF treatment, open reduction and internal fixation (ORIF) is the gold standard, while for stable USFs several procedures were described. The aim of this study is to compare the outcomes in patients with stable USFs treated by either ORIF or intramedullary nail (IMN).

Methods: According to their surgical treatment, 23 eligible USF-affected patients were divided into ORIF (14 subjects) and IMN (nine subjects) groups. The subjects underwent postoperative clinical follow-up at 1, 3, 6, and 12 months, which included calculation of the Disabilities of the Arm, Shoulder and Hand (DASH) score and radiological follow-up. Time to union, time to return to sporting and occupational activities, duration of physical therapy, and surgical complications were recorded.

Results: DASH scores improved in both groups at the 6-month follow-up ( < 0.001). The IMN cohort recorded better DASH scores at the 1- and 3-month follow-ups, while similar results were reported at the 6- and 12-month follow-ups. Earlier fracture union ( = 0.001) and return to sporting activities and work ( = 0.002) were seen in the IMN group, compared with the ORIF group. No complications were observed in the IMN group.

Conclusions: The surgical treatment of isolated USF results in excellent functional and radiographic outcomes. IMN may be preferable, compared with ORIF, due to its faster recovery time, expedited union, and reduced likelihood of complications.
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http://dx.doi.org/10.3390/jfmk6020046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8163154PMC
May 2021

Targeting fibrosis in the failing heart with nanoparticles.

Adv Drug Deliv Rev 2021 07 11;174:461-481. Epub 2021 May 11.

Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy; Interdepartmental Center for Nanotechnology Research-NanoBem, University of Molise, Campobasso, Italy. Electronic address:

Heart failure (HF) is a clinical syndrome characterized by typical symptoms and signs caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress. Due to increasing incidence, prevalence and, most importantly mortality, HF is a healthcare burden worldwide, despite the improvement of treatment options and effectiveness. Acute and chronic cardiac injuries trigger the activation of neurohormonal, inflammatory, and mechanical pathways ultimately leading to fibrosis, which plays a key role in the development of cardiac dysfunction and HF. The use of nanoparticles for targeted drug delivery would greatly improve therapeutic options to identify, prevent and treat cardiac fibrosis. In this review we will highlight the mechanisms of cardiac fibrosis development to depict the pathophysiological features for passive and active targeting of acute and chronic cardiac fibrosis with nanoparticles. Then we will discuss how cardiomyocytes, immune and inflammatory cells, fibroblasts and extracellular matrix can be targeted with nanoparticles to prevent or restore cardiac dysfunction and to improve the molecular imaging of cardiac fibrosis.
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http://dx.doi.org/10.1016/j.addr.2021.05.004DOI Listing
July 2021

Injection-Based Management of Osteoarthritis of the Knee: A Systematic Review of Guidelines.

Front Pharmacol 2021 20;12:661805. Epub 2021 Apr 20.

Section of Orthopaedics, Department of General Surgery and Medical Surgical Specialties, A.O.U. Policlinico Rodolico - San Marco, University of Catania, Catania, Italy.

Osteoarthritis (OA) is a leading cause of disability among older adults. Numerous pharmaceutical and nonpharmaceutical interventions have been described. Intra-articular injections are commonly the first line treatment. There are several articles, reporting the outcome of corticosteroids (CS), hyaluronic acid (HA) and platelet rich plasma (PRP). The aim of the study is to highlight the usefulness, indication and efficacy of the intra-articular injection of principal drugs. CSs have been shown to reduce the severity of pain, but care should be taken with repeated injections because of potential harm. HA reported good outcomes both for pain reduction and functional improvement. Different national societies guidelines do not recommend the PRP intra-articular injection in the management of knee OA for lack of evidence. In conclusion, the authors affirm that there is some evidence that intra-articular steroids are efficacious, but their benefit may be relatively short lived (<4 weeks). Most of the positive outcome were limited to the studies or part of the studies that considered the injection of high molecular weight as visco-supplementation, with a course of two to four injections a year.
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http://dx.doi.org/10.3389/fphar.2021.661805DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096293PMC
April 2021

Sport Ability during Walking Age in Clubfoot-Affected Children after Ponseti Method: A Case-Series Study.

Children (Basel) 2021 Mar 1;8(3). Epub 2021 Mar 1.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico "Rodolico-San Marco", University of Catania, 95123 Catania, Italy.

Background: The Ponseti method (PM) of manipulative treatment for congenital talipes equinovarus (CTEV) or clubfoot became widely adopted by pediatric orthopedic surgeons at the beginning of the mid-1990s with reports of long-term successful outcomes. Sports are crucial for children's development and for learning good behavior. This study aimed to evaluate the sports activity levels in children treated with PM and to assess the different outcomes, according to gender and bilaterality.

Methods: A total of 25 patients (44 feet) with CTEV treated by the PM were included in the study. The patients were clinically evaluated according to the Clubfoot Assessment Protocol, American Orthopedic Foot and Ankle Society, Ankle-Hindfoot score, the Foot and Ankle Disability Index (CAP, AOFAS, and FADI, respectively), and FADI Sport scores.

Results: The overall mean CAP, AOFAS, FADI, and FADI Sport scores were 97.5 ± 6.4 (range 68.75-100), 97.5 ± 5.8 (range 73.00-100), 99.9 ± 0.6 (range 97.1-100), and 100, respectively. Gender and bilaterality did not affect outcome ( > 0.05).

Conclusions: The data confirmed good-to-excellent outcomes in children with CTEV managed by PM. No limitations in sport performance or activity could be observed. In particular, male and female patients and patients with unilateral or bilateral involvement performed equally well.
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http://dx.doi.org/10.3390/children8030181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001402PMC
March 2021

Dynamic and Static Splinting for Treatment of Developmental Dysplasia of the Hip: A Systematic Review.

Children (Basel) 2021 Feb 4;8(2). Epub 2021 Feb 4.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy.

Background: Developmental dysplasia of the hip (DDH) is one of the most common pediatric conditions. The current gold-standard treatment for children under six months of age with a reducible hip is bracing, but the orthopedic literature features several splint options, and each one has many advantages and disadvantages. The aim of this review is to analyze the available literature to document the up-to-date evidence on DDH conservative treatment.

Methods: A systematic review of PubMed and Science Direct databases was performed by two independent authors (C.d.C. and A.V.) using the keywords "developmental dysplasia hip", "brace", "harness", "splint", "abduction brace" to evaluate studies of any level of evidence that reported clinical or preclinical results and dealt with conservative DDH treatment. The result of every stage was reviewed and approved by the senior investigators (V.P. and G.T.).

Results: A total of 1411 articles were found. After the exclusion of duplicates, 367 articles were selected. At the end of the first screening, following the previously described selection criteria, we selected 29 articles eligible for full text reading. The included articles mainly focus on the Pavlik harness, Frejka, and Tubingen among the dynamic splint applications as well as the rhino-style brace, Ilfeld and generic abduction brace among the static splint applications. The main findings of the included articles were summarized.

Conclusions: Dynamic splinting for DDH represents a valid therapeutic option in cases of instability and dislocation, especially if applied within 4-5 months of life. Dynamic splinting has a low contraindication. Static bracing is an effective option too, but only for stable hips or residual acetabular dysplasia.
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http://dx.doi.org/10.3390/children8020104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913860PMC
February 2021

Intra-Articular Injections in Knee Osteoarthritis: A Review of Literature.

J Funct Morphol Kinesiol 2021 Feb 3;6(1). Epub 2021 Feb 3.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, 95123 Catania, Italy.

Knee osteoarthritis (OA) is a chronic, degenerative, and progressive disease of articular cartilage, producing discomfort and physical disability in older adults. Thirteen percent of elderly people complain of knee OA. Management options for knee OA could be divided into the following categories: conservative, pharmacological, procedural, and surgical. Joint replacement is the gold standard, reserved for severe grades of knee OA, due to its complications rate and increased risk of joint revision. A nonsurgical approach is the first choice in the adult population with cartilage damage and knee OA. Yearly, more than 10% of knee OA-affected patients undergo intra-articular injections of different drugs, especially within three months after OA diagnosis. Several molecules, such as corticosteroids injection, hyaluronic acid (HA), and platelet-rich plasma (PRP), are managed to reduce the symptoms of patients with knee OA. The aim of this review was to offer an overview of intra-articular injections used for the treatment of OA and report the conventional pharmacological products used.
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http://dx.doi.org/10.3390/jfmk6010015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931012PMC
February 2021

Is Supine Position Superior to Prone Position in the Surgical Pinning of Supracondylar Humerus Fracture in Children?

J Funct Morphol Kinesiol 2020 Jul 31;5(3). Epub 2020 Jul 31.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy.

Background: Supracondylar humerus fracture (SCHF) is a frequent injury in pediatric ages. Closed reduction and percutaneous pin fixation is a common treatment of displaced SCHF. Surgery is usually performed in the supine position; otherwise the prone position allows an easier fracture reduction and a safe placement of pins. The aim of study is to compare the clinical and radiographic results of the treatment of displaced SCHF, comparing two different intra-operative positionings.

Methods: 59 SCHF affected children were retrospectively divided into supine (Group 1; = 34) and prone (Group 2; = 25), according to intraoperative position. All treated subjects were clinically evaluated according to Flynn's criteria and Mayo Elbow Performance Score, and radiographically, including the measurement of the Baumann angle.

Results: Clinically, Group 1, according Flynn's criteria, had excellent cosmetic outcome in 32 subjects (94.1%). Mean MAYO Score was 96.0 ± 3.8. Group 2, according Flynn's criteria, had excellent cosmetic outcomes in 23 subjects (92.0%). Mean MAYO Score was 97.8 ± 3.3. Radiographically, mean difference of Baumann's angle between the injured limb and the normal limb was 5.5° ± 1.0° in Group 1 and 5.1° ± 1.1° in Group 2.

Conclusion: Both supine and prone positioning achieved a satisfying outcome with similar results in joint function recovery and complications.
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http://dx.doi.org/10.3390/jfmk5030057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739299PMC
July 2020
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