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Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 572 - 572
1 Nov 2011
Pegreffi F Belletti L Esposito M
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Purpose: The purpose of this study was to evaluate the long-term results of arthroscopic treatment in patients affected by triangular fibrocartilage complex (TFCC) type 1b lesions associated with distal radio ulnar joint (DRUJ) instability.

Method: 138 patients affected by TFCC type 1b lesions: Group A (117 patients, 27±7 yrs) were treated using an out-in arthroscopic technique and Group B (21 patients, 24±4 yrs) with an associated total DRUJ instability, were treated using an out-in arthroscopic technique in addition to an anchor placement. Inclusion criteria were: TFCC tears, type 1b lesions and no previous wrist fractures. SF-36, DASH, VAS, and ROM were accessed preoperatively and at four years follow-up.

Results: All the patients have a significant improvement in terms of SF-36 (p0.05).

Conclusion: Arthroscopy is a tool of paramount importance in both diagnosis and treatment of TFCC injuries even associated with DRUJ. Furthermore, type 1b lesions associated with total DRUJ instability should be managed combining an out-in arthroscopic technique with the use of an anchor to completely relieve pain and restore wrist function.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_III | Pages 430 - 430
1 Oct 2006
Maccauro G Liuzza F Esposito M Muratori F Salgarello M
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Primitive malignant neoplasms affecting the distal third of the tibia are altogether rare. The authors describe the diagnostic procedure and surgical strategy of limb salvage in a case of malignant fibrous histiocytoma in this region, in a 50-year-old male. In this anatomic region, considering the limb salvage surgery, there are different reconstructive possibilities, as ankle prosthesis and arthrodesis with or without vascolarized fibula. The Authors underline the infective and mechanic problems of these surgical solutions, proposing a different arthrodesis. The surgical treatment consisted in resection of the distal third of the tibia and fibula. The restoration of the skeletal continuity has been obtained by a locked nail. The mechanical resistance of the system has been obtained by acrylic cement. A vascularized myocutaneous flap allowed the cover of the resection area. About 28 months after surgical intervention, the patient is now able to walk without the aid of the knee stabilizer nor the sticks; without signs of local recurrence of the disease, metastases, with no implant failure, nor of the cement. The very favourable outcome of the clinical case previously described should make this method be looked at as one of the available surgical options in treating these lesions.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_III | Pages 422 - 422
1 Oct 2006
Maccauro G Esposito M Conti C Salvatori S Aulisa A
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Elastofibroma dorsi is a rare benign unencapsulated tumour characterized by a elastic fibres proliferation in a collagen stroma with adipose tissue. Lesion is often asymptomatic, monolateral and localized at the tip of the scapular. It is slow-growing. It mainly occurs in adult females. At now some controversies concerning diagnosis and modality of treatment are reported in the literature. Authors report clinicopathological features of elastofibroma dorsi analysing 8 cases from 2001 to 2005, and revise the literature. Seven females and 1 adult male were observed, often dedicated to manual labour. Six symptomatic patients underwent marginal excision of tumour, and the remaining asymptomatic 2 patients were only followed. No local recurrences were observed in operated patients.

On the basis of these data Authors evidenced limits of different instrumental methodologies of diagnosis (ultasonography, computer tomography and magnetic resonance imaging) and suggested a algorithm for diagnosis and treatment remarking that marginal excision constitutes effective treatment of symptomatic patients.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 41 - 41
1 Mar 2006
Maccauro G Piconi C Muratori F Sangiorgi S Sgambato A Burger W Prisca P Esposito M
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Aim. Ceramic-ceramic coupling is currently used in Orthopaedics in younger patients with longer life expectance, for the high biocompatibility of these materials. More recently new ceramic materials have been developed with better mechanical properties in comparison to Alumina, as the Alumina Matrix Composites by Transformation Toughened and in situ Plateled Reinforcement (ZPTA). The aim of the study was to analyze the biological properties of this material in comparison to Alumina and Zirconia. Materials and methods. Cylinders of different ceramic materials were inserted into surgical created defect of proximal metaepiphysis of New Zealand White adult rabbits to analyze the bone response to ceramics. Percentage of bone ceramic contact was measured. Massive inflammatory response was analyzed by intraarticullar injection of powders of different materials; while chronic low grade response as the one observed in long term well functioning implants was tested by implantation of low cohesive ceramic pellets under patellar tendons of rabbits: thank to leg movements few particles were released in time. Systemic host response was tested analyzing peripheral organs of animals. Results. Connective tissue was present at bone ceramic interface whatever materials used: no statically differences were observed in term of bone ceramic contact among Alumina, Zirconia and ZPTA. Inflammatory response with new vessels was observed around powders, especially with small diameter; while low cohesive pellets did not elicited inflammatory response neither systemic toxicity. Discussion and conclusion. Our results confirm that Alumina Matrix Composites by Transformation Toughened and in situ Plateled Reinforcement, as well as Alumina and Zirconia ceramics, induces a low inflammatory reaction in periprosthetic tissues without any systemic toxicity, due to massive or chronic release. So thank to its higher mechanical properties than Alumina and Zirconia, it should be indicated for ceramic to ceramic coupling in Orthopaedic Surgery.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_III | Pages 278 - 278
1 Mar 2003
Guida P Esposito M Esposito A Costabile T Sorrentino B Esposito V De Rosa M Riccio V Riccardi G
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Objective: Starting from results of studies made in the last ten years about the presence of myofibroblasts as the main cells involved into fibro-contractile disease, we investigated if this cells were also involved into pathogenesis of club foot deformities.

Methods: Specimens removed surgically from five patients affected by congenital club foot were investigated. Each specimen was cut in three parts: the first, was fixed for optical microscopy in formalin; the second was fixed for trasmission electron microscopy (TEM) in glutaraldehyde and postfixed in osmium tetroxide; the third was immediately placed in cold (4°C) tissue culture medium. We have stained the first part of each specimen with: haematoxylineosin, Pasini, Masson, Congo red, Van Gieson, Martius scarlet blue and immunostaining for a-smooth muscle actin (a-SM actin). The third part of each specimen, dissected into 2mm. cubes, was place in standard medium and cultured at 37°C. On the cultured cells, we have valued metalloproteinases and a-SM actin expressions. Moreover, a part of culture cells, when reached confluence, were detached with trypsin-EDTA and centrifuged for 10 min. at 2000 rpm. to obtain a pellet, subsequently fixed for TEM.

Results: Optical and electron microscopy have showed, only in one of our cases, the presence of myofibroblast’s clusters in the Henry’s nodule and in the medial and lateral fibrous nodules, that are characteristic nodule of congenital club foot.

Conclusions: Starting from the results of our studies, we would like to study in detail the role of myofibroblast in the pathogenesis of club foot.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_III | Pages 277 - 277
1 Mar 2003
Monorchio P Esposito M Rizzo M Di Giacomo P Riccardi G
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Objective: Bone marrow stromal cells (BMSC) represent an interesting target for novel strategies in the gene and cell therapy of skeletal pathologies, involving BMSC in vitro expansion/transfection and reinfusion.

Materials and Methods: Stromal cells were obtained from healthy donors. For the first 2 weeks, culture medium was supplemented only with human recombinant fibroblast growth factor 2 (FGF-2) to promote cell proliferation and maintain cells in a more immature state. Confluent cultures were detached with trypsin-EDTA. Cells were replated for the in vitro differentiation experiments and for determination of BMSC growth kinetics. Cultures were stimulated with appropriate inductive media and the chondro-/osteo-/adipo-diferentiations were tested by staining with alizarin red, alcian blue, Sudan black and by immunostaining for osteocalcina or collagen II.

Results: After the first passage, BMSC had a markedly diminish proliferation rate and gradually lost their multiple differentiation potential. Their bone-forming efficiency in vivo was reduced by about 36 times at first confluence as compared to fresh bone marrow.

Conclusion: Culture expansion causes BMSC gradually to lose their early progenitor properties. Both the duration and the conditions of culture could be crucial to successful clinical use of these cells and must be considered when designing novel therapeutic strategies involving stromal mesenchymal progenitor manipulation and reinfusion. There are numerous potential applications of this novel strategy, for example: reconstruction of extensive long-bone defects, osteochondral defect repair, treatment of bone cyst, bioactivable scaffolds, etc.