To report clinical and radiographic results of treatment of patients with complex open tibial pilon fractures.
A retrospective analysis in 14 patients with complex open pilon fractures treated ...between 2010 and 2015 was conducted. The injuries were graded according to AO Classification and the Gustillo-Anderson system. Routine follow-up was performed at 1, 3, 6, 12 month with an annual evaluation thereafter. All patients were included for the assessment of the rate of infection, wound and fracture-healing. Functional outcome assessment was performed in all patients according to the American Orthopedic Foot and Ankle Score (AOFAS) at 12 months after the injury. The radiological outcome was evaluated through standard XR using the criteria proposed by Burwell and Charnley.
Analysis were conducted in 12 men and 2 women, with a mean age of 50.4 years (20–77) who were followed up for an average 34 months (range: 9–60 months). All patients had a AO type 43C fracture. There were three Gustilo Type IIIA injuries, seven Type III B and four Type III C. The mean time to fracture healing was 6.3 months. 4 patients underwent definitive treatment with external fixation at the time of the initial irrigation and debridement. 10 patients underwent delayed definitive surgery: in 10 patients ORIF was used. Soft-tissue coverage by vascularized muscle flap was necessary in 4 patients (28%) and was typically performed on the day of definitive fixation. One patient required iliac crest bone-grafting. 4 patients (28%) had a deep infection.6 patients (43%) had a superficial pin infection or cellulitis. 6 patients (43%) presented delayed union. The average AOFAS score was 71.5 (40–95). According to the Burwell-Charnley score, the anatomical reduction of the fracture was obtained in 50% of patients and a good reduction in 86% of cases. 5 patients (35.7%) had loss of joint congruity and evidence of osteoarthritis on radiographs at final follow-up. No patient needed arthrodesis or amputation.
The results of our study suggest that open tibial pilon fractures can be safely managed with low rate of complications using intensive debridement, antibiotics, adequate devices and patient-tailored timing of definitive surgical treatment.
Patients with symptomatic idiopathic venous thromboembolism and apparently cancer‐free have an approximate 10% incidence of subsequent cancer. Apparently cancer‐free patients with acute idiopathic ...venous thromboembolism were randomized to either the strategy of extensive screening for occult cancer or to no further testing. Patients had a 2‐year follow‐up period. Of the 201 patients, 99 were allocated to the extensive screening group and 102 to the control group. In 13 (13.1%) patients, the extensive screening identified occult cancer. In the extensive screening group, a single (1.0%) malignancy became apparent during follow‐up, whereas in the control group a total of 10 (9.8%) malignancies became symptomatic relative risk, 9.7 (95% CI, 1.3–36.8; P < 0.01. Overall, malignancies identified in the extensive screening group were at an earlier stage and the mean delay to diagnosis was reduced from 11.6 to 1.0 months (P < 0.001). Cancer‐related mortality during the 2 years follow‐up period occurred in two (2.0%) of the 99 patients of the extensive screening group vs. four (3.9%) of the 102 control patients absolute difference, 1.9% (95% CI, −5.5–10.9). Although early detection of occult cancers may be associated with improved treatment possibilities, it is uncertain whether this improves the prognosis.
Thromboembolic complications represent one of the most important cause of morbidity and mortality in cancer patients. Although several data have been published demonstrating the strong association ...between cancer and venous thromboembolism (VTE), there is poor perception, among oncologists, of the level of risk of thrombosis and of relevance of managing VTE in these patients. The Associazione Italiana di Oncologia Medica (AIOM) has provided some recommendations to direct clinical practice according to evidence-based data concerning cancer and VTE. In fact, we conducted an extensive literature review (1996–2005) to produce evidence-based recommendations to improve perceptions of the magnitude of this risk among Italian medical and surgical oncologists and alert on the new approaches to prophylaxis and treatment of VTE in cancer patients. Levels of evidence are given according to a five-point rating system, and similarly for each key recommendation a five-point rating system suggests if the evidence is strong and indicate that the benefits do, or do not, outweigh risks and burden.
Surgical treatment of acetabular metastasis Spinelli, M S; Ziranu, A; Piccioli, A ...
European review for medical and pharmacological sciences,
07/2016, Letnik:
20, Številka:
14
Journal Article
Recenzirano
Breast cancer is the most common malignancy in women. Bone represents the first site of metastasis in more than 50% of patients who relapse systematically. The pelvis in the most common localization ...after spine in bone metastasis due to breast cancer. The peri-acetabular localization is a greater concern rather than another part of the pelvis. Bone destruction in this anatomical localization lead to pain and mechanical instability, resulting in a great reduction of autonomy and deterioration of patient's quality of life. In the current report, the Authors review the literature about the surgical treatment, the indications and complications of each surgical technique underling the importance of tailoring each surgical procedure on life span and quality of life in order to minimize peri-operative complications and maximize functional results for the patients.
Unprovoked venous thromboembolism (VTE) may be the first manifestation of an underlying cancer. We aimed to assess the period prevalence of occult cancer detection stratified by VTE location (deep ...vein thrombosis DVT, pulmonary embolism PE or both) and the anatomical relationship between occult cancer and VTE.
Post-hoc analysis of a systematic review and individual patient data meta-analysis of adults with unprovoked VTE with at least 12 months of follow-up. Cancer types were grouped according to thoracic, abdomino-pelvic, or other locations.
A total of 2300 patients were eligible including 1218 with DVT only (53%), 719 with PE only (31%), and 363 with both PE and DVT (16%). The pooled 12-month period prevalence of cancer in DVT only, PE only, and DVT + PE was 5.6% (95% CI, 4.4 to 7.2), 4.3% (95% CI, 2.7 to 6.9), and 5.6% (95% CI, 1.7 to 15.5), respectively. Most occult cancers were located in the abdomen (68.4%). The proportion of patients with an abdomino-pelvic cancer was not different in patients with DVT + PE (81%; 95% CI, 54 to 96) than in those with DVT (68%; 95% CI, 57 to 78) or PE alone (65%; 95% CI, 48 to 79).
The 12-month prevalence of occult cancer was similar in patients with DVT only, PE only, or both. Most cancers were located in the abdomen, and there was no relationship between VTE type and cancer location.
•The relationship between sites of VTE and occult cancer is unclear.•The 12-month prevalence of occult cancer was similar in DVT only, PE only, or both.•There were no relationship between unprovoked VTE and occult cancer locations.•Two thirds of cancers diagnosed after unprovoked VTE were located in the abdomen.
Abstract Advances in adjuvant and neoadjuvant therapies have improved the prognosis of cancer patients leading to an increasing incidence of bone metastases and consequent long bone fractures. In the ...present study the authors consider the indications and the different surgical options of treatment of tibial pathological lesions. 13 patients (14 lesions, 6 pathological fractures), treated according to histotype and lesion localisation, were retrospectively evaluated. Using generic outcome instruments such as the Eastern Cooperative Oncology Group (ECOG) and Quality of life questionnaire of European Organization for Research and Treatment of Cancer (QLQ-C30) pain, mobility and use of analgesics were evaluated before and after surgery. In all patients, mechanical stabilisation of the osteolytic lesion was achieved. There were no pathological fractures, and no implant mechanical failure. All patients reported pain relief, with a relevant reduction in the amount of analgesics used. Surgical treatment of tibial metastases has to be decided taking into consideration the histotype, localisation of the metastases and life expectancy. The treatment has to be all-encompassing in a solitary lesion in patients with a good prognosis but less invasive in plurimetastatic patients with poor prognosis. Acquisition of good mechanical stability is crucial for a successful outcome.
Commissioning and first tests of the MAGIC telescope Baixeras, C.; Bastieri, D.; Bigongiari, C. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
02/2004, Letnik:
518, Številka:
1
Journal Article
Recenzirano
Major Atmospheric Gamma Imaging Cherenkov telescope is starting its operations with a set of engineering runs to tune the telescope subsystem elements to be ready for the first physics campaign. Many ...technical improvements have been developed and implemented in several elements of the telescope to reach the lowest energy threshold ever obtained by an Imaging Atmospheric Cherenkov Telescope. A general description of the telescope is presented. The commissioning of the telescope's elements is described and the expected performances are reviewed with the final detector set-up.
Pathological fractures have a high incidence in musculo-skeletal oncology, and localization in long bone causes severe pain, disability and poor quality of life. The aim of this retrospective case ...series is to evaluate the clinical results, in particular regarding the quality of life, in patients affected by lower long bone pathological fractures surgically treated. We analyzed 93 patients with pathological fractures of tibia and femur surgically treated in our Orthopaedic Department and followed up for at least 3 years or until their death. Intramedullary nailing or endoprosthetic reconstruction for pathologic fractures located in the metadiaphyseal and diaphyseal or proximal regions in advanced-stage cancer patients are suitable methods for a stable fixation or reconstruction. These approaches guarantee a good mechanical stability, a faster mobilization, a better control of pain with an overall improvement in quality of life in all patients, confirmed also by the trend of the ECOG performance status and QOL-ACD.
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