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Cesare Faldini

Publications and source records attributed to Cesare Faldini.

14 recordsLinked to original sources
PubMed2007

Alendronate improves screw fixation in osteoporotic bone.

BACKGROUND: Animal studies have demonstrated the efficacy of the use of bisphosphonates to enhance screw fixation in bone. In this prospective, randomized study of pertrochanteric fractures treated with external fixation, we tested whether systemic administration of bisphosphonates would improve the fixation of hydroxyapatite-coated screws implanted in osteoporotic bone. METHODS: Sixteen consecutive patients with a pertrochanteric fracture were selected. Inclusion criteria were female gender, an age of at least sixty-five years, and a bone mineral density T-score of less than -2.5 standard deviations. Exclusion criteria included bisphosphonate treatment during the two-year period prior to the fracture. Fractures were fixed with a pertrochanteric fixator and four hydroxyapatite-coated pins. Two pins were implanted in the femoral head (pin positions 1 and 2), and two were placed in the femoral diaphysis (pin positions 3 and 4). The patients were randomized either to therapy with alendronate for a three-month postoperative period (Group A) or to no therapy (Group B). The Group-A patients received an oral dose of 70 mg of alendronate per week. The fixators were removed after three months. RESULTS: All of the fractures healed, and no loss of reduction, nonunion, or delayed union was observed. The combined mean extraction torque (and standard deviation) of the pins implanted at positions 1 and 2 (cancellous bone) was 2558 +/- 1103 N/mm in Group A and 1171 +/- 480 N/mm in Group B (p < 0.0005). The combined mean extraction torque of the pins implanted at positions 3 and 4 (cortical bone) was 4327 +/- 1720 N/mm in Group A and 4075 +/- 1022 N/mm in Group B. CONCLUSIONS: These data show that weekly systemic administration of alendronate improves pin fixation in cancellous bone in elderly female patients with osteoporosis. We observed a twofold increase in extraction torque with the pins implanted in cancellous bone. These results support the use of alendronate in the treatment of osteoporotic pertrochanteric fractures to improve screw fixation in the femoral head.

Aged↗
PubMed2006

Surgical treatment of neck hyperextension in duchenne muscular dystrophy by posterior interspinous fusion.

STUDY DESIGN: Seven patients affected by Duchenne muscular dystrophy with neck hyperextension or poor head control in extension have undergone surgery consisting of posterior cervical interspinous fusion. OBJECTIVE: To report the results of surgical treatment of neck hyperextension executed simultaneously with the correction of the thoracolumbar scoliosis. SUMMARY OF BACKGROUND DATA: A severely progressive deformity of the spine in patients affected by DMD can involve also the cervical spine presenting a rigid neck hyperextension or poor head control in extension, forcing the patients to assume awkward compensating postures in order to look straight ahead, worsening significantly their quality of life. METHODS: The procedure consisted of a posterior approach to the cervical spine, correction of the hyperextension by releasing the fibrotic muscles and ligaments, and stabilization with bone grafts driven into the interspinous spaces, to achieve solid fusion. RESULTS: No surgical complications were observed, and fusion was achieved in all patients. The mean angle between C2-C7 decreased from an average of 29.8 degrees (7 degrees -56 degrees) before surgery, to an average of 18.5 degrees (6 degrees-30 degrees) at 1 year of follow-up. Range of motion between C1-C2 was preserved. CONCLUSIONS: Surgical treatment of neck hyperextension in these patients contributes to a better sitting position, to an easier nursing, to a better appearance.

Adolescent↗
PubMed2006

Scapulopexy of winged scapula secondary to facioscapulohumeral muscular dystrophy.

UNLABELLED: Facioscapulohumeral muscular dystrophy is an hereditary disease that causes weakness of the scapulothoracic muscles and leads to winged scapula. Patients with facioscapulohumeral muscular dystrophy are unable to sustain shoulder abduction or flexion and are limited in daily activities. We retrospectively reviewed nine patients (18 procedures) who had scapulothoracic fixation without arthrodesis (scapulopexy). The technique consists of repositioning the scapula over the rib cage and fixation to four ribs with metal wires. We assessed improvement in range of motion of the shoulder, maintenance of the correction with time, and cosmetic and functional results. The average age of the patients at surgery was 25.2 years (range, 15-35 years), and there were no major complications. The average followup was 9.9 years (range, 3-16 years). All patients had complete resolution of the winged scapula and improved range of motion. Arm abduction increased from an average of 68.3 degrees (range, 45 degrees-90 degrees) preoperatively to 96.1 degrees (range, 60 degrees-120 degrees) postoperatively. Arm flexion increased from an average of 57.2 degrees (range, 45 degrees-90 degrees) preoperatively to 116.1 degrees (range, 80 degrees-180 degrees) postoperatively. The position of the scapula obtained by surgery was maintained with time, and the patients had satisfactory cosmetic results. LEVEL OF EVIDENCE: Therapeutic study, Level IV. See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2005

Surgical treatment of neck hyperextension in myopathies.

Neck hyperextension occurs in relation to several myopathies. It is a progressive increase of lordosis associated with a limitation in flexion of the cervical spine, forcing the patient to assume awkward compensatory postures to maintain balance and level vision. We evaluated operative complications, degree of correction, achievement of a solid arthrodesis, maintenance of the correction, and clinical assessment of seven patients. All had surgery in which the interspinous processes between C2-C7 were opened in a posterior approach and bone graft wedges driven into them to maintain the correction. The mean age of patients at the time of surgical intervention was 16.5 years (range, 10-28 years). The average followup was 10.4 years (range, 2.4-16.5 years). No major surgical complications occurred. After surgery, the average angle between C2-C7 in neutral position had decreased from 50.7 degrees (range, 40 degrees -70 degrees ) to 21.4 (range, 2 degrees -50 degrees ). The range of motion in the C1-C2 joint remained unaffected, whereas it decreased in C2-C7 from 33.5 degrees (range, 15 degrees -64 degrees ) to 1.8 degrees (range, 0 degrees -8 degrees ). A solid arthrodesis was achieved in all patients The followup showed significant clinical improvement of posture in all patients. The operating technique used proved to be safe and effective.

Adolescent↗
PubMed2005

Dynamic hip screw compared with external fixation for treatment of osteoporotic pertrochanteric fractures. A prospective, randomized study.

BACKGROUND: Although the use of a sliding hip screw is considered to be the preferred treatment for pertrochanteric femoral fractures, we theorized that external fixation could produce clinical outcomes equal to, if not better than, the outcomes obtained with conventional treatment. Furthermore, because external fixation is minimally invasive, we expected a lower rate of morbidity and a reduced need for blood transfusions. Therefore, we compared the two treatments in a clinical trial of elderly patients with pertrochanteric fracture. METHODS: Forty consecutive elderly female patients who had a pertrochanteric fracture were randomized to be treated with either fixation with a 135 degrees four-hole sliding hip screw (Group A) or an external fixation device with hydroxyapatite-coated pins (Group B). The inclusion criteria were female gender, an age of at least sixty-five years, an AO/OTA type-A1 or A2 fracture, and a bone mineral density T-score of less than -2.5. There were no differences in patient age, fracture type, bone mineral density, comorbidities, length of hospital stay, or quality of reduction between the two groups. RESULTS: The average intraoperative time (and standard deviation) was 64 +/- 6 minutes in Group A and 34 +/- 5 minutes in Group B (p < 0.005). The average number of units of blood transfused postoperatively was 2.0 +/- 0.1 in Group A and none in Group B (p < 0.0001). Group B had less pain five days postoperatively (p < 0.05). Varus collapse of the fracture at six months averaged 6 degrees +/- 8 degrees in Group A and 2 degrees 1 degrees in Group B (p < 0.002). No pin-track infections occurred in Group B. The average Harris hip score at six months was 62 +/- 19 points in Group A and 63 +/- 17 points in Group B. CONCLUSIONS: This study showed that external fixation with hydroxyapatite-coated pins is an effective treatment for this fracture in this patient population. The operative time is brief, the blood loss is minimal, the fixation is adequate, and the reduction is maintained over time.

Aged↗
PubMed2004

HA-coated screws decrease the incidence of fixation failure in osteoporotic trochanteric fractures.

This study was done to determine if elderly patients with trochanteric fractures and with osteoporosis could benefit from treatment with a dynamic hip screw fixed with HA-coated AO/ASIF screws. One hundred twenty patients with AO, A1, or A2 trochanteric fractures were selected. Patients were divided into two groups and randomized to receive a 135 degree-four-hole dynamic hip screw fixed with either standard lag and cortical AO/ASIF screws (Group A), or HA-coated lag and cortical AO/ASIF screws (Group B). Lag screw cutout occurred in four patients in Group A, but not in any patients in Group B. In Group A, the femoral neck shaft angle was 134 degrees +/- 5 degrees postoperatively and 127 degrees +/- 12 degrees at 6 months. In Group B, the femoral neck shaft angle was 134 degrees +/- 7 degrees postoperatively and 133 degrees +/- 7 degrees at 6 months. The Harris hip score at 6 months was 60 +/- 25 in Group A and 71 +/- 18 in Group B. The superior results of Group B can be attributed to the increased screw fixation provided by the HA-coated screws. We recommend lag screws coated with HA for dynamic hip screw fixation, especially in osteoporotic bone.

Aged↗
PubMed2003

Plate fixation with hydroxyapatite-coated screws: a comparative loaded study.

The authors evaluated whether AO/ASIF screws coated with hydroxyapatite are better fixed than standard screws in a highly loaded plate fixation animal study. Twelve sheep were divided into two groups. The medial tibial middiaphysis was exposed and a 5-mm long bone cylinder was removed. The tibiae were fixed with six-hole dynamic compression plates. Six sheep received standard AO/ASIF stainless steel cortical screws (Group A), and six sheep received AO/ASIF stainless steel cortical screws coated with hydroxyapatite (Group B). Three months after surgery, the sheep were euthanized. The mean screw insertion torque was 4800 +/- 768 N/mm in Group A and 4847 +/- 450 N/mm in Group B. The mean screw extraction torque was 530 +/- 374 N/mm in Group A and 3733 +/- 849 N/mm in Group B. Extraction torque of Group A was significantly lower compared with the corresponding insertion torque. In Group B, there were no differences between extraction and insertion torque. Morphologic analyses showed marked fibrous tissue encapsulation in Group A and bone to screw direct contact in Group B. The results confirm that hydroxyapatite-coated AO/ASIF screws prevent deterioration of screw anchorage, even under highly loaded conditions. By using hydroxyapatite-coated screws, complications resulting from inadequate fixation could be avoided.

Animals↗
PubMed2002

Fixation strength of tapered versus bicylindrical hydroxyapatite-coated external fixation pins: an animal study.

The purpose of this study was to comparatively measure the bone-pin interface strength in two types of hydroxyapatite-coated pins that differed in shape, diameter, and implantation technique. Both pin types are commonly used for tibia fixation. Thirty bicylindrical 5/4-mm stainless-steel pins (Group A) and 30 tapered 6/5-mm stainless-steel pins (Group B) were implanted in the left tibiae of 10 adult sheep. A monolateral fixator was mounted on the pins after implantation. A 5-mm-long bone segment was removed from the tibial mid-diaphysis to ensure high load at the bone-pin interface. Pin insertion torque was 830 +/- 446 N/mm in Group A and 3415 +/- 743 N/mm in Group B (p<0.0001, one-way ANOVA). Six weeks after surgery, the sheep were euthanized and pin extraction torque measured. Pin extraction torque was 1237 +/- 499 N/mm in Group A and 3367 +/- 1512 N/mm in Group B (p<0.0001, Mann-Whitney test). Morphological analysis performed at 60x magnification showed a direct bone-pin contact in both groups. Despite challenging biomechanical conditions, this study showed both pin types to be well-fixed and osteointegrated. Therefore, both pin types are recommended for tibial fixation. However, the tapered pins showed higher extraction torque, an important result for external fixation treatments.

Animals↗
PubMed2002

Improvement of the bone-screw interface strength with hydroxyapatite-coated and titanium-coated AO/ASIF cortical screws.

OBJECTIVE: To evaluate whether coating AO/ASIF screws with osteoconductive materials can improve bone-screw fixation. DESIGN: Ninety-six AO/ASIF 4.5-millimeter cortical screws were divided into four paired groups and implanted in the femurs and tibiae of six sheep: Group A = standard stainless steel screws; Group B = stainless steel screws coated with highly crystalline hydroxyapatite; Group C = stainless steel screws coated with low crystalline hydroxyapatite; Group D = titanium screws coated with titanium. The screws were implanted according to the standard AO technique to an insertion torque of 2,000 Newton-millimeters. Sheep were killed at one, three, and twelve months after surgery. MAIN OUTCOME MEASURES: Extraction torque was measured on six screws from each group selected at random at time of each euthanization. Morphologic analysis of the bone-screw interface was performed on the remaining screws. RESULTS: At each euthanization the extraction torque of Group A was lower than that of the other groups (p < 0.0001). At three and twelve months the extraction torque of Group B was higher than that of Group D (p = 0.002). Morphologic results showed extensive bone-screw gap in Group A. Optimal osteointegration was observed in Groups B and C. Osteointegration of Group D was higher than that of Group A and lower than that of Groups B and C. CONCLUSIONS: It was demonstrated that AO/ASIF screws coated with osteoconductive materials achieve optimal fixation strength, even in the early phase. This fixation strength was significantly higher than that of the standard screws.

Animals↗