The pediatric nurse practitioner as a way of life in rural health.
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Nurse Practitioners↗
Biomedical subjects
E Gozzi
Publications and source records attributed to E Gozzi.
Pediatric nurse practitioner at work.
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Child Health Services↗
Locked nailing in subtrochanteric fractures of the femur in the elderly patient.
Subtrochanteric fractures are a typical pathology in the elderly patient, they are not very common and they are difficult to treat. The general conditions of these patients, often at the limit of operability, are further compromised by surgery and time spent in bed, leading to the death of the patient in a high percentage of cases. The fracture is often spyroid, it has multiple fragments, with interruption of the medial cortical bone. The quality of the bone, because of the marked osteoporosis, does not guarantee the good hold of the means of fixation used. The use of intramedullary nailing is a safe method, that allows for stabilization of the fracture without excessive blood loss, it allows for early partial weight-bearing and it has a lower number of complications as compared to other methods. Between 1-1-97 and 31-12-00 a total of 59 persubtrochanteric fractures were treated; there were 15 males and 44 females. A Gamma Long nail was used in 46 cases, a Gamma Standard in 13. Eleven of the patients died within 6 months. A total of 27 patients aged an average of 78 years (minimum 65, maximum 87) were evaluated at a mean follow-up of 10 months (minimum 7, maximum 27). A Gamma Long nail had been used in 18 cases, and Gamma Standard in 8. Partial weight-bearing was allowed after a mean of 20 days (minimum 10, maximum 35), total weight-bearing after a mean of 60 days (minimum 40, maximum 75). Consolidation was obtained after a mean of 4 months (minimum 3, maximum 7). There were no significant complications.
Age Factors↗
Conjoined fracture-dislocation of the forearm at the elbow.
Conjoined fracture-dislocation of the elbow were first described by Marotte in 1982. In this study, a total of 41 patients treated between 1975 and 1995 at the Rizzoli Orthopaedic Institute and 4 patients treated between 1997 and 2000 at the Division of Orthopaedics at the Maggiore Hospital are evaluated. Based on the Marotte classification, the patients are divided into 4 groups, by site of dislocation of the radial capitellum and amount of comminution of the fracture of the ulna. A clinical and radiographic evaluation was made after a mean follow-up of 5.3 years based on Anderson criteria. The results obtained were excellent in 17 patients (37.8%) satisfactory in 13 (28.9%), dissatisfactory in 12 (26.7%); 3 patients were considered to be failures (6.7%), the best results were obtained in type I anterior dislocations.
Adolescent↗
The results of the surgical treatment of bone tumors using massive homoplastic grafts.
We reviewed our experience as concerns 588 patients treated by resection for bone tumor and reconstructed by massive bank bone implant. The period taken into consideration goes from 1984 to 2001. The mean age of the patients was 24 years with a minimum of 1 and a maximum of 77 years: in 186 cases (31.6%) age was lower by 14 years. Most of the patients were referred for a diagnosis of malignancy (85%), and of these, 70% had undergone antiblastic therapy postoperatively according to the modalities of the protocols. Of the cases that were not treated by chemotherapy there are 16 that had a homoplastic graft after failure of a previous one. In a high number of cases (189) surgery included reconstruction of an intercalar segment of a long bone. Of these, 106 were in the femur, 69 in the tibia, and 14 in the humerus. One joint reconstruction was carried out in 128 cases of which 52 in the knee, 49 in the shoulder, 10 in the elbow, 11 in the wrist, 3 in the ankle, and 3 in the metatarsals. Fusion, which was one of the most frequent indications in the eighties, is used less today; overall it was carried out in 91 cases of which 65 in the knee, 14 in the hip, 9 in the ankle and 3 in the wrist. This type of implant may also be used in the pelves, and this took place in 56 cases using different procedures of reconstruction. The most current method of reconstruction for a joint is composite prosthesis, and this was used in 124 cases of which 67 around a knee, 53 in the hip, 4 in the shoulder. Finally, in 78 cases a vascularized fibula transplant was associated with an intercalar graft, fusion, or osteoarticular graft to increase the mechanical capacity of the implant together with a more rapid integration of the implant, particularly at the osteotomic lines. Despite the excellent results demonstrated in the first 3 years of follow-up, infection, resorption, delay in consolidation and fracture led to 18% failures of the implant. Massive homoplastic graft is still a good means of reconstruction that allows for excellent functional results, but despite this intense research activity is required to improve its mechanical hold in time together with better and complete integration.
Adolescent↗
Knee resection arthrodesis with allograft: a long-term follow-up study.
A consecutive series of 57 patients treated by knee resection arthrodesis for malignant or aggressive tumor around the knee was reviewed. Infection was present only after repeated surgery for other complications, delayed union or non-union occurred in 50% of the cases that could be evaluated, but were still easy to manage. Fracture incidence was higher than expected (32.6%) even occurring after 10 years; this was difficult to deal with and it often led to failure. The best possible method of fixation is still being debated, but locked nail and allograft cementation is often advised. Several satisfactory functional results were however achieved when surgery was performed in young patients; final results can be less satisfactory when there is leg length discrepancy and poor acceptance on the part of the patient. In recent years this type of surgery has been limited to younger male patients (10 to 14 years of age) in whom extra-articular knee resection was required or when most of the quadriceps muscle must be removed.
Adolescent↗