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Biomedical subjects

Marco Rizzo

Publications and source records attributed to Marco Rizzo.

17 recordsLinked to original sources
PubMed2007

Pyrolytic carbon proximal interphalangeal joint arthroplasty: results with minimum two-year follow-up evaluation.

PURPOSE: To retrospectively review the surgical technique, postoperative therapy/splinting protocols, and clinical and radiographic outcomes of patients who had pyrolytic carbon proximal interphalangeal (PIP) joint arthroplasty. METHODS: A total of 50 PIP joint replacements in 35 patients were performed with a minimum follow-up period of 27 months. Indications for surgery included pain, decreased range of motion, instability, and/or deformity. The preoperative diagnosis was osteoarthritis in 14, rheumatoid arthritis in 11, and posttraumatic arthritis in 10. There were 20 women and 15 men affected. The average age at the time of surgery was 53 years. The fingers replaced included the index (15), middle (18), ring (10), and small (7). The preoperative arc of motion averaged 40 degrees (0 degrees-60 degrees ), and the pinch and grip measurements averaged 3 and 19 kg, respectively. The preoperative pain scores averaged 6 (scale, of 0-10) on a visual analog space scale. RESULTS: The arc of motion was 47 degrees after surgery, and the average pinch and grip measurements were 4 and 25 kg, respectively. Pain scores improved to 1. At the final follow-up evaluation the overall patient satisfaction was nearly 80%. The results of index finger PIP replacements are compatible with other digits. Fourteen joints (in 14 patients) to date have required additional procedures to improve or maintain joint motion/function or pain; 5 for minor reasons and 9 for major complications. The revision arthroplasty rate was 8%. No infections were noted. Although not medically necessary, 2 patients requested and had an amputation. Radiographic subsidence and subsequent settling (in accordance with Wolff's law) without apparent loosening occurred in 20 joints. CONCLUSIONS: Our 2-year minimum follow-up evaluation of pyrolytic carbon implant arthroplasty showed improved pain relief and good overall patient satisfaction. Twenty-eight percent of patients required a second procedure and 8% required a revision arthroplasty. Radiographs showed gross changes in implant and eventual settling to a stable position in 40% of the joints. A longer follow-up period will help to better determine the efficacy of this implant. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adult↗
PubMed2006

Nonrheumatoid metacarpophalangeal joint arthritis. Unconstrained pyrolytic carbon implants: indications, technique, and outcomes.

Unconstrained pyrolytic surface replacement arthroplasty provides the benefits of a more natural center of rotation with preservation of native ligamentous joint stability. Initial short-term results show excellent motion, pain relief, and restoration of pinch and grip strength. These results are encouraging, and suggest that pyrolytic carbon arthroplasty may be a reasonable option for joint salvage in patients suffering from MP joint osteoarthritis.

Adult↗
PubMed2006

Thumb arthrodesis.

PURPOSE OF REVIEW: Arthrodesis of the thumb carpometacarpal, metacarpophalangeal, and interphalangeal joints are well-established options in the management of arthritis, instability, and/or deformity. This review includes a general review of the indications and technique of arthrodesis and recent review of the literature. RECENT FINDINGS: New literature has focused on the role of arthrodesis in managing carpometacarpal arthritis and compared its results with ligament reconstruction and tendon interposition. However, no conclusive evidence demonstrates the superiority of arthrodesis. Several new articles have demonstrated good long-term results of carpometacarpal arthrodesis. A new report on complications associated with plate and screw fixation for carpometacarpal arthritis has been published, leading the authors to conclude that k-wire fixation was a better option. A technique of metacarpophalangeal joint arthrodesis using a cannulated screw has been recently published with good success. Moreover, a cup-in-cone technique of reaming surfaces of the thumb metacarpophalangeal joint to maximize bone contact surface area has been described. Other authors have reiterated and reinforced the success of some of the more standard techniques including Herbert screws for interphalangeal joint arthrodeses. SUMMARY: Thumb arthrodesis of the carpometacarpal, metacarpophalangeal, and interphalangeal joints maintains a significant role in the management of deformity and arthritis. Better comparison studies are necessary in evaluating arthrodesis of the carpometacarpal joint versus arthroplasty. New fixation techniques for metacarpophalangeal joint arthrodesis are promising. Standard fixation for interphalangeal joint fusion has been reiterated. Successful arthrodesis can lead to excellent patient outcomes and function.

Arthritis↗
PubMed2006

Treatment of acute scaphoid fractures in the athlete.

Scaphoid fractures in athletes can be very disabling and may limit successful and early return to play. Typically, the mechanism of injury is a fall onto an outstretched hand or a direct blow; the patient will present with swelling, limited motion, and snuffbox tenderness. Multiple-view plain images will very often reveal the diagnosis. In addition, diagnostic modalities such as CT scanning and MRI are helpful in better defining the architecture of the fracture and vascularity of the scaphoid, and diagnosing occult fractures. Early and accurate diagnosis is critical to help ensure appropriate treatment and optimal outcome. Traditional treatment of stable nondisplaced fractures remains cast immobilization. However, if early return to play is desired operative fixation may be warranted. For nondisplaced fractures operative techniques include open reduction and internal fixation (ORIF), and percutaneous fixation through a dorsal or volar approach. Arthroscopy can be used as an adjunct to the percutaneous technique. For displaced fractures, the preferred technique remains ORIF through either a volar or dorsal approach. Considerations in treatment type are based on the stability and location of the fracture as well as patient issues such as compliance and the need for return to play. With appropriate diagnosis and individualization of treatment, scaphoid fractures can be successfully managed in most athletes with few or no long-term sequelae.

Acute Disease↗
PubMed2005

Stacking of a dermal regeneration template for reconstruction of a soft-tissue defect after tumor excision from the palm of the hand: a case report.

Excision of tumors from the hand often leaves tissue defects with exposed tendons or neurovascular structures that require coverage. Various types of free and pedicled grafts have been described for use in these situations. We present a patient who had a tumor excision in the hand followed by wound coverage with a stacked dermal regeneration template. A 50-year-old man presented with a mass over the palm of the hand. He had an incisional biopsy procedure, the results of which suggested malignancy. He then had wide excision with planned temporary skin coverage with a dermal regeneration template. The dermal template incorporated nicely. With adequate skin coverage the palmar defect still was substantial in terms of depth. This was raised with layering or stacking of the template followed by a split-thickness skin graft. Excellent wound healing and coverage of the defect ultimately were achieved. Additionally the patient went on to obtain full range of motion. Stacking of a dermal regeneration template coupled with split-thickness skin grafting was used to fill a soft-tissue defect over the median and nerve and flexor tendons after wide tumor excision.

Diagnosis, Differential↗
PubMed2005

No correlation between trapeziometacarpal arthritis and abductor pollicis longus insertion.

The primary hypothesis of this study is that supernumerary slips of the abductor pollicis longus (particularly those slips inserting distal to the trapeziometacarpal joint) increase the risk of trapeziometacarpal osteoarthritis on account of increased transarticular forces. Other hypotheses surmised that age and female gender were directly correlated with severity of arthritis. We did cadaveric dissection of the distal first dorsal compartment in 61 specimens, noting the cadaveric age, gender, and number and insertion sites of abductor pollicis longus tendon slips. Each variable was statistically correlated with visual grade of trapeziometacarpal arthritis. The median number of abductor pollicis longus tendon slips in these cadaveric hands was three (range, 1-4). Seventy-nine percent of the hands had a digastric-type insertion into the abductor pollicis brevis. Ninety percent had an insertion into the trapezium. All hands possessed an insertion into the base of the first metacarpal. Age and female gender were directly correlated with severity of arthritis. No other correlations existed. We conclude that trapeziometacarpal joint arthritis progresses with age and occurs independently of any aspect of abductor pollicis longus insertion. Based on our results, we do not recommend surgical release of these supernumerary abductor pollicis longus tendon slips for the treatment of trapeziometacarpal osteoarthritis.

Adult↗
PubMed2004

Oral simvastatin treatment in relapsing-remitting multiple sclerosis.

Many drugs have been approved for relapsing forms of multiple sclerosis but are only partly effective, are injected, and are expensive. We aimed to investigate use of of oral simvastatin (80 mg) in 30 individuals with relapsing-remitting multiple sclerosis. The mean number of gadolinium-enhancing lesions at months 4, 5, and 6 of treatment was compared with the mean number of lesions noted on pretreatment brain MRI scans. Number and volume of Gd-enhancing lesions declined by 44%, (p<0.0001) and 41% (p=0.0018), respectively. Treatment was well tolerated. Oral simvastatin might inhibit inflammatory components of multiple sclerosis that lead to neurological disability.

Adjuvants, Immunologic↗
PubMed2004

Arthroscopic resection in the management of dorsal wrist ganglions: results with a minimum 2-year follow-up period.

PURPOSE: The purpose of this report is to review the results of arthroscopic resection of dorsal wrist ganglions. METHODS: Forty-one patients with dorsal wrist ganglions had arthroscopic resection: 24 women and 17 men. The average patient age was 29.8 years. All of the patients had some or all of the following: pain, localized swelling, and limited range of motion. Along with clinical examination, 19 wrists had ultrasound or magnetic resonance imaging to confirm diagnosis. Twelve patients had previous injections with recurrence. The average follow-up time to date is 47.8 months (range, 28-97 months). RESULTS: Overall postoperative motion improved compared with preoperative values. No cases of scapholunate instability were noted. The average postoperative grip strength improved significantly. Only 2 ganglions recurred and required 2 attempts at open resection for successful eradication the ganglion. No major intraoperative or postoperative complications occurred. CONCLUSION: Arthroscopic ganglionectomy is a safe and reliable alternative to open resection.

Adolescent↗
PubMed2004

Thoracoscopic sympathectomy in the management of vasomotor disturbances and complex regional pain syndrome of the hand.

Complex regional pain syndrome, vasospastic disorders, and hyperhidrosis are chronic and debilitating upper extremity problems. Twenty-nine consecutive patients treated with thoracoscopic sympathectomy are presented. Diagnoses included complex regional pain syndrome, hyperhidrosis, Buerger's disease, Raynaud's disease, and peripheral vascular disease. All patients with hyperhidrosis had complete symptom resolution. Patients with Buerger's and Raynaud's disease had excellent/good results. Six patients with complex regional pain syndrome had excellent or good relief; the remaining six patients had varying degrees of recurrence. A statistically significant association was noted between duration of complex regional pain syndrome prior to sympathectomy and outcome. Thoracoscopic sympathectomy is an effective treatment for hyperhidrosis and vasospastic disorders. Although the results for complex regional pain syndrome are not uniformly excellent, this technique offers promise in the treatment of this difficult problem.

Adolescent↗
PubMed2004

Physicians and health professionals with osteonecrosis of the femoral head: results of management with free vascularized fibular grafting.

Outcomes of free vascularized fibular grafting for the treatment of femoral head (FH) osteonecrosis between 1) physicians/health professionals and 2) a comparison group of the population at large was performed. Twenty-one healthcare providers (32 hips) were treated: 10 stage II, 7 stage III, and 15 stage IV were treated over a 13-year period. The control group consisted of 1257 hips: 221 with stage II, 220 with stage III, and 816 with stage IV. All patients were followed for a minimum of 2 years. The end point for failure was conversion to total hip arthroplasty. The physician group demonstrated a high degree of postoperative compliance. The conversion rate to total hip arthroplasty was significantly lower in the physician group (6.25%) compared to the control group (20.6%). Outstanding postoperative compliance appears to be related to favorable outcomes. Further evaluation of failure in both groups may help better understand FH osteonecrosis and improved patient outcomes.

Adult↗
PubMed2003

Results of biaxial total wrist arthroplasty with a modified (long) metacarpal stem.

PURPOSE: To evaluate the results of Biaxial (DePuy Orthopedics, Inc., Warsaw, IN) total wrist arthroplasty (TWA) with a long metacarpal stem. METHODS: A retrospective review of the results of 17 long-stem metacarpal components for the Biaxial TWA implanted between 1993 and 1997 is presented. RESULTS: After surgery pain and grip strength improved markedly. Overall motion improved but only radial deviation was significantly better. All of the patients were satisfied. At the most recent follow-up evaluation 4 cases showed evidence of radiographic lucency about the cement mantle, but with no gross loosening or settling. No failures at a greater than 6-year average (4-year minimum) follow-up period have been noted. Two cases of intraoperative third metacarpal fracture and one case of dorsal metacarpal component placement were encountered but did not affect the outcomes. CONCLUSIONS: To date the survivorship of the Biaxial TWA with the long stem is favorable compared with previous reports with the standard Biaxial distal component.

Adult↗
PubMed2003

Treatment of mucous cysts of the fingers: review of 134 cases with minimum 2-year follow-up evaluation.

PURPOSE: To evaluate the results of a single surgeon's treatment of mucoid cysts, comparing outcomes between injection and surgery. METHODS: One hundred thirty-four cysts were treated, with a minimum 2-year follow-up period. Thirty-one patients had nail ridging or deformity at presentation. Eighty patients had multiple soft-tissue punctures into the cyst with a 25-gauge needle and injection with local anesthetic and steroid. Fifty-four patients had surgical excision and joint debridement. RESULTS: In the injection group, complete resolution of the cyst occurred in 48 cases (60%). Among the 32 that recurred, repeat injections were performed in 8 cases; 3 resolved. No recurrences were noted in the surgery group. Nail ridging resolved after surgery in 25 digits; the remaining 6 digits had partial improvement or persistent ridging. Five infections occurred and were treated successfully with antibiotics (4) or debridement (1), or both. CONCLUSIONS: Aspiration and injection was convenient but had a 40% recurrence rate. Surgery provided definitive treatment with no major long-term problems.

Anesthetics, Local↗
PubMed2003

Premature failure of a hip hemiarthroplasty secondary to osteolysis and aseptic loosening.

Bipolar hemiarthroplasty and unipolar hemiarthroplasty have been widely used, especially in cases of femoral neck fracture in elderly patients. In this article, we report on a single case of premature loosening of a bipolar endoprosthesis secondary to presence of titanium and polyethylene debris from wear. We removed the patient's prosthesis and performed a total hip arthroplasty. With use of improved surgical and cementing techniques, state-of-the-art biomaterials, and better patient selection, hemiarthroplasties recently became as long-lived a stotal hip arthroplasties. However, our patient's case of premature loosening points up some basic principles regarding the tribology of implant failure: First, the surface of titanium is poor for articulation; second, polyethylene wear, especially in cases of bipolar hemiarthroplasty with a thin liner and in the presence of titanium prostheses, may hasten failure; third, meticulous third-generation cementing techniques minimize the risk for premature failure; and fourth, hemiarthroplasties performed in patients with previous surgery have higher rates of premature failure.

Aged↗
PubMed2002

Fractures of the elbow's lateral column radial head and capitellum.

Fractures of the lateral column of the elbow involve radial head fractures or capitellum fractures. As the biomechanics of the elbow have become better understood, the importance of the radiocapitellar joint in stabilizing the elbow has been emphasized. Preservation of the radial head has gained importance. For nondisplaced radial head fractures, good results are generally obtained with a short period of immobilization followed by early range of motion. In managing displaced radial head fractures, improved techniques and more versatile instrumentation have helped make preservation more feasible. Excellent results can be achieved with ORIF. In cases in which ORIF is impossible, prosthetic replacement of the radial head is a sound alternative. Successful results have been obtained with arthroplasty, and with second-generation modular systems, the facility of performing this procedure should increase. Treatment of capitellar fractures has also benefited from improved fixation systems. If the fragment is large enough, reduction and fixation with small screws or Kirschner wires have had good success. Excision works well in patients with fragments that are too small or not amenable to fixation, especially if the other structures of the medial elbow and forearm axis are competent.

Biomechanical Phenomena↗
PubMed2002

Giant-cell tumor of the appendicular skeleton.

The common objective of all surgical procedures in the treatment of giant-cell tumor of bone is to minimize the incidence of local recurrence. The purpose of this study was to determine what, if any, patient factors, tumor characteristics, or surgical practices correlate with local recurrence. Seventy-five patients treated for a giant-cell tumor of the appendicular skeleton were followed up for at least 2 years. The mean duration of followup was 62 months (range, 24-224 months). The highest proportion of patients had intralesional curettage, high-speed burring, and adjuvant treatment. Ten patients (13%) had a local recurrence. Bivariate analysis revealed that, with the numbers available, none of the patient variables, tumor variables, or surgical approaches correlated with local recurrence. Post hoc power analysis revealed the power of the study to be 33% to detect a clinically significant difference between treatment groups. The data presented here potentially could contribute to a metaanalysis, which would have the statistical power to determine which tumor-related factors and surgical techniques are most important in predicting recurrence in giant-cell tumor of bone.

Adolescent↗
PubMed2002

Free vascularized fibular bone grafting in the management of femoral neck nonunion in patients younger than fifty years.

PURPOSE: The incidence of nonunion and osteonecrosis after femoral neck fracture has been well documented. In older patients implant arthroplasty is well established as an acceptable treatment of these problems. However, in the younger population alternatives to implant arthroplasty are favored to preserve the femoral head. Surgical treatments for nonunion of the femoral neck include osteotomy, nonvascularized bone grafting, muscle-pedicle bone grafting, and vascularized bone grafting. The purpose of this study is to examine the results of free vascularized fibular grafting as a treatment of nonunion of the femoral neck in patients younger than fifty years. MATERIALS AND METHODS: Twenty-two consecutive patients underwent vascularized bone grafting for nonunion of the femoral neck after failed internal fixation between 1984 and 1998. The mean age of the patients was 28.7 years. There were thirteen male and nine female patients. The mean interval between internal fixation and free vascularized fibular grafting was 18.3 months. The average follow-up to date is 84.7 months (range 29 to 195 months). RESULTS: Twenty of twenty-two nonunions healed. Two patients required an additional procedure to facilitate union; one patient had iliac crest bone grafting at four months postoperatively and another underwent muscle-pedicle grafting at six months postoperatively. The average time to union for all patients was 9.9 months (range 3 to 23 months). Progression of osteonecrosis of the femoral head occurred in thirteen patients. However, successful long-term salvage of the femoral head was achieved in twenty of twenty-two patients, with an average Harris hip score of 78.9. Four patients required hardware removal or exchange for intraarticular migration with no long-term clinical sequelae. DISCUSSION: Rates of complications, such as nonunion and osteonecrosis, after femoral neck fractures in young patients have been reported to be as high as 86 percent. Treatments such as osteotomy, muscle-pedicle bone grafting, nonvascularized bone grafting, and vascularized bone grafting have reported variable results. Based on the results reported in this study, vascularized fibular bone grafting compares favorably with a high union rate (91 percent initially, 100 percent after secondary procedures) and successful long-term salvage of the femoral head in 91 percent of the patients. Free vascularized fibular bone grafting represents a promising solution for this difficult problem.

Adolescent↗