177 results on '"Vulcano, Ettore"'
Search Results
152. Epidemiology of Contact and Non-Contact Ankle Injuries in Collegiate Athletes.
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Guzman, Javier Z., Chen, Kevin K., Chan, Jimmy J., and Vulcano, Ettore
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- 2019
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153. Impact économique des comorbidités dans l’arthroplastie totale de cheville et l’arthrodèse de cheville
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Chan, Jimmy J., Guzman, Javier Z., Garden, Evan, Chan, Jesse C., Poeran, Jashvant, Zubizarreta, Nicole, Mazumdar, Madhu, and Vulcano, Ettore
- Abstract
Background: The demand for total ankle arthroplasty (TAA) and ankle arthrodesis surgery is increasing. Findings from other orthopaedic populations suggest an increasing comorbidity burden among those planned for surgery, however, data on TAA and ankle arthrodesis is limited. The goal of this study is to study the comorbidity burden for TAA and ankle arthrodesis.
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- 2021
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154. Breast-like vulvar lesion with concurrent breast cancer: A case report and critical literature review
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Perrone, Giuseppe, Altomare, Vittorio, Zagami, Mariagiovanna, Vulcano, Ettore, Muzii, Ludovico, Battista, Cleonice, Rabitti, Carla, and ANDREA ONETTI MUDA
155. Femoral bone plug in total knee replacement
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Michele Francesco Surace, Ettore Vulcano, Mario Ronga, Paolo Cherubino, Luigi Murena, Gianmarco Regazzola, Vulcano, Ettore, Regazzola, Gianmarco M. V., Murena, Luigi, Ronga, Mario, Cherubino, Paolo, and Surace, Michele F.
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Male ,medicine.medical_specialty ,Chamfer ,Total knee replacement ,Postoperative Hemorrhage ,Seal (mechanical) ,Transplantation, Autologous ,law.invention ,Intramedullary rod ,Cohort Studies ,Bone plug ,law ,medicine ,Humans ,Femur ,Orthopedics and Sports Medicine ,Arthroplasty, Replacement, Knee ,Aged ,Aged, 80 and over ,Bone Transplantation ,business.industry ,Femoral canal ,Middle Aged ,Surgery ,medicine.anatomical_structure ,Femoral bone ,Female ,business - Abstract
The intramedullary alignment guides used in total knee replacement disrupt the intramedullary vessels, resulting in greater postoperative blood loss. The use of an autologous bone plug to seal the intramedullary femoral canal has been shown to be effective in reducing postoperative bleeding. The authors present a simple technique to create a bone plug from the anterior chamfer femoral cut to perfectly seal the intramedullary canal of the femur. [ Orthopedics. 2015; 38(10):617–618.]
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- 2015
156. Treatment of humeral shaft aseptic nonunions in elderly patients with opposite structural allograft, BMP-7,and mesenchymal stem cells
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Paolo Cherubino, Luigi Murena, Michele Francesco Surace, Ettore Vulcano, Gianluca Canton, Murena, Luigi, Canton, Gianluca, Vulcano, Ettore, Surace, Michele Francesco, and Cherubino, Paolo
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musculoskeletal diseases ,Male ,medicine.medical_specialty ,Humeral Fractures ,Bone Morphogenetic Protein 7 ,Nonunion ,Mesenchymal Stem Cell Transplantation ,Drug Implant ,Fracture Fixation, Internal ,Fracture Fixation ,Bone plate ,medicine ,80 and over ,Humans ,Orthopedics and Sports Medicine ,Radial nerve ,Aged ,Aged, 80 and over ,Drug Implants ,Bone Plate ,Bone Transplantation ,business.industry ,Mesenchymal stem cell ,Combined Modality Therapy ,Female ,Fractures, Ununited ,Osteonecrosis ,Treatment Outcome ,Bone Plates ,Humeral Fracture ,Neurovascular bundle ,medicine.disease ,Ununited ,Internal ,Surgery ,Radiography ,surgical procedures, operative ,medicine.anatomical_structure ,Orthopedic surgery ,Osteonecrosi ,Upper limb ,Complication ,business ,Fractures ,Human - Abstract
Full article available online at Healio.com/Orthopedics. Search: 20140124-26 Humeral shaft aseptic nonunions occur in 2% to 10% of patients managed conservatively and 10% to 15% of patients treated surgically. The complex muscular and neurovascular anatomy of the upper limb makes the surgical approach to the fracture site demanding and risky, especially when previous surgeries have been attempted. The clinical consequence of atrophic humeral shaft nonunions is a severe functional limitation that may significantly affect activities of daily living, especially in the elderly. The surgical treatment of humeral shaft nonunions is challenging for orthopedic surgeons. Patients with atrophic nonunions require both a stable fixation and enhance ment of the biologic response because of the weak biologic reaction observed at the fracture site. The gold standard of treatment in elderly patients has not been described. Nonetheless, older age and comorbidities are associated with potentially malignant nonunions. This study reports the authors’ experience using opposite cortical allograft combined with bone morphogenetic protein 7 and mesenchymal stem cells to treat humeral shaft atrophic nonunions in 2 elderly patients. The nonunion site healed at 4 months (patient 1) and 8 months (patient 2) postoperatively, with full return to activities of daily living and no pain. Neither patient reported complications of the radial nerve, which is at high risk of injury during this type of surgery. The only reported complication (patient 2) was an intraoperative longitudinal partial distal humeral fracture, probably caused by compression screw overtightening. The use of a locking plate and opposite cortical allograft, combined with BMP-7 and mesenchymal stem cells, represents a safe and effective treatment for malignant nonunions in older patients.
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- 2014
157. Racial Disparities in 30-day Readmission After Orthopaedic Surgery: A 5-year National Surgical Quality Improvement Program Database Analysis.
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Bergstein VE, O'Sullivan LR, Levy KH, Vulcano E, and Aiyer AA
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- Humans, Asian, Patient Readmission, Quality Improvement, Black or African American, White, Orthopedic Procedures adverse effects, Orthopedics
- Abstract
Background: Readmission rate after surgery is an important outcome measure in revealing disparities. This study aimed to examine how 30-day readmission rates and causes of readmission differ by race and specific injury areas within orthopaedic surgery., Methods: The American College of Surgeon-National Surgical Quality Improvement Program database was queried for orthopaedic procedures from 2015 to 2019. Patients were stratified by self-reported race. Procedures were stratified using current procedural terminology codes corresponding to given injury areas. Multiple logistic regression was done to evaluate associations between race and all-cause readmission risk, and risk of readmission due to specific causes., Results: Of 780,043 orthopaedic patients, the overall 30-day readmission rate was 4.18%. Black and Asian patients were at greater (OR = 1.18, P < 0.01) and lesser (OR = 0.76, P < 0.01) risk for readmission than White patients, respectively. Black patients were more likely to be readmitted for deep surgical site infection (OR = 1.25, P = 0.03), PE (OR = 1.64, P < 0.01), or wound disruption (OR = 1.45, P < 0.01). For all races, all-cause readmission was highest after spine procedures and lowest after hand/wrist procedures., Conclusions: Black patients were at greater risk for overall, spine, shoulder/elbow, hand/wrist, and hip/knee all-cause readmission. Asian patients were at lower risk for overall, spine, hand/wrist, and hip/knee surgery all-cause readmission. Our findings can identify complications that should be more carefully monitored in certain patient populations., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)
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- 2024
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158. Risk factors for nonunion following tibiotalocalcaneal arthrodesis: A systematic review and meta-analysis.
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Patel S, Baker L, Perez J, Vulcano E, Kaplan J, and Aiyer A
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- Ankle Joint surgery, Arthrodesis, Humans, Retrospective Studies, Risk Factors, Subtalar Joint
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Background: The goal of this study is to review the literature to identify risk factors for nonunion after tibiotalocalcaneal arthrodesis (TTCA) and stratify them based on strength of evidence., Methods: Five databases were searched from inception to May 17th, 2020. Abstracts and full-text articles were screened for those that included risk factors predictive of nonunion following TTCA., Results: Eight studies involving 624 patients were included and 33 potential risk factors for nonunion were identified. Strong evidence supported prior peripheral neuropathic conditions as risk factors for nonunion following surgery (OR: 2.86, 95% CI: 1.56-5.23)., Conclusion: TTCA is an effective salvage procedure but is associated with high nonunion rates. The results of our meta-analysis suggest that prior peripheral neuropathic conditions have strong evidence for failure to achieve union. Surgeons should be cognizant of these risks when performing TTCA and carefully monitor patients with the aforementioned comorbidity to achieve successful results., (Copyright © 2021. Published by Elsevier Ltd.)
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- 2022
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159. Peripheral nerve block use in ankle arthroplasty and ankle arthrodesis: utilization patterns and impact on outcomes.
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Chan JJ, Garden E, Chan JC, Poeran J, Zubizarreta N, Mazumdar M, Galatz LM, and Vulcano E
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- Ankle Joint surgery, Arthrodesis adverse effects, Humans, Peripheral Nerves, Retrospective Studies, Ankle surgery, Arthroplasty, Replacement, Ankle adverse effects
- Abstract
Purpose: Ankle arthrodesis and total ankle arthroplasty (TAA) are often associated with significant postoperative pain. While this may be mitigated by the use of peripheral nerve blocks (PNB), large-scale data are lacking. Using national data, we aimed to evaluate PNB utilization pattern and its impact on outcomes., Methods: This retrospective cohort study utilized data from the nationwide database (2006-2016) on TAA (n = 5,290) and ankle arthrodesis (n = 14,709) procedures. PNB use was defined from billing; outcomes included opioid utilization, length and cost of stay, discharge to a skilled nurse facility, and opioid-related complications. Mixed-effects models estimated the association between PNB use and outcomes, separate by procedure type and inpatient/outpatient setting. We report odds ratios and 95% confidence intervals (CI)., Results: Overall, PNB was utilized in 8.7% of TAA and 9.9% of ankle arthrodesis procedures, with increased utilization from 2006 to 2016 of 2.6% to 11.3% and 5.2% to 12.0%, respectively. After adjustment for relevant covariates, PNB use was significantly associated with decreased total opioid utilization specifically in the inpatient setting in TAA ( - 16.9% CI - 23.9%; - 9.1%) and ankle arthrodesis procedures ( - 18.9% CI - 24.4; - 13.0%), this was particularly driven by a decrease in opioid utilization on the day of surgery. No clinically relevant effects were observed for other outcomes., Conclusion: PNB utilization is associated with substantial reductions in opioid utilization, particularly in the inpatient setting. Our study is in support of a wider use of this analgesic technique, which may translate into more benefits in terms of clinical outcomes and resource utilization., Level of Evidence: III., (© 2021. Japanese Society of Anesthesiologists.)
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- 2021
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160. Use of tranexamic acid does not influence perioperative outcomes in ambulatory foot and ankle surgery-a prospective triple blinded randomized controlled trial.
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B H PP, Diskina D, Lin HM, Vulcano E, and Lai YH
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- Ankle surgery, Foot surgery, Humans, Prospective Studies, Antifibrinolytic Agents, Blood Loss, Surgical prevention & control, Tranexamic Acid
- Abstract
Study Objective: TXA is an antifibrinolytic medication widely used to reduce perioperative blood loss, but it has been seldom used during foot and ankle surgery. Our study evaluates the impact of TXA use on blood loss, post-operative pain, peri-operative opioid consumption, and wound healing in ambulatory outpatient foot and ankle procedures., Design: Prospective, triple-blinded, randomized controlled trial., Setting: Peri-operative environment of a major academic health centre in New York City., Patients: A total of 100 participants who were scheduled for ambulatory foot and ankle surgery with a single surgeon., Interventions: Patients receive either 10 mg/kg TXA (TXA group) or 10 ml/kg of normal saline (placebo group) intravenously prior to skin incision., Measurements: Primary outcome was intra-operative blood loss. Secondary outcomes were peri-operative opioid consumption and wound complications between post-operative days 14 and 21., Main Results: We found no difference between TXA and placebo groups in terms of intra-operative blood loss, p value 0.71, 95% CI (63.13-19.80). There was no difference between the two groups in terms of post-operative morphine milliequivalents (MME). The incidence of wound complications was 16.3% in the TXA group compared to 15.7% in the placebo group with OR 1.04, p value 0.93, 95% CI (0.32-2.77). No adverse events associated with TXA were reported., Conclusions: The use of TXA during foot and ankle surgery was not associated with any benefits in perioperative outcomes in our outpatient ambulatory surgical population. Considering potential risks, we do not support the routine use of TXA in this surgical model., (© 2021. SICOT aisbl.)
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- 2021
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161. Letter Regarding: Risk Factors for Complications Associated With Minimally Invasive Medial Displacement Calcaneal Osteotomy.
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Guzman JZ, Schipper O, and Vulcano E
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- Humans, Risk Factors, Flatfoot, Osteotomy
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- 2021
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162. Achilles Tendinosis Injuries-Tendinosis to Rupture (Getting the Athlete Back to Play).
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Okewunmi J, Guzman J, and Vulcano E
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- Achilles Tendon surgery, Ankle Injuries diagnosis, Ankle Injuries etiology, Ankle Injuries physiopathology, Athletic Injuries diagnosis, Athletic Injuries etiology, Athletic Injuries physiopathology, Conservative Treatment methods, Humans, Rupture diagnosis, Rupture etiology, Rupture physiopathology, Tendinopathy diagnosis, Tendinopathy etiology, Tendinopathy physiopathology, Treatment Outcome, Achilles Tendon injuries, Ankle Injuries therapy, Athletic Injuries therapy, Orthopedic Procedures methods, Return to Sport, Rupture therapy, Tendinopathy therapy
- Abstract
Recreational athletes are susceptible to experiencing pain in the Achilles tendon, affecting their ability to complete daily activities. Achilles tendinosis is a degenerative process of the tendon without histologic or clinical signs of intratendinous inflammation, which can be categorized by location into insertional and noninsertional tendinosis. This condition is one that can be treated conservatively with great success or surgically for refractory cases. Currently, there is a lack of consensus regarding the best treatment options. This review aims to explore both conservative and operative treatment options for Achilles tendinopathy and Achilles tendon rupture., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2020
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163. Percutaneous Zadek osteotomy for the treatment of insertional Achilles tendinopathy.
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Nordio A, Chan JJ, Guzman JZ, Hasija R, and Vulcano E
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- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Achilles Tendon diagnostic imaging, Achilles Tendon surgery, Osteotomy methods, Tendinopathy diagnosis, Tendinopathy physiopathology, Tendinopathy surgery
- Abstract
Background: Insertional Achilles tendinopathy (IAT) is a challenging common lower extremity disorder, despite several treatment options described in literature. Open dorsal closing wedge calcaneal osteotomy or Zadek Osteotomy (ZO), for the treatment of the IAT has good clinical results but a high rate of postoperative complications. The purpose of this study is to describe percutaneous ZO for the treatment of the IAT and to evaluate its impact on the clinical and functional postoperative outcomes., Methods: Twenty-six consecutive patients presenting with unilateral IAT refractory to nonoperative measures were treated with percutaneous ZO. Visual Analogue Scale (VAS) and Foot Function Index Score (FFI) were recorded preoperatively and at final follow-up visit (12±3) months. Postoperative complications, satisfaction, and relief of the pain were also recorded., Results: The percutaneous ZO showed a significant improvement (p<0.0001) in preoperative to postoperative FFI (from 65±9 to 8±12) and VAS (from 9±1 to 1±2). Two postoperative complications (8%) were observed: a case of symptomatic non-union and hardware pain, both in healthy patients. The overall rate of satisfaction after surgery was (92%). The relief from pain was achieved after an average period of 12 weeks., Conclusions: ZO is a safe and effective procedure for the treatment of IAT. The use of a minimally invasive surgical approach is associated with excellent pain reduction (VAS score) and improved clinical function (FFI score). When compared to the open surgical approach, the percutaneous ZO may decrease recovery time and postoperative complications., Level of Evidence: III, retrospective case series., (Copyright © 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2020
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164. Factors influencing treatment recommendations for base of 5th metatarsal fractures in orthopaedic residency programs.
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Chan JJ, Mohamadi A, Kaiser P, Stupay K, DiGiovanni C, Kaplan JR, Cerrato R, Jeng C, and Vulcano E
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- Female, Humans, Male, Foot Injuries surgery, Fractures, Bone surgery, Internship and Residency methods, Metatarsal Bones surgery, Orthopedic Procedures education, Orthopedics education, Practice Guidelines as Topic
- Abstract
Background: Management of proximal 5th metatarsal fractures remains a controversial topic in orthopaedic surgery. Both operative and non-operative approaches have been described in the clinical setting. This confusion has led to non-standardized treatment recommendations for proximal 5th metatarsal fractures. This study was designed to analyze concordance rate of treatment recommendations between orthopaedic trainees and orthopaedic foot and ankle experts., Methods: An online survey containing 14 cases of proximal 5th metatarsal fractures were distributed to 92 orthopaedic residents in two ACGME-accredited programs. Relevant weight-bearing radiographs, patient's age and gender were provided, and two questions regarding treatment recommendations were surveyed. Resident's recommended treatment was then matched against ultimate treatment by orthopaedic foot and ankle experts. ANOVA and T-test are used for associations between the rate of concordant treatment with PGY and trainee foot and ankle experience. Fleiss' kappa was used to assess the inter-observer agreement., Results: Seventy-two residents returned the survey. The overall concordance rate was 43.98% with no correlation between agreement rate and PGY-years. No difference in agreement rate was observed between residents who had completed their foot and ankle rotation versus those who had not. There was a slight inter-observer agreement in recommending treatment among all residents (κ=0.117, 95% CI: 0.071-0.184)., Conclusions: Our data demonstrated no significant concordance between resident level in training regarding proximal 5th metatarsal fracture treatment decisions, nor between residents and subspecialty-trained foot and ankle surgeons. Increased rotations with foot and ankle fellowship-trained surgeons throughout residency may be desirable to improve the quality of residency training., Level of Evidence: III., (Copyright © 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)
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- 2020
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165. Epidemiology of Achilles tendon injuries in collegiate level athletes in the United States.
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Chan JJ, Chen KK, Sarker S, Hasija R, Huang HH, Guzman JZ, and Vulcano E
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- Achilles Tendon surgery, Ankle Injuries epidemiology, Ankle Injuries surgery, Athletes, Athletic Injuries surgery, Female, Humans, Incidence, Male, Sex Factors, Sports statistics & numerical data, Students statistics & numerical data, Tendon Injuries surgery, United States epidemiology, Universities statistics & numerical data, Achilles Tendon injuries, Athletic Injuries epidemiology, Tendon Injuries epidemiology
- Abstract
Background: Achilles injuries are devastating injuries, especially for competitive athletes. No studies have examined the outcomes of Achilles injuries in NCAA athletes. Therefore, a better characterization and understanding of the epidemiology is crucial., Methods: Achilles injuries across 16 sports among NCAA men and women during the 2004-2005 to 2013-2014 academic years were analyzed using the NCAA Injury Surveillance Program (NCAA-ISP). Achilles tendon injury rate (IR) per 100,000 athlete-exposures (AEs), operative rate, annual injury rate trends, reinjury rates, mechanism of injury, in-season status (pre/regular/post season), and time loss distributions were compiled and calculated. A sub-analysis of comparing gender and injury mechanism was also performed for both all injuries and severe injuries., Results: Overall, N = 255 Achilles injuries were identified with an injury rate (IR) of 2.17 (per 100,000 AEs). These injuries occurred most often in women's gymnastics (IR = 16.73), men's basketball (IR = 4.26), and women's basketball (IR = 3.32), respectively. N = 52 injuries were classified as severe injuries which have higher median time loss (48 days) and higher operative rate (65.4%). For severe Achilles injuries, female athletes had higher operative (77.8% vs. 58.8%) and higher time loss compared to male athletes (96 days vs. 48 days). Contact mechanisms were associated with a higher season-ending injury rate., Conclusion: Overall, 20.4% of Achilles injuries were considered severe with 65.6% operative rate. About 73.1% were season-ending injuries, and the remaining athletes have a median time loss of 48 days. Severe Achilles injuries create significant impact on playing time and career for NCAA athletes.
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- 2020
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166. Resection Arthroplasty: Current Indications and Tips.
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Guzman JZ and Vulcano E
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- Arthritis, Rheumatoid complications, Foot Deformities, Acquired etiology, Forefoot, Human surgery, Humans, Arthritis, Rheumatoid surgery, Arthroplasty methods, Foot Deformities, Acquired surgery, Metatarsalgia surgery, Metatarsophalangeal Joint surgery
- Abstract
Resection arthroplasty for metatarsalgia is a selective procedure primarily indicated for patients with rheumatoid arthritis. These patients present with significant forefoot deformities, poor bone quality, and loss of soft tissue integrity. Resection of the metatarsal heads and correction of lesser toe deformities improve pain and decrease transfer metatarsalgia. Patients with concurrent hallux valgus may benefit from a lapidus procedure or hallux metatarsophalangeal fusion in an effort to improve outcomes and decrease incidence of recurrent hallux valgus. In rare cases, diabetics with neuropathy may require resection arthroplasty in the setting of forefoot deformities recalcitrant to other modalities., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
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167. Dynamic Stress MRI of Midfoot Injuries: Measurable Morphology and Laxity of the Sprained Lisfranc Ligament During Mechanical Loading: A Case Report.
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Gunio DA, Vulcano E, and Benitez CL
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- Adult, Humans, Ligaments, Articular diagnostic imaging, Male, Dancing injuries, Foot Injuries diagnostic imaging, Ligaments, Articular injuries
- Abstract
Case: Our 26-year-old patient is a professional ballet dancer who suffered a classic Lisfranc joint injury while performing a dancing maneuver with his foot in full plantar flexion. Initial workup with radiographs revealed borderline Lisfranc interval widening without definitive joint instability. Further evaluation with an innovative dynamic stress magnetic resonance imaging (MRI) revealed mild interosseous Lisfranc ligament laxity and sprain, which allowed the orthopaedic surgeon to pursue conservative management, rather than surgery. After physical therapy, our patient reports a successful return to dancing., Conclusions: Dynamic stress MRI may become a useful technique in evaluating equivocal cases of midfoot injury through the use of new imaging-based criteria.
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- 2019
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168. Infections in primary total ankle replacement: Anterior approach versus lateral transfibular approach.
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Usuelli FG, Indino C, Maccario C, Manzi L, Liuni FM, and Vulcano E
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- Adult, Aged, Female, Fibula, Humans, Incidence, Italy epidemiology, Middle Aged, Osteoarthritis surgery, Retrospective Studies, Surgical Wound Infection etiology, Surgical Wound Infection prevention & control, Treatment Outcome, Young Adult, Ankle Joint surgery, Arthroplasty, Replacement, Ankle methods, Surgical Wound Infection epidemiology
- Abstract
Background: Total ankle replacement (TAR) represents an alternative to fusion for the treatment of end-stage ankle osteoarthritis. The aim of the present study was to retrospectively assess the frequency of infections between TARs with anterior and lateral transfibular approach at 12-months follow-up., Methods: 81 TARs through an anterior approach and 69 TARs through a lateral approach were performed between May 2011 and July 2015. We compared surgical time and tourniquet time, as well as superficial and deep infections frequency during the first 12 postoperative months., Results: In the anterior approach group, there were 3 (3.7%) deep infections and 4 (4.9%) superficial wound infections. In the lateral approach group, there were 1 (1.4%) deep infection and 2 superficial wound infections (2.9%). There were not statistically significant differences between the groups. There was a significant difference between anterior approach (115minutes) and lateral approach group (179minutes) in terms of surgical time (P<0.001)., Conclusions: The frequency of superficial and deep periprosthetic infections during the first postoperative year was not significantly different in the lateral approach group compared to the anterior approach group, despite the significantly longer surgical time in the lateral transfibular approach group., (Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)
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- 2019
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169. Surgeon Type and Outcomes After Inpatient Ankle Arthrodesis and Total Ankle Arthroplasty: A Retrospective Cohort Study Using the Nationwide Premier Healthcare Claims Database.
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Chan JJ, Chan JC, Poeran J, Zubizarreta N, Mazumdar M, and Vulcano E
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- Aged, Analgesics, Opioid therapeutic use, Female, Hospital Costs statistics & numerical data, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Multivariate Analysis, Retrospective Studies, Ankle Joint surgery, Arthritis surgery, Arthrodesis statistics & numerical data, Arthroplasty, Replacement, Ankle statistics & numerical data, Orthopedics statistics & numerical data, Podiatry statistics & numerical data
- Abstract
Background: Two main treatments for end-stage ankle arthritis are ankle arthrodesis and total ankle arthroplasty (TAA). While both procedures can be performed either by a foot and ankle orthopaedic surgeon or a podiatrist (when within a particular state's scope of practice), studies comparing the surgical outcomes of the 2 surgeon types are lacking. Therefore, in this study, we compared outcomes by surgeon type for TAA and for ankle arthrodesis., Methods: This retrospective cohort study utilized data from the nationwide Premier Healthcare claims database (2011 to 2016) regarding TAA (n = 3,674) and ankle arthrodesis (n = 4,980) procedures. Multivariable models estimated associations between surgeon type (podiatrist versus orthopaedic foot and ankle surgeon) and opioid utilization (in oral morphine equivalents [OMEs]), length of stay, and cost of hospitalization. We report percent change (compared with reference) and 95% confidence intervals (CIs)., Results: Overall, 76.5% (n = 2,812) and 18.8% (n = 690) of TAA procedures were performed by orthopaedic foot and ankle surgeons and podiatrists, respectively; surgeon type was unknown for 4.7% (n = 172). For ankle arthrodesis, 75.3% (n = 3,752) and 18.3% (n = 912) of the procedures were performed by orthopaedic foot and ankle surgeons and podiatrists, respectively; surgeon type was unknown for 6.3% (n = 316). The proportion of TAA and ankle arthrodesis procedures performed by podiatrists increased over time, from 12.8% and 13.6% in 2011 to 24.6% and 26.0% in 2016, respectively. When adjusting for relevant covariates, procedures performed by podiatrists (compared with orthopaedic foot and ankle surgeons) were associated with increased length of stay: for TAA, +16.7% (95% CI, 7.6% to 26.5%; median, 2 days in both groups) and for ankle arthrodesis, +14.2% (95% CI, 7.9% to 20.9%; median, 3 compared with 2 days) (p < 0.05 for both). In addition, ankle arthrodesis performed by podiatrists was associated with increased cost of hospitalization: +28.5% (95% CI, 22.1% to 35.2%; median, $19,236 compared with $13,433) (p < 0.05). Differences in opioid utilization were nonsignificant in the main analysis: +10.9% (95% CI, -3.1% to 26.8%; median, 345 compared with 250 OMEs) and +2.8% (95% CI, -5.9% to 12.4%; median, 351 compared with 315 OMEs) for TAA and ankle arthrodesis, respectively., Conclusions: An increasing trend in the proportion of procedures performed by podiatrists was coupled with apparent increases in length of stay and cost compared with procedures performed by orthopaedic foot and ankle surgeons. Given the increasing demand for these procedures, factors associated with resource utilization, such as type of surgeon, may be increasingly important on the population level., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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- 2019
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170. Assessment of Bone Healing During Antegrade Intramedullary Rod Femur Lengthening Using Radiographic Pixel Density.
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Vulcano E, Markowitz JS, Ali S, Nguyen J, Fragomen AT, and Rozbruch SR
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- Adolescent, Adult, Child, Female, Femur surgery, Humans, Leg Length Inequality surgery, Male, Middle Aged, Postoperative Period, Radiography methods, Retrospective Studies, Treatment Outcome, Weight-Bearing, Young Adult, Femur diagnostic imaging, Fracture Fixation, Intramedullary methods, Leg Length Inequality diagnostic imaging, Osteogenesis, Distraction methods, Radiographic Image Interpretation, Computer-Assisted methods
- Abstract
Introduction: Premature full weight bearing after femur lengthening can lead to implant failure, telescopic nail shortening, and regenerate fracture. This study aimed at performing a retrospective analysis of the correlation between pixel density ratio (PDR) calculations and clinical readiness for weight bearing in patients undergoing intramedullary nail-mediated femoral distraction osteogenesis., Methods: Thirty-two patients who underwent antegrade femur lengthening were included in this study. The PDR was calculated on femur radiographs in a picture archiving and communication system for each cortex (ie, medial, lateral, anterior, and posterior) at each postoperative visit. These values were then correlated with subjective evaluation of bone healing by the treating physician with expertise in bone lengthening., Results: Bone regenerate healing was clinically declared by the treating surgeons (S.R.R. and A.T.F.) at a mean of 8.5 weeks (range, 4 to 18 weeks). No implant failure, nail shortening, or regenerate fracture was observed. The overall mean PDR corresponding to clinical bone healing was 0.90, which was significantly (P < 0.001) greater than the mean value at the previous visit (0.82), when the bone was not clinically declared to be healed. The PDR increased in all cortices at all postoperative visits., Conclusions: The findings of the present study suggest that there may be a correlation between the PDR and clinical bone healing. This observational pilot study should be followed by additional studies to understand the relationship between the PDR and bony union.
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- 2018
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171. The spectrum of indications for subtalar joint arthrodesis.
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Vulcano E, Ellington JK, and Myerson MS
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- Adult, Female, Foot Deformities etiology, Humans, Joint Diseases etiology, Male, Middle Aged, Patient Selection, Weight-Bearing, Arthrodesis, Foot Deformities diagnosis, Foot Deformities surgery, Joint Diseases diagnosis, Joint Diseases surgery, Subtalar Joint
- Abstract
The preferred surgical approaches to subtalar fusion are the sinus tarsi incision, the medial incision, and the extensile lateral approach. The choice of one over the other depends on the underlying pathology, previous surgeries, associated foot pathologies, soft tissue quality, and medical comorbidities. This article reports on several cases of subtalar joint fusion., (Copyright © 2015 Elsevier Inc. All rights reserved.)
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- 2015
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172. Approach and treatment of the adult acquired flatfoot deformity.
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Vulcano E, Deland JT, and Ellis SJ
- Abstract
Adult acquired flatfoot deformity (AAFD), embraces a wide spectrum of deformities. AAFD is a complex pathology consisting both of posterior tibial tendon insufficiency and failure of the capsular and ligamentous structures of the foot. Each patient presents with characteristic deformities across the involved joints, requiring individualized treatment. Early stages may respond well to aggressive conservative management, yet more severe AAFD necessitates prompt surgical therapy to halt the progression of the disease to stages requiring more complex procedures. We present the most current diagnostic and therapeutic approaches to AAFD, based on the most pertinent literature and our own experience and investigations.
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- 2013
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173. Treatment of severe post-traumatic bone defects with autologous stem cells loaded on allogeneic scaffolds.
- Author
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Vulcano E, Murena L, Cherubino P, Falvo DA, Rossi A, Baj A, and Toniolo A
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Bone Marrow Transplantation methods, Equipment Failure Analysis, Female, Fractures, Bone diagnosis, Humans, Male, Mesenchymal Stem Cell Transplantation methods, Middle Aged, Prosthesis Design, Treatment Outcome, Young Adult, Bone Marrow Transplantation instrumentation, Bone Substitutes therapeutic use, Fracture Healing, Fractures, Bone surgery, Mesenchymal Stem Cell Transplantation instrumentation, Tissue Scaffolds
- Abstract
Mesenchymal stem cells may differentiate into angiogenic and osteoprogenitor cells. The effectiveness of autologous pluripotent mesenchymal cells for treating bone defects has not been investigated in humans. We present a case series to evaluate the rationale of using nucleated cells from autologous bone marrow aspirates in the treatment of severe bone defects that failed to respond to traditional treatments. Ten adult patients (mean age, 49.6-years-old) with severe bone defects were included in this study. Lower limb bone defects were >or=5 cm3 in size, and upper limb defects .or=2 cm3. Before surgery, patients were tested for antibodies to common pathogens. Treatment consisted of bone allogeneic scaffold enriched with bone marrow nucleated cells harvested from the iliac crest and concentrated using an FDA-approved device. Postsurgery clinical and radiographic follow-up was performed at 1, 3, 6, and 12 months. To assess viability, morphology, and immunophenotype, bone marrow nucleated cells were cultured in vitro, tested for sterility, and assayed for the possible replication of adventitious (contaminating) viruses. In 9 of 10 patients, both clinical and radiographic healing of the bone defect along with bone graft integration were observed (mean time, 5.6 months); one patient failed to respond. No post-operative complications were observed. Bone marrow nucleated cells were enriched 4.49-fold by a single concentration step, and these enriched cells were free of microbial contamination. The immunophenotype of adherent cells was compatible with that of mesenchymal stem cells. We detected the replication of Epstein-Barr virus in 2/10 bone marrow cell cultures tested. Hepatitis B virus, cytomegalovirus, parvovirus B19, and endogenous retrovirus HERV-K replication were not detected. Overall, 470 to 1,150 million nucleated cells were grafted into each patient. This case series, with a mean follow-up of almost 2 years, demonstrates that an allogeneic bone scaffold enriched with concentrated autologous bone marrow cells obtained from the iliac crest provides orthopedic surgeons a novel option for treating important bone defects that are unresponsive to traditional therapies.
- Published
- 2012
174. The use of cementless acetabular component in revision surgery without pelvic discontinuity.
- Author
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Cherubino P, D'Angelo F, Surace MF, Murena L, and Vulcano E
- Subjects
- Cementation, Humans, Reoperation instrumentation, Reoperation methods, Treatment Outcome, Acetabulum surgery, Arthroplasty, Replacement, Hip instrumentation, Arthroplasty, Replacement, Hip methods, Hip Joint surgery, Hip Prosthesis, Pelvic Bones surgery, Prosthesis Failure
- Abstract
Reconstruction of the failed acetabular component in total hip arthroplasty (THA) can be challenging. Although there are multiple reconstructive options available, a cementless acetabular component inserted with screws has been shown to have good intermediate-term results and is the reconstructive method of choice for the majority of acetabular revisions This reconstruction is feasible provided at least 50% of the implant contacts host bone. When such contact is not possible, and there is adequate medial and peripheral bone, techniques using alternative uncemented implants can be used for acetabular reconstruction. An uncemented cup can be placed at a "high hip center." Alternatively, the acetabular cavity can be progressively reamed to accommodate extra-large cups. Oblong cups, which take advantage of the oval-shaped cavity resulting from many failed acetabular components, can also be used. The success of these cementless techniques depends on the degree and location of bone loss. The correct indication to revision and the choice of the correct implant is the keystone for the success of this type of surgery and follows an accurate preoperative planning in order to understand the specific pathologic scenario. The aim of this paper is to review some technical options for the revision of the acetabular component also taking into account our personal experiences and series.
- Published
- 2010
175. Italian cross-cultural adaptation and validation of the Oxford Shoulder Score.
- Author
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Murena L, Vulcano E, D'Angelo F, Monti M, and Cherubino P
- Subjects
- Adult, Aged, Disability Evaluation, Female, Humans, Joint Diseases complications, Male, Middle Aged, Quality of Life, Cross-Cultural Comparison, Health Status Indicators, Pain Measurement, Psychometrics, Shoulder Pain etiology, Surveys and Questionnaires
- Abstract
Background: The Oxford Shoulder Score (OSS) is an English-language questionnaire specifically designed to evaluate patients affected by shoulder pain. Although this scoring system has been translated into other languages, an Italian version of it is still not available. The aim of the present study was to translate, culturally adapt, and validate the Italian version of the OSS., Materials and Methods: We recruited 140 patients with shoulder pain caused by degenerative or inflammatory state or disorder of the shoulder. Patients completed the following questionnaires: Italian OSS, University of California, Los Angeles (UCLA) Shoulder Rating Scale, Constant-Murley shoulder assessment, and the Medical Outcome Study Short-Form 36 Health Survey (MOS SF-36). Internal consistency was tested using Cronbach coefficient alpha. Reproducibility was assessed by asking 110 patients to complete another OSS 48 hours after the first. Correlation between the total results of both tests was determined by the Pearson correlation coefficient. Validity was assessed by calculating the Pearson correlation coefficient between the OSS and the UCLA, Constant-Murley, and SF-36 assessments., Results: Cronbach alpha was 0.95. The Pearson correlation coefficient was r=0.97. With respect to validity, there was a significant correlation between the Italian OSS and the individual scores of UCLA, Constant-Murley, and SF-36., Discussion: Psychometric properties of the Italian OSS compared well with those reported for the English OSS. As demonstrated by the high values of Cronbach alpha and Pearson correlation coefficients, in accordance with the English version of the OSS, the Italian version proved to be a reliable, valid, and reproducible measure of shoulder pain perception in Italian-speaking patients., (2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)
- Published
- 2010
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176. Breast-like vulvar lesion with concurrent breast cancer: a case report and critical literature review.
- Author
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Perrone G, Altomare V, Zagami M, Vulcano E, Muzii L, Battista C, Rabitti C, and Muda AO
- Subjects
- Aged, Diagnosis, Differential, Female, Humans, Breast Neoplasms pathology, Carcinoma, Ductal secondary, Vulvar Neoplasms secondary
- Abstract
In the current report, we describe an intriguing case of a breast-like cancer lesion located in the vulvar region in a woman lacking a remarkable past medical or family history of breast cancer but with concurrent breast cancer. Consequently, a differential diagnosis between a primary synchronous breast and vulvar cancer or a metastatic breast carcinoma to the vulva is a key point in terms of the clinical approach. In a review of the literature, 39 cases of breast-like cancer lesion have been described: 23 cases of primary infiltrating carcinoma of the vulva and 16 cases of vulvar metastases of breast carcinoma. To the best of our knowledge, this is the first report of a clinically synchronous vulvar metastasis from an invasive ductal carcinoma. The main diagnostic criteria for differential diagnosis between primary or metastatic breast-like vulvar carcinoma are also discussed.
- Published
- 2009
177. Alexithymia-A disorder of the regulatory mechanism of the emotion elaboration-and quality of life in gynecologic surgery.
- Author
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Battista C, Angioli R, Cafà EV, Sereni MI, Vulcano E, and Bruni R
- Subjects
- Cohort Studies, Female, Gynecologic Surgical Procedures adverse effects, Humans, Interviews as Topic, Pilot Projects, Affective Symptoms complications, Gynecologic Surgical Procedures psychology, Laparoscopy psychology, Quality of Life psychology
- Abstract
Study Objective: Alexithymia is a disorder of the regulatory mechanism of the emotion elaboration. To verify the influence of the personality trait in the evaluation of quality of life (QoL), we analyzed the effect of alexithymia on the outcome of gynecologic surgery. The purpose of this study was to investigate the presence of alexithymia by using the Toronto Alexithymia Scale (TAS)-20, and to examine the relationship between alexithymia and self-reported descriptors of QoL in a gynecologic population., Design: All patients were evaluated in a semistructured interview in which personal, medical, and social data were collected. They were provided with a set of questionnaires that included both measure of alexithymia (TAS-20) and QoL perception (the Medical Outcomes Study short-form general health survey-36 [SF-36]). The patients were assessed before the surgical procedure and 1 month postoperatively., Setting: Campus BioMedico Hospital in Rome, Italy., Patients: In all, 40 consecutive patients with benign gynecologic pathology were enrolled in the study., Interventions: A total of 20 of the patients underwent laparoscopy (LPS) and 20 underwent laparotomy (LPT)., Measurements and Main Results: Patients were separated into 2 groups, with respect to the TAS questionnaire score: the high-level alexithymia (HA) group, with scores above 59, and the low-level alexithymia group, with scores below 59. The HA group represented 61% in patients who underwent LPS and 50% in patients who were submitted to LPT. Patients who underwent LPS showed a slight decrease in the QoL score after the surgical procedure. Patients who underwent LPT showed different QoL scores depending on the high or low TAS level: high-level TAS group showed higher SF-36 domain scores compared with the presurgical scores, whereas low-level TAS group showed lower scores compared with the presurgical scores., Conclusion: Our data show that the subjective QoL tested with SF-36 in patients with gynecologic conditions undergoing surgery is clearly influenced by the level of alexithymia. This influence is clearly detectable when a more invasive surgery is performed. In this case, patients with low-level alexithymia show a worsening of QoL. Contrarily, patients with HA have a better perception of QoL after more invasive surgery.
- Published
- 2009
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