Autologous bone grafting is a standard procedure for the clinical repair of skeletal defects, and good results have been obtained. Autologous vascularized bone grafting and allografts are often used, presenting several drawbacks. On the other side, several studies in literature reported the ability of bone marrow derived cells to promote neo-vascularization thanks to specific GF, hematopoietic and nesenchymal stem cells. In this scenario a new procedure was developed, consisting in an allogenic bone graft transplantation in a critical size defect in rabbit radius, plus a deviation at its inside of the median artery and vein with a supplement of autologous bone marrow concentrate on a collagen scaffold. Twenty-four rabbits were were operated with different experimental and control procedures. For each group, 3 experimental times: 8, 4 and 2 weeks. An in vitro evaluation of bone marrow concentrate was performed and at the time of sacrifice histological and histomorphometrical assessment were performed with immunohistochemical assays for VEGF, CD31 e CD146 to highlight the presence of vessels and endothelial cells. Micro-CT Analysis with quantitative bone evaluation was performed. The bone marrow concentrate showed a marked capability to differentiate into osteogenic, chondrogenic and agipogenic lineages. No complications were reported. The bone grafts showed only a partial integration, mainly at the extremities in the group with vascular and bone marrow concentrate supplement. Immunohistochemistry showed an interesting higher VEGF expression in the same group. Micro CT analysis showed a higher remodeling activities in the groups treated with vascular supplement, with an area of integration at the extremities increasing with the extension of the sacrifice time. The present study suggests that the vascular and marrow cells supplement may positively influence the neoangiogenesis and the neovascularization of the homologous bone graft.

The aim of our RCT was to evaluate safety and efficacy of a new device called Prevention Nail System (PNS) developed for the prevention of femoral neck fractures (FNFs) in patients with severe osteoporosis. The PNS is a titanium screw with a hydroxyapatite coating implanted in the femoral neck in order to reinforce it. We enrolled patients with: FNF; age ≥65 years; DXA of the noninjured hip with a T-score ≤ −2.5 SD. In the fractured hip patients received standard treatment while the contralateral hip was randomized either to receive PNS (group A) or not: control group (B). During each follow-up (FU) at 3, 12 and 24 months, DXA, CT and X-rays of the reinforced hip were performed. The mean age was 83 years and the preoperative DXA was −3.3 SD in both groups. The walking ability of patients with PNS were comparable to controls. The CT scan showed good integration of the PNS in the bone. At the longest available FU 23 patients reported one or more falls. 16 nonfemoral fractures were recorded: 10 (A) and 6 (B) and 6 contralateral hip fractures (CHFs): 3 in the PNS group and 3 in the control group. In A all CHFs occurred within 1 month after surgery and there was a difficult screw placement during surgery, in the control group the CHFs were consequence of a fall (6 months to 2 years after the first FNF). No statistical differences were reported between groups A and B. In conclusion, the device was well tolerated; CHFs in the PNS group should be considered a technical error due to the surgical instruments. Safety of the device can be increased by improving the instruments to reduce the risk of iatrogenic fractures.

Introduzione: Scopo dello studio è stato analizzare i risultati oncologici e funzionali di un’ampia casistica multicentrica di pazienti trattati chirurgicamente per condorsarcoma (CS) della pelvi. Materiali e metodi: La casistica comprende 309 pazienti trattati nel periodo 1975-2013: 193 uomini (63%) e 116 donne (37%) con un età media di 46,4 anni (15-81 anni). I CS erano centrali in 136 casi (34 grado 1; 83 grado 2; 19 grado 3), periferici in 109 (60 grado 1; 47 grado 2; 2 grado 3), dedifferenziati in 36, a cellule chiare in 4, mesenchimali in 2 e periostei in 3, mentre in 19 casi non era nota la variante istologica. Il tumore aveva una localizzazione di tipo I in 74 casi, I-IV in 13, I-II in 39, II-III in 57, III in 35, II in 42 e I-II-III in 49 casi. Un’amputazione interileoaddominale è stata effettuata in 49 pazienti (16%), mentre 260 (84%) sono stati trattati conservativamente: 144 resezioni senza ricostruzione e 116 resezioni con ricostruzione. Margini ampi in 212 casi, ampi contaminati in 23, marginali in 50 ed intralesionali in 24 casi. Risultati: La sopravvivenza a 10 e 15 anni è stata rispettivamente del 73% e 70%. Ad un follow-up medio di 9 anni (range 2-32 anni), 188 pazienti (61%) risultavano continuativamente liberi da malattia, 28 liberi dopo trattamento di recidiva locale (9%), 54 (17%) deceduti per malattia, 13 (4%) deceduti per altre cause e 26 (8%) vivi con malattia. L’alto grado istologico ed il sottotipo dedifferenziato correlano significativamente con peggior prognosi (p<0,0001). All’analisi multivariata sulla sopravvivenza, stadio e grado influenzano significativamente la prognosi. L’incidenza di recidiva locale è stata del 27,8% (86 pazienti). Conclusioni: La chirurgia conservativa è il trattamento “gold standard”. La localizzazione acetabolare pone importanti difficoltà tecniche per la ricostruzione. C’è una correlazione significativa tra grado tumorale e sopravvivenza. / Introduction. Aim of this study was to review the long-term oncologic and functional outcome of surgical management in a large series of patients with pelvic chondrosarcoma (CS). Material and Methods. We analyzed 309 patients treated between 1975-2013: 193 males (63%) and 116 females (37%) with a mean age of 46.4 years (range, 15-81 years). There were 136 central CSs (34, 83 and 19 cases grade 1, 2 and 3 respectively), 109 peripheral CSs (60, 47 and 2 cases grade 1, 2 and 3), 36 dedifferentiated CSs, 4 clear cell CSs, 2 mesenchymal CSs and 3 periosteal CSs, 19 otherwise defined CSs. Tumor site was classified as type I in 74 cases, I-IV in 13, I-II in 39, II-III in 57, III in 35, II in 42 and I-II-III in 49 cases. Forty-nine patients had an external hemipelvectomy (16%), whereas 260 patients (84%) underwent a limb-salvage procedure: 144 resections without reconstruction and 116 resections with reconstruction. Margins were wide in 212 cases, wide but contaminated in 23, marginal in 50 and intralesional in 24 cases. Results. Survival on Kaplan Meier curve was 73% and 70% at 10 and 15 years respectively. At a mean of 9 years (1 to 32 years), 188 patients (61%) were continuously NED, 28 were NED after treatment of local recurrence (9%), 54 (17%) DWD, 13 (4%) died of other causes and 26 (8%) AWD. In central and peripheral CSs, high-grade tumors correlated with worse survival. Dedifferentiated CS had a significantly worst prognosis (p<0.0001). At multivariate analysis on survival, stage and grade statistically influenced prognosis. Overall incidence of local recurrence was 27.8% (86 patients). Conclusions. Surgery is the mainstay of treatment for pelvic CS. CSs with acetabular involvement offer challenging technical problems to reliable and lasting reconstruction. There was a significant correlation between histologic grade and survival.

Il rachide è stato suddiviso in tre colonne da Denis: anteriore e centrale comprendono la metà anteriore del corpo vertebrale, la metà posteriore e l’inizio dei peduncoli, mentre la colonna posteriore comprende l’arco e i peduncoli stessi. In caso di resezione o lesione della colonna anteriore e media è indicata la ricostruzione. Diverse tecniche e materiali possono essere usati per ricostruire il corpo vertebrale. Innesti vascolarizzati, autograft, allograft sono stati usati, così come impianti sintetici di titanio o materiale plastico come il PEEK (Poly etere etere ketone). Tutti questi materiali hanno vantaggi e svantaggi in termini di proprietà intrinseche, resistenza meccanica, modulo di elasticità, possibilità di trasmissione malattie, capacità di fondersi con l’osso ospite o meno. Le soluzioni più usate sono le cage in titanio o carbonio, il PMMA ( Poli methil metacrilato), gli innesti ossei massivi. Si è effettuato uno studio di coorte retrospettivo paragonando due gruppi di pazienti oncologici spinali trattati da due chirurghi esperti in un centro di riferimento, con vertebrectomia e ricostruzione della colonna anteriore: un gruppo con cage in carbonio o titanio, l’altro gruppo con allograft massivo armato di innesto autoplastico o mesh in titanio. Si sono confrontati i risultati in termini di cifosi segmenterai evolutiva, fusione ossea e qualità di vita del paziente. Il gruppo delle cage in carbonio / titanio ha avuto risultati leggermente migliori dal punto di vista biomeccanico ma non statisticamente significativo, mentre dal punto di vista della qualità di vita i risultati sono stati migliori nel gruppo allograft. Non ci sono stati fallimenti meccanici della colonna anteriore in entrambi i gruppi, con un Fu tra 12 e 60 mesi. Si sono paragonati anche i costi delle due tecniche. In conclusione l’allogar è una tecnica sicura ed efficace, con proprietà meccaniche solide, soprattutto se armato con autograft o mesi in titanio. / According to Denis the spine can be subdivided in 3 columns: anterior and central made by the anterior half and posterior half of the vertebral body, and posterior column made by the pedicles and posterior arch. Reconstruction of large anterior and middle column defects is indicated in a number of pathological entities including tumor, infection, trauma and post traumatic deformity, usually after a previous partial or total vertebral body resection. Several substitutes and techniques are available for the functional restoration of the vertebral column. Vascularized bone transfers, autografts, allografts or xenografts have been used, as well as metal, plastic or ceramic implants. All of these bear potential advantages and drawbacks in terms of associated morbidity of graft harvesting, disease transmission, mechanical failure, implant incorporation and over all long term outcome. The most frequently used solutions are: PMMA, Titanium Mesh Cages, Carbon Fiber Stackable cages, Massive allografts. a retrospective cohort study has been done comparing two groups of oncologic spine patients treated by 2 surgeons with vertebrectomy and anterior reconstruction: one group with cages, the other with allograft. We have compared results in terms of post surgical kyphosis and its worsening in time, fusion of the graft, quality of life. Results have been slightly better in the cage group but with no statistical relevance. No mechanical failure of the anterior column in both groups with a FU range from 12 to 60 months. A cost comparison has also been made. In conclusion we have realized allograft are a safe and cheap alternative to carbon fiber cages, with strong mechanical properties above all if helped by small titanium cages or rib autograft inside.

No description available.

Specific aims The aim is to improve the treatment of the bone losses at the metacarpal bones level (both diaphysis and epiphysis) combining microsurgery, tissue engineering and biomaterials, so to minimize the donor side morbidity and optimize healing and outcomes. Methods Pre-operative controlateral X-ray or 3-D CT to allow custom-made HA scaffolds. Cement as temporary spacer in acute lesion and monitoring of infective risks. Treatment of the bone loss recurring to pre-fabricated or custom-made HA scaffolds, adding platelet gel or growth factor OP1. Stable synthesis. Control group with auto/omografts. Outcome indices: % of bone-union; finger TAM, Kapandji, DASH score; NMR and Scintigraphy at 180 days for revascularisation and bio-substitution of the scaffold. Preliminary results The authors just treated 6 patients, 4 males and 2 females, with an average age of 38.5 yrs, affected by segmental bone losses at the hand and wrist, recurring to pre-fabricated not vascularised scaffolds. In all cases the synthesis was performed with angular stability plates and a stable synthesis achieved. All patients have been controlled at a mean follow-up of 10.5 months (from 2 to 16 ). In all case but one the bone-scaffold osteo-integration was achieved at an average of 38 days at the hand, and 46 days at the wrist. The outcome studies, according to the DASH score, finger TAM, and Kapandji, were good and excellent in 5 cases, poor in one.

Reconstruction of bone is needed for high bone loss due to congenital deformities, trauma or neoplastic diseases. Commonly, orthopaedic surgical treatments are autologus or allogenic bone implant or prosthetic implant. A choice to the traditional approaches could be represented by tissue engineering that use cells (and/or their products) and innovative biomaterials to perform bone substitutes biologically active as an alternative to artificial devices. In the last years, there was a wide improvement in biology on stem cells potential research and in biomedical engineering through development of new biomaterials designed to resemble the physiological tissues. Tissue engineering strategies and smart materials aim together to stimulate in vivo bone regeneration. This approaches drive at restore not only structure integrity and/or function of the original tissue, but also to induce new tissue deposition in situ. An intelligent bone substitute is now designed like not only a scaffold but also as carrier of regeneration biomolecular signals. Biomimetics has helped to project new tissue engineered devices to simulate the physiological substrates architecture, such extracellular matrix (ECM), and molecular signals that drive the integration at the interface between pre-existing tissue and scaffold. Biomimetic strategies want to increase the material surface biological activity with physical modifications (topography) o chemical ones (adhesive peptides), to improve cell adhesion to material surface and possibly scaffold colonization. This study evaluated the effects of biomimetic modifications of surgical materials surface, as poly-caprolattone (PCL) and titanium on bone stem cells behaviour in a marrow experimental model in vitro. Two biomimetic strategies were analyzed; ione beam irradiation, that changes the surface roughness at the nanoscale, and surface functionalization with specific adhesive peptides or Self Assembled Monolayers (SAMs). These new concept could be a mean to improve the early (cell adhesion, spreading..) and late phases (osteoblast differentiation) of cell/substrate interactions.

No description available.

Controlled delivery of anticancer drugs through osteotropic nanoparticles (NP) is a novel approach for the adjuvant therapy of osteolytic bone metastases. Doxorubicin (DXR) is widely used in chemotherapy, although its activity is restricted by dose-dependent cardiotoxicity and marrow toxicity. However, its efficacy can be improved when specific targeting at the tumor site is obtained. The aim of this study was to obtain osteotropic biodegradable NP by nanoprecipitation of a copolymer between poly(D,L-lactide-co-glycolide) (PLGA) and an osteotropic bisphosphonate, sodium alendronate (ALE). NP were subsequently characterised for their chemical-physical properties, biocompatibility, and the ability to inhibit osteoclast-mediated bone resorption, and then loaded with DXR. The effectiveness of NP-loaded DXR was investigated through in vitro and in vivo experiments, and compared to that of free DXR. For the in vitro analysis, six human cell lines were used as a representative panel of bone tumors, including breast and renal adenocarcinoma, osteosarcoma and neuroblastoma. The in vitro uptake and the inhibition of tumor cell proliferation were verified. To analyse the in vivo activity of NP-loaded DXR, osteolytic bone metastases were induced through the intratibial inoculation in BALB/c-nu/nu mice of a human breast cancer cell line, followed by the intraperitoneal administration of the free or NP-loaded DXR. In vitro, aAll of the cell lines were able to uptake both free and NP-loaded drug, and their proliferation was inhibited up to 80% after incubation either with free or NP-loaded DXR. In addition, in vivo experiments showed that NP-loaded DXR were also able to reduce the incidence of bone metastases, not only in comparison with untreated mice, but also with free DXR-treated mice. In conclusion, this research demonstrated an improvement in the therapeutic effect of the antineoplastic drug DXR, when loaded to bone-targeted NP conjugated with ALE. Osteotropic PLGA-ALE NP are suitable to be loaded with DXR and offer as a valuable tool for a tissue specific treatment of skeletal metastases.

Total ankle arthroplasty (TAA) is still not as satisfactory as total hip and total knee arthroplasty. For the TAA to be considered a valuable alternative to ankle arthrodesis, an effective range of ankle mobility must be recovered. The disappointing clinical results of the current generation of TAA are mostly related to poor understanding of the structures guiding ankle joint mobility. A new design (BOX Ankle) has been developed, uniquely able to restore physiologic ankle mobility and a natural relationship between the implanted components and the retained ligaments. For the first time the shapes of the tibial and talar components in the sagittal plane were designed to be compatible with the demonstrated ligament isometric rotation. This resulted in an unique motion at the replaced ankle where natural sliding as well as rolling motion occurs while at the same time full conformity is maintained between the three components throughout the flexion arc. According to prior research, the design features a spherical convex tibial component, a talar component with radius of curvature in the sagittal plane longer than that of the natural talus, and a fully conforming meniscal component. After computer-based modelling and preliminary observations in several trial implantation in specimens, 126 patients were implanted in the period July 2003 – December 2008. 75 patients with at least 6 months follow-up are here reported. Mean age was 62,6 years (range 22 – 80), mean follow-up 20,2 months. The AOFAS clinical score systems were used to assess patient outcome. Radiographs at maximal dorsiflexion and maximal plantar flexion confirmed the meniscalbearing component moves anteriorly during dorsiflexion and posteriorly during plantarflexion. Frontal and lateral radiographs in the patients, show good alignment of the components, and no signs of radiolucency or loosening. The mean AOFAS score was observed to go from 41 pre-op to 74,6 at 6 month follow-up, with further improvement at the following follow-up. These early results reveal satisfactory clinical scores, with good recovery of range of motion and reduction of pain. Radiographic assessment reveals good osteointegration. All these preliminary results confirm biomechanical studies and the validity of this novel ligamentcompatible prosthesis design. Surely it will be important to re-evaluate these patients later.