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Luigi TARALLO

Professore Associato
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto

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Pubblicazioni

2023 - Acute elbow dislocations: current concepts [Articolo su rivista]
Tarallo, Luigi; Bonfatti, Rocco; Donà, Alessandro; Micheloni, Gian M.; Catani, Fabio; Porcellini, Giuseppe
abstract

2023 - Navigation in reverse shoulder arthroplasty: how the lateralization of glenosphere can affect the clinical outcome [Articolo su rivista]
Tarallo, Luigi; Giorgini, Andrea; Micheloni, Gianmario; Montanari, Marta; Porcellini, Giuseppe; Catani, Fabio
abstract

IntroductionOne of the main causes of RSA failure is attributable to the malpositioning of the glenoid component. Initial experiences with computer-assisted surgery have shown promising results in increasing the accuracy and repeatability of placement of the glenoid component and screws. The aim of this study was to evaluate the functional clinical results, in terms of joint mobility and pain, by correlating them with intraoperative data regarding the positioning of the glenoid component. The hypothesis was that the lateralization more than 25 mm of the glenosphere can led to better stability of the prosthesis but should pay in term of a reduced range of movement and increased pain.Materials and methods50 patients were enrolled between October 2018 and May 2022; they underwent RSA implantation assisted by GPS navigation system. Active ROM, ASES score and VAS pain scale were recorded before surgery. Preoperative data about glenoid inclination and version were collected by pre-op X-Rays an CT. Intraoperative data-inclination, version, medialization and lateralization of the glenoid component-were recorded using computer-assisted surgery. 46 patients had been further clinically and radiographically re-evaluated at 3-months, 6-months, 1-year, and 2-years follow-up.ResultsWe found a statistically significant correlation between anteposition and glenosphere lateralization value (DM - 6.057 mm; p = 0.043). Furthermore a statistically significant correlation has been shown between abduction movement and the lateralization value (DM - 7.723 mm; p = 0.015). No other statistically significant associations were found when comparing the values of glenoid inclination and version with the range of motion achieved by the patients after reverse shoulder arthroplasty.ConclusionWe observed that the patients with the best anteposition and abduction results had a glenosphere lateralization between 18 and 22 mm. When increasing the lateralization above 22 mm or reducing it below 18 mm, on the other hand, both movements considered decreased their range.

2023 - Single approach versus double-incision technique for the repair of distal biceps tendon ruptures [Articolo su rivista]
Micheloni, Gian M.; Delvecchio, Matilde; Giorgini, Andrea; Porcellini, Giuseppe; Tarallo, Luigi
abstract

2023 - Study of a constrained finite element elbow prosthesis: the influence of the implant placement [Articolo su rivista]
Nalbone, Lorenzo; Monac, Francesco; Nalbone, Luca; Ingrassia, Tommaso; Ricotta, Vito; Nigrelli, Vincenzo; Ferruzza, Massimo; Tarallo, Luigi; Porcellini, Giuseppe; Camarda, Lawrence
abstract

BackgroundThe functional results of total elbow arthroplasty (TEA) are controversial and the medium- to long-term revision rates are relatively high. The aim of the present study was to analyze the stresses of TEA in its classic configuration, identify the areas of greatest stress in the prosthesis-bone-cement interface, and evaluate the most wearing working conditions.Materials and methodsBy means of a reverse engineering process and using a 3D laser scanner, CAD (computer-aided drafting) models of a constrained elbow prosthesis were acquired. These CAD models were developed and their elastic properties, resistance, and stresses were studied through finite element analysis (finite element method-FEM). The obtained 3D elbow-prosthesis model was then evaluated in cyclic flexion-extension movements (> 10 million cycles). We highlighted the configuration of the angle at which the highest stresses and the areas most at risk of implant mobilization develop. Finally, we performed a quantitative study of the stress state after varying the positioning of the stem of the ulnar component in the sagittal plane by +/- 3 degrees.ResultsThe greatest von Mises stress state in the bone component for the 90 degrees working configuration was 3.1635 MPa, which occurred in the most proximal portion of the humeral blade and in the proximal middle third of the shaft. At the ulnar level, peaks of 4.1763 MPa were recorded at the proximal coronoid/metaepiphysis level. The minimum elastic resistance and therefore the greatest stress states were recorded in the bone region at the apex of the ulnar stem (0.001967 MPa). The results of the analysis for the working configurations at 0 degrees and 145 degrees showed significant reductions in the stress states for both prosthetic components; similarly, varying the positioning of the ulnar component at 90 degrees (- 3 degrees in the sagittal plane, 0 degrees in the frontal plane) resulted in better working conditions with a greater resulting developed force and a lower stress peak in the ulnar cement.ConclusionThe areas of greatest stress occur in specific regions of the ulnar and humeral components at the bone-cement-prosthesis interface. The heaviest configuration in terms of stresses was when the elbow was flexed at 90 degrees. Variations in the positioning in the sagittal plane can mechanically affect the movement, possibly resulting in longer survival of the implant.Level of evidence: 5

2023 - Tailored modular spacers and handmade spacers in periprosthetic shoulder infection: clinical and functional results after 2-year follow-up [Articolo su rivista]
Porcellini, G.; Montanari, M.; Selleri, F.; Giorgini, A.; Paladini, P.; Padolino, A.; Tarallo, L.
abstract

2022 - Anatomically reduced fixation should always be considered when treating B and C proximal epiphyseal humeral fractures [Articolo su rivista]
Tarallo, Luigi; Micheloni, Gian Mario; Giorgini, Andrea; Lombardi, Martina; Limone, Beatrice; Catani, Fabio; Porcellini, Giuseppe
abstract

Background Proximal humeral fractures are commonly observed in elderly patients. Management of these injuries is controversial. Literature comparing locking plate fixation, arthroplasty, and conservative treatments show no clear advantages for any of these management strategies. Thus far, no study has considered anatomically reduced fractures obtained after locking plate treatment. To clarify the best surgical procedure in middle-aged patients, we considered outcomes and major complications leading to surgical revision following an anatomically reduced fracture fixed with locking plate and reverse shoulder arthroplasty (RSA) in the treatment of type B/C fractures in patients between 50 and 75 years of age. Methods This is a retrospective study including 59 patients between 50 and 75 years of age with type B/C proximal humeral fracture treated with RSA or with locking plate fixation (resulting in an anatomical reduction) between January 2010 and December 2018. Preoperative radiographs and computed tomography (CT) were evaluated in all patients. Clinical and radiologic follow-up was performed using range of motion (ROM), the Constant-Murley Score (CMS), the Oxford Shoulder Score (OSS), the Simple Shoulder Test (SST), the Subjective Shoulder Value (SSV), and visual analog scale (VAS). Major complications were considered. Results In the plate fixation group, ROM, CMS, SST, and VAS were higher than in the RSA group. Lower complication rates compared with the literature were observed in both groups. Anatomically reduced fracture fixed with plate and screw could outperform RSA in terms of outcome. In second-level centers where traumatology is performed by surgeons with great expertise in upper limb trauma, the choice between plate fixation and reverse arthroplasty should be made during surgery. Conclusion Anatomically reduced fractures showed better outcomes compared with RSA in type B/C fractures. Surgeons should always try to perform a reduction of the fracture in order to understand if a plate fixation could be feasible. If it is impossible to perform an anatomical reduction, we suggest to consider RSA. This is a retrospective observational study.

2022 - Concern regarding open reduction in Gartland type III supracondylar fractures in children [Articolo su rivista]
Tarallo, Luigi
abstract

2022 - Correction to: Pediatric elbow arthroscopy: clinical outcomes and complications after long-term follow-up (Journal of Orthopaedics and Traumatology, (2021), 22, 1, (55), 10.1186/s10195-021-00619-2) [Articolo su rivista]
Micheloni, G. M.; Tarallo, L.; Negri, A.; Giorgini, A.; Merolla, G.; Porcellini, G.
abstract

Following publication of the original article [1], the authors identified an error in the author names. The given name and family name were erroneously transposed. The incorrect author names: Micheloni Gian Mario, Tarallo Luigi, Negri Alberto, Giorgini Andrea, Merolla Giovanni and Porcellini Giuseppe. The correct author names: Gian Mario Micheloni, Luigi Tarallo, Alberto Negri, Andrea Giorgini, Giovanni Merolla, Giuseppe Porcellini. The author group has been updated above and the original article [1] has been corrected.

2022 - Current concepts in management of coronal shear fractures of the elbow [Articolo su rivista]
Novi, M.; Tarallo, L.; Dona, A.; Micheloni, G.; Giorgini, A.; Porcellini, G.
abstract

Coronal shear fracture of the capitellum is a rare articular injury of the distal humerus and could be burdened by high complications if an accurate reduction is not achieved. This complex lesion is usually displaced and requires open reduction and internal fixation for a better outcome. Better results are reported in isolated radiocapitellar joint fracture, while lower results are associated with trochlear involvement and articular comminution. CT scan is helpful to understand the fracture pattern and for a surgical planning. Several classifications have been proposed, mainly based on topography of the lesion or more management oriented such as Dubberly's classification. Headless screws guarantee a stable fixation but when medial extension of the fracture or comminution are present, an extensible approach and supplemental fixation with cannulated screws or plate are indicated. Fragment excision can be attempted for small fragments difficult to fix, with a higher risk of elbow instability especially if associated lesions are present. Arthroscopic reduction and elbow arthroplasty are also described for selected cases. Anatomical reduction provides high union rates and good elbow function. Complications' rate is approximately 30%, mostly elbow stiffness, and in a minor part pseudoarthrosis and osteonecrosis.

2022 - Gartland type III supracondylar fracture in children: is open reduction really a dangerous choice? [Articolo su rivista]
Tarallo, L.; Novi, M.; Porcellini, G.; Schenetti, C.; Micheloni, G. M.; Maniscalco, P.; Catani, F.
abstract

Background: Type III supracondylar fractures represent a difficult injury to treat and there is no universal consensus regarding the best treatment. The purpose of this study is to assess the incidence of complication associated with open reduction and compare open reduction vs closed reduction, in order to determine which treatment lead to better clinical and radiological outcomes. Is open reduction really associated with a higher number of iatrogenic complication and worse clinical outcomes in comparison to closed reduction? Methods: A total of 55 patients, affected by type III supracondylar humerus fracture, were retrospectively selected and divided into two groups according to which type of treatment they received (open reduction or closed reduction). Major complications correlated with surgical procedure, such as infections, neurovascular iatrogenic lesions, elbow stiffness and painful scarring were assessed. The treatment outcomes and clinical features were compared among the two groups. A statistical analysis to find association between the type of reduction, the restored elbow anatomy and the clinical outcomes were performed. The follow-up varies between 1 year and 7 years. Results: No major complications occurred in our series of patients. Excellent and good outcomes were reported among all 26 patients that underwent an open reduction surgery and in 23 out of the 29 patients who received a closed reduction surgery. A higher number of patients in the open reduction group presented angles with normal values; moreover 3 out of the 6 patients with unsatisfactory outcomes presented with angles not in range, underlying the presence of a connection between the restored elbow anatomy and the clinical outcomes. There were no differences among the two groups regarding the presence of complications. Discussion: open reduction should not be considered as a first line option of treatment in any pediatric patient with a type III supracondylar humerus fracture, but in several cases open surgery must be viewed as the choice with the best outcomes not only in presence of neurovascular lesion but also in case of irreducible fracture.

2022 - Locked anterior glenohumeral dislocation: is it always recommendable a conservative treatment? [Articolo su rivista]
Novi, M.; Tarallo, L.; Colozza, A.; Paladini, P.; Micheloni, G.; Catani, F.; Porcellini, G.
abstract

Purpose: Chronic anterior shoulder dislocation represents a rare condition, and there is still lack of consensus in its treatment. Purpose of this study is to evaluate the clinical and radiological outcome of painful locked dislocation underwent shoulder replacement, with a minimum follow-up of two years. Second endpoint is to assess the glenoid bone graft, harvested from the humeral head. Methods: Eight patients underwent shoulder replacement for locked anterior shoulder dislocation. Four patients with a mean age of 23 y.o. were treated with Pyrocarbon-hemiarthroplasty and four patients with a mean age of 76 y.o. were treated with reverse shoulder arthroplasty. Glenoid single stage reconstruction was performed with a bone autograft harvested from the resected humeral head. Patients were observed for a clinical and radiological follow-up for a minimum period of 2 years; ASES and Constant score were assessed. Results: Pain and ROM improvement was reported in all the patients. In one case, postoperative recurrent RSA instability was found. Glenoid reconstruction was performed in seven cases, showing a good integration and no reabsorption issues in all but one cases. ASES and Constant-Murley functional outcomes were rated as excellent by 1 patient with pyrocarbon HA and 1 patient with RSA, good by 3 patients with RSA and 2 patients with HA, fair by 1 patient with HA and poor by one patient with RSA. Conclusion: The treatment of locked anterior glenohumeral dislocation still represents a challenge in symptomatic patients. Shoulder replacement showed good results in young and older patients, with HA and RSA, respectively. Autograft from the humeral head is reliable for glenoid defect, even in ream and run procedure. Locked dislocation lasting more than one year, surgery is debatable for higher risk of a poor outcome and recurrent instability.

2022 - Radial head fractures: review of current evidence about assessment, classification and management [Articolo su rivista]
Tarallo, L.; Negri, A.; Novi, M.; Micheloni, G.; Keeling, E.; Porcellini, G.
abstract

The radial head fractures are frequent elbow injuries with several fracture patterns and associated lesions. The literature highlights the importance of correct patient management right from the earliest stages to achieve the best results and to avoid complications. The purpose of this article was to provide an overview of current concepts of the management of radial head fractures. The main goal of each treatment should be to restore elbow biomechanics, kinematics and stability to achieve a complete range of motion and to early begin rehabilitation programs. For Mason type 1 fractures the nonoperative management is the best choice providing good or excellent results in most patients. There is less agreement regarding Mason type 2 fractures, in term of nonoperative or surgical treatment. When surgical treatment is chosen, open reduction and internal fixation seems to guarantee the best clinical outcomes with excellent results reported. The Mason type 3 or 4 fractures are managed with surgical treatment. However, the best method of treatment remains controversial in literature between open reduction and internal fixation, radial head arthroplasty and radial head excision. In the last years, arthroscopy is going to assume an important role in the management of elbow diseases, not only as diagnostic tool but also as surgical solution and probably in the future its role will become more and more relevant. Further studies with long-term follow-up are needed to determine the best form of treatment of these complex injuries. (Cite this article as: Tarallo L, Negri A, Novi M, Micheloni G, Keeling E, Porcellini G. Radial head fractures: review of current evidence about assessment, classification and management.

2022 - Replacement of radial head [Articolo su rivista]
Porcellini, G.; Micheloni, G. M.; Negri, A.; Novi, M.; Keeling, E.; Tarallo, L.
abstract

Radial head prosthesis (RHP) is the primary solution for the treatment of unfixable radial head fractures, especially if also associated with complex elbow instability. The aim of the implant is to replicate the physiological tracking, reproducing the mechanical function of a native radial head. In this review we analyzed indications and types of implants. The surgical technique is also accurately discussed, considering this implantation with the same attention and precision used for the replacement of all the other joints. The most common complications after RHP are loosening, overstuffing, stiffness and heterotopic ossifications. However recent studies reported good clinical results in particular where correct rehabilitation programs were followed. Studies with high level of clinical evidence are necessary to provide definitive evidence to support the widespread use of this implant.

2022 - The traumatic elbow: current concepts [Articolo su rivista]
Tarallo, L.
abstract

2021 - 3-dimensional printing in shoulder surgery: Current literature and state of the art [Articolo su rivista]
Novi, M.; Tarallo, L.; Giorgini, A.; Micheloni, G.; Porcellini, G.
abstract

3D printing technologies provide physical models of patient-specific anatomy for preoperative study, training and patient-specific instruments to improve accuracy and reproducibility during surgery. A literature review has been performed on principal fields of application of this technology in shoulder surgery. Anatomic models in shoulder surgery can improve understanding the spatial orientation in trauma surgery, and shoulder replacement, especially when degenerative conditions alter normal anatomy. Patient-specific models ensure a better understanding of anatomy by haptic feedback of the surgeon during the preoperative planning. In shoulder arthroplasty patient-specific guides seems to ensure high accuracy in the placement of glenoid component. Patient specific instruments improve reliability of components alignment and a good correlation with the preoperative planning. However, surgeon's double check remains essential for the whole procedure. Drawbacks of 3DP technologies remain limited access to 3D printers, long time to produce the models, and the absence of surrounding soft tissues. Anatomical models and patient-specific instruments seem to improve accuracy and reliability, improve preoperative planning and reduce intraoperative time, but whether this is correlated to a clinical benefit is unconfirmed and further clinical studies with long follow-up are necessary.

2021 - A Long-Term Follow-Up of Post-Operative Periprosthetic Humeral Fracture in Shoulder Arthroplasty [Articolo su rivista]
Novi, M.; Porcellini, G.; Dona, A.; Tarallo, L.; Micheloni, G.; Giorgini, A.; Paladini, P.; Catani, F.
abstract

Background: During the last decades, the growing number of shoulder replacement has increased the associated complications. Periprosthetic fractures have a low incidence but can be a severe clinical condition, especially in elderly population. There are still no guidelines to define the best treatment protocol for post-operative periprosthetic humeral fractures. Factors associated to these fractures and consequently the decision-making for the best treatment seem to be patient-related but also correlated with the type of implant. The aim of this study is to analyze the patient’s risk factors, fracture pattern, implant type and treatment, evaluating the outcome with a long-term follow-up. Methods: A retrospective study was performed on more than 2700 shoulder prostheses implanted over 10 years in two specialized centers, identifying 19 patients who underwent surgery for post-operative periprosthetic fracture. Gender, age, comorbidities, type of prosthetic implant, type of fracture, and cortical index of each patient were evaluated. All patients underwent surgery and were evaluated with a mean follow-up of 5 years with radiographic controls and functional assessment with the Constant–Murley score. Results: Complete healing was achieved in 18 of 19 patients. All patients presented a lower Constant–Murley score than the pre-fracture score, there were no significant differences between prosthetic implants, and the cortical index was lower than the threshold level in more than 60% of cases. Conclusion: The results of this study showed that a correct preoperative planning is essential to evaluate the type of implant and possible signs of stem mobilization. With a stable stem, it is preferable to maintain it and proceed to a synthesis. The decision process is more complex in periprosthetic fractures with a reduced cortical index, when some radiolucency lines are present in stems with high primary stability, because it is not always indicative of an unstable stem. Level of Evidence: Therapeutic III

2021 - Acute elbow dislocation: comparison between magnetic resonance imaging and intra-operative finding of ligament injury [Articolo su rivista]
Tarallo, L.; Merolla, G.; Porcellini, G.; Amorico, M. G.; Micheloni, G.; Novi, M.; Di Giovine, E.; Catani, F.
abstract

Purpose: The aim of this current study was to assess elbow ligament tears after dislocation using magnetic resonance imaging (MRI) and to correlate any pre-operative imaging with intra-operative findings of elbow ligament tears. Methods: We prospectively included 32 patients with acute elbow dislocation investigated by MRI at a means of five days from dislocation. A simple elbow dislocation was diagnosed in 14 patients (44%); associated bone injuries were identified in 18 elbows (56%). Surgical repair of elbow ligaments was carried out in 23 patients, and nine cases were treated non-operatively. A blinded MRI evaluation of all 32 elbows was performed by an orthopaedic surgeon (rater 1) and a musculoskeletal radiologist (rater 2). Results: Inter-rater agreement for MRI evaluation of 32 was poor for lateral ulnar collateral ligament (LUCL) tears, fair for radial collateral ligament (RCL), moderate for annular ligament (AL), and fair for ulnar collateral ligament (UCL). All tears were reported as complete by rater 1; 13/32 partial tears were identified by rater 2 (LUCL = 2, RCL = 2, UCL = 9). Correlation between surgical and MRI findings showed good inter-rater agreement for LUCL and AL tears in both raters. Agreement for RCL tear was poor for rater 1 and fair for rater 2; agreement for UCL tear was fair for rater 1 and poor for rater 2. Intra-operative findings showed ten radial head fractures (RHFs) and ten coronoid fractures (CFs). LUCL tears were found in the four cases of type II RHFs and in 3/4 cases of CFs. Bone injuries and ligament tears were not significantly associated. Conclusion: MRI scan supported surgeons to identify soft tissue injuries and to address the most suitable surgical approach after acute elbow dislocation. Inter-observer agreement for intra-operative findings was high for LCL complex injuries and poor for UCL.

2021 - Advantages of preoperative planning using computed tomography scan for treatment of malleolar ankle fractures [Articolo su rivista]
Tarallo, L.; Micheloni, G. M.; Mazzi, M.; Rebeccato, A.; Novi, M.; Catani, F.
abstract

Malleolar ankle fractures have been classified using plain radiographs, and there is no consensus regarding the role of computed tomography (CT) scans in preoperative planning. We analyzed critical aspects, such as limits of standard radiographs, types of injury, classification methods and cost/benefit evaluations. CT scans allow a 3D analysis of the fracture to be obtained and consequently assess the indication for surgical procedure, surgical access and the type of fixation devices required. This exam is useful for detecting lesions that may go unnoticed on radiographs and will help surgeons to clarify the pathoanatomy of ankle fractures. According to Arbeitsgemeinschaft fur Osteosynthesefragen/ Orthopaedic Trauma Association (AO/OTA) classification, CT scan is recommended in medial malleolar fractures with vertical rim, type 44B fractures with posterior malleolar involvement and all type 44C fractures (according to AO/OTA). Also Tillaux-Chaput fractures (43-B1 according to AO/OTA), malleolar fractures in the presence of distal tibial fractures (43 according to AO/OTA) and distal tibia fractures in adolescents should be studied with CT scans.

2021 - Computer-Assisted Surgery in Reverse Shoulder Arthroplasty: Early Experience [Articolo su rivista]
Giorgini, A.; Tarallo, L.; Novi, M.; Porcellini, G.
abstract

Background: In the last decade, new technologies have been applied to shoulder arthroplasty. The aim of this work was to show that navigated RSA allows the surgeon to reach the planned version/inclination in all cases. In this article are shown preliminary data, advantages, disadvantages and limits of the technique. Methods: Eighteen computer-assisted reverse shoulder arthroplasty were performed. Preoperative glenoid version and inclination were evaluated with preoperative CT scan using Orthoblue® (Exactech, Gainesville, FL,USA) software, as well as baseplate type, planned glenoid component seating, planned postoperative version, planned postoperative inclination, intraoperative glenoid version/inclination, screw length and surgical time. A senior shoulder surgeon has analyzed the advantages, disadvantages and limitation of this kind of surgery. Results: Mean surgical time of the primary implants was 92 ± 12 min (min 75–max 110). Mean preoperative inclination was + 2.6° ± 6.4, mean preoperative version was − 7.6° ± 8.4. Mean planned postoperative inclination was − 2.7° ± 2.3, mean planned postoperative version was − 1.6° ± 2.9 and mean planned glenoid seating was 89% ± 8%. Planned settings were reached in all cases during surgery. Baseplate implanted were in nine cases 8° posterior augmented, in six cases standard and in three cases 10° superior augmented. Mean screw length was 33.5 mm ± 4.2 mm. No GPS system failure has been recorded. One coracoid fracture occurred during the first case. Discussion: Intraoperative navigation system is a reliable and user-friendly technology that allows the surgeon to reach planned glenoid positioning during surgery. Furthermore, this technology will allow the surgeon to compare clinical outcomes to component positioning data. The lack of humeral implant navigation is the main limit of this technique.

2021 - Current concepts of acute scaphoid fractures [Articolo su rivista]
Tarallo, L.; Novi, M.; Giorgini, A.; Dona, A.; Porcellini, G.
abstract

Scaphoid fractures represent a common injury, but diagnosis sometimes can be challenging, and a delayed treatment is burdened by severe complication such as avascular necrosis, delayed union or nonunion, with consequent degenerative conditions of the wrist. An early diagnosis and an appropriate treating algorithm are necessary for a good outcome. Clinical suspicion and specific clinical tests help in the diagnosis, but up to 25% of scaphoid fractures remain not detected on initial radiographs. MRI has a high sensitivity for early fractures and CT scan is more indicated to assess the healing process. Conservative treatment with 6 weeks long arm cast is indicated for undisplaced distal third or waist fracture in children or low demanding patients, while proximal pole of the scaphoid usually requires a surgical treatment. Several techniques and implants are proposed, especially percutaneous or minimally invasive fixation, but the surgical approach needs to be considered according to the fracture pattern in order to minimize secondary displacement and increase compression of the fragments. If a proper planning and indications are respected, vascularity is preserved and shear forces on the fragment are reduced, high union rates are achieved.

2021 - Custom-made reverse shoulder arthroplasty for severe glenoid bone loss: review of the literature and our preliminary results [Articolo su rivista]
Porcellini, G.; Micheloni, G. M.; Tarallo, L.; Paladini, P.; Merolla, G.; Catani, F.
abstract

The treatment of severe glenoid bone loss in shoulder arthroplasty represents a challenge, and the results of current prosthetic designs with only glenoid fixation still remain unsatisfactory. In the past decade, customized glenoid prostheses have been developed to address severe glenoid arthritis and in the revision setting. In this review, we analyzed the current surgical options, the classification limits, past literature evidence, and our preliminary results of 6 patients (3 male, 3 female) treated with a reverse implant and custom-made glenoid implant (ProMade; LimaCorporate, Italy). Computer analysis of the residual shape and the amount of glenoid bone stock in association with new classifications could help the surgeon to obtain good clinical and radiological outcomes. The development of navigation systems could improve the adequacy of the implant and, thus, the reliability and longevity of the implant itself.

2021 - Implant sonication versus intraoperative tissue sample cultures for periprosthetic joint infection (PJI) of shoulder arthroplasty [Articolo su rivista]
Padolino, Antonio; Cataldo, Giacomo; Tarallo, Luigi; Fabbri, Elisabetta; Merolla, Giovanni; Mario Micheloni, Gian; Paladini, Paolo; Porcellini, Giuseppe
abstract

Introduction: Periprosthetic joint infection (PJI) is the most problematic complications after shoulder arthroplasty. Many diagnostic tools have been identified to find infection, such as hystopatologic examination of tissue sections or cultures of intraoperative tissue. Implant sonication fluid culture showed good results in order to enhance diagnostic accuracy, but literature results are still controversial. Aim of our study is to compare the results of sonication with intraoperative tissue sample cultures. Patients and Methods: From February 2016 to January 2018 we performed 102 revisions of Total Shoulder Arthroplasty (TSA) for suspected PJI. Sixty-five patients respected the criteria for admission to the study and were enrolled. In each case periprostethic specimens were collected and explanted prosthesis were put inside sterile fluid, sonicated and then placed under culture. Results: Among the sixty-five patients, 36 were considered as possible, probable or certain infection. Tissue cultures were positive for infection in thirty-four cases (52,3%) and in nineteen cases was found the positivity for Cutibacterium acnes. Sonication fluid cultures were positive in forty cases (61,5%), with a positivity for Cutibacterium acnes in twenty-seven cases. The sensitivities of sonication and tissue cultures for the diagnosis of shoulder PJI were 83.3% and 88,9% (P = 0,08); the specificities were 65.5% and 93,1% (P < 0.01) respectively. Conclusion: Our results suggest that sonication technique had not shown a clear advantage in postoperative shoulder PJI diagnosis, but it’s a real aid to detect Cutibacterium acnes. In any case, sensitivity and mostly specificity were higher with tissue cultures. (www.actabiomedica.it).

2021 - Pediatric elbow arthroscopy: clinical outcomes and complications after long-term follow-up [Articolo su rivista]
M., Gian Mario; Tarallo, Luigi; N., Alberto; G., Andrea; M., Giovanni; Porcellini, Giuseppe
abstract

Background: Elbow arthroscopy is becoming increasingly important for the treatment of a wide range of acute and chronic elbow pathologies. Even if elbow arthroscopy is technically demanding, in the pediatric population this minimally invasive technique is preferred by many surgeons for the treatment of pathologies such as osteochondritis dissecans (OCD), posttraumatic stiffness (PTS), or elbow posterior impingement (PI). The aim of this study is to evaluate outcomes and safety of elbow arthroscopy in the pediatric and adolescent population after long-term follow-up. Materials and methods: In this retrospective study, 26 patients younger than 18 years old undergoing elbow arthroscopy were evaluated. All surgeries were performed by a single senior surgeon. Patients were divided into three subgroups based on preoperative diagnosis: OCD, PTS, and PI. After at least 60 months follow-up, several outcome measures, including range of motion (ROM), Mayo Elbow Performance Score (MEPS), and visual analog scale (VAS) were evaluated in relation to preoperative values. The level of patient satisfaction on a five-level Likert scale, any limitation or change in sport activity, and the onset of any possible complications were also evaluated. Results: In the study population, we found an improvement in ROM (flexion of 14.4 ± 13.6°, extension of 19.5 ± 13.9°, pronation of 5.8 ± 5.7°, and supination of 8.5 ± 11.6°) and in validated outcome measures (MEPS of 21.0 ± 13.5 points and VAS of 3.8 ± 2.2 points). The satisfaction rate was 4.5, with no dissatisfaction. Eighty-seven percent of patients fully recovered their performance levels, 9% changed sport, and 4% were unable to return to sport. We identified one major and one minor complication, with an overall complication rate of 7.7%. No neurovascular injuries were detected. Conclusions: Elbow arthroscopy in a pediatric population can be considered an effective and safe procedure for selected pathologies when performed by an experienced surgeon. At long-term follow-up, we reported excellent clinical outcomes (both objective and subjective), with a relatively low complication rate without permanent injuries. Level of evidence: Level IV—case series.

2021 - Supracondylar fractures in children: Management and treatment [Articolo su rivista]
Tarallo, Luigi
abstract

Supracondylar humeral fractures are widely considered the most common elbow fracture in children. Gartland classification plays a fundamental role in decision-making regarding management and prognosis. Recent literature recommends conservative management for non or minimally displaced fractures, whereas there seems to be a trend towards surgical treatment for all displaced fractures. The preferred treatment for displaced Gartland II and Gartland III fractures is closed reduction and percutaneous fixation with lateral pins. In particular patterns medial pin is recommended for obtain a stable construct. Neurovascular complications are mostly associated with Type III fractures and sometimes surgical exploration with fracture reduction is needed. Correct diagnosis and proper management protocol is mandatory for avoid early and late complications such as neurovascular impairment and malunion.

2021 - Surgical tips and tricks for coronal shear fractures of the elbow [Articolo su rivista]
Tarallo, L.; Novi, M.; Porcellini, G.; Giorgini, A.; Micheloni, G.; Catani, F.
abstract

Introduction: Coronal shear fractures of the distal humerus represent an uncommon lesion and could be burdened by high complications. This complex lesion requires an accurate reduction and surgical fixation for a better outcome. Different techniques have been described, however no standard protocol have been proposed. Purpose of this retrospective study, is to evaluate the clinical and radiological outcome with posterior cannulated self-tapping headless screws followed by an early-active-motion protocol and to outline the surgical tips and tricks for different fracture patterns. Materials and methods: From 2013 to 2019, a consecutive series of 24 patients with coronal shear fracture undergoing ORIF were included in the study. Fractures were classified according to Dubberley’s classification. Cannulated self-tapping headless screws were used to fix the fragments. When necessary, additional cannulated half-threaded screws on the lateral edge of the humerus were used, as well as bone chips and fibrin sealant on severe comminution. All patients underwent an assisted early-active-motion rehabilitation protocol. Mean follow-up was 30 months; patients underwent standard X-rays and clinical outcome assessment with range of motion, Broberg and Morrey score and MEPI score. Results: Surgical fixation with headless screw guaranteed complete healing of all shear fractures examined, no loss of reduction were reported. ROM assessment showed good results with an average arc of 113.1°. Excellent to good Broberg-Morrey and MEPI score were reported. No cases of avascular necrosis nor post-traumatic osteoarthritis resulted in our series. Complications occurred in 16.6% of the patients. Conclusion: Coronal shear fracture represents a challenging injury to treat. Anatomical reduction and the use of cannulated self-tapping headless screws from posterior provide a stable fixation, high union rates and good elbow function, with a low cartilage damage and risks of necrosis over 2 years of follow-up. Level of evidence: Therapeutic III.

2021 - The rediscovery of hydroxychloroquine in allergic diseases in the covid-19 era [Articolo su rivista]
Bonzano, L.; Cassone, G.; Tarallo, L.; Pellacani, G.
abstract

2020 - Autologous platelet rich plasma (PRP) in the treatment of elbow epicondylitis and plantar fasciitis: Medium to long term clinical outcome [Articolo su rivista]
Leigheb, M.; Massa, M.; Bosetti, M.; Nico, P.; Tarallo, L.; Pogliacomi, F.; Grassi, F. A.
abstract

Background and aim: Platelet-Rich-Plasma(PRP) is a popular biological therapy especially used to regener-ate different musculoskeletal tissues by releasing growth-factors and cytokines promoting cell proliferation, chemotaxis, differentiation, and angiogenesis. The aim was to evaluate the clinical effectiveness and safety of PRP for Lateral-Epicondylitis (LE) of the elbow and Plantar-Fasciitis (PF). Methods: A retrospective study was conducted including patients treated with a single topic autologous-PRP-injection between 1-1-2009 and 7-18-2019 for LE or PF at our institution; patients operated for the same problem, patients refusing the study or not traceable were excluded. Patients were assessed with VAS for pain and clinical scales. Results: 33 patients were treated with PRP and 13 (8F, 5M) included: 4LE and 9PF for a total of 16 cases. The average pain level was 0.61±0.63: 1±1.41 for LE and 0,44±0 for PF. No significant side effect was reported. 4 PRP-treatments failed: 2LE and 2PF. OES and PRTEE gave excellent results for elbow. Average foot scores were AOFAS 98.2±5 and FADI 91.3±1. Patients were stratified and compared according to plantar arch conformation, follow-up length, healing time, time from diagnosis to PRP-treatment, therapies before PRP (physiotherapy, steroid infiltration or shock-waves), risk factors (standing work, sport, age, sex). Conclusions: As in other studies, our results do not allow to draw sufficiently valid conclusions regarding the effectiveness and safety of PRP in the treatment of LE and PF: in particular the statistical significance is limited by the small sample size. PRP can be chosen as a non-first-line treatment for LE and PF.

2020 - Isolate and irreducible radial head dislocation in children: A rare case of capsular interposition [Articolo su rivista]
Tarallo, L.; Novi, M.; Porcellini, G.; Catani, F.
abstract

Background: Radial head dislocation with no associated lesions, is a relatively uncommon injury in children. In this case report, it is reported a case of anteromedial locked radial head dislocation in children, and we discuss its clinical presentation and pathogenetic mechanism of injury. Case presentation: An 8-year-old girl fell off on her right forearm with her right elbow extended in hyperpronation. An isolated radio-capitellar dislocation was identified with no other fractures or neurovascular injuries associated. Elbow presented an extension-flexion arc limited (0°-90°), and the prono-supination during general anesthesia shows "a sling effect"from maximal pronation (+ 55°) and supination (+ 90°) to neutral position of forearm. The radial head dislocation was impossible to reduce and an open reduction was performed using lateral Kocher approach. The radial head was found "button-holed"through the anterior capsule. The lateral soft tissues were severely disrupted and the annular ligament was not identifiable. Only by cutting the lateral bundle of the capsule was possible to reduce the joint. At 50 moths follow-up, patient presented a complete Range of motion (ROM), complete functionality and no discomfort or instability even during sport activities. Discussion and conclusion: It is important to understand the pathogenic mechanisms of locked radial head dislocation in children. Some mechanism described are the distal biceps tendon or the brachialis tendon interposition. However even the anterior capsule can hinder reduction. A characteristic "sling-effect"of the forearm could be pathognomonic for capsular button-holing. Surgical release of the capsular bundle sometimes is the only way to reduce the dislocation and obtain a good outcome.

2020 - Isolated displaced type II partial articular radial head fracture: correlation of preoperative imaging with intraoperative findings of lateral ulnar collateral ligament tear. [Articolo su rivista]
Tarallo, L; Porcellini, G; Merolla, G; Pellegrini, A; Giorgini, A; Catani, F.
abstract

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2020 - Reinsertion of distal biceps ruptures with a single anterior approach: analysis of 14 cases using tension-slide technique and interference screw [Articolo su rivista]
Micheloni, G. M.; Tarallo, L.; Porcellini, G.; Novi, M.; Catani, F.
abstract

BACKGROUND: Several techniques of surgical repair of biceps tendon ruptures are described in literature. Cortical button repair have shown minimal loss of elbow flexion, supination and strength. In this retrospective study we report the outcomes in terms of elbow function and complications of tension-slide technique and interference screw. Matherials and methods: 14 patients with complete distal biceps tendon rupture were included in the retrospective study and treated with the same tension-slide technique (BicepsButton® - Arthrex, Inc, Naples, Florida) evaluating the clinical and functional outcomes and the complication rate with a follow-up average of 18 months. RESULTS: The flexion recovered compare to the healthy contralateral was 96% (min 115° - max 135°; average 128°), the extension was 97% (min: -2° - max 15°; average 4°), the supination was 90% (min 20° - max 90°; average 75°), the pronation was 95% (min 15° - max 90°; average 76°). The mean Disabilities of Arm, Shoulder and Hand (DASH) score was 8.1 ± 10.5 and Mayo Elbow Performance Score overall (MEPS) score was 97.6 ± 8.2. Two patients had LABCN paresthesia, one case, treated 2 months after injury, had posterior interosseus nerve palsy. One patient had heterotopic ossification at the radiological examination without consequences for the clinical performances. No case of non-traumatic tendon re-rupture and no case of ROM deficiency > 20%. In all case the cortical button remains well positioned and no case of osteolysis were reported. CONCLUSIONS: Distal biceps tendon repair with BicepsButton® system seems to be a safe, relyable and reproducible technique providing excellent clinical, functional and radiological outcomes. Comparing with other techniques the BicepsButton® system has the advantages of the single approach procedures, the reduction of surgical time and risk of heterotopic ossifications. (www.actabiomedica.it).

2020 - The glad lesion: Are the definition, diagnosis and treatment up to date? A systematic review [Articolo su rivista]
Porcellini, G.; Cecere, A. B.; Giorgini, A.; Micheloni, G. M.; Tarallo, L.
abstract

Introduction: Although GLAD lesions are quite common, only sporadic case reports describe surgical techniques and clinical outcomes. Even if cartilage defects can result from various pathogenic mechanisms, the resulting defect has some similarities with GLAD, and its management can be a start-ing point to treat both types of lesion. Aim of the present study is to find a commonly accepted definition for GLAD lesions in order to understand its pathogenesis, diagnosis and possible treatments. Methods: A search of PubMed (MEDLINE) database has been performed in June 2020 to identify relevant articles including a combination of the following search terms: “GlenoLabral Articular Disruption” OR “GLAD” AND “shoulder” AND “cartilage, articular”. Results: Abstract evaluation included 31 articles in the full-text review. Various studies showed that the performance of MR arthrography in the detection of gleno-humeral cartilage lesions, including GLAD lesions, was moderate. Different therapeutic solutions have been described. Arthroscopic debridement of the lesion and reattachment of the labrum have been often used. In case of large articular defects, the labrum could be advanced in the cartilage defect to cover it. In case of cartilage flap with reparable margins, this could be reattached with different suture constructs. Neglected GLAD lesions following a chronic trauma or shoulder instability have not been described in literature. Conclusions: The definition of GLAD injury has changed over the time. Many authors associate this lesion with shoulder instability, with trauma in abduction and extra rotation, while Neviaser’s original definition described stable shoulders following a trauma in adduction.(www.actabiomedica.it).

2020 - Two rotator cuff tear repair techniques for sovraspinatus tendon tear: transosseous sharc-ft vs single row repair [Articolo su rivista]
Pellegrini, A.; Baudi, P.; Rebuzzi, M.; Gialdini, M.; Tarallo, L.; Porcellini, G.
abstract

BACKGROUND: Despite rotator cuff repair techniques have developed significantly in last decade, pushed by the progress in technology and materials, the treatment of rotator cuff tears and re-tears is still a big challenge for shoulder surgeons. The aim of this study is to perform clinical and radiological evaluation (ultrasound and MRI) of patients treated with transosseous sharc-ft, and single row techniques for sovraspinatus rotator cuff tear at 6, 12 and 24 months follow up. METHODS: Twenty-eight consecutive patients who underwent arthroscopic repair for rotator cuff tear were enrolled in the study and divided in two different groups: group A (14 patients) underwent a single row technique repair; group B (14 patients) underwent a transosseous sharc-ft technique repair. All participants had MRI or ultrasound examination confirmed fullthickness tears of sovraspinatus tendon before surgery. All the patients underwent clinical evaluation at 45 days, 3 months, 6 months, 12 and 24 months post-operatively with VAS, Dash, Constant and ASES score. Diagnostic ultrasound examination was performed at 6 months follow up while the MRI examination at 1 and 2 year follow up. RESULTS: The whole primary variables didn't show any significant difference and the groups were homogenous (age, Goutallier fatty infiltration, VAS, DASH, Constant, ASES). Some statistically significant differences are visible at discrete variables in a specific time: Dash at 12 months and Constant at 24 months show a significant improvement versus single-row technique. CONCLUSION: The arthroscopic transosseous repair technique with sharc-ft showed excellent results with little significant statically difference between this technique and the single row for this kind of lesion after 1 year of follow-up. Clinical data from this study confirmed, with the help of ultrasound examination and MRI, the excellent clinical outcome obtained by the patients. Further studies are needed to find differences between these techniques in the repair of large and massive rotator cuff lesions. (www.actabiomedica.it).

2020 - Volar PEEK plate for distal radius fracture: analysis of adverse events [Articolo su rivista]
Tarallo, L.; Giorgini, A.; Novi, M.; Zambianchi, F.; Porcellini, G.; Catani, F.
abstract

Background: The aim of the present retrospective study was to evaluate complications following carbon-fiber-reinforced polyetheretherketon (CFR-PEEK) volar plating in distal radius fracture in a large cohort of patients. As an alternative to conventional metallic devices, CFR-PEEK plates have been introduced over the last few years. Methods: We performed a retrospective study including all patients who were treated for distal radius fracture using a volar fixed-angle plate DiPHOS-RM (Lima Corporate, Udine, Italy). All CFR-PEEK plates implanted were reviewed between May 2012 and December 2017. Plate removal, second surgery and adverse events were collected by reviewing medical records. A total of 110 patients were included with a mean follow-up of 4 years. Results: Adverse side effects were observed in 9 cases (8%), developed during or after treatment. The most frequent complication was represented by intraoperative plate rupture (4%). Infection was reported in one case. Discussion: The rate of complications of PEEK volar plates seems to be similar to those occurring with plates of different materials. Advantages of PEEK plates are the absence of the cold-welding phenomenon and the absence of exuberant bone callus on the plate, ensuring an easy hardware removal. Intraoperative rupture remains the main complication correlated with PEEK material. These complications can be reduced with an accurate surgical technique, especially at the beginning of the learning curve. Level of evidence: Therapeutic IV.

2019 - Comparison between conservative treatment and plate fixation for displaced middle third clavicle fracture: clinical outcomes and complications. [Articolo su rivista]
Micheloni, Gm; Tarallo, L; Porcellini, G; Catani, F.
abstract

2019 - Epidemiology and demographics of elbow arthroplasties [Capitolo/Saggio]
Tarallo, L.
abstract

2019 - Management of High-Pressure Injection Hand Injuries: A Multicentric, Retrospective, Observational Study [Articolo su rivista]
Vitale, Ermanno; Ledda, Caterina; Adani, Roberto; Lando, Mario; Bracci, Massimo; Cannizzaro, Emanuele; Tarallo, Luigi; Rapisarda, Venerando
abstract

2019 - Technology applications in shoulder replacement [Articolo su rivista]
Porcellini, G; Tarallo, L; Novi, M; Spiezia, F; Catani, F
abstract

The advancement of technologies in orthopaedic surgery should provide the surgeon with precise and trustworthy support for pre-operative planning, intra-operative guidance and post-operative follow-up. The request for greater accuracy, predictable results and fewer complications, is the engine of digital evolution in pre-operative planning and computer-assisted surgery (CAS). It is an evolution rather than a revolution, and in the last few years these developments have begun to involve shoulder replacement surgery, too.

2019 - Volar PEEK plate for distal radial fracture: analysis of plate ruptures in a group of 120 patients [Articolo su rivista]
Tarallo, L.; Giorgini, A.; Catani, F.
abstract

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2018 - A Rare Case of Triceps Brachii Injury after Electrocution [Articolo su rivista]
Lana, Debora; Tarallo, Luigi; Catani, Fabio
abstract

Injuries of the triceps brachii muscle are a rare entity and mostly concern its distal tendon. These represent the least common of all muscle and tendons injuries. The most common reported causes are repeated strong physical efforts, a fall on an outstretched forearm when a sudden deceleration is put on contract triceps, or a direct trauma. High-dosed and prolonged corticosteroid therapies, repeated local steroid injections, chronic renal failure, diabetes, rheumatoid arthritis, hyperparathyroidism, and osteogenesis imperfecta are reported as systemic causes. Even rarer are lesions of muscle fibers and avulsions or rupture at its musculotendinous junction, and these can be caused by direct trauma or by forced elbow flexion during triceps contraction. To the best of our knowledge, there is no article in the literature describing this type of injury that occurred after electrocution. In this article, we report an uncommon case of intramuscular tear associated with insertional distal tendon injury occurred in a man survived to high-voltage electric discharge.

2018 - Biomechanical comparison between stainless steel, titanium and carbon-fiber reinforced polyetheretherketone volar locking plates for distal radius fractures [Articolo su rivista]
Mugnai, Raffaele; Tarallo, Luigi; Capra, Francesco; Catani, Fabio
abstract

Introduction: As the popularity of volar locked plate fixation for distal radius fractures has increased, so have the number and variety of implants, including variations in plate design, the size and angle of the screws, the locking screw mechanism, and the material of the plates. Hypothesis: Carbon-fiber reinforced polyetheretherketone (CFR-PEEK) plate features similar biomechanical properties to metallic plates, representing, therefore, an optimal alternative for the treatment of distal radius fractures. Materials and Methods: Three different materials-composed plates were evaluated: stainless steel volar lateral column (Zimmer); titanium DVR (Hand Innovations); CFR-PEEK DiPHOS-RM (Lima Corporate). Six plates for each type were implanted in sawbones and an extra-articular rectangular osteotomy was created. Three plates for each material were tested for load to failure and bending stiffness in axial compression. Moreover, 3 constructs for each plate were evaluated after dynamically loading for 6000 cycles of fatigue. Results: The mean bending stiffness pre-fatigue was significantly higher for the stainless steel plate. The titanium plate yielded the higher load to failure both pre and post fatigue. After cyclic loading, the bending stiffness increased by a mean of 24% for the stainless steel plate; 33% for the titanium; and 17% for the CFR-PEEK plate. The mean load to failure post-fatigue increased by a mean of 10% for the stainless steel and 14% for CFR-PEEK plates, whereas it decreased (−16%) for the titanium plate. Statistical analysis between groups reported significant values (p < 001) for all comparisons except for Hand Innovations vs. Zimmer bending stiffness post fatigue (p =.197). Discussion: The significant higher load to failure of the titanium plate, makes it indicated for patients with higher functional requirements or at higher risk of trauma in the post-operative period. The CFR-PEEK plate showed material-specific disadvantages, represented by little tolerance to plastic deformation, and lower load to failure. Level of evidence: N/A.

2018 - Biomechanical comparison between stainless steel, titanium and carbon-fiber reinforced polyetheretherketone volar locking plates for distal radius fractures [Articolo su rivista]
Mugnai, R.; Tarallo, L.; Capra, F.; Catani, F.
abstract

Introduction: As the popularity of volar locked plate fixation for distal radius fractures has increased, so have the number and variety of implants, including variations in plate design, the size and angle of the screws, the locking screw mechanism, and the material of the plates. Hypothesis: Carbon-fiber reinforced polyetheretherketone (CFR-PEEK) plate features similar biomechanical properties to metallic plates, representing, therefore, an optimal alternative for the treatment of distal radius fractures. Materials and methods: Three different materials-composed plates were evaluated: stainless steel volar lateral column (Zimmer); titanium DVR (Hand Innovations); CFR-PEEK DiPHOS-RM (Lima Corporate). Six plates for each type were implanted in sawbones and an extra-articular rectangular osteotomy was created. Three plates for each material were tested for load to failure and bending stiffness in axial compression. Moreover, 3 constructs for each plate were evaluated after dynamically loading for 6000 cycles of fatigue. Results: The mean bending stiffness pre-fatigue was significantly higher for the stainless steel plate. The titanium plate yielded the higher load to failure both pre and post fatigue. After cyclic loading, the bending stiffness increased by a mean of 24% for the stainless steel plate; 33% for the titanium; and 17% for the CFR-PEEK plate. The mean load to failure post-fatigue increased by a mean of 10% for the stainless steel and 14% for CFR-PEEK plates, whereas it decreased (−16%) for the titanium plate. Statistical analysis between groups reported significant values (P < 001) for all comparisons except for Hand Innovations vs. Zimmer bending stiffness post fatigue (P = 0.197). Discussion: The significant higher load to failure of the titanium plate, makes it indicated for patients with higher functional requirements or at higher risk of trauma in the postoperative period. The CFR-PEEK plate showed material-specific disadvantages, represented by little tolerance to plastic deformation, and lower load to failure. Level of evidence: N/A.

2018 - Comparison between absorbable pins and mini-screw fixations for the treatment of radial head fractures Mason type II-III [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Rocchi, Martina; Capra, Francesco; Catani, Fabio
abstract

Background: The treatment of comminuted radial head fractures can include prosthetic replacement or open reduction and internal fixation. The purpose of this study is to evaluate the results of two different internal fixation systems for Mason type II-III radial head fractures. Methods: Between 2005 and 2015, 82 patients were treated using pins and 65 patients by mini-screws. The follow-up protocol included: a clinical evaluation 15 days after surgery, and clinical and radiographic evaluations performed at 30 and 60 day intervals, unless any complications were reported by the patient. Over a period of at least 12-months of follow-up, patients were checked and interviewed. Clinical examinations included elbow range of motion (ROM), arm, shoulder and hand Disabilities, (DASH), and the Mayo Elbow Performance Score (MEPS). Results: Sixty-one subjects who had been treated with mini-screws were clinically reviewed at a mean 47.3 ± 35.8 month of follow-up; all patients who had been treated using absorbable pins were evaluated at a mean 82.5 ± 20.6 month of follow-up. No significant statistically differences were observed between the two groups in the mean ROM, DASH, and MEPS scores. Residual pain was reported in 15.8%of the patients treated by pins and 9.2% patients treated by mini-screws. Secondary displacement of fracture fragments was observed in 8.5% patients treated by pins and 1.6% using mini-screws. Conclusions: Both absorbable pins and mini-screws provided adequate strength and rigidity, allowing good clinical and functional scores at a mid-term follow-up. However, a higher rate of secondary displacement of the fracture fragments was reported among subjects who had been treated using absorbable pins.

2018 - Distal biceps tendon rupture: Advantages and drawbacks of the anatomical reinsertion with a modified double incision approach 11 Medical and Health Sciences 1103 Clinical Sciences [Articolo su rivista]
Tarallo, L.; Lombardi, M.; Zambianchi, F.; Giorgini, A.; Catani, F.
abstract

Background: Distal biceps tendon rupture occurs more often in middle-aged male population, involving the dominant arm. In this retrospective study, it's been described the occurrence of the most frequent adverse events and the clinical outcomes of patients undergoing surgical repair of distal biceps tendon rupture with the modified Morrey's double-incision approach, to determine better indications for patients with acute tendon injury. Methods: Sixty-three patients with acute distal biceps tendon rupture treated with a modified double-incision technique between 2003 and 2015 were retrospectively evaluated at a mean 24 months of follow-up. Clinical evaluation including range of motion (ROM) and isometric strength recovery compared to the healthy contralateral side assessment, together with documentation of nerve injury, was performed. Patients were asked to answer DASH, OES and MEPS scores. Results: The ROM recovery showed excellent results compared to the healthy contralateral side. The reported major complications included: one case of proximal radio-ulnar synostosis, 3 cases of posterior interosseous nerve (PIN) palsy and one case of a-traumatic tendon re-rupture. Concerning minor complications, intermittent pain, ROM deficiency < 30° in flexion/extension and pronation/supination, isometric flexion strength deficiency < 30% and isometric supination strength deficiency < 60%, lateral antebrachial cutaneous nerve (LACBN) injury, were observed. The average DASH score was 8.5; the average OES was 41.5 and the MEPS was 96.3. Conclusion: The Morrey modified double-incision technique finds its indication in young and active patients if performed within 2 weeks from injury. If performed by experienced surgeons, the advantages can exceed the drawbacks of possible complications.

2018 - Traumatic lesions of peripheral nerves at the elbow [Capitolo/Saggio]
Rovesta, C.; Marongiu, M. C.; Tarallo, L.; Catani, F.
abstract

2018 - Vascular lesions at the elbow and compartmental syndrome [Capitolo/Saggio]
Adani, R.; Mugnai, R.; Tarallo, L.
abstract

2017 - An Unusual Case of Posterolateral Rotatory Instability of the Elbow [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Catani, Fabio
abstract

The authors present a case of posterolateral rotatory elbow instability (PLRI) caused by the concomitant presence of lateral ulnar collateral ligament (LUCL) insufficiency and an impression fracture of the volar margin of the radial head.

2017 - Mason type III radial head fractures treated by anatomic radial head arthroplasty: Is this a safe treatment option? [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Rocchi, M.; Capra, F.; Catani, Fabio
abstract

Background Radial head fractures make up approximately 3% of all fractures and they are the most common elbow fracture in adults. Replacement through arthroplasty is the recommended treatment in the context of unstable elbow injury and comminuted radial head fracture. The midterm clinical, functional, and radiographic results in patients treated with anatomic radial head arthroplasty for a Mason type III radial head fracture are presented. Material and methods We performed a retrospective search of our facility's prospective trauma database to identify all skeletally mature patients who were treated by primary radial head replacement or open reduction and internal fixation following an acute radial head fracture. Inclusion criteria were Mason type III fractures and anatomic radial head arthroplasty (RHA). All the patients included were evaluated using a standard postoperative protocol including clinical and radiographic evaluation at 1, 3 and 12 months of follow-up. All the patients were reviewed clinically at an average of 30 months’ follow-up. Results Forty-one subjects (32 Mason type III and 9 Mason IV fractures) were treated with anatomic RHA (Acumed, Hillsboro, OR, USA). Of these, two patients (1 Mason type III and 1 Mason type IV) were excluded from the analysis because severe cognitive impairment. Moreover, we decided to exclude the subjects with a Mason type IV fracture to obtain a more homogeneous sample. Therefore, 31 patients with a Mason type III fracture were included in this study. Based on the Mayo Elbow Performance Score, excellent results were obtained in 24 (77%) patients, good in 3 (10%) and fair in 4 (13%) patients. Heterotopic ossification was reported in 8 patients (26% of cases). The final elbow flexion-extension range of motion was of 112°, with a mean flexion of 125°. The final forearm rotational range of motion was 134° with a mean pronation of 68° and a mean supination of 66°. Discussion Anatomic radial head replacement leads to a good functional recovery, even in the presence of severe instability, such as coronoid fractures and LUCL injury. However, patients should be informed of the high number of adverse events (mainly heterotopic ossification) following this treatment. Level of evidence Therapeutic IV.

2017 - Mason type III radial head fractures treated by anatomic radial head arthroplasty: Is this a safe treatment option? [Articolo su rivista]
Tarallo, L.; Mugnai, R.; Rocchi, M.; Capra, F.; Catani, F.
abstract

Background Radial head fractures make up approximately 3% of all fractures and they are the most common elbow fracture in adults. Replacement through arthroplasty is the recommended treatment in the context of unstable elbow injury and comminuted radial head fracture. The midterm clinical, functional, and radiographic results in patients treated with anatomic radial head arthroplasty for a Mason type III radial head fracture are presented. Material and methods We performed a retrospective search of our facility's prospective trauma database to identify all skeletally mature patients who were treated by primary radial head replacement or open reduction and internal fixation following an acute radial head fracture. Inclusion criteria were Mason type III fractures and anatomic radial head arthroplasty (RHA). All the patients included were evaluated using a standard postoperative protocol including clinical and radiographic evaluation at 1, 3 and 12 months of follow-up. All the patients were reviewed clinically at an average of 30 months’ follow-up. Results Forty-one subjects (32 Mason type III and 9 Mason IV fractures) were treated with anatomic RHA (Acumed, Hillsboro, OR, USA). Of these, two patients (1 Mason type III and 1 Mason type IV) were excluded from the analysis because severe cognitive impairment. Moreover, we decided to exclude the subjects with a Mason type IV fracture to obtain a more homogeneous sample. Therefore, 31 patients with a Mason type III fracture were included in this study. Based on the Mayo Elbow Performance Score, excellent results were obtained in 24 (77%) patients, good in 3 (10%) and fair in 4 (13%) patients. Heterotopic ossification was reported in 8 patients (26% of cases). The final elbow flexion-extension range of motion was of 112°, with a mean flexion of 125°. The final forearm rotational range of motion was 134° with a mean pronation of 68° and a mean supination of 66°. Discussion Anatomic radial head replacement leads to a good functional recovery, even in the presence of severe instability such as coronoid fractures and LUCL injury. However, patients should be informed of the high number of adverse events (mainly heterotopic ossification) following this treatment. Level of evidence Therapeutic IV.

2016 - Clinical outcome is not affected by total knee arthroplasty alignment [Articolo su rivista]
Mugnai, Raffaele; Zambianchi, Francesco; Digennaro, Vitantonio; Marcovigi, Andrea; Tarallo, Luigi; DEL GIOVANE, Cinzia; Catani, Fabio
abstract

Purpose: This study aims to analyse the influence on total knee arthroplasty (TKA) clinical outcomes of biomechanical intra-operative computer-assisted surgery-measured parameters, together with radiographic and demographical data. Methods: Between 2007 and 2009, 227 computer-assisted surgery (CAS) primary TKAs were performed in 219 consecutive patients. Information about gender, age and body mass index (BMI) was collected for each patient. Before knee replacement, all patients underwent a complete radiographic examination and passive flexion–extension range of motion was recorded. All TKAs were implanted using an image-free knee navigation system. Patients included in the study were evaluated at 3, 6 and 12 months of follow-up and then yearly. At each follow-up, subjects were asked to answer the validated Italian version of the Knee Injury and Osteoarthritis Outcome Score. Results: One hundred and eighty patients (187 knees) had data available for analysis. Complications were reported in 13 patients (7.0 %). Intra-operative CAS-measured parameters, together with age, BMI, gender, pre- and post-operative radiographic alignment, did not influence TKA clinical results at a mean 2 years of follow-up. On the other hand, higher post-operative flexion arc of movement was suggestive of better clinical outcomes. Conclusion: TKA clinical outcome is influenced by post-operative knee flexion, other than neutral mechanical limb alignment. Therefore, it is recommended to prefer TKA designs that allow high flexion and to encourage early physical rehabilitation. Level of evidence: IV.

2016 - Corrective osteotomies of the radius: Grafting or not? [Articolo su rivista]
Mugnai, Raffaele; Tarallo, Luigi; Lancellotti, Enrico; Zambianchi, Francesco; Di Giovine, Ettore; Catani, Fabio; Adani, Roberto
abstract

AIM: To review the current literature regarding corrective osteotomies to provide the best evidence of the rule of bone grafting. METHODS: Our MEDLINE literature search included 280 studies using the following key words "Malunited distal radius fracture" and 150 studies using key words "Corrective osteotomy of the distal radius". Inclusion criteria were: Malunited distal radial, extra articular fracture, volar locking plate, use of iliac bone graft (cancellous or corticocancellous), non-use of bone graft. Twelve studies met the inclusion criteria. RESULTS: Seven of the 12 studies considered, described the use of a graft; the remaining five studies didn't use any graft. Type of malunion was dorsal in most of the studies. The healing time was comparable using the graft or not (mean 12.5 wk), ranging from 7.5 to 16 wk. The mean disabilities of the arm, shoulder and hand score improvement was 23 points both in the studies that used the graft and in those not using the graft. CONCLUSION: This review demonstrated that corrective osteotomy of extra-articular malunited fractures of the distal radius treated by volar locking plate does not necessarily require bone graft.

2016 - Double-locking precontoured plating system for malunited fractures of the distal end of humerus [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Rocchi, M.; Rovesta, Claudio; Catani, Fabio
abstract

Background: Distal humeral malunions are uncommon injuries, often associated with limited elbow motion, pain, instability, weakness, and sometimes ulnar neuritis. The complex anatomy of the elbow joint makes this condition one of the most complex elbow injuries to treat. Materials and methods: Four patients were treated by the same surgeon between 2011 and 2013 using a double-locking precontoured plating system for malunited intra-articular or extra-articular fractures of the distal end of the humerus. Results: At a mean 3 years of follow-up, a significant improvement in the elbow motion and functional outcome, evaluated with the Mayo Elbow Performance Index and the Disability of the Arm, Shoulder, and Hand, were observed. Articular reduction obtained after the surgery was maintained in all patients without evidence of avascular necrosis. No other complications (i.e., infection, nervous iatrogenic lesions) were reported. Conclusions: Corrective osteotomy using double-locking precontoured plating system preceded by preoperative planning using a CT scan allowed an improvement in the functional outcome and elbow motion, without complications.

2016 - Humerus shaft fracture complicated by radial nerve palsy: Is surgical exploration necessary? [Articolo su rivista]
Rocchi, M.; Tarallo, L.; Mugnai, R.; Adani, R.
abstract

Fractures of the humerus shaft often are complicated by radial nerve palsy. Controversy still exists in the treatment that includes clinical observation and eventually late surgical exploration or early surgical exploration. Algorithms have been proposed to provide recommendations with regard to management of the injuries. However, advantages and disadvantages are associated with each of these algorithms. The aim of this study was to analyze the indications of each treatment options and facilitate the surgeon in choosing the conduct for each lesion, proposing our own algorithm.

2016 - Osteotomie correttive di radio distale:è sempre indicato l'utilizzo dell'innesto osseo? [Articolo su rivista]
Mugnai, Raffaele; Tarallo, Luigi; Lana, Debora; Adani, Roberto
abstract

2016 - Scapholunate interosseous ligament injury in professional volleyball players [Articolo su rivista]
Mugnai, R.; Della Rosa, N.; Tarallo, L.
abstract

Injuries to the scapholunate interosseous ligament (SLIL) are the most common cause of carpal instability. A SLIL injury typically follows a fall on an outstretched hand, with the wrist in hyperextension, ulnar deviation and intercarpal supination. We hypothesize that repetitive axial loading on the wrist in hyperextension, during the reception and digging motions of volleyball, can lead to functional overloading of the SLIL. To identify patients and to determine the clinical history and surgical treatment performed, we analyzed hospital records, X-rays, electronic databases containing all the operations performed, and image files (including before and after surgery and follow-up). We identified three SLIL injury cases in national volleyball team players, also at the libero position, who were treated at our clinic between 2007 and 2013 for scapholunate instability. Open reduction and Berger capsulodesis was performed in all cases. At a mean follow-up of 3 years (range, 22â 50 months), the mean pain level on VAS was 0.3 (range, 0â 1) at rest and 1.7 (range 1â 2) during sport activities. The mean DASH score was 4 (range 2â 5). The mean wrist flexion was 60° (range 55â 70°) and extension was 80° (range 75â 85°). Given the greater susceptibility of these players for developing a SLIL injury, a high index of suspicion is needed when managing athletes presenting with wrist pain or instability.

2015 - Distal triceps tendon repair using Krakow whipstitches, K wires, tension band and double drilling technique: A case report [Articolo su rivista]
Tarallo, Luigi; Zambianchi, Francesco; Mugnai, Raffaele; Costanzini, Carlo Alberto; Catani, Fabio
abstract

Introduction: The management of distal triceps tears must address each patient's medical and functional status: in general, the literature has described satisfactory nonsurgical treatment in tears less than 50%. Tears greater than 50% are treated nonsurgically in a sedentary person and surgically in active patients. Complete tears are generally managed surgically: most reported repair techniques describe the use of Bunnell or Krakow whipstitch techniques, passing the sutures through transosseous drill holes in the ulna. Other described techniques include the use of suture anchors and direct tendon repair to a periosteal flap raised from the olecranon. Case presentation: In the presented report we describe the surgical technique used to treat a complete traumatic distal triceps tendon rupture associated with olecranon fracture in a 40-year-old Caucasian man with underlying poor tendon quality and postoperative assessment. To the best of our knowledge no studies describing the performed surgical technique, utilizing Krakow whipstitches, olecranon fixation with K wires and Zuggurtung tension band through transosseous drill holes have been previously described in the literature. At 30 days postoperatively the patient had regained full elbow flexion/extension and pronation/supination. Conclusions: The described methodology, using a double ulnar tunnel to obtain fixation of the fragment, associated with a whipstitch locking-type suture for the triceps tendon, allowed proper fixation of the fracture and optima reinsertion of the detached tendon on its footprint with sufficient strength.

2015 - Pediatric medial epicondyle fractures with intra-articular elbow incarceration [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Fiacchi, Francesco; Adani, Roberto; Zambianchi, Francesco; Catani, Fabio
abstract

Background: Intra-articular incarceration of the epicondylar fragment occurs in 5–18 % of all cases of medial epicondyle fracture. It requires stable fixation to allow early motion, since elbow stiffness is the most common complication following medial epicondyle fracture. In this retrospective study, we report the clinical and functional outcomes and the complications that occurred following open reduction and screw fixation of medial epicondyle fractures with intra-articular fragment incarceration. Methods: Thirteen children who had a fracture of the medial epicondyle with incarceration of the fragment in the elbow joint (type III) were surgically treated in our university hospital between 1998 and 2012. There were eight male and five female patients. The mean age at the time of injury was 13 years (range 9–16). Operative treatment consisted of open reduction and internal fixation with one or two 4.0-mm cannulated screws under fluoroscopic control. Results: All of the patients were clinically reviewed at an average follow-up of 29 months. The overall range of motion limitation was about 5° for flexion–extension and 2° for pronation–supination. The score was excellent in all patients (mean 96.3). Complications occurred in four (31 %) children: two cases of symptomatic screw head prominence, irritation with partial lesion of the distal triceps myotendinous junction in one patient, and median nerve entrapment syndrome in one patient. Conclusions: In conclusion, open reduction and screw fixation yielded excellent clinical and functional outcomes for the treatment of medial epicondyle fractures with intra-articular fragment incarceration. However, particular attention is should be paid when treating these potentially serious injuries in order to minimize the risk of possible complications. Level of evidence: Therapeutic IV.

2015 - Shear fractures of the distal humerus: Is the use of intra-articular screws a safe treatment? [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Adani, Roberto; Zambianchi, Francesco; Costanzini, Carlo Alberto; Catani, Fabio
abstract

Background: Coronal shear fractures of the distal humerus are uncommon injuries and are not exempt from complications. The aim of this research is to evaluate the possible advantages and drawbacks using cannulated compression headless screws. Materials and methods: We performed a prospective study including all the consecutive patients who were treated with cannulated screws for coronal shear fractures of the distal humerus between 2010 and 2013. Following the Dubberley’s classification, three patients were type 1A, one patient was 1B, three patients were 2B, and one patient was 3B. The mean follow-up was 30 months. The clinical and radiological evaluation included analysis of passive range of motion, functional outcome, radiological evaluation of fracture healing and reduction maintenance, and the occurrence of possible adverse events. Results: All fractures healed, and radiographic union was observed at an average of 3 months. The average elbow range of motion was 125°, with 125° of flexion and 20 of extension. According to the Broberg and Morrey score, there were four excellent and four good results. Using the Mayo Elbow Performance Index, five cases achieved excellent scores and three reported good results. Adverse events reported in three cases were as follows: heterotopic ossification, complex regional pain syndrome and delayed lateral collateral ligament disruption. Conclusions: The use of cannulated compression headless screws has given satisfactory results, allowing a strong inter-fragmentary compression, early mobilization, with high union rates and good elbow function. However, patients should be counseled about the high proportion of adverse events following these injuries.

2014 - A new volar plate made of carbon-fiber-reinforced polyetheretherketon for distal radius fracture: analysis of 40 cases [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Adani, Roberto; Zambianchi, Francesco; Catani, Fabio
abstract

BACKGROUND: Implants based on the polyetheretherketon (PEEK) polymer have been developed in the last decade as an alternative to conventional metallic devices. PEEK devices may provide several advantages over the use of conventional orthopedic materials, including the lack of metal allergies, radiolucency, low artifacts on magnetic resonance imaging scans and the possibility of tailoring mechanical properties. The purpose of this study was to evaluate the clinical results at 12-month follow-up using a new plate made of carbon-fiber-reinforced polyetheretherketon for the treatment of distal radius fractures. MATERIALS AND METHODS: We included 40 consecutive fractures of AO types B and C that remained displaced after an initial attempt at reduction. The fractures were classified according to the AO classification: 21 fractures were type C1, 9 were type C2, 2 were type C3, 2 were type B1 and 6 were type B2. RESULTS: At a 12-month follow-up no cases of hardware breakage or loss of the surgically achieved fracture reduction were documented. All fractures healed, and radiographic union was observed at an average of 6 weeks. The final Disabilities of Arm, Shoulder and Hand score was 6.0 points. The average grip strength, expressed as a percentage of the contralateral limb, was 92 %. Hardware removal was performed only in one case, for the occurrence of extensor tenosynovitis. CONCLUSION: At early follow-up this device showed good clinical results and allowed maintenance of reduction in complex, AO fractures. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

2014 - Distal biceps tendon rupture reconstruction using muscle-splitting double-incision approach [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Zambianchi, Francesco; Adani, Roberto; Catani, Fabio
abstract

To evaluate the clinical and functional results after repair of distal biceps tendon tears, following the Morrey's modified double-incision approach.

2014 - Malunited extra-articular distal radius fractures: corrective osteotomies using volar locking plate [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Adani, Roberto; Catani, Fabio
abstract

Background: Multiple techniques for corrective osteotomy have been developed in recent years with the same aims: to improve the radiographic parameters and improve motion, pain and grip strength. Volar fixed-angle plates have added a new concept to the treatment of distal radius fractures thanks to the low morbidity of the surgical approach and the strength of the final construct, allowing early mobilization and return to function.Materials and methods: Between 2005 and 2012, 20 patients with symptomatic dorsally malunited extra-articular fractures of the distal radius underwent corrective osteotomy using a volar locking plate without additional bone graft. At a mean follow-up of 50 months, all the patients were clinically and functionally evaluated.Results: All measurements of pain, final range of motion and grip strength significantly improved compared with preoperative measurements. The mean preoperative DASH score reduced from 54 points preoperatively to 25 postoperatively. Based on the modified Mayo wrist score, we obtained 14 excellent and six good results. Palmar tilt improved from an average of 23° to 11°. Radial inclination improved from an average of 29° to 22°, and ulnar variance decreased from an average of 3.6 mm to 0.9 mm. There were two cases of transient median neuroapraxia that resolved before the 6-week follow-up appointment. No other major complications, including non-union and infection, were observed.Conclusion: The volar approach and locking plate, without necessarily the use of bone grafting, proved to be an effective approach for addressing symptomatic and even severe deformities of the distal radius.Type of study/level of evidence: Therapeutic IV.

2014 - Microsurgical soft tissue and bone transfers in complex hand trauma [Articolo su rivista]
Adani, Roberto; Tarallo, Luigi; Caccese, Armando Fonzone; Delcroix, Luca; Cardin-Langlois, Etienne; Innocenti, Marco
abstract

Treatment of complex hand trauma includes adequate debridement of nonviable tissue, early reconstruction, and careful selection of various available surgical procedures tailored to patients' needs and requests. Debridement of all necrotic tissue is crucial before any attempt at reconstruction. Surgeons should also consider cosmetic outcomes of the reconstructed hand and donor-site morbidity. For best results reconstruction should be performed early, with proper early postoperative therapy. This article reviews the principles and surgical options in the management of complex hand injuries involving the dorsal and the palmar aspects of the hand, and the different types of tissue in the hand. © 2014 Elsevier Inc.

2014 - Schwannomas of the upper extremity: analysis of 34 cases [Articolo su rivista]
Adani, Roberto; Tarallo, Luigi; Mugnai, Raffaele; Colopi, Stefano
abstract

Schwannomas are the most common benign tumours developing in peripheral nerves. They usually present as a slow-growing mass, sometimes associated with pain and paraesthesia. The aim of this study is to define the correct preoperative diagnosis, to review the surgical treatment employed and to evaluate short- and long-term neurological deficits.

2014 - Simple and comminuted displaced olecranon fractures: A clinical comparison between tension band wiring and plate fixation techniques [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Adani, Roberto; Capra, Francesco; Zambianchi, Francesco; Catani, Fabio
abstract

Introduction: The purpose of this retrospective study is to compare the clinical, functional outcome and complications occurrence between tension band wiring (TBW) and plate fixation both for simple and comminuted displaced olecranon factures.Materials and methods: Between January 2005 and June 2012 (minimum 1-year follow-up), 78 consecutive patients with Mayo type IIA and IIB fractures were treated with the following methods: tension band wire or plate and screws fixation. The primary outcome of this study was the functional outcome, assessed by the following self-administered evaluation scales: the disabilities of the arm, shoulder and hand, and the Mayo Elbow Performance Score. Secondary outcome measures included the assessment of pain level, analysis of passive range of motion, and the occurrence of any early or late complications.Results: Comparing the clinical results between the two groups, at mean 33 months follow-up, no significant differences in the functional and clinical outcome were observed. Complications were reported in 48 and 17 % of cases, following TBW and plate fixation in patients treated for type IIA fractures, and similarly in 40 and 23 % of cases in type IIB fractures, respectively. Hardware removal was more frequently performed in TBW group: 38 versus 17 % for type IIA fractures and 20 versus 6 % for type IIB fractures.Conclusions: The findings of this study indicate that both with the use of TBW and plate fixation excellent/good clinical outcomes with minimal loss of physical capacity, little pain and disability can be obtained in the majority of patients with simple and comminuted displaced olecranon fractures. Hardware removal was most frequently observed after TBW.Level of evidence: Therapeutic IV.

2014 - Treatment of painful median nerve neuromas with radial and ulnar artery perforator adipofascial flaps [Articolo su rivista]
Adani, Roberto; Tos, Pierluigi; Tarallo, Luigi; Corain, Massimo
abstract

Purpose To review the outcomes of 8 patients with painful median nerve neuromas at the wrist treated with external neurolysis and covered with pedicled perforator adipofascial flaps. Methods Between 2004 and 2010, we treated 8 patients, who had a mean age of 37 years, and who had posttraumatic painful median nerve neuromas at the level of the wrist but with retained median nerve function. All of them reported neuropathic pain and had a positive Tinel's sign over the site of the presumed neuroma. The surgical procedure included external neurolysis and coverage with an ulnar artery perforator adipofascial flap (4 patients) or with a radial artery perforator adipofascial flap (4 patients). Patients were reviewed after a mean follow-up of 41 months (range, 18-84 mo). Preoperative and postoperative pain was measured with a visual analog scale. Results Pain improved from a preoperative mean value of 7.8 to a postoperative mean value of 3.6. There was complete resolution of pain in 5 patients, mild pain persisted in 2 patients, and 1 patient reported no improvement. No complications occurred at the donor site. Conclusions Vascularized soft tissue coverage of painful median nerve neuromas is an effective treatment. We do not believe that a free flap is of any particular advantage over a local pedicle flap which we suggest using to protect the median nerve. Type of study/level of evidence Therapeutic IV. © 2014 ASSH r Published by Elsevier, Inc. All rights reserved.

2014 - Use of integra artificial dermis to reduce donor site morbidity after pedicle flaps in hand surgery [Articolo su rivista]
Adani, Roberto; Rossati, Leonardo; Tarallo, Luigi; Corain, Massimo
abstract

Purpose To assess the results obtained with Integra artificial dermis to cover donor site following the harvesting of pedicle flaps for hand reconstruction.Methods Between April 2010 and August 2013, 11 patients (8 men and 3 women; mean age, 37 y) were treated with Integra Dermal Regeneration Template (Integra LifeSciences, Inc., Plainsboro, NY) to cover donor defects after raising pedicle flaps for hand and finger reconstruction: radial forearm flap (4 cases), ulnar artery perforator flap (2 cases), and heterodigital island flap (5 cases). After neodermis formation the silicone layer of the artificial dermis was removed (on average after 22 days) and a split- or full-thickness epidermal autograft placed.Results No infections, hematoma, or bleeding were recorded during the entire phase in which the artificial skin was applied. Two patients experienced a partial skin graft loss. Median follow-up was 20 months, and results included an average Vancouver Scar Scale rating of 2.7 and an average DASH score of 39. There were no cases of graft adherence to the underlying tendons or muscles.Conclusions Favorable cosmetic and functional outcomes were obtained using a dermal regeneration template for the treatment of donor site defects. Despite the drawback of an additional surgical procedure (secondary skin graft), the use of this artificial skin produced soft-tissue augmentation and graft-skin quality, reducing donor site morbidity. Type of study/level of evidence Therapeutic IV.

2013 - A new volar plate DiPhos-RM for fixation of distal radius fracture: Preliminary report [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Adani, Roberto; Catani, Fabio
abstract

We analyzed the efficiency of a new plate DiPhos-RM in CFR-PEEK [carbon-fiber-reinforced poly (etheretherketone)] for the volar fixation of distal radius fractures. The new plate's composition has the advantage of x-ray absolute transparency, therefore allowing to monitor the healing of the fracture. The desired combination of high strength and low rigidity is obtained through the use of the polymer composites CFR-PEEK. In this preliminary study (from March 2012 to June 2012), 10 cases of intra-articular distal radius fractures were treated with DiPhos-RM produced by Lima Corporate (Italy). The fractures were classified according to the AO classification, 4 fractures were type C1, 3 type C2, and 3 were A2. A preoperative computed tomography scan was carried out in all patients. One patient also underwent a postoperative computed tomography scan. Grip strength, range of motion, and DASH score were evaluated at follow-up. There were no cases of hardware failure. Specifically, no loss of position or alignment of fixed-angle locking screws or breakage of the plate were observed. Radiographic union was present at an average of 6 weeks (range, 5 to 8 wk). The overall preliminary experience with this new plate is favorable. The new plate is easy to apply and provides the surgeon dual options of fixed-angle or variable-angle screws. It was rigid enough to maintain the reduction also in AO type C articular fractures. Copyright © 2013 by Lippincott Williams & Wilkins.

2013 - Alternative method for thumb reconstruction. Combination of 2 techniques: Metacarpal lengthening and mini wraparound transfer [Articolo su rivista]
Adani, Roberto; Corain, Massimo; Tarallo, Luigi; Fiacchi, Francesco
abstract

Amputation at the proximal phalanx or at the metacarpophalangeal joint can be treated by pollicization of a finger, osteoplastic reconstruction, free microvascular transfer of a toe, or distraction lengthening. The best technique to use to treat these cases depends on the place of amputation and the patient's age, sex, occupation and functional demands. In the past 6 years, we treated 4 patients by lengthening the thumb metacarpal ray and adding a mini wraparound flap from the great toe. All the subjects were female with an average age of 22 years. All 4 patients had sustained traumatic amputations: 2 at the metacarpophalangeal joint and 2 at the base of the proximal phalanx. Distraction was completed approximately 65 days after osteotomy, obtaining an average lengthening of 23 mm. To achieve bone consolidation, the lengthener was left in place for 127 days on average. Microsurgical thumb reconstruction was performed around 3 months after consolidation of the osteotomy. There were no failures or cases of postoperative vascular compromise. The average pinch power was 66% of the opposite hand. The static 2-point discrimination of the reconstructed thumb was 8 mm (range, 7-10 mm). All patients reported being satisfied with the treatment, although 1 patient was partially dissatisfied due to the prolonged length of the treatment. Donor site morbidity was minimal. This procedure is mainly chosen by selected patients who refuse standard microsurgical thumb reconstruction because it requires a longer treatment period. © 2013 American Society for Surgery of the Hand.

2013 - Closed reduction of acute volar dislocation of the distal radioulnar joint [Articolo su rivista]
Tarallo, L.; Adani, R.; Catani, F.
abstract

Isolated acute distal radioulnar joint (DRUJ) dislocation is a rare injury. In this report we describe a case of acute traumatic volar dislocation of the ulnar head in a 70-year-old man after an accidental fall

2013 - Great toe transfer survival after thrombosis at 7 days [Articolo su rivista]
Tarallo, L
abstract

2013 - Management of displaced radial neck fractures in children: Percutaneous pinning vs. elastic stable intramedullary nailing [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Fiacchi, Francesco; Capra, Francesco; Catani, Fabio
abstract

Background: The treatment of radial neck fractures in children varies according to the displacement, angulation, and skeletal maturity. There is a general agreement that displaced radial neck fractures with more than 30 angulations (Judet type III and IV fractures) should be surgically treated. There are several treatment possibilities for Judet type III and IV fractures including percutaneous pin reduction, elastic stable intramedullary nailing (ESIN), and open reduction with or without internal fixation. In this retrospective study we compared the clinical and radiographical outcomes, and complications following intramedullary versus percutaneous pinning in displaced radial neck fractures in children. Materials and methods: Between 2000 and 2011, 20 patients were treated using closed reduction: in 12 cases we used percutaneous pinning, and in 8 cases we used ESIN. According to Judet classification the two groups were composed as follows: 10 (77 %) type III and 3 (23 %) type IV fractures in the percutaneous pinning group; 4 (57 %) type III, and 3 (43 %) type IV fractures in the ESIN group. Results: After an average of 42 months, excellent results in Mayo elbow performance scores (MEPS) were obtained in 71 and 69 % of ESIN and percutaneous pinning groups respectively, with good results in the remaining cases apart from one fair case (8 %) in the percutaneous pinning group. After a radiological evaluation, all fractures healed in excellent or good alignment. When comparing the two groups, the subjects treated with the ESIN technique had higher range of motion (ROM) in flexion, extension and pronation. No patients developed complications, except three cases of asymptomatic enlargements of the radial head, reported only in the percutaneous pinning group. Conclusion: In this research the clinical outcome, assessed with the MEPS, and the radiological alignment, were comparable between the subjects that were treated with percutaneous pinning and those with ESIN techniques; whereas the ESIN technique demonstrated higher ROM in flexion, extension and pronation. The ESIN technique seems to be the ideal approach both for the higher ROM values and for the absence of complications. © 2012 The Author(s).

2013 - Results of replantation of 33 ring avulsion amputations [Articolo su rivista]
Adani, Roberto; Pataia, Elisabetta; Tarallo, Luigi; Mugnai, Raffaele
abstract

Purpose: Despite microsurgical advances, it is still difficult to achieve satisfactory functional results in cases of replantations following complete ring avulsion amputations. Our aim is to report the experience we have collected since the early 1990s in the treatment of this type of injury. Methods: We replanted 33 fingers on 33 patients (age, 15-54 y) with complete ring avulsion amputation injuries. Twenty-eight amputations were distal to the insertion of the flexor digitorum superficialis, and 5 were complete degloving injuries with intact tendons. Vascular transpositions and vein grafts were used, and in all cases, only 1 of the digital nerves was repaired. Results: The 29 successful cases were tracked over an average follow-up of 89 months. The average total active motion of the reconstructed finger was 185°. Sensibility evaluated by static 2-point discrimination varied from 9 to 15 mm and by moving 2-point discrimination from 8 to 15 mm. Five patients complained of cold intolerance. Conclusions: Resection of the avulsed digital artery and vein is the most crucial part of the procedure.Vessels reconstruction can be performed using various methods, but vessel transfers from the middle finger appear to be the most reliable solution. The outcome of the cases demonstrates that replantation should be attempted. Type of study/level of evidence: Therapeutic IV. © 2013 American Society for Surgery of the Hand.

2013 - Volar plate fixation for the treatment of distal radius fractures: Analysis of adverse events [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Zambianchi, Francesco; Adani, Roberto; Catani, Fabio
abstract

OBJECTIVES:: Determining the rate of specific adverse events after volar plating performed for distal radius fractures. DESIGN:: Retrospective. SETTING:: University level I trauma center. PATIENTS:: We searched the electronic database of all surgical procedures performed in our department using the following keywords: distal radius fracture, wrist fracture, and plate fixation. We identified 315 patients, 12 of whom were lost at follow-up. INTERVENTION:: Volar plate fixation for the treatment of distal radius fractures. MAIN OUTCOME MEASUREMENTS:: At an average follow-up of 5 years, 303 patients were evaluated through medical records and clinical and radiographic assessment for specific adverse events after volar plate fixation. RESULTS:: Adverse events were observed in 18 patients (5.9%). Implant-related adverse events, including tendon impairments, intra-articular screws, and screw loosening, were observed in 15 patients (5.0%). Extensor tendon impairments were represented by 5 cases of extensor tenosynovitis and 3 cases of rupture of the extensor pollicis longus due to screws protruding dorsally. Flexor impairments were represented by 2 cases of tenosynovitis and 2 cases of flexor pollicis longus rupture. Screw penetration into the radioulnar joint was observed in 1 case. Loss of reduction was identified in 3 cases. One patient had a deep postoperative infection treated with operative debridement. One patient experienced injury to the median nerve during routine implant removal unrelated to tendon issues. CONCLUSIONS:: The majority of adverse events after volar plate fixation were due to technical errors in implant placement. In our cohort, tendon impairments were the most frequently observed; among these, extensor tendon impairments were the most represented (50% of all adverse events). All 12 tendon-related adverse events were due to technical shortcomings with implant placement. LEVEL OF EVIDENCE:: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

2012 - Letter regarding "microsurgical arterialization of degloving injuries of the upper limb" [Articolo su rivista]
Adani, Roberto; Tarallo, Luigi
abstract

case report

2012 - Letter regarding "salvage of complete degloved digits with reversed vascularized pedicled forearm flap: A new technique" [Articolo su rivista]
Adani, Roberto; Tarallo, Luigi
abstract

letter to editor

2012 - Treatment of the ulna non-unions using dynamic compression plate fixation, iliac bone grafting and autologous platelet concentrate [Articolo su rivista]
Tarallo, Luigi; Mugnai, Raffaele; Adani, Roberto; Catani, Fabio
abstract

Clinical study of a series of ten patients treated between 2004 and 2009 for non-unions of the ulna. The patients have been treated with osteosynthesis using a dynamic compression plate and biological enhancement of the consolidation using bone graft and autologous platelet injection. The follow-up consisted of clinical and radiographic assessment. Functional scores used were the Visual Analogue Scale (VAS) for pain and the Disability Assessment for the Shoulder and Hand (DASH) questionnaire. The mean time of follow-up was 21 months. Considering both clinical and radiological criteria, bony union was achieved in 9/10 cases on average time of 4 months. According to the system of Anderson, 5 patients provided an excellent result, 2 a satisfactory result, 2 an unsatisfactory result and 1 treatment resulted in failure. At follow-up, the mean VAS score for pain in the upper limb was 1 (range, 0-4) at rest and 2 (range, 0-7) during activities. The physical function and symptoms of the upper limb, evaluated with the DASH questionnaire, scored 17 points. In conclusion, at a mean 21 months follow-up, there was high success regarding both forearm alignment, clinical and functional results. The use of three combined methods provides high success regarding both radiological and clinical results, even if we have no information on the prevalent efficacy of one particular method. © Springer-Verlag 2011.

2011 - The treatment of distal radius articular fractures of C1-C2 type with DVR plate: analysis of 40 cases. [Articolo su rivista]
Tarallo, Luigi; Adani, Roberto; Mugnai, Raffaele; Catani, F.
abstract

The aim of this investigation was to evaluate the efficiency of fixed angle plates DVR in the treatment of C1 and C2 type articular wrist fractures according to the AO classification. From July 2005 to March 2009, 40 wrist fractures were treated: 18 were of C1 type while 22 of C2 type according to AO classification. The age of patients varied from 25 to 79 years old. The average length of follow-up was 17 months (range, 4-37 months). The average articular motility was flexion 59.4° and extension 62.7°. Final radiographic parameters were of 18.7° of average ulnar inclination, 10.3° of average dorsal inclination, and 1.45 mm of negative ulnar variance. All patients were reassessed according to Mayo Modified Wrist Score getting a very good/good result in 82% of cases and a medium/poor one in 18%. The DASH score pulled off 46.3 points in the first group, 5.1 in the second group, and 6 in the third one. The statistical analysis based on Student's t test showed how C1 and C2 classification did not influence the results using the same treatment. DVR plate showed a very good reliability and a sufficient stability with both C1 and C2 fractures. © 2011 Springer-Verlag.

2008 - Extracorporeal hydroxyapatite-chamber for bone and biomaterial studies [Articolo su rivista]
Tarallo, Luigi; Zaffe, Davide; Adani, Roberto; Krajewski, A.; Ravaglioli, A.
abstract

Hydroxyapatite (HA) spherules and autologous bone (AB) with a central vascular pedicle were housed inside an HA-chamber to form the skeletal segment of specific shape. Experimental chambers were then inserted in a pocket between medial thigh muscles in 13 New Zealand male rabbits for 3 months. Three graft group were scheduled: (A) HA and AB without vascular pedicle, (B) HA with vascular pedicle, (C) HA and AB with vascular pedicle. At term, histology showed tissue and cellular degeneration in group A chambers. Due to spherules coalescence, fibrous tissue is formed in group B chambers. Group C chambers contained living osteocytes in the implanted bone, several newly formed vessels in soft tissue, bone and partial hydroxyapatite erosions. New bone was formed in apposition to both autologous bone and hydroxyapatite. Our study suggests that this experimental model could be used to grow adequately sized vascularized skeletal segments.

2008 - Free fibula flap for humerus segmental reconstruction: report on 13 cases [Articolo su rivista]
Adani, Roberto; Delcroix, Luca; Innocenti, Marco; Tarallo, Luigi; Baccarani, Alessio
abstract

In the period between 1994 and 2004, 13 patients (10 male, 3 female) presenting with post-traumatic defects to the humerus were treated with vascularised fibula graft. Age ranged from 21 to 62 (mean 37) years. Length of the bony defect ranged from 6 to 16 cm. Graft fixation was performed with plates in 12 cases, and in one case only screws were used. All patients were clinically reviewed between 120 days and 14 months after surgery. In one patient the flap was lost and a second free fibula flap was performed to achieve the reconstructive goal. Mean time for segmental bony union was 6 months (range from 3 to 13 months). Vascularised fibula graft allows for a successful humerus reconstruction when traditional techniques provide unsatisfactory results.

2008 - Reconstruction of posttraumatic bone defects of the humerus with vascularized fibular graft [Articolo su rivista]
Adani, Roberto; Delcroix, Luca; Tarallo, Luigi; Baccarani, Alessio; Innocenti, Marco
abstract

Humeral nonunions still present a challenge to the orthopedic surgeon. Many methods of treating recalcitrant, posttraumatic humeral shaft nonunions have been described, with varying degrees of success. The present report reviews our experience with the use of vascularized fibular grafting for the treatment of large humeral defects. We treated 13 patients, with an average length of the humeral defect of 10.5 cm. Nine patients healed primarily, 3 required additional bone grafting, and 1 had a second fibular transplant. The mean period to radiographic bone union was 6 months. Only 5 patients regained full range of motion of the shoulder and elbow. The vascularized fibular graft is a reliable reconstructive procedure for recalcitrant pseudoarthrosis of the humerus in which the bony gap is greater than 6 to 7 cm, especially when traditional procedures have not provided the expected result. © 2008 Journal of Shoulder and Elbow Surgery Board of Trustees.

2008 - Schwannomas of the upper extremity: diagnosis and treatment [Articolo su rivista]
Adani, Roberto; Baccarani, Alessio; Guidi, Enrico; Tarallo, Luigi
abstract

Schwannomas are the most common benign tumors developing in peripheral nerves. They account for 5% of all tumors in upper extremity. They usually present as a slow-growing mass, sometimes associated to pain and paresthesia. Preoperative evaluation is based on US and MRI, but final diagnosis requires histopathology. The aim of this study is to define clinical findings and MRI characteristics in identification, localization, and possible differential diagnosis of schwannomas.

2008 - The treatment of distal radius articular fractures through lcp system [Articolo su rivista]
Adani, R.; Tarallo, L.; Amorico, M. G.; Tata, C.; Atzei, A.
abstract

We analysed LCP efficiency in type B and type C wrist fractures (according to the AO Classification). We treated 58 wrist fractures (19 B-type fractures and 39 C-type fractures) in 35 male and 23 female patients, aged 19 to 87 years. Forty-one cases were followed up for an average period of 13 months. We performed a volar approach on 32 patients, a dorsal approach on five, and a double approach on four (both volar and dorsal). Twenty-six cases were pre-operatively examined with CT. All patients were evaluated using the "Mayo modified wrist score", with an excellent/good result in 76% of patients and a satisfactory/poor result in 24%. The LCP system proved to be adequately reliable and stable to keep the reduction in complex fractures (e.g. the C-type fractures in patients with low bone quality).

2006 - First Web-Space Reconstruction by the Anterolateral Thigh Flap [Articolo su rivista]
Adani, Roberto; Tarallo, Luigi; Marcoccio, Ignazio; Fregni, Umberto
abstract

Four patients with severe contracture of the first web space were treated with an anterolateral thigh perforator flap. The flap size ranged from 10 to 13 cm in length and from 7 to 8 cm in width. The donor site was closed directly and thinning of the flap was performed in all cases. All flaps survived and there were no re-explorations. Web space opening was maintained over the follow-up period. There was an average postoperative increase of the angle of the first web space of 61°. The thinned anterolateral thigh flap provides a pliable vascularized tissue for resurfacing the skin after release of severe contracture of the first web space and represents a reliable alternative to other flaps. © 2006 American Society for Surgery of the Hand.

2006 - Nail salvage using the eponychial flap [Articolo su rivista]
Adani, Roberto; Leo, Giovanni; Tarallo, Luigi
abstract

Loss of distal fingertip bone and soft tissue defect can be treated using different methods, but the involvement of the nail influences the choice of surgical approach and makes reconstruction more difficult. The eponychial flap is a backward cutaneous translation flap that lengthens the nail plate and restores a good appearance of the nail apparatus. Pulp reconstruction is usually performed using local flaps (Tranquilli-Leali or Venkataswami flaps). The eponychial flap technique is a safe and easy technique that is indicated in cases of transverse fingertip angulations for lengthening the short amputated nail. This procedure can be used in combination with different flaps for pulp reconstruction. © 2006 Lippincott Williams & Wilkins, Inc.

2006 - The use of allografts in hand surgery [Articolo su rivista]
Tarallo, Luigi
abstract

Massive bone allografts have been extensively used in orthopaedic surgery. They are mainly employed in the reconstruction of large bone defects following bone tumor resections and in prothesic surgery. They may consist either of diaphyseal or of methaepiphyseal segments and they may be provided, if requested, with ligaments and tendons. Bone allografts are very popular in large defects reconstruction, but few reports are available on their use in small segments. Authors report their experience in allografts in hand surgery consisting of two cases of intercalary reconstruction (one metacarpal bone and one proximal phalanx) and of nine cases of joint reconstruction (five MPJ and four PIPJ). In eight cases also the extensor apparatus has been reconstructed using the allograft tendon. The bone fixation has been as stable and rigid as possible in order to allow an early mobilization. Seven patients with a follow up longer than 1 year have been controlled both clinically and radiographlcally with encouraging results. All the allografts but one healed with the host bone, and the functional recovery was good in the majority of cases. To our knowledge, this series of patients is the largest ever reported in the medical literature and our experience seems to point out the validity of this procedure in osteoarticular reconstruction of the hand. Longer follow up is however mandatory in order to exclude late degenerative problems, particularly due to cartilage consumption.

2005 - Hand reconstruction using the thin anterolateral thigh flap [Articolo su rivista]
Adani, Roberto; Tarallo, Luigi; Marcoccio, Ignazio; Cipriani, Riccardo; Gelati, Chiara; Innocenti, Marco
abstract

Perforator flaps have been introduced for various kinds of reconstruction and resurfacing; in particular, the free thin anterolateral thigh flap is becoming one of the most preferred options for reconstruction of soft-tissue defects.

2005 - The aesthetic mini wrap-around technique for thumb reconstruction [Articolo su rivista]
Adani, Roberto; Marcoccio, Ignazio; Tarallo, Luigi; Fregni, Umberto
abstract

In the past 12 years, 16 thumb defects at, or distal to, the interphalangeal joint were reconstructed using a great toe mini wrap-around flap. A flap including the entire nail and most of the distal phalanx of the great toe was used. Fifteen of the grafts survived. The sensory recovery of the reconstructed thumb was good as assessed by 2-point discrimination test with an average of 10 mm (range 5-15), and there were no complaints of cold intolerance. This technique results in good cosmetic appearance, and all patients were pleased with the cosmetic aspect of the thumb and there was no significant morbidity at the great toe donor site. The final decision to reconstruct a distal thumb amputation is influenced by gender, job, and age of the patients. The great toe mini wrap-around flap is an excellent reconstruction technique in selected patients.

2005 - The reverse heterodigital neurovascular island flap for digital pulp reconstruction [Articolo su rivista]
Adani, Roberto; Marcoccio, Ignazio; Tarallo, Luigi; Fregni, Umberto
abstract

A heterodigital neurovascular reverse-flow flap island flap for extensive pulp defects is described. A dorsolateral flap from the middle phalanx, based on the digital artery, is harvested from the adjacent uninjured finger. The common digital artery between the injured finger and the donor finger is ligated and transected just before its bifurcation. At this point the 2 converging branches of the digital arteries can be entirely mobilized as a continuous vascular pedicle for the flap. The vascularization is now supplied by reverse flow through the proximal transverse digital palmar arch of the injured finger; to provide sensation, the dorsal branch of the digital nerve from the donor finger must be included in the flap. This technique is indicated for large pulp defects with bone exposure of index and middle finger pulps, which are important for sensation.

2004 - Prefabbricazione su misura di un innesto osseo neovascolarizzato con camera cilindrica in idrossiapatite: studio sperimentale [Articolo su rivista]
Tarallo, Luigi; Adani, R.; Marcoccio, Ignazio Mario; Celli, A.; Zaffe, Davide
abstract

Il concetto di prefabbricazione dei tessuti è divenuto in questi ultimi anni una realtà della chirurgia ricostruttiva. In un lavoro precedentemente svolto si è valutata la possibilitàdi creare un innesto osseo neovascolarizzato; il nuovo studio rappresenta l’evoluzione del precedente. Lo scopo è stato quello di creare un innesto osseo prefabbricato neovascolarizzato avvalendosi però, in questo caso di biomateriali come l’idrossiapatite per definirne forma e dimensioni prestabilite. Lo studio è stato condotto su conigli New Zealand suddivisi in tre gruppi. Nel gruppo A (5 animali) si è eseguito un prelievo di tessuto spongioso dalla cresta iliaca poi inserito in una camera di idrossiapatite di 15 mm di diametro richiudibile con due dischi, uno dei quali con un foro di 8 mm di diametro per consentire il passaggio del peduncolo vascolare. La spongiosa è stata miscelata con microparticelle di forma sferica di idrossiapatite. Il tutto è stato “neovascolarizzato” con l’arteria e la vena femorale superficiale delconiglio. Nel gruppo B (5 animali) sono state utilizzate, a differenza del precedente, solamente le microparticelle di idrossiapatite all’interno della camera. Infine nel gruppo C, di controllo, (3 animali) si è impiegata l’associazione di spongiosa e microparticelle di idrossiapatite senza però ricorrere all’impianto del peduncolovascolare. Le camere di idrossiapatite, avvolte da un foglietto di silicone sono state posizionate in una “tasca” tra i muscoli della faccia mediale della coscia di ciascun animale. Gli animali sono stati sacrificati a distanza di 3 mesi dall’intervento chirurgicoe i frammenti ossei sono stati fissati in paraformaldeide e poi in poli-metil-metacrilato a 4°C. Sezioni spesse e sottili di segmenti ossei sono state utilizzate per lo studio su microradiografie ed istologico al microscopio ottico, a luce ordinaria, polarizzata e fluorescente. Sono stati inoltre eseguiti studi e valutazioni al microscopio elettronico a scansione. Nel primo gruppo l’analisi delle sezioni istologiche ha evidenziato la neoformazione di un tessuto fibroso avvolgente sia l’idrossiapatite che l’osso, la presenza di osteociti vivi e di numerosi vasi neoformati. Nel secondo gruppol’idrossiapatite è risultata avvolta da un tessuto connettivo con presenza di vasi neoformati nei pressi del peduncolo vascolare. Il terzo gruppo è stato caratterizzato da una completa assenza di tessuti neoformati. In conclusione l’involucro utilizzato permette di conferire all’impianto una forma prestabilita; i risultati dimostrano una volta di più la capacità dell’impianto vascolare di indurre la neovascolarizzazione e confermano le caratteristiche di osteoconduzione dell’idrossiapatite. Le camere di idrossiapatite si dimostrano un valido supporto nel tentativo di conferire all’impiantouna forma “su misura”.

2004 - Reconstruction of large posttraumatic skeletal defects of the forearm by vascularized free fibular graft [Articolo su rivista]
Adani, Roberto; Delcroix, Luca; Innocenti, Marco; Marcoccio, Ignazio; Tarallo, Luigi; Celli, Andrea; Ceruso, Massimo
abstract

Vascularized bone graft is most commonly applied for reconstruction of the lower extremity; indications for its use in the reconstruction of the upper extremity have expanded in recent years. Between 1993-2000, 12 patients with segmental bone defects following forearm trauma were managed with vascularized fibular grafts: 6 males and 6 females, aged 39 years on average (range, 16-65 years). The reconstructed site was the radius in 8 patients and the ulna in 4. The length of bone defect ranged from 6-13 cm. In 4 cases, the fibular graft was harvested and used as a vascularized fibula osteoseptocutaneous flap. To achieve fixation of the grafted fibula, plates were used in 10 cases, and screws and Kirschner wires in 2. In the latter 2 cases, an external skeletal fixator was applied to ensure immobilization of the extremity. The follow-up period ranged from 10-93 months. Eleven grafts were successful. The mean period to obtain radiographic bone union was 4.8 months (range, 2.5-8 months). Fibular grafts allow the use of a segment of diaphyseal bone which is structurally similar to the radius and ulna and of sufficient length to reconstruct most skeletal defects of the forearm. The vascularized fibular graft is indicated in patients with intractable nonunions where conventional bone grafting has failed or large bone defects, exceeding 6 cm, are observed in the radius or ulna. © 2004 Wiley-Liss, Inc.

2004 - Update on replantation of degloved skin of the hand [Articolo su rivista]
Adani, Roberto; Busa, Riccardo; Tarallo, Luigi; Castagnetti, Claudio
abstract

update on replantation degloved skin of the hand

2003 - Flap coverage of dorsum of hand associated with extensor tendons injuries: A completely vascularized single-stage reconstruction [Articolo su rivista]
Adani, Roberto; Marcoccio, Ignazio Mario; Tarallo, Luigi
abstract

This study reports results in 12 patients treated with "completely vascularized single-stage approaches," so defined because skin, tendon, and nerve are transferred as a compound flap, and all are vascularized. A free dorsalis pedis cutaneotendinous flap was used in 7 patients, while a radial forearm cutaneotendinous island flap was transposed in 5 patients. A dorsalis pedis flap provides four vascularized extensor tendons (extensor digitorum comunis tendons), and the radial artery flap permits the inclusion of one completely vascularized tendon (palmaris longus) and two "strips" of vascularized tendons (flexor carpi radialis and brachioradialis). The flaps survived in all cases, and the transferred tendons were functioning well. The dorsalis pedis flap can be employed in the reconstruction of cutaneotendinous defects of the dorsum of the hand which require the use of three or four tendons grafts. We suggest the use of forearm cutaneotendinous flaps in cases of reconstruction of one or two extensor tendons. The "completely vascularized single-stage reconstruction" avoids prolonged hospitalization and results in a rapid restoration of near-normal function and appearance, of the hand. © 2003 Wiley-Liss, Inc.

2003 - Long-Term Results of Replantation for Complete Ring Avulsion Amputations [Articolo su rivista]
Adani, Roberto; Marcoccio, Ignazio; Castagnetti, Claudio; Tarallo, Luigi
abstract

Ring avulsion injuries have long presented complex management problems. Despite microsurgical advances, it is difficult to achieve good functional results in complete degloving injuries or amputations, and their management remains somewhat controversial. Ten patients with class IV injuries according to Kay's classification were treated from 1986 to 2000. In this study the authors subdivided class IV injuries into those with amputation distal to the insertion of the flexor digitorum superficialis tendon (class IVd, 5 cases); those with amputation proximal to the insertion of the flexor digitorum superficialis tendon (class IVp, 3 cases); and complete degloving injuries leaving the tendons intact (class IVi, 2 cases). Replantation was done in class IVi and class IVd injuries, and 6 cases were revascularized successfully. In all these patients range of motion was complete at the metacarpal and proximal interphalangeal joints, but reestablishing sensibility was more difficult. Patients with class IVp injuries were treated by surgical amputation of the digit. Modifications of Kay's classification system based on anatomic injury is more predictive of functional outcome for completely amputated ring avulsion injuries. The authors conclude that complete ring avulsion amputations are salvageable, with acceptable functional results in select patients.

2003 - Nail lengthening and fingertip amputations [Articolo su rivista]
Adani, Roberto; Marcoccio, Ignazio; Tarallo, Luigi
abstract

Fingertip injuries can be treated in different ways, including shortening with primary closure, skin grafts, and local or distant flaps. Nail bed involvement complicates fingertip reconstruction and may influence the choice of treatment. Local flaps can usually replace the pulp and provide a satisfactory functional and aesthetic result, whereas reconstruction of the fingernail apparatus is more difficult. In the period between 1998 and 2001, 12 fingertip injuries with nail bed involvement were treated with a combination of local flaps (Tranquilli-Leali and Venkataswami flaps) and the eponychial flap. The eponychial flap described by Bakhach is a backward cutaneous translation flap that lengthens the nail plate and restores a good appearance of the nail apparatus. This technique is simple to use and can be used with different flaps for pulp reconstruction.

2003 - Treatment of fingertips amputation using the Hirase technique [Articolo su rivista]
Adani, R; Marcoccio, I; Tarallo, L
abstract

The management of very distal finger amputations when the amputated part is saved is still difficult and controversial. Both re-attachment of the amputated portion as a composite graft and microvascular anastomosis can fail in this distal location. Replantation is, in fact, associated with certain problems, such as technical difficulty, risk of failure because of the poor venous drainage, and costs. With the exception of children, amputations at the level of the lunula poorly survive direct re-attachment. Hirase has described a new replantation model without vascular anastomosis and used ice water and aluminium foil to enhance survival of the composite graft. Cooling the entire recipient site retards cellular degeneration in the graft until neovascularisation occurs. The present authors applied this method to seven cases in which a digit had been amputated between the tip and the lunula. In four cases the method proved to be completely successful, whereas in two an area of tip necrosis was observed. The Hirase method has proven to be a simple and reliable surgical technique for fingertip re-attachment.

2002 - Management of neuromas in continuity of the median nerve with the pronator quadratus muscle flap [Articolo su rivista]
Adani, R; Tarallo, L; Battiston, B; Marcoccio, I
abstract

Treatment of painful neuromas in continuity of the median nerve at the wrist level is a challenging problem. Nine median nerve neuromas were covered with the pronator quadratus muscle preelevated as an island flap. Patients were followed for 10 to 60 months after surgery. Results showed a marked improvement in terms of symptoms in all patients. In particular, 6 patients had complete pain relief and 3 patients complained of mild intermittent pain.

2002 - Microsurgical reconstruction of the traumatized thumb [Articolo su rivista]
Tarallo, L
abstract

Amputation of the thumb means serious functional, aesthetic and psychological damage. Thumb reconstruction has been the subject of great interest in recent years and the advent of microsurgery has radically modified the surgical approach. Composite transfer of the hallux or second toe makes it possibile to reconstruct a thumb of sufficient lenght, sensitivity and grip stability and, above all, with and acceptable aesthetic appearance, thanks to the presence of the nail, which is similar to contralateral thumb. The different microsurgical transfer techniques might suggest the existence of a great freedom of choice in therapeutic indications. The different possibilities are, however, considerably restricted if all the factors necessary to arrive at a correct surgical indication are considered. It can be maintained that every case of thumb amputation ideally requires a specific reconstructive procedure. The purpose of the present paper is to describe the use of the various reconstructive techniques on the basis of levels of thumb amputation in the attempt to identify on each occasion the correct technique that enables us to construct a custom-made thumb.

2002 - Tendinous cutaneous dorsal hand injuries. One-stage reconstruction [Articolo su rivista]
Adani, R; Tarallo, L; Castagnetti, C; Pancaldi, Maria Grazia; Marcoccio, I
abstract

The reconstruction of complex cutaneous tendinous dorsal hand injuries represents a problem that is not easy to solve. The transferral in a single surgical stage, with a single flap, of skin, tendons, and nerves, all completely vascularized, is probably the ideal solution. Between 1988 and 1999 the one-stage reconstruction method was used in 13 patients. A cutaneous tendinous dorsalis pedis free flap was used in 7 cases, and a cutaneous tendinous radial forearm island flap with an inverted flow was used in 6. The dorsalis pedis flap allows for the inclusion of 4 tendons that are completely vascularized (extensor digitorum communis), while the radial flap allows us to completely insert a single tendon (palmaris brevis) and two vascularized tendinous strips taken from the flexor carpi radialis and from the brachioradialis. All of the flaps transferred survived perfectly with good functional recovery. One-stage reconstruction that is "completely vascularized" allows us to reduce the amount of time spent in hospital, the number of operations, and above all it provides cosmetic and functional results that are close to normal. The dorsalis pedis flap is indicated in cases of cutaneous tendinous dorsal hand injuries that require the simultaneous reconstruction of three or four extensor tendons. On the other hand, the radial flap may be used in situations where it is necessary to reconstruct only 1 or 2 tendons.

2001 - Island radial artery fasciotendinous flap for dorsal hand reconstruction [Articolo su rivista]
Adani, R; Tarallo, L; Marcoccio, I
abstract

The authors report a one-stage repair for a dorsal hand injury that involves the loss of skin and tendons. The injury was repaired using an island radial artery flap complete with fascia and tendons, leaving the forearm skin behind. The functional and aesthetic results are excellent, and there was minimal donor site morbidity.