Papers by claudio carlo castelli
Minerva Ortopedica E Traumatologica, 1989
Introduction: A novel device for two-stage septic revision of TKA was checked to evaluate for mec... more Introduction: A novel device for two-stage septic revision of TKA was checked to evaluate for mechanical and pharmacological properties. Methods: The articulated knee spacer is a temporary device made entirely of gentamicin bone cement industrially preformed and available in 3 sizes. It maintains joint space and motion, allowing partial weight-bearing. It provides an in situ release of antibiotic. Static and dynamic mechanical testing was performed according to ISO/DIN 14243-1. Surface rugosity was assessed according to DIN 4768. Pharmacological behaviour was evaluated according to the European Pharmacopoeia. Results: Static mechanical testing: the device resists a load >10000N (physiological load peak = 2500N). Dynamic mechanical testing: no breakage after 500.000 cycles at 1300N (half load for physiological knee joint). Wear produced by the PMMA-PMMA coupling is not much higher than wear produced by PE-metal coupling. Surface rugosity (polishing effect) decreases of an order of...
Introduction Antibiotic-loaded cement spacers are commonly used in the two-stage management of th... more Introduction Antibiotic-loaded cement spacers are commonly used in the two-stage management of the infected total knee replacement (TKR). Static spacer blocks make exposure and reimplantation difficult because of soft-tissue retraction and muscle shortening. To avoid these problems, a temporary articulating moulded implant has been recently introduced in the marketplace. The device is industrially preformed in three sizes (two articulating components), has standardised mechanical and pharmacological characteristics. Methods We present a multicentre study designed to assess the safety of the device, patients’ satisfaction and functional outcome at a minimum follow-up of six months. Twenty-four knees have been treated for TKR deep infection due to CNS (15),S.aureus (three),E.coli (one),mixed flora (two), unidentified (three). Continuous passive motion and partial/touch weight-bearing were started after surgery. Second-stage surgery was performed after normalisation of serological para...
LO SCALPELLO-OTODI Educational, 2018
Femoral periprosthetic fractures in hip surgery still represent a difficult surgical procedure an... more Femoral periprosthetic fractures in hip surgery still represent a difficult surgical procedure and a secure optimal treatment has not been found yet. Great help is provided by the development of commonly used classifications such as the Vancouver classification and the recent Unified Classification System (UCS), which introduce clearer fracture patterns with the respective surgical indications. The most discussed pattern is related to category B of both classifications in which, despite the use of established treatment paradigms, results are poor or otherwise unpredictable. This study reviews the literature related to the analysis of fractures and its following treatment.
La Medicina del lavoro
Several reports of postural problems among video display unit workers are available, most frequen... more Several reports of postural problems among video display unit workers are available, most frequently involving the back, neck and shoulder. The case described is an example of tenosynovitis of the right wrist at the point where the wrist rests on the work surface while operating the mouse in a computer workstation (2-3 hours/day 6 days/week). The alteration was caused by a combination of friction and pressure on the wrist joint tendon due to the faulty positioning of the hand and wrist. This is the normal resting position for the wrist (inclined towards the ulnar side), and is thus the most natural position to adopt. The reported alteration, which responded to a short period of rest and treatment with non-steroid anti-inflammatory drugs for 2-3 days, is described as an example of common injury caused by an unusual faulty posture of the hand. The preventive measures suggested to avoid the occurrence of this type of injury include: (i) instead of resting the weight of the hand on the ...
LO SCALPELLO-OTODI Educational, 2009
Two-stage debridement, antibiotic impregnated cement spacer insertion, appropriate intravenous an... more Two-stage debridement, antibiotic impregnated cement spacer insertion, appropriate intravenous antibiotic therapy and delayed revision are well-accepted methods of treatment of infected TKA. We review the current use of spacers in the management of infected knee prostheses.
Lo Scalpello - Otodi Educational, 2020
Humeral shaft fractures account for about 1-3% of all fractures in adults and are classified acco... more Humeral shaft fractures account for about 1-3% of all fractures in adults and are classified according their location, open or closed status and the pattern of fracture lines. Conservative treatment with functional bracing has been the most widely accepted treatment option in the last decades, however an increasing number of patients is treated surgically. This article overviews the indications, pros and cons of the most used fixation methods. Plates and nails are the most used devices, have widely overlapping indications, mostly depending on surgeon's preference. Plate fixation can be used for almost all humeral fractures and represent the best option for transitional fractures (proximal or distal shaft), particularly those with intra-articular involvement. MIPO techniques combines the advantages of plates with less soft tissue impairment. Fractures associated with nervous lesions deserve special considerations: the need to explore the radial nerve can drive the choice of implant more than the fracture itself. Intramedullary implants are the best option for pathological fractures of the humeral shaft, and can appropriately replace plates fixation for middle third or proximal shaft even with intra-articular simple patterns. External fixation is rarely indicated, mainly for damage control and/or extensive soft tissue damage.
Journal of Orthopaedics and Traumatology, 2021
Background Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and pat... more Background Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. Materials and methods Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type ...
EFORT Open Reviews, 2022
Hip, spine, and pelvis move in coordination with one another during activity, forming the lumbope... more Hip, spine, and pelvis move in coordination with one another during activity, forming the lumbopelvic complex (LPC). These movements are characterized by the spinopelvic parameters sacral slope, pelvic tilt, and pelvic incidence, which define a patient’s morphotype. LPC kinematics may be classified by various systems, the most comprehensive of which is the Bordeaux Classification. Hip–spine relationships in total hip arthroplasty (THA) may influence impingement, dislocation, and edge loading. Historical ‘safe zones’ may not apply to patients with impaired spinopelvic mobility; adjustment of cup inclination and version and stem version may be necessary to achieve functional orientation and avert complications. Stem design, bearing surface (including dual mobility), and head size are part of the armamentarium to treat abnormal hip–spine relationships. Special attention should be directed to patients with adult spine deformity or fused spine because they are at increased risk of compli...
reproduction in any medium, provided the original work is properly credited. The Creative Commons... more reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver
Turkish journal of trauma & emergency surgery, 2016
Turkish journal of trauma & emergency surgery, 2016
Journal of Orthopaedics and Traumatology, 2021
Background Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has... more Background Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1 month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1 month on the basis of type of fracture and type of surgical treatment. Materials and methods For this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+ group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C− group) were asymptomatic and t...
International Journal of Environmental Research and Public Health, 2021
Background: From 10 March up until 3 May 2020 in Northern Italy, the SARS-CoV-2 spread was not co... more Background: From 10 March up until 3 May 2020 in Northern Italy, the SARS-CoV-2 spread was not contained; disaster triage was adopted. The aim of the present study is to assess the impact of the COVID-19-pandemic on the Orthopedic and Trauma departments, focusing on: hospital reorganization (flexibility, workload, prevalence of COVID-19/SARS-CoV-2, standards of care); effects on staff; subjective orthopedic perception of the pandemic. Material and Methods: Data regarding 1390 patients and 323 surgeons were retrieved from a retrospective multicentric database, involving 14 major hospitals. The subjective directors’ viewpoints regarding the economic consequences, communication with the government, hospital administration and other departments were collected. Results: Surgical procedures dropped by 73%, compared to 2019, elective surgery was interrupted. Forty percent of patients were screened for SARS-CoV-2: 7% with positive results. Seven percent of the patients received medical ther...
EFORT Open Reviews, 2019
Preoperative planning is mandatory to achieve the restoration of a correct and personalized biome... more Preoperative planning is mandatory to achieve the restoration of a correct and personalized biomechanics of the hip. The radiographic review is the first and fundamental step in the planning. Limb or pelvis malpositioning during the review results in mislead planning. Correct templating is possible using three different methods: acetate templating on digital X-ray, digital 2D templating on digital X-ray and 3D digital templating on CT scan. Time efficiency, costs, reproducibility and accuracy must be considered when comparing different templating methods. Based on these parameters, acetate templating should not be abandoned; digital templating allows a permanent record of planning and can be electronically viewed by different members of surgical team; 3D templating is intrinsically more accurate. There is no evidence in the few recently published studies that 3D templating impacts positively on clinical outcomes except in difficult cases. The transverse acetabular ligament (TAL) is ...
South African Journal of Surgery, 2018
Background: We present our experience after the introduction of Advanced Trauma Life Support (ATL... more Background: We present our experience after the introduction of Advanced Trauma Life Support (ATLS) © , Trauma Team (TT) and Preperitoneal Pelvic Packing (PPP) protocols for the treatment of hemodynamically unstable pelvic blunt trauma. Methods: This is a retrospective study with historical controls: before (Control Group, CG) and after (Study Group SG) the introduction of the protocol. A single physician managed the CG and angiography was the emergency manoeuvre. A team with ATLS guidelines and PPP as an emergency manoeuvre managed the SG. Data were collected retrospectively. Patients were divided into two groups: before and after the introduction of protocols.
HIP International, 2018
Introduction: There have been reported adverse reactions in patients with large head metal-on-met... more Introduction: There have been reported adverse reactions in patients with large head metal-on-metal hip arthroplasty, therefore metal particle debris are a cause for concern. The aim of this study was to evaluate the release trend of metal ions and the correlated variables. Methods: 54 patients were prospectively enrolled into the study from 2004 to 2006. All patients had 36-mm metal head, Pinnacle acetabular component, Summit stem and Ultamet CoCr alloy liner (Depuy Inc.), and underwent clinical and radiological management. The haematic concentration of Cr-Co at 0, 6, 12, 24, 60 and 120 months after the implantation was analysed in a sub-cohort of 34 patients. Results: 10-year revision rate for each case was 8.9%. The average concentration of Co at 120 months was 3.12 μg/L (median 2.20) with 53% values >2 μg/L and 1 >7 μg/L. After 6 months the median levels of Cr and Co were higher than time 0 ( p < 0.0001); no significant differences were found between 6 and 24 months; wh...
BioMed research international, 2018
Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors... more Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: = 0.63 ( < 0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. This study...
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Papers by claudio carlo castelli