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2006 2
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2018 4
2019 2
2020 4
2021 7
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Review
. 2019 Apr 24;90(5-S):84-94.
doi: 10.23750/abm.v90i5-S.8351.

Imaging of long head biceps tendon. A multimodality pictorial essay

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Free PMC article
Review

Imaging of long head biceps tendon. A multimodality pictorial essay

Marcello Zappia et al. Acta Biomed. .
Free PMC article

Abstract

The aim of this is article is to provide an imaging review of normal anatomy, most common anatomical variants and pathologies of the long head of the biceps tendon (LHB) encountered during the daily practice.

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Review
. May/Jun 2019;43(3):359-366.
doi: 10.1097/RCT.0000000000000846.

Imaging of Usual and Unusual Complication of Rotator Cuff Repair

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Review

Imaging of Usual and Unusual Complication of Rotator Cuff Repair

Domenico Albano et al. J Comput Assist Tomogr. May/Jun 2019.

Abstract

Several complications may be encountered after rotator cuff (RC) repair. A thorough knowledge of surgical interventions, normal postoperative findings, and postoperative complications is crucial to provide a timely diagnosis, improving the clinical outcome of patients. Postoperative complications may involve RC, implanted device, osteochondral tissue, surgical-site infection, peripheral nerves, soft tissues, and vascular structures. In this review, we discuss the usual and unusual complications detectable after RC repair.

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Review
. 2020 Mar;23(1):14-22.
doi: 10.1080/13685538.2018.1482866. Epub 2018 Jun 27.

Consequences on aging process and human wellness of generation of nitrogen and oxygen species during strenuous exercise

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Review

Consequences on aging process and human wellness of generation of nitrogen and oxygen species during strenuous exercise

Francesco Sessa et al. Aging Male. 2020 Mar.

Abstract

Impairment of antioxidant defense system and increase in metabolic rate and production of reactive oxygen species have been demonstrated in strenuous exercise. Both at rest and during contractile activity, skeletal muscle generates a very complex set of reactive nitrogen and oxygen species; the main generated are superoxide and nitric oxide. The nature of the contractile activity influences the pattern and the magnitude of this reactive oxygen and nitrogen species (ROS) generation. The intracellular pro-oxidant/antioxidant homeostasis undergoes alteration owing to strenuous exercise and the major identified sources of intracellular free radical generation during physical activity are the mitochondrial electron transport chain, polymorphoneutrophil, and xanthine oxidase. Reactive oxygen species increased tissue susceptibility to oxidative damage and pose a serious threat to the cellular antioxidant defense system. The possible dangerous consequences of the aging process and human wellness are emphasized in this review.

Keywords: Skeletal muscle; aging process; human wellness; oxidative stress; physical activity.

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. 2020 Oct;29(10):e374-e385.
doi: 10.1016/j.jse.2020.02.022. Epub 2020 Jun 9.

A new classification of impacted proximal humerus fractures based on the morpho-volumetric evaluation of humeral head bone loss with a 3D model

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A new classification of impacted proximal humerus fractures based on the morpho-volumetric evaluation of humeral head bone loss with a 3D model

Raffaele Russo et al. J Shoulder Elbow Surg. 2020 Oct.

Abstract

Background: This study aimed to classify the pathomorphology of impacted proximal humeral fractures according to the control volume theory, with the intention to introduce a severity index to support surgeons in decision making.

Methods: In total, 50 proximal humeral fractures were randomly selected from 200 medical records of adult patients treated from 2009 to 2016. Four nonindependent observers used 2 different imaging modalities (computed tomography scans plus volume rendering; 3D model) to test the classification reliability. A fracture classification system was created according to the control volume theory to provide simple and understandable patterns that would help surgeons make quick assessments. The impacted fractures table was generated based on an evaluation of the calcar condition, determined by the impairment of a defined volumetric area under the cephalic cup and the humeral head malposition. In addition to the main fracture pattern, the comminution degree (low, medium, high), providing important information on fracture severity, could also be evaluated.

Results: From 3D imaging, the inter- and intraobserver reliability revealed a k value (95% confidence interval) of 0.55 (0.50-0.60) and 0.91 (0.79-1.00), respectively, for the pattern code, and 0.52 (0.43-0.76) and 0.91 (0.56-0.96), respectively, for the comminution degree.

Conclusions: The new classification provides a useful synoptic framework for identifying complex fracture patterns. It can provide the surgeon with useful information for fracture analysis and may represent a good starting point for an automated system.

Keywords: 3D; Control volume; calcar; classification; comminution; fracture severity; proximal humeral fractures; shoulder.

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. 2020 Sep;29(9):1843-1851.
doi: 10.1016/j.jse.2020.01.077. Epub 2020 Apr 22.

Analysis of early and late clinical and radiologic complications of proximal humeral fractures using open reduction, internal fixation, and intramedullary titanium cage augmentation

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Analysis of early and late clinical and radiologic complications of proximal humeral fractures using open reduction, internal fixation, and intramedullary titanium cage augmentation

Giuseppe Della Rotonda et al. J Shoulder Elbow Surg. 2020 Sep.

Abstract

Background: An intramedullary augmentation technique using a titanium cage with different types of hardware can be considered a new option in the management of proximal humeral fractures. This study aimed to report the perioperative, early, and late complications of proximal humeral fractures using the intramedullary augmentation technique.

Methods: From 2005 to 2017, 142 displaced proximal humeral fractures were treated in the same unit by the aforementioned technique. Perioperative, early, and late complications were evaluated in all patients. Clinical evaluation was performed according to the Constant and Disabilities of the Arm, Shoulder and Hand scores. Only 115 patient records could be considered to have long-term follow-up (7-12 years).

Results: Extra-articular migrations of K-wires, plate cutout, and screw penetration were not observed. A transitory axillary nerve palsy with inferior humeral head subluxation was observed in 41 patients (29.8%). Of the 142 patients, 2 (1.4%) manifested early signs of infection, and 1 underwent a reoperation after 30 days. Complete bone healing was obtained at a mean of 3.5 months in 140 of 142 shoulders (98.6%). We achieved long-term follow-up on only 115 patients because 14 had died, 6 lived abroad, and 7 could not participate due to illness. The results were good or excellent in 99 patients (86%), fair in 12 (10.4%), and poor in 4 (3.4%). K-wires were removed in 15 of 79 patients (11.5%). Nonunion or malunion occurred in 1 patient (0.8%). Asymptomatic avascular necrosis developed in 8 patients (6.9%) after 5 years, and secondary glenohumeral osteoarthritis occurred in 6 (5.2%).

Conclusions: Intraoperative and postoperative analyses with short-, medium-, and long-term outcomes show that the intramedullary augmentation technique improves fracture treatment with significantly good anatomic reconstruction in complex and unstable cases. The bone healing rate is significantly high, and the technique is associated with a significantly low percentage of complications.

Keywords: Proximal humeral fracture; augmentation technique; complications rate; da Vinci system; hybrid osteosynthesis; intramedullary triangular titanium cage; shoulder trauma.

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. 2015 Nov 3;3(2):62-6.
doi: 10.11138/jts/2015.3.2.062. eCollection Apr-Jun 2015.

Analysis of complications of reverse total shoulder arthroplasty

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Free PMC article

Analysis of complications of reverse total shoulder arthroplasty

Raffaele Russo et al. Joints. .
Free PMC article

Abstract

Purpose: the aim of this study was to analyze complications of reverse total shoulder arthroplasty (RTSA) used to treat different shoulder diseases.

Methods: from March 2000 to March 2013, 195 RTSA were implanted by the senior Author. The indications for reverse prosthesis surgery were secondary osteoarthritis (OA) in 49 cases, irreparable rotator cuff tear (RCT) in 48 cases, and complex humeral fractures in 75 cases, while 19 were patients requiring surgical revision for first prosthesis implant. We used different prostheses with different designs.

Results: the clinical and radiological results of all the patients were analyzed retrospectively at an average follow-up of 7 years. The cases were divided into four groups on the basis of the diagnosis and complications were classified as perioperative, postoperative, or late. The mean total Constant score improved from 28 to 69 points in the OA group; from 21 to 70.8 points in the irreparable RCT group, to 76.4 in the fracture group, and from 16.6 to 59.8 points in the revision group. Scapular notching was observed in 59 cases (30.2%). Thirty-three other complications (16.9%) were observed, namely: hematomas (n=3), instability of the humeral component (n=1), scapular spine fractures (n=2), ulnar nerve deficit (n=2), long thoracic nerve palsy (n=2), deep infections (n=2), periprosthetic fractures (n=6), glenoid fractures (n=2), implant loosening (n=2), anterior deltoid muscle deficiency (n=2) and periarticular heterotopic calcifications (n=9).

Conclusions: the rates of complications, especially fractures, reported in the present study were lower than those reported in the current literature.

Level of evidence: Level IV, therapeutic case series.

Keywords: complications; results; reverse shoulder prosthesis; surgical technique.

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. 2021 Mar;37(3):824-833.
doi: 10.1016/j.arthro.2020.11.037. Epub 2020 Dec 24.

Arthroscopic Iliac Crest Bone Allograft Combined With Subscapularis Upper-Third Tenodesis Shows a Low Recurrence Rate in the Treatment of Recurrent Anterior Shoulder Instability Associated With Critical Bone Loss

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Arthroscopic Iliac Crest Bone Allograft Combined With Subscapularis Upper-Third Tenodesis Shows a Low Recurrence Rate in the Treatment of Recurrent Anterior Shoulder Instability Associated With Critical Bone Loss

Raffaele Russo et al. Arthroscopy. 2021 Mar.

Abstract

Purpose: To evaluate the clinical and radiologic outcomes of patients undergoing arthroscopic glenoid bone allograft combined with subscapularis upper-third tenodesis for anterior shoulder instability associated with clinically relevant bone loss and hyperlaxity.

Methods: Between January 2016 and December 2017, patients with recurrent anterior shoulder instability associated with bone loss and hyperlaxity were selected and treated with arthroscopic iliac crest bone graft combined with subscapularis upper-third tenodesis. The selection criteria were as follows: more than 5 dislocations; positive apprehension, anterior drawer, and Coudane-Walch test results; glenoid bone defect between 15% and 30% and humeral bone defect with an engaging Hill-Sachs lesion; and no previous shoulder surgery. All patients were followed up with the Constant score, University of California-Los Angeles (UCLA) rating, Rowe score, and visual analog scale evaluation. Assessments were performed with plain radiographs and a PICO computed tomography scan before surgery and at 2 years of follow-up.

Results: Nineteen patients were included in the study, with a mean follow-up duration of 34.6 months (range, 24-48 months). In 17 patients (89%), excellent clinical results were recorded according to the Rowe score. The Constant score improved from 82.9 (standard deviation [SD], 5.2) to 88.9 (SD, 4.3) (P = .002); Rowe score, from 25.3 (SD, 5.3) to 89.1 (SD, 21.8) (P < .001); UCLA score, from 23.7 (SD, 3) to 31.5 (SD, 4.8) (P < .001); and visual analog scale score, from 3.2 to 1.3 (P < .001). Patients met the minimal clinically important difference 94.7%, 89.5%, and 47.3% of the time for the Rowe score, UCLA score, and Constant score, respectively. Bone graft resorption was observed in all patients: partial in 9 and complete in 10. We recorded 2 recurrent traumatic dislocations (11%), with no case of persistent anterior apprehension or other complication.

Conclusions: An arthroscopic glenoid bone graft combined with subscapularis upper-third tenodesis may be a valid surgical option to treat recurrent anterior instability associated with both bone loss and hyperlaxity.

Level of evidence: Level IV, case series.

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. 2021 Jul;37(7):2055-2062.
doi: 10.1016/j.arthro.2021.01.062. Epub 2021 Feb 10.

Bankart Repair With Subscapularis Augmentation in Athletes With Shoulder Hyperlaxity

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Bankart Repair With Subscapularis Augmentation in Athletes With Shoulder Hyperlaxity

Marco Maiotti et al. Arthroscopy. 2021 Jul.

Abstract

Purpose: The purpose of this study was to demonstrate that arthroscopic Bankart repair with associated arthroscopic subscapularis augmentation (ASA) could be a valid surgical option in the treatment of anterior shoulder instability, in collision and contact sports athletes, affected by shoulder hyperlaxity.

Methods: In total, 591 arthroscopic Bankart repairs plus ASA were performed in 6 shoulder centers from 2009 to 2017. Inclusion criteria were the following: collision and contact sports activities, recurrent anterior instability associated with hyperlaxity and glenoid bone loss (GBL) < 15%. Exclusion criteria were GBL > 15%, voluntary instability, multidirectional instability, pre-existing osteoarthritis and throwing athletes. The minimum follow-up was 24 months. Hyperlaxity was clinically evaluated according to Neer and Coudane-Walch tests. Before surgery, all patients underwent magnetic resonance imaging and computed tomography scanning. Pico area method was used to assess the percentage of GBL. Patients were operated on by 6 surgeons, and their functional outcomes were evaluated by 2 independent observers. The Western Ontario Shoulder Instability Index (WOSI), Rowe, American Shoulder and Elbow Surgeons (ASES) scores were used to assess results.

Results: Overall, 397 patients with evidence of shoulder hyperlaxity (positive sulcus sign in ER1 position and Coudane-Walch test > 85°) met all inclusion criteria. The mean WOSI score was 321; the mean Rowe score rose from 68.5 to 92.5 (P = .037), and the ASES score rose from 71.5 to 97.4 (P = .041). Seven patients (1.6%) had atraumatic redislocation, and 9 patients (2.2%) had post-traumatic redislocation. At final follow-up the mean functional deficit of external rotation was 15° with the arm in adduction (ER1 position) and 10° in abduction (ER2 position).

Conclusions: The Bankart repair plus ASA has been demonstrated to be safe and effective for restoring joint stability in patients practicing collision and contact sports or affected by chronic anterior shoulder instability associated with GBL (<15%) and hyperlaxity, without compromising external rotation.

Level of evidence: Level IV, case series.

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. 2018 May 14;7(6):e623-e632.
doi: 10.1016/j.eats.2018.02.009. eCollection 2018 Jun.

Arthroscopic Bone Graft Procedure Combined With Arthroscopic Subscapularis Augmentation for Recurrent Anterior Instability With Glenoid Bone Defect

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Free PMC article

Arthroscopic Bone Graft Procedure Combined With Arthroscopic Subscapularis Augmentation for Recurrent Anterior Instability With Glenoid Bone Defect

Raffaele Russo et al. Arthrosc Tech. .
Free PMC article

Abstract

Glenoid bone loss and capsular deficiency represent critical points of arthroscopic Bankart repair failures. The purpose of this Technical Note is to present an all-arthroscopic bone block procedure associated with arthroscopic subscapularis augmentation for treating glenohumeral instability with glenoid bone loss and anterior capsulolabral deficiency. Two glenoid tunnels are set up from the posterior to the anterior side using a dedicated bone block guide, and 4 buttons are used to fix the graft to the glenoid. The subscapularis tenodesis is performed using a suture tape anchor. This combined arthroscopic technique (bone block associated with arthroscopic subscapularis augmentation) could be a valid and safe alternative to the arthroscopic or open Latarjet procedures.

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. 2021 Jul 19;8:707602.
doi: 10.3389/fmed.2021.707602. eCollection 2021.

Lung Ultrasound in the Diagnosis of COVID-19 Pneumonia: Not Always and Not Only What Is COVID-19 "Glitters"

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Free PMC article

Lung Ultrasound in the Diagnosis of COVID-19 Pneumonia: Not Always and Not Only What Is COVID-19 "Glitters"

Carla Maria Irene Quarato et al. Front Med (Lausanne). .
Free PMC article

Abstract

Background: In the current coronavirus disease-2019 (COVID-19) pandemic, lung ultrasound (LUS) has been extensively employed to evaluate lung involvement and proposed as a useful screening tool for early diagnosis in the emergency department (ED), prehospitalization triage, and treatment monitoring of COVID-19 pneumonia. However, the actual effectiveness of LUS in characterizing lung involvement in COVID-19 is still unclear. Our aim was to evaluate LUS diagnostic performance in assessing or ruling out COVID-19 pneumonia when compared with chest CT (gold standard) in a population of SARS-CoV-2-infected patients. Methods: A total of 260 consecutive RT-PCR confirmed SARS-CoV-2-infected patients were included in the study. All the patients underwent both chest CT scan and concurrent LUS at admission, within the first 6-12 h of hospital stay. Results: Chest CT scan was considered positive when showing a "typical" or "indeterminate" pattern for COVID-19, according to the RSNA classification system. Disease prevalence for COVID-19 pneumonia was 90.77%. LUS demonstrated a sensitivity of 56.78% in detecting lung alteration. The concordance rate for the assessment of abnormalities by both methods increased in the case of peripheral distribution and middle-lower lung location of lesions and in cases of more severe lung involvement. A total of nine patients had a "false-positive" LUS examination. Alternative diagnosis included chronic heart disease (six cases), bronchiectasis (two cases), and subpleural emphysema (one case). LUS specificity was 62.50%. Collateral findings indicative of overlapping conditions at chest CT were recorded also in patients with COVID-19 pneumonia and appeared distributed with increasing frequency passing from the group with mild disease (17 cases) to that with severe disease (40 cases). Conclusions: LUS does not seem to be an adequate tool for screening purposes in the ED, due to the risk of missing some lesions and/or to underestimate the actual extent of the disease. Furthermore, the not specificity of LUS implies the possibility to erroneously classify pre-existing or overlapping conditions as COVID-19 pneumonia. It seems more safe to integrate a positive LUS examination with clinical, epidemiological, laboratory, and radiologic findings to suggest a "virosis." Viral testing confirmation is always required.

Keywords: COVID-19; comorbidities; computed tomography; lung ultrasound; screening method; sensitivity; specificity.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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