Luigi Cianni
Verified @libero.it
Scopus Publications
- Epidemiology and treatment of surgical infections after distal radius fractures: a systematic review
Andrea Cruciani, Cristina Giuli, Giulia Di Pietro, Luigi Cianni, Camillo Fulchignoni, Pierluigi Del Vecchio, Giulio Maccauro, Raffaele Vitiello
Archives of Orthopaedic and Trauma Surgery, 2025
Introduction Distal radius fractures (DRFs) are among the most frequent injuries treated by orthopaedic surgeons. Although postoperative infection is uncommon, it represents a clinically relevant complication that may affect outcomes. This systematic review aimed to evaluate the incidence, subtypes, and treatment of infections following surgical management of DRFs. Materials and methods A systematic search of MEDLINE/PubMed and Cochrane Library was performed from inception to June 2024, following PRISMA guidelines. English-language longitudinal studies (prospective or retrospective) reporting infection after DRF surgery were included. Case reports, meta-analyses, animal studies, and articles without relevant outcomes were excluded. Extracted data included infection incidence, classification, microbiological findings, and reported management. Results Fifty-five studies met inclusion criteria, encompassing 6499 patients and 6451 procedures. A total of 341 infections were reported (5.3%). Superficial surgical site infections accounted for 22.6% of cases, deep infections for 12.0%, and pin-tract infections for 61.0%. Infection rates differed by fixation method: approximately 2.0% for open reduction and internal fixation, 12.0% for Kirschner-wire fixation, and 13.9% for external fixation. Microbiological confirmation was reported only in a minority of studies; when available, Staphylococcus aureus was the most frequently isolated organism. Management strategies ranged from oral antibiotics and local wound care for superficial infections to intravenous antibiotics with debridement and hardware removal for severe cases. Conclusions Infections following DRF surgery are relatively rare but vary across fixation techniques, with pin-tract infections predominating in percutaneous and external constructs. The heterogeneity of infection definitions and the scarcity of microbiological reporting limit comparability between studies. Standardized SSI/FRI classification and more consistent documentation are needed to improve evidence-based prevention and treatment strategies. - Glenohumeral Instability and Clinical Outcomes Following Proximal Humerus Resection and Megaprosthesis Implantation: A Systematic Review
Luigi Cianni, Giacomo Capece, Luca Fiore, Andrea De Fazio, Sara Martellini, Giulio Maccauro, Maristella Francesca Saccomanno
Journal of Clinical Medicine, 2025
Background: Glenohumeral instability is one of the most frequent and clinically impactful complications following proximal humerus resection and reconstruction with a megaprosthesis, especially in patients treated for bone tumors or complex fractures. Its incidence, risk factors, and influence on functional recovery remain variably reported in the literature. Methods: A systematic review was conducted according to PRISMA guidelines, searching PubMed, Scopus, and Google Scholar up to April 2025. Studies reporting on postoperative instability, dislocation, functional outcomes (MSTS, DASH), and related complications were included. Two independent reviewers performed data extraction and quality assessment. A pooled analysis was performed using random-effects models. Results: A total of 17 studies including 387 patients were analyzed. The pooled incidence of glenohumeral instability was 32%, with a revision surgery rate of 10% due to instability. The most common reconstruction technique was modular megaprosthesis (47%), followed by allograft–prosthesis composites (APCs) and reverse total shoulder arthroplasty (RSA). Functional outcomes were reported in 12 studies using the Musculoskeletal Tumor Society (MSTS) score, with a weighted mean of 22.3 ± 3.8 (74.3% ± 12.7%). Disabilities of the Arm, Shoulder, and Hand (DASH) scores, reported in 3 studies, showed worse outcomes in unstable shoulders (mean 61.4 ± 5.2 vs. 26.6 ± 4.1). Soft tissue reconstruction, particularly involving the rotator cuff and deltoid, significantly influenced postoperative stability and function. Conclusions: Glenohumeral instability after proximal humerus megaprosthesis is a common and disabling complication that adversely affects functional outcomes and revision rates. Optimizing soft tissue management and prosthetic design is essential to improve joint stability and long-term results. - Megaprosthetic replacement in complex distal humerus fractures in elderly patients: a case series
Matteo Caredda, Luigi Cianni, Andrea De Fazio, Antonio Ziranu, Raffaele Vitiello, Giulio Maccauro
Journal of Orthopaedic Surgery and Research, 2024
Background Managing distal humeral fractures can be challenging for orthopedic surgeons. There are several treatment options for managing this type of fracture, and the treatment method for these fractures should be based on patient-related factors. In elderly patients with osteoporotic bone and severe comminution of the fracture, adequate fixation can be a major challenge for surgeons. The use of megaprosthesis has been recently proposed in traumatology as an alternative to osteosynthesis or conventional prosthesis for the management of comminuted articular fractures in elderly patients with poor bone stock. Methods A consecutive case series of 5 patients who underwent reconstruction of the elbow joint with a trabecular hinged modular elbow megaprosthesis was reviewed retrospectively. All patients included had AO/OTA 13C2 and 13C3 fractures with metaphyseal extension and considerable bone loss of the distal humerus. The primary outcome was the evaluation of functional and clinical outcomes with the MEPS score in comminuted distal humerus fractures with metaphyseal extension and poor bone stock in elderly patients treated with elbow megaprosthesis. The secondary outcome was assessing the treatment-related complication rate of this technique in non-oncological fields. Results Five patients were included in the study with a mean age of 82.66 ± 7.72 years at surgery. The mean MEPS value was 63 ± 24.2 at 1 month, 81 ± 23.53 at 3 months, 83 ± 24.2 at 6 months, and 84 ± 24.57 at 12 months. No intraoperative complications were recorded in our series. Of 5 patients, four patients had excellent clinical and functional outcomes. We did not encounter wound dehiscence, prosthetic joint infection, aseptic loosening, or periprosthetic fractures. Conclusions The indication for this type of treatment must be selected and narrowed down, as it is a salvage procedure, and any failure would cause even more complex situations. Short operating times and early mobilization of the elbow are the advantages of this technique. - Characteristics and Epidemiology of Megaprostheses Infections: A Systematic Review
Luigi Cianni, Francesco Taccari, Maria Beatrice Bocchi, Giulia Micheli, Flavio Sangiorgi, Antonio Ziranu, Massimo Fantoni, Giulio Maccauro, Raffaele Vitiello
Healthcare Switzerland, 2024
Background: Megaprostheses were first employed in oncological orthopedic surgery, but more recently, additional applications have arisen. These implants are not without any risks and device failure is quite frequent. The most feared complication is undoubtedly the implants’ infection; however, the exact incidence is still unknown. This systematic review aims to estimate in the current literature the overall incidence of megaprosthesis infections and to investigate possible risk/protective factors. Methods: We conducted a systematic search for studies published from July 1971 to December 2023 using specific keywords. To be included, studies needed to report either the megaprosthesis anatomical site, and/or whether the megaprosthesis was coated, and/or the surgical indication as oncological or non-oncological reasons. Results: The initial literature search resulted in 1281 studies. We evaluated 10,456 patients and the overall infection rate was 12%. In cancer patients, the infection rate was 22%, while in non-oncological patients, this was 16% (trauma 12%, mechanical failure 17%, prosthetic joint infections 26%). The overall infection rates comparing coated and uncoated implants were 10% and 12.5%, respectively. Conclusions: The number of megaprosthesis implants is increasing considerably. In traumatological patients, the infection rate is lower compared to all the other subgroups, while the infection rate remains higher in the cancer patient group. As these devices become more common, focused studies exploring epidemiological data, clinical outcomes, and long-term complications are needed to address the uncertainties in prevention and management. - A Two-Step Approach to the Surgical Treatment of Soft-Tissue Sarcomas
Camillo Fulchignoni, Luigi Cianni, Maria Rosaria Matrangolo, Mariagrazia Cerrone, Francesco Cavola, Elisabetta Pataia, Raffaele Vitiello, Giulio Maccauro, Pasquale Farsetti, Giuseppe Rovere
Current Oncology, 2024
Background: Nowadays, limb-sparing procedures are the gold standard in the treatment of soft-tissue sarcomas of the limbs. Wide tumor resection with appropriate oncological margins, reconstruction, and stabilization of the involved bone and joint and restoration of the soft tissue lost are essential in order to obtain good clinical and functional outcomes. Tumor excision and soft-tissue reconstruction performed in one-step surgery is chosen by many centers as the preferred approach; however, according to our experience in some selected patients, two-step surgery performed using a dermal regeneration template first and then a margin revision, taking into account the definitive results of the anatomopathological exam conducted over the surgical specimen from the previous surgery, associated with definitive reconstruction surgery over a healthy bed of granulated tissue, showed many potential benefits. Methods: A retrospective observational study was conducted on thirteen patients who underwent a two-step reconstruction procedure using dermal substitution after soft-tissue sarcoma excision. Results: Clinically, the enrolled patients achieved excellent contour and cosmesis of their surgical wounds, with a mean VSS value of 3.07. During the follow-up period, no local recurrences were observed in any patient. Conclusions: Two-step surgery represents the most suitable solution to allow surgical radicality with minimal recurrency and adequate soft-tissue reconstruction, avoiding the possibility of wasting autologous tissue. Our patients generally embraced this approach and the management that followed. - Current Evidence Using Pulsed Electromagnetic Fields in Osteoarthritis: A Systematic Review
Luigi Cianni, Emidio Di Gialleonardo, Donato Coppola, Giacomo Capece, Eugenio Libutti, Massimiliano Nannerini, Giulio Maccauro, Raffaele Vitiello
Journal of Clinical Medicine, 2024
(1) Background: Osteoarthritis (OA) significantly impacts patients’ quality of life and negatively affects public healthcare costs. The aim of this systematic review is to identify the effectiveness of pulsed electromagnetic fields (PEMFs) in OA treatment across different anatomical districts, determining pain reduction and overall improvement in the patient’s quality of life. (2) Methods: In this systematic review following PRISMA guidelines, PubMed and Google Scholar were searched for randomized controlled trials involving patients with osteoarthritis undergoing PEMF therapy. Seventeen studies (1197 patients) were included. (3) Results: PEMF therapy demonstrated positive outcomes across various anatomical districts, primarily in knee osteoarthritis. Pain reduction, assessed through VAS and WOMAC scores, showed significant improvement (60% decrease in VAS, 42% improvement in WOMAC). The treatment duration varied (15 to 90 days), with diverse PEMF devices used. Secondary outcomes included improvements in quality of life, reduced medication usage, and enhanced physical function. (4) Conclusions: Diverse PEMF applications revealed promising results, emphasizing pain reduction and improvement in the quality of life of patients. The variability in the treatment duration and device types calls for further investigation. This review informs future research directions and potential advancements in optimizing PEMF therapies for diverse osteoarthritic manifestations. - Stress-Induced Hyperglycemia is a Risk Factor for Surgical-Site Infections in Nondiabetic Patients with Open Leg Fractures
Luigi Cianni, Matteo Caredda, Andrea De Fazio, Mattia Basilico, Tommaso Greco, Gianpiero Cazzato, Carlo Perisano, Giulio Maccauro, Raffaele Vitiello
Advances in Orthopedics, 2023
Background. Nondiabetic patients with open leg fractures who have elevated blood glucose levels on arrival in the emergency department have an increased risk of surgical-site infections (SSIs). Objective. This study evaluates the association between the incidence of SSIs in nondiabetic patients with an open leg fracture and blood glucose levels registered on arrival in the ER. We also analyzed the correlation between patients’ days of hospital stay and the incidence of SSIs and the time elapsed between the damage control with external fixation and final fixation and the incidence of SSI. Methods. We retrospectively studied nondiabetic patients admitted to our emergency unit from 2017 to 2021 with a diagnosis of open leg fracture consecutively treated. Based on the diagnosis of SSIs, all enrolled patients were divided into two groups based on the developed (group A) or not developed (group B) SSIs within 1 year after surgery. All patients enrolled in the study underwent damage control within 24 hours after admission to the ER. At stabilization of general clinical and local wound conditions, all patients underwent definitive surgery. Results. We enrolled 80 patients. In group A, glycemia on arrival in the ER was on average 148.35 ± 19.59 mg/dl, and in group B, it was 122.61 ± 22.22 mg/dl ( p value: 0.0001). In group A, glycemia in the first postoperative day was on average 113.81 ± 21.07 mg/dl, and in group B, it was 99.02 ± 17.60 mg/dl ( p value: 0.001). In group A, the average hospitalization was 57.92 ± 42.43 days, and in group B, it was 18.41 ± 14.21 days ( p value: 0.01). Through Youden’s J, we therefore analyzed the value with the highest sensitivity and specificity which proved to be 132 mg/dl. Conclusion. Our findings show that nondiabetic patients with SIH have a significantly increased risk of SSIs compared to patients without SIH within 1 year after surgery. Patients with open leg fractures with SIH have a significantly higher average hospital stay than patients without SIH. Further studies are needed to confirm 132 mg/dl of blood glucose levels as a value to stratify the risk of SSIs in these patients. - MENISCAL ALLOGRAFT TRANSPLANTATION COMBINED WITH ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A SYSTEMATIC REVIEW
Dario Candura, Gianluca Ciolli, Federico Chiriacò, Luigi Cianni, Marina Marescalchi, Vincenzo Brancaccio, Katia Corona, Domenico Alessandro Santagada, Giulio Maccauro, Simone Cerciello
Orthopedic Reviews, 2023
Introduction To evaluate the clinical and functional outcomes of meniscal allograft transplantation (MAT) with anterior cruciate ligament reconstruction (ACLR) in a single surgical stage through a systematic review of the currently available evidence. Methods A systematic search of the PubMed and Google Scholar databases, with no publication date limit, until December 2022 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Follow-up studies and case series published in English involving patients undergoing a combination of ACLR and MAT were included. The quality of these studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) checklist. A systematic review of the International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scores was conducted. Results Seven studies involving 154 patients were included. The mean follow-up was 5,3 years. The mean age at the time of the surgery was of 35.3 years. All studies used the Lysholm Knee score, IKDC score or Tegner activity score to measure clinical outcomes post-operatively and the mean improvements were 26.7, 24.7, and 1.8 respectively. The rate to return to sport was 75.5 %. No intra-operative complications were reported. The post-operative complication rate was 11.6%. Conclusions MAT combined with ACLR procedure showed good clinical results up to an average of 5 years of follow-up. More studies need to be conducted that can better understand the long-term effects of this combined procedure. - Predictive Factors of Poor Outcome in Sanders Type III and IV Calcaneal Fractures Treated with an Open Reduction and Internal Fixation with Plate: A Medium-Term Follow-Up
Luigi Cianni, Raffaele Vitiello, Tommaso Greco, Mattia Sirgiovanni, Giulia Ragonesi, Giulio Maccauro, Carlo Perisano
Journal of Clinical Medicine, 2022
Background: Consensus on the treatment for severely comminuted calcaneus fractures has yet to be found. This study aims to analyze the functional and radiological short- and medium-term outcomes of displaced calcaneus fractures of type III and IV treated with ORIF, and to identify, if present, the early predictors of unfavorable outcomes. Methods: Thirty-three calcaneal fractures were included, 23 type III and 10 type IV, according to Sanders classification. AOFAS scales for ankle and hindfoot and SF-12 were used. Böhler and Gissane angles were analyzed before and after surgery. Results: The minimum follow-up was six years. The mean AOFAS score at six months was 16.5 points (24.2 ± 10.8 vs 10.8 ± 9.5; p = 0.03) with better outcomes in patients with Sanders type III fractures. This difference decreased in the subsequent follow-up. Likewise, the mental and physical score of SF-12 had the same trend. Two wound infections and no deep infections were recorded in the Sanders type III fracture group. Instead, in the Sanders type IV group, there were four wound infections and one deep infection. Conclusions: Clinical and radiological outcomes in Sanders Type III and Type IV calcaneus fractures treated with plate and screws were very similar in long-term follow-up. If ORIF provided better short- to medium-term follow-up in Sanders type III fracture, these benefits have been lost in six years. Polytrauma and psychiatric patients showed significantly lower clinical outcomes in long-term follow-up, appearing as the most reliable negative predictors. - Plate Augmentation in Aseptic Femoral Shaft Nonunion after Intramedullary Nailing: A Literature Review
Carlo Perisano, Luigi Cianni, Chiara Polichetti, Adriano Cannella, Massimiliano Mosca, Silvio Caravelli, Giulio Maccauro, Tommaso Greco
Bioengineering, 2022
Background: Femoral shaft fractures (FSFs) are a frequent injury in traumatology for which intramedullary nailing (IMN) is considered the gold standard treatment. Nonunion (NU) is one of the most frequent complications in FSF treated with IMN, with a percentage from 1.1% to 14%. Plate augmentation (PA), the addition of a compression plate and screws, with or without bone graft has been described as an effective option for the treatment of NU, improving the biomechanical conditions at the fracture site. The aim of this review was to analyze the literature relating to the use of PA in NU after IMN in FSFs to assess the efficacy of the technique. Methods: An electronic search on PubMed, Google Scholar, and Web of Science was conducted to search for all studies concerning PA of femoral shaft NUs after IMN. Results: Twenty-four studies were included in the review comprising a total of 502 patients with a mean age of 39.5 years. Of these, 200 hundred patients had atrophic pseudoarthrosis and 123 had hypertrophic pseudoarthrosis, while in 179, the type of pseudoarthrosis was not reported. The most frequently used plate for PA was the dynamic compression plate (DCP); in 87.1% of the cases, the authors added a bone graft to the plate fixation. In 98.0% of the patients, a complete bone union was achieved in a mean time of 5.8 ± 2.12 months. Conclusion: The patients treated with PA included in this review showed a good rate of consolidation in the femoral shaft NUs, with good functional recovery and a low incidence of complications. - Three-Dimension-Printed Custom-Made Prosthetic Reconstructions in Bone Tumors: A Single Center Experience
Raffaele Vitiello, Maria Rosaria Matrangolo, Alessandro El Motassime, Andrea Perna, Luigi Cianni, Giulio Maccauro, Antonio Ziranu
Current Oncology, 2022 - Correlation between Neutrophil-to-lymphocyte ratio and Euthyroid Sick Syndrome in elderly patients with proximal femur fractures
L. Cianni, A. Perna, S. Pietramala, A. de Fazio, M. Oliva, M. B. Bocchi, M. Covino, A. Ziranu, R. Vitiello
European Review for Medical and Pharmacological Sciences, 2022 - Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective study
Raffaele Vitiello, Carlo Perisano, Tommaso Greco, Luigi Cianni, Chiara Polichetti, Rocco Maria Comodo, Ivan De Martino, Vincenzo La Vergata, Giulio Maccauro
BMC Musculoskeletal Disorders, 2021 - Surgical management of tibial metastases: a systematic review
T. Greco, C. Fulchignoni, L. Cianni, G. Maccauro, C. Perisano
Acta Biomedica, 2021 - Uncoated vs. Antibiotic-Coated Tibia Nail in Open Diaphyseal Tibial Fracture (42 according to AO Classification): A Single Center Experience
Tommaso Greco, Luigi Cianni, Chiara Polichetti, Michele Inverso, Giulio Maccauro, Carlo Perisano
Biomed Research International, 2021 - Evaluation of PD1 and PD-L1 expression in high-grade sarcomas of the limbs in the adults: Possible implications of immunotherapy
Journal of Biological Regulators and Homeostatic Agents, 2020 - Intramedullary antibiotic coated nail in tibial fracture: A systematic review
Journal of Biological Regulators and Homeostatic Agents, 2020 - Predictable risk factors for infections in proximal femur fractures
Journal of Biological Regulators and Homeostatic Agents, 2020 - A rare case of bacillus megaterium soft tissues infection
M. B. Bocchi, A. Perna, L. Cianni, R. Vitiello, T. Greco, G. Maccauro, C. Perisano
Acta Biomedica, 2020 - Arthrodesis in the charcot foot: A systematic review
Luigi Cianni, Maria Beatrice Bocchi, Raffaele Vitiello, Tommaso Greco, Davide De Marco, Giulia Masci, Giulio Maccauro, Dario Pitocco, Carlo Perisano
Orthopedic Reviews, 2020 - Induced membrane by silver-coated knee megaprosthesis: Keep or toss?
Journal of Biological Regulators and Homeostatic Agents, 2020 - Bifocal parosteal osteoma of femur: A case report and review of literature
Raffaele Vitiello, Tommaso Greco, Luigi Cianni, Silvia Careri, Maria Serena Oliva, Marco Gessi, Ivan De Martino, Maria Beatrice Bocchi, Giulio Maccauro, Carlo Perisano
Orthopedic Reviews, 2020 - Foot metastasis: Current knowledge
Tommaso Greco, Luigi Cianni, Domenico De Mauro, Giacomo Dughiero, Maria Beatrice Bocchi, Gianpiero Cazzato, Giulia Ragonesi, Francesco Liuzza, Giulio Maccauro, Carlo Perisano
Orthopedic Reviews, 2020 - A report of a very rare isolated bone metastasis in the midfoot due to cervix cancer
Carlo Perisano, Raffaele Vitiello, Tommaso Greco, Luigi Cianni, Giulio Maccauro, Stefania Sfregola, Marco Gessi, Fabio Mancino
Minerva Ortopedica E Traumatologica, 2019
