Is transphyseal intramedullary fixation of the distal radius in pediatric fractures a safe procedure? An MRI study Marco Giordano, Michela Florio, Silvia Careri, Marco Cirillo, Angelo Gabriele Aulisa, et al. Frontiers in Surgery, 2025 BackgroundRadius and ulna fractures are very common in the pediatric population. Despite the use of pinning through the growth plate, which was proposed in the past and is still being used to treat these fractures, an instrumental validation to define this procedure as safe has not yet been done. Because of this, in the absence of reliable data regarding the passage of fixation devices through the growth plate, most surgical techniques used for treating radius and ulna fractures are based on absolute respect for the growth cartilage. We conducted an MRI pilot study to evaluate the presence of any growth disturbances, bone bridge formation across the physis, or premature closure of the cartilage, to verify the correlation between wire diameter and the percentage of lesions tolerated by the growth plate and to confirm the safety of the trans-physeal pinning procedure. To specifically avoid the wrist fracture healing process near the growth plate as possible bias of the study, we enrolled only patients with mid-shaft forearm fractures.Materials and methodsWe evaluated 26 patients with diaphyseal forearm fractures who underwent intramedullary percutaneous transphyseal fixation of the distal radius with a Kirschner wire. Intramedullary K-wire and plaster cast were removed, without a second surgery or anesthesia, about 35-40 days after surgery. A clinical and radiographic evaluation was performed at 1, 3, 6 and 12 months from surgery. We conducted a comparative MRI evaluation of both wrists 12 months after the removal of the K-wire to exclude any growth plate damage related to the passage of the wire through it.Resultsclinical data underlined excellent results in most patients. Radiographic healing was achieved in all cases at three months. No significative cartilage disturbances related to the procedure were found in any patient. An asymmetrical bridge that did not correspond to the wire position was found in some older patients, probably related to the initial phase of the growth plate closure process.ConclusionThis study demonstrates that the percutaneous trans-physeal technique could become a valid alternative to the standard method, offering a rapid learning curve, shorter surgical times, and reduced healthcare costs.
Paediatric Calcaneal Osteochondroma: A Case Report and a Literature Review Valeria Calogero, Michela Florio, Silvia Careri, Angelo Gabriele Aulisa, Francesco Falciglia, et al. Diseases, 2024 Background: Heel pain in children is a common condition. The aetiology can be ascribed to fractures, osteochondrosis, tendinitis, calcaneal-navicular or talo-calcaneal coalition, osteomyelitis, rheumatic diseases, anatomic variants, malignant tumours (osteosarcoma, Ewing’s sarcoma), and benign lesions (bone cyst, aneurismal bone cyst, osteoid osteoma, or exostosis). In particular, this manuscript focuses on a case of calcaneal exostosis in the paediatric age, aiming to highlight its rarity. Osteochondromas are benign tumours of the surface of the bone and the overlying cartilage. They grow until skeletal maturity and can cause stiffness, pain, cosmetic alterations, tendinitis, and neuro-vascular compression. The calcaneus is an extremely rare site for these tumours. Only two case reports of paediatric exostosis of the calcaneus bone are available. Methods: We describe a case of a girl of 16 years of age, affected by multiple cartilaginous exostosis, who presented with a painful mass on the inferior margin of the foot in the calcaneal region, which was diagnosed as an exostosis. The neoformation was excised, and the girl underwent clinical follow-up. Results: The patient was promptly discharged in good condition, and on the 25th postoperative day, she was completely pain-free and allowed weight bearing. Conclusions: In the case of heel pain resistant to conservative treatment, the presence of an osteochondroma should be considered after excluding more common causes. If symptomatic, calcaneal osteochondromas could require surgical excision.
Evaluation of Gartland Classification, Baumann Angle and Anterior Humeral Line in Paediatrics Supracondylar Fractures: An Inter and Intra-Observer Reliability Study Valeria Calogero, Angelo Gabriele Aulisa, Silvia Careri, Giulia Masci, Giuseppe Mastantuoni, et al. Journal of Clinical Medicine, 2024 Supracondylar fractures of the humerus are frequent paediatric injuries. The aims of this study were to evaluate the applicability and reproducibility of the Gartland and Wilkins classification, the Baumann angle (BA) and the Anterior Humeral Line (AHL). This retrospective monocentric observational study was conducted on 217 patients. Four observers assessed the pre-operative radiographs by applying the Gartland and Wilkins classification and the post-operative X-rays by measuring the BA and AHL. The kappa coefficient (K) and the Cohen’s kappa were used for the reliability of the Gartland classification; the Intraclass Correlation Coefficient (ICC) for that of the BA. The AHL was evaluated in a double manner by using first the K and the Cohen’s kappa and then the ICC. A total of 186 patients were eligible. Inter-observer reliability for the Gartland classification was K = 0.73–0.61 for type III, 0.65–0.61 for type Ia and 0.43–0.26 for type IIb. The Baumann angle mean value in the first data collection was 73.5 ± 6.85 (inter-observer ICC 0.74) and 72.9 ± 6.83 (inter-observer ICC 0.77) for the second data collection; AHL: inter-observer ICC 0.87 for the first evaluation and 0.80 for the second one. Gartland’s classification modified by Wilkins has a high degree of reliability. BA and AHL appear reproducible and reliable.
Vertebral Rotation in Functional Scoliosis Caused by Limb-Length Inequality: Correlation between Rotation, Limb Length Inequality, and Obliquity of the Sacral Shelf Martina Marsiolo, Silvia Careri, Diletta Bandinelli, Renato Maria Toniolo, Angelo Gabriele Aulisa Journal of Clinical Medicine, 2023 Background: Scoliosis is a structured rotatory deformity of the spine defined as >10° Cobb. Functional scoliosis (FS) is a curve < 10° Cobb, which is non-rotational and correctable. FS is often secondary to leg length inequality (LLI). To observe vertebral rotation (VR) in functional scoliosis due to LLI, one must demonstrate a correlation between LLI, sacral shelf inclination (SSI), and VR and discover a predictive value of LLI capable of inducing rotation. Methods: We studied 89 patients with dorso-lumbar or lumbar curves < 15° Cobb and radiographs of the spine and pelvis. We measured LLI, SSI, and VR. The patients were divided into VR and without rotation (WVR) groups. Statistical analysis was performed. Results: The mean LLI value was 6.5 ± 4.59 mm, and the mean SSI was 2.8 ± 2.53 mm. The mean value of LLI was 5.2 ± 4.87 mm in the WVR group and 7.4 ± 4.18 mm in the VR group. The mean SSI value for WVR was 1.4 ± 2.00 and that for VR was 3.9 ± 2.39. For each mm of LLI, it was possible to predict 0.12° of rotation. LLI ±5 mm increased the probability of rotation (R2.08 p < 0.0016), while this was ±2 mm for SSI (R2 0.22 p < 0.01). Each mm of LLI corresponded to 0.3 mm of SSI (R2 0.29, p < 0.01). Conclusions: FS secondary to LLI can cause VR, and 5 mm of LLI can cause SSI and rotation.
Reconstruction of metatarsal bone after giant cell tumor resection with no vascularized fibular graft in a pediatric patient: Case report and review of literature M. Florio, S. Careri, C. Zoccali, A. G. Aulisa, F. Falciglia, et al. Frontiers in Pediatrics, 2022 The Giant Cell tumor (GCT) is a benign, locally aggressive lesion that cause bone destruction and shows a malignant potential. It is a relatively common skeletal tumor that is therefore typically seen in young adults. Few cases are described in literature of GCT in the immature skeleton, and the metatarsal is an unusual location for a primary bone GCT, especially in pediatric age. Therefore, there are very few data reported regarding the management protocol of GCT in metatarsal bones. We report a case about the use of no vascularized fibular graft for an original Y-shaped reconstruction of the metatarsal bone after Giant Cell Tumor resection in a 9 years-old patient, and performed a literature review about metatarsal bone reconstruction in skeletally immature patient.
Initial In-Brace Correction: Can the Evaluation of Cobb Angle Be the Only Parameter Predictive of the Outcome of Brace Treatment in Patients with Adolescent Idiopathic Scoliosis? Angelo Gabriele Aulisa, Marco Galli, Marco Giordano, Francesco Falciglia, Silvia Careri, et al. Children, 2022 Background: Patients with a better initial in-brace correction could show a higher probability of a successful outcome. However, no one has investigated whether parameters can affect the outcomes. The aim of this retrospective study was to evaluate if the initial correction rate (ICR) could be predictive of the bracing outcome and to determine the role of some mechanical and biological parameters in ICR. Methods: The study population comprised 449 patients who met the inclusion criteria. Curve correction > 10° Cobb defines brace treatment success. Success and failure groups were compared in terms of the Risser sign, initial Cobb angle, initial Perdriolle value and ICR. Results: ICR significantly correlates with initial Perdriolle. The success group had a significantly lower value of Pedriolle and initial Cobb angles, Risser sign and ICR than the failure group. The ICR and lower Risser were significantly associated with the brace treatment outcome. This seems particularly suitable for positivity prediction (Predicting value VP+: 87%). Conclusions: This study confirms that immediate in-brace correction can foretell the brace treatment outcome. Patients with a low Risser sign and a high rate of in-brace correction showed a bracing success of 87%. A correlation between rotation and in-brace correction confirms that rotation is among the parameters that influence the deformed spine reaction to corrective actions the most.
A new proximal femur reconstruction technique after bone tumor resection in a very small patient: An exemplificative case Carmine Zoccali, Silvia Careri, Dario Attala, Michela Florio, Giuseppe Maria Milano, et al. Children, 2021 For patients too young to be fitted with an expandable prosthesis, limb salvage surgery requires other strategies. The main problems are related to the impossibility of implanting an expandable prosthesis to the residual bone growth that is much too big in relation to the bone size, with the precocious implant loosening and/or the residual absence of bone growth, as well as the problem of limb length and shape difference. In this paper, we report a possible reconstruction solution using a composite prosthesis for an Ewing’s sarcoma of the proximal femur in an infant patient. After resection, a femoral stem was cemented into the distal third of a homoplastic humerus; a carbon fiber plate was used to stabilize the bone/homograft interface. At the one-year follow-up, the patient was free of disease and able to walk with only a slight limp. This case report describes a possible solution for very small patients. An adult humerus is of the right size to replace a child’s lower limb segments, and the distal humerus can be shaped, maintaining a cortex stiff enough to support a prosthesis. Very young patients might obtain a faster osteointegration of the graft than adults, due to their higher biological activity and, in this case, the diapasonal shape of the allograft might also have contributed to accelerated fusion. Moreover, the use of a graft to fit the prosthesis avoids loosening issues due to canal widening, hypothetically providing more growing time before system failure and revision surgery. However, although this technique is promising, further studies are necessary to confirm our findings and to verify if this procedure allows easier future prosthesis implantation.
Seven-year clinical outcomes after collagenase injection in patients with Dupuytren's disease: A prospective study Rocco De Vitis, Marco Passiatore, Andrea Perna, Silvia Careri, Vitale Cilli, et al. Journal of Orthopaedics, 2020 Introduction This investigation is a prospective cohort study examining the use of Clostridium histolyticum collagenase injection (CCH) for the treatment of Dupuytren's disease (DD) with a 7 years follow-up. Methods Forty-five monodigital DD patients were injected with CCH on a single joint. Assessment included measurement of residual passive extension deficit (PED), function (using QuickDASH) and patient satisfaction. Results 86.7% of PIPJ and 65.6% of MPJ had a worsening of PED. Nevertheless, thirty-nine patients (86.7%) concluded their treatment with only one injection, without any further treatment. Conclusion CCH provides a long-term effective solution. Recurrence occurs, especially in PIPJ, with acceptable rates.
The importance of geriatric and surgical co-management of elderly in musculoskeletal oncology: A literature review Raffaele Vitiello, Andrea Bellieni, Maria Serena Oliva, Beatrice Di Capua, Domenico Fusco, et al. Orthopedic Reviews, 2020 People over 65 years old are the fastestgrowing part of the population and also the most common population in oncological practice. The geriatric co-assessment when involved in the management of orthopedic elderly patients could improve the survival and clinical outcomes of the patients. The aim of this review is to understand the importance of comprehensive geriatric assessment in elderly cancer orthopaedic patients affected by bone and soft tissue sarcoma in order to apply it and identify the mean surgical prognostic factors of this population.
Bifocal parosteal osteoma of femur: A case report and review of literature Raffaele Vitiello, Tommaso Greco, Luigi Cianni, Silvia Careri, Maria Serena Oliva, et al. Orthopedic Reviews, 2020 Osteoma is a benign, slowly growing, asymptomatic, bone-forming tumor arising from cancellous or compact bone. Osteoma usually is a solitary lesion, but in patients with Gardner’s Syndrome it may be multiple. osteoma may rarely have a parosteal localization. Parosteal osteoma has peculiar radiographic, histologic and clinical features. We describe a case report of a 51- years old man with a bifocal parosteal osteoma of the femur in a non-syndromic patient. This is the first described patient with a bifocal lesion. In literature only 24 cases of paraosteal osteoma are found. Our patient underwent surgery and the lesions were fully excised. At one year follow-up there was no evidence of recurrence.
