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Pseudoartrosi e perdite di sostanza juxta-articolari

Juxta-articular non unions and bone defects

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Riassunto

Le pseudoartrosi (PSA) e le perdite di sostanza ossea juxta-articolari sono una rara complicanza in ortopedia e traumatologia, ma rappresentano situazioni assai impegnative dal punto di vista clinico e della scelta del trattamento.

Alcuni problemi coesistenti, come l’osteoporosi, la deformità, l’atrofia dei tessuti molli, l’eventuale presenza di infezione e la possibile compromissione articolare, ne complicano ancor più l’inquadramento e la scelta terapeutica. A tal fine abbiamo sviluppato un nuovo sistema classificativo: il Non Union Scoring System (NUSS) che consente di identificare forme di PSA prognosticamente omogenee, indipendentemente dal solo sospetto radiografico, e quindi di strutturare una piu? completa ricerca clinica per ricavarne un algoritmo di cura.

La scelta del trattamento di queste delicate situazioni deve prevedere quindi un approccio globale al paziente che permetta di pianificare una strategia di trattamento che consenta di ottenere una valida stabilità meccanica, di correggere eventuali deformità e di fornire un adeguato stimolo biologico, quando richiesto. In tale panorama, quale ruolo quindi possiamo attribuire alla fissazione esterna?

Abstract

Juxta-articular non unions and bone defects are a rare complication in orthopedics and traumatology, but they represent very difficult situations in terms of clinical outcome and treatment options.

Some coexisting problems, such as osteoporosis, deformity, bone loss, soft tissue atrophy, infection and the possible association of articular degeneration, usually make the grading and the treatment choice very difficult. For this purpose we have developed a new classification system: the Non Union Scoring System (NUSS) which allows to identify prognostically homogeneous forms of non unions, regardless of the radiographic aspect only, and then to structure a more complete clinical grading in order to obtain an algorithm of care.

The choice of treatment of these delicate situations should utilize a global approach to the patient so to allow the clinician to plan a treatment strategy. A good mechanical stability must be reached, the deformity has to be corrected and an appropriate biological stimulus must be provided when required. In this scenario, which role can we attribute to external fixation?

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Authors and Affiliations

  1. COR, Istituto Ortopedico G. Pini, Università degli Studi di Milano, Piazza Cardinal Ferrari, 1, 20122, Milano, Italy

    G. M. Calori, M. Bucci, P. Fadigati, E. Mazza, M. Colombo & C. Ripamonti

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  1. G. M. Calori
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  2. M. Bucci
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  3. P. Fadigati
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  4. E. Mazza
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  5. M. Colombo
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  6. C. Ripamonti
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Correspondence to G. M. Calori.

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Calori, G.M., Bucci, M., Fadigati, P. et al. Pseudoartrosi e perdite di sostanza juxta-articolari. Aggiornamenti 18, 71–76 (2012). https://doi.org/10.1007/s10351-012-0012-2

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  • DOI: https://doi.org/10.1007/s10351-012-0012-2

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