Prof. Franco Piccione

 University professor of Orthopaedics and Traumatology at the Policlinic of Palermo University until 1998. Since then he practises orthopaedic surgery privately and operates in the Casa di Cura Triolo-Zancla, Palermo. Also specialist in Physiokinesitherapy, author of over 130 publications and speaker at national and international conferences. 

 

Orthopaedic Diseases in the Mediterranean Area 

Orthopaedics and Traumatology include several diseases that can effect Mediterranean peoples. They are often socially significant both for the functional limitations and the invalidity that they cause and for the considerable cost to the national health services. In fact, in most cases they allow a long survival, as they do not affect the main vital organs, and they obtain benefit from the reduction in physical activity. In the Mediterranean area there is a significant contrast between the socially and economically more advanced countries (European ones) and those on the North African coast and in the Near East, which unfortunately do not yet enjoy widespread well-being, which is reflected in the expectancy and quality of the peoplesí lives.

Coming back to the orthopaedic pathologies, the most widespread and socially important in the Mediterranean area are osteoarthritis, osteoporosis and malign tumours. Osteoarticular tuberculosis is present but less frequent.

Osteoarthritis

Osteoarthritis is the main and most frequent degenerative disease; it begins in the cartilagineous tissue of the joints but its symptoms become evident only after years and in a very insidious way, with pain in a joint that is at first slight and intermittent, then it becomes more frequent and continues until it limits movement and little by little the other joints begin to show signs of suffering. The disease, that can have a rapid (rarely) or a slow evolution, alters considerably all the joint components until it limits or impedes walking because of the severe pain.. The joints that are most commonly affected are the hip and the knee, that can benefit from the substitution with prostheses. The prevention of osteoarthritis must begin at an early age with a healthy diet and healthy life habits that allow the harmonious development of the body; balanced sports activities can be practised by the young as a play activity without pushing a boy or girl necessarily towards competitive sports even if there is talent, because  he/she may be too young to do excessively exacting exercises before the joint structures are sufficiently mature and ready to support the enormous burdens that put excessive stress on the various apparatuses. One must avoid overweight. Traumatic lesions, even minor ones, should be given adequate consideration, for they are often the first step in joint suffering that gives origin to anatomo-pathological and biological  alterations that, after a few decades, will become evident with the appearance of signs of a progressive pathology.

 Arthroprosthesis       

Operations for arthroprosthesis are indicated only at an advanced age and not in all cases. Unfortunately nowadays, because of information from the media that is not always correct and sometimes because of the pressure exerted by the patients themselves, prostheses are implanted without due consideration, as if the operation were free of all risks and solved the problem once and for all. Even if today technology has allowed the construction of reliable joint prostheses, the operation of arthroprosthesis must be carried out not by choice but for necessity when all other therapies have proved unsuccessful and taking into account above all the patientís age, work and social activities.

Osteoporosis

Osteoporosis, that is more common and begins at an earlier age in women, in its most common forms (in the menopause and in elderly women) develops in genetically pre-disposed individuals. However, one should not forget that environmental factors can play a decisive role. For decades it has been known that the maximum bone mass, reached at 20-25 years of age, conditions the future heritage of the skeleton but little is done in the family to give the children healthy eating habits. It is necessary to go back to a breakfast of milk and dairy products (in a balanced way), reducing fats and sugars. Great importance is rightly given to the hormonal imbalance in adolescents for when they become adults they must procreate but what is not emphasized is the essential role that the sex hormones have on the skeleton. People wrongly believe that osteoporosis cannot be treated. Of course, when the disease is advanced and the patient with osteoporosis has multiple vertebral fractures or fractures of the femur-head the treatment is difficult. Such considerations must underline the necessity for an early diagnosis (laboratory and instrumental tests after the menopause) that allow the beginning of treatment that can prevent fractures. In some Mediterranean countries with a medium-low income the above-mentioned steps for prevention, diagnosis and treatment should be carried out considering the cost-benefit ratio.

 Malignant tumours      

The number of registered malignant tumours is on the increase. This is due to the greater exposition to carcinogenic substances in the environment but also to the more sophisticated methods that allow the diagnosis of tumours of even very small dimensions and to the increase in the average life expectancy, for many tumours are discovered even in very old people. As for other pathologies, a precocious diagnosis is essential: in fact, many tumours are curable both surgically and non-surgically. Most malignant bone tumours are metastatic ones, that is secondary tumours that come from other organs or apparatuses and can be found in the skeleton. How can we limit their number and aggressiveness? In this case too prevention is very important (periodic mammographies, gynaecological check-ups, Pap tests, check-ups of the prostate gland and the thyroid gland) because if it were carried out the number of metastatic tumours would certainly fall in the future.

T.B.C. of the Bone

Nowadays T.B.C.of the bone (almost always secondary to tracheobronchial or peritoneal focalizations) is rare in almost all European countries thanks to the good level of hygiene and to the prophylaxis carried out by vaccination. Notwithstanding this  a few new cases have been discovered recently following the arrival of immigrants from countries where the pathology is frequent. However, since there are only a few cases it is possible to treat them successfully and they do not constitute a risk to the community. In several non-European countries in the Mediterranean area anti-tuberculosis vaccination should be carried out on the whole population. Today T.B.C. of the bone is curable only if one considers it as a possible diagnosis and proceeds to the appropriate investigations that allow a precocious diagnosis  and specific treatment.

Malformations of the spinal column

The malformations are congenital anomalies found quite frequently but not always accompanied by symptoms in the first ten years of life. Among them, we can mention spondylolysis and spondylolysthesis which can make the spinal column slide forward and can compress the roots, sometimes calling for surgical treatment. The mono- and bilateral sacralization of the fifth lumbar vertebra, the posterior fission of the arch of the fifth lumber vertebra and of the first part of the sacrum, the anomalies in the direction of the articular apophyses  are all pathologies that cause functional assymetries that in time are followed first by postures and then by anomalous structures of the spinal column. An early diagnosis often allows various provisions to be taken (functional re-education, aids, changes in posture and in work movements etc.) that allow the patients a normal working and social life. Surgical treatment is very rarely indicated in these pathologies and is more frequent in spondylolysthesis.

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