percutaneous injectable bone grafts: an experimental study in rabbits and a clinical pilot study

Twenty-four male Newzealand rabbits were subjected to two operations one week apart. In the first operation an osteoperiosteal defect 2 cm in length was created in both ulnae. In the second operation a 2 cm[2] block of bone was removed from the right ilium and treated with a fine grater to obtain fine cancellous particles less than 0.4 mm in diameter. The particles were collected and mixed with 5% glucose solution and injected percutaneously in the right ulnar defect. The left control ulnar defect was injected with plain 5% glucose solution. Three groups of animals were sacrificed successively after two, four and six weeks. The changes in both defects were examined radiologically, macroscopically and microscopically. The experimental defects showed a cellular reaction followed by marked osteoblastic activity and osteoid formation, then complete bone consolidation was evident in fifteen animals out of sixteen involved in the last group. The control defects showed healing by fibrous tissue formation. It may be concluded that bone grafts applied by this technique have satisfactory osteogenic and osteoinductive potentials. This new personal technique is particularly valuable when the local conditions of the recipient site are not favorable for other techniques. Gratifying results were obtained in four patients treated by this technique as a pilot study to be extended and perfected in a future work

Primary osteoarthritis of the knee joint histological and histochemical study

Primary osteoarthritis of the knee joint was studied in 15 patients aged 55 - 65 years, one control specimen was obtained from a 35 years old man presented with comminuted intercondylar Femoral fracture. Specimens were taken from the medial femoral condyle during an operation in which five big holes were created in femoral, tibial condyles and the patella, Synovial biopsies were obtained from the vicinity of the affected medial condyles. Specimens were prepared for histological and histochemical studies. The results showed that mild changes of the articular cartilage were associated with slight necrosis of osteocytes in subchondral bone, moderate and severe articular cartilage changes were associated with extensive necrosis of osteocytes, signs of regeneration and decreased alkaline phosphatase activity in the blood vessels of the subchondral bone. Synovial membrane showed cellular hyperplasia and degeneration, intimal proliferation in blood vessels, fibrosis and minor inflammatory changes. The results supported the vascular theory as a cause of primary osteoarthritis

Cast bracing for fractures around the knee joint

Thirty-eight patients, 22 with fractures of the distal third of the femoral shaft and 16 with fractures of the proximal third of tibia, not involving the joint, were treated by a preliminary traction or above knee plaster of Paris cast and mobilized in a cast brace using a locally made unicentric knee hinge, beside the clinical and radiological criteria for union, a simple test was carried out to follow the progress of the healing process. The overall end results were satisfactory in 84% of cases. Complications in patient with poor results were analyzed

Five big holes in the surgical debridement of the osteoarthritic knee

Forty-two patients suffering from primary osteoarthritis of the knee joint were operated upon using the authors technique in which 5 big holes were made, one hole for each of the femoral condyles, tibial condyles, and the patella, aiming at removal of as much as possible of degenerated cartilage and underlying necrosed subchondral and cancellous bone, together with reduction of intraosseous pressure in the lower end of the femur, upper end of the tibia, and the patella. Excellent functional results were obtained in 66.67%, good results in 26.19%, fair in 4.76%, and poor in 2.38%. The success rate compared favorably to the results of intra-articular surgery for OA by other procedures. No specific complications can be attributed to this new technique

modification of the AO condylar plate guide

The A.O. Seating chisel guide does not lie flat against the femur allowing for errors in the required parallelism between its flap and the long axis of the bone. On the other hand, the condylar plate guide fits well in position. Both instruments were combined in one formed of a condylar blade guide with a slot on its upper edge corresponding to the body of the original seating chisel guide. Forty three fractures were fixed using the condylar plate. In an earlier experience, surgeons were unable to properly introduce screws through the lowermost two holes in four cases. Since utilizing this modified guide, no such problems were encountered