Antibiotic-loaded bone allograft: personal experience

The main purposes are to present the objective principle of this work which emphasized the antibiotic loaded bone allograft experience and the results of a research on the characteristics "in vitro" and "in vivo" of this material [morecellized antibiotic loaded bone allograft with PMMA] related to our orthopaedic field. Since 1998 in the Rizzoli Institute morcellized bone graft has been used for the treatment of bone loss caused by different pathologies. Since 1998 to 2002, in Rizzoli Institute 249 patients have been operated for different orthopaedic pathological reasons, in most of the cases treated to restore the septic bone defect, a large quantity of morcellized antibiotic loaded bone allograft was used. The good outcome from the use of the morcellized-defatted and antibiotic loaded allograft invited our mind to a research about physical and clinical characteristic of a new composite [which we called CAMB]: morcellizsed allograft with vancomycin impregnated in PMMA, in order to search for a bio-artificial substance similar to human bone. The outcome of morcellized bone allograft with vancomycin and PMMA [CAMB] "in vitro" and in human plasma was best antibiotic carrier compared to PMMA impregnated in antibiotic only, both in human plasma and saline solution. The mechanical characterization of the composite CAMB established a compressive strength of 13,6 mega-Pascal, comparable to the compressive strength measure for human cancellous bone. Since these peculiarities, we have considered useful to verify the biocompatibility in vivo of the CAMB. Morcellized bone graft has a high resistance to septic breakdown, but low resistance to mechanical strength. It has a good affinity to antibiotic release and a good bone-induction. About it carrier properties, we think that it is necessary to have much more experience to evaluate its efficiency. About CAMB composite we can emphasize it for the best antibiotic delivery in human plasma for the high resistance to mechanical loading and a good "in vivo" biocompatibility

Club foot. Management and long term follow-up

Club foot [Congenital Talipes equinovarus] is one of the oldest and best known of all orthopedic problems. Carefull clinical assessment of congential feet deformities by interested and experienced orthopedic team, with early detection of patients starting from obstetric units are still the corner stone in club foot treatment. 278 club feet were treated, male to female ratio 3:1, [10 percent] had associated anomalies, [60 percent] less than 3 months of age at presentation, [29 percent] between 3-9 months, [11 percent] over 9 months. Only 215 had positive family history of club foot, [70 percent] were mild, [23 percent] were moderate and only [7 percent] were severe. Conservative management carried out for [86 percent] of patients initially, it was satisfactory for only [12 percent]. Different surgical modalities were applied for the rest