The Marchetti-Vicenzi elastic locked nail for the treatment of femoral shaft fractures: a review of 100 consecutive cases.

A total of 100 hundred femoral fractures in 97 patients were treated with the Marchetti-Vincenzi universal bundle elastic nail; six of the fractures were open. Closed fractures were classified according to AO and Winquist; open fractures were classified according to Gustilo. A total of 91 fractures united (average 12 weeks) and six led to non-union. There were two deep and one superficial infections. In three cases, the secondary nails protruded from the anterior cortex of the femoral condyle; in two cases intraoperatively and in the third case 2 months postoperatively, due to severe osteoporosis. The cylindrical part of the nail did not fail, whereas all the secondary nails failed in one patient as well as one secondary nail in another patient at the level of the fracture; these two cases exhibited non-union. We consider the absence of distal screws the major advantage of this particular nail, followed by position of the entry point and the limited reaming. We believe that the absence of a pin guide is a disadvantage. The elasticity of the nail has a positive effect in certain cases while in other cases it acts negatively, resulting in a relatively high proportion of non-unions as in our series. Therefore our conclusion is that this nail is not appropriate for the treatment of femoral shaft fractures.

The innervation of the human meniscus.

Fourteen menisci from seven anatomic specimens were examined to identify their innervation. After staining by a modified gold chloride method, the menisci were sectioned on a sliding microtome and were studied under a light microscope. Free nerve endings in the peripheral and the medial thirds of the meniscal body were identified, and three types of encapsulated mechanoreceptors were found in the anterior and posterior horns. Based on these findings and a review of the relevant literature, it is considered that menisci both receive and transmit proprioceptive information. Therefore, they not only are stabilizers of this joint, but also contribute to the function of deep sensitivity.

Ipsilateral fractures of the femur and tibia.

From October 1987 to September 1990, 32 patients with ipsilateral fractures of the femur and the tibia were treated. There were 20 men and 12 women with a mean age of 27 years (range 18-75 years). All were caused by road accidents. There were 7 femoral and 22 tibial open fractures. The management of the fractures was partially the same. The tibial fractures were reduced and stabilized by a unilateral external fixator, while in 29 out of 32 femoral fractures, a closed intramedullary nailing was performed. The remaining three patients with an open grade III fracture were initially treated by external fixation, with two of them converted into nailing. The time of hospitalization ranged from 12 to 105 days (mean 30 days). The femoral fractures healed in an average of 15.5 weeks, while the tibial fractures healed in 18.5 weeks. The evaluation of our results was made according to Karlstrom and Olerud's criteria. We achieved 81 per cent excellent or good results and 19 per cent acceptable or poor, in a follow-up time of 19.5 months.

Mechanoreceptors in the posterior cruciate ligament. Histologic study on cadaver knees.

The purpose of the study was to identify mechano-receptors in the healthy, human posterior cruciate ligament. Ten ligaments from 10 fresh cadavers were studied with light microscopy. In addition to free nerve endings, two types of encapsulated mechanoreceptors were identified. They were located at the femoral and tibial attachments, and on the surface of the ligament. These findings support the hypothesis that the posterior cruciate ligament has an anatomic basis for a discriminating afferent flow of nerve impulses to the central nervous system. Therefore, its neural network may play a role in regulating the contraction of muscle groups that are fundamental to knee stability.

Soft tissue recurrence of osteoclastoma.

We report a case of osteoclastoma of the distal radius originally treated by curettage, then by resection and bone replacement. There was a soft tissue recurrence of the tumor 13 years later.