Radial head prosthesis: results overview.

BACKGROUND/PURPOSE: Radial head replacement is frequently used in treatment of radial head fractures or sequela. Impossibility to restore a correct anatomy, acute elbow traumatic instability and failure of osteosynthesis hardware are the most common indications. The authors describe their case studies and results on the implantation of various radial head prostheses. MATERIALS: Between June 2005 and June 2016, 28 radial head prostheses were implanted in the same number of patients with an average follow-up of 49 months (6-104). Indications for implantation were: Mason type III and IV radial head fractures and post-traumatic arthritis due to failure of previous treatments. Monopolar prostheses were used and were press-fit implanted via Kaplan's lateral access and Kocher's anconeus approach to the humeroradial joint. At the follow-up, assessments were made of the pain, according to the visual analogic scale, range of motion (ROM), stability and functionality according to the Mayo Elbow Performance Score, presence of osteolysis and mobilization during radiography tests, personal satisfaction of the patients, Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation outcomes measurements. RESULTS: At the follow-up, we recorded an average level of pain of 1.8 in patients under acute treatments for radial head fractures and a marked reduction in the remaining cases from 6.7 to 2.1. ROM was found on average to be 107° of flexion-extension and 159° of pronosupination. Personal satisfaction was good-excellent in 23 cases. There was no case of infection; removal of the implant was necessary in three cases due to mobilization of the stem and oversized implants. In six cases, bone resorption was seen at the level of the prosthetic collar and it was in all cases asymptomatic. CONCLUSIONS: The results of this study suggest that the use of prostheses, if well positioned, is a valid solution in the treatment of secondary arthritis and fractures of the radial head with poor prognosis, with good results in the reduction of pain, recovery of movement and improved quality of life.

Reinsertion of the distal head of the biceps using mini-anchors and the anterior access: a retrospective study.

The authors describe their experience in the treatment of the lesions of the distal tendon of the biceps through the anatomic insertion with Mitek mini-anchors using Henry anterior single-incision access. From 1996 to 2007, 12 patients, all male, average age 51.2 years, were treated for a lesion of the distal tendon of the biceps. In all cases, post-operative pain according to the visual analogical scale, the articular motion of the elbow, the occurrence of neurological disorders and the formation of ectopic ossifications appreciated by radiographies were evaluated. Furthermore, the patient's satisfaction and the impact on his quality of life were assessed using the DASH questionnaire. The results that were evaluated at an average follow-up of 65.6 months were satisfactory: in two cases a temporary deficit in the innervation area of the radial nerve occurred; in two cases ossifications formed at the tendon insertion level but with no clinical repercussions. All patients returned to their previous working activity and their level of satisfaction was good in five cases and very good in the other seven cases. In agreement with literature data, this technique, when compared with other treatment methods, proved effective and safe in the treatment of acute lesions of the distal tendon of the biceps brachii.

Analysis of the T cell receptor repertoire in rheumatoid arthritis.

OBJECTIVE: To evaluate whether there is a restricted T cell receptor repertoire in rheumatoid synovium and to analyse the CDR3 region of the V beta families found to be more expressed in the synovial membrane than in the peripheral blood, in order to ascertain the presence of clonotypic expansion of T lymphocytes. METHODS: The level of expression of individual V beta and V alpha families of the TCR was evaluated in paired synovial membrane and peripheral blood T cells from 8 female patients affected by rheumatoid arthritis, using the RT-PCR method. Nucleotide sequences of the CDR3 region of some V beta families were analysed in order to identify the presence of conserved sequences. Sequencing was carried out with the dideoxy chain termination method using modified T7 DNA polymerase. RESULTS: All of the V alpha and V beta families were amplified in both compartments of the 8 patients. Four patients did not show any preferential expression of the TCR alpha or beta chains in synovium compared with peripheral blood. The other 4 patients showed increased expression of one or more V alpha and/or V beta families in the synovium. We did not find any correlation between the duration of disease, rheumatoid factor status, HLA-DR type and the V gene families which were elevated in the synovium. Analysis of the CDR3 region showed the presence of conserved amino acid sequences in the synovium, but not in the peripheral blood. CONCLUSION: The V families found to be increased in 4 of the 8 patients studied were different, except for V beta 1 which was more highly expressed in 2 patients. The presence of conserved amino acid sequences in the CDR3 region is consistent with an antigen-driven T cell expansion at the site of autoimmune inflammation. These findings do not support our original hypothesis of the possible usefulness of therapy based on the inactivation or elimination of presumed pathogenic T cells using TCR-derived peptides or monoclonal antibodies against particular TCRs.

Segregation analysis of dominant osteogenesis imperfecta in Italy.

We have performed linkage analysis in seven Italian families, in which mild osteogenesis imperfecta (OI) segregated as a dominant trait, by means of six DNA restriction fragment length polymorphisms (RFLPs) of type I collagen genes. OI type I was linked to the alpha 1(I) gene (COL1A1) in two families, and to the alpha 2(I) gene (COL1A2) in one family. OI type IV segregated with COL1A2 in two families. In two OI type I families, the molecular genetic data were insufficient for exclusion of one gene. Four DNA polymorphisms were particularly informative for cosegregation analysis of OI in Italian kindreds.

Haplotype frequencies of the collagen type-I genes in the Italian population.

We have determined the frequencies of six restriction fragment length polymorphisms (RFLPs) of type-I collagen genes in a random sample of 100 subjects. Alpha 1 gene (COL1A1) DNA polymorphisms, FG2/MspI, 2FC6/RsaI, and NST70/RsaI, had polymorphism information content (PIC) values of 0.35, 0.32, and 0.26, respectively. Alpha 2 gene (COL1A2) RFLPs, NJ3/EcoRI, Hf32/RsaI, and Hf32/MspI had PIC values of 0.36, 0.35, and 0.25, respectively. The combined haplotype PIC values were 0.71 at the COL1A1 locus and 0.73 for COL1A2. Two COL1A1 and two COL1A2 RFLPs were more polymorphic than in the English population, making them better markers for the analysis of Italian families affected by osteogenesis imperfecta and some other inherited collagen diseases.

Synovial sarcoma: with radial nerve involvement.

An unusual case of radial nerve involvement at the elbow by a synovial sarcoma is reported. The patient was a 16-year-old Caucasian girl presenting with signs of a radial nerve palsy. Treatment was by surgical excision of the tumour and grafting the defect in the radial nerve. The histological diagnosis was a synovial sarcoma. Recovery of function was almost complete eight months later.

[Osteoid osteoma of the vertebral column as a cause of scoliosis]. / L'osteoma osteoide del rachide come causa di scoliosi.

After reminding how difficult it is to reach the diagnosis for an osteoid osteoma of rachis, the Authors report of a patient who was put under their observation after having been treated as lumbar scoliosis and discitis for one year. As they removed the osteoid osteoma, the painful symptomatology punctually disappeared and the rachis, after few months, was in its normal order.