Nerve growth factor administration on cultured human ligamentocytes: an in vitro pilot study.

Nerve growth factor (NGF) is involved in several joint pathologies. It has been demonstrated that its concentration increases in synovial fluid and tissue from arthritis. However, its role in joint homeostasis and pathophysiology still remain to be clarified. This study analyzed the effect of 200 ng/ml on cultured human ligamentocytes by evaluating cell proliferation, cell phenotype and gene expression. The MTT test excluded an influence on cell viability at 7 and 14 days. Regarding cell phenotype, we observed that NGF might promote the synthesis of COL1A1. On the other hand, real time PCR showed that NGF did not influence gene expression of COL3A1, FGF-BETA, IGF1, MMP2, MMP3, MMP9 and MMP13. However, COL1A1 gene was significantly upregulated in treated cell at 14 days. Our results suggest that NGF may have an anabolic effect on ligament. Additional investigations are necessary to determine how NGF may influence ligamentocytes..

Interlocking nail for femoral shaft fractures: is dynamization always necessary?

A series of 179 closed femoral fractures treated by static interlocking nailing (Grosse-Kempf nail) was reviewed to evaluate the effect of dynamization on the time to bony union. In 75 patients, dynamization was performed whereas in 104 the implant was left static. Union occurred in 178 patients. We observed one infection. Time to union was significantly shorter in the static group (103 days) compared to the dynamized group (126 days).

Bone with cement and antibiotic: antibiotic release in vitro.

It was the purpose of the study to evaluate morcellized bone with cement and antibiotic release mixed with vancomycin and methylmethacrylate cement (PMMA). The aim of the study is part of a wider one aimed at verifying the possibility of using this composite for the treatment of chronic septic pathologies of the bone. Five cylinders 1 cm in height by 1 cm in diameter, formed by morcellized bone with cement and vancomycin were immersed in plasma and 5 in physiological solution. Three cylinders equal in size but formed by cement and antibiotic alone were immersed in plasma and 3 in physiological solution. All of the cylinders remained in immersion for 28 days at a temperature of 37 degrees C. The immersion fluids were changed every day during the first week and on days 14, 21 and 28. The quantity of vancomycin released was dosed in each specimen. The greatest and most constant release of antibiotic took place in the cylinders of morcellized bone, cement and antibiotic immersed in plasma.

The treatment of bone defects in primary arthroplasty of the knee.

The authors reviewed the literature as well as their own cases in order to discuss the indications, advantages and disadvantages relative to the methods used to treat bone defects in primary knee arthroplasty. An analysis shows that the use of cement represents the most unfavorable method from a mechanical point of view and it should thus be limited to defects that are not too deep and extensive. Bone grafts, both homoplastic and autoplastic, are preferred in younger patients. The former in lesions that are smaller, the latter in those that are larger. Currently, modular prostheses are diffusedly used because of their versatility and relatively low cost if we compare them with prostheses that are custom made. Finally, the authors emphasize the need to use intramedullary stems in bone defect with the purpose of reducing stress in the metaphyseal region.

Distal diaphyseal fractures of the tibia treated by modified Grosse-Kempf nail.

Fractures of the distal fourth of tibia are difficult to treat because of the possible involvement of the joint, the comminution of the fragments, the local skin conditions and the surgical method required. There are many methods of osteosynthesis, and these range from external fixation to use of a plate to combined methods. Intramedullary nailing is generally not indicated in the treatment of such fractures, but if the correct technical procedure is used, indications may be widened, and the method may even be used in cases such as these. It is necessary to saw the tip of the nail so that the distal holes go beyond the fracture line. A total of 30 cases of fracture of the distal fourth of the tibia treated by Grosse-Kempf nailing sawed distally are reported.

MRI in diagnosis of osteoid osteoma of the proximal femur: a potentially deviating aspect. Description of a clinical case.

Osteoid osteoma constitutes 10-12% of all benign neoplasms of the bone. The tumor more frequently involves the male sex (male to female ratio 2.1:1) and it may be observed in all age groups, with evident predilection for the second decade of life. All of the skeletal segments may be affected, but the most frequent site is the long bones, in the diaphyseal, metaphyseal and more rarely epiphyseal regions. The lesion is characterized by an osteolytic area, the nidus, which is at times partially calcified, surrounded by an osteosclerotic zone that is more or less accentuated. Clinical suspicion and traditional radiography are essential in diagnostic orientation; usually, further imaging methods are also recommended, such as bone scan with Tc99, CT scan and MRI. This last method allows for easy localization of the lesion, although with a sensitivity that is less than that of the CT scan. Nonetheless, the finding, if not supported by clinical suspicion, may be dangerously deviating and it may orient diagnosis towards a more aggressive disease.

Traumatic injuries of the pelvis. SIOT paper 1967.

The paper that Prof. Campanacci read at the Annual Meeting of the Italian Society of Orthopaedics and Traumatology in 1967 was the product of vast research aimed at clarifying and classifying traumatic injuries of the pelvic girdle. The basic idea behind the study was that correct therapeutic conduct cannot neglect an in-depth knowledge of the pathologic anatomy and pathogenesis of the injury. What emerges, in addition to the knowledge of anatomopathology, is the continuing validity of the scientific method with which the problem was dealt with.

Ceramic-ceramic coupling. Total hip arthroplasty in young patients.

Between 1994 and 2000 at the 7th Division of the Rizzoli Orthopaedic Institute a total of 123 total hip arthroplasties were implanted in 105 patients aged under 40 years (mean age 32 years). In most of the cases the patient was affected with osteoarthrosis secondary to congenital hip dysplasia (35%) or osteonecrosis (29%). In all of the cases the same type of cup was press-fitted with alumina on alumina bearing surfaces. The stem was cemented in 4 cases. Six of the patients were submitted to prosthetic revision surgery: 1 as a result of deep infection, 2 recurring dislocation, 3 aseptic loosening of one of the components. Radiographic evaluation did not reveal signs of periprosthetic osteolysis. We did not observe any cases of rupture of the alumina head or any problems related to the modularity of the implant. The authors wish to stress the reliability of using alumina on alumina in a population with high functional demand.

Infected nonunion of the femur.

From 1988 to 2000, 21 patients with infected nonunion were treated by wide resection of the nonunion site and fixation with Ilizarov's external ring fixator. Of the 21 cases, 2 are still under treatment. 18 cases resolved. In two cases iterative fracture occurred, which was successfully treated by internal fixation. One case treated by external fixator failed; any further attempts at surgery were abandoned, and the patient was put in a brace. The ring fixator enabled a sufficiently wide resection to remove the infection. It also provided stability for long periods of time, unrestricted weight bearing, and, after resolution, the same set up was used to restore the femur to its original length by corticotomy and distraction according to Ilizarov.