Medium-term results of trapezio-lunate external fixation for scaphoid fractures.

We treated 36 scaphoid fractures in 34 patients with trapezio-lunate external fixation. According to the Herbert and Fisher classification, there were 16 type B1, 14 type B2, four type B3 and two type B4 fractures. Trapezial and lunate pins broke in three patients and these were rated as failures. The remaining 33 fractures were followed-up for 3 years and all had excellent outcomes, without signs of arthritis, avascularity or instability.

Prevention of heterotopic ossification after total hip replacement: a prospective comparison of indomethacin and salmon calcitonin in 60 patients.

We did a prospective consecutive study of prophylaxis for heterotopic ossification (HO) comparing indomethacin (100 mg/day) and salmon calcitonin (3 MRC-U/kg/day) for 14 days. Each group consisted of 30 patients. 19 patients in the indomethacin group and 2 in the calcitonin group developed HO. We conclude that use of calcitonin in the prophylaxis of HO after total hip replacement is more effective than indomethacin.

Arthroscopic-assisted percutaneous stabilization of patellar fractures.

The authors did percutaneous, arthroscopic-assisted osteosynthesis of patellar fractures associated with skin abrasions and lacerations in 11 patients. Skin problems did not delay the operation and the rehabilitation. The average followup was 2.8 years. All fractures healed without complications and good results were obtained in all patients using the criteria of Levack et al. This technique avoids the problems of patellar fractures with skin abrasions and may be adapted to other fractures of the patella.

Effects of various irrigating solutions on articular cartilage. An experimental study in rabbits.

The effect of six different solutions (normal saline, ringer's lactate, chlorhexidine, povidone iodine, ceftriaxone, chloramphenicol) on articular cartilage was investigated in an in vivo rabbit model study. The right knees were aspirated and injected with one of these solutions for five days and, three days later, the patellae of the rabbits were excised and investigated histologically. Left knees were used as controls. There was no difference between the groups and the controls with respect to structure, cell density, and nuclei-to-lacunae ratio. These results suggest that, these solutions have no noxious effects on articular cartilage when used as irrigating fluids in orthopaedic practice.

Rotational profile of the lower extremity and foot progression angle: computerized tomographic examination of 50 male adults.

Acetabular, femoral and tibial torsion of 50 normal adult male subjects were measured by computerized tomography and the relationship between these angles and foot-progression angle was examined. The mean acetabular anteversion was 15.6 degrees on the right and 15.8 degrees on the left, (range 3 degrees-30 degrees). The mean femoral torsion was 6.5 degrees on the right and 5.8 degrees on the left (range 14 degrees-28 degrees). The mean tibiofibular torsion was 30.9 degrees on the right and 29.1 degrees on the left (range 16 degrees-50 degrees). Although the normal range of torsional measurements of the lower extremity was very broad, subjects usually had out-toeing, with a mean foot-progression angle of 13.7 degrees on the right and 13.0 degrees on the left (range 6 degrees-21 degrees). No correlation was detected on the rotation between different levels of the lower limb. No difference was detected in the lower extremity rotational profile between right and left sides.

Interspinous distance in congenital dislocation of the hip.

We measured radiographically the interspinous distance in 50 normal children and in 50 children with congenital dislocation of the hip. The value increased proportionally with age in normal children, but not in those with congenital dislocation of the hip. Our results indicate that a bony parameter, rather than the age of the child, is suitable for the indication of lower age limit for Salter's innominate osteotomy.

Percutaneous autologous bone marrow grafting for simple bone cysts.

Twelve patients with simple bone cysts treated by percutaneous autologous bone marrow grafting were studied prospectively to evaluate the radiographic healing of the cysts, complications, and clinical outcome. The procedure included percutaneous aspiration of the cyst's fluid and the injection of the autologous bone marrow into the cyst cavity, which was aspirated from the posterior iliac crest. The mean volume of the lesions was 51.2 cubic centimeters (27 to 74 cc). The mean follow-up time was 23 months (range: 18 to 38 months). Complete healing occurred in two of the patients. Three cysts had residual cystic defect in which two required curettage and bone chip grafts. Six cases recurred. One patient failed to show any signs healing. We concluded that factors such as the size, multi-loculation, and completeness of the filling of the cyst with bone marrow grafting might influence the postoperative results of the treatment of simple bone cysts with bone marrow injection. We found more favorable result with unilobular, small cysts. Therefore, we believe that this method of treatment should be applied to carefully selected patients.

Treatment of severe residual clubfoot deformity by trans-midtarsal osteotomy.

This study reviews the preliminary results of transmidtarsal osteotomy performed on 11 patients (12 feet) who previously underwent surgery for resistant clubfoot and needed further surgery for severe residual deformities. Opening wedge medial cuneiform osteotomy, closing wedge cuboid osteotomy, and truncated wedge middle and lateral cuneiform osteotomy were performed. The procedure was performed initially on normal cadaver feet. The average improvement of anteroposterior talo-first metatarsal angle was 20 degrees and lateral calcaneo-first metatarsal angle was 16 degrees. The authors conclude that with this simple procedure, angular and rotational correction in three planes can be obtained simultaneously in severe residual clubfoot deformity without the need for extensive soft tissue release.

Correlation of magnetic resonance imaging and intraoperative punctate bleeding to assess the vascularity of scaphoid nonunion.

Thirty-two patients with radiographic evidence of scaphoid nonunion were preoperatively evaluated by magnetic resonance imaging (MRI), then observed intraoperatively for punctate bleeding of the fragments. Although MRI and intraoperative findings matched in 19 patients, there was no correlation in 13 patients. While 7 of these latter patients showed normal MRI but no punctate bleeding during the operation, the remaining 6 had preoperative MRI of avascularity but punctate bleeding during the operation. After internal fixation and bone grafting, all but 1 of these 13 patients achieved union. We conclude that the diagnosis of avascular necrosis should only be made when both MRI and intraoperative findings indicate avascularity.

The relationship of heel pad elasticity and plantar heel pain.

Loss of heel pad elasticity has been suggested as one of the possible explanations of plantar heel pain. This hypothesis is evaluated by this blinded observer prospective study, using an age and weight matched control population. Hindfoot lateral radiographs of 73 patients with plantar heel pain, 29 of whom had bilateral involvement (102 feet), and who ranged in age from 20 to 60 years, were studied and compared with 120 healthy subjects (240 feet). Heel pad thickness and heel pad compressibility index were not significantly different in patients with plantar heel pain than in healthy subjects matched for age and weight. In patients with unilateral heel pain, heel pad thickness and heel pad compressibility index on the painful side were not significantly different from the opposite painless side. The contribution of the heel pad elasticity measured as a visual compressibility index for plantar heel pain is a matter of debate.

Oxidant status increased during fracture healing in rats.

We evaluated oxidant status during bone healing in 50 rats. In 40 rats, the right tibia was fractured and fixed intramedullarly (study leg) and the left tibia was pinned but not fractured (control leg). Rats were killed on days 1, 3, 7, 14, 28 and malondialdehyde (MDA) levels were determined in tibial bone tissue. The MDA levels of study and control legs were compared with basal MDA levels in bone in 10 rats. There was no apparent difference between the basal level and control legs, but the study legs showed a statistically significant increase in MDA levels on days 7 and 14. We conclude that no oxidative stress injury occurs during the ischemic period of fracture healing, but it may be significant during inflammation and the formation of callus.

Antibiotic-impregnated xenografts in the treatment of chronic osteomyelitic cavities. Seven cases followed for 3 to 5 years.

We describe seven patients with chronic osteomyelitis which developed in 3 following operation and in 4 after trauma. The treatment consisted of removal of dead tissue and filling the resulting cavities with gentamicin-impregnated xenografts. No antibiotics were used postoperatively. Urine gentamicin levels were above 0.5 microgram/ml for 8 days. The patients were followed up for at least 3.5 years and neither clinical nor laboratory signs of infection were detected. These results lead us the conclusion that gentamicin-impregnated xenografts may have a place in the treatment of chronic osteomyelitis.

Patellectomy with vastus medialis obliquus advancement for comminuted patellar fractures: a prospective randomised trial.

We have compared the results of simple patellectomy (group A, n = 16) and patellectomy with advancement of the vastus medialis obliquus (group B, n = 12) in a prospective, randomised trial, with a minimum follow-up of three years. The results in group B were significantly better (p < 0.001) than those in group A. Although the patella should be preserved if possible, we advocate advancement of the vastus medialis obliquus when patellectomy is necessary.

Normal range of motion of the joints of the upper extremity in male subjects, with special reference to side.

We measured, with a universal full-circle manual goniometer, the active and passive arcs of motion of the shoulder, elbow, forearm, and wrist in 1000 healthy male subjects who were right-hand dominant and who ranged in age from eighteen to twenty-two years. The ranges of motion on the right side were significantly smaller than those on the left. We concluded that the contralateral, normal side may not always be a reliable control in the evaluation of restriction of motion of a joint.

[In vitro evaluation of antibiotic diffusion from antibiotic impregnated xenografts]. / Evaluation in vitro de la diffusion des antibiotiques à partir d'une xénogreffe imprégnée d'antibiotiques.

PURPOSE OF THE STUDY: The purpose of the study was to evaluate xenografts as a slow release antibiotic delivery system, as xenografts also have excellent biocompatibility and osteogenesis-stimulating effect. MATERIAL: Xenograft (Unilab Surgibone) blocks of 5 x 5 x 5 mm were used in the study. Antibiotics used for impregnation were gentamicin sulphate, ciprofloxacin and penicillin G. METHODS: In the pilot study, xenograft blocks impregnated with gentamicin sulphate solution and the contact time was between 1/2 to 10 hours. Then the grafts were incubated and the antibiotic concentration was measured in the elution fluid changed every day. The minimum contact time to release the antibiotic 10 days over 0.5 microgram/ml was 8 hours. The 8 hours contact time was used in the main study to evaluate gentamicin sulphate, ciprofloxacin and penicillin G. The method was the same as in the pilot study. RESULTS: All antibiotics showed similar release patterns reaching their peaks on the 5th day and then gradually decreasing below the effective level (0.5 microgram/ml) approximately on day 10. DISCUSSION: Although various materials have been used to deliver antibiotics, they have some certain disadvantages especially reduced biocompatibility. The superiority of xenografts over other materials, is not only biocompatibility but also to facilitate osteogenesis. The only objection may be the relatively short duration of release (10 days) but the length of antibiotherapy is controversial and standard 6 weeks of administration has no documented superiority over other time intervals. CONCLUSION: Our delivery system is superior to others as its function is not only to deliver antibiotics but has its place in orthopedic practice to fill defects and stimulate osteogenesis. Also the preparation of this system is not time and skill consuming.

Oxygen-free radicals impair fracture healing in rats.

We studied the effect of oxygen-free radicals on fracture healing. 30 male rats were divided into 2 groups: 15 rats were given saline 5 mL/kg i.p. (control group) and 15 were given zymosan 100 mg/kg i.p. to induce oxygen-free radicals through stimulation of NADPH oxidase in polymorphonuclear leucocytes. 1 hour later, the right forelimbs of the rats were broken by light manual compression. These treatments were given once a day until the fifth post-fracture day. All rats were killed on day 22, and histological sections of the radius and ulna were examined without knowledge of the treatment given. The administration of zymosan impaired the fracture healing and therefore oxygen-free radicals appear to play an important role in fracture healing.

Dacryocystitis associated with osteopoikilosis.

We report five members of a family with dacryocystitis associated with osteopoikilosis. The inheritance is autosomal dominant. Review of the literature revealed no other report of this kind of association. Osteopoikilosis must not be considered as a coincidental radiographic finding but as part of a systemic disorder.