Changes in the avascular area of the meniscus using mesenchymal stem cells and growth plate chondrocytes in a pig model.

Menisci are wedge-shaped cartilage discs that are divided into two parts: the avascular and vascular regions. They are formed by fibrocartilage tissue, which contains round cartilage-like cells and extracellular matrix. Meniscus injury in animals is a common orthopedic problem, but data on the natural healing process mainly deals with the vascular zone. The healing processes in the avascular zone of the meniscus are significantly limited. Thus, this study aimed to evaluate autologous growth plate chondrocytes' impact on the healing process of a damaged meniscus in the avascular zone based on a growing animal model. The study group consisted of 10 pigs at about three months of age. From each animal, chondrocytes from the iliac growth plate and from concentrated bone marrow were taken. Knee joints were divided into right (R) and left (L). The medial meniscus of the R knee joint was treated with a hyaluronic acid based scaffold incubated with bone marrow cells from marrow aspirates (nCHON). The medial meniscus of the L knee joint was treated with a hyaluronic acid based scaffold incubated with bone marrow cells from marrow aspirates supplemented with immature chondrocytes isolated from growth plates (wCHON). The meniscus was damaged in the avascular zone in both knee joints. Followingly, the damaged part of the meniscus was filled with a scaffold with cells from the concentrated bone marrow and from growth plate chondrocytes. In the control group, a scaffold with concentrated bone marrow cells was used. After three months the animals were euthanized and preparations (microscopic slides) were made from the meniscus' damaged part. A qualitative and quantitative analysis have been prepared. The wCHON group in comparison with the nCHON group showed a statistically significantly higher number of fusiform cells on the surface of the graft as well as better healing of the graft. In addition, the degree of vascularization was higher in specimens from the wCHON group than in the nCHON group. The results of our research on immature pig knees revealed that mesenchymal stem cell and growth plate chondrocytes could be treated as the cell source for meniscus reconstruction, and growth plate chondrocytes enhance healing processes in the avascular zone of the injured meniscus.

Treatment of Unstable Occipital Condylar Fractures in Children-A STROBE-Compliant Investigation.

Background and objectives: Occipital condyle fractures (OCF) occur rarely in children. The choice of treatment is based on the Anderson-Montesano and Tuli classification systems. We evaluated the outcome of unstable OCF in children and adolescents after halo-vest therapy. Materials and Methods: We treated 6 pediatric patients for OCF, including 3 patients (2 girls, 1 boy) with unstable OCF. Among the 3 patients with unstable OCF, 2 patients presented with an Anderson-Montesano type III and Tuli type IIB injury, while 1 patient had an Anderson-Montesano type I fracture (Tuli type IIB) accompanied by a C1 fracture. On admission, the children underwent computed tomography (CT) of the head and cervical spine as well as magnetic resonance imaging (MRI) of the cervical spine. We treated the children diagnosed with unstable OCF with halo-vest immobilization. Before removing the halo vest at the end of therapy, we applied the CT and MRI to confirm OCF consolidation. At follow-up, we rated functionality of the craniocervical junction (CCJ) based on the Neck Disability Index (NDI) and Questionnaire Short Form 36 Health Survey (SF-36). Results: All children achieved OCF consolidation after halo-vest therapy for a median of 13.0 weeks (range: 12.5-14.0 weeks). CT and MRI at the end of halo-vest therapy showed no signs of C0/C1 subluxation and confirmed the correct consolidation of OCF. The only complication associated with halo-vest therapy was a superficial infection caused by a halo-vest pin. At follow-up, all children exhibited favorable functionality of the CCJ as documented by the NDI score (median: 3 points; range: 3-11 points) and SF-36 score (median: 91 points; range: 64-96 points). Conclusions: In our small case series, halo-vest therapy resulted in good mid-term outcome in terms of OCF consolidation and CCJ functionality. In pediatric patients with suspected cervical spine injuries, we recommend CT and MRI of the CCJ to establish the diagnosis of OCF and confirm stable fracture consolidation before removing the halo vest.

Results of Femoral Elongation Treatment Using Electromagnetic Intramedullary Nail. Preliminary Report.

BACKGROUND: Surgical correction of lower limb discrepancy in children poses a significant clinical problem. The aim of this paper is to present our experience with the PRECICE electromagnetic intramedullary nail. MATERIALS AND METHODS: The study group consisted of 5 patients (2 girls; 3 boys) aged 11.5 to 18 years (mean age 16.3) treated for lower limb discrepancy by femoral lengthening using the PRECICE nail intramedullary system. Average discrepancy was 63 mm (range: 45-74.5 mm). RESULTS: Femoral lengthening was successful in all patients. The femur was lengthened by a mean of 49 mm (range: 40-58 mm). A knee flexion contracture of about 10° occurred in one patient. CONCLUSIONS: 1. Femoral lengthening in children poses a therapeutic challenge. 2. The PRECICE intrame-dullary nail system helps reduce complications and increases patient comfort.

Enhancement of cartilage repair through the addition of growth plate chondrocytes in an immature skeleton animal model.

BACKGROUND: The treatment of articular cartilage damage is a major clinical problem. More often, this clinical issue affects children, which forces doctors to find the best treatment method. METHODS: The aim of this experimental study on 2-month-old Landrace pigs was to compare the results of two cartilage defect treatments: (1) filling the cartilage defect with a scaffold incubated with bone marrow aspirate supplemented with growth plate chondrocytes (the CELLS group) and (2) filling the cartilage defect with an empty scaffold implanted after drilling the subchondral bone (the CTRL group). The treatment outcomes were assessed macroscopically and microscopically. RESULTS: Based on the macroscopic evaluation, all animals showed a nearly normal morphology, with an average of 9.66/12 points (CTRL) and 10.44/12 points (CELLS). Based on the microscopic evaluation, 1 very good result and 8 good results were obtained in the CTRL group, with an average of 70.44%, while 5 very good results and 4 good results were obtained in the CELLS group, with an average of 79.61%. CONCLUSIONS: (1) Growth plate chondrocytes have high chondrogenic potential and thus offer new possibilities for cartilage cell therapy. (2) The implantation of a scaffold loaded with bone marrow-derived MSCs (mesenchymal stem cells) and growth plate chondrocytes into a cartilage defect is a good therapeutic method in immature patients. (3) Cartilage repair based on a scaffold with bone marrow aspirate-derived cells supplemented with autologous growth plate chondrocytes achieves better results than repair with marrow stimulation and a hyaluronic acid-based scaffold (overall microscopic rating). (4) Chondrocyte clustering is a manifestation of the cartilage repair process but requires further observation.

Orthotopic Autologous Chondrocyte Grafting as a Method of Treatment of Growth Plate Damage in Rabbits.

BACKGROUND: With the continuous advances in the therapy of joint cartilage injury, some of those classification systems are also being used for evaluating the quality of regenerating cartilage. Histo lo gi cal assessment of joint cartilage is a very important component in the staging of osteoarthritis and tracing therapeutic outcomes. We performed a histological assessment of regenerating growth plate in a group of New Zealand white rabbits as a component of autologous chondrocyte therapy for growth plate damage. MATERIAL AND METHODS: We studied a group of 14 five-week-old in-bred white rabbits. We used a tre phine needle to harvest growth plate from the medial fourth of tibial width. The mean duration of the procedure was 25 minutes (range: 12-37 minutes). We conducted a total of 25 growth plate harvesting procedures. In 21 cases, we placed a drainage tube at the site of the defect for 22 days. After removing the tube, we introduced a cartilago-fibrinous construct containing cultured autologous chondrocytes into 14 defects, while 4 defects were left intact. Three growth plates represented non-intervention controls. RESULTS: Our analysis showed satisfactory graft morphology and integration; absence of inflammatory res ponse and fair restitution of growth plate architecture. CONCLUSIONS: 1. Growth plate damage can lead to the development of an angular deformity as a result of im paired longitudinal bone growth; 2. Autologous chondrocyte grafting is a good method of treatment for growth plate damage; 3. A weakness of autologous chondrocyte grafting is the relatively long time of chondrocyte culturing.

Results of the treatment of the open femoral shaft fractures in children.

BACKGROUND: Intramedullary nailing has become the treatment of choice for closed femoral shaft fractures in children and adolescents. Immediate intramedullary nailing of open fractures of femur in children remains controversial, with most surgeons preferring to treat grade II or III open fractures either by debridement and traction or external fixation. THE AIMS: The aim of this study is to evaluate the results of intramedullary nailing of open femoral fractures in children. METHODS: 172 children were treated for femoral shaft fracture in our department. 19 fractures were opened in 18 patients. RESULTS: In children with polytrauma, multiple fractures, head injuries and other conditions which necessitate intensive nursing care, intramedullary nailing of opens femoral shaft fractures (type I, II, IIIA, IIIB) should be preferred. CONCLUSION: Satisfactory results were obtained in all patients in terms of self evaluation of patients, radiological and clinical evaluation. The infection rate was much lower for patients who had been given a cephalosporin than for patient who had been given a penicillin or had been given no antibiotic.

Analysis of early vascular and neurological complications of supracondylar humerus fractures in children.

BACKGROUND: Supracondylar fracture of the humerus is one of the most common elbow injuries in children. It represents 60% elbow fractures and 16% all pediatric fractures. Extension-type fracture is the most frequent mechanism of this injury. MATERIAL/METHODS: The aim of our study was to analyse early vascular and neurological complications of supracondylar humerus fractures in 122 children hospitalized in the Department of Orthopaedics and Traumatology, determine fracture types and duration of symptoms, as well as to establish methods of early diagnosis and treatment. The study covered cases of patients treated in the years 2004-2010. RESULTS: Acute neurovascular complications occurred in 15% patients with supracondylar fractures (18 children). Nerve damage was found in 11% patients with displaced fractures (12 children). The average duration of symptoms was 49 days (ranging from 2 days to 5 months). Symptoms of vascular injury occurred in 8% children with displaced fractures (8 children) and were characterized by absent or weak pulse of the radial artery. CONCLUSIONS: 1. Fracture reduction is a priority procedure in the cases of displaced supracondylar fracture, while further diagnostic steps and treatment of possible complications should only be applied afterwards. 2. The incidence of vascular and neurological complications positively correlates with fracture progression according to Gartland classification.

Operative treatment of pediatric pelvic fractures--our experience.

BACKGROUND: Treatment of unstable pelvic fractures in children is a serious surgical problem. Despite similarities between the epidemiology, diagnosis and treatment of pelvic fractures in children and adults, this article attempts to demonstrate age-specific differences in patient management. MATERIAL AND METHODS: In a group of 46 children with pelvic fractures hospitalized in the years 2001-2009, 18 patients required surgical treatment. The fractures were classified according to Tile as type B1 fractures (11% of the patients operated on), type B2 (28%), B3 (22%), and C (39%). Surgical treatment was based on Gordon's classification. RESULTS: Patients were evaluated at 3, 6, and 12 months after surgery. All patients achieved radiological bone union by 3 months after surgery. The length of the lower limbs assessed at 12 months after surgery was the same in all patients. No patients demonstrated an oblique pelvic position. None of the patients had resting pain, but in one case there was slight pain in the sacro-iliac joint region due to incomplete reduction of sacro-iliac subluxation, but repeat surgery was not necessary. In one patient, there was a difference of approximately 15˚ in internal rotation of the hip joints caused by asymmetrical reduction of the pelvic fracture. One patient developed inflammation, which resolved after antibiotic therapy. CONCLUSIONS: Operative treatment of pelvic fractures in children over 8 years of age should be based on the principles of stable fixation and early rehabilitation, as it is in adults. Surgical treatment of unstable pelvic fractures with osteosynthesis in children is a challenge and needs expertise and a well-prepared multi-specialty team.

[Surgical approach through the femoral neck in pathological changes of the femoral head]. / Pozastawowy dostep operacyjny przy zmianach sródkostnych glowy kosci udowej.

Three cases patients with tumors or pathological changes of femoral head. They were treated by surgery by femoral neck approach. We reach the tumor without destroy any articular structures of the hip. In two cases the tumors were removed in total, coagulated and filed up with autogenic bone graft. Third patient with traumatical necrotic changes was treated by autograft.