[Treatment principles in bone reconstruction and limb lengthening of the lower extremity].

Limb length discrepancies, axis deviations and bone loss on a congenital, traumatic or infectious basis are treated with restoration of axis and bone elongation. The intention is to improve gait and function, to relieve pain caused by imbalance in the musculoskeletal system and to prevent degenerative joint disease. Modern motorized intramedullary nails spare the patients for external fixators, and thus complications are being reduced. X-ray, CT-based planning and a thorough clinical examination is essential for a good result. Complications are frequent, and treatment can be lengthy. Modern techniques have made treatment more gentle and allow a normal daily life during treatment and rehabilitation.

The Masquelet technique of induced membrane for healing of bone defects. A review of 8 cases.

BACKGROUND: Segmental defects of long bones are notoriously difficult to treat. This study evaluates eight cases in which the Masquelet technique of induced membranes was used. The primary purpose was to assess the results compared to other types of bone reconstruction and share our tips and tricks to improve the outcome. METHOD: Retrospective study based on patient records and radiographs. Eight patients operated between 2011 and 2014 were included. Three had infected non-unions. Outcome measures were time-to full weight-bearing, time to radiographic consolidation, need for secondary bone grafting procedures and occurrence of complications. RESULTS: Time to full weight bearing seemed shorter in patients treated with nails. In two cases only partial radiographic consolidation was noted at the latest follow up visit. One patient needed secondary bone grafting and two limbs were malaligned. There were no amputations, no persistent infections, and no implant failures. DISCUSSION: The induced membrane technique is a useful tool to substitute bone loss yet consolidation time is somewhat unpredictable and prolonged non-weight bearing is required. CONCLUSION: Nailing seems to improve outcome compared to plating. It shortens treatment time, reduces the amount of bone graft needed, aligns the bone and should be considered when feasible. Further larger scale studies are welcome to throw more light into the efficacy and effectiveness of this technique.

Bone infection in patients suspected of complicating osteomyelitis: the diagnostic value of dual isotope bone-granulocyte scintigraphy.

AIM: The purpose of this study was to evaluate the diagnostic value of dual isotope bone-granulocyte scintigraphy in patients with known bone pathology clinically suspected of osteomyelitis, i.e. complicating osteomyelitis, using per-operative bacterial culture from bone as reference. METHODS: Simultaneous dual isotope bone-granulocyte scintigraphic images were obtained in 42 consecutive patients in whom conventional X-ray, erythrocyte sedimentation rate, and C-reactive protein were also available. 99mTc MDP bone and 111In labelled granulocyte imaging was obtained simultaneously. The images were interpreted as positive for osteomyelitis if regions of interests of pathologic 111In granulocyte accumulation included 99mTc MDP activity on the bone images (except in the spine). RESULTS: The sensitivity, specificity, and accuracy were 84, 71 and 79%, respectively, for simultaneous, dual isotope bone-granulocyte scintigraphy, higher than the other diagnostic parameters. CONCLUSION: Simultaneous bone-granulocyte scintigraphy is a valuable diagnostic tool in diagnosing osteomyelitis complicating other bone pathology with or without soft-tissue infection.

Partial or total open meniscectomy? : A prospective, randomized study.

In order to compare partial with total meniscectomy a prospective clinical study of 200 patients was carried out. At arthrotomy 100 patients were allocated to each type of operation. The two groups did not differ in duration of symptoms, age distribution, or sex ratio. The operations were performed as conventional arthrotomies. One hundred and ninety two of the patients were seen at follow up 2 and 12 months after operation. There was no difference in the period off work between the two groups. One year after operation, 6 of the 98 patients treated with partial meniscectomy had undergone further operation. In all posterior tears were found at both procedures. Among the 94 patients undergoing total meniscectomy, 4 required further operation. In each, part of the posterior horn had been left at the primary procedure. One year after operation significantly more patients who had undergone partial meniscectomy had been relieved of symptoms. However, the two groups did not show any difference in the degree of radiological changes present.