Successful treatment of infectious delayed union after ulnar shortening osteotomy using once-weekly teriparatide with low-intensity pulsed ultrasound.

We report a 50-year-old woman who presented with infected delayed union after ulnar shortening osteotomy. She was a chronic smoker. Implants were removed and infected tissue was debrided. Sufficient bony union was obtained after 5 months of treatment with weekly teriparatide and low-intensity pulsed ultrasound during the infection-controlled waiting period.

Palmar plating for AO/ASIF C3.2 fractures of the distal radius with arthroscopically assisted reduction.

We performed a retrospective study of 15 patients with AO/ASIF C3.2 fracture of the distal radius. All patients were treated with arthroscopically assisted reduction of the radiocarpal joint followed by palmar plating with autologous bone graft, with a follow-up evaluation of 24 months. According to the demerit point system of Gartland and Werley, five patients had excellent results and 10 had good results. Grade 1 arthritic changes were found in 10 patients even though with no step-off on radiographs. In the current study, this combined treatment was challenging and useful for AO/ASIF C3.2 fractures.

Palmar plating system for Colles' fractures--a preliminary report.

PURPOSE: To present our results of the palmar plating system that we developed for the treatment of Colles' fractures. METHODS: By using the palmar plating system that we developed a consecutive series of 40 acute Colles' fractures were treated surgically. There were 12 men and 28 women with a mean age of 57 years at the time of the injury (range, 25-90 y). All patients had internal fixation using the trans-flexor carpi radialis tendon approach. The system has 3 main features. First, the plate is small in size, being 1.1 mm in thickness and 47 mm in length. Only a 3- to 4-cm skin incision is required for application of the plate. Second, the screw is cannulated and cancellous in type, with a low-profile head. Subchondral screw fixation is achieved both easily and safely by using a guidewire. Third, the plate has a window through which injectable bone cement can be placed. RESULTS: Union was achieved in all patients. The palmar tilt, radial inclination, radial length, and ulnar variance were maintained after surgery. According to the Gartland and Werley rating scale that was modified by Sarmiento there were 12 excellent and 28 good results. There were no extensor tendon injuries that could occur when the dorsal approach was used. CONCLUSIONS: This palmar plating system can make fixation of the distal radius easy, safe, and effective in the treatment of unstable Colles' fractures.

Creating bioabsorbable Schwann cell coated conduits through tissue engineering.

Enormous effort has been devoted to the generation of a synthetic guidance conduit for nerve repair instead of utilizing autograft. Several studies show neural guidance conduit is more effective when coated with Schwann cells. In this study, we synthesized bioabsorbable conduit consist of L-lactide and epsilon-caprolactone which was useful clinically and examined adhesion of Schwann cells to bioabsorbable conduits. In vivo studies were done in which these polymer conduits coated with Schwann cells were implanted across a 12 mm gap in the rat sciatic nerve. Silicone conduits were implanted across the same gap as control. At 12 weeks, axonal regeneration was observed in the midconduit region of these polymer conduits and was not in control. This study assesses the feasibility of a tissue engineering approach to constructing bioabsorbable conduits coated with Schwann cells.

Experimental study of polarity in reversing cable nerve grafts.

To evaluate the effect of cable nerve graft polarity, the bilateral common peroneal nerves in 12 rabbits were excised to create 20-mm nerve gaps. These gaps were repaired with cable grafts using three strands of 20-mm ipsilateral sural nerves. In the left leg, the sural nerves were grafted with the original orientation. In the right leg, the nerve graft polarity was reversed 180 degrees. Six months later, motor conduction velocities were evaluated, and the bilateral anterior tibial muscles and extensor digitorum longus muscles were measured. The nerves were harvested and analyzed histologically. Motor conduction velocity was 37.4+/-4.1 m/s in the reversed group, and 36.6+/-5.5 m/s in the control group. The weight of the muscles was 7.2+/-0.8 g in the reversed orientation, and 7.0+/-1.0 g in the original orientation. None of the differences was statistically significant. Histologically, the axon counts and the axonal density distal to the nerve graft also showed no differences between groups. The sural nerves used did not have a major branch and their diameter was almost the same throughout its length. Reversing nerve graft polarity of a cable graft did not affect nerve regeneration electrophysiologically or histologically.