ABSTRACT
It is known that metallic elements of joint endoprostheses undergo elastic strain due to their mechanical function. This is one of the factors which may be responsible for the loosening of endoprostheses. Since mechanisms involved in it remain unclear, it seems valuable to verify if cells responsible for bone regeneration are affected by a strain of the implant. Our experiment examines the influence of elastic strain applied to Ti6Al4V samples on osteoblasts cultured on their surface in vitro. Human bone-derived cells are observed in contact with metallic plates. Titanium alloy was chosen as a support since it is one of the most commonly used materials for stems in joint endoprostheses. Cyclic elastic deformation of 0.1% was applied to the support once daily for 7 days. Two thousand cycles were applied each time. Samples which were not subject to strain served as control. After the observation period XTT assay was performed, alkaline phosphatase activity as well as osteocalcin concentration and nitric oxide secretion were determined and compared with the results obtained in the control group. It was found that the number of viable cells in the mechanically stimulated population was significantly higher than in control, while both alkaline phosphatase activity and osteocalcin concentration were significantly lower in the experimental group. Nitric oxide secretion was found in the culture which was subject to elastic strain, but not in the control. The possible clinical implication is that elastic strain of the metallic endoprostheses may influence osteoblasts which are in contact with the implant in vivo.
Subject(s)
Biocompatible Materials , Joint Prosthesis , Osteoblasts/cytology , Titanium , Adolescent , Aged , Alloys , Biomechanical Phenomena , Cells, Cultured , Female , HumansABSTRACT
In the process of treating children with cerebral palsy one of the basic elements is the skill of identifying the foundations for making the decision to employ the proper types of procedures. These decisions should be based on an evaluation of the etiology of the child's mobility impairments, or more precisely the factors that impede the child's movement. These factors may be the sequelae of the primary damage to the central nervous system, or of secondary complications, such as muscle spasms, and this distinction effects and complicate the primary disability.
ABSTRACT
Results of treatment with three various kinds of allografts: lyophilized bone, deep frozen bone and cartilage preserved in physiological solution, all of them radiation-sterilized are presented. We believe that this presentation may be helpful in estimating the tissue bank's allografts and in establishing indications and contraindications in the application of allografts in surgery.The 'indices of coincidence' were compared in a group of 1014 patients after bone (lyophilized and radiation-sterilized) transplantation. It seems that such a variable as 'rebuilding of graft' may be of prognostic value in analysing the results of treatment in this group.The application of frozen and radiation-sterilized allogenic bone grafts for reconstructions is also described. An analysis of the results of treatment in 1125 patients reveals that the use of preserved bone reduces the extent and duration of surgery. Almost total substitution of grafts may be seen in 3-8 months after surgery.Allogenic, preserved cartilage is often used in facial reconstructions of face. Human costal cartilage, preserved in 0.9% NaCl and radiation-sterilized, was used for reconstruction. The patients were examined 24-190 months after surgery (in several clinical units) and results were collected in a special questionnaire by the team that performed surgery. In an analysed group of 437 patients after cartilage transplantation, 42.2% were operated because of posttraumatical changes, 29.0% because of congenital malformations and in 16.7% non-specific inflammations were the cause of reconstructive operations. Malformations were located mainly in the nose (59%), the ear concha (16.5%) and 10.9% were mandible.The results of treatment were compared with ages of patients, diagnosis and the locations of the changes. Very good results were achieved in 33.5% of the patients, and satisfactory in 41.8% of the patients. However, in 19.9% of the patients the result of treatment was unsatisfactory. Correlation between some clinical and biological characteristics and the result of treatment is under discussion.
ABSTRACT
Between 1981 and 1998 frozen and radiation sterilized bone allografts were transplanted into 1376 patients at the Institute of Traumatology, Orthopaedic and Neurosurgery of the Military School of Medicine in Warsaw. Of these 179 (13%) required treatment due to benign tumours. Incidence of solitary cysts was highest (127 cases, 71%), mainly occurring in children (84%). During surgery bone cysts were excised and filled by bone grafts. Results were evaluated several years after surgery (2-10 yrs) using x-rays and clinical examination. Rebuilding of allografts was one of the most important prognostic factors. Within the period of observation time 83% of transplanted allografts were rebuilt and substituted by own patients bone.
Subject(s)
Bone Cysts/surgery , Bone Transplantation/methods , Adolescent , Adult , Bone Cysts/diagnostic imaging , Child , Child, Preschool , Female , Freezing , Humans , Infant , Infant, Newborn , Male , Middle Aged , Radiography , Sterilization , Transplantation, HomologousABSTRACT
Post-traumatical malformations of bone are often reconstructed with the use of preserved bone allografts. At the Institute of Traumatology, Orthopaedics and Neurosurgery 495 patients were treated with use of preserved (frozen and radiation-sterilized) bone allografts, following trauma, between 1981 and 1995. Non union of bone and osteomyelitis were main reasons for allotransplantation of bone. Remodelling of bone allografts has been observed during 2-8 years after surgery. Substitution of allografts and good result of treatment were found in 80% of all cases. In paper the analysis of results of treatment is presented.
Subject(s)
Bone Transplantation/methods , Fractures, Malunited/surgery , Adolescent , Adult , Aged , Child , Fractures, Malunited/diagnostic imaging , Freezing , Humans , Middle Aged , Osseointegration , Osteomyelitis/diagnostic imaging , Osteomyelitis/surgery , Radiography , Sterilization , Transplantation, HomologousABSTRACT
102 children have been treated at the Institute of Traumatology, Orthopaedics & Neurosurgery a result of scoliosis. In all of these multi-step treatment has been applied. Initially a telescopic rod was implanted into the spine. Allografts were introduced around the rod hook, after 6 or 8 months, when angle of scoliosis increased, the rod was exchanged for a longer one. The final step was performed when conditions permitted and the scoliosis was markedly corrected and the fusion of the spine with the solid allograft was accomplished. The result of treatment was evaluated 1 to 7 years after surgery. Bone allografts were rebuilt within 6 month. Correction of scoliosis of 50% to 70% was achieved in all cases.
Subject(s)
Bone Transplantation/methods , Scoliosis/surgery , Spinal Fusion/methods , Adolescent , Child , Female , Freezing , Humans , Orthopedic Fixation Devices , Radiography , Scoliosis/diagnostic imaging , Sterilization , Time Factors , Transplantation, HomologousABSTRACT
The number of posttraumatic spinal fractures is constantly growing. About 15-20% of patients injury need surgery after injury, as result of spinal instability or canal stenosis often leading to neurological complications. In 1987-97 56 patients (6 female and 50 male) were treated following serious spine trauma with fractures. The age of the patients was 19-61 years. Car accidents were the most common cause of trauma affecting 30 patients (53%), falls from heights affecting 26 patients (47%). Multiple injuries were diagnosed in 24 patients (43%). More than one vertebra was fractured in 15 patients (27%). In 9 cases (16%) surgery was performed within 24 hours of the accident, in 22 (39%) within 72 hours and in 25 patients (45%) after 72 hours, in some cases even several weeks after the trauma. 20 patients (36%) required spinal decompression after the accident. The fracture in one case was located in the thoracic section, in 17 patients in Th11-L2 and in 2 patients in L3-L5 section. In 4 cases reconstruction of the meninx was performed. 48 patients were treated by stabilisation using Harrington rods; in 5 patients Kluger stabilisers were used, in the remaining 3 patients stabilization was carried out by wire loop. In all cases frozen and radiation-sterilized bone allografts were applied. Results were evaluated 2-8 years after surgery using X-rays, CT-pictures and direct examination. In 25 patients (45%) results were found to be good, in 23 patients (41%) mediocre and in 8 patients (14%) results were unsatisfactory.
Subject(s)
Bone Transplantation/methods , Spinal Fractures/surgery , Adult , Female , Humans , Lumbar Vertebrae , Male , Middle Aged , Spinal Cord Compression/surgery , Thoracic Vertebrae , Transplantation, HomologousABSTRACT
The application of frozen and radiation sterilized allogenic bone grafts for reconstructions in orthopaedic operations is described. Analysis of results of treatment of 1125 patients was performed. It was found that use of preserved bone allows to reduce the extend and duration of surgery. Nearly total substitution of grafts may be seen in 3 to 8 months after surgery.
Subject(s)
Bone Transplantation/methods , Adolescent , Adult , Aged , Bone Remodeling , Bone and Bones/radiation effects , Child , Child, Preschool , Cryopreservation , Disinfection , Female , Follow-Up Studies , Humans , Infant , Male , Middle AgedABSTRACT
Geometric osteotomy and the results of treatment of axial deformities of lower extremities with this method have been presented. The major point of the procedure is cutting out a solid figure, usually a triangle based prism in order to achieve large contact surface and decrease muscle leverage at the site of the osteotomy. The method has been used in 12 operations around the hip and in 19 around the knee. Good results have been achieved with the exception of 4 children operated around the knee (3 of them because of Blount disease); the results were rated fair.
Subject(s)
Femur/surgery , Osteotomy/methods , Tibia/surgery , Adolescent , Child , Female , Femur/abnormalities , Humans , Male , Tibia/abnormalitiesABSTRACT
Functional treatment of crush fractures of distal femur in 2 patients is described. Quadriceps-plasty has been performed in both cases due to the muscle adhesion to bony fragments. Osteosynthesis was contraindicated by the nature of the fracture. Functional treatment resulted in good function and efficient gait in both patients.
Subject(s)
Femoral Fractures/surgery , Muscle, Skeletal/injuries , Wounds, Nonpenetrating/surgery , Adult , Femoral Fractures/diagnostic imaging , Gait , Humans , Male , Middle Aged , Muscle, Skeletal/surgery , Muscular Diseases/surgery , Radiography , Tissue Adhesions/surgery , Wounds, Nonpenetrating/diagnostic imagingABSTRACT
A case of 12 years old girl operated on because of genu recurvatum and paretic clubfoot after buttock and thigh phlegmon in infancy has been presented. There were 2 stages. In the first one the correction of clubfoot was performed, m.quadriceps was elongated in the second one. Good cosmetic and functional result has been achieved.
