[Maxillofacial trauma in pediatric age]. / Traumi maxillofacciali in età pediatrica.

The different incidence of various kinds of maxillofacial fractures in children are examined and the causes of such differences are analyzed. The most significant are the variations in morphology of the maxillofacial skeleton during the children's growth and the physical-statistic problems strictly connected. Attention is drawn on the diagnostic difficulties of traumas due to fractures during childhood, sometimes unknown, especially with regard to the heavy functional and aesthetic exits which may occur.

Does total hip arthroplasty mean sensorial and proprioceptive lesion? A clinical study.

Total hip arthroplasty means sacrificing the joint capsule and the mechanoreceptors contained therein. Recent neurophysiological experiences seem to redefine the sensorial and proprioceptive role of the joint capsule in favor of the activity of the muscular mechanoreceptors, particularly in the area of the coxofemoral joint. The authors have examined the sensorial lesion caused by total hip arthroplasty in a group of 20 patients. Clinical testing was conducted prior to surgery, 7 and 40 days later. The tests were aimed at exploring the perceptive and proprioceptive activity of the hip, and showed marked decrease in all of the receptorial activity one week after surgery. After 40 days perceptive function was completely recovered, as the scores for tests conducted were the same as those obtained prior to surgery: proprioceptive activity was instead considerably improved, with significant changes in most parts of the tests. The authors conclude by observing that total hip arthroplasty does not cause permanent lesion of the perception of joint movement; furthermore, renewed coxofemoral mechanics allow for a better proprioceptive response with strengthening of static and dynamic antigravitational reactions.

Chondromalacia of the patella. Natural progression.

A total of 42 cases of patellar pain in subjects aged an average of 17.2 years submitted to arthroscopy are analyzed. Femoropatellar balance, where indicated, led to resolution of disorders with full resumption of sports activity. In the remaining cases chondromalacia showed the features of an affection with a spontaneously favorable course, confirming the common orientation towards conservative treatment. Arthroscopy is effective for a correct classification of cartilaginous lesions, and it is a good instrument to use when attempting to achieve recovery of patellofemoral joint when disorders are caused by a lack of equilibrium.

CKS knee prosthesis: biomechanics and clinical results in 42 cases.

From 1991 to 1993 a total of 42 CKS prostheses were implanted for the following reasons: osteoarthrosis (34 cases), rheumatoid arthritis (7 cases) tibial necrosis (1 case). At follow-up obtained after 17 to 41 months the results were: excellent or good: 41; the only poor result was probably related to excessive tension of the posterior cruciate ligament. 94% of the patients reported complete regression of pain, 85% was capable of going up and down stairs without support. Mean joint flexion was 105 degrees. Radiologically the anatomical axis of the knee had a mean valgus of anatomical axis of the knee had a mean valgus of 6 degrees. The prosthetic components were always cemented. The posterior cruciate ligament was removed in 7 knees, so that the prosthesis with "posterior stability" was used. The patella was never prosthetized. One patient complained of peri-patellar pain two months after surgery which then regressed completely.

Changes in growth of the ilium after sopraacetabular osteotomy. Long-term evaluation.

It is commonly known that in acetabuloplasty according to the Pemberton-Zanoli method the insertion of the graft produces an immediate increase in the height of the iliac wing which in successive months could become hypergrowth caused by the hyperactivity of the underlying Y cartilage. A total of 40 cases of insufficiency of the acetabular roof treated by this method were examined based on measurements on follow-up radiograms and an evaluation of the spino-malleolar distance until puberty. The clinical evaluation showed that in 82.5% of cases there is dysmetria that is less than or equal to 0.5 cm. An evaluation of radiograms at the end of growth of the ilium [correction of ileum] did not reveal significant variations between the hemipelvis submitted to surgery and the contralateral one either in cases treated by acetabuloplasty alone or in those in which intertrochanteric osteotomy was associated. Acetabuloplasty according to the Pemberton-Zanoli method is thus effective in the treatment of acetabular dysplasia at a young age, obtaining long-lasting effects and ones that do not cause dysmetria in the adult.

The Marfan syndrome. An underdiagnosed killer.

The Marfan syndrome is an inherited connective-tissue disorder. The sequela of the syndrome is premature death that is most often due to cardiac complications and that can be prevented with early diagnosis and aggressive management. Although research has identified a gene responsible for the myriad of phenotypic presentations, the diagnosis of Marfan syndrome remains clinical. The family physician is well positioned, with consultation from an experienced cardiac surgeon, to orchestrate the diagnosis and management of the Marfan syndrome.

Acute posterior dislocation of the shoulder: diagnosis.

The authors describe the clinical and radiographic findings of posterior dislocation of the shoulder by examining 19 cases observed at the Rizzoli Orthopaedic Institute between 1981 and 1990; of the total number of cases, 16 were acute and 3 inveterate, equal to 1.7%. After analyzing the pathogenesis of the lesion, which was due to direct trauma, indirect trauma, or which occurred during an episode of convulsions, the authors call attention to the rareness of the lesion, and consequently the little amount of knowledge of the clinical and radiographic elements characterizing it. Three varieties are distinguished: subacromial (or retroglenoid), subglenoid, and subspinous. Finally, the results obtained with non-surgical treatment, which always allows for recovery of the joint relationships and complete functional recovery, are reported.

The herniated lumbar intervertebral disc in children and adolescents. Long-term follow-up of 101 cases treated by surgery.

The authors review 101 cases of herniated lumbar intervertebral disc in children and adolescents treated by surgery. The most significant etiologic and pathogenetic factors in this series were early onset of disc degeneration, congenital lumbosacral malformations, and repeated trauma. The main clinical symptom was pain, usually sciatica, while neurological symptoms were less common than they are in adults. In all patients diagnosed correctly with the aid of appropriate imaging studies (myelography, CT scan, MRI), discectomy by means of conservative hemilaminectomy achieved satisfactory results, except in two cases of concomitant spinal instability due to spondylolysis and in one case of recurrence.

The surgical treatment of fractures of the pagetic femur: a case report.

Based on anatomo-pathological findings in fractures in bones affected with Paget's disease, the authors discuss problems related to treatment. One case is reported in which treatment involved intramedullary osteosynthesis with locked nailing and corrective osteotomy. This type of treatment achieved a dual purpose of obtaining fracture consolidation within a short amount of time, and correcting the deformity.

[Cephalometric analysis in acromegalic patients]. / Analisi cefalometrica nel paziente acromegalico.

The authors of the present work have done a cephalometric study on 11 patients affected by acromegaly. The target of this research was to obtain with cephalometric analysis a means for the follow up of the disease together with an important provisional parameter of growth of the face bones, helping thus to obtain an early diagnosis and the general lines for a correct therapy. With the data obtained has been extrapolated a table with average data of cephalometric angles that, transferred on to a tracing could represent the cephalometric prototype of an acromegalic patient.

Osteoid osteoma of the spine.

After reviewing the international literature the authors present three new cases of osteoid osteoma with vertebral body localisation, two in the lumbar region, and one in the cervical region. This rare localisation necessitates the use of accurate instrumental techniques, based on radiography, scintigraphy, and in particular, CT scanning, in order to arrive at a correct diagnosis as a prelude to the correct surgical treatment.

[Radiographic diagnosis of dislocations and fracture-dislocations of the carpus]. / Diagnosi radiografica delle lussazioni e fratture-lussazioni del carpo.

A variety of unique and very rare carpal dislocations are reported. According to personal findings, an extension of the descriptive classification of this pathology is proposed, utilizing also the X-ray files of the Rizzoli Orthopaedic Institute. Moreover, the radiographical features are evaluated which help choosing the treatment to be followed.

Effect of temperature on isoprenaline- and barium-induced slow action potentials in guinea-pig ventricular strips.

The effect of variation in temperature (37-32 and 27 degrees C) on electrical and mechanical activity of depolarized and isoprenaline- or barium-reactivated guinea pig ventricular strips was studied. Lowering the temperature brings a marked prolongation of isoprenaline-induced slow action potentials. In addition the maximal rate of depolarization was strongly reduced at lower temperatures. These effects were observed at an extracellular Ca2+ concentration of either 0.9 or 2.5 mM. The accompanying mechanical activities was significantly increased by reduction in temperature. Barium-induced slow action potentials were similarly affected by temperature variations. These observations suggest that hypothermia exert a sort of calcium antagonistic action probably coupled to a reduction of repolarizing outward potassium currents.