Is minimally invasive application by intramedullary osteosynthesis in comparison with volar plating real benefit in the treatment of distal radius fractures?

PURPOSE OF THE STUDY: Can minimally invasive intramedullary osteosynthesis of distal radius fractures provide better therapeutic results than multidirectional locking plates. Retrospective study of 68 patients operated for distal radius fractures, 18 were treated with intramedullary X-screw (XSCR) fixation and 50 with the multidirectional angle-stable plate system (APTUS). The evaluation at 1-year follow-up included functional status of the wrist and hand, and radiographic findings. In the XSCR group, the functional outcomes of the treated extremity did not achieve values comparable with those of the uninjured side in any of the parameters measured. The radiographic findings did not meet the requirements of successful healing due to failure to restore an anatomical volar tilt in 22.2% cases. In the APTUS group, comparable values of the injured and the uninjured side were achieved in radial deviation, ulnar deviation, pronation, supination and grip strength. The radiographic criteria of successful healing were met by all fractures treated by locking plate osteosynthesis. Implant migration associated with secondary displacement of bone fragments was recorded in 33.3 % of the XSCR patients and only in 4.0 % of the APTUS patients. The overall evaluation show that intramedullary osteosynthesis does not produce better treatment outcomes compared with plate osteosynthesis in indicated types of fractures.

Expression of heat shock protein receptors on fibroblast-like synovial cells derived from rheumatoid arthritis-affected joints.

We examined the membrane expression of inducible Hsp70 and HSP receptors like TLR2, TLR4, CD14, CD36, CD40 and CD91 on fibroblast-like synovial cells (SC) derived from synovial tissue in 23 patients with rheumatoid arthritis (RA), who underwent synovectomy by using flow cytometric analysis. For comparison, autologous skin fibroblasts (SF) derived from the operation wound were tested. Significantly higher Hsp70 expression was found on synovial cells than on skin fibroblasts (median SC 21.4% x SF 5.0%, P < 0.001). Both synovial cells and skin fibroblasts expressed high levels of cell surface CD91 (median SC 80.2% x SF 79.2%), however, no or low levels of CD14, CD40, TLR2, TLR4 and CD36. Further, we observed high co-expression of CD91 and Hsp70 on RA synovial cells (median 18.6%), while skin fibroblasts showed only background Hsp70 expression (median 3.9%, P < 0.001). Since we demonstrated the high prevalence of inducible Hsp70 in RA synovial fluids, we speculate that Hsp70 might be captured onto the membrane of synovial cells from the extracellular space via the CD91 receptor. The significance of the Hsp70 interaction with synovial cells via CD91 remains undefined, but may mediate other non-immune purposes.

Primera experiencia con un método propio en la artrodesis total de muñeca / The first experience on a personal surgery technique of arthrodesis

Se enfatiza sobre la importancia de un carpo estable y no dolorosa para la función de los dedos. Las reflexiones sobre nuestro propio método de osteosintesis están basados en hallazgos anatómicos y biomecanicos, enfatizando el concepto, funcional del pilar central de la muñeca donde la flexión y la extensión maxima ocurre. En este sentido se aplica la placa en la línea formada por la porción distal del radio, semilunar, hueso grande y la base del tercer metacarpiano. La placa es comparada con la clasica placa AO, baja, (solo 2,7 mm) con forma de L y ligeramente convexa dorsalmente en su sección transversal. Esto sigue el arco natural del carpo y metacarpianos no aumentando la tensión de las estructuras blandas ni de la piel que la cubre. Por la focalización de los agujeros ovales permite una ligera autocompresión y asegura una adecuada fijación en tres puntos del metacarpo. La abertura oval en la rama corta de la placa sirve para localizar en centro de la sección transversa del segundo metacarpiano y asegura una correcta colocación del tornillo, haciéndose así posible una operación plástica de los extensores los cuales en sinovitis reumática y destrucción del carpo son frecuentemente lesionados. Se presentan los resultados de 29 operaciones. La consolidación ósea adecuada fue lograda en todos los pacientes con un promedio de 2 meses y medio. El inicio de altura del carpo (CIH) aumento y el agarre de la mano mejoro. En 11 pacientes se encontró ruptura de los extensores, los cuales se repararon. En todos los casos se realizo sinovectomia y resección de la cabeza del cubito. Se realizo la artrodesis bilateral en 3 pacientes. En un caso se observó infección de la herida cicatrizando por segunda intención