Radiographic changes of the revascularized femoral head.

Twenty-two necrotic femoral heads in young adults were radiologically followed-up after grafting with vascularized bone by comparing the preoperative and the postoperative state of the hip joint. Three parameters were observed and followed; the flattening of the femoral head; the degree of osteoarthrosis of the joint; and the degree of incorporation of the graft into the recipient bone. The results, expressed by index figures, showed that the femoral head flattened during the first two years postoperatively; that the maximal incorporation occurred during the same period of time; and that the appearance of postoperative osteoarthrosis was slow during the first year and increased subsequently. This numerical characterization of radiological findings allows systematic individual analysis after revascularization of the femoral head with bone grafts. It is also suited for comparisons between patients, between series of patients and of various treatment techniques. Furthermore, this quantification provides a numerical index that seems to correlate with the outcome of the treated hip joint.

Vascularized pedicled bone graft into the femoral head--treatment of aseptic necrosis of the femoral head.

Revitalization of the femoral head in cases of aseptic necrosis was attempted in 13 hips of 11 patients 15-33 years of age. The necrotic bone was replaced by a vascularized pedicular iliac bone graft and free cancellous transplants. The results after an average follow-up of 53 months are satisfying in some cases. The surgical technique used is simple and applicable when a vascularized bone graft is needed in the hip region.

Results of treatment of aseptic necrosis of the femoral head with vascularized bone graft.

Osteonecrosis of the femoral head with deformity was treated with vascularized iliac crest grafts or with free microanastomosed fibular grafts in 20 young adults (22 hips). The clinical and radiographic results at two years and five years are presented. The overall results are promising. The hips gradually improved both clinically and radiographically during the first two years. The changes after that were less significant. The Danielsson pain score decreased from 91 (preoperative) to 28 during the first two years and declined to 18 during the second period of observation. Walking ability (measured by the Merle d'Aubigné method) improved from a preoperative score of 46 to 29 during the first two years and then to 10 during the three following years. The range of joint movement first decreased, and then increased again during the second follow-up period. There was radiographic evidence of graft fusion to the surrounding bed in 18 hips during the first two years and in all 12 hips of the second series with a two to five year follow-up. Homogenization of the femoral head was observed in 18 cases in the first two year follow-up series and in 10 in the second two to five year follow-up series. Stabilization of the femoral head shape was observed in 19 hips in the first series and in 12 hips in the second series. During the second period of observation, 9 patients were able to return to their former occupation and 2 were retained for new occupations.

Vascularized pedicled pubic graft. A topographical anatomical study in human cadavers.

The topographical anatomy and the vascular variety of the pubic arch was studied on ten fresh human cadavers (15 hemipelves). The idea was to obtain a pedicled vascularized bone graft to be used in the hip region and as an alternative to an iliac crest pedicled graft. The size of the possible graft and the length of the pedicle were measured and evaluated.

Construction of acetabular bone stock. A staged cementless arthroplasty of the hip.

Vascularized pedicular bone graft was used for the purpose of achieving a sufficient bone stock for cementless total hip arthroplasty in patients with major acetabular bone defects. A useful bed for the acetabular prosthesis was obtained in all three cases. The ordinary prosthetic arthroplasty was performed in the second phase. The vitality of the grafted bone was then controlled. The results after a follow-up time of 23, 32 and 40 months respectively are good.

Muscle pedicled bone graft in revascularization of aseptic necrosis of the humeral head.

A deltoid muscle-pedicled bone graft was used to treat avascular necrosis of the humeral head. Eighteen months later there was evidence of clinical improvement of the joint function, and plain x-rays and tomography showed signs of graft fusion in the recipient bed with reorganization of the formerly necrotic bone matrix in the humeral head.

High doses of the diphosphonate EHDP for the prevention of heterotopic ossification. An experimental and clinical study.

The effect of Ethane-1-Hydroxyl-1, 1-Diphosphonate (EHDP) on experimental and clinical heterotopic ossification was studied. Demineralized cortical bone matrix was implanted in the abdominal wall of three groups of adult male rats. Two groups received injections amounting to 5 and 20 mg/kg/day of EHDP, respectively, and a control group received placebo. The lower dose of EHDP had no effect on bone formation, whereas the higher dose resulted in a marked reduction in ash content and 45Ca uptake in the implants. Inhibitory effects on heterotopic bone and serum alkaline phosphatase activity were observed when treating with high doses (50 mg/kg/day) a paraplegic patient following resection of para-articular ossifications around the hips. The effect of EHDP on bone formation is interpreted as reflecting a dose-dependent interference with the deposition of hydroxyapatite crystals in the bone matrix.

Angiography of a hand with symptoms of an ulnar nerve entrapment syndrome.

An angiography of the hand was performed on a pianist suffering from symptoms of an ulnar nerve entrapment syndrome. The examination revealed in the hand a rare anomalous arterial pattern, which explains the patient's symptoms.

A new atraumatic and simple method of taking sural nerve grafts.

Because the sural nerve has become the most frequently used nerve as graft material in peripheral nerve reconstruction, an atraumatic method was developed for its harvesting. The nerve is easily identified in the popliteal region by stretching it slightly behind the lateral malleolus. Only two short skin incisions are needed for centrifugal liberation of the nerve. The advantages of the method presented lie in shorter operation time, a superior cosmetic result and a fairly intact nerve for grafting.

Tourniquet ischaemia. Clinical and biochemical observations.

The duration of tourniquet ischaemia was recorded in 1000 consecutive operations on extremities under a bloodless field, the average ischaemia time was 74.11 +/- 29.52 minutes. The duration of tourniquet ischaemia in meniscectomies was 58.47 +/- 15.91 minutes, in osteosynthesis of malleolar fractures 88.46 +/- 23.33 minutes and in operations for endoprosthetic replacement of the knee joint 131.19 +/- 11.24 minutes. In 85 cases the commonly accepted two hour limit for tourniquet time was exceeded without clinical complications. LDH and CPK levels in venous blood were studied in 15 operations. No significant changes were seen in LDH levels when recorded up to 24 hours following release of the tourniquet. CPK levels increased significantly (p less than 0.05) and highly significantly (p less than 0.005) when measured three hours and 24 hours after the release of the tourniquet, respectively. The results of the study suggest that two hours of ischaemia of the extremities is relatively well tolerated.