Low-intensity pulsed ultrasound in the conservative treatment of pseudoarthrosis.

AIM: The management of pseudarthrosis remains a challenge. Several in vivo animal and controlled clinical studies have demonstrated that low-intensity pulsed ultrasound can influence fracture healing. METHODS: A prospective longitudinal design was used. Fifteen patients (12 males and 3 females; mean age 35.5+/-12.9, range 18 to 60), all amateur athletes, under treatment for pseudarthrosis at different sites (average fracture age: of 336.6+/-60.1 days) were treated with a single 20 min daily application of low-intensity pulsed ultrasound (frequency 1.5 MHz and intensity 30 mW/cm2). All patients underwent clinical examination and plain radiography at the beginning of treatment and were followed up clinically and radiographically at 4, 8, 12, 16, 20 and 24 weeks until the fracture healed. RESULTS: All fractures healed with a mean healing time of 94.7+/-43.8 days. CONCLUSION: Low-intensity pulsed ultrasound is effective in the management of long standing fracture non-unions. Prospective randomized studies are needed to confirm the value of this modality of treatment.

Post-traumatic cubitus varus. Long-term follow-up of corrective supracondylar humeral osteotomy in children.

The results in twenty-four patients who had had a supracondylar osteotomy of the humerus to correct post-traumatic cubitus varus were reviewed after the patients had completed skeletal growth. The average age of the patients was 7.9 years at operation and thirty-one years at the time of follow-up. The average duration of follow-up was twenty-three years. According to our grading system, seven patients had a good; six, a fair; and eleven, a poor result. All but two of the nineteen patients in whom the humero-ulnar angle had been measured preoperatively lost correction that had been obtained at operation. No correlation was found between the quality of the result and either the age of the patient at operation or the amount of correction that had been obtained at operation. The correction that was obtained at operation was maintained in the two patients in whom the cubitus varus deformity had been caused by malunion of a supracondylar fracture. However, when the deformity followed either physeal injury or supracondylar fracture with damage to the physis secondary to the initial trauma, the correction was not maintained. At the most recent follow-up, three patients were symptomatic, and fourteen were dissatisfied with the cosmetic result because of the residual deformity of the elbow or the postoperative scar, or both. In spite of the partial recurrence of the deformity, which was sometimes severe, all but the three symptomatic patients had a very good functional result. Many of these patients worked at heavy manual labor.

An evaluation of the Doppler-laser system in monitoring the free skin flap in the rat.

The authors discuss their experience in monitoring the free skin flap in the rat with a newly-conceived Doppler-Laser system. The results obtained are compared with a method which is currently used as skin thermometry and the influence in the clinical field is evaluated.

The treatment of congenital clinodactyly of the hand.

Based on a review of 49 cases (involving 92 digits) of clinodactyly of the hand the authors analyse the cause, associated deformities and amount of time and procedures required for treatment. What emerges in particular is the importance of the age at which corrective surgery is performed.

The tarsal tunnel syndrome: a report of eight cases.

The authors report eight cases of tarsal tunnel syndrome, pointing out the difficulty of a differential diagnosis and the possibility of a complete restoration to normality by surgery in those cases which were resistant to local conservative treatment. Tight laciniate ligament, varices, exostosis, and adhesions were noted as the causative factors.