Pseudarthrosis of the Calcaneus: Advantages of Regenerative Medicine in the Management of a Rare Entity, A Case Report and Review of Literature.

BACKGROUND: The follow-up of calcaneal fractures has shown that they are difficult to manage and lead to multiple complications such as malunion and subtalar osteoarthritis. Pseudarthrosis of the calcaneus is an extremely rare complication, which was described in the literature through case reports.In the existing literature, only seven studies, including thirteen patients have reported the nonunion. However, to the best of our knowledge, no study elucidates the role of new techniques of regenerative medicine such as Bone Marrow Concentrates (BMC) or Platelet Rich Plasma (PRP) in the management. METHODS: We report a case of a patient with a pseudarthrosis after a calcaneal fracture treated with BMC injection in the non-union site, without the need for surgical approach. RESULTS: Four months after treatment, the patient was ambulant without support and was completely pain-free. Moreover, after one year the radiological follow up by CT scan showed a satisfactory filling of the non union. CONCLUSION: In one case, we try to highlight the advantage of our therapeutic alternatives, which are having a good union while avoiding the complications of surgical approaches and without sacrificing the subtalar joint when it is possible.

The periosteum-like effect of fresh human amniotic membrane on bone regeneration in a rabbit critical-sized defect model.

OBJECTIVE: The purpose of this study was to investigate the effect of fresh human amniotic membrane (FHAM) as a substitute of periosteum to enhance bone regeneration in critical-sized defects. METHODS: Tibial diaphyseal bone defects were created in forty New Zealand white rabbits and treated with FHAM or left empty. Treatment groups consisted of: FHAM implanted in the place of removed periosteum (FHAMP group); FHFAM implanted to fill the entire defect (FHAMF group) compared to negative control group; empty defect with removing the periosteum (NC group) and positive control group; and empty defect without removing the periosteum (PC group). Bone regeneration was evaluated by radiographic, micro-computed tomography (µ-CT) and histological analyses at 4 and 8weeks post-surgery. RESULTS: Radiographic and µ-CT analysis demonstrated clearly enhanced new bone formation in positive control group (PC) and FHAMP group compared to negative control group (NC) and FHAMF group. Histological staining exhibited remaining woven bones and cartilage matrix in the FHAMP group, immature lamellar bone with medellury cavity and marrow bone formation in PC group from 4weeks post-operatively. For FHAMF group, a little new bone formation was detected only from 8weeks post-operatively, and an absence of any sign of healing in NC group at both time points. CONCLUSION: The results provide that FHAM increases bone regeneration in critical-sized defects when it is implanted in the place of the removed periosteum, but its additive effect does not have the same effect of the natural periosteum.

Trauma of the hand from circular saw table: a series of a 130 cases.

INTRODUCTION: Trauma of the hand from a circular saw table is a common occurrence in developing countries it tends to occur in young hand working people and it causes a serious lesions. METHODS: It was a retrospective series about a 130 cases of hand trauma from circular saw table. Epidemiological features, treatment, and permanent disabilities left by hand trauma from circular saw table were studied to identify ways to prevent such an accident. RESULTS: The average age was 31.24 years, these patients were exclusively men, 62% were apprentice wood workers, and the left hand was twice more injured than the right hand. Regarding clinical aspects, in 77% of cases, two or more fingers were injured, tip amputations of the left fingers predominated (49%), in 50% of the cases of hand wounds occurred to the dorsum of the hand, and extensor tendon injuries were observed twice more than flexor tendon injuries. Regarding the surgical treatment, performing an amputation stump was the most practiced primary surgery (107 cases i.e. 82% of primary surgeries). Arthrodesis, reconstructive flap surgery, and spongy bone grafts were the most practiced secondary surgeries (79% of secondary surgeries). Joint stiffness was the most observed complication (26%). CONCLUSION: Hand injuries from circular saw table such as those described in this study will continue to challenge the skill of surgeons devoted to the restoration of function and form to the damaged hand. Prevention, of course, should be the goal because of the severe functional and psychological impairment that may result from them.