Evolution of disc degeneration in lumbar spine: a comparative histological study between herniated and postmortem retrieved disc specimens.

This is a prospective comparative histological study on blood supply between lumbar herniated discs and postmortem retrieved ones. The aim of this study is to observe the evolution of disc degeneration in relation to its blood supply changes. Disc vascularization is present early in life, but the nucleus pulposus becomes avascular after adolescence. Vascularization of the annulus fibrosus (AF) probably also occurs late in life in association with degenerative changes and in response to trauma. Capillary neoformation and hypervascularity in degenerated discs have also been mentioned, based on animal cases. In the present study, intervertebral lumbar disc specimens were surgically removed from 84 patients with an average age of 41 years (range 24-60 years) operated on for disc herniation. In addition, control autopsy specimens were selected from 24 cadavera with an age of 39 years (range 24th gestation week to 80 years). The material was fixed in neutral buffered formalin, and 4-microm-thick sections were stained with hematoxylin-eosin and reticulin. In addition, with use of an immunohistochemical avidin-biotin complex technique, paraffin sections were stained for Ulex europaeus agglutinin receptors (UEA-1) after binding UEA-1 to the tissue. In surgical specimens, small blood vessels were identified in 45% of the disc cases. They were of the capillary-type vessels and were intermingled with proliferating endothelial cells, fibroblasts, and few mononuclear cells. All of them were located along the edges of the surgically retrieved fibrocartilage fragments. Sometimes thin bands of fibrin were attached to them and extravasated erythrocytes were occasionally seen. In autopsy specimens, blood vessels were identified in 78% of the retrieved discs. In contrast to the edge neovascularity observed in surgical specimens, capillaries were observed at the outer layer of AF surrounded by dense hyalinized and inactive-appearing collagen. From these results it is concluded that the blood vessels in extruded tissue from every type of herniation are newly formed, possibly through metaplasia of undifferentiated mesenchymal cells. It is also possible that they are derived from blood vessels that have invaded the AF as a result of disc degeneration. The finding of detection of progressive disc degeneration in both groups after 20-25 years seems to be of special interest because disc degeneration is a process that may not be directly correlated to disc herniation in these age groups.

Acetabular roof reinforcement rings.

A series of 30 total hip arthroplasties was performed in 29 patients with the use of the Mueller roof reinforcement ring (RRR). The mean follow-up observation time was 30 months (standard deviation [SD] = 7.6). The clinical and radiologic results were evaluated according to the Mayo Clinic scoring system. The overall preoperative clinical score of 21.963 (SD = 18.776) points improved to a follow-up examination score of 69.533 (SD = 11.599), a correction of 68.41%. The authors' goal in this series was to implant the ring together with the polyethylene socket as close to the anatomic position of the acetabulum as possible. There was no loosening of the RRR or the polyethylene sockets, nor was there material failure in the last evaluation of the hips. No statistically significant difference was found when the differences between the follow-up scores of the primary versus the revisionary procedures were compared. The roof replacement ring has been helpful for primary and revision arthroplasties of acetabular deficiencies occurring within five years after operation.

Acute rupture of an aortic aneurysm mimicking the discus hernia syndrome. A case report.

Aneurysms of the abdominal aorta have been recognised as a cause of back pain and vertebral erosion. However back pain and paraplegia are uncommon, presenting complaints in patients with aortic aneurysms. A case of acute rupture of an abdominal aortic aneurysm is presented mimicking the symptoms of a discus hernia syndrome and paraplegia.

Complete lateral dislocation of the talus without fracture.

A pure total dislocation of the talus from all its surrounding joints without a concomitant fracture is an extremely rare injury. Because of an inability to reduce this talus dislocation by closed methods, we performed an open reduction and stabilization with Steinmann pins. At 2-year follow-up, our patient had good functional and good roentgenographic results with no posttraumatic avascular necrosis of the talus or posttraumatic arthritis. To our knowledge, this is the first report regarding complete talar dislocation without an associated fracture.

Open tibial shaft fractures: a comparative analysis of different methods of fixation in southwestern Greece.

A change in the method of managing open-grade-III tibial shaft fractures provided a new opportunity for a comparative study. One series of patients was treated exclusively by internal fixation and compared with another series treated with external fixation solely as well as with a series treated initially by external skeletal fixation and later by "Sarmiento walking plaster." The latter method was found to be a successful treatment and a good alternative to internal fixation for open grade-II and grade-III tibial shaft fractures when soft-tissue healing was completed. The supplementary use of the Sarmiento walking plaster had dramatically decreased the duration of hospital stay, saving the patient from an additional operation. There were no nonunions in this series. In open grade-I-II tibial shaft fractures, the deep infection rate in the cases in which internal fixation was used was significantly higher (5.4%), than that observed in the cases treated with external fixation, in which there was no deep infection. The nonunion rate was higher (22%) in the external fixation group compared with the internal fixation group (9%). The functional impairment of the ankle joint of the affected limb was less (15%) by using internal fixation than that of either the external fixation group (20%) or the group where the external fixation was changed to a Sarmiento walking plaster (35%).

Acute osteomyelitis of the patella 50 years after a knee fusion for septic arthritis. A case report.

Nontraumatic, hematogenous osteomyelitis of an unfused patella occurred in a 62-year-old female patient, 50 years after septic arthritis of the knee was treated in childhood by femorotibial fusion. This extremely rare condition was successfully treated by a patellectomy, continuous irrigation, and antibiotics. This occurrence seems not to have been reported previously in English literature.

Simultaneous rupture of the tibialis posterior and flexor digitorum longus tendons in a closed tibial fracture.

An interposition of ruptured tendons of the tibialis posterior and flexor digitorum longus occurred between the lower third tibial fracture fragments in a closed tibial fracture in a 26-year-old man. The tendon ruptures were not diagnosed preoperatively but were recognized at the time of open reduction. The tendons were repaired and the fracture internally fixed. Six months postoperatively, the patient had a 10 degree dorsal extension deficit in the ankle joint, the motion was painless, and the strength of the posterior tibial compartment muscles was grade 5.

Acetabular protrusion in thalassemia. A report of four cases.

Four female patients with thalassemia intermedia developed secondary acetabular protrusion. These cases could be the first reported cases of nontraumatic acetabular protrusion in patients with thalassemia. The rarified pelvic bone may be due to medullary hyperplasia, iron overload, or disordered calcium metabolism in conjunction with osteomalacia. The fact that currently patients with beta-thalassemia have a longer life expectancy may explain the recent observation of this entity, which should become more familiar to orthopedic surgeons who treat thalassemia patients in the future.

Anterior dislocation of the hip associated with fracture of the ipsilateral greater trochanter. A case report.

A 22-year-old male motorcyclist fell from a height and sustained an obturator hip dislocation with concomitant fracture of the ipsilateral greater trochanter. The immediate reduction of the dislocation associated with open reduction of the fracture of the greater trochanter showed excellent results at the short-term and long-term follow-up examinations. This extremely rare hip injury seems not to have been previously reported in the literature.