Archivio "Putti" di chirurgia degli organi di movimento最新文献

An ultrastructure study (S.E.M.) was performed on adult albino rats of the age, sex, and weight in order to assess the qualitative and quantitative variations in the endosteal diaphyseal surface of limbs relieved of mechanical stresses by means of prolonged cast immobilization. The final results confirmed the primary role played by osteoclasts and vascular bone channels, the latter of which open into the diaphysis, during resorption of compact diaphyseal bone, which occurs to the detriment of the bone surfaces in deposition and at rest.

Severely comminuted and wide open fractures of the femoral shaft, with or without condylar involvement, have always been very difficult to deal with order to assess the quantitative. Over a period of ten years, 35 "problem" fractures, selected from a series of 129 femoral shaft fractures, were managed by "functional treatment" with the aim of avoiding the risks inherent to osteosynthesis and achieving rapid healing while maintaining, from the very beginning, full function of the injured limb. The most frequent fractures in this series were severely comminuted and open fractures. All fractures healed within a mean time of 12.5 weeks. The results, evaluated according to the score table of the Functional Treatment Study Group, were as follows: excellent in 32 cases, good in 2 cases, and poor in one case (refracture). Functional treatment of "problem" femoral shaft fractures has proven to be reliable in light of the good results, despite the fact that the technique employed for this particular bone and type of fracture requires great care and expertise as well as careful patient selection.

On the basis of clinical observation and reports in the literature, the authors discuss the etiology, pathogenesis, and clinical and radiographic aspects of "slow" fractures, with particular reference to those involving the metatarsal. The different etiologic and pathogenetic theories agree upon one point: the concentration of the stresses as a prelude to areas of osteoclastic resorption which lead to microfractures and thus to "slow" fractures. Many factors are responsible for this concentration, and they may very even according to the site of the lesion. In the foot there are many conditions which can potentially explain the pathogenesis of "slow" metatarsal fractures. Overload of the middle metatarsals is one of the most common causes. The overloaded and fractured metatarsal may then become insufficient and in turn, by the same mechanism, cause fracture of the adjacent metatarsals.

The authors take advantage of an incidental observation of osteochondroma in a patient affected by familial metaphyseal dysplasia to look further into the study of this congenital osteopathy. Examination of the family medical background brings to light the blood-relation of the patient's parents and the presence of the same clinical and radiological features in the patient's sister. Particular attention is given to histological and ultrastructural study of the removed bone tissue.

The authors clinically and radiographically review 42 of 53 children between the ages of 5 months and 3 years treated by closed means from 1983 to 1987 for femoral fracture (average follow-up, 4 years). Evaluation of a large number of patients in this particular age group offers several advantages: a) it regards a phase of evolution in which the modalities of growth do not affect in any significant way the metabolic balance of the growth plate chondrocyte, as occurs in periods of rapid growth. This makes the sample group statistically homogeneous; b) it eliminates the age variable in the search for the factors which may contribute to limb-length discrepancy. The importance of the following factors was statistically analyzed: location, type, and initial displacement of the fracture, accuracy of reduction, and characteristics of the traumatic event. There was a significant correlation between a large degree of limb lengthening and further reduction or corrective procedures under general anesthesia. Overlapping reduction and limb shortening were also closely related. A highly significant correlation was also found between limb lengthening exceeding 15 mm. (range, 15-22 mm.) and the time of day at which the trauma occurred (9-10 pm). The results of treatment suggest the need for a reevaluation, using recently gained knowledge, of Lacroix's theory of the pathogenesis of this disorder as well as the need to examine more thoroughly, with further clinical and experimental studies, the hormonal changes following the trauma.

In a series of 67 displaced ankle fractures, the significance of the following factors is evaluated: age, sex, obesity, adequacy of the post-reduction position of the malleoli, restoration of distal tibio-fibular syndesmosis, talo-crural angle, talar tilt, width of medial clear space, severity of injury, traumatic mechanism, treatment. The statistical study is developed using stepwise discriminant analysis up to multiple linear regression. The significant parameters are the talo-crural angle, residual malleolar displacement, the integrity of the syndesmosis, and obesity. The discrimination is very good (p < 0.01).

The experience of the Clinica Ortopedica dell'Università di Firenze in the surgical treatment of cervical disk disease has changed over time due to both the ongoing improvement of surgical techniques and the availability of ever more effective and less invasive diagnostic tests. Although our first experience was indirect and we were not able to review all patients due to the long follow-up period, we believe that our current setup provides valid data, as is demonstrated by the thorough clinical and radiographic evaluation we performed on patients reviewed after a minimum of 5 years. We believe that the anterior-approach procedure, which can currently be recommended thanks to non-invasive diagnostic tests, is effective not only in cases of spinal cord impingement but also in cases of cervicobrachialgia. In the latter, aside from the relief of nerve root impingement, we noticed that intersomatic spinal fusion helped relieve pain at the site of the lesion even after a considerable period of time, whereas cervical pain often remained after laminectomy and frequently increased over time.

After reviewing their series of prosthetic revisions and comparing it with other reports in literature, the authors reassess, where possible, classic conservative intervention as well as the indications for cemented prostheses given the poor long-term reliability of the bone-cement interface. The authors emphasize the always more frequent incidence of prosthetic loosening and the resulting need for surgical revision, especially in patients who were under 65 years of age at the time of primary prosthetic replacement. Finally, the authors present their clinical and surgical experience in revision using cementless implants, which they prefer in this type of operation.

The authors present the preliminary results (after 4-7 years) of 69 cases of congenital torsive equino-varus-supinated foot treated operatively from 1982 to 1985 (of a total of 25% cases treated from 1982 to 1989). Both the modalities and the stages of execution of the treatment are described. After the initial clinical evaluation and the first weeks of manipulation, the feet were immobilized in corrective plaster casts, which were carefully constructed to correct the varus and supination. After 4-8 months, thorough clinical and radiographic assessment enabled the authors to plan the surgical procedure for correction of the remaining deformity, customizing it for each individual patient. There is an in-depth discussion of the stages of the "widened" posterior release procedure. Using this procedure, the authors achieved satisfactory intraoperative correction in 85% of the patients, correction which was maintained over time in 76.5% of the cases. In this way the medial stage of the surgical procedure, associated "ab initio" to the posterior release, may be reserved to a fewer number of patients (15-20%) under one year of age.

The authors report their experience in the treatment of complex fractures of the tibial plateau (epi-metaphyseal and comminuted bicondylar and spinotuberosity fractures) using the Kerboull epiphyseal plate and autogenous cancellous bone grafts if sinking occurs. It is not always possible to perfectly restore joint anatomy and stability. Plate fixation ensures solidity by not exposing the load-bearing axis, eliminating the risk that the tibial plate will later give way and thereby allowing early mobilization and rapid functional recovery of the knee. The authors emphasize the importance of both consensual treatment of possible ligament tears and preservation, when possible, of the meniscus. They claim that the frequent complications can only be prevented by careful preliminary assessment of general and local conditions which may absolutely or relatively contraindicate this type of surgery.