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

The authors explain the general criteria in performing an ultrasound exam and the pathological finding of congenital dislocation of the hip. They based the study on the screening of 500 patients between the ages of ten days and eight months (2% of which resulted pathological) and on evaluation of 80 cases of dislocated hip not included in the original sample group. The ultrasound test in dislocated hip pathology proved to be superior to traditional x-ray tests for viewing the muscular and cartilaginous elements, obtaining a dynamic view of the anatomical structures and, in particular, studying the morphological aspect and the development of the acetabulum. Thus it is possible diagnose different types of CDH at very early stage. The authors, however, consider an easier classification more useful than the original one suggested by Graf and propose division of the abnormal hip into three pathological types based on clinical, radiological and ultrasound findings: primary sub-luxation or "non-dislocatable" hip; pre-dislocation or "dislocatable" hip; dislocation or "dislocated" hip. This is extremely important in order to better understand and evaluate each singular case and then set up adequate therapy.

"Tenodermodesis" is a surgical technique devised and recommended in order to correct chronic mallet finger deformity. In the last ten years, at the I Orthopedic Clinic of Padua University, tenodermodesis combined with a longitudinal transarticular Kirschner wire fixation has been used for treating a total of 25 mallet fingers: 20 acute and 5 chronic lesions. This lesion was always due to a simple tendon injury with a flexion deformity up to 45 degrees. Based on the results, the authors suggest the use of this techniques for treating acute lesions especially in young people, whatever finger has been injured. The reason why the authors themselves are not capable of giving a significant opinion on the validity of the method in the treatment of chronic mallet deformity is the small number of patients treated.

This paper analyses the effect of mechanical loading on bone remodelling under both physiological and pathological conditions. The sensitivity and the type of the biological response of bone to the changes in mechanical loading are conditioned by several factors: individual race and age, pattern of stress, systemic and local metabolic conditions, etc. Therefore, bone remodelling following mechanical stress is not only a simple repair process, but a complex mechanism of functional adaptation which is controlled by the strain magnitude of bone structure rather than the extent of the stress. Results show that the skeletal changes induced by mechanical stress involve not only the structural properties but also the material characteristics of bone. For example, the size of hydroxyapatite crystals increases under load. These findings allow us to hypothesize that mechanical stress could directly modify the mineral component of bone. Hydroxyapatite appears to be a highly dynamic structure, able to change its crystallinity in relation to external stimuli. It is thus conceivable that hydroxyapatite crystals gather and arient themselves along bone and improve their crystallinity not only under the influence of biological mechanisms, but also as a reaction to mechanical stimuli.

The results of treatment of 10 both-bone unstable diaphyseal fractures of the forearm in children by open-reduction and intramedullary fixation with Kirschner wiring of the radius are presented. All fractured healed in perfect alignment. No complications occurred. In a 3 year and 2 month follow-up all the patients had excellent results with full range of movement. The advantages of this method are: a) it is easy to carry out; b) it maintains anatomical reduction; c) a second operation to remove the internal fixation device is not required; d) fixation of the ulna is not necessary, because in all patients a realignment of the ulnar fragments occurred after radius reduction.

Non union of the olecranon is rare, resulting from inadequate or failed primary internal fixation, or from extension immobilization. Olecranon non unions can generally be handled by open reduction and strong internal fixation with or without application of a bone graft. We also observed radiographic evidence of non union in several patients with full range of motion and no pain. In these cases the non union slowly but spontaneously healed.

The authors conducted a macroscopic anatomical study of the metatarsophalangeal joints of the middle toes in order to add to our knowledge of the anatomy and physiology of this structure. Anatomical observations reveal the foot's lack of transverse ligamentous formations (as the sagittal bundle in the hand) connecting the extensor tendon to the glenoid plate. Consequently, the containment of the extensor tendon above the metatarsophalangeal joint is considerably less stable in the foot than in the hand, since it is entrusted to the posterior portion of the interossei muscles and the deep and superficial retinacula (all formations which run in a prevalently oblique direction). Hyperextension of the metatarsophalangeal joint causes the posterior portion of the interossei muscles, bound to the extensor tendon, to slide proximally, straightening the fibers and loosening the structures that stabilize the extensor tendon. The tendon can then easily shift in a lateral direction with respect to the rotation axis of the metatarsophalangeal joint, acquiring a valgus action. Even though the metatarsophalangeal joint is equipped with strong collateral ligaments, the valgus action of the extensor tendon eventually overcomes the resistance of both these and the weaker connections to the plantar aponeurosis of the foot and the extensor tendons. In conclusion, the lack of structures to provide passive stabilization of the extensor tendon in the metatarsophalangeal joints of the toes makes the foot particularly susceptible to multiple-toe deformity.

Taking advantage of the observation of 2 instances of intradural disk herniation, the authors examine the pathogenetic, clinical, diagnostic, and therapeutic aspects of this rare occurrence in light of a review of the literature and their own observations. Of the theories as to the cause of the syndrome, two appear worth noting: the relative immobility of the dural sac, bound by the surrounding nerve roots; the inflammatory and cicatricial adhesions that establish themselves between the posterior longitudinal ligament and the dural sac. The clinical features as well as the laboratory and diagnostic tests suggest compression of one or more nerve roots similar to that caused by other intradural expansion processes. The onset can be sudden and acute or delayed depending on whether the dural sac adhesions were present before disk herniation or appeared at a later stage. Intradural disk herniation must be checked for, often intraoperatively, in all cases of radiculopathy due to intradural compression. Error in the assessment of the level of the lesion, concomitant extruded extradural disk herniation, or failure to recognize the immobility of the dural sac can all lead to misdiagnosis of intradural disk herniation if the search for this syndrome is not correctly carried out.

The authors report a case of intradural disk herniation at L4-5 observed in a patient with longstanding low back pain and sciatica due to a herniated disk. After having undergone various surgical procedures for this disorder, the patient recently developed a multiradicular syndrome of the cauda equina.