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

The authors state the indications and report the results of 43 revision arthroplasties performed with cementless total hip implants. They describe both the criteria leading to this therapeutic decision and the technique employed given the bone loss caused by the failure of the previous arthroplasty. The long-term results are analyzed with particular reference to radiographic evidence of implant stability.

The authors state the indications and report the results of their first 35 consecutive AGC total knee arthroplasties. Both the characteristic of the prosthesis and the modalities of the application technique are analyzed. The results are evaluated from a clinical and radiographic point of view.

In 1984 a "bone bank" containing femoral heads taken from live donors was created at the 2nd Orthopaedic Department of the University of Florence. The authors emphasize that these bones are very easy and inexpensive to obtain and store. They describe the organization of the "bone bank" and present the results of its first four years of activity.

Thirty patients affected by osteochondroma were divided in two groups: 15 patients were in the age of development, and 15 patients had ended their development. The patients' age ranged from 4 to 42 years; 18 of them were males. The mineralization process (M.P.) of the osteochondral tissue was studied following hypochlorite treatment of the specimens. M.P. was particularly evident in patients during development and was characterized by round calcific nodules (calcospherites) which were linked to crossed collagen fibers. M.P. was morphologically similar to what is usually observed in normal and pathological specimens. Except in two cases, at the end of development the intertrabecular spaces were free of calcific material. In those two cases we observed a resumption of M.P. Mineralization was of calcospheritic type and started from islands of metaplastic cartilage. It was interpreted as a sign of possible transformation to peripheral chondrosarcoma. In a third case, osteoclastic activity caused deep, wide subperiosteal and trabecular erosion resulting in osteocartilaginous neoplastic tissue involution.

The good results achieved with osteotomy in the treatment of arthritic varus knee lead the authors to pinpoint some frequently controversial aspects that are important for the attainment of an excellent outcome. The study consisted of 46 patients, each subjected to valgus osteotomy. The site of the tibial osteotomy should be above the insertion point of the patellar tendon in order to better guarantee stability and healing. For mechanical reasons, high metaphyseal peroneal osteotomy is preferred over other methods such as diaphyseal osteotomy, excision of the peroneal head, and proximal tibioperoneal syndesmotomy. Both osteotomies can be done through a single anterolateral incision, without risking injury to the lateral popliteal sciatic nerve. The preferred method of osteotomy is to cut a noncuneiform linear rima with the osteotome and perform the angular correction at the joint of the metaphyseal spongy bone. The osteotomy is then stabilized with staples and a cast for a period of 40 days. Overcorrection past the physiological valgus deformity is necessary in order to move the weight-bearing axis onto the lateral hemirima; the degree of surgical correction should be calculated on the basis of orthostatic radiographs. Good clinical results are always accompanied by the following radiographic developments: opening of the medial articular hemirima, improvement of the subchondral bone sclerosis, and reappearance of the outlines of both the spongy bone and the subchondral bone lamina; all these are signs of good bone adjustment made possible by the reinstatement of mechanical equilibrium in the knee.

Because of its high incidence of rheumatoid arthritis, the foot is probably the best place to study this pathology. Timely diagnosis is very important considering the high risk of disability. On the basis of both other studies and first-hand observations, the particular clinical and radiographic characteristics of rheumatoid arthritis of the foot are analyzed, differentiating it from the same disease in other joints. The research and comparison of these particular aspects helped with the overall clinical evaluation of early-diagnosed rheumatoid arthritis, that is before the development of reabsorption phenomena, bone damage, deformities, and ankylosis of the joints of the foot.

Thirty-five patients, selected according to the criteria of Onik and operated on by automated percutaneous lumbar discectomy, were evaluated in a retrospective study in order to assess correlation between clinical results and characteristics of the disc herniation and the value of current imaging techniques in selecting patients for percutaneous discectomy. Percutaneous discectomy is not indicated for narrow, postero-lateral herniated discs (3 cases, 3 failures). Two-thirds of the failures are consequences of inaccurate CAT scan images (false-negative images of subligamentous migration of the herniated disc).

The authors report two cases of Freeman-Sheldon syndrome, characterised by recessive autosomic transmission, affecting a brother and a sister born of parents who were not blood relations. The syndrome, for which 50 cases are described in the literature, takes its name from the authors who were the first to describe it in 1938. The typical picture is based on congenital deformity involving the cranium, the face and the locomotor apparatus, with a particular aspect of the subject affected related to his or her expression, resembling that of someone whistling ("whistling face", Burian, 1963). In addition to the descriptive aspect of the syndrome and to the means of its transmission, the authors report orthopaedic aspects concerning the locomotor apparatus and problems related to the type of surgery performed.