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

The mineralization process of the osteoid osteoma, after removal of the organic matrix from the specimens by treatment with 6% sodium hypochlorite, has been studied by SEM. The process was characterized by calcified nodules or calcospherites, variable in size from 0,1 to 2 microns, embedded among randomly oriented collagen bundles, which delimited trabeculae of sponge primary bone. Numerous osteocytic lacunae, in various degrees of development, in the mineralizing front were present. The ultrastructural feature of the mineralization in osteoid osteoma reflected a pattern of nodular and collagenous calcification, essentially similar to primary calcification, characteristic of rapidly developing woven bone.

We relate about our direct clinical experience on 8 cases of osteoid osteoma localized in the bones of the foot. Some atypical appearances, clinical and roentgenographic, of the osteoid osteoma in this bony district may sometimes cause problems in diagnosis and localization, which are exposed and discussed in this paper. Particularly, we underline the importance of bone scan in the detection of the lesion.

Based on their observation of approximately 1000 patients aged from 4 to 14 years and on a comparison of their experience with the data reported in the literature, the authors discuss the problem of modifications in torsion of the lower limbs during pediatric age. After a brief discussion of anatomy and the natural progression of the angle of femoral anteversion and tibial torsion, they stop to accurately describe the most frequently occurring defects in torsion, both isolated and combined. After affirming the contribution that axial vision has made to an understanding of the subject, they emphasise the current usefulness of the method in cases in which a clinical examination allows for doubts to persist and, in particular, if qualitative and quantitative diagnosis is required in relation to the therapeutic protocol. The authors conclude by suggesting that therapy be carried out during the growth age (much before 14 years of age) while they suggest waiting until skeletal maturity in order to make a general evaluation and to decide on treatment of combined defects.

The results of surgical intervention in 183 patients operated on for recurrent shoulder dislocation from 1962 to 1985 are reported. After an average follow-up of 10 year (min. 3, max. 24), 115 patients (117 shoulders) were evaluated. The Putti-Platt technique was used in 65 patients and Scaglietti's modified technique in 52. Results were evaluated on the basis of pain, mobility, strength, stability, function and subjective opinion of the patient. External rotation was measured in adduction as well as in abduction at 90 degrees. The results were excellent or good in 90% of cases. Almost all the athletes returned to the same level as before dislocation. In 2.5% of cases the results were poor, due to excessive limitation of external rotation which caused severe osteoarthritis of the glenohumeral joint. Recurrence of dislocation occurred in 2 patients.

After a brief introduction, the authors experience on 71 capsular-ligamentous traumatic lesions of the acromion-clavicular articulation is reported. Statistical considerations are made and clinical results, obtained after three years from conservative treatment (all lesions were lifting in Allmann's standards), are exposed.

The authors report their experience in epiphyseal and apophyseal chondroblastoma. A double localization in both proximal humeral epiphyses is presented. Four apophyseal localizations are studied and particular attention is given to histological and ultrastructural features of neoplastic cells.

Fibrous dysplasia generally leads to skeletal deformity over time, particularly when the lower extremities are affected. The authors describe their experience in this field, proposing mainly preventive treatment of progressive deformities and pathological fractures. They prefer intramedullary nailing, which by strengthening the affected bone allows free and early mobilization of the limb. Moreover, full weight-bearing prevents the onset of "ex non usu" osteoporosis, which is quite often responsible for pathological fractures.

Forty fractures of the humerus associated with radial nerve palsy were reviewed after an average follow-up of 11 years. Early exploration of the radial nerve and internal fixation of the fracture was performed in 20 patients, while the other 20 patients were treated by closed reduction and immobilization in a plaster cast. In four patients of the latter group the radial nerve did not recover and a delayed exploration was performed. In each treatment group functional recovery of the radial nerve was observed in 16 patients (80%). On the basis of these results the authors suggest treating fractures of the humerus with radial nerve palsy by closed reduction. If there is no evidence of spontaneous recovery within 3-4 months, an exploration of the radial nerve should be performed.

The authors relate their experience in the treatment of subcutaneous disruption of the Achilles tendon with tenorraphy and neutering tenoplasty by quadriceps muscular aponeurosis. The results obtained in 33 patients confirm the effectiveness of this method.

The study of four cases of osteosis caused by primary hyperparathyroidism, tree female and one male, which have undergone surgery for pathological fractures in met-epiphysis bone, allows to analyze with the help of scanning electron microscope modifications occurring in periosteal and endosteal bone matrix. The periosteal surface appears abundantly furrowed by large and deep canals, irregularly joined together. Areas of resorption, these at rest and these of osteodeposition are distributed in changeable but regular way. The bone turnover of endosteal side is particularly accentuated. This surface contains the bone trabeculae residuals and is widely marked by deep Howship's lacunae, which show intense osteoclastic activity. It seem that osteocytes cells participate actively in the process of osteolysis, widening the lacunae and small canals which appear to be surrounded by calcospherites arranged in irregular way. Osteogenetic activity, with large areas of deposition, is very intense, as a defence attempt against osteolytic resorption process.