Bulletin of the Hospital for Joint Diseases Orthopaedic Institute最新文献

Free vascularized fibular grafts were used for reconstruction of massive long bone defects in 10 cases. The causes of the defects included 3 congenital pseudarthroses of the tibia, 2 traumatic bone defects, and 5 bone tumors. The average graft length was 13.2 cm (range 6-21 cm). Follow-up ranged from 4-18 months, with a mean of 8.5 months. Seven cases established bony union at graft host junctions within 3 months. Two congenital pseudarthroses of the tibia exhibited recurrence of neurofibromatosis at the proximal graft-host junctions; one was complicated by infection and had not yet obtained bony union on the patient's most recent visit. In 2 cases of bone tumor, the malignant tumor recurred; one of these patients underwent a below-elbow amputation. Early results indicate that the vascularized fibular graft is a useful alternative for reconstruction of some large bone defects. Adequate removal of the underlying lesion is essential if this procedure is to be used for treatment of congenital pseudarthrosis or for filling in the bone after resection of a tumor.

Macrodactyly is an unusual congenital anomaly in which there is hamartomatous proliferation of the soft tissue of the affected digit. It is usually present at birth or recognized during adolescence. Eleven cases are presented. All showed abnormal accumulation of adipose tissue in the affected digits. In five cases, prominent endoneural and perineural fibrosis was noted. Two cases also demonstrated focal neural and vascular proliferation. This is an unusual finding in macrodactyly and may be a part of the abnormal hamartomatous proliferation that is observed in this condition. None of the patients had clinical evidence of neurofibromatosis. One patient had the Proteus syndrome.

The authors describe the use of a freeze-dried human dura allograft in a 9-year-old child with a dislocated hip of many years duration. The membrane was placed over the deformed femoral head prior to open reduction and a Chiari medial displacement osteotomy to prevent damage to the articular cartilage.

A 25-year-old female with primary malignant fibrous histiocytoma of the distal fibula is presented. Malignant fibrous histiocytoma of bone is a rare primary bone tumor in this anatomic location. Careful preoperative staging studies and neoadjunct chemotherapy permitted an unusual resection to be performed resulting in successful limb salvage for the patient.

A case of a giant cell tumor of the right proximal femur that developed malignant change following surgical treatment ("secondary" malignant giant cell tumor) is presented. The patient had a cystic lesion that was initially interpreted as an aneurysmal bone cyst. A local recurrence six months later demonstrated the histological features of typical giant cell tumor. A further recurrence 22 months after the original treatment showed histological malignancy. Death was due to massive local recurrence and to extension of the malignancy to the pleura.

An increasing number of orthopaedic surgical cases involve revision total hip replacement, not only first time revisions, but often second, third, or more. With each revision, the number of good results tends to decline. The authors present a technique that makes use of bone grafts to support and strengthen the fixation of hip prostheses in total joint replacement surgery.

Hydroxyapatite ceramics have been used as bone implants in a number of experimental systems and clinical applications. We have developed a unique experimental model that allows study of the interface between bone and implant materials. A comparison of titanium and hydroxyapatite materials, using this model, has demonstrated the osteoconductive nature of hydroxyapatite and its ability to bond directly to bone.

To avoid skin sloughs about the knee following knee arthroplasty, the principles that need to be emphasized are the blood supply in the area so that appropriate incisions can be designed; careful operative technique to avoid hematomas; appropriate use of drains and dressings; and postoperative care that monitors increased range-of-motion as it affects the wound. Should secondary coverage be needed, the options include secondary closure, skin graft, muscle or myocutaneous flaps, and on rare occasions, a free tissue transfer. In this way, the plastic surgeon can assist the orthopaedist by providing the appropriate soft tissue coverage in difficult knee surgical situations.

Five patients with calcinosis circumscripta were treated, four of them surgically. The indications for surgery included painful lumps, recurrent infection of the calcified masses, secreting ulcers, functional disorders, severe esthetic problems, and pressure on nerves. One patient showed permanent improvement; four gained temporary relief.

The presence and distribution of type II collagen was studied in 36 cartilage and cartilage-related tumors, including five osteosarcomas and one chordoma. A monoclonal antibody prepared from chicken type II collagen was used with paraffin sections, employing the ABC (avidin biotinylated horseradish peroxidase complex) peroxidase technique. Fetal cartilage and fracture callus were used as control materials. Type II collagen was present in the matrix of all the cartilage tumors. The reaction was strongest in areas of well-differentiated cartilage and weakest in the poorly differentiated tissue of high-grade chondrosarcomas. Areas of mineralization or ossification, and areas of eosinophilic, fibrous, or degenerated cartilage gave a negative reaction.