Deep peroneal nerve paresis in a runner caused by ganglion at capitulum peronei. Case report and review of the literature.

Although lateral popliteal sciatic nerve damage is not one of the commonest diseases in the general population, it is quite frequent among athletes. Several physiopathologic mechanisms have been thought to bring about this damage in athletes. Soft tissue ganglions with neurological involvement of the lateral popliteal sciatic nerve or its terminal rami are in differential diagnosis with several lesions of this area, as direct or indirect trauma, subcutaneous rupture of anterior tibialis muscle and long peroneal muscle, disc hernia, intraspinal tumor, anterior tarsal tunnel syndrome, cysts, neurofibroma, baker's cyst, vascular claudication, stenosing or inflammatory pathology of 2(nd) motoneuron, antimicrobial agents for urinary tract infection (nitrofurnantoin). The authors report the case of a 34-year-old amateur athlete with a recent paralysis of the hallux extensor, paresis of the toe extensor and hyposthenia of the tibialis anterior. The patient had been suffering from episodes of lumbalgia for a long time. He was sent to us because neurological damage due to disc herniation was suspected. Electromyography, sonography, and CT showed peripheral compression of the deep peroneal nerve caused by a mucous cyst at the capitulum peronei, a ''rare'' condition. The patient underwent surgery to excise the cyst, which led to the rapid resolution of the nerve deficit shown by clinical and electromyographical tests. A meticulous anamnesis and accurate objective examination, followed by specific tests (radiographs, sonography, and possibly CT scan) generally enable a correct diagnosis to be made. If diagnosis and therapy are carried out correctly, and without delay, symptoms quickly resolve and the nerve deficit progressively regresses.

Lumbar pain and fin swimming.

BACKGROUND: It was hypothesised that fin swimming have unique physiopathologic features in particular concerning low back involvement. METHODS: Retrospective study. SETTING: elite competitive fin swimmers. PARTICIPANTS: 17 males and 14 females aged from 16 to 23 years. INTERVENTION: piroxicam, sport interruption for a week, proper warming-up and wearing suggestions during out-of-water exercises in the symptomatic group. Absence of intervention in the asymptomatic one. MEASURES: anthropometric measures (weight, height, legs length discrepancy), isokinetic measures (trunk flexor/extensor ratio) and conventional radiological investigation were taken for all subjects. RESULTS: Low back pain was present in 14 subjects during off season but only 7 referred discomfort in competitive season. 78.5% of symptomatic subjects showed radiological abnormalities while imaging changes were present in 52.9% of the asymptomatic group. Flexor/extensor ratio isokinetically evaluated was less than one in 6 athletes complaining back discomfort. Non steroid medication, physiotherapy, training and wearing cares was suggested. Authors report a pain free return to competition in 57% and a partial resolution in 28% of those symptomatic cases who were not used to training cares (in particular proper "out-of-water" warming up) and wearing precautions (complete wiping and suitable thermic clothing after swimming). CONCLUSIONS: In fin swimming low back pain can be related to the existence of environmental and intrinsic factors. In our series no significant difference in imaging changes was pointed out among asymptomatic or painful athletes. Therefore a cyclic load on the column, in absence of training precautions can make spine abnormalities (in particular schisis, facet derangement and pars lesion) symptomatic.

Gamma nailing for the treatment of subtrochanteric nonunion: two clinical cases.

The authors propose two cases of subtrochanteric nonunion (one infected) treated by Gamma nailing. Early movement and the fact that weight-bearing is allowed are particularly advantageous for functional recovery. This method is proposed as a good alternative to open osteosynthesis with bone grafting.

CKS knee prosthesis: biomechanics and clinical results in 42 cases.

From 1991 to 1993 a total of 42 CKS prostheses were implanted for the following reasons: osteoarthrosis (34 cases), rheumatoid arthritis (7 cases) tibial necrosis (1 case). At follow-up obtained after 17 to 41 months the results were: excellent or good: 41; the only poor result was probably related to excessive tension of the posterior cruciate ligament. 94% of the patients reported complete regression of pain, 85% was capable of going up and down stairs without support. Mean joint flexion was 105 degrees. Radiologically the anatomical axis of the knee had a mean valgus of anatomical axis of the knee had a mean valgus of 6 degrees. The prosthetic components were always cemented. The posterior cruciate ligament was removed in 7 knees, so that the prosthesis with "posterior stability" was used. The patella was never prosthetized. One patient complained of peri-patellar pain two months after surgery which then regressed completely.

Giant cell reparative granuloma: presentation of one case and review of the literature.

The authors describe a case of giant cell reparative granuloma (GCRG) of the distal phalanx of the thumb. After differential diagnosis involving other lytic lesions of the phalanges was made, surgical treatment was planned. The authors emphasize the importance of suitable treatment of GCRG in order to avoid the danger of recurrence and the risk of loss of the phalanx.

The use of bioabsorbable polymers in reconstruction of the anterior cruciate ligament. A preliminary experiment conducted on bioabsorbable interference screws: bovine model vs. ovine model.

The use of interference screws in the reconstruction of the anterior cruciate ligament has increased over the years. Despite doubtless advantages there are some problems, too, some involving method of fixation, others the metallic nature of the screws. With the purpose of overcoming the latter, the authors evaluated the possibility of using interference screws made of bioabsorbable material. This preliminary study was conducted on two animal models (bovine and ovine); as a comparison parameter the torsional pair of screw insertion was used. A substantial similarity in the results thus obtained was observed that, together with the minor difficulties observed in the surgical field, contributes to the indication of the ovine model as preferential, based also on successive tests of functional validation conducted in vivo.

Fracture of the patella in children and adolescents.

Fractures of the patella in childhood and adolescence are a rare occurrence, and they are differentiated from those occurring the adult. Between 1975 and 1995, 76 cases of fracture of the patella in patients aged under 15 years were treated at our institute. A mean clinical-radiographic follow-up of 2 years was available for all of the patients; 18 patients were followed-up after a considerable amount of time (mean 18 years). After analyzing the specific features that distinguish there fractures when they affect a subject who is still growing, the authors report the results obtained and the short and long-term complications observed.

Changes in growth of the ilium after sopraacetabular osteotomy. Long-term evaluation.

It is commonly known that in acetabuloplasty according to the Pemberton-Zanoli method the insertion of the graft produces an immediate increase in the height of the iliac wing which in successive months could become hypergrowth caused by the hyperactivity of the underlying Y cartilage. A total of 40 cases of insufficiency of the acetabular roof treated by this method were examined based on measurements on follow-up radiograms and an evaluation of the spino-malleolar distance until puberty. The clinical evaluation showed that in 82.5% of cases there is dysmetria that is less than or equal to 0.5 cm. An evaluation of radiograms at the end of growth of the ilium [correction of ileum] did not reveal significant variations between the hemipelvis submitted to surgery and the contralateral one either in cases treated by acetabuloplasty alone or in those in which intertrochanteric osteotomy was associated. Acetabuloplasty according to the Pemberton-Zanoli method is thus effective in the treatment of acetabular dysplasia at a young age, obtaining long-lasting effects and ones that do not cause dysmetria in the adult.

Chondromalacia of the patella. Natural progression.

A total of 42 cases of patellar pain in subjects aged an average of 17.2 years submitted to arthroscopy are analyzed. Femoropatellar balance, where indicated, led to resolution of disorders with full resumption of sports activity. In the remaining cases chondromalacia showed the features of an affection with a spontaneously favorable course, confirming the common orientation towards conservative treatment. Arthroscopy is effective for a correct classification of cartilaginous lesions, and it is a good instrument to use when attempting to achieve recovery of patellofemoral joint when disorders are caused by a lack of equilibrium.

Arthroscopic lateral meniscectomy in adults with stable knees. A medium term evaluation of the results and a comparison with similar lesions of the medial meniscus.

The results obtained in 37 cases of arthroscopic meniscectomy in isolated lesions of the lateral meniscus in adult patients are analysed. Isolated lesions were chosen as it is our belief that the results may be considerably influenced by the presence of ligamentous lesions. After an average follow-up of 33 months the results were: excellent, 32; good, 2; fair, 2; poor, 1. The lowest percentage of improvement was observed in subtotal meniscectomies. The presence of changes in the joint cartilage is not always responsible for mediocre results.

Arthroscopic medial meniscectomy. Technique, results, complications and medium-term follow-up in adult patients with no ligamentous lesion.

The authors report the medium-term results of arthroscopic medial meniscectomy performed on 102 adult patients. Some notes on the surgical technique and the objective and subjective results obtained in each type of meniscal lesion are also reported.