Late osteochondral allograft resurfacing for tibial plateau fractures.

Seventeen patients in whom secondary degenerative arthritis developed after a tibial plateau fracture underwent osteochondral allograft resurfacing of the involved plateau. The transplantation was done within twenty-four hours of procurement of the allograft from a cadaver donor so that viable cartilage would be used. There were sixteen tibial resurfacing grafts, and one patient had a tibial and femoral graft. Twelve patients have been followed for more than two years. A rating system for pain and function showed marked improvement in ten of the twelve patients. The clinical results were not related to age, interval from injury to grafting, type of graft, length of follow-up, or radiographic data. We believe that appropriate selection of patients for the procedure was the factor that led to the best results. Collapse of the osseous portion of the graft measuring more than three millimeters occurred in two patients, and there was obliteration of the cartilaginous joint space in one patient. This method of joint resurfacing requires minimum resection of tissue and avoids the use of a prosthesis. The ultimate fate of these grafts is not known, but the results in our series were encouraging. however, at this time the procedure should be restricted to younger patients with disabling, localized post-traumatic arthritis.

Haemophilic arthropathy of the shoulder.

Among 41 adult haemophiliacs 15 suffered from shoulder symptoms. We examined 12 patients by radiography and ultrasound. Four had bilateral symptoms making a total of 16 symptomatic shoulders. Of these, 10 had abnormal ultrasound scans with eight having evidence of rotator cuff tears. Evidence of bicipital tendonitis was found in two. Pain with loss of range of movement and a positive impingement sign was the most reliable clinical indicator of a cuff tear. Joint incongruity and superior migration of the humeral head were the best radiographic indicators. Rotator cuff tears are a common component of haemophilic arthropathy of the shoulder.

Subperiosteal hemorrhage and cyst formation in neurofibromatosis: a case report.

A 7-year-old girl was disabled by neurofibromatosis complicated by leg hypertrophy, recurrent massive hemorrhage, and cyst formation in her right tibia. A grotesque deformity resulted in the right lower leg over a three-year period despite elevation, compression, and aspiration for various bleeding episodes. Massive areas of bone had to be resected on two separate occasions. The extreme vascularity of the region caused postoperative recurrences, but there was always some improvement. The pathologic findings consisted of true schwannomas in the periosteum. The basic problem of neurofibromatosis was the endoneural cell proliferation that was responsible for the hypertrophy, hemorrhages, and cyst formation. While there are various hemorrhagic problems in neurofibromatosis, this case demonstrates the characteristic massive hemorrhage and rapid new bone formation that follow minimal trauma, and illustrated the difficulties that are encountered in both nonoperative and operative management.