Predictors of early outcome in unstable pelvic fractures.

OBJECTIVE: To define the preoperative and intraoperative variables which may affect the immediate postoperative outcome in surgically managed patients with unstable pelvic fractures. METHODS: This study was performed prospectively from January 2009 to June 2011 on 36 consecutive patients admitted to the trauma ward of Postgraduate Institute of Medical Education and Research, Chandigarh, with unstable pelvic injuries. RESULTS: In the present study of 36 patients, 29 were managed surgically. Surgical duration was 2 hours in patients operated on within 1 week and 3.4 hours in those operated on after 1 week. The blood loss was 550 ml when surgery was done after a week, but when done within a week it was 350 ml. The average blood loss through Pfanenstial approach was 360 ml, through posterior approach was 408 ml and through combined approach was 660 ml which was significantly high. CONCLUSION: Anterior approach to the pelvis would cause significantly more amount of blood loss than posterior approach and external fixation. Surgical approaches do not have any influence on the surgical duration or the infection rate. The blood loss significantly increases when the surgical time is more than 1 h. The infection rate is not influenced by the duration of surgery. Presence or absence of associated injuries to the head, chest or abdomen is the main determinants of patient's survival and it greatly influences the duration of hospital stay.

Early, reliable, utilitarian predictive factors for fat embolism syndrome in polytrauma patients.

BACKGROUND: Fat embolism is one of the apocalyptic pulmonary complications following high energy trauma situations. Since delay in diagnosis may have devastating consequences, early, easily accessible and relatively inexpensive investigations for risk stratification may prove useful, especially in developing nations. MATERIALS AND METHODS: This prospective trial included a total of 67 young polytrauma patients, in whom the role of nine easily available, rapidly performable clinical or laboratory investigations (or observations noted at admission) in predicting the later occurrence of fat embolism syndrome were assessed. All the patients also underwent continuous monitoring of oxygen saturation with pulsoximetry. RESULTS: The correlation between initial serum lactate (within 12 hours of injury) and hypoxia was statistically significant. There was a trend towards correlation with FES(by Gurd's criteria) (P=0.07), Sensitivity of 24-hour monitoring of oxygen saturation in predicting later pulmonary deterioration approached 100%. CONCLUSIONS: The combination of three factors including polytrauma (with NISS >17), serum lactate >22 mmol/l at admission (within 12 hours of injury) fall in oxygen saturation (SaO2 below 90% in the initial 24 hours) predict the development of post-traumatic pulmonary complications, especially the fat embolism syndrome.

Buttress plating for a rare case of comminuted medial condylar Hoffa fracture associated with patellar fracture.

Hoffa fracture is an uncommon injury. In the literature, lateral condylar Hoffa fracture is mentioned as a more common injury pattern than medial condylar Hoffa fracture. The mechanism of injury and method of treatment is not very well described in the literature. We are presenting a rare case of comminuted medial condylar Hoffa fracture with ipsilateral patellar fracture. The mechanism of injury has not been described in the literature. Lag screw fixation, which is the most acceptable method of treatment, is not possible due to comminution. We explain the possible mechanism of injury and fix the fracture with L-buttress plate.

Safety and efficacy of perioperative tranexamic acid infusion in acetabular fracture fixation: A randomized placebo-controlled double-blind prospective study.

INTRODUCTION: Open reduction and internal fixation of acetabular fracture is associated with significant blood loss. Although Tranexamic acid (TXA) infusion effectively reduces perioperative blood loss and transfusion requirements in elective orthopedic surgery, its efficacy in major orthopedic trauma surgery is controversial. MATERIAL AND METHODS: Sixty-three patients undergoing open reduction and internal fixation of acetabular fracture were randomized into either TXA (n = 36) or placebo (n = 27) group. TXA group received a bolus dose of TXA (10 mg/kg) 15 min prior to incision, followed by another similar dose after 3 h of surgery. The placebo group received the same volume of normal saline similarly. All patients were operated on by a single pelviacetabular surgeon with a uniform perioperative protocol. The intraoperative blood loss, drain output, the number of blood transfusions, postoperative hemoglobin (Hb) drop, and hematocrit (Hct) drop were calculated. RESULTS: Both groups were similar in relation to age, sex, BMI, preoperative Hb, the timing of surgery, fracture pattern, operative time, and surgical approaches. The mean postoperative Hb was 10.35 ± 1.36 gm% in TXA group and 9.74 ± 1.98 gm% in placebo group (p-value 0.158). There were no differences in intraoperative blood loss (438.11 ml vs. 442.81, p=.947), drain output (131.94 ml vs. 129.63, p=.870), and blood transfusion (8 patients vs. five patients, p=.719) between the groups. The drop in Hb and Hct in the postoperative period was also statistically not significant between the groups. CONCLUSION: There is no significant reduction in blood loss and blood transfusion with the use of intravenous Tranexamic acid in open reduction and internal fixation of acetabular fractures.

A New Classification System for Acetabular Bone Defect Evaluation in Posttraumatic Acetabular Nonunion and Malunion.

Introduction: There is no distinct classification system to evaluate the bone defect in previously managed acetabular fractures. We propose a new classification system for bone defect evaluation in a previously managed acetabular fracture that will be helpful for total hip arthroplasty (THA). Materials and Methods: The preoperative pelvis radiographs of 99 THA patients with previous acetabular fractures with at least 2 years of follow-up were evaluated by 10 experienced surgeons (Paprosky and new classification systems). As per the new classification system, the five types of bone defects are circumferential, posterior wall, posterior column, both column defect, and anterior column. The interobserver and intraobserver reliability was calculated, and a consensus management plan based on the recommendation of the observers was formulated. Results: There was fair interobserver reliability for Paprosky classification (alpha coefficient 0.39) and substantial interobserver reliability for the new classification (alpha co-efficient 0.71). There was a substantial intraobserver agreement for the new classification (kappa value 0.80) and moderate intraobserver agreement for Paprosky classification (kappa value 0.55). Sixty-nine patients who were treated as per the management plan of the observers reported significant improvement in modified Harris hip score (improved from 25 to 85.88, p < 0.001). 89.7% of patients reported good to excellent outcomes. Overall best health as per EQ-5D VAS was obtained in THA following anterior column fracture (EQ-5D VAS 97.5), and relatively poor health was obtained after THA of posterior column nonunion (EQ-FD VAS 80). Conclusions:  The new classification system for bone defect evaluation in previously treated acetabular fractures is valid and reliable. The proposed surgical plan for the management of bone defects in THA provided good to excellent outcomes.

Satisfaction and Health-Related Quality of Life Following Hip and Knee Arthroplasty Surgeries in Indian Patients: A Cross-Sectional Study.

Introduction: Recently, the patient-reported outcome measures (PROMs) have been considered as the most important assessment tool for surgical outcome evaluation in arthroplasty. However, no study from the Indian subcontinent has evaluated the PROM in the total hip (THA) and knee (TKA) arthroplasties. Materials and Methods: This cross-sectional study evaluated the health-related quality of life (HRQoL) of 1244 North Indian patients following primary THA and TKA who had at least one-year follow-up. This study included 617 patients with 664 THA and 627 patients with 1152 TKA. The patients were asked to answer the EQ-5D-5L questionnaires and EQ-VAS in their own languages. The EQ-5D-5L values were used to derive level frequency scores (LFS) with validated Indian norms of EuroQoL. Results: Ninety percent of THA and 82% of TKA patients rated excellent HRQoL using EQ-VAS. The regression analysis revealed age, gender, etiology and brand of prosthesis had a significant impact on EQ-5D-5L following THA. However, gender and simultaneous bilateral surgery were found to be important predictors of outcome in TKA. The mean value of LFS for THA was 0.95 ± 0.12 and TKA was 0.88 + 0.24 (p < 0.001). However, There was no difference in LFS between THA and TKA when only elderly patients (> 60 years) were considered (p = 0.168). Conclusion: THA patients reported better HRQoL than TKA in the Indian subcontinent. One of the factors for a better outcome in hip arthroplasty was the relatively younger age of the patients. Patients above 60 years of age reported similar levels of statisfactior in both THA and TKA. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-021-00589-x.

Internal fixation and bone grafting for intraarticular nonunion of tibial plateau: a report of four cases.

Intraarticular nonunion of tibial plateau is rare. In the literature, only 9 patients were found to be treated for intraarticular tibial plateau nonunion and they got varying results. Internal fixation along with bone grafting was done as a standard treatment in all cases. We treated 4 different profile cases of intraarticular tibial plateau nonunion in our institution by 4 different methods. We treated these cases with plaster of paris cast, internal fixation along with bone graft, arthrodesis with K-nail and total knee replacement. Case 1 was treated with plaster of paris (POP) cast as the patient refused surgery. The fracture was united and the patient was fully satisfied with full range of motion despite valgus malalignment. Case 2 was managed with open reduction internal fixation along with bone grafting. The patient had a good union and got full range of motion at the knee joint. Case 3 was treated with total knee arthroplasty due to her old age and got satisfactory result. Case 4 was an infected nonunion. Arthrodesis was done and the patient could walk with full weight bearing independently. We conclude that internal fixation along with bone grafting may not be suitable in all cases of intraarticular nonunion of tibial plateau. Causes of nonunion, present condition and range of motion of the knee joint, as well as the age of patient should be all considered and the treatment should be individualised according to each patient's situation.

Use of gentamicin-loaded collagen sponge in internal fixation of open fractures.

OBJECTIVE: To assess the outcome of immediate plate osteosynthesis via application of antibiotic impregnated collagen fleeces (gentamicin-collagen and antibiotic sponge) which gradually release antibiotic locally in the surgical treatment of open fractures presented to us 6 hours after injury. METHODS: All cases were treated in our tertiary level trauma center and teaching hospital including 35 patients with open fractures who were treated by immediate open reduction and plate fixation from January 2008 to August 2010. Among them, 31 patients were available for adequate follow-up and assessment. All fractures were treated by irrigation and debridement, immediate open reduction and plate fixation along with placement of antibiotic-releasing collagen fleeces around the plate just before closure of wound. Patients were assessed to determine postoperative infection, delayed union or nonunion and development of other postoperative complications. It was hypothesized that immediate plate osteosynthesis after thorough debridement and local antibiotics would give safe and acceptable clinical results in treatment of open fractures. RESULTS: The 31 patients with adequate final follow-up were assessed at a mean time of 40 weeks (15-160 weeks). Most fractures united primarily in an acceptable time period according to area of involvement. Local wound complications (superficial infection and skin loss) were found in 3 patients (9.67%). Deep infection was noted in 2 patients (6.45%). None of these patients needed implant removal and both fractures united in due time. Delayed union was noted in 5 patients (16.13%). No patient progressed to nonunion or implant failure in long term follow-up. Excessive scarring was developed in 2 patients (6.45%). CONCLUSIONS: Immediate plate osteosynthesis after adequate debridement and placement of collagen film eluting antibiotics locally produces excellent results regarding bone union and absence of deep infections and is a safe technique in the management of open bone injuries. These sponges can be used easily with any form of internal fixation and there is no need of second surgery for the removal of these antibiotic carriers since they are bioabsorbable. Local antibiotic-impregnated collagen sponges along with systemic antibiotics for 3 to 5 days offer promising results in open fracture management.

Osteochondral allograft transplantation after excision of femoral head giant cell tumour: a case report.

We report a case of Giant Cell Tumour of the femoral head in a 22-year-old man that was excised and reconstructed with an osteochondral allograft. After 3.5 years follow-up, the graft had completely united and there were no signs of recurrence or resorption; the patient had an excellent functional outcome. Osteochondral allograft transplantation may provide a viable option for joint salvage after excision of a benign or locally aggressive tumour in the femoral head in selected cases.

Anatomical quadrilateral plate for acetabulum fractures involving quadrilateral surface: A review.

INTRODUCTION: The management of acetabulum fractures in osteoporotic elderly, as well as comminuted fractures in younger patients is likely to be difficult. These fractures need specific fixation techniques especially when the quadrilateral plate is involved. Standard implants may not be able to adequately support the fixation, so newer pre-shaped fixation plates have been proposed with some of these already in use. The concept of anatomic plates has come up for many fracture locations for providing a better buttress effect to the comminuted fragments. There has been a need to look for an anatomic buttress plates being developed for acetabulum fractures involving the quadrilateral surface. MATERIALS AND METHODS: The literature has been reviewed to find the various newer designs that have been used for buttressing the quadrilateral surface in comminuted acetabular fractures. An attempt has been made to study their design characteristics and clinical outcomes. The review also includes the analysis of Anatomic Quadrilateral plate (AQP) used in fixation of acetabulum fracture involving quadrilateral surface in a series of 33 patients. RESULTS: There has been few anatomical plates developed for the stabilization of acetabular quadrilateral surface fractures. Some of these plates have been successfully used in management of acetabular fractures primarily in young patients. Issues however remain in their application and outcomes in osteoporotic fractures of the acetabulum, as these plates support the pelvic brim fragments either from superior or medial surface. The newer development i.e. 'Anatomical Quadrilateral Plate' is optimized to counter the displacement forces due to its positioning on the pelvic brim rather than its superior or medial surface. Other special features include the possibility of longer screws across bone due to oblique position of holes, the typical location of a locking hole on the plate beam which permits dual cortical compression fixation either by using a bigger screw or a specially designed screw in screw construct across the supra-acetabular corridor. The option of using hybrid fixation of both locking and unlocked screws in AQP allows proper stress distribution on the underlying bone, aiding both primary as well as secondary stability. The minimum of one year post surgery outcome of patients having acetabular fixation using this Anatomic quadrilateral plate has been analyzed in 33 patients. Twenty three of these were aged more than 50 years and 28 out of total 33 were males. Associated injuries included Ipsilateral lower limb injury in 2 patients and distal radius fracture in 5 patients. The fracture pattern included 'Anterior column posterior hemi-transverse' in 10 patients,' Associated Both Column' injury in 9 and 'T type' acetabular fractures in 8 patients. Isolated 'Anterior column' was fractured in 6 patients. The surgical approach was 'Anterior Intra-pelvic' (AIP) in 23 patients and 'Modified Ileo-femoral' in other 10 patients. One patient had additional K L approach. Among the implants, the AQP plate was used without its pubic arm in 6 patients. The post-operative x rays showed anatomical reduction in 28 patients, while other 5 had gaps and/or steps up to 2 mm size. In subsequent car, one of these patients needed hip arthroplasty for problem arising due to collapse in fixation within six months. EQ 5D 5L telephonic score was used to know the outcome at minimum of one year follow up in 33 patients. As per this score, only 3 patients had an issue with mobility, with only one having problem in self-care activity. Six patients complained of minor limitations in carrying out their usual activities and only one patient had anxiety affecting him. In their self-assessment of overall health status, 22 patients marked it 100, 7 made it 90, 3 as 80 and 1 had marked it as 70 in a score range of 0-100. Considering the predominant elderly profile in this series of patients, the acetabular reconstruction using 'Anatomic quadrilateral plate' has shown encouraging results. CONCLUSION: For stabilization of acetabular fractures involving quadrilateral surface area and pelvic brim, various new implants have been used. The Anatomic quadrilateral plate due to its anatomical shape, the various options in fracture fixation is best optimized for management of comminuted acetabulum fractures especially in poor quality bones. It has been successful in achieving good outcome in elderly group of patients having these complex injuries.

Common hip conditions requiring primary total hip arthroplasty and comparison of their post-operative functional outcomes.

BACKGROUND: Primary osteoarthritis of hip has been widely reported to be the leading cause for total hip replacement (THR) in the world. The other common causes are avascular necrosis of hip, inflammatory diseases and trauma sequelae. We report the prevalence of these disease as studied retrospectively at a tertiary healthcare centre and discuss the common age groups and sex ratios of these patients as compared to the West. Additionally, we compare the outcomes of these surgeries based on the aetiologies for which they were done. METHODOLOGY: Patients who underwent primary THR in our institute within six years were called and retrospectively analysed. Revision cases were excluded. All the surgeries were done by a single experienced arthroplasty surgeon. On follow ups, functional scores were assessed using standard Harris hip score (HHS) and quality of life scores were assessed using the Short musculoskeletal functional assessment (SMFA) score. RESULTS: 118 hips in 99 patients (M:F- 3.2:1) with a mean age group of 43.22 years, were operated over a period of six years. Non traumatic avascular necrosis (AVN) of hip topped the list in our study with 42.4% of cases, followed by post-traumatic sequelae (30.5%). These were followed subsequently by primary osteoarthritis (OA) (14.4%) and the remaining were inflammatory pathologies (IA). The HHS of patients with non traumatic AVN hip, traumatic sequelae and primary osteoarthritis were significantly superior to inflammatory arthritis with a p value of 0.001, 0.001 and 0.016 respectively. Additionally the short musculoskeletal functional assessment score was also significantly higher in IA than AVN, OA and post trauma groups (p = 0.001, 0.037 and 0.002 respectively); where a higher score denotes inferior outcomes. CONCLUSION: In our part of the world, non traumatic AVN hip is the commonest indication for primary hip arthroplasty, followed by traumatic sequelae. The frequency of males undergoing hip arthroplasty is much more than females and at a younger age as compared to the West. Additionally, the functional outcomes in cases of inflammatory arthritis are inferior as compared to the other indications, probably because of associated contractures, deformity and spinal issues.

Long-term outcome of conservatively managed displaced acetabular fractures.

BACKGROUND: The purpose of this study was to determine the long-term outcome of conservatively managed acetabular fractures involving the weight-bearing dome, which otherwise deserves an operative treatment. METHODS: Thirty-two patients with displaced acetabular fractures (>3 mm displacement) involving the weight-bearing dome and not associated with unstable pelvic ring injuries met the inclusion criteria for this study with a minimum of 2 years of follow-up evaluation. They were assessed using the Merle de'Aubigne and Postel clinical scoring and Matta's radiologic scoring system. The mean duration of follow-up was 4.1 years (2-12 years). RESULTS: The reducibility of acetabular fractures by conservative management stood at 18 of 32 (56.3%) synchronizing with 18 of 32 (56.3%) good to excellent clinical score. The mean clinical score was 14.25 +/- 3.41 of a total score of 18. In patients with good fracture reduction, good to excellent results were seen in 83.3% cases. The radiologic grade was good to excellent in 50% cases with good clinicoradiologic correlation (p = 0.0001). CONCLUSIONS: Acetabular fractures involving the weight-bearing dome if reduced by closed means can be maintained by heavy lateral and longitudinal traction resulting in good clinicoradiologic outcome comparable with operative management.

Clinico-radiological assessment and their correlation in clubfeet treated with postero-medial soft-tissue release.

The controversy regarding the radiographic parameter which best represents the various deformities of clubfoot continues. The aim of our study was to clear up this controversy. Fifty surgically treated (soft-tissue release) congenital clubfeet were studied clinically using Laaveg and Ponseti score and radiologically using twelve different radiographic parameters in weight-bearing AP and lateral views. The talo-calcaneal angle (TCA) in AP and lateral view showed statistically significant correlation with the functional rating, but significant variation in the dimension of the angles among the different functional groups was found with AP angle only. The talo-first metatarsal angle in AP and lateral view averaged 10 degrees and 19 degrees respectively, and showed significant correlation with the functional rating. The talo-navicular subluxation in AP, the calcaneo-fifth metatarsal angle and the first-fifth metatarsal angle in lateral view did not show any significant correlation with function. Talo-calcaneal index averaged 44 degrees in the clubfeet and showed significant correlation. The wide range of parameters representing each of the deformities gives a better radiological assessment of the clubfoot than any single parameter.

Scapulothoracic dissociation: level of vascular insult, an indirect prognostic indicator for the final outcome?

Scapulothoracic dissociation is the result of severe blunt trauma or sudden forceful traction applied to the shoulder, simulating a traumatic forequarter amputation but with sparing of the skin. This grievous injury results in injury at three levels: neural, vascular and musculoskeletal. Since the neural damage cannot be ascertained in the acute stage of this injury, wheras the vascular injury can be defined, this study aimed to find out any correlation of the eventual neural damage with the level of vascular injury. It became evident, after compilation of the authors' 8 cases and the 37 relevant cases reported in literature, that the patients with subclavian artery injury had more frequently a complete brachial plexus involvement, whereas those with axillary artery involvement sustained more often a partial plexus injury. This correlation was found to be statistically significant (p < 0.05). It is thus concluded that the more proximal the level of vascular injury, the more grave is the neurological damage. This fact can be utilized to prognosticate the eventual outcome of the limb concerned.

Refolding of HLA-B27 heavy chains in the absence of beta2m yields stable high molecular weight (HMW) protein forms displaying native-like as well as non-native-like conformational features: implications for autoimmune disease.

Refolding of the heavy chain of the Class I HLA molecule, HLA-B27, in the absence of beta(2)m, yields soluble high molecular weight (HMW) oligomers reminiscent of the oligomeric forms of beta(2)m-free heavy chains (FHCs) of class I HLA antigens observed on cell surfaces. Here we examine the structural characteristics of HMW B27 in respect of features potentially relevant to autoimmunity, such as: (a) retention of native-like structure, since this could facilitate non-canonical interactions with T-cell receptors even in the absence of bound beta(2)m and peptide, or (b) presence of non-native structure, since this could yield novel (non-self) antigenic conformational epitopes that could elicit immune attack. We report that HMW B27 is characterized by high secondary structural content, structural stability, stability to proteolysis by trypsin, and structural features that are both partly native-like, and partly non-native-like, as assessed through the binding of conformationally-distinguishing and cross-reacting scFv antibodies specifically selected against HMW B27. We also present cell ELISA data with conformation-specific scFv antibodies that distinguish between lymphocytes from individuals who are healthy and B27 positive, and those who are B27 positive but suffering from ankylosing spondylitis.

Diaphyseal sclerotic osteosarcoma presenting as a pathological fracture.

A diaphyseal, intramedullary, highly sclerotic lesion presenting as a pathological fracture, without a periosteal reaction or an appreciable soft tissue component on radiographs was investigated. A discrepancy between the MRI and histopathological findings led to marginal excision of the lesion only to reveal later that it was a sclerotic variety of osteosarcoma. Such a presentation has not been reported in literature as per our knowledge. We forfeited the opportunity of limb salvage by doing initial marginal excision and fixation. In such circumstances, a representative biopsy is critical and repeat biopsy is warranted before going for definitive management.

Blocking osteopontin-fibronectin interactions reduce extracellular fibronectin deployment and arthritic immunopathology.

Elevated levels of a thrombin-cleaved fragment of osteopontin (OPNT) are seen in synovial fluid (SF) and tissues of rheumatoid arthritis (RA) patients. OPNT binds to integrins on cell surfaces, inducing adhesion, migration and survival of inflammatory cells in the synovial joints, where OPNT binds to fibronectin to link fibroblast-like synoviocytes (FLS) with B cells, stimulating the latter to produce inflammatory cytokines. Our aim was to block OPNT-fibronectin interactions and examine whether this reduces inflammation. A human antibody (phage displayed) library was used to select scFv antibodies cognate to OPNT, and a particular scFv antibody (scFv 31) was evaluated. Adhesion, migration and fibronectin polymerization of FLS cells derived from RA patients were monitored, in cultures incorporating scFv 31. Also, scFv 31 was used in mice with CAIA (collagen antibody-induced arthritis), subjected to clinical and histological assessment, analysis of fibronectin and cartilage damage and induction of pro-inflammatory cytokines. The scFv antibody, scFv 31, appeared to cause significantly reduced migration of synovial fibroblasts, altered cell morphology, changes in actin stress fiber arrangement, and marked reduction in fibronectin. In CAIA mice, scFv 31 appeared to prevent arthritic changes through inhibition of synovial hypertrophy and loss of articular cartilage, decrease in fibronectin polymerization and expression of pro-inflammatory cytokines implicated in arthritis. Osteopontin-fibronectin interaction(s) appear to play a role in the expression of key inflammatory molecules by B cells infiltrating the synovial joint. The scFv antibody, scFv 31, provides a potential therapeutic lead for inhibition of some processes implicated in rheumatoid arthritis.

18F-FDG PET/CT in Diagnostic and Prognostic Evaluation of Patients With Suspected Recurrence of Chondrosarcoma.

PURPOSE: The aim of the study was to analyze the diagnostic and prognostic utility of F-FDG PET/CT to predict the disease-specific survival (DSS) with FDG uptake and tumor grade in recurrent chondrosarcoma. METHODS: Retrospective analysis of FDG PET/CT findings in 31 previously treated patients (46 studies) with mean follow-up period of 40.7 ± 23.9 months (range, 3-77 months) from the date of first PET/CT study was done. Kaplan-Meier DSS analysis was made with respect to tumor grade, FDG uptake at the recurrent primary sites, and a combination of grade and FDG uptake as parameters. RESULTS: Recurrence (local and distant) was shown in 28 (60.8%) of 46 FDG PET/CT studies with sensitivity and specificity of 88.9% and 78.9%, respectively. The median SUVmax at the recurrent primary sites differed significantly (P = 0.008) among 3 tumor grade groups, with higher median SUVmax in higher grades. There was significant difference in median SUVmax among different grade groups except between grade II and grade III. Recurrent primary site SUVmax cutoff at 6.15 derived from the receiver operating characteristic curve yielded significant difference (P < 0.001) in mean DSS time. Significant difference in survival was noted between 3 different tumor grade groups (P = 0.016). The combination of SUVmax and grade improved the survival prediction than with grade alone. CONCLUSIONS: In recurrent chondrosarcoma, the recurrent primary site FDG uptake and grade were found to be reliable prognostic factors with respect to DSS. PET/CT in recurrence setting has the potential to predict tumor grade and survival and may assist in clinical management.

Amelioration of collagen antibody induced arthritis in mice by an antibody directed against the fibronectin type III repeats of tenascin-C: Targeting fibronectin type III repeats of tenascin-C in rheumatoid arthritis.

Tenascin-C (TN-C) levels are elevated in the synovial tissue and fluid, as well as cartilage of rheumatoid arthritis (RA) patients. In addition, the presence of TN-C fragments has also been documented in arthritic cartilage. We have previously shown that a single chain variable fragment antibody (TN64), directed against the fibronectin type III repeats 1-5 (TNfnIII 1-5) of TN-C, effectively inhibits fibrotic pathology. Given that fibrosis results from chronic inflammation, and the fact that increased levels of TN-C in the synovial fluid of patients with RA contributes to synovial inflammation and joint destruction, we aimed to investigate the role of TNfnIII 1-5 region of TN-C in RA pathogenesis. Using either the wild type or variants of the two integrin-binding motifs (RGD and AEIDGIEL) present within the TNfnIII 1-5 polypeptide, we demonstrate that the adhesion and migration of synovial fibroblasts is RGD-dependent. The antibody TN64 is effective in inhibiting migration of cells in response to TnfnIII 1-5, and prevents fibroblast-mediated destruction of cartilage. The TN64 antibody was further tested in collagen antibody induced arthritic (CAIA) mice. Our data shows the efficacy of TN64 in preventing induction of arthritis, with significant downregulation of RA-associated cytokines. This suggests that components of the extracellular matrix such as the TNfnIII 1-5 region of TN-C could be exploited to develop therapies to suppress inflammation seen in RA. The TN64 antibody is one such promising candidate in the development of novel treatments for RA.

The effect of local administration of phenytoin on fracture healing: an experimental study.

The antiepileptic drug phenytoin (Diphenylhydantoin) has been documented to have a beneficial effect on wound healing; its effect on fracture healing, however is still unclear. In an attempt to evaluate any potential benefits phenytoin may have on fracture healing, a prospective study was undertaken combining histology, histomorphometry and radiology, in which the effects of locally administered phenytoin were analysed. Twenty-four Wistar strain rats of 8-9 months age were assigned into two groups of 12 each (matched for age, sex and weight). In the study group, phenytoin 20 mg/kg was administered through a 24 gauge needle directly on to the fracture site every 72 hours, while in the control group an equivalent volume of normal saline was administered at similar intervals. At 28 days radiographic and histological analysis was done, the scoring for which did not show any statistical difference between the control and test animals. Histomorphometric analysis of the callus however, showed that the total periosteal callus on either side of the central bridging callus was mineralised to a greater extent in the phenytoin group animals as compared to the control group animals (p = 0.011). After analysing our data, we concluded that phenytoin does have an influence in fracture healing, albeit small, which is primarily on the hard callus region. The hard callus region is the high oxygen tension region and the first region to differentiate. It appears that the effect of phenytoin is probably exerted at the early mesenchymal differentiation stage. However our preliminary work shows that the effect is small and it is not justifiable at this stage to advocate the use of phenytoin clinically to augment fracture healing.