[Classification of acetabular fractures]. / Tipizzazione delle fratture del cotile.

Morphologic classification of fractures, however analytical they may be, is not sufficient to give precise indications as to the most adequate management decision for the various types of fractures of the acetabulum. The authors therefore find it necessary to typify these fractures on the basis of some anatomical and radiographic elements that may cause the prognosis to vary from case to case even in the same type of fracture. Two of the most important typifying factors are: articular congruity and the damage to the weight-bearing dome. The authors point out that such factors are necessary elements in the choice of a logical management decision and consider illogical an aprioristic approach whether surgical or not.

Congenital hip dysplasia treated by the Salter osteotomy. Long-term review of 18 patients.

Between 1965 and 1974 at the Orthopaedic Clinic of the University of Perugia, 20 osteotomies of the innominate bone were performed on 18 patients aged between 18 months and 10 years. All the patients were followed up for 10 to 19 years (average 15 years) after operation. The results were evaluated both clinically and radiographically (according to the Severin and MacFarland methods). The data were later submitted to computer analysis, using a semiautomatic aquisition programme which allowed for evaluation of the geometry of the hip. The most important parameters for evaluation of the results were the Wiberg CE angle, the acetabular angle, the minimum joint space, and the horizontal component of the resultant force. Clinically and radiographically there was an 80% success rate according to Severin's method of evaluation. There was also good correlation with the computerized analysis. Biomechanically, there was almost normal recovery of the load distribution. The clinical, radiographic and biomechanical parameters worsened slightly with age, particularly during puberty.

Fractures of the acetabulum: conservative treatment and results.

The treatment of fractures of the acetabulum is still a controversial subject. There has in recent years been a tendency towards surgical rather than conservative treatment but more recently it has been observed that the long-term results of both types of treatment are not dissimilar. The classification of these fractures is important in relation to both conservative and surgical treatment. With the objective of rationalising the choice of treatment, 72 comminuted fractures of the acetabulum treated conservatively at the Orthopaedic Clinic in Perugia between 1959 and 1980 were reviewed. Both the clinical and radiographic features of these cases were analysed. The overall results were 70% successes and 30% failures. Several correlations indicating which features of the fracture had most influence on the final results were established; the involvement of the support surfaces (acetabular dome) and joint congruency were found to be the most important. In addition to these major factors, the age of the patient, presence or absence of dislocation, the degree of displacement and topography of the fragments collectively define the "type" of fracture and the criteria which are indispensable for the choice of treatment.

Ulnar nerve compression at the elbow level.

The long-term results are reported (average 9 years) of anterior transposition of the ulnar nerve into a muscular groove in the treatment of ulnar nerve compression at the elbow level. The series of 27 elbows consisted mostly of patients with muscle deficit. The results were examined in relation to the preoperative duration of symptoms, particularly weakness and wasting of muscles, and were satisfactory in 78% of cases in that recovery of the muscle deficit was either complete or showed marked improvement. When the duration of symptoms exceeded one year, the results were less satisfactory.

Congenital ocular and other systemic abnormalities associated with ring-11 chromosome.

The ocular and systemic abnormalities in a boy with ring chromosome 11 [46, XY/46, XY, r(11) (p 15.5----q25] are described. The ocular anomalies consisted of bilateral hypermetropia, microcornea, anterior chamber cleavage syndrome with prominent Wölfflin nodes, and cartwheel configuration of the anterior iris leaf. The systemic changes consisted of skeletal, muscular and articular defects, obesity, cryptorchidism, and mild mental retardation.

Stable fixation of fractures of the forearm in adults.

The results are presented of 148 fractures of the radius and ulna in 89 patients. All were treated by AO compression plating. The results were assessed at an average of 4.5 years. In 80% of cases these were functionally excellent and confirm that this method of treatment gives early consolidation and restoration of good function in adults. However, there is a significant percentage of complications in open fractures of both bones.

Changes in respiratory function in disorders of the thoracic cage. With special reference to the ventilatory mechanism and the regulation in scoliosis.

After describing the clinical and functional effects of pathological changes in the thoracic cage ("mechanical syndrome" and "neuromuscular syndrome"), the authors discuss the disorders of respiratory function observed in a group of patients with poliomyelitic scoliosis. The aim was to establish the type and nature of these changes with a view to clarifying certain pathogenetic aspects. Two factors suggest that the altered geometry of the thoracic cage in scoliosis is responsible for the mechanical inefficiency of the thoracopulmonary apparatus, namely: 1. changes in respiratory function, since there was a strict correlation between the severity of the scoliosis and the degree of change in certain indices of respiratory function (vital capacity, maximum expiratory volume per second, maximum ventilation per minute); 2. changes in the regulation of ventilation, indicated by: a) good correlation between the ventilatory response to CO2 and the severity of the anatomical lesion; b) a reduction in the occlusion pressure, which is regarded as the pressure available to produce ventilation.

Osteosynthesis of closed femoral shaft fractures by plate fixation: indications and results.

Osteosynthesis of fractures of the shaft of the femur by plating is not so widely used as intramedullary nailing. It does, however, have precise indications in certain situations that preclude the use of nails or render them inadvisable. The purpose of the present paper is to make a contribution to this aspect of the problem, the literature on which is by no means extensive. The results of forty-seven cases, performed on the basis of the writers' indications, are reported after a long term follow up period.

[Intercellular substance of connective tissue: collagen and mucopolysaccarides]. / La sostanza intercellulare del tessuto connettivo. Collagene e mucopolisaccaridi.

The paper deals with the more salient data on the principal components of the intercellular substance of connective tissue: collagen and mucopolysaccharides. With regard to collagen, is described the sub-microscopic structure of single units of "tropocollagen" and the interpretation of the periodic structure of fibrils, their organization in tissue as well as the synthesis and reabsorption of collagen itself is discussed. With reference to mucopolyaccharides, their chemical structure, distribution in the tissues and their relation with the protein component of the protein-polysaccharide complex is described. Furthermore the Author points out the quantitative and qualitative changes of the various mucopolysaccharides in connection with age, site and function. Brief reference is also made to the essential characteristics of sialic acid.