Single stage reconstruction of segmental skeletal defects by bone graft in a synthetic membrane.

INTRODUCTION: Segmental skeletal defects are very difficult to treat. The current options are lengthy procedures, require more than one surgery and plagued with many complications. The aim of this study is to assess the results of bone graft in surgicel as a synthetic membrane for reconstruction of segmental skeletal defects in one stage surgery. METHODS: Fourteen patients with segmental skeletal defects were included in the study. The ages ranged from 20 to 54 years with an average of 32 years. The defects were due to high energy trauma in all cases. The size of the defects ranged from 5 to 12 cm with an average of 7 cm. They were located in the distal femur in 11 cases and middle third of the femur in three cases. All cases were treated by the synthetic membrane technique in one stage surgery. Surgicel was used as a synthetic membrane and both the fibular strut autograft and morselized allograft were used to fill the defects in all patients. RESULTS: All cases healed without additional procedures after the index surgery except in three cases. The time-to-bone union ranged from six to 13 months with an average of eight months. After physiotherapy all patients regained good range of knee movements except two cases. The complications included deep wound infection in two cases, nonunion of the graft in one case and joint stiffness in two cases. CONCLUSION: Primary bone graft in surgicel as a synthetic membrane is a good technique for management of post-traumatic bone defects. It reduces the time and number of surgeries required for reconstruction of this difficult problem.

Treatment of proximal humerus fractures in children with a modified palm tree technique.

Although most pediatric proximal humeral fractures can be successfully treated conservatively with satisfactory results, many operative techniques have been described for the treatment of displaced proximal humeral fractures. The aim of this study is to evaluate the efficacy of percutaneous fixation using a modified palm tree technique for proximal humerus fractures in children. Between March 2011 and May 2013, the modified palm tree technique was used for the management of 30 children (20 boys and 10 girls) with displaced proximal humeral fractures. The average age of the patients was 11.5 years (age range from 8 to 15 years). They were evaluated clinically by the Constant-Murley score and by radiological analysis. The average follow-up duration was 18 months. The average time of fracture union was 6 weeks (range from 4 to 8 weeks). The average Constant score of the patients was 92 (range from 87 to 95), with excellent results in 27 (90%) cases, good results in three (10%) cases, and no fair or poor results (0%). The reported complications were superficial pin-tract infection in five cases, treated by daily dressing and local antibiotics, and malunion with a varus deformity in two cases (about 15°), with no recorded cases with deep infection. None of the cases required open reduction. No cases were complicated by avascular necrosis of the head humerus or loss of fixation. Kirschner wires were removed after an average period of 7 weeks. The modified palm tree technique represents an efficient method for the treatment of proximal humerus fractures in children. It produces a good grip in both the proximal and distal fragments. It allows for early joint movements.

Ilizarov External Fixator Versus Retrograde Intramedullary Nailing for Ankle Joint Arthrodesis in Diabetic Charcot Neuroarthropathy.

Charcot neuroarthropathy of the ankle joint is a destructive process that leads to instability and significant morbidity that can end with amputation. Surgical arthrodesis in Charcot neuroarthropathy has a high failure rate. The aim of the present prospective study was to compare the outcomes of an Ilizarov external fixator and retrograde intramedullary nailing (IMN) for tibiotalar arthrodesis in Charcot neuroarthropathy. From February 2010 to October 2013, 27 patients (16 males and 11 females) with Charcot neuropathy of the ankle joint were treated in our department. Their ages ranged from 32 to 75 (average 54) years. Of the 27 patients, 14 received an Ilizarov external fixator and 13 underwent IMN. A preoperative clinical and radiologic assessment of all patients was performed. The outcomes were measured for bone union, development of complications, and clinical follow-up. The mean score of modified American Orthopaedic Foot and Ankle Society ankle hindfoot scale was 80 ± 2.7 points in the Ilizarov group and 75 ± 1.9 points in the IMN group. In the Ilizarov group, 12 of 14 patients achieved union, and in the IMN group, 10 of 13 patients achieved union. The complication rate was significantly greater in the external fixator group than in the IMN group. The complications in the Ilizarov group included nonunion in 2 patients (14%), pin tract infection in 8 (57%), pin tract loosening in 3 (21%), surgical wound infection in 3 (21%), and wound breakdown in 1 patient (7%). In the IMN group, nonunion occurred in 3 patients (23.1%), back-out of a distal locking bolt in 2 (15.4 %), and a superficial wound infection that resolved with antibiotics in 1 patient (7.7%). In conclusion, retrograde IMN and the Ilizarov external fixator both yielded better union for tibiotalar arthrodesis in Charcot neuroarthropathy. The Ilizarov external fixator resulted in a greater union rate than IMN but the complications with external fixation were significantly greater than those with IMN.

Ilizarov bone transport versus fibular graft for reconstruction of tibial bone defects in children.

The aim of this study was to compare the results of treatment of segmental tibial defects in the pediatric age group using an Ilizarov external fixator versus a nonvascularized fibular bone graft. This study included 24 patients (age range from 5.5 to 15 years) with tibial bone defects: 13 patients were treated with bone transport (BT) and 11 patients were treated with a nonvascularized fibular graft (FG). The outcome parameters were bone results (union, deformity, infection, leg-length discrepancy) and functional results: external fixation index and external fixation time. In group A (BT), one patient developed refracture at the regenerate site, whereas, in group B (FG), after removal of the external fixator, one of the FGs developed a stress fracture. The external fixator time in group A was 10.7 months (range 8-14.5) versus 7.8 months (range 4-11.5 months) in group B (FG). In group A (BT), one patient had a limb-length discrepancy (LLD), whereas, in group B (FG), three patients had LLD. The functional and bone results of the Ilizarov BT technique were excellent in 23.1 and 30.8%, good in 38.5 and 46.2, fair in 30.8 and 15.4, and poor in 7.6 and 7.6%, respectively. The poor functional result was related to the poor bone result because of prolonged external fixator time resulting in significant pain, limited ankle motion, whereas the functional and bone results of fibular grafting were excellent in 9.1 and 18.2%, good in 63.6 and 45.5%, fair in 18.2 and 27.2%, and poor in 9.1 and 9.1%, respectively. Segmental tibial defects can be effectively treated with both methods. The FG method provides satisfactory results, with early removal of the external fixator. However, it had a limitation in patients with severe infection and those with LLD. Also, it requires a long duration of limb bracing until adequate hypertrophy of the graft. The Ilizarov method has the advantages of early weight bearing, treatment of postinfection bone defect in a one-stage surgery, and the possibility to treat the associated LLD. However, it has a long external fixation time.

Comminuted long bone fractures in children. Could combined fixation improve the results?

Comminuted diaphyseal fractures in the pediatric age group represent a major orthopedic problem. It is associated with a high incidence of complications and poor outcomes because of the instability and difficulty in treatment. The aim of this study was to evaluate the efficacy of combined external skeletal fixation and flexible intramedullary nails in reconstruction of comminuted diaphyseal fracture in skeletally immature patients. Combined external fixator and elastic stable intramedullary nails were used in the management of 27 pediatric patients (15 males and 12 females) with unstable comminuted diaphyseal fractures of the tibia and femur. There were 19 fractures of the femur and eight fractures of the tibia. The average age of the patients was 8.7 years (range 7-14 years) for the femur and 10.8 years (range 6-15 years) for the tibia. Fractures were classified according to the system of Winquist and Hansen as grade II (five cases), grade III (nine cases), and grade IV (13 cases). All cases were operated within 6 days (range 0-6 days) after injury. The mean follow-up period was 2.8 years (range 2-3.5 years). The average duration of the external fixation was 1.6 months for fractures of the tibia, whereas it was 1.4 months for fractures of the femur. The average time for tibia fracture union was 2.8 months for fractures of the tibia, whereas it was 1.9 months for fractures of the femur. Malalignment in varus less than 5° was noted in one patient. One patient had a limb-length discrepancy of 1.5 cms. There were five cases (18.5%) with pin-tract infection. According to the Association for the Study and Application of the Methods of Ilizarov evaluation system, bone results were excellent in 23 cases (85.2%), good in three cases (11.1%), and poor in one case (3.7%). Functional results were excellent in 22 (81.5%) cases and good in five (18.5%) cases. Combined use of external fixators and elastic intramedullary nails is a good method for the treatment of comminuted long bone fractures in children.

Dome osteotomy using the paratricipital (triceps-sparing) approach for cubitus varus deformity in children: a surgical technique to avoid lateral condylar prominence.

Twenty patients (11 males and nine females) with cubitus varus deformity were treated with corrective dome osteotomy through the paratricipital approach. Patients presented after an average 3 years of appearance of the deformity. The average age of the patients was 8.5 years (range 6-14 years). All patients had a previous history of supracondylar fracture. Preoperatively, carrying angle, lateral condylar prominent index, and range of motion were recorded. There were no intraoperative complications. Postoperatively, three patients developed a superficial skin infection. No patient had unsightly scarring or a prominent lateral condyle. No patient reported pain, motor weakness, or atrophy of the arm musculature. There was no fixation failure or loss of correction during the healing stage and no revision surgery was needed. The results were graded according to the preoperative and postoperative carrying angle, movement of flexion and extension, and lateral condylar prominence index and they were evaluated statistically. Preoperative and postoperative extension, carrying angle, and lateral condylar prominence index were statistically significant. Corrective dome osteotomy using the paratricipital approach seems to be a reliable technique for correction of cubitus varus in children. The procedure is relatively simple and enables correction of the deformity without inducing lateral condylar prominence.

Management of segmental skeletal defects by the induced membrane technique.

BACKGROUND: Surgical reconstruction of segmental skeletal defects represents a true challenge for the orthopedic surgeons. Recently, Masquelet et al. described a two-stage technique for reconstruction of bone defects, known as the induced membrane technique. The aim of this study is to assess the results of the induced membrane technique in the management of segmental skeletal defects resulting from debridement of bone infection. MATERIALS AND METHODS: Seventeen patients with segmental skeletal defects were treated in our institution by the induced membrane technique. The average age of the patients was 43 years (range 26- 58 years). The causes of the defects were infected gap nonunion in 12 cases and debridement of osteomyelitis in 5 cases. The defects were located in the tibia (n = 13) and the femur (n = 4). The mean defect was 7 cm (range 4 cm - 11 cm). All cases were treated by the induced membrane technique in two-stages. RESULTS: Bone union happened in 14 patients. The limb length discrepancy did not exceed 2.5 cm in the healed cases. The mean time of healing was 10 months (range 6-19 months). The complications included nonunion of the graft in five cases, failure of graft maturation in two cases, reactivation of infection in two cases and refracture after removal of the frame in one case. These complications were managed during the course of treatment and they did not affect the final outcome in all patients except three. CONCLUSION: The induced membrane technique is a valid option for the management of segmental skeletal defects. It is a simple and straight forward procedure, but the time required for growth and maturation of the graft is relatively long.

Can platelet-rich plasma shorten the consolidation phase of distraction osteogenesis? An experimental study.

PURPOSE: The purpose of this study was to evaluate the effects of platelet-rich plasma (PRP) on distraction osteogenesis. MATERIALS AND METHODS: Tibias of 36 New Zealand white rabbits were distracted at a rate of 0.25 mm/8 h for 20 days with a circular external fixator. The animals were randomly divided into a control group that did not receive PRP therapy and an experimental group, with PRP injection into the distracted area. Radiographic examinations were performed at the 10th, 20th, 30th, 40th and 50th days after end of distraction. By the 50th day after distraction, all animals were sacrificed, the external fixator was removed and the tibia was dissected. After that, each group was subdivided into two subgroups: one for pathological study and another one for mechanical study. RESULTS: Radiologic scores were statistically similar at the 10th, 20th and 30th days. However, the experimental group demonstrated higher radiologic scores at the 40th and 50th days. Histopathologic examination revealed a statistically significant higher score in the experimental group. The PRP injected group showed an improvement of their mechanical properties. CONCLUSION: The results of this study show that PRP has beneficial effects on new bone formation during distraction osteogenesis.

Musculoskeletal congenital malformations: do paternal occupational exposures play a role?

BACKGROUND: Paternal occupational exposures to potential health hazards are likely to affect congenital malformations through the spermatogenesis cycle. PURPOSE: The aim of this case-control study was to assess the relationship between the risk of musculoskeletal congenital malformations in offspring and paternal workplace exposure to potential health hazards during the preconception period. METHOD: The study comprised 105 patients (cases) with a musculoskeletal congenital malformation(s) and 135 controls matched for age and demographic characteristics. Both parents of each case and control were interviewed in the hospital by a trained physician. They also completed a questionnaire focusing on the preconception period and on the 3-month period immediately before and after the pregnancy conception date, respectively, of the child under study. RESULTS: The odds of having a child with a congenital malformation was higher (P < 0.05) if the father was occupationally exposed to pesticides, solvents, or welding fumes during the preconception period. CONCLUSION: Control of workplace exposures and adherence to threshold limit values of these potential health hazards should be adopted to minimize the risk of fathers having offspring with a congenital malformation.

Is there a safe zone to avoid superficial radial nerve injury with Kirschner wire fixation in the treatment of distal radius? A cadaveric study.

AIM OF THE STUDY: To determine the relation of the superficial radial nerve to bony land-marks and to identify a safe zone for K-wire pinning in the distal radius. METHOD: The superficial radial nerve was dissected in sixteen upper extremities of preserved cadavers. RESULTS: We found that the superficial radial nerve emerged from under brachioradialis at a mean distance of 8.45 (±1.22) cm proximal to the radial styloid. The mean distance from the first major branching point of the superficial radial nerve to the radial styloid were 4.8 ± 0.4 cm. All branches of the superficial radial nerve were found to lie in the radial half of an isosceles triangle formed by the radial styloid, Lister's tubercle and the exit point of the superficial radial nerve. There is an elliptical area just proximal to the Lister's tubercle. This area is not crossed by any tendons or nerve. It is bounded by the extensor carpiradialis brevis, extensor pollicis longus. CONCLUSION: Pinning through the radial styloid is unsafe as the branches of the superficial radial nerve passé close to it. The ulnar half of the isosceles triangle is safe regarding the nerve. The elliptical zone just proximal to the Lister's tubercle is safe regarding the tendons and nerve.

Cemented bipolar hemiarthroplasty with a cerclage cable technique for unstable intertrochanteric hip fractures in elderly patients.

AIM: The purpose of this study is to evaluate the clinical and radiological outcomes of cemented bipolar arthroplasty as a primary treatment for unstable intertrochanteric fracture in the elderly patients. METHODS: Twenty hips with unstable intertrochanteric fractures were followed for more than 2 years after cemented bipolar hemiarthroplasty. The mean age was 69 years, and the mean follow-up period was 30.5 months. We evaluated the results by Harris hip score, complications, and radiologic findings. RESULTS: At the last follow-up, the mean Harris hip score was 83.3 points. Radiologically, there was no case of osteolysis. All stems were stable without significant changes in alignment or progressive subsidence. CONCLUSIONS: Bipolar hemiarthroplasty with calcar reconstruction is a good option for unstable intertrochanteric fractures in elderly patients with severe osteoporosis with strict indication selection. Longer-term studies with larger numbers of patients are required to address the issues of late complications.

Outcomes of open bicondylar tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation.

This study was conducted to evaluate the outcome of treatment for open fractures of the tibial plateau using external circular fixation combined with or without limited internal fixation. Twenty-five patients (16 males and 9 females) with open fracture tibial plateau were treated with circular external fixator with minimal internal fixation. The mean age of the patients was 36 years (range between 23 and 62 years). According to AO classification system, there was six (24 %) C1, eleven (44 %) C2, and eight (32 %) C3. According to Gustilo and Anderson classification, seven (28 %) were grade 1; nine (36 %), grade 2; six (24 %), grade 3b; and three (12 %), grade 3c. According to ASAMI score, Italy, the results were excellent in 8 (32 %) cases, good in 12 (48 %) cases, and fair in five (20 %) patients. The patients' satisfaction was significantly related to the functional results (p < 0.05). Complications included skin gaping in one case 10 days postoperatively. Pin tract infection was seen in 20 % of cases, one case showed deep infection and no cases of septic arthritis. There is no correlation between the final outcome and articular depression (p > 0.05). Ilizarov external fixator provides acceptable outcomes but with a high rate of complication rate, typical of this type of fracture. It avoids extensive soft tissue dissection.

Does bone marrow affect the radiological outcome when added to biphasic ceramic graft in treatment of benign bone lesions?

PURPOSE: The aim of this study is to describe the role of bone marrow aspirate in treatment of the benign bone lesions by comparing two groups of patients (16 patients in each group) with benign bone lesions treated with surgical curettage and filling the defect with either composite ceramic graft hydrated with bone marrow aspirate "group 1" or composite ceramic graft alone without a bone marrow aspirate "group 2". MATERIALS AND METHODS: The mean age was 19.7 years (group 1) and 18.5 years (group 2). The mean size of the cavitary bone lesions was 29.2 cm(2) (group 1) and 25.9 cm(2) (group 2). The mean follow-up period was 47 months. RESULTS: The percentage of ceraform resorption had increased from 31.3% at 6 months to 75.4% at 36 months for group 1 patients and from 20.9% at 6 months to 60.3% at 36 months for group 2 patients. The percentage of bone trabeculation through the cavitary defects had increased from 30.3% at 6 months to 85.5% at 36 months for group 1 patients and from 18.9% at 6 months to 72.0% at 36 months for group 2 patients. The mean of the percentage of ceraform persistence at 36 months after its implantation was 24.6% for group 1 patients and 39.7% for group 2 patients. CONCLUSION: Adding bone marrow aspirate to ceraform biphasic ceramic had hastened the rate of its resorption and had decreased the rate of its persistence.

Outcome of elastic nailing of diaphyseal forearm fractures in adolescents after failure of conservative management.

PURPOSE: This is a prospective study to evaluate the efficacy of elastic nails for the treatment of diaphyseal forearm fractures after failure of conservative management. METHOD: In 35 patients with a mean age of 15.3 years (14-17 years), elastic nails were used for the treatment of diaphyseal forearm fractures after failure of conservative management. In 32 patients (91.4%), we performed closed reduction. In the remaining 3 (8.6%), closed reduction failed and an open reduction, through a minimal approach, was required before nailing. RESULTS: After a mean follow-up of 31 months (range 24-48 months), 20 (60%) patients had an excellent result 10 (34.3%) patients had a good result, and two (5.7%) patients had fair result. The mean time of union was 12 weeks (range 8-15). The mean time in cast was 8.5 weeks (range 7-11). Full range of elbow movement was regained in all cases; however, supination and pronation were limited in two patients. One patient had a superficial infection at the site of entry of the ulnar nail which was successfully treated with oral antibiotics and daily dressing. Neurapraxia affecting superficial branch of the radial nerve in one patient was resolved over a period of time. One case with partial rupture of extensor pollicus longus tendon was reported. There was one case of delayed union. No cases of refracture were reported after removal of the implant. CONCLUSION: In adolescents, intramedullary fixation by using elastic nail plus cast immobilization provides effective treatment for diaphyseal forearm fracture when closed management has failed. However, it is of special importance to follow the right indication and to pay attention to correct technical procedure.

Bipolar versus fixed-head hip arthroplasty for femoral neck fractures in elderly patients.

Between 2002 and 2007, fifty elderly patients with displaced femoral neck fractures were treated with hip replacement at Emergency Hospital, Mansoura University. Patients were randomly selected, 25 patients had either cemented or cementless bipolar prosthesis, and another 25 patients had either cemented or cementless fixed-head prosthesis. There were 34 women and 16 men with an average age of 63.5 years (range between 55 and 72 years). All patients were followed up both clinically and radiologically for an average 4.4 years (range between 2 and 6 years). At the final follow-up, the average Harris hip score among the bipolar group was 92 points (range between 72 and 97 points), while the fixed-head group was 84 points (range between 65 and 95 points). Radiologically, joint space narrowing more than 2 mm was found in only 8% (2 patients) among the bipolar group, and in 28% (7 patients) of the fixed-head group. Through the follow-up period, total hip replacement was needed in two cases of the bipolar group and seven cases of the fixed-head group. Bipolar hemiarthroplasty offered a better range of movement with less pain and more stability than the fixed-head hemiarthroplasty in elderly patients with displaced femoral neck fractures.

Management of calcaneal fractures using the Ilizarov external fixator.

Twenty five intra-articular fractures of the calcaneus in 25 patients were reduced through a minimal incision and fixed with an Ilizarov external fixator. The average age of patients was 38.6 years (range: 17 to 62 years). According to the Sanders CT classification, 10 (40%) were type II, 9 (36%) type III, and 6 (24%) type IV. The average follow-up was 30 months (range: 24-40 months). According to the AOFAS scale for ankle and hind foot there were 6 (24%) excellent, 11 (44%) good, 6 (24%) fair, and two (8%) poor results. The average score was 68 with a range of 48 to 92. The average length of the treatment period with the fixator was 9.7 weeks (range, 8 to 12 weeks). Radiological assessment revealed reduction malalignment < 5 degrees in 22 cases and > 10 degrees in 3 cases. The calcaneal width averaged 112% of the contralateral side. The calcaneal height was restored to 92% of the normal side, the mean (+/- SD) Böhler angle was changed from 11 degrees +/- 9 degrees preoperatively to 24 degrees +/- 5 degrees postoperatively. The most common complication was superficial skin infection at wire insertion sites. The results with this technique in a small number of non randomised cases with an average follow-up of 2.5 years seem to indicate that it could be a good alternative to traditional methods for management of intraarticular calcaneus fractures, with fewer secondary problems.

External fixation of intertrochanteric fractures in elderly high-risk patients.

Intertrochanteric fractures of the femur were treated with an external fixator in 38 elderly high-risk patients between November 2005 and February 2007. The mean operation time was 25 min (range: 20 to 32 min), the mean fluoroscopy time was 15 sec (range: 10 to 18 sec), and the mean hospital stay was four days (range: 3 to 7 days). The average time to union was 9.5 weeks. No deep pin track infections occurred; superficial skin inflammation was seen in 30%. Implant failure or knee stiffness were noted in no instance. At the latest follow-up, the mean femoral shaft-neck angle was 130 degrees (range: 116 degrees to 138 degrees), the average Harris hip score was 64 (range: 50-80). Mortality rate was 8% at 6 months from causes unrelated to the operation. The use of a multiplanar external fixator in these patients provided a satisfactory stability, reduced their time in hospital and facilitated their postoperative rehabilitation.

Management of intercondylar fractures of the humerus using the extensor mechanism-sparing paratricipital posterior approach.

Twenty two patients with intra-articular fractures of the distal humerus were operatively treated using the extensor mechanism-sparing paratricipital approach as described by Schildhauer et al. All fractures were AO type C (six AO type C1, 11 C2 and five C3). There were 16 males and six females with a mean age of 32.5 years. Internal fixation was achieved with bilateral plates and screws. The results were evaluated after a mean follow-up period of 30 months using Mayo Elbow Score. The results were graded as excellent in 13 patients (59.2%), good in six (27.3%), fair in two patients (9%) and poor in one (4.5%). The average range of flexion was 120 degrees +/- 8 degrees (range: 100 to 140), extension 6 degrees (range: 0 to 15). Eighty-two percent of patients had normal muscle strength in comparison to the contralateral side and 18% had good muscle strength. The average time to union was 2.4 +/- 1.6 months (range: 2 to 4). No implant failure, neurovascular deficit or nonunion was noted. There was one deep infection. The extensor mechanism-sparing paratricipital approach is an invaluable approach for fixation of intercondylar fractures of the humerus without negative effects on triceps strength; however it is not recommended for multifragmentary type C3 fractures.

Tibial corticotomy and periosteal elevation induce angiogenesis in chronic critical limb ischaemia.

Corticotomy and periosteal elevation as a surgical procedure for management of chronic critical limb ischaemia is a relatively new technique. The current study aimed at assessing its safety, efficiency and cost/benefit ratio. The procedure was performed in 36patients. Preoperative documentation for age, sex, co-morbidities, ankle systolic pressure, and magnetic resonance contrast angiography was obtained. Early results included evaluation of skin perfusion. Late results involved assessment of wound healing, which was documented with photographs and was graded (healed, healing, resistant, recurrent), pain (intermittent claudication and pain at rest), Kelkar score, procedure morbidity, patient satisfaction and quality of life. Mean age was 68.03 +/- 5.5 years; 23 patients were males (63.9%) and 13 females (36.1%). Twenty (55.6%) patients had ankle systolic pressure < 50 mmHg and 29 (80.5%) had infra-inguinal vascular disease. Skin perfusion improved in 33/36 patients (91.7%). At final follow-up, 34 patients (94.1%) achieved complete wound healing. Relief from ischaemic rest pain and intermittent claudication was achieved in 86.1% and 55.6% respectively, with 20 (55.6%) patients having an excellent Kelkar score. Only one patient required a major amputation. Morbidity was noted in 17.7% of cases. Patient satisfaction scores at 12 months and at final follow-up were 7.1 +/- 1.3, and 8.7 +/- 1.7 respectively, on a scale from 0 to 10. Quality of life was markedly improved as compared to the preoperative status (overall score: p = 0.05, mental health scale: p <0.05 and pain/anxiety domain: p < 0.001). The procedure appears to represent an interesting tool, which should be evaluated in randomised studies. Our findings support the postulated angiogenic effect of the fracture haematoma.

Experimental induction of anterior disk displacement of the rabbit craniomandibular joint: an immuno-electron microscopic study of collagen and proteoglycan occurrence in the condylar cartilage.

BACKGROUND: Results from our previous studies suggest that surgical induction of anterior disk displacement (ADD) in the rabbit craniomandibular joint (CMJ) leads to histopathological alterations consistent with osteoarthritis. In addition, molecular changes in collagens and glycosaminoglycans (GAGs) were observed using immunohistochemistry. The purpose of the present study was to further characterize those molecular changes in collagens and GAGs using immuno-electron microscopy. METHODS: The right joint of 15 rabbits was exposed surgically and all discal attachments were cut except for the posterior attachment (the bilaminar zone). The disc was then repositioned anteriorly and sutured to the zygomatic arch. The left joint was used as a sham-operated control. Ten additional joints were used as non-operated controls. Mandibular condyles were removed 2 weeks following surgery and processed for light and immuno-electron microscopy using colloidal gold-labeled antibodies against collagen type I, II, VI and IX and against keratan sulfate, chondroitin-4 and -6-sulfate, and link protein. RESULTS: Light microscopic results showed osteoarthritic changes. Immuno-electron microscopy of osteoarthritic cartilage demonstrated a decline in type II collagen, the abnormal presence of type I collagen and loss of type VI and IX collagens. Quantitative colloidal gold immuno-electron microscopy confirmed the depletion of keratan sulfate, chondroitin-4 and -6-sulfate, and link protein in osteoarthritic cartilage. CONCLUSION: Anterior disk displacement leads to molecular alterations in both the collagen and the proteoglycans of rabbit condylar cartilage characteristic of osteoarthritis in other synovial joints. These alterations are consistent with loss of the shock absorber function of the cartilage and injury of the underlying bone.