The locomotory index: a new proposal for evaluating walking impairments.

The energy cost of walking per unit of body mass and of distance (Cw) was determined before total hip (n = 17) or total knee (n = 16) arthroplasty and ten days, two, six or twelve months after surgery. The ratio of Cw observed on patients (at the self selected speed) relative to that observed in healthy subjects of the same age at the same speed was defined Locomotory Index (Index Locomotorius, IL). So, IL is a quantitative measure of the economy of walking; for both groups of patients IL amounted to about 1.40 before surgery; it increased significantly 10 days after the operation to 1.86 or to 1.58, for hip or knee patients, respectively. Two, six and twelve months after the operation IL had decreased significantly below presurgery values (1.29, 1.30 and 1.30) for knee replacement, whereas it was still larger, albeit not significantly so, after hip replacement (IL = 1.61; 1.56 and 1.50). It was also observed that the self selected speed increased and the traditional clinical scores (Harris for hip and B.O.A. for knee) improved, with decreasing IL. It is suggested that IL is a useful quantitative tool, in addition to the more traditional clinical scores, for evaluating ambulatory disability in patients.

Prospects and advantages in the use of cartilage cell cultures for in vivo transplants.

The authors present a critical analysis of the literature in order to evaluate the current prospects and advantages of cartilage cell cultures for in vivo transplants. The analysis is relative to their use or to the treatment of isolated osteochondral lesions of the knee, and it is preceded by an analysis of the methods used in the treatment of this pathology, such as: 1) debridement, 2) abrasion of the subchondral bone, 3) perforations and decortication of the subchondral bone, 4) perichondral transplants. The most significant results obtained for cartilage cell transplants for the repair of focal osteochondral defects in experiments conducted on animals and in successive clinical trials in man, also revealing the complex problems that may lead to a variability in chondrocytary activity, going from an in vitro to an in vivo environment, are presented.

A new cervical orthosis with multiplanar adjustment.

It is the purpose of this paper to introduce a new cervical orthosis with multiplanar adjustment. Many orthoses are available to the physician today, but all of them may be classified based on function into two groups: 1) orthoses that immobilize the neck in a fixed position; 2) orthoses that immobilize the patient in a position that may be set in the sagittal plane. At present no orthosis are available to immobilize the neck in a position to anything but the sagittal plane. This new orthosis, with four tridimensional swinging posters, allows for immobilization of the neck in the desired position, according to the clinical evaluation performed. This treatment offers advantages in terms of patient compliance and functional results. An alternative model, with increased stability, has especially been planned for the treatment of pathology at C1-C2.

Mimickry in osteogenic sarcoma. Clinical considerations and report of 2 cases.

The authors report two cases of osteogenic sarcoma which presented under the false diagnosis of aneurysmal bone cyst and benign fibrous histiocytoma respectively. This mimickry is discussed: a) It is certainly more common than would appear from the literature, particularly in the case of aneurysmal bone cyst; b) this mimickry applies particularly to the lytic type of osteosarcoma; c) the adjective telangiectatic which is often used to describe malignant bone aneurysms is equivocal; d) immature forms of osteogenic sarcoma all possess a common factor with regard to onset, course and outcome of the disease; e) microscopic anaplastic elements may not always be observed in these imitations; f) clinical examination may often achieve or at least get closer to a true diagnosis of the disease: it is necessary to be aware of the existence of mimetic forms of osteogenic sarcoma and carefully evaluate all the available information; g) surgery should be delayed where clinical doubt exists and the histological report is negative. Such a delay may allow the tumour to reveal its true nature so that the surgeon and oncologist can select the correct treatment.

[Surgical treatment of lesions of the cruciate and collateral ligaments of the knee]. / II trattamento chirurigico delle lesioni dei legamenti crociati e collaterali del ginocchio.

The paper describes a number of patients operated for recent lesions of cruciate anterior ligament associated with lesions of internal collateral ligament. Patients were controlled after a time from operation of a 4 months- 4 years. For an exact functional valuation, a personal protocol was used, elaborated from the methods of the Orthopedic School of Lion. In the majority of cases, the trauma was secondry to sport practice, expecially sky. The technique used were the O'Donoghue one for cruciate ligament and the Vigliani one for collateral. Results were in all cases very good.

[Surgical treatment of pertrochanteric fractures with Ender's intramedullary nails]. / Trattamento chirurgico delle fratture pertrocanteriche con chiodi endomidollari di Ender.

Endomedullary nailing by Ender technique is a new method of metallic synthesis for perthrocanteric and subthrocanteric fractures. The difference with the other methods of ostheosinthesis is given by an elastic sinthesis of dynamic type, with endomedullary pins. The surgical technique is easy, not excessively stressing, very rapid. A surgical approach to distal femoral metaphysis is necessary; successively three or four particular metallic pins are put inside the medullary space, in proximal direction. This technique given excellent results in 50% of cases; good results in 25%; poor in 15%. The postoperatory mortality is particular limited amounts only to 10% (with an average of 78 years).

[A review technique: the interscalene brachial plexus block in orthopedic surgery (author's transl)]. / Una tecnica revisitata: il blocco del plesso brachiale per via interscalenica negli interventi di chirurgia ortopedica.

The paper is dedicated to the description of a technique now new but also not very used, of regional anesthesia, indicated for surgery of upper limbs: the interscalene brachial plexus block. In Author's experience this type of anesthesia has many indications, related especially to orthopedic and traumatologic surgery, in patients with high anesthesiologic danger. This type of regional anesthesia by interscalene technique is, in Author's opinion, much better than the axillar technique, now moore frequently used.

Meta-echinococcal arthrosynovitis: a clinical, anatomical and pathological entity not previously recognised.

The authors describe a case of echinococcosis of the tibia which occurred twice in seven years, the first time with signs of active involvement of the knee joint. Certain special aspects of articular echinococcosis, not up to now reported in the literature, are dealt with. The conclusion reached is that in an articular site the parasite can give rise either to a veritable "echinococcal" arthritis or, as in the case presented, to a the synovial affection which cannot be defined as "echinococcal" because the synovium did not contain living larval forms of the parasite, but only microscopic chitinous inclusions, arising from the disintegration of sterile hydatids, which had escaped from the adjacent bony focus into the joint. The synovium reached to their presence with an intense inflammatory response of a predominantly histiocytic nature. The term "meta-echinococcal arthrosynovitis" is suggested as a more accurate designation of this syndrome.

Neurotic rachialgia.

After a discussion of the term "benign dorsalgia," and a description of the clinical picture of the syndrome, the term "neurotic rachialgia" is proposed as being more exact. In fact, pain is not always referred to the dorsal tract of the spine but to other areas as well. Furthermore, the syndrome is an expression of a neurotic condition. Diagnosis is based on exclusion: no clinical or radiologic signs are demonstrable. The utility of "relaxation therapy" is described by several technics.

Stimulation of 45Ca efflux from smooth muscle cells by metabolic inhibition and high K depolarization.

The characteristics of the extracellular and cellular calcium exchange in taenia coli have been studied by efflux experiments under different experimental conditions. The exchange of extracellularly bound calcium is accelerated by the presence of calcium in the external solution. If a Ca-free solution is used as washing solution, the slowly exchanging extracellular calcium also contributes appreciably to the later phase of the Ca efflux and obscures the changes of the cellular calcium exchange. There is no evidence for a Ca-Ca exchange diffusion. Most of the 45Ca bound at extracellular binding sites can be released by a 10 min exposure to 2 mM EGTA or to 10 mM La3+. This La concentration moreover largely inhibits the release of 45Ca from the cellular compartment by metabolic depletion. A release of cellular 45Ca can be induced by metabolic depletion or by K depolarization. Both procedures probably act at the same sequestering sites. However, while DNP + IAAa cts in the absence of external Ca, it is observed that K depolarization can only cause a Ca release if external Ca can enter the cells.

[Cerebral malformation and thanatophoric nanism]. / Malformation cerebrale particuliere et nanisme thanatophore

Report of one case of atypical osteo-chondrodysplasia, which was classified as a thanatophoric dwarfism, with neuropathological examination of the brain. Microgyria and cytological changes were in the ectocinerea. Too heterotypies in the neuronal place were observed.

Dyschondrosteosis.

The authors present three cases of dyschondrosteosis occurring in a single family unit. The characteristics of the "major" and "minor" forms of this genetically derived chondrosteodysplasia are described. The other members of the family examined presented no signs of the disease, but they were very young. The possibility of successful surgical correction of the deformities caused by dyscondrosteosis is stressed.

[The foot in leprosy]. / II piede lebbroso.

The more frequently occurring bone lesions of leprosy of the foot are described with illustrations from patients with leprosy seen some years previously in Sardinia. These cases are classified into groups depending on the presence of osteoporosis, osteitis, lesions with predominantly inflammatory manifestations, those with a spindle-shaped appearance and lastly those with pathological fractures. The anatomical relationship between cutaneous and bone lesions is outlined.