Poly-L-lactic acid beta-tricalcium phosphate screws: a preliminary in vivo biocompatibility study.

The aim of this study is to assess the biocompatibility of two types of Poly-L-lactic acid (PLLA) screws (with either hydroxyapatite (HA) or beta-tricalcium phosphate (beta-TCP)) implanted in the left femur of four sheep euthanized at 42, 50, 57 and 84 days after surgery. Titanium screws were also implanted for comparison purposes. No signs of inflammation were seen in the 240 specimens. A rating of "+/-" for macrophages and "-" for neutrophils was assigned to all specimens. All specimens were assigned a rating which ranged from "+/-" to "+++" for fibroblasts and osteoblasts. The presence of macrophages, neutrophils and fibroblasts/osteoblasts was not statistically different for the four implantation periods. PLLA implants with beta-TCP have a biocompatibility comparable to PLLA implants with HA.

Effects of anterior cruciate ligament (ACL) injury on postural control and muscle activity of head, neck and trunk muscles.

The aim of the study was to evaluate the effects that an anterior cruciate ligament injury of the knee has on postural control and activity of neck, head and trunk muscles to investigate the existence of connections between the masticatory system and body posture. Surface electromyographic activity of the muscles at mandibular rest position, and during maximal voluntary clenching and posturometric and stabilometric measurements of 25 adult patients having pathology on the left knee were compared with a control non-pathological group. At rest, the patients showed a higher muscular activity of anterior temporalis, masseter, sternocleidomastoid and lower trapezius, compared with the control subjects (P < 0.05). At maximal voluntary clenching, the patients showed a lower muscular activity of the right anterior temporalis and masseter and a higher muscular activity of the lower trapezius, compared with the control subjects. For the stabilometric measurements, all the subjects showed a significant reduction in the postural centre of pressure path length during the test with eyes open and cotton rolls, compared with the test with eyes closed and mandibular rest position (P < 0.05). In addition, the patients showed a significant displacement of the postural centre of pressure in a forward direction (P < 0.05) and into the right side (P < 0.05), compared with the control subjects. Anterior cruciate ligament injury appears to be associated to a change in the activity of head, neck and trunk muscles and to a change in the position of the postural centre of pressure. Cotton rolls seem to improve the stability of the subject.

Arthroscopic treatment of post-traumatic elbow stiffness.

AIM: The treatment of post-traumatic elbow stiffness has seen many important changes over the years, particularly through the development of arthroscopy, greater knowledge of anatomy and improvements in operative techniques, that reduce the incidence of complications and facilitate postoperative recovery. In this study mid-term clinical results of arthroscopy for post-traumatic elbow stiffness are evaluated in 15 sporting patients, with an average age of 32 years. METHODS: Eight patients reported post-traumatic stiffness due to fracture of the radial head, 3 to fracture-dislocation, 1 to fracture of the radial diaphysis complicated by osteosynthesis, and the remaining 3 patients to stress syndromes with osteochondral detachment. Surgical treatment consists in debridement, arthroscopic capsular release, and removal of bone fragments by arthroscopy. Patients were followed up from 4 up to 36 months, with a mean follow-up time of 18 months. RESULTS: Results obtained have been good to excellent in 84% of cases with an average range in postoperative movement of 13 degrees-137 degrees and reduction in pain symptomatology. The statistic results obtained from this study, under the same conditions and with a confidence interval = 0.01, show that the treatment will have favorable outcomes in 63% of patients of entire population (0.6285

Influence of knee pathology on body posture and muscle activity of head, neck and trunk muscles.

AIM: The aim of the study was to evaluate the effects that an anterior cruciate ligament (ACL) injury of the knee has on postural control and activity of neck, head and trunk muscles in order to investigate the existence of connections between the masticatory system and body posture. METHODS: Surface electromyographic (sEMG) activity of the muscles and their asymmetry index, at mandibular rest position, and during maximal voluntary clenching (MVC), and posturometric and stabilometric measurements of 25 patients (mean age 28+/-9 years) having undergone ACL injury of the left knee were compared with a control non-pathologic group. RESULTS: At rest, the patients showed a higher sEMG activity of the anterior temporalis, masseter, sternocleidomastoid and lower trapezius, compared with the control subjects (P<0.05). At MVC, the patients showed a lower sEMG activity of the right anterior temporalis and masseter and a higher sEMG activity of the lower trapezius, compared with the control subjects. For the stabilometric measurements, all the subjects showed a significant reduction in the Center of Pressure (CoP) path length during the test with eyes open and cotton rolls, compared with the test with eyes closed and mandibular rest position (P<0.05). In addition, the patients showed a significant displacement of the CoP in a forward direction (P<0.05) and to the righ side (P<0.05), compared with the control-subjects during each test. CONCLUSIONS: ACL injury appears to be associated to a change in the sEMG activity of head, neck and trunk muscles and to a change in the position of the CoP of the body. Cotton rolls seem to improve the stability of the subject.

[The distal pedicle fasciocutaneous flaps of the leg. Analysis of 21 cases of lower limb reconstruction]. / I lembi fascio-cutanei di gamba a peduncolo distale. Analisi di 21 casi di ricostruzione dell'arto inferiore.

The fascio-cutaneous flaps with distal pedicle, with the new discoveries on fascial and septal circulation of the lower limbs, are a valid reconstructing method for the loss of substance localized on the third inferior of the leg and in the heel's region. In 21 patients, 18 men and 3 women, fascio-cutaneous flaps were employed for the traumatic loss of substance, just in two cases consequentially to removal of maligns lesions, all of them were omolaterals except in three cases in which cross-leg were used. The results are satisfying if we remember that just in two cases we had partial necrosis and in other two cases we had to reinstate the flap which had survived just in his deep position. The advantages of using this technique are supported by his good results and simple execution, realising anyhow that complicated or contaminated trumas need more complex plastic reconstruction.

[Fractures of the calcaneus. The indications for surgical treatment]. / Le fratture del calcagno. Indicazioni al trattamento chirurgico.

The authors report the results obtained from a study of 41 cases of calcaneal fractures. Surgical treatment, when possible, is to be applied because it allows a satisfactory reconstruction of the subtalar and calcaneocuboid joint. The choice of various surgical methods is facilitated by computerised tomography which allows a precise assessment of the calcaneum. The quality and the stability of the reduction determine in a significant way the functional result.

[The carpal tunnel syndrome in hemodialysis patients]. / La sindrome del tunnel carpale negli emodializzati.

The authors describe etiopathogenetic and anatomopathological characteristics of the carpal tunnel syndrome in patients undergoing chronic hemodialysis. In light of clinical experience early surgical treatment, which resolves the syndrome, is recommended.

[The rectus-adductor syndrome. The nosographic picture and treatment criteria]. / Sindrome retto-adduttoria. Inquadramento nosografico e criteri di trattamento.

The authors present a detailed study on the rectum-adductor syndrome, describing etiopathogenesis, physiotherapy, medical clinical and surgical treatment. They point out the importance of a wide knowledge of this syndrome commonly occurring to football players but occasionally found in players of other sports.

[Latissimus dorsi flap in reconstructive surgery of the lower limbs]. / Il lembo libero di gran dorsale nella chirurgia ricostruttiva degli arti inferiori.

The free latissimus dorsi flap has been used to repair 10 complex losses of substance of the lower extremity. The results have shown the great reconstructive potentialities of the microvascular transfer of this muscle, considered by the authors the most versatile of the myocutaneous flaps. Among the advantages there are the extended surface, its thickness, its pedicle with adequate length and diameter as well as the absence of functional involvement, especially by preserving the upper branch of the thoracodorsal nerve. The indications, however, are limited due to a significant rate of complications which prevent its extended use.

[Osteoarticular lesions from parachuting]. / Lesioni osteoarticolari da paracadutismo.

Based on personal experience gained in a parachuting centre (Pescara Aero-club) from 1975 up to 1988, the authors report their evaluation on chronic and acute osteoarticular lesions. The review of the cases was not based on the incidence of the lesions nor on their characteristics, normally found in common traumatology, but it was related to the dynamics of the trauma during the landing and to painful syndromes following a prolonged parachuting activity.

[Bifocal fractures of the leg]. / Fratture bifocali di gamba.

The authors present the results obtained on 28 tibial bifocal fractures surgically treated with Kuntschers' intramedullary nailing and P.T.B. functional plastering. Among these cases, 21 occurred at the orthopaedic and traumatologic Clinic of Siena University, while the remaining 7 patients were treated at Chieti University. The authors point out the validity of this method comparing in with other different techniques (Grosse-Kempf method, intramedullary fixation obtained with Ender nails, both associated with functional treatment).

[Solitary chondromas of the hand: treatment indications]. / Condromi solitari della mano. Indirizzi di trattamento.

The authors report their own experience on eleven cases of solitary chondroma of the hand, that occurred at the orthopaedic and traumatologic clinic of Chieti University. The patients were treated with curettage and spongy-cortical autoplastic bone-grafting or with injection of calcitonin and spongostan. No case had relapsing symptoms and the results obtained showed satisfactory improvements, even though with short-medium follow-up.

Atherosclerosis of the vessels in the ligamentum teres. Optical and electron microscopy findings in elderly patients with femoral neck fractures.

The ligamentum teres was studied in 20 subjects, aged from 64 to 83 years, with fractures of the femoral neck treated by prosthetic replacement during 1985. The arterioles were examined under a stereoscopic dissection microscope; they were further studied by optical and electron microscopy. Almost complete occlusion by typical proliferative atherosclerotic changes was a constant finding, thereby cutting off any significant vascular supply to the femoral head.

Atherosclerosis of the microcirculation in the femoral head: based on a study by optical and electron microscopy of femoral heads removed at operation.

The authors studied 56 femoral heads removed at operation, using dissection stereoscopic microscopy and electron microscopy. They were able to demonstrate atherosclerotic lesions involving the microcirculation in the femoral head. Atheromatous changes in the external iliac and profunda femoris arteries have already been documented, but similar changes in the small vessels within the femoral head have not previously been noted in the literature.

The Analgesic Effect of Calcitonin in Active Paget's Disease of Bone and in Metastatic Bone Disease.

In a clinical study of 25 pagetic patients, it was found that calcitonin has analgesic activity independent of its metabolic efficacy on bone turnover. A separate study in 21 patients demonstrates greater analgesia from doses of salmon calcitonin than from human calcitonin or placebo.