Histopathologic assessment of healed osteochondral fractures.

PURPOSE: To assess the histopathologic features of healed tissue to define its biological and biomechanical properties after internal fixation of osteochondral fractures. Type of Study: Cohort study. METHODS: The general principle of management of detached acute osteochondral fractures is reattachment of the fragment by internal fixation, but the opinions on the quality and structure of the healed tissue that will be obtained after treatment is controversial. This study included 13 patients with acute osteochondral fractures who were treated arthroscopically and had surgical fixation providing joint-surface congruity. Patients with osteochondral fractures too small for fixation or with the overlying cartilage frayed, and patients with associated injuries were excluded from the study. The mean age of patients was 17 years (9 to 24 years). In 2 cases the fractures were localized at medial, in 7 at lateral femoral condyles, and in 4 at the patella. Internal fixation materials were K-wires for 1 case, Herbert screws for 3, and mini cancellous screws for 9 cases. The mean follow-up period was 6.3 years (3 to 13 years). On second-look arthroscopy, congruity of the joint surfaces and healed fractures was observed in all cases. Beside removal of the implant, punch biopsies were performed extending to the osteochondral junction; biopsy specimens were taken from the junction of the articular margin of the fragment and the edge of the remainder of the articular surface. RESULTS: On histologic examination of the specimens, scarce mature chondrocytes among regenerative stroma, which dyed more eosinophilic than the basophilic chondral stroma and which had a chondrocyte-like appearance, were seen. Maturation of histologic architecture to hyaline or articular cartilage was not recorded in any of these cases. CONCLUSIONS: The clinical results did not correlate with the histologic findings. Despite the protected joint surface congruence, restoration of the hyaline cartilage at the chondral junctions could not be obtained.

In-hospital outcome and resource use in hip arthroplasty: influence of body mass.

To determine the influence of body mass index (BMI) on perioperative morbidity, functional recovery, and hospital use, the records of 207 patients who underwent primary total hip arthroplasty were reviewed and patients were grouped according to BMI. Transfusion requirements, operative complications, functional recovery, and assistance needed for transfers from supine to sit, sit to stand, and bed to chair positions were analyzed at the first physical therapy. Compared with others, morbidly obese patients (BMI > or = 40 kg/m2) had significantly longer mean operative time and higher mean intraoperative blood loss (P<.05), a trend toward more complications, but no significant difference in functional recovery and hospital use.

Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes.

Compared with patients with total hip arthroplasty (THA) via a direct lateral approach, patients treated with THA via a mini-incision approach had significantly earlier ambulation, less transfer assistance, and more favorable discharge dispositions; they also had decreased transfusion requirements and better functional recovery with early physical therapy. This procedure achieved accurate and reproducible implantation, regardless of patient habitus.

[Short-term results of treatment of humeral and tibial fractures with new inflatable intramedullary nails]. / Sisirilebilen intramedüller çivi kullanilarak tedavi edilen humerus ve tibia diafiz kiriklarinda kisa dönem sonuçlar.

OBJECTIVES: We evaluated the effectiveness of a new inflatable intramedullary nail system in the treatment of tibial and humeral fractures. METHODS: The study included seven patients (4 men, 3 women; mean age 37.5 years; range 27 to 48 years) whose humeral or tibial fractures were treated by new inflatable intramedullary nails. Five fractures were in the tibial diaphysis; three were humerus fractures. One patient had bilateral involvement. All tibial fractures and one humeral fracture were fresh, whereas two patients presented with delayed union. Treatment consisted of closed reduction and antegrade intramedullary nailing, with the addition of bone grafting in delayed unions. The patients were evaluated with regard to operation duration, healing periods, complications, and final clinical and radiologic findings. The mean follow-up period was 15.3 months (range 12 to 20 months). RESULTS: Operation time for both tibial and humeral fractures was less than that with other internal fixation techniques. The need for fluoroscopic monitoring decreased appreciably, as well. Healing times were similar to those of other intramedullary nailing systems. No complications occurred related to the use of the inflatable intramedullary nail system. CONCLUSION: The use of inflatable intramedullary nails may have significant implications in selected fractures, allowing easier stabilization of long bone fractures and saving valuable operation time.

Assessment of tissue repair in full thickness chondral defects in the rabbit using magnetic resonance imaging transverse relaxation measurements.

The purpose of this study was to determine if the noninvasive and nondestructive technique of magnetic resonance imaging could be used to quantify the amount of repair tissue that fills surgically-induced chondral defects in the rabbit. Sixteen 4-mm diameter full-thickness chondral defects were created. A photopolymerizable hydrogel was used to seal the defects as a treatment modality. At 5 weeks, the animals were sacrificed and the distal femur was subjected to MRI analyses at high field (9.4 T). The transverse relaxation time (T(2)) in each defect was measured. Histology and histomorphometric analysis were used to quantify the amount of repair tissue that filled each defect. The relationship between T(2) and percent tissue fill was found to fit well to a negatively sloped, linear model. The linear (Pearson's product-moment) correlation coefficient was found to be r = -0.82 and the associated coefficient of determination was r(2) = 0.67. This correlation suggests that the MRI parameter T(2) can be used to track changes in the amount of repair tissue that fills cartilage defects. This would be especially useful in in vivo cartilage tissue engineering studies that attempt to determine optimal biomaterials for scaffold design.

Postoperative fever after total knee arthroplasty: the role of cytokines.

Febrile temperatures commonly are seen after total knee arthroplasty, but their source and importance are unclear. The goal of the current study was to determine whether such fevers are part of the normal physiologic response to surgery mediated by inflammatory cytokines. In 20 patients who had total knee arthroplasty, serum and wound drain fluid samples were collected preoperatively and at 1, 6, 24, and 48 hours postoperatively; oral temperatures were measured postoperatively every 4 hours for 3 days. Concentrations of interleukin 1beta, interleukin 6, and tumor necrosis factor alpha in the samples were measured via enzyme-linked immunosorbent assays and compared in patients who did and did not have fevers develop (>or=38.5 degrees C). Gender, age, operative time, amount of blood loss or drain output, anesthesia type, drop in hematocrit, and transfusion administration were not associated with fever. Significant increases were seen postoperatively in drain fluid concentrations of interleukin 1beta and interleukin 6 and in serum concentrations of interleukin 6. Patients who were febrile had significantly higher drain and serum interleukin 6 concentrations than patients who were afebrile. These findings suggest that fevers seen after total knee arthroplasty are at least partly the result of surgical site inflammation and subsequent local and systemic release of the endogenous pyrogen interleukin 6.

Posterior instability of the shoulder after supracondylar fractures recovered with cubitus varus deformity.

Cubitus varus is a common complication after supracondylar fractures of the humerus, and there have been several discussions about the timing of correction of deformity. Although surgery is performed mainly for cosmetic purposes, the authors in this article show the relationship between cubitus varus and dislocation of the ulnar nerve and posterior instability of the ipsilateral shoulder with a Bankart lesion in three children. A special type of osteotomy to obtain three-dimensional correction was made. All shoulders were found to be clinically stable at follow-up with full pain-free range of motion. Corrective osteotomy of the distal humerus itself corrected the varus angulation and dislocation of the medial portion of the triceps in two patients and prevented the ulnar nerve from dislocating. The authors' experience illustrates the importance of biomechanics in understanding the pathoanatomy of cubitus varus; this deformity should not be regarded as a cosmetic deformity and should be treated early.