The repair of the Achilles tendon rupture: comparison of two percutaneous techniques

This study proposes a comparison between two percutaneous techniques of subcutaneous Achilles tendon rupture by evaluating the risk of lesion developing, the morbidity of the surgical technique adopted and the effectiveness of each technique. Sixty patients were operated at Padua Orthopaedic Clinic by using the two different procedures: (1) Ma and Griffith in 30 cases and (2) Tenolig in 30 cases. Risk of rupture developing has been evaluated in relation to sex, age, side, kind of trauma, work and presence of preoperative risk factors. The Morbidity of surgical technique has been evaluated in with respect to surgical time, hospital permanence, immobilization, active nonweight-bearing mobilization, assisted weight bearing until the full one, number of early and late complications before and after hospital discharge. Effectiveness has been evaluated in relation to return time to common life, work and sport; anatomical and functional features have been evaluated using McComis score, rating results as: very good (from 80 to 70), good (from 69 to 60), fair (from 59 to 50) and poor (<50). Tenolig group shows shorter average time from hospital admission and operation, hospital permanence and immobilization (P < 0.05), and it results in an easier and quicker execution and functionally stimulates the tendon healing in a short time. Effectiveness was the same for both techniques because average McComis score was good (P = 0.35), and there was no significant differences in common life returning time (P = 0.12). Tenolig technique seems to be preferable to Ma and Griffith.

The tantalum screw for treating femoral head necrosis: rationale and results

Femoral head necrosis (FHN) is a progressive pathology due to the failure of blood supply to the proximal femoral epiphysis, with consequent necrosis of the sub-chondral bone and collapse of the articular cartilage and loss of congruity between the head and the acetabulum. Borrowing the biological and mechanical principles from the vascularized fibular graft technique for the femoral neck, the tantalum screws have been introduced. They show an extraordinary porosity, osteoconductivity, biocompatibility and very good osteoinductivity. Vitreous tantalum can be processed to take the form of a screw, with a round medial extremity and a 25 mm threaded lateral extremity that can be inserted into the neck of the femur, thereby supporting the articular cartilage, stimulating the repair process, interrupting the interface between necrotic and healthy tissue and favoring local vascularization. We have drawn up a treatment protocol for early-stage FHN, based on the insertion of a tantalum screw into the femoral neck. The implant has a cylindrical shape, with a 10 mm diameter in the smooth part and 15 mm in the threaded part. It is available in different sizes from 70 to 130 mm, with 5 mm increments. The aim of the study is to describe the clinical and instrumental results of the tantalum screw for FHN. From June 2004 to June 2006 we performed 15 implants. The tantalum screw was inserted with an incision on the trochanteric region with traction and under X-ray control. For the clinical evaluation of the hip, we used the Harris hip score (HHS). For diagnosis and staging we used standard X-rays in two views and/or MRI, using the Steinberg classification (J Bone Joint Surg Br 77:34-41, 1995) and CT. In all cases, the osteonecrosis extended to not more than 30% of the joint surface and the cartilage was intact with no collapse. To assess the results, we compared the pre-operative and the post-operative HHS, calculated the percentage differences between the two. We then compared X-rays, CT scans and MRI before and some time after the operation to assess whether the problem had been addressed, taking into account the intracancellous edema and the possible extension of necrosis. After an average follow-up period of 15.43 +/- 5.41 months, ten implants (seven patients out of ten) were examined and all but one patient showed a marked improvement in HHS (the average increase was 127.9%), with no further progression of the disease. We believe that this procedure can be suitable for young patients with limited first or second stage osteonecrosis. The objective for the foreseeable future is to resolve the pain, improve the quality of life and prevent or at least postpone arthroplasty.

Anisotropic elasto-damage constitutive model for the biomechanical analysis of tendons

The aim of this work is to investigate the instantaneous mechanical response of tendons by the use of an anisotropic elasto-damage constitutive model. This study addresses the analysis of the mechanical behaviour of healthy tendons during physiological loading and to degeneration phenomena. These are correlated with aging or traumatic events such as chronic or acute overloading during sporting activities. Histo-morphometric considerations suggest the adoption of a transversally isotropic constitutive model that describes the anisotropy of the material. The non-linearity of its overall mechanical response is taken into account by using a hyperelastic approach and also evaluates softening behaviour related to damage phenomena. The values of the parameters adopted within the analytical model are estimated both for human tendons previously subjected to cyclical loading and for specimens not subjected to cyclical loading. The results obtained by adopting this analytical model are compared with the experimental data in order to evaluate the capability of the model to describe the mechanical response of the tissue.

[Bilateral synovial chondromatosis of the first metatarsophalangeal joint: a case report. ]

Synovial chondromatosis is a rare pathology of unknown aetiology. It originates from the chondroid metaplasia of the connective tissue of the synovial membrane. Consequently, cartilaginous nodules develop in the affected joints, first calcifying and then ossifying. The bursae mucosae, the vaginae tendinis and the para-articular connective tissue are less frequently affected. The most common locations of this pathology are the knee, the hip, the shoulder, the elbow and the ankle. The small joints are rarely affected, even less the bilateral involving of joints, above all of hand or foot, is exceptional. In a clinical and radiological valuation, it is difficult to distinguish synovial chondromatosis from osteoarthritis and from degenerative arthopathies in general. A sure diagnosis can be obtained only by means of a histological examination. We here report a case of synovial chondromatosis bilaterally located on the first metatarsophalangeal joint. Clinical and radiological features were similar to those of hallux rigidus, a typical and peculiar metatarsophalangeal joint pathology. The diagnostic suspicion arose during surgery, and was subsequently confirmed by histological examination. During the following visits, the patient did not present any painful symptomatology.

Vascular leiomyoma of the limbs

After reporting the most significant data in the literature, the authors present 5 cases of vascular leiomyoma of the limbs (1 in the upper limb, 4 in the lower limb) in subjects of both sexes. In all of the patients, diagnosis was only possible thanks to histological examination, confirmed by an immunohistochemical examination. In none of the cases was there recurrence of neoplasm after surgical exeresis.

Spondylocostal dysplasia (Jarcho-Levin syndrome)

The authors report 3 cases of rare spondylocostal dysplasia (Jarcho-Levin syndrome) associated with multiple visceral anomalies (V.A.C.TE.R.L. syndrome). The difficulty encountered in treating the disease because of the complexity and multiplicity of the visceral anomalies, and the extent and type of associated vertebral deformities is emphasized. The cases described revealed a moderate amount of progression, and were able to be treated non-surgically. It is also emphasized that even when there is moderate scoliosis associated costal deformities may cause anti-cosmetic thoracic gibbosity.

[Conservative treatment of acromioclavicular luxation]

The authors consider the conservative treatment of acromioclavicular dislocation and present a revision of 59 cases treated by Desault bandage and thoraco-brachial cast (mean follow up 46 mos). The indications to conservative treatment are pointed out and the good functional results are stressed.

Osteochondritis dissecans of the talus. A report on 7 cases

The clinical and radiological findings in 7 cases of osteochondritis dissecans of the talus indicate that this is a potentially progressive condition. Surgical treatment was carried out in 4 cases while the remaining 3 were treated conservatively. Surgery produced good clinical and radiological results. The conservative treatment consisted of immobilisation and abstention from weight-bearing. This was unsuccessful in 2 adult patients but in a 9 year old girl it led to a virtually complete recovery in 3 months.

A case of progressive scoliosis in a patient with craniocleidopelvic dysostosis

The authors describe a case of craniocleidopelvic dysostosis in a patient with progressive scoliosis. They attribute the pathogenesis of the vertebral deformity to imbalance of the shoulder girdle muscles and dysplasia of the vertebral metameres. They agree with the majority of authors in regarding craniocleidopelvic dysostosis as a specific clinical manifestation of a complex hereditary syndrome.

Relationship between rib hump deformity and vertebral rotation in idiopathic scoliosis

The authors advance the theory that there are two distinct groups of idiopathic scoliosis, of different aetiology and with different potential for development. This is based on the relationship between vertebral rotation and wedge deformity of the vertebral bodies. The rotatory type can be identified, to a statistically significant extent, in the initial phases of thoracic scoliosis. In order to test this hypothesis, we therefore confined our study to cases in which the initial Cobb angle was less than 20 degrees.