Effects of designed PLLA and 50:50 PLGA scaffold architectures on bone formation in vivo

Biodegradable porous scaffolds have been investigated as an alternative approach to current metal, ceramic, and polymer bone graft substitutes for lost or damaged bone tissues. Although there have been many studies investigating the effects of scaffold architecture on bone formation, many of these scaffolds were fabricated using conventional methods such as salt leaching and phase separation, and were constructed without designed architecture. To study the effects of both designed architecture and material on bone formation, this study designed and fabricated three types of porous scaffold architecture from two biodegradable materials, poly (L‐lactic acid) (PLLA) and 50:50 Poly(lactic‐co‐glycolic acid) (PLGA), using image based design and indirect solid freeform fabrication techniques, seeded them with bone morphogenetic protein‐7 transduced human gingival fibroblasts, and implanted them subcutaneously into mice for 4 and 8 weeks. Micro‐computed tomography data confirmed that the fabricated porous scaffolds replicated the designed architectures. Histological analysis revealed that the 50:50 PLGA scaffolds degraded but did not maintain their architecture after 4 weeks implantation. However, PLLA scaffolds maintained their architecture at both time points and showed improved bone ingrowth, which followed the internal architecture of the scaffolds. Mechanical properties of both PLLA and 50:50 PLGA scaffolds decreased but PLLA scaffolds maintained greater mechanical properties than 50:50 PLGA after implantation. The increase of mineralized tissue helped support the mechanical properties of bone tissue and scaffold constructs between 4–8 weeks. The results indicate the importance of choice of scaffold materials and computationally designed scaffolds to control tissue formation and mechanical properties for desired bone tissue regeneration. Copyright © 2011 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96424/1/term497.pd

Non-reducible knee dislocation with interposition of the vastus medialis muscle

Irreducibility of the knee following complete dislocation is a rare event determined by the interposition of various capsulo-ligamentous structures in the joint space. Such cases often require urgent surgical treatment. We report the case of a healthy 70-year-old man with a sprain of the left knee that occurred after a sports trauma. The patient showed knee dislocation with multiple ligamentous injuries and articular block due to interposition of a portion of the vastus medialis muscle. After arthroscopic evaluation, we performed surgical treatment to free the muscle, regularize the medial meniscus and suture the posterior and medial capsule and ligaments; the cruciate ligaments were not treated. The most interesting aspect of the articular damage in this case was a wide detachment of the vastus medialis muscle with intra-articular dislocation. The decision to treat only the posterior lesions and allow the healing of the front ones by rehabilitation treatment was supported by full functional recovery and return to sports activity

Shoulder hemiarthroplasty for fractures of the proximal humerus

Proximal humeral fractures were managed with primary hemiarthroplasty in 57 patients, 53 women (93%) and 4 men (7%) aged 51–87 years (mean 72.2). The mean follow-up period was 52 months (range 12–98), and the mean Constant score was 59.2 (range 38–76). Patients were very satisfied (n = 19); satisfied (n = 32) or dissatisfied with the outcome (n = 5). One patient required early revision surgery. Surgical treatment of three- and four-part fractures of the proximal humerus with hemiarthroplasty is a safe and effective approach, the outcome of which appears to be related to the quality of the anatomical reconstruction of the tuberosities