Treatment of late-stage Freiburg\u2019s disease using a temporary metal interpositional device

There are few reports of the surgical treatment for late stage Freiburg\u2019s disease with flattening of the metatarsal head and osteoarthritis. We describe the results of the surgical treatment of ten consecutive patients with advanced stage Freiburg\u2019s disease (Smillie\u2019s stage V), using a technique that has not been published previously

Results of Distal Metatarsal Osteotomy Using Absorbable Pin Fixation

Background: Metatarsalgia with plantar hyperkeratosis can be a difficult problem to treat. Many different techniques have been reported with the Weil osteotomy very popular currently. Despite good results complications include metatarsophalangeal stiffness, hyperextension of the toe, prehensile deficit and a reduction in strength. We evaluated our results with a distal diaphyseal osteotomy. Materials and Methods: From 1999 to 2005, we performed 66 distal midshaft subtraction osteotomies in 62 patients suffering from metatarsal overload without metatarsophalangeal subluxation. Fixation was obtained with an absorbable pin. Some patients underwent simultaneous corrective surgery for hallux valgus, hallux rigidus or lesser toe deformities. There was an average of 18 months followup. Results: The mean preoperative Maryland score was 52; the mean postoperative score was 86. Seventy-two percent of the patients were very satisfied and 28% felt their condition improved with only occasional pain (VAS 2 to 4). The only complications reported was a loss of correction due to breakage of the pins in three patients (two sustained trauma and the third began walking prematurely without a postoperative shoe). Conclusion: The good clinical results obtained and the low incidence of complications have encouraged us to use this technique to treat symptomatic metatarsal overload. Surgical accuracy,adherence to the postoperative regimen and, where necessary, adequate correction of the first ray were important factors for success

Efficacy of platelet gel in reconstructive bone surgery

Autologous platelet concentrate and cryoprecipitate, mixed to obtain a gel, have been successful in various operations, primarily oral and maxillofacial surgery. This study assessed the use of platelet gel in 19 patients undergoing 22 reconstructive bone surgical procedures. After a median follow-up of 12.9 months, improved osteoblastic reaction and reconstruction of physiologic bone structure was observed in all patients with no adverse reactions. These findings confirm the osteoinductive property of platelet gel in reconstructive bone surgery

Ruolo dei fattori di crescita autologhi nella chirurgia ossea ricostruttiva.

Introduzione. Il trattamento ricostruttivo della perdita di sostanza ossea e quello della mancata consolidazione delle fratture richiedono quasi sempre un apporto biologico mediante trapianto osseo, autologo od omologo. L\u2019indicazione \ue8 diventata molto frequente e la quantit\ue0 d\u2019osso necessaria \ue8 sempre maggiore. Una possibilit\ue0 sostitutiva potrebbe essere, secondo gli Autori, l\u2019innesto locale di fattori di crescita autologhi (AGF) che abbiano attivit\ue0 osteoinduttiva. Materiali e metodi. Nel periodo compreso fra ottobre 2001 e maggio 2002 sono stati utilizzati 14 volte gli AGF in associazione con idrossiapatite granulare d\u2019origine corallina (ProOsteon 500 R) per indicazioni e sedi ossee differenti. Sono state trattate 8 perdite di sostanza (5 tibie, 1 omero, 1 acetabolo, 1 femore), 4 difetti iliaci periprotesici, un difetto femorale periprotesico, un ritardo di consolidazione tibiale. Sono stati operati 11 pazienti, otto femmine e tre maschi,che avevano l\u2019et\ue0 media di 36 anni (minimo 15, massimo 69). Gli AGF sono stati ricavati mediante degranulazione del concentrato piastrinico preparato 24 ore prima dell\u2019intervento. Il gel piastrinico \ue8 stato innestato assieme ai granuli d\u2019idrossiapatite.Sono stati valutati parametri clinici e radiografici. Risultati. L\u2019integrazione \ue8 stata totale in tutti i casi; non si sono verificati fenomeni generali e locali di intolleranza biologica e clinica; nessun paziente ha necessitato di emotrasfusioni; non ci sono state complicazioni intraoperatorie o perioperatorie o post-operatorie. In tutte le sedi d\u2019innesto il controllo radiologico ha mostrato il progressivo incremento della reazione ossea riparativa ed il ripristino della architettura scheletrica fra i tre ed i sei mesi postoperatori. Conclusioni. Lo studio ha dimostrato che il composto utilizzato, autologo e chimico, associando l\u2019attivit\ue0 osteoinduttiva degli AGF e quella osteoconduttiva del Pro- Osteon 500 R, pu\uf2 avere un ruolo sostitutivo al trapianto osseo, in particolare nelle sedi scheletriche a prevalente contenuto spugnoso

Knee arthrodesis by the Ilizarov method in the treatment of total knee arthroplasty failure

Background Currently, the main indication for knee arthrodesis is septic failure of a total knee arthroplasty (TKA). The purpose of this study was to evaluate the results of knee arthrodesis by circular external fixation performed in the treatment of TKA failure in which revision arthroplasty was not indicated. Methods The study involved 19 patients who underwent knee arthrodesis by the Ilizarov method. Clinical and functional assessments were performed, including Knee Society Score (KSS). A postoperative clinical and radiographic evaluation was conducted every three months until the end of the treatment. Postoperative complications and eventual leg shortening were recorded. Results KSS results showed a significant improvement with respect to the preoperative condition. Of the 16 patients in the final follow-up, 15 patients (93.7%) achieved complete bone fusion. Major complications occurred in patients treated for septic failure of TKA and most occurred in patients over 75\ua0years of age; the mean final leg shortening was four centimeters. Conclusion In our experience, the Ilizarov method is effective for performing a knee arthrodesis in the case of extensive bone loss. At the same time, it is possible to correct the associated leg deformities or limb length difference. In addition, only the Ilizarov method provides a mechanical stimulus for bone formation and improves the quality of the bone and of the microcirculation, which enhances the host response against infection. Despite these attributes, knee arthrodesis by the Ilizarov method must be considered a \u2018salvage procedure\u2019 in cases of severe outcomes from knee surgery in which revision arthroplasty is not indicated