Outcome after tantalum rod implantation for treatment of femoral head osteonecrosis: 26 hips followed for an average of 3 years

Background and purpose Tantalum rod implantation has recently been proposed for treatment of early stages of femoral head osteonecrosis. The purpose of our study was to report the early results of its use in pre- and post-collapse stages of the disease

Venous Graft-Derived Cells Participate in Peripheral Nerve Regeneration

Background: Based on growing evidence that some adult multipotent cells necessary for tissue regeneration reside in the walls of blood vessels and the clinical success of vein wrapping for functional repair of nerve damage, we hypothesized that the repair of nerves via vein wrapping is mediated by cells migrating from the implanted venous grafts into the nerve bundle. Methodology/Principal Findings: To test the hypothesis, severed femoral nerves of rats were grafted with venous grafts from animals of the opposite sex. Nerve regeneration was impaired when decellularized or irradiated venous grafts were used in comparison to untreated grafts, supporting the involvement of venous graft-derived cells in peripheral nerve repair. Donor cells bearing Y chromosomes integrated into the area of the host injured nerve and participated in remyelination and nerve regeneration. The regenerated nerve exhibited proper axonal myelination, and expressed neuronal and glial cell markers. Conclusions/Significance: These novel findings identify the mechanism by which vein wrapping promotes nerve regeneration. © 2011 Lavasani et al

Prognosis of collapse of the osteonecrosis of the femoral head for patients treated with a tantalum rod by determining location and size of the lesion

The purpose of this study is to predict the osteonecrosis of the femoral head by examining the location and size of the lesion of the femoral head. A triangulation approximation algorithm is used for the computation of the geometric center of the lesion based on magnetic resonce imaging scans for patients treated with a tantalum rod. Twenty eight patients (thirty four hips) with osteonecrosis of the femoral head were treated with the tantalum rod procedure. Then mean age was 39,21 years (14-59). All necrotic lesions were confirmed by magnetic resonance imaging. A customized triangulation approximation algorithm was developed in order to compute the geometric center of the lesion of the reconstructed model. Lesion volume, the distance from the origin (ρ or R), latitude (φ) and longitude (θ) of the geometric center of the lesion within the femoral head were calculated. The mean follow-up was 3 (1-7) years. Ten hips (29.4%) showed radiographic progression. Statistical method Cox regression analysis showed that lesion volume and longitude angle (θ) were important factors to predict radiographic progression. Lesions having an angle (θ) of [15° - 35°] and [50° - 60°] and size c in Steinberg scale with lesion size greater than 27% of the femoral head were more likely to develop radiographic progression. For hips that developed radiographic progression out of this range, lesion size was the only significant factor. The results suggest that lesion volume is an important factor strongly correlated with the risk of collapse of the femoral head. The location of the lesion of the necrotic area is an important supplemental parameter in order to predict with accuracy the progression of the disease. However further studies with the current algorithm that computes the geometric center of the lesion, larger study groups and long-term follow-up are needed in order to predict accurately the progression of the disease and the collapse of the femoral head. ©2009 IEEE

Pediatric Terrible Triad Elbow Fracture Dislocations: Report of 2 Cases

An elbow dislocation associated with radial head and coronoid process fractures, the terrible triad injury, has an unpredictable outcome in adults and is rare in children. We present 2 such injuries in children, 1 combined with an olecranon fracture, and both with good early clinical outcomes. However, in 1 of the 2 cases, avascular necrosis of the proximal radius was evident on radiographs. Copyright (C) 2013 by the American Society for Surgery of the Hand. All rights reserved

DONOR SITES FOR PEDICLED SKELETAL GRAFTS OF THE HAND, WRIST, AND FOREARM

Pedicled bone and periosteal grafts provide successful reconstruction of skeletal problems of the distal radius, wrist, and hand. The purpose of this study was to evaluate the available alternatives and to propose the most suitable skeletal grafts for the reconstruction of the distal radius, and the carpal and hand bones. The alternative donor sites (dorsal and palmar distal radius, and metacarpals), their pedicles, and the potential coverage area in relation to specific wrist and hand pathology were determined in the cadaveric dissections. In the clinical setting, 75 pedicled grafts were used for the treatment of scaphoid nonunions (62 cases), lunate necrosis (8 cases), reconstruction of the metacarpal defects (2 cases), and wrist fusions (3 cases). All alternatives have the advantage of a single approach that may be performed under tourniquet control, from the same team. Among the available alternatives, surgeon's familiarity plays the most important role for the final selection of the graft. (c) 2009 Wiley-Liss, Inc. Microsurgery 29:408-412, 2009