Objectives

Injectable Bromelain Solution (IBS) is a modified investigational derivate of the medical grade bromelain-debriding pharmaceutical agent (NexoBrid) studied and approved for a rapid (four-hour single application), eschar-specific, deep burn debridement. We conducted an ex vivo study to determine the ability of IBS to dissolve-disrupt (enzymatic fasciotomy) Dupuytren’s cords.

Summary of background data: Lumbar interbody arthrodesis can be achieved by using autograft or allograft bone.

One of the disadvantages of using autograft bone graft is complications related to the iliac crest donor site.

Another option is using an allograft bone (ex.-femoral head from bone bank). There are few reports of using allograft bone for instrumented lumbar spinal fusion.

Methods: Fifteen patients were treated at our institution by lumbar fusion in various indications. We used allograft bone and evaluated their outcome for an average period of 3 years. The recovery rate, complications and radiographic findings were evaluated.

Results: Good radiographic and clinical results were achieved by using allograft bone graft. No complications were detected.

Conclusions: The clinical and radiographic results of Allograft bone graft, for lumbar spine arthrodesis, are impressive. One of the advantages of this method, comparing to an autograft is avoiding any donor site complications.

Introduction: There is a controversy regarding the treatment of the intra articular fracture of the distal radius. Plating for anatomical reduction vs the minimally invasive method by mini external device and K wires. We report our experience with the minimal invasive technique.

Materials and Methods: Between January 2003 and march 2005, 43 patients with intra articular fracture of distal radius were treated. 22 females, 16 males were followed. Age range 23–81 (mean 55 years). All cases were uni lateral. 38 patients were followed out of 43 fractures. Causes: 23 fall, 9 RTA, 6 sport accidents. The fractures were classified according the Frykman classification: 5 F3, 6 F4, 6 F5, 9 F6, 5 F7 and 7 F8. Follow up was 6 weeks after treatment and 6 months later. A Lateral and PA views were performed and the angles were measured. The V.A.S. was used to quantify the painful level. The Lidstrom criteria scale was used to evaluate the functional outcome. The surgical procedure was performed on the same day or one day later. In all cases the mini external device of AO (2 threaded rods in the second metacarpal and another 2 rods in the radius) was used. In 20 cases, 1 or 2 K wires were inserted in addition from the radial styloid to stabilize the fracture. The mini external was removed 6 weeks later.

Results: According to Lidstorm criteria, 12 patients (31%) had excellent results, 23 (61%) good, 2 (5.5%) fair and 1 (2.5%) poor outcome. The results of the VAS were good: 33 had less than 3, 4 patients less than 5 and one patient chose the number 9 to quantify his pain. At the follow up, 35 patients restored a very good range of motion (ROM) of the wrist, while 3 patients had markedly reduced ROM. The best outcome is shown in the younger population, except one case, a young man 33 years old, who was unable to return to work 6 months later. Four patients (1%) had a pin tract infection treated by PO antibiotics.

Conclusion: In our hands, the minimally invasive technique seems to be a satisfactory procedure. In the young population, the restoration of the range of motion was very good. The loose of few degrees in the arc of motion in the elderly population didn’t disturb there functional performance. We think that the mini-invasive method is excellent tool for treating intra-articular fractures of the distal radius; the procedure is shorter and there is less chance of infection and less damage to the surrounding tissues.

Recently, secondary life-threatening inflammatory reactions have been identified with molecular biological techniques in patients with multi-system injuries who were submitted to immediate or early intramedullary fixation of their fractured femora. This phenomenon was called “The second hit”, and it caused ARDS, PE, and Renal Failure.

In a consecutive series of 135 trauma patients with high energy long bone fractures, 40 had sustained multiple-injuries. All fractures were reduced and stabilized on admission by AO-Tubular External Fixation systems. After 72–96 hours, this system was converted to an hybrid-ring-tubular system, which had three dimensional stability. They commenced partial weight bearing 24 hours later, and were followed by bony union.

One patient developed DVT, none developed ARDS, PE, Renal Failure.

Superficial pin-tract infection was common, but no-deep infection and’or osteomyelitis were encountered.

With this minimal-invasive surgical technique, life threatening complications were avoided while preserving the integrity of the soft tissue envelope, the critical contributing biological factor for fracture healing.