Satisfactory healing of soft tissue wounds and bone fracture requires activation and response of the immune system. Our previously reported laboratory observations revealed that proper healing of the long bone fractures corresponds with an increased mass of lymph nodes (LNs) draining the site of injury when compared with contralateral limb, whereas delayed fracture healing is characterized by decreased mass of the regional LNs. Aim of the study was to investigate whether an image of LNs may be an indicator of the kinetics of fracture healing.

Patients & Methods. Observations were carried out in two groups of adult patients with closed not infected fractures of lower extremities healing uneventfully (n=15) and fractures with delay healing (n=17, diagnosed clinically and with X-ray and CT scans). Patients with venous thromboses were excluded. Morphologic structures of the lymphatic system of lower extremities were visualized on lymphoscintigraphies with 99mTc-Nanocol. Lymphoscintigrams were scanned and evaluated quantitatively. The surface of iliac lymph nodes of the fractured and contralateral limb served to calculate of LNs size index. Differences between groups were evaluated using Student-T-test.

Results. The surfaces of inguinal LNs of the fractured limb in patients with uneventful healing fractures were larger than in contralateral limbs (index=1.67±0.57), whereas in patients with non-union the inguinal LNs surface was smaller (index=0.49±0.45, p=0,00000031).

Conclusions. Lymphoscintigraphic pictures of the lymph nodes draining the site of injury reflect to a certain extent regenerative processes. Speculatively, observed changes depend upon molecular mediators drained with the lymph from fracture gap. The method can be used for non-invasive monitoring of the fracture repair process.

The quantitative measurement is required for fracture healing evaluation in clinical studies approaching toward Evidence Based Medicine. Early detection of fracture healing impairment is demanded to introduce as early as possible the optimal treatment leading to recovery. Clinically validated and tested methods usually utilize X-ray and CT data. The aim of this study was to improve assessment of fracture healing progress or impairment examined with X-ray and computed tomography (CT) and to determine the usefulness of quantitative methods based on newly developed 3D image analyzing software. An original software “3D Reconstructor” was developed. The application operates on medical image data stored in DICOM format. 3D Reconstructor v.2.0 allows 2D reconstruction in custom surface directs through data block and 3D reconstruction as well. The usefulness of the application was evaluated for long bone fracture healing with three-dimensional presentation of fracture callus. Twenty otherwise healthy fracture patients (average age 43 years) with fractures of the tibial shaft, humerus, forearm, and clavicle were enrolled and underwent chronological series X-ray imaging and spiral CT scanning when it was clinically justified and necessary. Patients were preselected for CT study because of healing impairment suspicion. Computer Tomography examination was performed 14 to 56 weeks after injury (GE Pro Speed SX, slice 2–3 mm, image reconstruction 1 – 1,5 mm, 120 kV, 100 mAs). Qualitative assessment included fracture line/margins, fracture gap, external callus appearance, callus-to-cortex ratio, bridging, and radiologic union. Quantitative assessment of CT density changes (Hounsfield units [HU]) in the fracture gap was performed in patients using 3D Reconstructor multimodality image analysis software. Regions of interest (ROI) were analyzed in details by quantitative and qualitative assessment. Complete bone union was confirmed in 2 cases, delayed union in 8 cases and nonunions in 10 cases. The use of 3D Reconstructor enhanced quantitative evaluation of fracture callus in all evaluated cases. Low union rate observed in computed tomography derives from patient’s preselection based on clinical observations. Reliable fracture healing assessment can be enhanced with computed tomography and Computer Aided Diagnostic methods that supplement quantitative analysis of CT images. CAD quantitative assessment of the fracture gap and callus was successfully performed using 3D Reconstructor software in clinical cases. Higher accuracy of pseudoarthrosis and delayed union diagnosis was achieved. The reliable diagnosis in fracture cases may be supported with Computer Aided Diagnostic Methods. Still ongoing project, “3D Reconstructor” seems to be more accurate over not “armed” evaluation of original CT DICOM files of fracture healing in selected cases.

Bacteriophage state currently an attractive alternative for antibiotics, especially due to the strong in vitro activity and lack of side effects.

Eight patients with chronic infection in musculoskeletal system.are presented

This group includes: 3 cases of deep periprosthetic infection, posttraumatic osteomyelitis of tibia in 2 cases, infected pseudoarthrosis of femur in 1 case, chronic hematogenous osteomyelitis of tibia in 1 case, chronic infection in diabetic foot in 1 case.

Adequate tissue specimen for bacteriology was taken during operation and selection of bacteria strains was subsequently done and appropriate phage were cultured. Phage were taken orally by patients 4–6 weeks after operation. Despite of paralel phage and systemic antibiotic administration all patients underwent operative debridement of infected bone.

Simultaneously, every 7 days parameters of immunological response was measured in peripheral blood. They were: lymphocyte B activity (PFC and SAC test), lymphocyte T (NK) activity and phagocytose stimulation (PMA 30 test).

There was a two-fold increase of lymphocyte B activity in PFC test with peak on day 7 after phage administration. Additionally slightly increase of NK cells and phagocytic activity and both increase and decrease of lymphocyte B and T activity in SAC test was observed. Eventually remission of infection was achieved in 6 from 8 patients.

It is difficult to state a correlation between in vitro bactericidal effect of bacteriophage, immunological stimulation in peripheral blood and clinical results achieved after both operative and antimicrobial therapy.