Juvenile bone cysts in children and adolescents are often discovered incidentally or in connection with a pathologic fracture. Although the diagnostic procedure in this type of lesion affecting the skeleton has become uniform, the treatment varies according to the principles established at different clinics. The aim of our study was to compare two Methods: applied in the treatment of juvenile bone cysts, i.e. the established method of a series of Methylprednisolone injections and a new mini-invasive method using a Tricalcium phosphate. In both groups of patients, we performed an evaluation of the number of required surgeries, general anaesthesias and subsequent hospitalizations (including the length of hospitalization), the treatment results and the interval between surgery and complete cyst healing using Neer’s evaluation criteria. The group of patients treated with Methylprednisolone consisted of 24 patients and the group of patients treated with Tricalcium phosphate comprised 20 patients. The outcome of the statistical analysis proves that in patients treated with Tricalcium phosphate significantly better results were obtained compared to patients where Methylprednisolone was applied. A subsequent surgery (additional application) was necessary only in two Tricalcium phosphate patients (10%) compared to nineteen Methylprednisolone patients (79%). The average length of hospitalization was 4 days in Tricalcium phosphate patients and 3.5 days in Methylprednisolone patients. Excellent and good results according to the Neer classification were documented in eighteen Tricalcium phosphate patients (19%) and in twelve Methylprednisolone patients (50%). The treatment of juvenile bone cysts with a biocompatible resorbable synthetic filler Tricalcium phosphate helps reduce the number of surgeries necessary for complete cyst healing and produces better results in terms of Neer’s evaluation criteria of bone cyst treatment results compared to the application of Methylprednisolone into the cyst. This work was supported by the Internal Grant Agency of the Ministry of Health of the Czech Republic (NS9860-3/2008).
Mesenchymal stem cells (MSCs) from bone marrow are multipotent cells capable of forming cartilage, bone, and other connective tissues. The objective of this study was to determine whether the use of allogenic mesenchymal stem cells could functionally heal defect in the distal femoral physis in rabbits without the use of immunosuppressive therapy. An iatrogenic defect was created in the lateral femoral condyle of thirty-two New Zealand white rabbits, 7 weeks old, that weighed 2.25 ? 0.24 kg. Each defect, 3.5 mm in width and 12 mm in length, in the right distal femoral physis was treated with allogenic mesenchymal stem cells in new composite hyaluronate/ collagen type I/fibrin scaffold. The healing response was evaluated radiographically, by MRI (at three weeks and four months after implantation), and also histologically, by Pearls’ reaction and with immunofluorescency (at four months after implantation). The results were compared with the data for the control defects (without stem cell implantation) in left distal femoral physes. In average, right femurs with damaged distal physis and transplanted MSCs grew more in length (0.55? 0.21 cm) as compared with left femurs with physeal defect without stem cell transplantation (0.46? 0.23 cm). Valgus deformity of right femurs with physeal defect and transplanted MSCs was mild (0.2? 0.1°). On the contrary, left femurs with physeal defect without transplantated MSCs showed significant valgus deformity (2.7? 1.6°). For defects treated with allogenic mesenchymal stem cell implants, no adverse immune response and implant rejection were detected in this model. Histologically, no lymphocytic infiltration occurred. At four months after transplantation, hyalinne cartilage had formed throughout the defects treated with allogenic MSCs. Labeled mesenchymal stem cells/diferentiated chondrocytes were detected in the physeal defects based on magnetic resonance imaging and immunofluorescency. The results of this study demonstrated that allogenic mesenchymal stem cells in a new composite hyaluronate/collagen type I/fibrin scaffold repaired iatrogenic defects in the distal femoral physes in rabbits without the use of immunosuppressive therapy. The use of allogenic mesenchymal stem cells for the repair of physeal defects may be an alternative to autologous MSCs transplantation. An allogenic approach would enable mesenchymal stem cells to be isolated from any donor, providing a readily available source of cells for cartilage tissue repair.
Physeal cartilage is known to have poor self-repair capacity after injury. Evaluation of the ability of cultured mesenchymal stem cells to repair damaged physis is the actual research topics. In 10 immature New Zealand white rabbits autogenous mesenchymal stem cells were transplanted into iatrogenic physeal defect in lateral portion of distal growth plate of the right femur. The same defect without stem cells transplantation in the left femoral distal physis served as a control. In our study, we used our own technique of implantation of MSCs with a newly modified gel scaffold (New Composite Hyaluronate/Collagen Type I/Fibrin Scaffold). The rabbits were euthanized 4 months after transplantation. Bone length discrepancy and valgus deformity were measured from femoral radiographs. Healing of the defect was investigated histologically. The ability of mesenchymal stem cells to survive and promote cartilage healing in the physeal defect was assessed by immunofluorescence. Average difference in femur length measured from surgery to euthanasia (4 months) was 0.61? 0.19 cm after preventive transplantation of MSCs in right femur, but only 0.11 ? 0.07 cm in left femur. Average angular (valgus) deformity of right femur with MSCs preventively transplanted to iatrogenically damaged distal femoral physis was 1.2? 0.72°. Valgus deformity in left femur was 5.4? 2.5°. Prophylactic transplantation of autogenous mesenchymal stem cells to iatrogenically damaged distal growth plate of rabbit femur prevented bone bridge formation and resulted in healing of the physeal defect with hyaline cartilage. Immunofluorescence examination showed that the chondrocytes newly formed in growth zone are the result of implanted MSCs differentiation. Femur growth in traumatized physis was maintained even after transplantation of autogenous MSCs. As compared with the opposite femur (with physeal defect but without transplanted MSCs), the bone showed no significant shortening or valgus deformity (p=0.018).
Compartment syndrome (CS), a serious complication in paediatric trauma, can be prevented by timely diagnosis and adequate therapy. From 1990 to 2000 we treated 22 patients with suspected CS in the arm. Incision into the intrafascial spaces of nine forearms and three hands confirmed the diagnosis. In 10 patients, fracture had caused the syndrome, and in two, the cause was contusion. In two patients the CS resulted from incorrect treatment procedures. We also treated 22 patients with suspected CS in the lower limb. The diagnosis was confirmed in 15. Incision into the intrafascial spaces was performed during treatment, 13 times on the crus and twice on the femur. Fractures were always the primary cause. In the upper limb outcomes were good. One patient developed a Volkman’s contracture but this was only disfiguring. Some patients treated for lower limb CS had cosmetic after-effects, but only one patient, in whom CS was diagnosed late, had functional after-effects. We advocate permanent monitoring of intrafascial pressures, using piezoelectric sensors, and timely performance of adequate dermofasciotomies.
We evaluated the outcomes of fractures of the femoral shaft treated by elastic stable intramedullary nailing (ESIN). From 1994 to 1999, 100 children were treated. The mean age of the 65 boys and 35 girls was 8.7 years. The mean follow-up was 5.4 years. There were 30 type-AII fractures, 21 type-AIII, 17 type-AI, 13 type-BI, nine type-BII, four type-BIII and six type-CI. Implants were inserted using the ascending method in 92 patients and the descending method in eight. The mean period of implant insertion was 172 days. Steel implants (Medin) were used in 54 patients and titanium implants (Synthes) in 46. Evaluated according to Flynn, 86 patients had an excellent outcome, 13 a satisfactory outcome and one a poor outcome. The greatest limb length discrepancy was 3.2 cm. A steel implant was used in eight of the 13 patients whose results were merely satisfactory and in the patient who had a poor outcome. There were no pyogenic complications. In five patients, the inserted implant required shortening during treatment. We believe that in 5 to 12-year-old patients the ESIN method with titanium implants can be used to treat femoral shaft fractures.
