Aim

The aim of this prospective comparative study was to evaluate the serum levels of different cytokines in patients underwent total knee replacement (TKR) and received allogeneic blood transfusion, post-operative auto-transfusion or not transfused.

Objective: Primary reconstruction of soft tissues in acute complex lower limb injuries is often mandatory in order to protect exposed bones, nerves, tendons and/or vessels, however it may be precluded by general clinical and/or local wound conditions. Vacuum assisted closure (VAC^®) has been introduced in the management of complex wounds for its ability to remove third space fluids, improve oxygen delivery to the wound bed, while it promotes angiogenesis and granulation. This retrospective study evaluates the use of VAC^® in lower limb trauma patients unsuitable for immediate reconstruction.

Patients and Methods: Fourty-two patients, 24 males and 18 females, with 49 complex lower limb traumas were treated with VAC^® therapy for a mean of 28 days (range 15–42 days). Mean age of patients was 47 years (range 21–82). All patients included were characterized by poor general condition or adverse local wound factors. VAC^® was applied 24–48 hours after bone fixation, vascular repair and surgical debridement of non viable tissues so as to minimize the risk of bleeding and ensure viability of soft tissues in the wound bed. Wound swab cultures were obtained before the application of VAC^® and before every change of sponge. The duration of therapy, wound flora, final reconstructive technique required, outcome and follow up period were recorded for each patient.

Results: Seventeen patients were over 65 years of age, 28 were Intensive Care Unit patients, 11 had heavily exuding wounds and in 9 the viability of soft tissues after initial debridement was questionable. Patients were followed up for 60 to 395 days. Two wounds (4%) healed spontaneously, 6 (12.2%) were managed with delayed direct suture, 31 (63.2%) were managed with skin grafts, 8 (16.3%) required local flaps. Two patients died during therapy due to concurrent conditions. In all but one patient, wound bacterial flora was progressively reduced during therapy. Scars were aesthetically acceptable, however, in 7 wounds hypertrophic scars were treated with triamcinolone injections combined with silicone sheeting.

Conclusion: VAC^® is a safe and effective method facilitating delayed soft tissue reconstruction in complex lower limb traumas in high risk patients. The development of healthy granulation tissue minimizes the need for major conventional reconstructive operations and therefore postoperative morbidity.

Objectives: The aim of this study was to explore the relationship between stress fractures, bone density and factors related to bone metabolism in a comparative group matched study including male military personnel beyond basic training.

Materials and Methods: Thirty two patients with stress fractures were matched with 32 uninjured-healthy volunteers (controls), by gender, age, height, body weight and level of physical performance. A questionnaire concerning the calcium intake, alcohol consumption and smoking was completed, the values of several biochemical markers related to bone metabolism were measured from blood samples, and calcaneal quantitative ultrasound was measured by heel ultrasound for each one of the 64 patients and healthy volunteers.

Results: Statistically significant lower levels of serum Osteocalcin (p=0.012) and higher levels of Albumin (p=0.006) were found among patients compared to controls. The levels of serum Total Protein, Ca, intact Parathormone and 25-hydroxy Vitamin D were lower among patients compared to controls, but none of these differences was statistically significant (all p> 0.10). Moreover, mean values of T-scores and Z-scores were statistically significantly lower in patients than in controls (p=0.018 for T-scores; p=0.016 for Z-scores).

Conclusions: Decreased bone turnover and low calcaneal bone density may increase the incidence of lower extremity stress fractures among men military personnel.

Aim: This study investigated the causes of meniscal tears in an unselected adult population. No epidemiological study of this type has been undertaken since the advent of arthroscopy and MRI.

Method: The notes of all patients (1236 cases) who underwent arthroscopic surgery under the care of one knee surgeon working in a District General Hospital between 1992 and 1998 were scrutinised. 392 patients aged between 18–60 years, with normal X-rays, no previous knee injury, surgery, or arthritis, and arthroscopically proven meniscal tears, form the basis of this study.

Results: Sports injuries (Group 1) occurred in 32.4% patients. Non-sporting injuries (Group 2) accounted for 38.8% patients, 71.9% of which happened in normal daily activities. Half occurred on rising from squatting position. No Injury (Group 3) was identified in 28.8% of patients. Average age of sports group was 33 years, non-sporting group 41 years & no injury group 43 years. Male:Female = 4: 1.

Age v cause: In patients under 20 years of age meniscal tears occurred mainly in sports. In patients 20–29 years, 64.5% were related to sports, 25% to non-sporting activities & 10.5% no specific injury. Between 30–39 years, distribution was about equal in each group. In patients aged 40–49, & 50–59 years sports related tears dropped below 20%, whilst non-sporting and spontaneous tears rose to 45% and 35% respectively.

A detailed analysis of: i) the tears in relation to different sports, ii) the nature of non-sporting injuries, iii) the pathological types and distribution of tears, and iv) the associated intra-articular injuries will be presented.

Conclusions: Approximately two thirds of meniscal tears in the general population occurred during normal daily activities and in the absence of sporting injury. In nonsporting injuries the mechanism of the tears was often unrelated to loading in flexion. Tears occurred in the absence of definitive injuries even in early adulthood and middle years. Degenerative change may contribute to the pathological mechanism of meniscal tears at an earlier age than generally appreciated. Ascent from the squatting position is an important common mechanism of injury not generally described or emphasised.