Bone marrow edema (BME) is a rare cause of pain in the foot.

We reviewed 19 patients with unilateral bone marrow edema of ischemic, stress or osteoarthritic origin located in the hindfoot treated with the vasoactive prostacyclin analogue iloprost. The patients’ mean age was 61,5 years (25–76) and the duration of symptoms lasted 19 weeks before the therapy started. Bone marrow edema was located 9x in the talus, 3x in the calcaneus, 3x in the navicular bone and 2x in the cuboid. 11 cases were estimated to have a primary ischemic origin, the other 8 ones to be secondary to an activated osteoarthritis or to mechanic stress. Our therapy consisted of a series of five infusions with 20 μg (50 μg in the first six patients) of iloprost given over 6 hours on 5 consecutive days each. Mazur’s foot score was used to assess function before and 3 months after therapy.

During this time, the score improved from a mean of 54,9 (range 23–73) before to 87,8 points (47–100) 3 months after therapy, with the best results in ischemic lesions with an improvement from 56,2 to 93,9 points and inferior results in patients with osteoarthritic edema as well as edema due to stress with a change in the score from 53 to 79,3 points. Magnetic resonance imaging showed complete recovery of the bone marrow edema within 3 months in 12 patients, 3x partial regression and no change in 4 cases with bone marrow edema due to activated osteoarthritis.

We conclude that the parenteral application of the vasoactive drug iloprost might be a viable method in the treatment of bone marrow edema of different origins but especially in ischemic ones. In edema secondary to osteoarthrosis or stress, therapy effect with iloprost is of a symptomatic character depending on the grade of the basic disease.

Background: Recent studies of arthroscopic rotator cuff repairs have shown high failure. The different suture configurations were mostly tested in non degenerative animal tendon specimen. We used instead fresh-frozen degenerative human cadaver rotator cuffs. The goal of this study was to determine the biomechanical properties of commonly used arthroscopic stitches in ruptured human cuffs in comparison to intact rotator cuffs.

Method: 36 human rotator cuff tendons were harvested, documented according to size, thickness and location of rupture, and divided into a ruptured and non ruptured specimen group. We found 12 ruptured and 24 intact cuffs. Three stitch configurations (simple, horizontal, and massive cuff stitch) with a Fiber Wire 2 (Arthrex) were randomized and biomechanically tested in each set of tendon specimen. The specimen were mounted on a uniaxial load machine (ZM200, Fa Shokoohi) and loaded to failure under displacement control at a rate of 0.6 mm/sec. Ultimate tensile load, and type of failure were recorded.

Results: Ultimate tensile load was significantly higher (p < 0.05) for the massive cuff stitch (186 ± 12 N) than it was for either the simple stitch (102 ± 9 N) or the horizontal stitch (138 ± 10 N) in the intact cuff cohort. In the ruptured cuff group ultimate tensile load was significantly lower (p < 0.05) for the massive cuff stitch (115 ± 12 N), the simple stitch (77 ± 9 N), and the horizontal stitch (103 ± 10 N) in comparison to the intact cuff group. The simple and horizontal stitches failed by tissue pull-out in both groups, whereas the massive cuff failed by pull-out and once by suture breakage in the group of intact cuffs.

Conclusion: Ruptured rotator cuffs showed significant less biomechanical strength concerning all three stitches in comparison to the intact cuff group. Overall the massive cuff stitch showed superior ultimate tensile load.

Aims: The purpose of this retrospective review was to analyze our results with the use of the Marchetti-Vicenzi elastic locked nail in femoral shaft fractures. Methods: Between Jan.1994 and Dec.1997, 75 femoral fractures in 73 patients were treated in our department. There were 51 men and 22 women with a mean age of 29 years. All patients were followed to fracture union. In 67 cases (89%) the cause of injury was a R.T.A. According to Winquist and Hansen, there were 8 fractures of type 0 (no comminution), 5 of type I, 22 of type II, 29 of type III and 11 of type IV. Six fractures were open grade II and two were grade IIIa. Multiple injuries were seen in 22 patients (30%). Results: Certain intraoperative complications were encountered in 25 cases (33%). Open nailing was required in 21 fractures (28%) mainly because of the loss of reduction (absence of guide wire) or because the distal pins jammed at the fracture site. Distal locking mechanism problems (bending of protruding locking wire or breakage of safety loops) occurred in 11cases (15%). In 3 patients the distal pins protruded from the anterior cortex and in another 4 breakage of one or more pins occurred during the postoperative period. Delayed union was seen in 7 patients (9%). Five fractures (7%) progressed to non-union. All the non-united fractures were type III or IV. The remaining fractures united after a mean period of 15 weeks. Four fractures (5%) which were located in the distal third, united with signiþcant varus deformity (≥10¡). Shortening (≥2 cm) were seen in 4 patients (5%). There was one deep infection that led to nonunion. Conclusions: Because of the high complication rate in this series, we do not recommend this type of elastic nail for the treatment of femoral shaft fractures.

Aim of the study: Lunate dislocation is very uncommon injury which occur due to acute hyperextension of the wrist.Factors who affecting the prognosis still controversial.The aim of this study is to present the classification,the management and the outcome of this type of dislocation.

Methods: Four patients were treated the last four years in our clinic with lunate dislocation.All patiends treated immediately.In two cases was followed dorsal approach and fixation, in one case performed palmar approach and decompression of the median’s nerve tunnel from the hematoma, and in one case dorsal approach and ligaments repair.

A functional score sustem in combination with radiological assesment were used for the postoperative evaluation of the patiends.The mean time of follow-up was 23,5 months.

Results: Two patiends had excellent, one good and one poor results. Complications as ligamentous instability, avascular necrosis, osteoarthritis or infection they didn’t remarked. One patient complains for a mild pain due to his work.

Conclusion: Early diagnosis of the lunate dislocation in combination with open reduction and fixation can offer satisfactory results.

Purpose: The advantages of the Scarf osteotomy are the greater ROM and the ability of better Stabilisation. We had compared our results with this theory.

Methods-Results: At 41 patients with mean age 52,5, y(16–70) we made 47 Scarf osteotomies. At 25 patients we made also corrective osteotomies at the kleiner toes.

The preoperative criteria for our study were degenerative Osteoarthritis of the 1st MP joint, HV angle> 40° or IM I-II angle> 20°.

The postoperative and radiologic control was continued for 11–18 months(M. 18m)

38 patients were very satisfied with the results,2 sat-isfied, 1 patient was claimed for reduced ROM of the 1st PIP joint. The mean rehabilitation time was 2,9 months(1,5–6M).

Pre- and postoperative compare had shown a change at AOFAS score from 48 (19–80) to 87 (35–100),change of the HVA from 35,2° (29°–48°) to 16°(4°–33°) and change of the IM I-II angle from 14,7°(11°–19°) to 8,4°(6°–12°).

The DMAA didn’t show any particular change. The major shortening of the 1st Metatarsal was 3mm.

A t 1 patient we find early osteoarthitic changes, but we have seen no pseudarthrosis or Metatarsal Head Necrosis. At 10 patients we measured the 1st MP joint ROM< 75° and at 1 patient < 30°.

Conclusions: The Scarf osteotomy with the modified Mc Bride procedure is an effective method for the treatment of Hallux Valgus.

Material-Methods: At 18 patients with Seronegative Chronic Polyarthritis(16 women, 2men, M.A 64,5 y) we made 24 Hoffmann-Tillmann procedures at the forefoot (6 right,6 left,6 both).At 2 patients we repeated the operation due to pseudarthrosis, at 2 patients we applied a corrective operation at the 2nd toe and at 1 patient we removed the osteosynthesis materials.

The postoperative and Radiologic control of 15 patients(20 foots) was continued for 1,5–7,5 y(M.3,5y).We had phone contact with 2 patients and for 1 patient, who died, we used the latest evaluation.

All the patients were satisfied with the postoperative results. Walking and shoe use were incompliant. At 2 patients we mentioned slight hyperextension of the 1st MP joint and at 2 patients asymptomatic pseuthasrthrosis of the 1st MP joint.

The M.V. of the HV angle was 17° and the inclination angle between Metatarsals and toes was 20°.The Phalanges showed mild to major degree Osteoporosis. The Hallux AOFAS Score was 83 (49–90) and for the remain toes 89,5(79–97).The results according to Mielke Score were very good at 15 foots and good at 5 foots.

Conclusions: Arthrodesis of the 1st MP joint in combination with head resection of the II-V Metatarsals is a very effective method for the treatment of the Rheumatoid foot.