Purpose: Filling bone defects is a major challenge in orthopaedic surgery. One of the therapeutical alternatives to combined autologous bone grafts and bone substitutes is to use a biomaterial carrying bone stem cells. The purpose of this study was to test a hybrid biomaterial in a major bone loss model in the rabbit.

Material and methods: The study material was the AN 69 hydrogel (Hospal). Twenty-four rabbits were divided into four identical groups of six individuals. Each animal underwent a unilateral resection measuring 2 cm in the mid third of the cubitus: group 1 simple resection; group 2 resection and centromedullary pin; group 3 resection, centromedullary pin and biomaterial; group 4 resection, centromedullary pin, biomaterial with bone marrow stem cells. Animal were sacrificed at six weeks. A radiograph was obtained immediately after surgery and at sacrifice. The study parameters were: new bone formation, bone healing, bone remodelling. Each criteria was assessed with a mean score (Werntz score). A pathology examination was performed in all cases to study new bone formation, polylmere degradation and inflammation.

Results: The overall radiographic score was group 1 = 2, group 2 = 8, group 3 = 24, group 4 = 42 for a maximum 62 points. Histologically, there was nonunion after simple pinning with formation of a defective callus. The nonunion persisted after pinning and hydrogel without cell seeding. New bone formation was moderate and predominated on the borders of the bone resection. After pinning associated with cell seeded hydrogel, an osteogenic lamina arose from the hydrogel network. This osteogenesis was continuous with osteogenesis originating from the bone section cut.

Discussion: These findings demonstrate that associated a hydrogel with bone stem cells can produce more significant bone formation than in controls, confirming the animal model. Treatment of major bone loss and aseptic osteonecrosis after curettage could be proposed with this new biomaterial combining a hydrogel and CD34+ stem cells in humans.

Purpose: Joint cartilage repair is one of the most widely studies aspects of orthopedic care. The tissue’s intrinsic capacity to repair degenerative, inflammatory or trauma-induce damage is low. The purpose of this study was to report early results obtained with an allograft using a hybrid biocartilage in the rabbit.

Material and methods: Chondrocytes obtained by successive enzymatic digestion of joint cartilage from the knee joint were implanted via medial arthrotomy into an osteo-cartilaginous knee defect measuring 4 cm in diameter and 3 mm in depth produced by trepanation of the tronchlea. Both knees were operated in six adult New Zealand rabbits. After eight weeks, the animals were assessed clinically then sacrificed. The femoral condyles were removed for histological study. All grafted joints were mobile and had normal function without risk of self-mutilation.

Results: The joint samples did not show any evidence of effusion. The implant site was still visible macroscopically and presented a cartilaginous surface continuous with the healthy cartilage. After HES staining, the distal pole of the implant was found to be colonised with young cartilage continuous with the trochlear cartilage. Enchondral ossification appeared to be present in the distal part of certain cartilaginous nodules with a bony lamina continuous with the adjacent subchondral bone. There was no evidence of an inflammatory reaction of the synovial and the patellar cartilage was normal.

Discussion: These preliminary results of a hybrid biocartilage graft combined with cartilage surface reconstruction and osteointegration of the deep implant without in vivo supply of growth factors are encouraging. The safety of the supporting material was demonstrated. We are currently working on developing an autograft from progenitor cells.

Purpose of the study: Sports activities requiring antepulsion, adduction and medial rotation can favor the development of posterior instability of the shoulder. Conservative treatment is indicated, but many techniques have been proposed in case of failure. All do not allow recovery of the same sports level. We report our experience with six cases of posterior shoulder instability treated with a Gosset posterior bone block.

Material and methods: We retrospectively reviewed cases treated between 1974 and 1995. Six athletes, aged 17 to 34 years (mean 25 years) underwent posterior bone block surgery using the Gosset procedure on their dominant shoulder. Three of the patients had experienced involuntary dislocation and three others involuntary and voluntary dislocation. One patient had a multidirectional hyperlaxity. Five patients had participated in rehabilitation programs for at least five months. Two patients had undergone unsuccessful bone block surgery in another unit.

Results: Stability and pain relief were achieved in all cases. Three patients recovered complete mobility. In the three others, mean limitation of mobility for the different sectors was 15°. There has been no sign of osteoarthrosis at three years follow-up. All patients have resumed their sports activities, three at the same level.

Discussion: In our experience, most surgical techniques proposed for the treatment of posterior shoulder instability are unsuccessful. The Gosset iliac bone block prolongs the articular surface. After consolidation, it allows sports activities requiring shoulder force and provides satisfactory mobility.

We performed a prospective study on 96 patients with extra-articular or intra-articular fractures of the distal radius with a dorsally displaced posteromedial fragment. After closed reduction, we compared trans-styloid fixation and immobilisation with Kapandji fixation and early mobilisation. Forty-two patients of mean age 57.1 years +/- 18.1 (SD) were treated by trans-styloid K-wire fixation and 45 days of short-arm cast immobilisation. Fifty-four patients of mean age 57.7 years +/- 18.7 (SD) had Kapandji fixation and immediate mobilisation according to the originator. All the patients had clinical and radiological review at about six weeks and at 3, 6, 12 and 24 months after the operation. Pain, range of movement and grip strength were tested clinically, and changes in dorsal tilt, radial tilt, ulnar variance, and radial shortening were assessed radiologically. Statistical analysis was applied to comparisons with the normal opposite wrist. Pain and reflex sympathetic dystrophy were more frequent after Kapandji fixation and early mobilisation, but the range of motion was better although this became statistically insignificant after six weeks. The radiological reduction was better soon after Kapandji fixation, but there was some loss of reduction and increased radial shortening during the first three postoperative months. The clinical result at two years was similar in both groups.