Background: Low back pain due to disc degeneration is a major problem in industrialized countries. So far surgical treatment has consisted of either fusing the involved segments or replacing them with a prosthetic disc. Both techniques yield unpredictable results.

Objective: Looking at a biological solution we have been exploring the possibilities of harvesting and culturing adult and fetal human intervertebral disc cells in vitro.

Methods: Nucleus pulposus tissue has been surgically removed in cases of scoliosis, lumbar disc degeneration and cervical disc herniation after obtaining patient’s consent. Fetal disc tissue was also obtained following approval by the hospital ethics committee. Tissue was put in culture with and without prior collagenase II digestion. No antibiotics or growth factors were used. Cells were kept in culture until confluence and preserved in liquid nitrogen for further study.

Results: We found that it was possible to obtain homogenous populations of cells macroscopically identifiable as chondrocytes from the adult donnors. Collagenase II treatment provided the best results in adult cells whereas digestion was not necessary for the fetal tissue. The latter showed rapid growth compared to adult cells. Further characterization is underway.

Conclusions: It is possible to obtain cultures of nucleus pulposus human cells from a variety of donors, including adolescent patients with little degeneration as well as from patients showing symptoms and signs of lumbar and cervical disc degeneration.. Fetal tissue could also be cultured without growth factor use. Fetal cells in particular multiplied faster than adult cells and could possibly be used as a cell bank in view of tissue engineering projects.

A multicentre trial of four Level One trauma centres retrospectively analysed complications and odds for complications in complex open and closed tibial fractures stabilised by unreamed, small diameter nails.

467 tibial fractures were included in the study. There were 52 proximal fractures (11.1%), 219 mid-shaft fractures (46.9%), and 196 distal fractures (42%). Breakdown into different AO/OTA groups revealed 135 type A fractures (28.9%), 216 type B fractures (46.3%), and 116 type C fractures (24.8%). 265 were closed fractures (56.7%) and 202 were open fractures (48 Gustilo grade I (10.3%), 80 grade II (17.1%), and 74 grade III (15.9%).

Analysis revealed five (1.1%) deep infections (with a 5.4% rate of deep infections in Gustilo grade III open fractures), 43 delayed unions (9.2%), and twelve (2.6%) non-unions. Compartment syndromes occurred in 62 cases (13.3%), screw fatigue in 47 cases (10%), and fatigue failure of the tibial nail in three cases (0.6%). Fracture distraction of more than 3 mm should not be tolerated when stabilizing tibial fractures with unreamed, small diameter nails as this increases the odds to acquire delayed union by twelve times (p < 0.001), and the odds to acquire non union by four times (p = 0.057).

There was a significant increase of complications in the group of grade III open fractures (p < 0.001), AO/OTA type C fractures (p = 0.002), and to a lesser extent in distal fractures. However, the rate of severe complications resulting in major morbidity was low compared to other methods of stabilisation in these severe fractures.