Introduction: Osteomyelitis and septic arthritis (SA) below the elbow are severe conditions affecting the function and viability of the hand. Factors predisposing to these conditions and parameters affecting prognosis are emphasized.

Material and Methods: In a 4 years period, 16 patients with SA (4) or osteomyelitis (12) were treated in a University Orthopaedic Department providing care to a rural population of 1.000.000, Nine had history of trauma in unhygienic environment, 3 had immunodeficiency and in 4 osteomyelitis was iatrogenic [previous fixation of fractures (3) and vein catheterization (1)]. SA was located in the wrist (2) and thumb joints (2) and osteomyelitis involved the radius (3), ulna (1), metacarpals (3) and phalanges (5). Ten patients received oral antibiotics in other centers. The mean delay from onset of symptoms to referral to our center was 22 days. Apart of antibiotics administration, surgical treatment included debridement and irrigation for SA and excision of necrotic bone, stabilization (external fixators), use of antibiotic beads and secondary bridging with bone graft for osteomyelitis. Additional procedures (amputations, arthrodesis) were also required in some cases.

Results: Cultures were positive in 9 of 16 cases [Staph. aureus (5) and enterobacter cloacae (3)]. Patients underwent multiple procedures (mean: 3.8) and 4 underwent amputation of a digit (2) and hand (2) due to the rapid extension of infection threatening and finally taking the lives of 2 elderly and immunosuppressed patients. Mean follow-up period of the 12 surviving and non-amputated patients was 18 months. Union was accomplished in all cases. Functional results were excellent or very good in 10 of 12 patients and good in 2 patients. All patients were satisfied and returned to their previous occupations.

Conclusions: Osteomyelitis and SA below the elbow was frequent in population living in unhygienic environment or working with soil. All cases received medical treatment with delay. Immunosuppressing conditions favored the extension of infection and threatened patients lives. Delay in treatment in combination to immunosuppression resulted to significant morbidity. Early treatment including surgical drainage, thorough debridement and antibiotic administration is necessary for elimination of skeletal infection and salvage of the hand and patients life.

Aim: Tissue injury leads to platelets migration and release of growth factors (GF): Platelet-Derived GF (PDGF) and Transforming GF-beta (TGF-b) that are particularly important for the bone repair process. The purpose of our study is to evaluate the new bone formation with the use of AGF-bone graft combination and to estimate the concentrations of PDGF-AB and TGFb2 during the procedure. Methods: AGF-bone graft combination was used in19 patients with long bone defects (11) and spinal fusion (8). TGF-b2 and PDGF-AB concentrations were assessed in samples from blood. Aliquots were taken at each stage of AGF preparation (whole blood, buffy coat, AGF, wound drain) and analyzed for TGF-b2, PDGF-AB concentration and platelet counts. ELISA was performed to quantify concentrations of active PDGF-AB and TGF-b2. Results: Mean follow up time was 9 months. Signs of bone union were apparent in radiographs 3–6 months after the index procedure. Average platelet count increased from 212x106 cells/ml to 680x106 cells/ml (buffy coat) and to 1280x106 cells/ml (AGF concentrate), resulting in a 604% increase. A 480% increase of PDGF-AB levels and a 320% increase of TGFb2 levels in AGF concentrate comparing to whole blood levels was determined. TGF-b2 and PDGF-AB levels were also detected in samples collected from the wound drains, in increased levels comparing to the AGF concentrates. Conclusions: In all cases the clinical results were very encouraging with augmented osteogenesis, whereas the laboratory results (increased values of TGF-b2 and PDGF-AB in subsequent stages of the procedure) practically predicted the clinical success.

Aim: Tissue injury leads to platelets migration and release of growth factors (GF): Platelet-Derived GF (PDGF) and Transforming GF-beta (TGF-b) that are particularly important for the bone repair process. The purpose of our study is to evaluate the new bone formation with the use of AGF-bone graft combination and to estimate the concentrations of PDGF-AB and TGF-b2 during the procedure.

Methods: AGF-bone graft combination was used in 34 patients with long bone defects (24) and spinal fusion (10). TGF-b2 and PDGF-AB concentrations were assessed in samples from blood. Aliquots were taken at each stage of AGF preparation (whole blood, buffy coat, AGF, wound drain) and analyzed for TGF-b2, PDGF-AB concentration and platelet counts. ELISA was performed to quantify concentrations of active PDGF-AB and TGF-b2. Postoperative evaluation was clinical and radiological (radiographs, tomograms, QCT).

Results: Mean follow up time was 9 months. Signs of bone union were apparent in radiographs 3–6 months after the index procedure. Average platelet count increased from 212x106 cells/ml to 680x106 cells/ml (buffy coat) and to 1280x106 cells/ml (AGF concentrate), resulting in a 604% increase. A 480% increase of PDGF-AB levels and a 320% increase of TGF-b2 levels in AGF concentrate comparing to whole blood levels was determined. TGF-b2 and PDGF-AB levels were also detected in samples collected from the wound drains, in increased levels comparing to the AGF concentrates.

Conclusions: In all cases the clinical results were very encouraging with augmented osteogenesis, whereas the laboratory results (increased values of TGF-b2 and PDGF-AB in subsequent stages of the procedure) practically predicted the clinical success.

Purpose: We present the results of subacromial decompression and repair of the rotator cuff through a minimal deltoid-on approach.

Material and Method: Eighty-seven patients with longstanding shoulder pain were evaluated in two years (1999–2000) in our department. In sixty -eight of them symptoms were due to impigment syndrome. Eight patients with follow up time less than six months were excluded from this study, twenty were treated conservatively and the remaining forty (22 female, 18 male, mean age 50.3) underwent surgery. Three x-ray views were obtained in all patients, i.e. standard AP, true AP, and subacromial space projection. MRI was also obtained in all patients. MRI revealed calcific tendinitis in fifteen patients, osteophytes of the acromioclavicular joint in thirteen, a hooked (type III) acromion in ten and partial tear of the supraspinatus tendon in nineteen. In five of them there was also a partial tear of the infraspinatus. Finally, seven patients were suffering of a full thickness tear of the supraspinatus tendon. All patients were operated through a minimal deltoid-on approach. Acromioplasty and coracoacromial ligament dissection was performed in all. In patients with osteoarthritis of the acromioclavicular joint, osteophytes were carefully removed. Calcific deposits were also removed in all patients. In eighteen patients tears of the rotator cuff were detected and repaired using bone anchors.

Results: All patients were examined six months postoperatively. Results were evaluated with CONSTANT SCORE and with a questionnaire for patient’s satisfaction. Thirty-seven patients were very satisfied with the result and three were satisfied. As for Constant score, pain improved at an average of 7.8 points, daily activities by 5.4, and range of movement by 4.2 points. Results were evaluated by the examiner as excellent in thirty-six patients (90%) and very good in four patients.

Conclusion: Deltoid-on approach, in patients with impingement syndrome of the shoulder provides adequate exposure for the surgical repair with minimal trauma and a very low rate of complications.