Introduction: Vertebral compression fractures (VCFs) are the most common complications in patients with poor bone quality: trabecular bone discontinuity, occurring with aging, leads to trabecular loosening, subsequent microcracks and vertebral collaps. Percutaneous vertebral augmentations as vertebroplasty and kyphoplasty are minimally invasive surgical procedures developed for the management of symptomatic VCFs not responding to medical treatment, but related complications are not uncommon. The aim of this international multicentric study was to assess the reduction of pain, complications and results of Vesselplasty, a new kyphoplasty procedure.

Material and Methods: From January 2006 to July 2008 we treated 327 VCFs in 264 patients, 193 women and 71 men (mean age 68 years). Procedures were managed by one or two C-arm fluoroscopic techniques. The highest level was D6 while more common were at the thoracolumbar junction. Patients were followed at 1, 6, 12 and 24 months using plain X-rays or reformatted CT images. Pain was evaluated with visual analog scale (VAS) and SF-36 assessed at baseline, after the procedure, and after 1, 6, 12 and 24 months. Data analysis was used Student-t test. All patients received antiosteoporosis medical treatment, pain medication, and physiotherapy.

Results: We always performed transpedicular minimally invasive approches using Vessel-X^® with low-viscosity bone cement mixed with calcium sulphate. The average amount of cement injected, for each vertebral body, was 5cc (range 3.5–7cc). The mean preoperative scores of 8.3 (VAS), 12.6 (SF-36 Bodily Pain) and 10.9 (SF-36 Physical Function) were improved to 2.3, 54.9 and 52.2, respectively (P< 0.001) at 1 month follow-up and 2.1, 65.7 and 59.4, respectively (P< 0.001) at 12 month follow-up. No case reported pedicular or intracanal leaks of cement. Intradiscal leakages occurred in 20 levels (6.1% of total) but asymptomatic. Another VCF, within the first year after operation, took place in 29 patients, but only in 9 cases (3.4% of total) was an adjacent level.

Conclusion and Discussion: Treatment of osteoporosis has made enormous advances in the past years, resulting in a wide range of options. Vesselplasty is a safe and effective minimally invasive procedure for pain relief associated with VCFs, and improves mobility and quality of life in these patients. Vesselplasty permits the interdigitation of bone filler materials into the surrounding trabecular bone: the double layers containers reduce the risk of leaks of cement and restore the vertebral height. We underline the importance of a global approach to the osteoporotic patients: the best treatment remains early diagnosis evaluating bone remodelling markers, lumbar and femoral DXA, thoraco-lumbar X-rays and risk fracture assessment to guarantee the most appropriated therapy as specific as possible.

A 20-year-old man sustained an open medial dislocation of the ankle without an associated fracture after a low-energy inversion injury. Prompt debridement and reduction with primary wound closure of the skin were performed without suture of the capsule. Immobilisation in a non-weight-bearing cast for 30 days followed by ankle bracing for two weeks and subsequent physiotherapy, produced full functional recovery by three months. At follow-up at one year there was a full range of pain-free movement, although the radiographs and MR scan showed early post-traumatic degenerative change at the medial aspect of the tibiotalar and the calcaneocuboid joints.

The study describes the changes of condrocytes and extracellular matrix occurring in Hip OA. 16 femoral heads were included in the study.

Cartilage explants were removed from 3 anatomical sites over the surface of 14 OA and 2 non-OA patients. Cartilage sections were evaluated with histological (EE, Alcian Blu and Mallory-Azan stainings) and immuno-histochemichal (antibodies directed against fibronectin, tenascin, laminin, type I and type IV collagen, metallo-proteinase-1,-2,-7 and -7) analysis.

Histological analysis of cartilage of central and per-hipheral biopsies from patients with severe OA showed significant reduced number of chondrocytes in both superficial and middle zones. In the lower cartilage layer with severe structural lesions a cospicous number of cartilagineous repair-islands were noticed. Immunohistochemical analysis showed high levels of tenascin in all cartilage layers of byopses showing structural damages. Frequently we observed an altered distribution of fibronectin. Metalloproteinase-2 (constitutive) is present in all stages during coxarthritis. Metalloproteinase-9 (not constitutive) is expressed at the final stages suggesting an important late role. Obtained results show that metalloproteinases have a peculiar behaviour during coxarthritis vs. other pathologies. Costitutive metal-loproteinases have a fundamental role in extracellular matrix remodelling, MMP-2 especially.