Aims

Options for the treatment of intra-articular ligament injuries are limited, and insufficient ligament reconstruction can cause painful joint instability, loss of function, and progressive development of degenerative arthritis. This study aimed to assess the capability of a biologically enhanced matrix material for ligament reconstruction to withstand tensile forces within the joint and enhance ligament regeneration needed to regain joint function.

Aim: Antibiotics are currently used during fracture healing for prevention or treatment of infection. Quinolones are well known to delay fracture healing, but little is known about other antibiotics. Cefazolin is the most commonly used drug for antibiotic prophylaxis, but many centres use cefuroxime. When allergy to cephalosporins is present, current recommendations include clindamicin or vancomicin. The purpose of this study is to know if other commonly used antibiotics can delay fracture healing.

Methods: 100 male 3-months-old Wistar rats were used. After anaesthesia with ketolar, a closed fracture in the middle third of the femur was carried out. Rats were divided in five groups (20 rats each): one receiving cefazolin (a first generation cephalosporin, CZ), other receiving cefuroxime (a second generation cephalosporine, CF), other vancomicin (group V), other clindamicin (group CL) and the other receiving placebo (P) for 4 weeks. Group CZ received a subcutaneous dose of 50mg/kg/daily, Group CF received a dose of 100 mg/Kg/daily, Group V received a dose of 20 mg/Kg/daily, Group CL received a dose of 25 mg/Kg/daily and group P received water. 4 weeks later rats were killed and femora extracted. A mechanical test (low speed torsion) was performed to evaluate healing. All four groups (CZ, CF, V, CL) were compared to placebo through ANOVA.

Results: Six bones were discarded because of technical errors, no infections were found. The maximum torque achieved by the calluses before breaking were 240 mNm in group P (n=18), 238 in group CZ (n=20), 178 in group CF (n=19), 167 in group V (n=19), and 205 in group CL (n=18). When compared to placebo, cefazolin and clindamicin showed no statistical differences (N.S, p> 0,10), vancomicin had lower callus strength (p=0,015), and cefuroxime had also lower callus strength near the significance level (p=0,084).

Conclusion: The mechanical strength of fracture callus is similar when rats are given cefazolin or clindamicin during fracture healing. The mechanical strength of fracture callus is lower when vancomicin (and probably cefuroxime) is given. If these results are similar to human, cefazolin and clindamicin are safe drugs to use during fracture healing. If possible, vancomicin (and perhaps cefiuroxime) use during fracture healing should be restricted.

Background: Acetabular retroversion has been proposed to contribute to the development of osteoarthritis of the hip. For the diagnosis of this condition, conventional AP pelvic radiographs may represent a reliable, easily available diagnostic modality as they can be obtained with a reproducible technique allowing the anterior and posterior acetabular rims to be visible for assessment. This study was designed to

establish a method to directly quantify anatomic acetabular version on AP pelvic radiographs and to

Methods: Using 43 desiccated pelves (86 acetabuli) the anatomic acetabular versions were measured at three different transverse planes (cranially, centrally and caudally). From these pelves, standardized AP pelvic radiographs were obtained. To directly measure central acetabular version (AV), a modified radiographic method is introduced for the use of AP pelvic radiographs. Moreover, the validity of the radiographic “cross-over-sign” to detect cranial acetabular retroversion was determined.

Results: The mean central and caudal anatomic AV were approximately 20°, the mean cranial AV was 8°. Cranial retroversion (AV < 0°) was present in 19 of 86 hips (22%). A linear correlation was found between the central and cranial AV. Below 10° of central AV, all acetabuli were cranially retroverted. Between 10° and 20°, 30% of the acetabuli were cranially retroverted and above 20°, only one of 45 acetabuli was cranially retroverted. The radiographic measurement of the central AV (20.3° ± 6.5) correlated strongly with the anatomic AV (20.1° ± 6.4). The sensitivity of the ‘cross-over-sign’ to detect an cranial acetabular anteversion of less than 4° was 96%, its specificity 95%, and the positive predictive and negative predictive values 90% and 98%, respectively.

Conclusions: The cranial AV is on average 12° lower than the central AV, with the latter directly measurable from AP pelvic radiographs. A central AV of less than 10° was associated with cranial retroversion. The presence of a positive ‘cross-over-sign’ is a highly reliable indicator of cranial AV of < 4°.

Introduction and objectives: The most commonly used treatment for extraarticular fractures of distal radius is closed reduction and maintenance of reduction in a cast. Two types of casts are used: plaster splint for 7–10 days and later exchanged to a circular cast and the use of circular cast immediately. The objective of this work is to compare both types of treatment in terms of ability to achieve reduction and to maintain it during healing.

Methods: A prospective, randomized and blinded study was designed. To date, 21 patients enrolled the study. Informed consent was given. The inclusion criteria were: older than 35 years, extraarticular distal radius fracture sustained less than 24 hours before and not previously treated. Exclusion criteria included previous injury in the same wrist, open fracture, and not compliance with the protocol. After intrafocal anesthesia with mepivacaine 1%, fracture was reduced under traction and immobilized in a dorsal short plaster splint (splint group) or a circular short plaster cast (circular group) randomly. After 10 days of immobilization, the plaster splint was changed to a circular short plaster cast. AP and lateral X-Rays were taken before reduction, after reduction, after 10 days (before changing cast), and at 21 days. Volar inclination of lunate fossa on the lateral X-Ray was obtained. On the AP proyection, the radial inclination and radial length was measured. Complications were recorded. Data was analysed through ANOVA between groups.

Results: When comparing X-rays before and after reduction, the volar inclination of the lunate fossa on lateral projection changed from −21,4° to 8,60° (30° change) after reduction in splint group and from −15,22° to 1,78° (17° change) in circular group (p< 0.05). The other comparisons were N.S. When comparing after reduction and 10 days later, the radial inclination changed from 20,20° to 18,80° (1,40° change) in the splint group and from 20,89° to 20,44 (0,44° change) in the circular group (p< 0.05). Other comparisons were N.S. No differences were found between 10 days and 21 days in any X-Ray parameter. No complications were found.

Conclusions: A better reduction was achieved with the plaster splint method in the immediate X-Ray control. Nevertheless, reduction was better maintained during the first 10 days with the circular plaster cast method.

Background: To determine patients clinical and haematological characteristics that could affect the use of blood and infection incidence with hip fractures (HF) treated with a dynamic hip screw (DHS).

Patients and Methods: A retrospective study of all the HF patients during 5 years (January1995- December1999) who were treated with a dynamic hip screw (DHS ïf’, Synthes-Stratec, Oberdof, Switzerland) at one unique university hospital. No patient was excluded. Age, gender, elapsed time, anaesthesia risk (ASA clasification), type of HF (internationalAO classification), transfusion procedure and the total used; haemoglobin (Hb) at days 0 (incoming to urgency service) and first postoperative (POD ï€1) were examined. We also analyzed the infection incidence (CDC criteria), place and severity. The statistical univariate analysis included Student’s t-test for numeric variables and Pearson’s chi-squared test for string variables. There was considered to be a statistically significant difference (SSD) when p< 0.05. A multivariate stepwise logistic regression model was used.

Results: Three hundred and one patients with HF were studied. 125 A1 and 176 A2, according to the AO classification. Male/female ratio: 76/225 (25.2%/74.8%); age 78.97 years old (range: 23–104); ASA: I 53 (17.6%); II 97 (32.2%); III 138 (45.8%) and IV 13 (4.3%). Hb Values on the day of admission: 128.7 g/L (range: 81.7–176.7) and POD ï€1: 101 g/L (range: 54.7–150.7). 186 (61.8%) patients were transfused with an average 1.42 red cell concentrate (range: 0–6). 89 (29.6%) had an infection diagnosis: 79 (26.2%) urinary tract infection (UTI), 7 (2.3%) pneumonia and 8 (2.7%) superficial wound. 18 (6%) died in the first month.

At univariant study of transfusion act, the transfused patients were older (p< 0.001), suffered more infections (p:0.019), more UTI (p:0.003), had lower Hb day 0 (p< 0.001) and POD ï€1(p< 0.001). When analyze the infection, the patients were older (p< 0.001), had higher ASA (p:0.019), lower Hb at day0 (p< 0.026), longer stay (p< 0.001), were more transfused (p:0.019), and received more transfusions (p:0.004). The logistic regression analysis identified only the type of HF, the age and the Hb level (p< 0.05) as independent predictors of transfusion.

Comments: In patients with HF the Hb is the most important predictor of blood transfusion, and it is associated with a higher rate of post surgical infection and longer hospital stays. These complications may be explained by the possible inmunomodulation effect of allogenic blood transfusion.

Radiodense structures resembling ossicles at the acetabular rim have received multiple names including “Os acetabuli, Os supertilii, Os marginale superius acetabuli, and Os coxae quartum”.

Various theories regarding their origin have been postulated. These structures commonly are observed in dysplastic hips and hips suffering from femoro-acetabular impingement and represent fractures of the acetabular rim. In our series we observed acetabular rim fragments in 4.9% of the dysplastic hips and in 6.4% of the hips with femoro-acetabular impingement.

Two different pathomechanics are responsible for the occurrence of these rim fragments. In dysplasia the short acetabular roof reduces the amount of available loading surface which leads to an overload on the lateral margin of the acetabulum, propagating the development of a fatigue fracture. However, as in all hips additional cysts were visible, it must be postulated, that cysts have to be present additionally and act as stress risers through which the rim bone eventually will fail. In hips with femoro-acetabular impingement the mode of failure is different. The relative anterior overcover in retroverted hips is subjected to stress during flexion of the hip, which is further increased by the frequent presence of an non-spheric extension of the femoral head as seen in cam impingement. The nonspheric femoral head-neck junction is jammed into the rim area. By repetitive traumatization the anterior rim eventually will fracture.

The clinical importance of acetabular rim fractures in the dysplastic hip is readily understood even by an unexperienced observer. However, it has to be considered as a sign that the hip has decompensated and it usually goes with significant articular cartilage damage. Because the radiographic appearance of the hip with femoro-acetabular impingement seems normal at first sight, the mechanism leading to anterior rim fracture may be overlooked. However, recognition and adequate treatment is important to prevent further degeneration of the hip.