The aim of this study is the presentation of the midterm results of the radial head replacement with pyrocarbon head prosthesis (MoPyc).

Thirty two patients (20 males and 12 females) with a mean age of 54 y.o. (32–68 y.o.) were subjected to replacement of the radial head with a pyrocarbon head prosthesis. Twenty of them had a comminuted radial head fracture(15 Mason IV type and 5 Mason III), two had a malunion and ten had a complex elbow injury (ligamentous rupture and comminuted radial head fracture with/without coronoid process fracture). In 22 patients the fracture was on the dominant side. The mean follow up time was 27 months (21 – 46 months).

The post-operative results were:

The mean range of motion in flexion-extension was 130° (105° to 150°), while in pronation and supination was 74° (60°–80°).

Pain was evaluated with a visual analogue scale. Finally there was also a radiographic evaluation of the patients (that yielded six cases of loosening or osteolysis without any clinical manifestation)

Replacement of the radial head with the specific prosthesis leads to very satisfactory results when performed under specific indications.

The use of polymethylmethacrylate (PMMA) bone cement loaded with antibiotics has become increasingly common in orthopaedic surgery. However, bacterial resistance in antibiotics is an increasing and emerging problem. PMMA bone cements containing different antibiotics, such as gentamicin plus vancomycin may be effective in prevention and treatment of infections (particularly from MRSA and MRSE).

The purpose of this study was to determine the in vitro elution characteristics of gentamicin and vancomycin when combined in acrylic cement.

Three groups of ten cement disks were prepared. Group I (control group) contained 0.5g of gentamicin per 40-g packet of Palacos-R+G powder. Group II contained 0.5g of gentamicin and 1g of powdered vancomycin and group III contained 0.5g of gentamicin and aqueous solution of vancomycin. Each cement disc (25mm x 20mm) was immersed in a 50-mL bath of normal saline at 37oC. Samples were taken at specific sampling intervals (1, 3, 7, 15, 30, 60, 90, 120, 150, 180 days). Antibiotic concentrations were measured using fluorescence polarisation immunoassay.

With regards to gentamicin release, high but rapidly decreasing antibiotic levels were detected within the first week and low concentration after the first month. Samples from Group II eluted significantly more gentamicin (120%–20% during the first month). The influence on the gentamicin release was significant but minor when aqueous solution of vancomycin (Group III) was added. With regards to vancomycin release, high antibiotic levels were detected within the first 3 days and low concentrations after the first week. Cement samples from Group II eluted significantly more antibiotic in comparison with samples from Group III.

Bone cements loaded with combinations of gentamicin and vancomycin are more effective in releasing gentamicin than bone cements with gentamicin as a single drug. Powdered vancomycin in cement samples has better elution characteristics in comparison with aqueous solution of vancomycin.

Introduction. This prospective cohort study aimed at the assessment of the incidence of indolent SH among otherwise ‘healthy’ and symptoms’ free postmenopausal women suffering from primary KOA.

Methods. During a period of 23 months (November 2004 – Sepetember 2006), two hundred and forty-two postmenopausal women suffering from primary KOA were enrolled. None of them had suffered any osteoporotic fracture, received any anti-osteoporosis treatment or suffered from any disease interfering with their bone mass/quality. The serum levels of Intact-Parathyroid Hormone (I-PTH), Calcium and Phosphorus were evaluated and Creatinine Clearance was calculated. The latter was performed in order to determine a possible relation between the patients’ renal function and the I-PTH level.

Results. The patients’ mean age was 70,20 years (range: 49–81). The years that had passed since their menopause ranged from 7 to 31 (mean of 18,7 years). The patients were divided into three groups according to their age: Group A (n=41) age < 64 years, Group B (n=140) age 65–74 years and Group C (n=61) age > 75. The overall incidence of SY in all three groups was 35,95% (87 out of 242 patients). Group C patients were most likely to suffer from SY (25 out of 61 patients or 40,98%). The I-PTH values of Group A patients were normal in 27 out of 41 patients (68,85%) and of Group B in 92 out of 140 patients (65,71%). One group B patient suffered from Primary Hyperparathyroidism. No statistically significant relation between the patient’s renal function and the I-PTH level was found.

Discussion/Conclusion. SH appears to be a ‘silent’ epidemic among elderly postmenopausal women. According to our results, women 75 years-old and older are most likely to suffer from SY. One of the main reasons for that seems to be the insufficient calcium and/or vitamin D intake. It is our belief that anti-osteoporosis diagnosis and treatment modalities should be focused on this group of patients.

Introduction: The use of polymethylmethacrylate (PMMA) bone cement loaded with antibiotics has become increasingly common in the treatment of infected knee and hip arthroplasties and also as prophylaxis in primary joint replacement. However bacterial resistance in antibiotics is an increasing and emerging problem. PMMA bone cements containing different antibiotics, such as gentamicin plus vancomycin may be effective in prevention and treatment of infections (particularly from MRSA and MRSE). The purpose of this study was to determine the in vitro elution characteristics of gentamicin and van-comycin when combined in acrylic cement.

Material and methods: Three groups of six cement disks were prepared. Group I (control group) contained 0.5g of gentamicin sulphate per 40-g packet of Palacos-R+G powder. Group II contained 0.5g of gentamicin sulphate and 1g of finely powdered vancomycin and Group III contained 0.5g of gentamicin sulphate and aqueous solution of vancomycin (containing 2mL water for injection and 1g vancomycin). All discs were prepared using vacuum mixing technique. Each cement disc (25mm diameter × 20mm thick) was fully immersed in a 50-mL bath of normal saline at 37o C temperature in a covered beaker. At specific sampling intervals (1, 3, 7, 15, 30, 60, 90, 120, 150, 180 days) the discs were removed and placed in fresh 50 ml bath for 24 hours. Then a 2 mL sample of each solution was taken. Samples were frozen at −60° C until they were analyzed. Gentamicin and vancomycin concentrations were measured using fluorescence polarization immunoassay.

Results: With regards to gentamicin release, high but rapidly decreasing antibiotic levels were detected within the first week, resulting in an almost steadily low concentration by the end of the first month. Cement samples eluted significantly more gentamicin (120%-20% during the first month) when powdered vancomycin (Group II) was added. The influence on the gentamicin release was significant but minor when aqueous solution of vancomycin (Group III) was added (40%-20% during the same period).

With regards to vancomycin release, high antibiotic levels were detected within the first 3 days and low concentrations after the first week. Cement samples from Group II eluted significantly more antibiotic (80%–100%) in comparison with samples from Group III during the first days.

Gentamicin and vancomycin are detectable in measurements at 150 and 180 days samples.

Conclusions: Bone cements loaded with combinations of gentamicin and vancomycin are more effective in releasing gentamicin than bone cements with gentamicin as a single drug. The presence of powdered vancomycin in cement samples has major influence on the total gen-tamicin release in comparison with cements containing aqueous solution of vancomycin.

Introduction: When possible direct repair of the chronic distal biceps tendon ruptures is recommended because the results of chronic repairs with grafts have traditionally not been as successful. Some key surgical tips will allow successful direct repair as it is noted in our series.

Material and Methods: Sixteen males with a chronic (6–14 weeks post injury) distal biceps rupture were repaired with the one-incision technique and 2 suture anchors. Average follow-up was 38 (range, 23–48) months. Involved arm was the dominant in 14 patients. The patients were assessed with the DASH questionnaire, goniometric range of motion and isokinetic strength testing of elbow flexion and supination. The position of the suture anchors was also evaluated radiographically. Surgical tips: 1) release adhesions between biceps and brachiallis, 2) release the bicipital aponeurosis, 3) “tease” the retracted tendon out of scar, 4) release the superficial biceps fascia and place relaxing incisions in the epimysium, 5) apply a surgical clamp to the end of the tendon and pull distally for 10–20 minutes. Note that the lateral antebrachial cutaneous nerve is frequently entrapped in scar and requires neurolysis.

Results: All patients regained almost normal flexion and supination strength, with a deficit of 12% and 15% respectively, compared with the uninvolved arm. Six patients had an average loss of extension of 120 (range, 50–180). According to the DASH test all patients had an excellent/good result (12 excellent, 4 good). X-rays revealed unchanged position of the anchors. No complications were noted.

Discussion-Conclusions: The use of flexor carpiradialis and of fascia lata that was used in several studies for repair of chronic distal biceps tendon ruptures has given controversial results mainly due to enlongation and inferior strength of the graft. Based on our results we believe that chronic (6–14 weeks post injury) distal biceps tendon ruptures can be successfully repaired through an anterior approach with direct repair and the use of suture anchors, avoiding the use of a graft.

Introduction: Currently the standard of care is to repair distal biceps tendon ruptures, particularly in active individuals. Although several studies have reported short-term good results with the one-incision technique none has report long-term results.

Material and Methods: Thirty- four male with distal biceps rupture were treated with an average follow-up of 5 (range,2–9) years. Involved arm was dominant in 28 patients. 22 ruptures were repaired acutely (less than 6 weeks from injury) and 12 had a late repair. The patients were assessed with the DASH questionnaire, goniometric range of motion and isokinetic strength testing of elbow flexion and supination. The position of the suture anchors was also evaluated radiographically.

Results: Patients with acute repair (82%) regained excellent flexion and supination strength, 108% and 99% respectively, compared with the uninvolved (usually nondominant) arm. Patients (18%) with chronic rupture repair had a slight deficit of supination (15%) and flexion (13%) strength. An average of 120 (range, 00–180) lack of extension was noted in the chronic tears while flexion/extension arc of the acute repairs was normal. With the exception of 4(12%) patients who returned to lighter work activities all patients return to their previous occupation. According to the DASH test all patients had an excellent/good result (28 excellent 6 good). X-rays revealed unchanged position of the anchors. No complications were noted.

Discussion-Conclusions: As in short-term results, long-term results of distal biceps tendon repair with the one-incision technique have an excellent result with no clinical or radiographic sign of suture anchors repair insufficiency.

Introduction: The objective of this study was to evaluate the structural properties of the native IOL and three different constructs for IOL reconstruction.

Methods: 24 fresh-frozen (FF) forearms, 6 FF Achilles (ACH) allografts, and 6 FF bone-patellar tendon-bone (BPTB) allografts were used. N=6 FCR, ACH, and BPTB reconstructions were performed at the angle of the native IOL. For the FCR and ACH constructs, 5 mm tunnels were drilled across the radius and ulna, the graft ends were sutured with a baseball stitch (#2 braided polyester), passed, cyclically pretensioned, and tied to suture posts under maximal manual tension. For the BPTB construct, troughs were created in the dorsal radius and ulna, and the bone blocks were secured in the troughs under maximal manual tension using 3.5 mm cortical lag screws.N=8 native IOL’s and N=6 each of the reconstruction constructs were resected from the forearms attached to 6 cm segments of radius and ulna.Specimens were potted and mounted on an Instron using custom clamps.

One-way ANOVA was used to compare results with p=0.05.

Results: The intact IOL was significantly 7–8 times stiffer than FCR/ACH and 3 times stiffer than BPTB constructs. Strength of the intact IOL was 3 to 4 times higher than FCR, ACH and BPTB constructs. No significant differences were detected between any properties of FCR and ACH grafts. BPTB displayed significantly greater structural properties compared to ACH and FCR.The load-elongation curves for the intact IOL displayed toe and linear regions, and abrupt failure typical for ligaments.

Discussion-conclusions:The graft constructs were structurally inferior to the native IOL. Achilles and FCR grafts were similar biomechanically, while BPTB displayed slightly higher properties. The BPTB reconstruction applied dorsally was observed to tighten in pronation, and become slack in supination, likely because these were dorsal to the interosseous ridge. It is important to note that all properties would be influenced by healing and remodeling in living subjects.

ACH and FCR reconstruction constructs were similar, but inferior to the intact IOL. BPTB was slack in supination. What remains unknown is how stiff an IOL reconstruction should be to provide a beneficial effect on forearm biomechanics. IOL reconstruction remains an experimental procedure.

Massive rotator cuff tears associated with glenohumeral arthritis are currently an unsolvable clinical entity. This study strictly defines the use of bipolar hemiarthroptasty for the entity of RCTA.

Materials – Methods: We review our series of 14 patients with Rotator Cuff Tear Arthropathy (RCTA) who underwent a bipolar prosthesis of their shoulder. The average follow up was 27.8 months (range 24–48 months) and the average age was 71 years old (range 57–84 years old), of these 14 patients there were 9 male and 5 female. None of these patients had previous shoulder surgery and all patients underwent conservative treatment that failed to improve their symptoms or range of motion

Results: Preoperatively the average forward flexion was 300, external rotation 100 and the American Shoulder and Elbow Society (ASES) score was 25 points. Postoperativety the average forward flexion improved to 880, external rotation increased to 370 and the ASES score improved to 80 pts, 12 of the 14 patients stated that they had no pain with activities of daily living. Two patients persisted to have moderate pain in everyday activity.

Conclusion: We believe that bipolar hemiarthroplasty is currently a good option for treatment of Rotator Cuff Tear Arthropathy, The results of bipolar hemiarthroplasty provided more reliable pain relief than that for hemiarthroplasty.

Proximal Row Carpectomy (PRO has been used as an alternative treatment for advanced radiocarpal arthrosis and carpal collapse. Its use has been recommended for Kienbock’s disease, chronic scaphoid nonunion and scapholunate advanced collapse (SLAC) deformity.

Materials – Methods: Twenty-three patients were divided into two groups: group 1, consisting of patients with Kienbock’s disease (10 patients), and group 2, consisting of patients with scapholunate advanced collapse (13 patients). The average age was 51 years (range 27–69) for group 1, and 45 years (range 29–57) for group 2. The average follow-up was 30 months for Kienbock’s disease (range, 23–49 months) and 31 months for SLAC deformity of the wrist (range, 24–51 months). Pre-operative staging was performed on all patients utilizing Lichtmann’s (Lichtmann and Degnan, 1993) classification for Kienbock’s disease and Watson’s (Watson and Ballet, 1984) classification for scapholunate advanced collapse.

The procedure was performed as described by Jorgansen (1969) utilizing a dorsal midline approach between the third and fourth dorsal compartments. Styloidectomy, preserving the radiocapitate ligament was performed in 7 out of the 23 patients (5 Kienbock’s and 2 SLAC wrist’s patients). Posterior Interosseous Nerve neurectomy was performed in 2 out of the 10 patients with Kienbock’s disease. Results: Statistically significant differences were noted between the Kienbock’s disease group and the SLAC wrist group (p=0.0023). Of the patients who underwent PRC for Kienbock’s disease 9 of 10 patients reported moderate to severe pain at the final follow-up visits. In the scapholunate advanced collapse group, 2 out of 13 patients demonstrated moderate or severe pain. It was noted that the patients in the SLAC wrist group lost less motion overall than those in the Kienbock’s dis ease group (p=0.00l 5). It was noted in the Kienbock’s disease group that at final follow-up the operated hand was weaker than preoperative (p=0.022). In the scapholunate advanced collapse group there was improvement of postoperative grip strength.

Conclusion: We currently recommend the use of wrist arthroscopy as an adjunct to determine the status of the lunate articular surface in Kienbock’s disease, before performing a proximal row carpectomy. Our results indicate that despite only minor chondromalacia of the capitate articular surface and lunate facet of the radius, the use of PRC in Kienbock’s has not been rewarding.