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We present the case of a young man with 13 cm of bone and soft-tissue loss in the tibia and a severe traction injury of the brachial plexus. A free vascularised composite transfer of the bone and soft tissues of the ulnar side of the forearm was undertaken to reconstruct the defect. Bony union was achieved after a year and was followed by complete functional recovery of the lower limb.

In selected patients with localized malignant bone tumors, radical en bloc resection with adjuvant chemotherapy is now performed. Vascularized bone autografts can be used for secondary reconstruction of the bone defect. These grafts have the advantages of the nonvascularized ones, as well as the advantages of preserved viability. The fibula is usually the most suitable donor bone. Our surgical technique and the advantages and limitations of vascularized bone grafts are discussed.

The relative elongation with elbow flexion of the ulnar nerve, proximal and distal to the cubital tunnel, and of the cubital tunnel retinaculum, was measured in cadaver specimens by stereophotogrammetry. The proximal part of the ulnar nerve elongated significantly with full elbow flexion. No significant change of length was measured in the distal part of the nerve. The length of the cubital tunnel retinaculum increased by an average of 45% from full elbow extension to full flexion.

In selected patients with localized malignant bone tumors, radical en bloc resection with adjuvant chemotherapy is now performed. Vascularized bone autografts can be used for secondary reconstruction of the bone defect. These grafts have the advantages of the nonvascularized ones, as well as the advantages of preserved viability. The fibula is usually the most suitable donor bone. Our surgical technique and the advantages and limitations of vascularized bone grafts are discussed. Certaines tumeurs malignes osseuses sélectionnées avec attention relèvent de nos jours d'une résection radicale en bloc complétée par la chimiothérapie. Des autogreffes osseuses bien vascularisées peuvent être employées pour procéder à la reconstruction d'un segment de squelette réséqué. Ces greffes présentent outre les mêmes avantages que les greffes non vascularisées le fait que leur viabilité est conservée. Le péroné constitue le greffon osseux de choix. La technique chirurgicale suivie par les auteurs ainsi que les avantages et la limitation des indications des greffes osseuses vascularisées sont étudiées et discutées dans l'article. En pacientes seleccionados de tumores óseos malignos localizados se puede realizar la resección en bloque con quimioterapia adyuvante, y es posible utilizar autoinjertos vascularizados de hueso para la reconstrucción secundaria del defecto óseo. La técnica del autoinjerto óseo vascularizado ha sido desarrollada en un esfuerzo por evitar los problemas de la revascularización de los injertos óseos convencionales. Los injertos óseos vascularizados poseen las ventajas de los no vascularizados, y todas las ventajas de la conservación de su viabilidad. Los injertos vascularizados, siendo independientes de la vecina vascularidad del lecho recipiente, parecen tolerar bien la irradiación y son resistentes a la infección. El peroné es generalmente el hueso más adecuado para servir como donante. Debido al estado vascular de la extremidad, no siempre es posible utilizar un injerto óseo vascularizado para la reconstrucción. El papel primordial del cirujano debe ser el de resecar el tumor maligno con márgenes adecuados de tejido normal, tanto de tejidos blandos como de hueso. Este objetivo no debe verse comprometido por tratar de preservar vasos que puedan permitir la reconstrucción con un injerto óseo vascularizado. En este artículo se discuten los aspectos de nuestra técnica quirúrgica y las ventajas y limitaciones de los injertos óseos vascularizados.

The relative elongation with elbow flexion of the ulnar nerve, proximal and distal to the cubital tunnel, and of the cubital tunnel retinaculum, was measured in cadaver specimens by stereophotogrammetry. The proximal part of the ulnar nerve elongated significantly with full elbow flexion. No significant change of length was measured in the distal part of the nerve. The length of the cubital tunnel retinaculum increased by an average of 45% from full elbow extension to full flexion.

External minifixators were used in the treatment of 63 closed diaphyseal metacarpal bone fractures. A simple half-frame configuration was applied in all the cases. Open reduction was performed in 26. The mean duration of external fixation was 30 days. There were no cases of nonunion. Anatomical reduction was obtained in 86.6 of the cases. There were no cases of reflex sympathetic dystrophy. The general functional results were very good or good in 96.6. Open reduction did not significantly alter the final results. External minifixation is usually accepted as a treatment of open metacarpal fractures. Because of the excellent results obtained in our series, we believe that the indications of external minifixation could be enlarged to closed metacarpal bone fractures.

A 22-year-old patient with type I trichorinophalangeal Langer-Giedion syndrome presented a stage 2 osteonecrosis of the lunate associated with congenital shortening of the ulna and carpal tunnel syndrome. The patient was treated by shortening osteotomy of the radius and median nerve neurolysis, with an excellent result. This case provides an additional piece of evidence associating ulnar-minus variance with lunatomalacia, and another argument in favor of the theory that Kienbock's disease results from microfractures sustained by the lunate under an abnormal stress distribution situation.

This study compares in normal subjects the variability of wrist x-ray film measurements between the right and left sides with the variability of the distribution of those measurements within the population. Additional purposes were to evaluate possible differences of these measurements according to sex, age, side, and hand dominance. The variability when comparing both sides was found to be statistically less for the carpal height, radiolunate, scapholunate, and capitolunate angles than within the whole group of subjects, and for those measurements, there was a high correlation (r>.88) between the right and left sides. In addition, the carpal height and the carporadial ratios were lower and the capitolunate angle was higher in women than in men. There was also a significant decrease of the scapholunate angle in older individuals. The clinical implication of these findings is that in unilateral wrist diseases, the normal wrist should be used to provide the reference values of the carpal height and of the carpal angles on profile x-ray films. However, for the radial inclination and palmar tilt of the distal radius and for the ulnar variance, the normal side does not provide a better reference than normal values obtained from databases.

A new technique is presented for the treatment of comminuted intraarticular fractures of the base of the thumb metacarpal. A triangular Hoffmann external radius and first- and second-metacarpal fixator is used. The reduction is maintained by prolonged distraction and abduction of the first metacarpal bone. The application of the technique in three cases is reported.

Electron probe microanalysis is a recent technique for the study of bone and the conditions for the correct interpretation of the results are described. The Ca/P molar ratio was measured in normal and in three pathological bones. These measurements were carried out in different regions of cortical bone. The results are in agreement with the results obtained by microradiography. Microprobe analysis, however, allows the measurement of elements at the microscopic level.

In order to evaluate the extraosseous temperature variations during polymerization of acrylic cement being used in hip arthroplasty, measurements were taken on the anterior aspect of the upper part of the femur and also in the ipsilateral iliac vein. No variations were observed in the blood stream. On the external surface of the upper femur, the greatest variations were of the order of 3° C. The significance of these findings is discussed.