Search

We report our results obtained using Ludloff’s anteromedial approach in 17 patients affected by disorders other than congenital dislocation of the hip. These disorders were all localized on the anteromedial aspect of the hip joint and the proximal part of the femur (6 heterotopic ossifications, 3 osteoid osteomas, 2 osteochondromas, 1 aspecific coxofemoral synovitis, 1 chronic epiphysiolysis of the hip, 3 fractures of the femoral head, and 1 malignant fibrous histiocytoma). The treated group comprised 10 males and 7 females with a mean age of 33 years (range, 11–72 years). The anteromedial approach allowed for complete or almost complete removal of the pathological masses, withdrawal of synovial tissue for biopsy purposes, the reduction and fixation of femoral head fractures and even a corrective femoral neck osteotomy. The suitability of this treatment for skeletal disorders has been confirmed by clinical and radiographic controls carried out after a mean period of 7 years (range, 2–10 years).

On the basis of the observation of a rare case of lipomatous macrodactyly of the foot associated with syndactyly in a young child, the authors analyze the anatomopathologic and therapeutic aspects of the pathology and report the data found in the literature. This disease initially requires careful surveillance of its progression, and use of correct footwear. Surgery is indicated when deformity achieves unacceptable values, both functional and cosmetic, in early childhood.

Ruptures of the long head of the biceps brachii are mostly of degenerative nature, secondary to subacromial impingement and morphological changes in the bicipital groove. Clinical findings are typical. Treatment is controversial, as it may either be surgical or non-surgical. The authors considered only those cases in which tendinous rupture was the first manifestation of pathology caused by wearing, with typical deformity of the profile of the arm. The favorable results of surgical treatment in 14 patients aged from 38 to 70 years, followed-up after an average of 10.9 years, are reported. Among surgical methods used, tenodesis at the bicipital groove currently constitutes the method of choice.

After reporting the most significant data in the literature, the authors present 5 cases of vascular leiomyoma of the limbs (1 in the upper limb, 4 in the lower limb) in subjects of both sexes. In all of the patients, diagnosis was only possible thanks to histological examination, confirmed by an immunohistochemical examination. In none of the cases was there recurrence of neoplasm after surgical exeresis.

The tolerability and safety of hyaluronan-based three-dimensional scaffolds as a culture vehicle for mesenchymal progenitor cells was investigated in this pilot study. The proliferation patterns and extracellular matrix production of rabbit and human mesenchymal, bone-marrow-derived progenitors first were characterized in vitro. Subsequently rabbit autologous cells were cultured in this hyaluronan-based scaffold and implanted in a full-thickness osteochondral lesion. In vitro histologic findings showed that mesenchymal progenitor cells adhered and proliferated onto the hyaluronan-derived scaffold. Human stem cells were shown to produce the main extracellular matrix molecules, accompanied by an occasional synthesis of mature type II collagen. In vivo data demonstrated that the biomaterial, with or without mesenchymal progenitors, did not elicit any inflammatory response and was completely degraded within 4 months after implantation. With regard to the efficacy of this cell therapy, even among the small number of animals tested there was histologic evidence that lesions filled with the biomaterial, either seeded or unseeded with cells, achieved a faster and better healing compared to empty controls. The present data suggest that the hyaluronan-based scaffolds are well tolerated and safe and may be a valuable delivery vehicle for tissue engineering in the repair of articular cartilage defects.

Compression of the inferior vena cava by bony excrescences on the lumbar spine has not been previously reported as a complication of diffuse idiopathic skeletal hyperostosis. We report a phlebography-proven case in a 67-year-old man.

Transient algodystrophy of the hip in pregnancy is a relatively rare condition, still unknown to many and easily overlooked. Diagnosis is important because of the related difficulties in natural delivery and the risk of fracture. Four unilateral cases are presented (two right and two left), characterised by pain, limping, limitation of the hip motion and demineralisation of the head and neck of the femur. Treatment was by rest and protected weight-bearing. Three were delivered by caesarean section. In one patient a fracture of the neck of the femur occurred a few weeks before delivery, requiring surgery. In all four cases the outcome was benign. Like algodystrophy occurring in adults of either sex the aetiology is unknown. In pregnant women the association with the right occiput anterior position of the fetus (documented in one patient where the affected hip was the right) suggests the possible involvement of one of the autonomic pelvic plexuses (right or left) in the unilateral cases.

A retrospective study was done on five adult patients in whom burst fractures of the low thoracic and lumbar spine were associated with intracanalar displacement of a large bony fragment. In one case two vertebrae were involved. Three of these patients presented with neurologic damage of different degrees. All but one underwent operative posterior stabilization by Harrington rods and bone autografts. Although no surgical decompression was performed, they showed gradual neurologic recovery at the follow-up, which is still incomplete in only one, initially paraplegic patient. In comparing the initial computed tomography scans of the five patients with those taken 1 1/2-5 years later at the same level, it was found that a process of total or subtotal resorption of the retropulsed fragment had occurred in all patients, with spontaneous remodeling of the spinal canal. These findings agree with the recent reports of other authors and provide the orthopedic surgeon with a new argument in favor of the possible conservative treatment of these severe, potentially unstable fractures. In most of the cases, and especially in those without neurological compromise, surgical reduction or surgical removal of the intraspinal fragment is not necessary. We believe that loss of mechanical loading and rhythmic respiratory oscillations in cerebrospinal fluid pressure are both important factors in the mechanism of bone resorption.

On the basis of previous EMG data, a retrospective study was carried out on the CT and MR features of the paravertebral musculature after lumbar spine surgery through the posterior approach. The authors reviewed the CT scans and some MR images of 35 symptomatic patients hospitalized 7 months to 42 years after operation for disc herniation. Changes in the paraspinal musculature were apparent in all of them on the surgical side. The changes were minimal or very slight in 14 patients, moderate in 13 and severe in 8. A close correlation was observed between the above changes and the surgical procedure used in every single case. Histology showed atrophy and degeneration of the muscle fibres and fibrofatty substitution. The possible responsible causes of damage to the postvertebral muscles during spinal surgery are briefly mentioned and practical implications discussed.

Three-dimensional CT was used to examine the atlantoaxial joint of a nine-year-old girl who presented with fixed rotation of the head 3.5 months after an apparently spontaneous acute torticollis. The method provided clear, anatomical images to show the site, extent and direction of the type-I rotatory fixation (Fielding and Hawkins 1977). The 3-D reconstructions helped to guide manipulation which was successful in this late case.

Lumbar disc herniation has been observed by the author in many members of a large family, with the maximum incidence in males of the third generation, where 8 siblings were similarly affected and 6 underwent operation, mostly in their third decade of life. A number of patients in the same family suffered from chronic low back pain. In the majority of cases environmental factors apparently do not seem to play a significant role in the development of the disease. The author believes that a genetic predisposition to early disc degeneration can be invoked to explain so large an aggregation of patients suffering from lumbar disc disorders.

The authors report their experience in conservative management of idiopathic scoliosis treated in the last 10 years with the Risser localizer cast method. The conclusion is that this method, alone or in combination with braces, is still a particularly effective therapeutic means in the correction of both angular deviation and rotation, provided that a rigid protocol is followed.

The hypothesis that side-to-side migration of an extruded lumbar disc herniation can be blocked or restrained by the presence of the ventral meningovertebral ligaments has been verified by the author by using the presently available methods of imaging of the spinal canal in vivo. The images obtained at levels L4-L5 and L5-S1 from nine patients showing this type of pathology and preoperatively assessed by transverse CT (eight patients) or MRI (one patient) seem to support the above assumption. These ligaments should not be confused with pathologic adhesions.

Among the minor soft structures of the lumbosacral spinal canal that computed tomography can visualize, the meningovertebral ligaments have been neglected. There are no specific reports on this subject, and the only knowledge we have comes from very ancient and nearly forgotten anatomical works. From our studies on cadaveric specimens, it has been confirmed that the ligaments consist segmentally of ventral and lateral fibrous bands, connecting the outer surface of the dura to the endostium of the spinal canal. The most characteristic component is the ventral one, running from the anterior wall of the dural sac to the posterior longitudinal ligament and vertebral endostium. Due to their anchoring function, the ligaments are significantly developed at the level of the dural conus (sacrodural ligaments of Trolard and Hofmann). On in vivo computed tomography studies, the ligament image appears most commonly on transverse scanograms of the lumbosacral segments as a median sagittal septum, easily identifiable when the extradural fat that it crosses is abundant. The meningovertebral ligaments may be implicated in pathological conditions of the spinal canal. They can calcify singly, though very rarely, and this process must be differentiated from degenerative marginal spurs, calcific disc herniation, circumscribed calcification of the posterior longitudinal ligament, or partial diplomyelia.

Starting from about the 40th year of life the lumbar spinous processes of man undergo morphological changes, which mainly affect their posterior edges. These changes consist of asymptomatic osseous appositions or spurs radiologically visible in the lateral view, with a major incidence in the elderly. Spondyloarthritis is a constant accompanying finding. Histologically the condition corresponds' to a process of substitution by Haversian bone of a layer of calcified fibrocartilage, which constantly occupies the ligamentous and tendinous attachments for a variable distance. While in the young adult fibrocartilaginous metaplasia is limited to the bony attachments of the spinous ligaments, in the elderly it spreads to the greater part or to all of their thickness. The author believes that such a phenomenon is due to a reduced flexibility of the vertebral column as a whole and to exaggerated lumbar lordosis with ageing. The elongation of the lumbar spinous processes secondary to osseous appositions increases the posterior arm of the lever and favours the "extensores spinae" m.

Independently of the local and general physiopathological factors that influence the repair of skin and bone, there seems to be marked parallelism in the same subject between hyperplastic scars, exuberant callus formation, and heterotopic ossification. The writer describes his findings in a series of personal cases. Arising out of these observations, he discusses the probable pathogenesis of this parallelism of behaviour, and its practical implications. Subjects in whom hyperplastic scars are produced are constitutionally more predisposed to form rapid and exuberant callus, or heterotopic ossification, than normal subjects.

Observation and histological study of a typical case of elastofibroma situated juxtascapularly, in a young man of 20, provides the Authors with an opportunity to review the as yet still sparse information on the nature and histogenesis of this relatively rare neoplasia benign, tumoral or, more probably pseudotumoral. Italian orthopaedic literature has nothing to say on the subject. Elastofibroma deserves to be better known both by Anatomists, Pathologists and Surgeons, so that we can be sure to distinguish it from other pathological disorders.

The results are presented of experience in early surgical treatment of congenital dislocation of the hip, using the anteromedial approach described by Ludloff. Surgery was performed in 20 hips of 18 children, aged between 3 and 23 months, in whom conservative treatment had failed. Eleven cases were followed up for five to seven years after surgery. In 50% of the hips, additional surgery was required to correct deformities of the femoral neck or of the acetabulum. Early open reduction with the Ludloff procedure has many advantages over more traditional treatment.

Obesity represents an accelerating factor in the development of osteoarthritis, mainly of the lumbar spine and knees. Overweight patients undergo, earlier than normal people, to painful syndromes which usually affect the elder. The mechansims through which joint degeneration gradually develops are analized; special reference is made to the rôle of mechanical and postural stresses. Some considerations are made about orthopaedic treatment in obesity and about orthopaedic surgery in selected cases.

Background. Joint hypermobility (JH) is frequently seen in rheumatology; in some cases, such as rheumatoid arthritis (RA), it may represent a worsening of disease evolution. The aim of our study was to evaluate the influence of joint hypermobility on RA synovial fluid (SF) inflammation. Patients and methods. One hundred consecutive adult patients with RA and joint effusion of the knee were examined for the presence of JH. In the SF we evaluated volume, the number of white blood cells (WBC) and the levels of interleukin (IL)-1β, IL-6 and IL-8 and prostaglandin E 2 (PGE 2 ). Results. JH was associated with RA (JH-RA) in 18 patients, all of whom were female. Compared with non-JH RA, all the SF indices found in JH-RA were higher, although significant differences were observed only for volume, IL-8 and PGE 2 . Conclusion. In JH-RA, increased joint mobility seems to be associated with a more severe local inflammatory response, which may contribute to the more erosive evolution observed in our patients.