Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1992
Intra-articular injections and articular cartilage metabolism. An experimental study in rabbits.
We studied the effects of repeated intra-articular injections of sterile 140 mM NaCl solution on articular cartilage in adult rabbits. After 20 injections into the knee joints over a period of 4 weeks, chondrocyte glucosaminoglycan synthesis was evenly reduced in all cartilage layers, accompanied by a significant proteoglycan depletion of the matrix which was most marked in the superficial half of the cartilage. ⋯ Our data underline the need for a clear-cut indication for intra-articular injections. The microtrauma caused by injection, in conjunction with the introduction of a carrier solution into the joint, may, at least when repeated at short intervals, lead to measurable damage to the articular cartilage.
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Arch Orthop Trauma Surg · Jan 1992
Fracture patterns in malignant osteopetrosis (Albers-Schönberg disease).
We report the occurrence and distribution of 17 fractures in four patients with malignant, autosomal recessive osteopetrosis. The frequency of the disease in the Caucasian population is in the order of 1 per 20,000, of which the vast majority suffer from a mild autosomal dominant form. ⋯ The traumata were all caused by common accidents, usually falls. Conservative treatment was successful, with normal healing time in the four cases presented.
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The cases of 80 patients with necrosis of the femoral head who underwent operative treatment in the period April 1980 to April 1988 are reported. Altogether, 102 operative procedures were carried out: 48 intertrochanteric osteotomies, 50 arthroplasties, 3 subchrondral bone graftings, and in one case drilling of the necrotic focus. Joint-preserving methods in advanced-stage disease seem to be of doubtful use when judged by clinical and socio-economic criteria over a mean follow-up time of 4.5 years. Since no conservative treatment exists, an improvement in therapeutic results can only be achieved by early diagnosis using magnetic resonance imaging and operating when the disease is still at an early stage.
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Arch Orthop Trauma Surg · Jan 1992
Aneurysmal bone cyst. A review of 52 primary and 16 secondary cases.
Authors report on the results of treatment of 52 primary and 16 secondary aneurysmal bone cysts (ABC). ABC grow rapidly; 84% of them have already destroyed more than the half of the bone width at recognition. En bloc resection is preferred when the ABC is growing superficially and eccentrically and more than half of the bone width is intact. ⋯ The 16 cases of secondary ABC were observed mostly in association with osteoblastomas, giant-cell tumors, and osteosarcomas. The incidence of the secondary ABC was 23% in the whole ABC group but not more than 2-4% among the osteosarcomas and giant-cell tumors. Secondary ABC may confuse the histological and clinical diagnoses and that, especially in cases of osteosarcoma, may have fatal consequences.
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Arch Orthop Trauma Surg · Jan 1992
No physiologic age-related increase of circulating somatomedin-C during early stage of Perthes' disease: a longitudinal study in 21 boys.
Perthes' disease was originally viewed as a local ischaemic necrosis of the femoral head. Several authors, however, have presented data suggesting that children with this disease also suffer from a general disorder of skeletal maturation. Hormonal changes in the hypothalamus-pituitary-growth plate axis have been discussed as a possible underlying cause and contradictory results reported on the role of the somatomedins in this process. ⋯ The physiologic increase with age of plasma Sm-C levels in the control group was either absent or diminished in children with early-stage Perthes' disease (P less than 10(-6), signs test). The Sm-C values in affected children were low. Our data correlate well with reports from others of retarded skeletal maturation in children with Perthes' disease and support the hypothesis of an accompanying disorder of the synthesis or release of Sm-C/IGF-I or its binding proteins.