Although joint infection with severe destruction remains a serious problem and severe bone loss is relative contraindication of arthrodesis, knee arthrodesis is most commonly a salvage procedure. Its goals are to relieve pain and restore the patient to functional level of activity. The purpose of this study is to evaluate the results and complications of Ilizarov method for knee arthrodesis in the presence of infection. We retrospectively reviewed the records of twelve patients who had managed with knee arthrodesis with Ilizarov method. Indications for the operation included a infected skeletal defect secondary severe open trauma in four patients, an infection at the site of an arthroplasty in three (with failure of previous arthrodesis with monofixator in one), an infected charcot joint in four and one pyogenic arthritis spreading from osteomyelitis of proximal tibia. The average age of the patients at the time of operation was fifty-three years (range twenty-two to eighty years). Follow-up averaged 17 months. The minimum follow up periods was 9 months. Average duration of Ilizarov fixator application was 7.2 months. In 3 cases we performed corticotomy and internal bone transport to treat large bone defect (17cm, 8cm, 6.5cm). Autoiliac bone graft was done in fusion site in two cases, and in three cases we performed bone graft at the docking site. Solid osseous union occured in each patient. There was no reinfection and nonunion. Average shortening was 3.4 cm. Complications were related to pin tract. When last seen, all patients were free of pain and could walk without cruthes or cane. Despite its pin tract problems, bulky cumbersome and expensive apparatus, the Ilizarov method is one of effective method for knee arthrodesis in the presence of infection and large bone loss especially.
Arthritis ; Arthrodesis* ; Arthropathy, Neurogenic ; Arthroplasty ; Canes ; Follow-Up Studies ; Humans ; Ilizarov Technique* ; Joints ; Knee Joint* ; Knee* ; Osteomyelitis ; Retrospective Studies ; Tibia ; Transplants

No abstract available.
Animals ; Histamine* ; Hydroxyzine* ; Rats* ; Urinary Bladder*

The formation, maintenance, and regeneration of bone is a complex precess involving the interactions of many cellular elements with systemic and local regulators. TGF-β is one of growth factors that play an important role in the formation and remodeling of bone. In vitro studies have suggested that TGF-β regulates chondrogenesis and possibly osteogenesis by affecting replication, gene expression, and structural protein synthesis in bone formation. We investigated the effect of TGF-β1 upon fracture callus formation and maturation in mature rate. Closed femoral shaft fracture was made consistently by three point stress technique after percutaneous intramedullary nailing. TGF-β1 was injected subperiosteally at the fracture site daily for 2 weeks. We examined the effect of TGF-β1 on the fracture healing process with the radiographic, densitometric, histologic, and immunohistochemical methods. The following results were obtained. 1. Radiographic examination demonstrated that TGF-β1 injection group appeared to have more abundant callus formation and earlier callus maturation as compared to the control group. 2. Bone densitometric examination revealed that TGF-β1 injection group had higher bone mineral density and content that the control group. 3. Thermographic examination revealed that TGF-β1 injection group had higher local temperature at the injection area than the control group. 4. Histologic examination suggested that TGF-β1 stimulates and accelerates fracture callus formation and endochondral bone formation. 5. Immunohistochemical examination revealed that chondrocytes at the fracture site in the TGF-β1 injection group seemed to produce type I collagen.
Bone Density ; Bony Callus ; Chondrocytes ; Chondrogenesis ; Collagen Type I ; Fracture Fixation, Intramedullary ; Fracture Healing ; Gene Expression ; In Vitro Techniques ; Intercellular Signaling Peptides and Proteins ; Osteogenesis ; Regeneration

Osteopoikilosis is an asymptomatic osteosclerotic dysplasia, initially described by Albers-Schönberg and Ledoux-Lebard and associates. This disorder is described as extremely rare. Inherited and sporadic cases of osteopopikilosis have been reported. A Case of familial osteopoikilosis is presented with a brief review of literatures.
Osteopoikilosis

The clinical entity of Dysplasia Epiphyseal Multiplex was first descrihed by Fairbank in 1935, characterized by the disturbance of endochondral ossification in hoth epiphyseal centers and regions of physeal growth. It manifests itself radiologically as late appearance and mottling of the ossification centers and clinically as short stature, stubby digits and painful stiffness of multiple joints. It is typically transmitted as an autosomal dominant trait though recessive forms have been described. The spine is normal apart from a mild increased lumbar lordosis. Many patients are referred to an orthopaedic surgeon for bilateral Perthes disease, as was one of the authors cases. This Paper reports four cases of multiple epiphyseal dysplasia which affected one family.
Animals ; Hip ; Humans ; Joints ; Knee ; Legg-Calve-Perthes Disease ; Lordosis ; Osteochondrodysplasias* ; Spine

STUDY DESIGN: This case report presents a 50-year-old patient with tabetic Charcoal spinal arthropathy combined with spinal stenosis, and its management. OBJECTIVES: To present the case report and follow-up results of Charcoal arthropathy with spinal stenosis of the lumbosacral spine, which was treated by circumferential fusion with instrumentation and decompressive laminectomy. LITERATURE REVIEW: Most reports of Charcot spine mention the etiology, clinical characteristics, pathology, and management of the condition. Surgical management of Chariot spines with spinal stenosis are rare. There is no report of the two-stage procedure of circumferential fusion and decom-pression for Charcot spine with spinal stenosis. MATERIALS AND METHODS: The patient complained of back pain, radiating pain to both lower legs, and 100m neurologic claudication. Serologic testing was positive in VDRL and FTA-ABS tests. Surgical treat-nent consisted of anterior resection of the L5 body with an autogenous iliad bone graft. It was followed by a posterior wide laminectomy of L5 for spinal stenosis, and CD instrumentation with transpedicular screws was applied to L3-S1 with lateral bone graft. RESULTS: At 27 months follow-up, clinical symptoms of back pain and radiating pain were disappeared. The patient walked without claudication, and satisfied with her condition. Firm bony fusions from L3 to S1 were obtained. There was no evidence of further destruction or neural compromise in the 27 months following surgery. CONCLUSION: A case of Charcoal arthropathy of the lumbosacral spine with spinal stenosis of L3-5 and L5-S1 has been reported, and the pathology, clinical features, and management of this condition were discussed. Circumferential fusion for Charcot spine and wide decompressive laminectomy for spinal stenosis are advisable.
Back Pain ; Charcoal ; Fluorescent Treponemal Antibody-Absorption Test ; Follow-Up Studies ; Humans ; Laminectomy ; Leg ; Middle Aged ; Pathology ; Pathology, Clinical ; Serologic Tests ; Spinal Stenosis* ; Spine* ; Transplants

OBJECTIVE: The treatment of intraepithelial neoplasia and microinvasive cervical cancer ranges from local destruvtive methods to total hysterectomy. The conservative treatment has increased as more lesions are being detected in young women. METHODS: This study was designed to compare the 112 microinvasive cervical cancer treatment reliability, efficacy, and safety of cold knife conization (23), electric conizer (31), and largr loop (58). RESULTS: The mean age for cold cone, conizer, and LEEP were 41.1, 41.4, and 42.2 years old. The parity for cold cone, conizer and LEEP were 3.1, 2.1, and 2.7 siblings. Resection margine involved pathologic finding were 47.8%, 54.8%, and 74.1% (P<0.05). After hysterectomy, residual disease for cold cone, conizer and LEEP were 1, 24, and 30 cases CONCLUSION: The results suggest that LEEP is quicker, safer, and lower cost than cold knife conization for the management of cervical intraepithelial neoplasia and micro invasive cancer.
Cervical Intraepithelial Neoplasia ; Conization* ; Female ; Humans ; Hysterectomy ; Parity ; Siblings ; Uterine Cervical Neoplasms

Fabella impingement syndrome after total knee arthroplasty (TKA) is a rare condition. However, the location of the inserted prosthesis and the size of the fabella are considered major causative factors. Thus far, a conventional surgical excision of the impinged fabella is recommended treatment for the impingement. A 72-year-old woman was diagnosed with degenerative arthritis of the knee. She complained of fabella impingement due to an incompletely excised bony spur behind the posterolateral femoral prosthesis after TKA. The fabella and remaining bony spur were removed using an arthroscopic procedure. The impingement has not recurred and the range of motion (ROM) of the knee was improved after a 12 months follow-up. Arthroscopic surgery might be an alternative treatment for fabella impingement after TKA.
Aged ; Arthroplasty* ; Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Knee* ; Osteoarthritis ; Prostheses and Implants ; Range of Motion, Articular

We report a rare case of a 47-year-old male with posttraumatic phlegmasia cerulea dolens caused by a ruptured right external iliac vein and treated with an endovascular venous stent graft. The patient was the victim of motor vehicle accident, and suffered direct injuries to the head and abdomen. The patient had a cyanotic and swollen right lower leg. Abdominal and lower extremity computed tomography angiography revealed a large retroperitoneal hematoma caused by a ruptured right external iliac vein, and grade I liver injury. The right external iliac vein rupture was successfully treated with a venous stent graft, followed by inferior vena cava filtering, because a venous thrombus was identified below the stent graft. He initially was hemodynamically unstable but recovered following treatment. The patient was comatose when presenting at the emergency department. He was discharged, fully recovered, on hospital day 18.
Abdomen ; Angiography ; Blood Vessel Prosthesis ; Coma ; Emergency Service, Hospital ; Head ; Hematoma ; Humans ; Iliac Vein* ; Leg ; Liver ; Lower Extremity ; Male ; Middle Aged ; Motor Vehicles ; Rupture* ; Thrombosis ; Vena Cava, Inferior