Early self-rehabilitation in thoracolumbar fractures (a guide for patients).

The authors report the purposes and the contents of a guide entitled "Early self-rehabilitation in thoracolumbar fractures" currently used at the Division of Orthopaedics and Traumatology in the Macerata hospital, for patients affected with somatic "benign" fractures of the thoracolumbar passage (from T10 to L3). With elementary language and the support of simple images, several indications are given as to the anatomy and function of the column and its features, and the type of treatment used for fractures, so that the patient is aware of his or her lesion; the guide then becomes an actual manual for early and independent functional rehabilitation, capable of improving the physical and psychological state of the patient, in addition to favoring and accelerating healing. According to the authors, this study is useful in perfecting the relationship between physician and patient in the field of injuries of the vertebral column, which is often characterized by confusion and fear.

Intertrochanteric valgus osteotomy and sliding compression hip screw in fractures of the femoral neck.

Twenty-four patients ranging from 28 to 56 years of age with Garden grade III or IV fractures of the femoral neck are reviewed after treatment by intertrocherantic valgus osteotomy and Richards sliding compression hip screw. The rationale behind this treatment, the operative technique, and the choice of internal fixation device are all discussed. All patients were followed up after more than 2 years so that any late complications could be documented.

Immediate multiple osteosynthesis in polytrauma.

Thirty polytraumatized patients underwent immediate osteosynthesis of two or more long bone fractures for a total of 82 operations (plus an additional 14 for pelvis, hand, and foot fractures). Since 1983, according to the modern and rational concepts of "all at one time treatment", open fractures as well as associated closed lesions are stabilized immediately if the patient's general condition permits. This type of procedure requires adequate facilities as well as availability of and collaboration between teams of specialists, but it is inarguably advantageous for the patient (relief of pain, drastic reduction in the rate of embolism, improvement of respiratory and circulatory function, only one anesthesia), the surgeons (operation technically easier and shorter), and the ancillary medical personnel (easier nursing, rapid functional rehabilitation).

Antibiotic and antithromboembolic prophylaxis in prosthetic surgery of the knee.

The prevention of deep sepsis and venous thromboembolism in knee replacement surgery is of great importance for the final success of treatment. General rules of prevention must be followed when using antimicrobial drugs (environment, surgical method, patient selection). Although it does have some negative aspects (overuse, high costs, development of resistant bacteria) the administration of antibiotics is recommended, but only when it is timely, correct, and carried out for a suitable amount of time.

Internal and external fixation in complex diaphyseal and metaphyseal fractures of the humerus.

The treatment of diaphyseal and metaphyseal fractures of the humerus is often controversial, especially when these fractures are complex and/or unstable (i.e. comminuted, segmental, or with a butterfly fragment).

Retention of the posterior cruciate ligament in total knee arthroplasty.

The importance of the preservation of the posterior cruciate ligament in total knee arthroplasty is analyzed from a biomechanical, clinical, and functional standpoint. Using clinical and radiographic criteria, the authors assess posterior cruciate ligament validity in a selected group of 31 of 45 total knee arthroplasties (PCA prosthesis) reviewed at least 18 months after the operation. Sixty-eight percent of the replaced knees, which were divided into two groups on the basis of preoperative deformity, had a functional posterior cruciate ligament.

Cemented arthroprosthesis in femoral neck fractures.

Primary total hip replacement in femoral neck fractures is still controversial. This report presents the findings of a study of 42 femoral neck fractures treated with cemented arthroprosthesis with an average follow-up of five years. The patients were divided into two groups according to the type of prosthesis, the reaming and cementing techniques, and the type of operating room.

The locked Grosse-Kempf intramedullary nail in the treatment of diaphyseal and metaphyseal fractures of the femur and tibia.

The Gross-Kempf locked intramedullary nail widens the indications for the traditional Küntscher nail in the treatment of diaphyseal and metaphyseal fractures of the lower limbs. The study includes 87 patients with a total of 93 closed fractures treated between 1981 and 1987. Osteosynthesis was carried out in 85 closed fractures and in 8 Grade 1 or 2 open fractures.

Lumbosciatic pain due to sacral pathology.

Lesions of the sacrum are a possible, albeit infrequent, cause of low back pain and sciatica. The purpose of this paper is to draw attention to this possibility which, perhaps due to the rarity of sacral pathologies, is often overlooked in the investigation of lumbosciatic pain. This may influence the prognosis because of the consequent delay in diagnosis.

Prolapsed intervertebral disc at the upper lumbar level. Diagnostic difficulties. A report on 12 cases.

Prolapsed intervertebral disc at the upper lumbar level causes problems in diagnosis. Compressive root syndromes at L1-L2-L3 present clinical features which are not very specific. They are frequently pluriradicular and may be referred to areas of atypical distribution.

Chondrosarcoma of the bones of the hand.

The authors report two cases of phalangeal chondrosarcoma treated by carpometacarpal disarticulation of the affected finger. In both cases chondroma had been diagnosed histologically at previous operations consisting of curettage and homoplastic grafting. The cases subsequently came under our observation because of recurrences and an analysis of the clinical and radiographic course, together with a critical review of the previous histological preparation (in one case) led us to conclude that these neoplasms presented malignant features from the beginning and were not due to the sarcomatous degeneration of benign chondromas.

Vascular complications of detachment of the proximal tibial epiphysis. Report of 2 cases.

The authors describe two cases of proximal epiphyseal detachment of the tibia complicated by lesions of the popliteal artery. Following reduction and stabilization by Kirschner wires, vascular repair was done, in one case by the Fogarty method, and in the other by resection and substitution with a vein graft. The outcome was successful only in the second case.

Segmental shortening and equalization for leg length discrepancies in adults.

The authors report 8 cases of leg length discrepancy in young adults, treated surgically by shortening or equalization techniques. The ages ranged from 16 to 35 years and the discrepancy from 2.5 to 12 cm.

Slow healing fractures: can they be prevented? (Results of electrical stimulation in fibular osteotomies in rats and in diaphyseal fractures of the tibia in humans).

The purpose of the study was to evaluate the possibility of preventing delayed union in fractures by the use of low-frequency pulsing electromagnetic fields (PEMFs). The study was conducted in two parts, both with control groups. Fibular osteotomies in rats and diaphyseal fractures of the tibia in humans were treated with and without electrical stimulation (PEMF).

Carpal tunnel syndrome. Comparative study between normal and dialyzed patients.

The various theories of carpal tunnel syndrome (CTS) are reviewed. The clinical and other features are compared and the results of surgical decompression and neurolysis reported in two groups of patients; 65 operations in "classical" CTS and 11 operations in patients on renal dialysis ("dialytic CTS"). Relief of pain and recovery of normal sensation was achieved in a high percentage of cases in both groups.

Treatment of delayed union and pseudarthrosis by low frequency pulsing electromagnetic stimulation. Study of 35 cases.

This is a study of 35 cases of delayed union or established fibrous union ("pseudarthrosis") treated by pulsing electromagnetic stimulation. The treatment, applied up to 12 hours per day, can be carried out at home, with clinical and radiological control every 60 days. The average time of healing was 6 months.

[Proglumetacin: a flexible and broad-spectrum antirheumatic agent].

Fifty-five patients with osteoarthritis, rheumatoid arthritis or spondyloarthritis, joint pain and other rheumatic-inflammatory disorders were treated with proglumetacin, at different doses, during 3-60 days. Assessment of therapeutic efficacy indicated 88.9% of good results.