Use of tourniquet does not increase serum concentration of inflammatory mark-ers following total knee arthroplasty during the first 24 postoperative hours.

Background: The literature on the systemic inflammatory reaction following tourniquet-induced ischemia and reperfusion in elective orthopedic surgery is limited.

Methods: This prospective comparative study compared the levels of clinically relevant cytokines and peripheral blood counts and major complications in patients undergoing total knee arthroplasty (TKA) with or without a tourniquet during the first postoperative day. Forty-three patients undergoing primary TKA for degenerative osteoarthritis were divided into two groups; 21 patients were operated on using (TG group) and 22 (NTG group) without using a tourniquet.

Reconstruction of elbow flexion with a modified Oberlin procedure: A comparative study.

Introduction: In upper brachial plexus injuries (C5-C6-C7), selective nerve transfers appear as a favourable technique. For this purpose, transfer of an ulnar nerve fascicle to the biceps motor branch (Oberlin's procedure) is often used. In this paper we present our modified Oberlin technique, as well as a comparison of this method with the classic Oberlin procedure.

Biomaterial osseointegration enhancement with biophysical stimulation.

Despite the ongoing improvement in implant characteristics, bone intrinsic potential for regeneration may be stimulated with adjuvant therapies to standard surgical procedures, as it is important to achieve the best possible implant osseointegration into the adjacent bone and to ensure therefore long-term implant stability. For this purpose various pharmacological, biological or biophysical modalities have been developed, such as bone grafting materials, pharmacological agents, growth factors and bone morphogenetic proteins. Biophysical stimulation of osseointegration includes two non-invasive and safe methods that have been initially developed to enhance fracture healing: pulsed electromagnetic fields (PEMFs) and lowintensity ultrasounds (LIPUS), for which most studies confirm their beneficial effects.

The effectiveness of the external distal aiming device in intramedullary fixation of tibial shaft fractures.

Introduction: Intramedullary nailing has become a popular and effective procedure for the treatment of most fractures of the tibial diaphysis. However, distal interlocking screw placement under fluoroscopic control is responsible for the majority of the radiation exposure and a significant loss of surgical time in the entire nailing procedure. To limit fluoroscopy use, during distal interlocking screw placement, Orthofix has developed a distal targeting device which compensates for the inevitable deformation of the nail in the sagittal plane during its insertion.

Pediatric scaphoid nonunion.

Purpose: To report the outcome of pediatric scaphoid nonunions treated with a Herbert screw and bone graft.

Methods: This is a retrospective review of 12 cases of scaphoid nonunion in 12 skeletally immature patients treated with a uniform approach consisting of open reduction, iliac crest bone grafting and Herbert screw fixation. All patients were boys and presented with nonunions of the scaphoid waist.

Eight years' clinical experience with the Orthofix tibial nailing system in the treatment of tibial shaft fractures.

Intramedullary nailing has become a popular and effective procedure for the treatment of most tibial fractures. However, concerns regarding difficulties with reduction, the use and extent of intramedullary reaming, and hardware failure are probably the only constraints to its widespread use. In this prospective study, we present the clinical and radiographic results of the Orthofix tibial nailing system used in the treatment of tibial shaft fractures.

Management of nonunion with distraction osteogenesis.

Nonunions of long bone fractures represent a clinical entity that is commonly perpetuated by a high velocity injury. There are both bony and soft tissue factors responsible for the nonunion. This paper is focused on the reported clinical and radiographic outcomes whenever treatment protocols pertaining to distraction osteogenesis are implemented.

Isolated dislocation of the scaphoid.

Isolated dislocation of the carpal scaphoid is an extremely rare injury. The authors report herein a case of a 28-year-old man managed with open reduction and Kirschner wire fixation. The aim of this study is to comprehensively present this unusual injury along with its treatment and to attempt to merge the available experience in the literature in a suggested algorithm that will guide the surgeon confronted with this rare problem to treat it promptly and effectively.

Closed, locked intramedullary nailing of pediatric femoral shaft fractures through the tip of the greater trochanter.

Background: Closed femoral nailing is universally accepted as the treatment of choice in almost all diaphyseal femoral fractures in adults. Numerous authors reported favorable results applying the same surgical technique in the adolescent patient group. Nevertheless, reports of complications such as avascular necrosis and alteration of the proximal femoral anatomy have dampened the initial enthusiasm.

Bone scaffolds: the role of mechanical stability and instrumentation.

Osteoconductive bone scaffolds are increasingly used today for regeneration of bone defects. Research is mainly focused on the scaffold material, its macro and micro architecture and mechanical properties. The mechanical environment and the optimal instrumentation, used to protect and enhance bone regeneration, are multifactorial issues and have not yet received the appropriate attention by researchers in the field.

Flexible intramedullary nailing of pediatric unstable forearm fractures.

In the pediatric population, the majority of displaced 2-bone forearm fractures can be reduced and stabilized by conservative means. In this article, we report on a retrospective study of 23 patients with unstable or open forearm fractures treated with closed reduction and percutaneous stabilization with flexible titanium nails. All fractures healed without complication, and final functional results were excellent.

Percutaneous reaming of simple bone cysts in children followed by injection of demineralized bone matrix and autologous bone marrow.

The authors report the successful treatment of 19 patients (mean age 10 years) with active unicameral bone cysts using a combination of percutaneous reaming and injection of a mixture of demineralized bone matrix and autologous bone marrow. Follow-up ranged from 12 to 42 months (mean 28 months). All patients were asymptomatic at the latest follow-up.

Offset acetabular cups: A solution to wear?

Change of tribological properties has been the main goal in the effort to augment the longevity of total hip arthroplasty, while the reduction of forces acting across the artificial joint space has received little attention. Spurred by recent reports of wear behaviour and good clinical results of the offset low friction arthroplasty cups, the authors, using the simplified free body technique, estimated the resultant hip joint reaction force and the angle of its application on 100 individual anteroposterior pelvic radiographs, by templating on the same hip a conventional concentric cup and an offset eccentric one. The results showed a highly significant reduction (p<0.

Diagnosis and management of the osteonecrotic triad of the knee.

Generalized osteonecrosis of the knee may include, in addition to osteonecrosis of the medial femoral condyle that occurs most frequently, osteonecrosis of the patella or the tibial plateau. Such involvement is known as the osteonecrotic triad of the knee. Although the clinical picture of idiopathic osteonecrosis of the medial femoral condyle seems similar to several other disorders, certain distinct features, including its typical location,clinical symptoms, and late onset of cartilaginous erosion, facilitate differential diagnosis.

Closed reduction and percutaneous stabilization of pediatric T-condylar fractures of the humerus.

T-condylar fractures of the humerus are a rare fracture pattern in children. The usual recommendation is to treat them with open reduction and internal fixation, in accordance to the usual practice in adult fracture patterns. This involves extensive surgical approach to the elbow to allow anatomic reduction and placement of hardware for rigid fixation.

Distal locking of femoral nails under direct vision through a cortical window.

We present a salvage technique for distal femoral interlocking under direct vision through a window in the anterior femoral cortex in a subgroup of six patients, among those presented to our institution during the last 10 years with a femoral shaft fracture treated with reamed, locked intramedullary nailing. The common characteristic of these patients was the performance of distal locking under direct vision through a small window in the anterior femoral cortex because of intraoperative dysfunction of the image intensifier. Screw insertion was successful in all cases.

Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures.

We retrospectively reviewed 84 patients who underwent internal fixation of an intracapsular femoral neck fracture. The mean age was 58 years and the time from injury to operative treatment was 5.3 days.

Spontaneous interbody fusion after controlled injuries to the spine: an experimental study in rabbits.

To evaluate the rationale of spontaneous spine fusion after a spinal injury, the authors conducted an experimental study that consisted of three types of controlled injuries to a rabbit spine model. The first was injury to the intervertebral disk (type I injury). The second was injury of the intervertebral disk along with injury to one of the adjacent vertebral end plates (type II).

Internal fixation of hip osteotomy in children. Successful healing in 26 children without postoperative casting.

We assessed the necessity of postoperative casting when a plate was used for fixation of a proximal femoral varus osteotomy. 26 children without postoperative immobilization were compared to 17 children with a cast. No complications were encountered in either group of children and all osteotomies showed similar healing.

Treatment of tibial and femoral bone loss by distraction osteogenesis. Experience in 28 infected and 14 clean cases.

42 patients with diaphyseal bone defects (25 tibial and 17 femoral) who were treated by radical debridement and bone transport are reviewed. Their mean age was 35 (10-64) years and there were 29 men. 19 patients had active infections with drainage and 9 were previously infected.

Surgical treatment of 35 volar Barton fractures. No need for routine decompression of the median nerve.

35 patients with volar Barton fractures were treated operatively from 1985-1994. The injury was due to a high velocity motor vehicle accident in 20 patients. All fractures were closed without major carpal injuries.

The significance of rotation in fracture-separation of the articular pillar of a lower cervical vertebra. A clinical and cadaveric study.

We report 13 fracture-separations of an articular pillar at the lower cervical spine in 12 patients. There were 9 men and 3 women with a mean age at injury of 32 years, with involvement of C4, C5 and C6 vertebrae. Neurological symptoms were present in 9 patients, 2 were classified as ASIA A and 7 as ASIA D.

Results of surgical treatment of tibial plafond fractures.

To clarify which factors influence the final result of surgical management of plafond or pilon fractures, 66 patients with 67 pilon fractures treated at the Orthopaedic Department of the University of Athens between 1978 and 1993 were reviewed. There were eight (11.95%) Type I, 33 (49.

Old injuries of the lower cervical spine treated surgically.

The present study involves 16 surgically treated patients who had sustained an old injury of their lower cervical spine. This group represents the 29% of the 55 patients that were admitted in our Department with an old injury of the cervical spine. The aim of the present study is to see the effect of surgery on these old injuries in relation to clinical and radiological parameters.

Operative treatment of type C intra-articular fractures of the distal humerus: the role of stability achieved at surgery on final outcome.

We report the results of 75 patients with type C intra-articular fracture of the distal humerus treated operatively by two methods and followed up for a mean period of 48.2 months. Minimal osteosynthesis and joint immobilization was used in 21 cases while the remaining 54 patients were treated according to AO recommendations.