La Clinica ortopedica最新文献

Bone metastases are the most frequently occurring tumours of the skeletal system. Clinically, diagnosis is important but more so the treatment, taking into account the type of lesion, its localization and diffusion. Early and combined treatment by general surgeon, radiotherapist and orthopaedic surgeon will provide a longer survival rate and relative physical and psychological well-being for the patient. Following the diffusion on surgical techniques designed to cope with tumor in different bones the wait-and-see attitude of the past has been abandoned. More vigorous attempts to excise metastatic tumours and aims at reconstruction and substitution of weightbearing bones by means of modern methods of osteosynthesis and application of prostheses, can be achieved. The more controversial clinical and radiological aspects and the results of 281 cases, seen at the Clinica Ortopedica of the University of Padua, are illustrated.

After simple premises on scoliosis and on physiotherapy, we design the evolution of the illness in: physiotherapic, orthopaedic and surgical scoliosis, connected with the therapeutic moment. Then we underline the necessity of surgical scoliosis to sustain it adequately with a careful physiotherapic treatment either for the preparation to the operation or in the stage following the operation.

Results of 35 cases of subcondylar tibial osteotomy performed for static osteo-arthritis of the knee from 1072-75 are reported. The surgical procedure consists of an oblique osteotomy followed by the removal of a wedge of bone with an internal or external base depending on the presence of "genu valgum" or "genu varum" respectively. Bone ends are united by screws. Major advantages of this operation are solid bony union of the osteotomy sections by screws and simplicity of execution.

Fifty-eight cases of solitary bone cyst are reported. Clinical and radiological features and the results of surgical treatment are discussed. In the evolution of bone cysts and in particular those of the humerus two forms of the disease can occur; that of the metaphysis and that of the diaphysis with pecliar features and indications for treatment. Permanent repair of a cyst is possible only after internal reconstruction of the involved segment.

The ultra-structural appearance of osteoid osteoma is described. Significant features are; a well-developed endocytoplasmic reticulum, dilated cisterns in the cytoplasm of the osteroblasts, mineralized mitochondria from the cytoplasm of the osteoblasts and crystalline agglomerates on the vesicles rather than on the collagen network. The increased bone forming activity of the tissues of the osteoid osteoma is confirmed by the appearance of the osteoblastic cytoplasm. The presence of needle-like endomitochondrial crystals are further proof of enhanced osteoblastic function of the osteoid osteoma. Granular crystals appear when degenerative processes take place.

The AA, report one case of Volkmann's contracture in a patient 8-1/2 years old treated by shortening of the ulna and radius according to Colzi's procedure. The reasons why such method was chosen are explained and the excellent result obtained described. In the light of their experience the AA. deem that the Colzi's procedure is still valid, also on the account that does not preclude the possibility to perform other procedure.

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.

A hundred and thirty-five cases of fracture of the acetabulum seen from 1964 to date are analysed. Thirty-four were treated conservatively, a hundred-and-one by surgery. A clinical assessment of the cases treated was carried out. The different types of fracture (of the anterior column, of the posterior column, of the posterior wall and transverse fractures) are briefly described. In conclusion, treatment by surgery gives much better results because anatomical reconstruction of the acetabulum is possible or, at least, partial reconstruction which can be completed by the application of a hip-joint prosthesis at a later date.

Vascular, neurological and bony complications of sopracondylar fractures of the humerus in children are discussed in detail. A series of cases seen and treated at the Orthopaedic Clinic of the University of Padua are reviewed. Most cases were treated conservatively with good results. Neurological and vascular complications cleared completely, functional recovery was most satisfactory with minimal axis deviation after manipulation of the supracondylar area. In conclusion, conservative treatment remains the treatment of choice for this injury. Local conditions or complications can, in a very limited number of cases, require surgical intervention.