In this paper we have attempted at proposing a new classification of scapholunate instability that in our opinion can be used in majority of cases with scapholunate complex injury. Incomplete and isolated scapholunate interosseous ligament lesions are of no clinical relevance to SL dissociation or carpal instability. We have concluded that the new classification can be used in all types of SLIL lesions and we are convinced that it will help in choosing the right type of surgery.

Study Design: Repeated Measures.

Objectives: To determine the short term impact of cold water immersion on sensory and vascular functions in patients with Distal Radius Fracture (DRF) and compare responses in the injured and uninjured hands.

Background: Cold exposure is used to assess neurovascular function. Cold is also used as therapeutic agent to reduce pain and swelling. There is a scarcity of trials that have looked at the impact of cold exposure in patients with DRF.

Methods: Twenty patients with DRF, aged 18 to 65 yrs. were recruited after cast removal. All patients underwent Immersion in Cold water Evaluation (ICE) which consisted of 5 min of hand immersion in water at 12°C. Skin Blood Flow (SBF) in hands, Skin Temperature (S Temp.) in index and little fingers and sensory Perception Thresholds (sPT) at 2000Hz (for Aβ fiber) and 5 Hz (for C fiber) were obtained from ring finger, before ICE, immediately after (0 min, 1 min) and 10 min later. Differences were analyzed using repeated measures.

Results: In the DRF hand, SBF increased immediately (Mean Difference = -42.2 A.U), at 1 min (-35 A.U) and 10 min after ICE (-1 A.U). Skin Temp. In index and little fingers decreased immediately after ICE (9.9°C and 9.1° C) and did not return to baseline by 10 min (4°C and 4.1°C). ICE had no effect on sPT at 5 Hz (p>0.05). There was no difference between the DRF and uninjured hand on all measures(p>0.05) except for the sPT at 2000Hz, which remained high on the DRF side for up to 10 min (-1.8 m. A).

Conclusion: Normal cold responses consistent with ‘hunting reaction’ were observed after ICE in both hands. Aβ fibers on DRF side became less sensitive after ICE. These findings suggest that a brief immersion in cold water does not produce any adverse events associated with cold exposure.

We present a case of a 38-year-old right-handed male physical worker with traumatic divergent dislocation of both the scaphoid and lunate bones. He was referred to our ward five days post-accident. After open reduction, he was treated with a novel technique of free tendon reconstruction of the scapholunate ligament complex and internal fixation with K-wires through the dorsal approach. At a 18-month-follow up the patient was pain-free, had a good wrist function with no evidence of avascular necrosis of the scaphoid nor lunate, and was satisfied with the general result.

Congenital pseudoarthrosis of the clavicle is a rare condition. It is diagnosed at an early age by a defect in the supraclavicular fossa and the absence of a central zone portion of the clavicle in the X-ray image. Origins of the condition are not well understood nor are the best age for, and need for treatment, since it is asymptomatic in many cases. If the clinical presentation is neurovascular compression or shoulder dysfunction, reconstruction of the clavicle with a plate and bone graft from the iliac crest seems to be the most commonly accepted option.

Our case corresponds to a girl aged 9 years with an established diagnosis and a dysfunctional clinical history of the shoulder, as well as a progressively worsening esthetic defect due to the progression of the malformation. The patient was treated using a 2.7 mm mandibular reconstruction plate shaped to resemble an adult clavicle plate with an iliac crest graft. Evolution after treatment was favorable.

Currently, mandibular reconstruction plates are broadly available for treatment in orthopedic and traumatology surgery departments, mainly in pediatric surgery, since they provide the same advantages as adult reconstruction plates but with lower profiles. Their main advantage lies in the availability of support materials for three-dimensional modeling systems allowing for the plate to be adapted to the particular anatomical site, which in this case would be the clavicle.

Today orthopedic surgery is becoming progressively interesting. The rapid stride related to excellence of implants, technologies and techniques

Tendon injuries are the second most common hand injuries in orthopedic patients. Tendon adhesions are one of the most concerning complications after surgical repair of the flexor tendon injury, particularly in zone II, which extends from the A1 pulley to the distal insertion of the Flexor Digitorum Superficialis (FDS) tendon in the finger

Based on the American Dental Association concept, Dentofacial Orthopedics is the branch of dentistry that has to do with the assessment, development and alignment of maxilla, mandible, and other cranial bones, with attendant improvement in airway, muscle and neurological tone.

Osteoarthritis is a disabling disease with no known cause. The role of muscle dysfunction as an etiological factor has however been discussed, and evidence in favor of this hypothesis has recently been sought.

To ensure the possible accelerated osteogenesis of long bone fractures in patients with concomitant spinal cord injury and to investigate the mechanism causing it with the understanding of a possible neuro-hormonal cause, a hormonal bioassay of the blood of 21 of these patients was measured in the prospective controlled study and compared to 20 patients with only spinal cord injuries, 30 patients with only long bone fractures, and 30 healthy volunteers.

The study results showed that Long bone fractures in patients with associated acute traumatic spinal cord injury of quadriplegia or paraplegia heal more expectedly, faster and with exuberant florid union callus (P>0.001) and showed statistically significant higher levels of parathyroid hormone and growth hormone (p<0.005) and normal corticosteroids levels. Patients with long bone fractures only showed consistent and statistically significant higher level of noradrenaline and adrenaline hormones compared to patients with spinal cord injury alone or associated with long bone fractures (p<0.001). Leptin hormone shows statistically significant consistent decrease in patients with spinal cord injury and concomitant long bone fractures compared to healthy subjects (p<0.001). We believe, according to the results of this study that bone healing is accelerated in long bone fractures in patients with associated spine fractures and spinal cord injuries. We also can conclude that bone healing has a central neuronal control and a combined neuro- hormonal mechanism with a relative inhibition of the sympathetic nervous system is a possible cause of accelerated healing of long bone fractures in patients with associated spinal cord injury.

 Globally, hundreds of millions of people are affected by musculoskeletal disorders (~10 million in the UK)

Meliodosis is an infection caused by the facultative intracellular gram-negative bacterium; Burkholderia pseudomallei, usually a soil saprophyte. It is a great masquerader of disease presenting in many disguises and mimics. Initially confined to Southeast Asia and Australia

Rapid Palatal Expansion (RPE) is a traditional orthodontic/orthopedic procedure for the skeletal widening of the maxilla according to which the two maxillary bones tear apart and the gap between them is filled in with hemorrhagic tissue which is gradually replaced by new bone formation. Indications for RPE are severe absolute or relative skeletal discrepancies with the maxilla being narrower than normal. This procedure seems to be accompanied by concomitant skeletal changes.

A prospective control clinical trial was designed in an effort to verify these alterations. A treated sample and a control sample consisted of 23 individuals each. The age of the examined patients was 14-16 years. The patients of the treated sample underwent RPE whereas in the control sample they received no treatment at all. Measurements were made before treatment (To), after RPE and 3 months retention with the appliance still in place (T1) and at the end of the orthodontic treatment (T2). Equivalent measurements were made in the control group as well. The variables measured were the lips length, the width of the base of the nose and the Soft Tissue Lower Anterior Face Height (SLAFH).

According to the results of this study, no statistically significant alteration found in the length of the lips due to the RPE procedure. On the contrary, the base of the nose presented statistically significant increase. The SALFH also increased with statistical significance due to RPE. These concomitant changes of the lower part of the face need to be taken into account and to be integrated in a patients’ treatment plan according to his facial type (dolichofacial or brachyfacial).

Further investigation with bigger sample sizes and more long term results can give more insight into this subject.

Background: Femoroacetabular impingement is a common source of hip pain and dysfunction, especially in young and active patients. It is considered to be the main cause of early hip osteoarthritis. We set the purpose to identify poor prognosis factors in the surgical treatment of femoroacetabular impingement.

Methods: We realized a prospective observational study in a case series of 50 hips in 44 patients with femoroacetabular impingement operated with surgical hip dislocation between 2001 and 2006. Clinical, radiologic, surgical and functional factors of whole patients were assessed. Clinical outcomes were determined with a subjective scale. Also, functional assessment was performed with a modified Harris Hip Score (HHS). Both evaluations were applied at 6, 9, and 12 months, and so every year once. Finally, the statistical analysis was done with SPSS 15.0 software.

Results: With an average of 6.2 post-operative years (5-10.1) of follow-up, 35 patients (70%) were “asymptomatic” (HHS=100), 11 patients (22%) “better” (HHS=94.09), and 4 patients (8%) “the same or worse” (HHS=68.25). 40% of patients older than 45 years old were “asymptomatic”, versus 77% younger than 45 years old (p=0.03). 37% of patients with mixed femoroacetabular impingement were “asymptomatic”, 87% of patients with cam-type and 82% with picer-type (p=0.003). The factors related to a poor prognosis were as follows: age >45 and mixed-type impingement; and other factors such as radiological osteoarthritis, labral injury and prolonged symptomatology were also associated to poor prognosis results in our study, without being statistically significant.

Conclusion: Age > 45 years old and mixed type of impingement are significant statistic factors related to a poor prognosis in patients treated with surgical hip dislocation. This data are useful to predict the treatment outcome for each patient.

Peritrochanteric diseases are a recurrent cause of lateral hip pain that usually affects middle age and active women. Despite questionable results, classically they have been treated in a conservative way. Surgical techniques are preferred for those who had unsatisfactory results with conservative treatment. In these patients we have developed an arthroscopic surgical treatment that includes the resection of the bursa and the partial release of the iliotibial band, showing satisfactory results. This article describes the surgical technique.

We report a case on a rare ankle injury which occurred after an opened trauma of the left ankle, associating a lateral subtalar dislocation with a ruptured tibialis posterior tendon. We treated him surgically with a good evolution clinic and radiological.

Tendons are anatomical structure that connects muscle to bone to allow the force to be transmitted from the muscle to the bone, allowing movement of fingers. The main objective of this study is to present the recent data from animal experimental studies where pharmacological topical agents are used after tendon repair in prevention of adhesion formation. Some of the most commonly used topical agents are: Hyaluronic Acid (HA) and its derivatives, 5-Fluorouracil (5-FU), lubricin, alginate solution and topical application of growth factors. These studies have shown that the above mentioned substances reduce adhesion formation through different mechanisms. The successes of the tendon healing after tendon repair in experimental studies using topical agents, can be evaluated using a variety of methods such as: biomechanical evaluation, macroscopic and microscopic evaluation, cell isolation and analysis of growth factors. However, most authors agree that despite good tendon repair and topical application of these substances, creation of adhesion formation continues to be a great problem for hand surgeons.

Purpose: This study was done to determine whether a) there is a correlation between the Notch Width Index (NWI) and notch volume, as measured by Magnetic Resonance Imaging (MRI), in patients with ACL-injured and non-ACL injured knees, b) there is a difference in NWI between patients with and without anterior cruciate ligaments tear, c) there is a relationship between ACL diameter, angle of ACL inclination and ACL injury and d) there are differences in distal femur morphology between the ACL-injured and non-ACL injured knees.

Materials and methods: In this study, 59 ACL-injured patients and 59 match-control ACL-intact patients were enrolled. MRI was used to measure the notch width, notch height and condylar widths. The thickness of ACL and ACL angle of inclination were also measured.

Results: Statistically, Notch Width Index (NWI) (0.47 +/- 0.07 vs 0.43+/-0.05, p <0.05) and Medial-condyle to-lateral condyle ratio (M:L ratio) ( 1.07 +/- 0.11 vs 1.02 +/- 0.09, p = 0.023) were all significantly greater in the ACL-ruptured group compared to the ACL-intact group. However the ACL angle of inclination from the vertical axis is statistically significantly smaller in the ACL-injured group compared to the ACL-intact group( 30.729 +/- 6.147 deg vs 43.339 +/- 12.950 deg, p<0.0001).

In both the ACL-injured and ACL-intact groups, the Notch Width (NW), Notch Height (NH) and Notch Volume (NV) measurements were all statistically significantly greater in males compared to females.In both ACL-injured and ACL-intact groups, Notch width indices showed no statistical significant difference between the sexes.

Conclusion: In this MRI study, a high femoral notch width indices and high medial condyle-to-lateral condyle ratio (M:L ratio) serve as accurate predictors in subjects prone to ACL injury. The MRI findings can guide future routine radiological or ultrasound screening of ACL-injury prone knees.

Patellofemoral Pain Syndrome (PFPS) is the most common type of knee pain. It is estimated that PFPS accounts for 25-30% of all knee pathologies. The condition can be very painful and the symptoms can take a long time to settle. There is general consensus that effective treatment strategies should be based on a thorough understanding of pathological changes of PFPS. This mini review briefly outlines biomechanical aspects of pathophysiology of the structures involved and describes current treatment strategies available in the literature, in particular it looks at muscle tightness and provides an insight into stretching techniques as an effective physiotherapy choice for the condition.

Arterio-venous malformations of the jaws are a very rare pathology, but can lead to fatal complications. Presented is the case of a young female patient who was referred to our hospital based on the clinical and radiological diagnosis of an odontogenic cyst related to the first molar in the right mandible. Due to a suspicious mobility of the tooth and root resorption a biopsy and tooth extraction was planned under general anaesthesia. Already during mobilisation of the tooth an enormous threatening bleeding occurred which forced in addition to surgical revision, immediate embolisation and intensive care treatment? The patient recovered well from the treatment without any long-term complications or damages. The later histo-pathological findings supported the intraoperative diagnosis of an intra-osseous haemangioma.

Background: C-Terminal Telopeptide of type I collagen (CTX-I) is a bone marker of resorption. We study levels and compare levels in hip and wrist fractures.

Material and methods: Our study population included 82 men and postmenopausal women with hip fractures and 27 with radius fractures. CTX-I serum concentrations (measured in nanograms/milliliter) in the blood were measured using immunoassay. Levels above 0.60 ng/ml and 0.30 ng/ml were considered to be abnormal for women and men, respectively. Statistics: descriptive, t-test, and linear regression statistics were performed. The significance level was set at p <0.05.

Results: The mean ages were 83.3 years and 74.1 years for patients with hip and radius fractures, respectively. The mean CTX-I serum concentrations were 0.74 ng/ml in patients with hip fractures and 0.64 ng/ ml in patients with radius fractures. Above normal CTX-I concentrations were seen in 62% of the women with hip fractures and all of the men and 50% of all patients with radius fractures. Neither age nor sex influenced the CTX-I levels in patients with hip or wrist fractures. Trochanteric fractures had higher β-crosslaps than did cervical fractures. Serum CTX-I levels were significantly higher in hip fractures than in radius fractures independently of age (p<0.001).

Conclusion: Resorption bone markers are higher in patients with hip fractures than in patients with radius fractures. In our study, patients with trochanteric hip fractures had greater CTX-I levels than did patients with cervical fractures. All males and most women with fractures had high CTX-I levels, regardless of age.

Level of Evidence: Level 4.

Intra-articular calcaneal fractures make up 2% of all fractures [1]. The management of displaced intra-articular calcaneal fractures remains controversial.

Septic arthritis of the ankle is a rare disease in pediatric population. We present a case of septic arthritis of the ankle starting with limping as initial symptom, with no specific presentation and no trauma history, focal tenderness over ankle joint is the most helpful clinical sign. A small joint effusion may be present. Treatment of septic arthritis is always an emergency and the delay in diagnosis may lead to progression of disease and complications. Arthroscopic procedure may give secure joint toilette, allowing less invasive spectrum.

Cartilage is a special avascular tissue with sparse chondrocytes imbedding in the dense Extracellular Matrix (ECM). Cartilage injuries can be caused by trauma, osteoarthritis, obesity, meniscus injury, joint line change and chronic joint instability.

Background: Despite a significant number of publications exploring hip shortening during Total Hip Arthroplasty (THA) and its effect on dislocation, the long term outcomes have been poorly characterized. Our purpose is to discuss the factors affecting hip stability and the outcomes of primary THA in a group of patients whose limbs were shortened.

Methods: We retrospectively reviewed all primary THAs from our institution’s joint database between 1998 and 2004. Patients with a minimum of 48 months follow up were included in our analyses. Patient demographics, radiographic measurements, and Harris hip scores were compared with outcomes. We developed a method using landmarks on pre and postoperative radiographs to measure overall shortening and shortening through the femoral component specifically.

Results: Mean follow up time was 84 months. 16 hips (16.8%) had dislocations. Student t-test comparing dislocated to non-dislocated hips showed overall shortening and shortening through the femoral component were both significantly associated with dislocation (p=0.0093, p=0.0066 respectively). Bivariate analysis showed that risk of dislocation increases with extent of shortening through the femoral component (p=0.012).

Conclusion: Hips that were shortened at their femoral components were more likely to dislocate. Furthermore, the degree of shortening corresponded with the degree of dislocation risk. Hip shortening is an important risk factor for postoperative dislocation, a major complication following THA.

We present a case of an unstable proximal interphalangeal fracture of the fifth finger. We want to review the treatment of this entity, by using a dynamic external distractor designed from the Suzuki frame; we recommend this technique to young orthopaedic surgeons.