The authors describe the clinical appearance of Ledderhose disease and emphasize the association with Dupuytren disease. They report on a series of patients treated at the 2nd Orthopedic Unit of University of Florence and describe the operating technique used. They believe that the procedure of removal of nodules must always be performed in association with careful exeresis of normal tissue, employing total aponeurectomy only in revision surgery.
Arthroplasty can be a successful treatment for arthritis even in cases of severe axial deviation of the knee. Since significant bone loss is often present in these cases, the technique and extent of the resection is very important. In this paper we review our series and compare it with solutions proposed by other authors, focusing our attention on the techniques of resection and replacement of lost bone employed in order to achieve optimal axial alignment and anchoring of the prosthetic components.
In a series of 67 displaced ankle fractures, the significance of the following factors is evaluated: age, sex, obesity, adequacy of the post-reduction position of the malleoli, restoration of distal tibio-fibular syndesmosis, talo-crural angle, talar tilt, width of medial clear space, severity of injury, traumatic mechanism, treatment. The statistical study is developed using stepwise discriminant analysis up to multiple linear regression. The significant parameters are the talo-crural angle, residual malleolar displacement, the integrity of the syndesmosis, and obesity. The discrimination is very good (p < 0.01).
On the basis of clinical observation and reports in the literature, the authors discuss the etiology, pathogenesis, and clinical and radiographic aspects of "slow" fractures, with particular reference to those involving the metatarsal. The different etiologic and pathogenetic theories agree upon one point: the concentration of the stresses as a prelude to areas of osteoclastic resorption which lead to microfractures and thus to "slow" fractures. Many factors are responsible for this concentration, and they may very even according to the site of the lesion. In the foot there are many conditions which can potentially explain the pathogenesis of "slow" metatarsal fractures. Overload of the middle metatarsals is one of the most common causes. The overloaded and fractured metatarsal may then become insufficient and in turn, by the same mechanism, cause fracture of the adjacent metatarsals.
This paper analyses the effect of mechanical loading on bone remodelling under both physiological and pathological conditions. The sensitivity and the type of the biological response of bone to the changes in mechanical loading are conditioned by several factors: individual race and age, pattern of stress, systemic and local metabolic conditions, etc. Therefore, bone remodelling following mechanical stress is not only a simple repair process, but a complex mechanism of functional adaptation which is controlled by the strain magnitude of bone structure rather than the extent of the stress. Results show that the skeletal changes induced by mechanical stress involve not only the structural properties but also the material characteristics of bone. For example, the size of hydroxyapatite crystals increases under load. These findings allow us to hypothesize that mechanical stress could directly modify the mineral component of bone. Hydroxyapatite appears to be a highly dynamic structure, able to change its crystallinity in relation to external stimuli. It is thus conceivable that hydroxyapatite crystals gather and arient themselves along bone and improve their crystallinity not only under the influence of biological mechanisms, but also as a reaction to mechanical stimuli.
The authors conducted a macroscopic anatomical study of the metatarsophalangeal joints of the middle toes in order to add to our knowledge of the anatomy and physiology of this structure. Anatomical observations reveal the foot's lack of transverse ligamentous formations (as the sagittal bundle in the hand) connecting the extensor tendon to the glenoid plate. Consequently, the containment of the extensor tendon above the metatarsophalangeal joint is considerably less stable in the foot than in the hand, since it is entrusted to the posterior portion of the interossei muscles and the deep and superficial retinacula (all formations which run in a prevalently oblique direction). Hyperextension of the metatarsophalangeal joint causes the posterior portion of the interossei muscles, bound to the extensor tendon, to slide proximally, straightening the fibers and loosening the structures that stabilize the extensor tendon. The tendon can then easily shift in a lateral direction with respect to the rotation axis of the metatarsophalangeal joint, acquiring a valgus action. Even though the metatarsophalangeal joint is equipped with strong collateral ligaments, the valgus action of the extensor tendon eventually overcomes the resistance of both these and the weaker connections to the plantar aponeurosis of the foot and the extensor tendons. In conclusion, the lack of structures to provide passive stabilization of the extensor tendon in the metatarsophalangeal joints of the toes makes the foot particularly susceptible to multiple-toe deformity.
The authors state the indications and report the results of 43 revision arthroplasties performed with cementless total hip implants. They describe both the criteria leading to this therapeutic decision and the technique employed given the bone loss caused by the failure of the previous arthroplasty. The long-term results are analyzed with particular reference to radiographic evidence of implant stability.
In 1984 a "bone bank" containing femoral heads taken from live donors was created at the 2nd Orthopaedic Department of the University of Florence. The authors emphasize that these bones are very easy and inexpensive to obtain and store. They describe the organization of the "bone bank" and present the results of its first four years of activity.
The authors report a rare case of partial agenesia of the pectoralis major muscle with presence of the "pars clavicularis" only. Full range of movement was possible in this case, in accordance with other reports in the literature.
The authors describe the clinical appearance of Ledderhose disease and emphasize the association with Dupuytren disease. They report on a series of patients treated at the 2nd Orthopedic Unit of University of Florence and describe the operating technique used. They believe that the procedure of removal of nodules must always be performed in association with careful exeresis of normal tissue, employing total aponeurectomy only in revision surgery.
The authors present the preliminary results (after 4-7 years) of 69 cases of congenital torsive equino-varus-supinated foot treated operatively from 1982 to 1985 (of a total of 25% cases treated from 1982 to 1989). Both the modalities and the stages of execution of the treatment are described. After the initial clinical evaluation and the first weeks of manipulation, the feet were immobilized in corrective plaster casts, which were carefully constructed to correct the varus and supination. After 4-8 months, thorough clinical and radiographic assessment enabled the authors to plan the surgical procedure for correction of the remaining deformity, customizing it for each individual patient. There is an in-depth discussion of the stages of the "widened" posterior release procedure. Using this procedure, the authors achieved satisfactory intraoperative correction in 85% of the patients, correction which was maintained over time in 76.5% of the cases. In this way the medial stage of the surgical procedure, associated "ab initio" to the posterior release, may be reserved to a fewer number of patients (15-20%) under one year of age.
The authors report their experience in the treatment of "osteoid osteoma", drawing attention to the great clinical polymorphism of this affection. They also demonstrate the reliability of a preliminary systematic study with bone scan and CT, which are indispensable to early diagnosis and correct surgical procedure.
The experience of the Clinica Ortopedica dell'Università di Firenze in the surgical treatment of cervical disk disease has changed over time due to both the ongoing improvement of surgical techniques and the availability of ever more effective and less invasive diagnostic tests. Although our first experience was indirect and we were not able to review all patients due to the long follow-up period, we believe that our current setup provides valid data, as is demonstrated by the thorough clinical and radiographic evaluation we performed on patients reviewed after a minimum of 5 years. We believe that the anterior-approach procedure, which can currently be recommended thanks to non-invasive diagnostic tests, is effective not only in cases of spinal cord impingement but also in cases of cervicobrachialgia. In the latter, aside from the relief of nerve root impingement, we noticed that intersomatic spinal fusion helped relieve pain at the site of the lesion even after a considerable period of time, whereas cervical pain often remained after laminectomy and frequently increased over time.
The authors report the result of the review of fractures of the growth plate of the distal humeral epiphysis treated at the Orthopaedic Clinic of the University of Pisa. They examine the varieties of lesions which may occur at that site and report the results after a follow-up of 5 to 15 years.
The authors report their experience in the treatment of complex fractures of the tibial plateau (epi-metaphyseal and comminuted bicondylar and spinotuberosity fractures) using the Kerboull epiphyseal plate and autogenous cancellous bone grafts if sinking occurs. It is not always possible to perfectly restore joint anatomy and stability. Plate fixation ensures solidity by not exposing the load-bearing axis, eliminating the risk that the tibial plate will later give way and thereby allowing early mobilization and rapid functional recovery of the knee. The authors emphasize the importance of both consensual treatment of possible ligament tears and preservation, when possible, of the meniscus. They claim that the frequent complications can only be prevented by careful preliminary assessment of general and local conditions which may absolutely or relatively contraindicate this type of surgery.
