[Maxillofacial trauma in pediatric age]

The different incidence of various kinds of maxillofacial fractures in children are examined and the causes of such differences are analyzed. The most significant are the variations in morphology of the maxillofacial skeleton during the children's growth and the physical-statistic problems strictly connected. Attention is drawn on the diagnostic difficulties of traumas due to fractures during childhood, sometimes unknown, especially with regard to the heavy functional and aesthetic exits which may occur.

Chondromalacia of the patella. Natural progression

A total of 42 cases of patellar pain in subjects aged an average of 17.2 years submitted to arthroscopy are analyzed. Femoropatellar balance, where indicated, led to resolution of disorders with full resumption of sports activity. In the remaining cases chondromalacia showed the features of an affection with a spontaneously favorable course, confirming the common orientation towards conservative treatment. Arthroscopy is effective for a correct classification of cartilaginous lesions, and it is a good instrument to use when attempting to achieve recovery of patellofemoral joint when disorders are caused by a lack of equilibrium.

Does total hip arthroplasty mean sensorial and proprioceptive lesion? A clinical study

Total hip arthroplasty means sacrificing the joint capsule and the mechanoreceptors contained therein. Recent neurophysiological experiences seem to redefine the sensorial and proprioceptive role of the joint capsule in favor of the activity of the muscular mechanoreceptors, particularly in the area of the coxofemoral joint. The authors have examined the sensorial lesion caused by total hip arthroplasty in a group of 20 patients. Clinical testing was conducted prior to surgery, 7 and 40 days later. The tests were aimed at exploring the perceptive and proprioceptive activity of the hip, and showed marked decrease in all of the receptorial activity one week after surgery. After 40 days perceptive function was completely recovered, as the scores for tests conducted were the same as those obtained prior to surgery: proprioceptive activity was instead considerably improved, with significant changes in most parts of the tests. The authors conclude by observing that total hip arthroplasty does not cause permanent lesion of the perception of joint movement; furthermore, renewed coxofemoral mechanics allow for a better proprioceptive response with strengthening of static and dynamic antigravitational reactions.

CKS knee prosthesis: biomechanics and clinical results in 42 cases

From 1991 to 1993 a total of 42 CKS prostheses were implanted for the following reasons: osteoarthrosis (34 cases), rheumatoid arthritis (7 cases) tibial necrosis (1 case). At follow-up obtained after 17 to 41 months the results were: excellent or good: 41; the only poor result was probably related to excessive tension of the posterior cruciate ligament. 94% of the patients reported complete regression of pain, 85% was capable of going up and down stairs without support. Mean joint flexion was 105 degrees. Radiologically the anatomical axis of the knee had a mean valgus of anatomical axis of the knee had a mean valgus of 6 degrees. The prosthetic components were always cemented. The posterior cruciate ligament was removed in 7 knees, so that the prosthesis with "posterior stability" was used. The patella was never prosthetized. One patient complained of peri-patellar pain two months after surgery which then regressed completely.

Changes in growth of the ilium after sopraacetabular osteotomy. Long-term evaluation

It is commonly known that in acetabuloplasty according to the Pemberton-Zanoli method the insertion of the graft produces an immediate increase in the height of the iliac wing which in successive months could become hypergrowth caused by the hyperactivity of the underlying Y cartilage. A total of 40 cases of insufficiency of the acetabular roof treated by this method were examined based on measurements on follow-up radiograms and an evaluation of the spino-malleolar distance until puberty. The clinical evaluation showed that in 82.5% of cases there is dysmetria that is less than or equal to 0.5 cm. An evaluation of radiograms at the end of growth of the ilium [correction of ileum] did not reveal significant variations between the hemipelvis submitted to surgery and the contralateral one either in cases treated by acetabuloplasty alone or in those in which intertrochanteric osteotomy was associated. Acetabuloplasty according to the Pemberton-Zanoli method is thus effective in the treatment of acetabular dysplasia at a young age, obtaining long-lasting effects and ones that do not cause dysmetria in the adult.

The Marfan syndrome. An underdiagnosed killer

The Marfan syndrome is an inherited connective-tissue disorder. The sequela of the syndrome is premature death that is most often due to cardiac complications and that can be prevented with early diagnosis and aggressive management. Although research has identified a gene responsible for the myriad of phenotypic presentations, the diagnosis of Marfan syndrome remains clinical. The family physician is well positioned, with consultation from an experienced cardiac surgeon, to orchestrate the diagnosis and management of the Marfan syndrome.

Acute posterior dislocation of the shoulder: diagnosis

The authors describe the clinical and radiographic findings of posterior dislocation of the shoulder by examining 19 cases observed at the Rizzoli Orthopaedic Institute between 1981 and 1990; of the total number of cases, 16 were acute and 3 inveterate, equal to 1.7%. After analyzing the pathogenesis of the lesion, which was due to direct trauma, indirect trauma, or which occurred during an episode of convulsions, the authors call attention to the rareness of the lesion, and consequently the little amount of knowledge of the clinical and radiographic elements characterizing it. Three varieties are distinguished: subacromial (or retroglenoid), subglenoid, and subspinous. Finally, the results obtained with non-surgical treatment, which always allows for recovery of the joint relationships and complete functional recovery, are reported.

The herniated lumbar intervertebral disc in children and adolescents. Long-term follow-up of 101 cases treated by surgery

The authors review 101 cases of herniated lumbar intervertebral disc in children and adolescents treated by surgery. The most significant etiologic and pathogenetic factors in this series were early onset of disc degeneration, congenital lumbosacral malformations, and repeated trauma. The main clinical symptom was pain, usually sciatica, while neurological symptoms were less common than they are in adults. In all patients diagnosed correctly with the aid of appropriate imaging studies (myelography, CT scan, MRI), discectomy by means of conservative hemilaminectomy achieved satisfactory results, except in two cases of concomitant spinal instability due to spondylolysis and in one case of recurrence.

The surgical treatment of fractures of the pagetic femur: a case report

Based on anatomo-pathological findings in fractures in bones affected with Paget's disease, the authors discuss problems related to treatment. One case is reported in which treatment involved intramedullary osteosynthesis with locked nailing and corrective osteotomy. This type of treatment achieved a dual purpose of obtaining fracture consolidation within a short amount of time, and correcting the deformity.

[Cephalometric analysis in acromegalic patients]

The authors of the present work have done a cephalometric study on 11 patients affected by acromegaly. The target of this research was to obtain with cephalometric analysis a means for the follow up of the disease together with an important provisional parameter of growth of the face bones, helping thus to obtain an early diagnosis and the general lines for a correct therapy. With the data obtained has been extrapolated a table with average data of cephalometric angles that, transferred on to a tracing could represent the cephalometric prototype of an acromegalic patient.

Osteoid osteoma of the spine

After reviewing the international literature the authors present three new cases of osteoid osteoma with vertebral body localisation, two in the lumbar region, and one in the cervical region. This rare localisation necessitates the use of accurate instrumental techniques, based on radiography, scintigraphy, and in particular, CT scanning, in order to arrive at a correct diagnosis as a prelude to the correct surgical treatment.

[Radiographic diagnosis of dislocations and fracture-dislocations of the carpus]

A variety of unique and very rare carpal dislocations are reported. According to personal findings, an extension of the descriptive classification of this pathology is proposed, utilizing also the X-ray files of the Rizzoli Orthopaedic Institute. Moreover, the radiographical features are evaluated which help choosing the treatment to be followed.

Effect of temperature on isoprenaline- and barium-induced slow action potentials in guinea-pig ventricular strips

The effect of variation in temperature (37-32 and 27 degrees C) on electrical and mechanical activity of depolarized and isoprenaline- or barium-reactivated guinea pig ventricular strips was studied. Lowering the temperature brings a marked prolongation of isoprenaline-induced slow action potentials. In addition the maximal rate of depolarization was strongly reduced at lower temperatures. These effects were observed at an extracellular Ca2+ concentration of either 0.9 or 2.5 mM. The accompanying mechanical activities was significantly increased by reduction in temperature. Barium-induced slow action potentials were similarly affected by temperature variations. These observations suggest that hypothermia exert a sort of calcium antagonistic action probably coupled to a reduction of repolarizing outward potassium currents.

Tumoral calcinosis

The authors present a case of tumoral calcinosis, a rare form of calcinosis due to the formation of "calcium tumours" in the vicinity of serous bursae. They discuss the clinical, anatomical and pathological features of the three principal forms of calcinosis, including the theories of pathogenesis. In the rare tumoral form the treatment is always radical excision.

Thoracic intervertebral disc protrusions

Intervertebral disc protrusions occur most frequently in the lumbar spine, much less frequently in the cervical spine and very rarely in the thoracic spine. The symptomatology of thoracic protrusions is both aspecific and polymorphic. The diagnosis is therefore difficult and necessarily depends on myelography and computerised axial tomography (CAT scanning). The treatment is surgical and should be undertaken early if pain and neurological damage are to be relieved.

Multiple osteoid osteoma in the 7th dorsal vertebra

The authors report a case of osteoid osteoma localised in both laminae of D7. No bilateral case of this type has previously been reported in the literature.

Diagnosis and treatment of cervical instability

Instability of the cervical spine gives rise to vertebral and neurological symptoms which may be progressive. The principal causes of instability are: trauma, sequelae of laminectomy, malformations, vertebral infections, rheumatoid arthritis, primary tumours (benign and malignant), metastases, and chronic degenerative disease of the discs. Each of these forms of instability must be identified and, depending on the symptoms and pathogenesis, is capable of responding to the appropriate treatment.

Fracture of glenoid fossa following mandibular trauma

A case of glenoid fossa fracture secondary to mandibular trauma is reported. Subjectively, this injury is characterized by pain in the temporomandibular region of the injured side and by mandibular function impotence. Objectively, there is disappearance of the mandibular condyle from the pretragic region, mandibular lateral deviation toward the fractured side, and premature occlusal contacts on the injured side. The injury can be definitively diagnosed only with a temporomandibular joint radiographic examination of them, which includes a lateral and front-back projection stratigraphy. The surgical techniques currently used in these cases are also discussed.

Giant cell tumour in a vertebra affected by Paget's disease of bone

A case of giant cell tumor in a vertebra affected by Paget's disease of bone is presented. This lesion, which is quite rare, has usually been observed in the bones of the skull and face, and is benign. It is probably hyperplastic rather than neoplastic in nature. Radiotherapy is contraindicated, since bone affected by osteitis deformans may possibly become malignant.