High calcitonin levels in unconscious polytrauma patients

We measured levels of calcitonin and other markers of calcium and phosphorus metabolism in both unconscious and conscious patients after multiple trauma. We found dramatic increases in calcitonin levels in unconscious patients, and smaller increases in conscious patients. In two cases, very high levels, more than 100 x normal, appeared to be related to more rapid healing of bone. Calcitonin levels were highest immediately after admission and decreased over the ensuing two weeks. The possible relationship between unconsciousness and the increased rate of healing of fractures is discussed.

Limb lengthening by callus distraction (callotasis)

Callotasis is a new technique of limb lengthening involving slow distraction of the callus formed in response to a proximal submetaphyseal corticotomy. Using a dynamic axial fixator with telescoping capabilities, distraction begins after 2 weeks. When the required length is attained, the fixator is held in the rigid mode until radiographic evidence of callus is observed. The locking screw is then released, and dynamic axial loading is instituted to promote corticalization. One hundred bony segments have been lengthened; 50 patients had limb length inequality, and 23 had achondroplasia. The mean lengthening achieved was 22% (maximum, 58%). There were 14 complications (14%).

Chondrodiatasis-controlled symmetrical distraction of the epiphyseal plate. Limb lengthening in children

We describe a technique for slow, progressive, symmetrical distraction of the growth plate using a lightweight dynamic axial fixation system. Results are given for the elongation of 40 bony segments in children with limb-length discrepancies and 60 segments in children with achondroplasia or hypochondroplasia. Increases in limb length of up to 36% were obtained in non-achondroplastic and up to 64.5% in achondroplastic patients. There were no nerve or vascular lesions or bony infections and no case required a bone graft. Pin-track complications occurred in only 1.5%.

Limb lengthening by distraction of the epiphyseal plate. A comparison of two techniques in the rabbit

We have compared, in rabbits, two techniques of limb lengthening by distraction of the epiphyseal plate using a unilateral external fixation frame. In all cases, 14 mm of symmetrical lengthening without deviation was achieved. With rapid distraction at rates of 1 mm per day (distractional epiphyseolysis) separation of the epiphysis from the metaphysis occurred by day 7, and by day 70 almost complete ossification of the cartilage and the elongated segment was evident. In contrast, slow distraction at 0.25 mm every 12 hours (chondrodiatasis) produced hyperplasia of growth cartilage without any evidence of detachment at 28 days, the end of the distraction period. By day 70 the epiphyseal plate had returned to normal thickness with normal cellular morphology, while the lengthened segment was occupied by ossified tissue. The significance of these findings is discussed.

The treatment of fractures with a dynamic axial fixator

The results obtained with a lightweight dynamic axial fixator in the treatment of fractures are reported. The apparatus comprises a single bar with articulating ends which clamp self-tapping screws and can be locked at an angle appropriate for axial alignment. A telescopic facility allows ready conversion from rigid to dynamic fixation once periosteal callus formation has commenced. Reduction and controlled distraction or compression are achieved by means of a detachable compressor unit. We treated 288 patients with fresh fractures and 50 with ununited fractures. The success rate for fresh fractures was 94%, with average healing times ranging from 3.4 to 6.5 months. In ununited fractures also, the success rate was 94% with average healing times ranging from 4.7 to 6.5 months. Complications were minimal. The device is versatile and can be applied in an average of 15 minutes. It permits ambulatory fracture care without sacrificing a sound anatomical result.

Metabolic and nutritional factors in the pathogenesis of idiopathic osteonecrosis of the head of the femur (preliminary results of a long-term follow-up investigation)

A double statistical study of a group of 56 patients affected by idiopathic osteonecrosis of the head of the femur is presented. A comparative investigation was undertaken into this group, taking into consideration the principal biochemical parameters, clinical findings, dietary and living habits. The statistical data that were analysed confirmed the role of some of the aetiological factors concerned. A long-term study was also undertaken, with a preliminary follow-up at 22 months, on the progress of the patients with monolateral idiopathic osteonecrosis of the femoral head who were subjected to a therapeutic programme of dietary correction and the administration of medicaments.

[Proglumetacin: analgesic anti-inflammatory treatment for orthopedic and traumatologic pathology]

Twenty-three patients with orthopedic and traumatic disorders, mostly hospitalized, were treated with proglumetacin, 450 mg/day, during 5-45 days. Proglumetacin resulted to be a good analgesic and anti-inflammatory drug. Tolerance was good or excellent in all patients but one. Proglumetacin appears to be drug particularly suitable for the treatment of orthopedic and traumatic disorders, also in the postoperative course.

[Clinical experience with human calcitonin]

The Authors report the results of treatment with synthetic human calcitonin in patients suffering from Paget's disease, osteoporosis, Sudeck's disease, osteolytic metastases and in one case adults Cooley's anaemia. They summarize the characteristic blood chemistry changes due to calcitonin in some cases and report a marked clinical improvement in the majority of the patients.

Arthroprosthesis of the ankle joint

The authors report the results obtained with arthroprostheses of the ankle joint in twelve patients. The surgical indications were severe post-traumatic degenerative, lesions, rheumatoid arthritis and post-traumatic necrosis of the talus. The types of prosthesis used were the St. Georg-Buchholz, Smith and TPR designs. The joint was exposed in the majority of cases by an antero-medial approach. The results (at a minimum of one year and a maximum of two and a half years) were satisfactory, being excellent in eight cases, fair in three and negative in one. The one failure was partly due to the surgical exposure, which involved osteotomy of the distal third of the fibula.

Syndesmomyolysis in early osteoarthrosis of the knee

The authors present a new operative procedure for the early stages of osteoarthrosis of the knee associated with varus or valgus axial deviations. This is based on biomechanical considerations related to the articular equilibrium of the knee, and on pathogenetic interpretations of arthrotic disease in this particular joint. After reviewing the capsular, muscular and ligamentous systems of the medial and lateral compartments of the knee, they consider the active forces capable of opposing the eccentric thrusts of load and gravity in disequilibrium due to axial deviation. Clinical investigations have been carried out which reveal that under these pathological conditions, cicatricial retraction occurs on the concave side and stretching on the convex side of the axial deviation. For the former they have devised the operation of "syndesmomyolysis", which must be preceded by preoperative muscular reinforcement on the convex side. The objective of this procedure is to restore the equilibrium of the forces acting on the articular axis.

[Treatment of algodystrophic syndromes with calcitonin]

A general account of algodystrophic syndromes is followed by the presentation of results obtained with 160 MRC U/day extracted pig or 100 MRC U/day synthetic salmon calcitonin in 95 patients with the most common form (Sudeck's syndrome). Clinical, biohumoral and radiographic data are reported. There was no difference in the response to the two products. Excellent results were noted, first clinically and then radiographically. Some radiographs are presented.

Pig calcitonin in the treatment of localised osteoporosis

On the basis of positive results obtained in the treatment of Sudeck's atrophy with calcitonin, the authors extended their investigation to other forms of localised osteoporosis. Six patients were examined affected by osteoporosis secondary to immobilisation, three patients with osteoporosis of the lower limbs from paralysis of the sciatic nerve and six patients with migrant osteoporosis. Treatment was as follows: pig calcitonin (Calcitar) in doses of 160 u MRC/daily + calcium gluconate in doses of 3 gr/daily. The duration of treatment averaged forty five days. In osteoporosis from immobilisation and nerve lesions the calcitonin treatment did not influence the condition and there was no change in radiographic appearances nor was there any analgesic action. On the other hand, the results were clearly positive in migrant osteoporosis: in all the patients treated there was complete regression of pain, cutaneous trophic changes, and functional loss. At a later stage, normal radiographic appearances were restored.

Effect of calcitonin on carrageenan foot oedema

The effect of salmon calcitonin (SCT) on acute inflammation was tested in carrageenan induced foot oedema of the rat. A considerable inhibition of the oedema was obtained with 20 MRC U/kg of SCT. The injection of SCT is followed by decrease of calcemia. A hypothesis of possible inhibition of prostaglandin (PG) synthesis and/or release, caused by decrease of calcemia, is advanced.