Radiological Healing Research Articles

Digital Joint Reconstruction with Osteotendinous Joint Allograft: Experimental Study in Rats.

Background:Fresh or frozen nonvascularized osteotendinous joint allografts (OTJA) have not been used previously, clinically or experimentally, for metacarpophalangeal joint reconstruction. Therefore, we evaluated the viability of OTJA for metatarsophalangeal joint (MTJ) reconstruction in rats.Methods:In the experimental group of 12 Lewis rats, we reconstructed the MTJ of the third digit of the hindlimb with a fresh, nonvascularized OTJA obtained from the same digit from 12 donor rats. In the control group of 6 Lewis rats, an autologous composite osteotendinous graft of the MTJ of the same digit was obtained and repositioned in situ as an auto-transplant. Weight, pain, edema, dehiscence, and wound infection were evaluated every 24 hours for 30 days postoperatively. At the end of 30 days, we evaluated digit position, flexion and extension, passive mobility, radiological bone healing, and histological grades of rejection.Results:We found no statistically different changes in weight, edema, pain, digit position, or radiological bone healing in either group. No wound dehiscence or infection was seen in any of the rats. Ten degrees of flexion and extension mobility were lost in the control group; the experimental group lost up to 30 degrees (P = 0.009). Histologically, 9 of the experimental group rats (9/12, 75%) showed rejection reactions compared with none of the controls (0%) (P = 0.009).Conclusions:Fresh nonvascularized OTJA caused an immune reaction without exposure of the graft, but with bone resorption. However, the rats maintained digital form and alignment with decreased passive flexion and extension of 10–30 degrees.

Absolute or relative stability in minimal invasive plate osteosynthesis of simple distal meta or diaphyseal tibia fractures?

IntroductionMinimal invasive plate osteosynthesis in simple distal meta or diaphyseal tibia fractures can be applied using absolute (lag screw and neutralisation plate; LSN) or relative stability (bridge plate; BP). The primary aim of the study was to compare time to radiological union and time to full weight bearing in the two groups (LSN vs. BP). Reduction was performed either percutaneously or by a minimally open approach (mini open). Secondary aim was to analyse the number of complications between both groups. MethodsRetrospective single centre review of patients with a simple distal meta or diaphyseal tibia fracture operated with a Locking Compression Plate (LCP) between 2009 and 2015 in a Level one Trauma Centre. Postoperative radiographs were assessed in a standardised manner. Time to radiological fracture union and time to full weight bearing were observed. Callus index and postoperative complications were analysed. ResultsFifty-seven patients with a minimum follow-up of 6 months were analysed. Forty-eight patients had a shaft (AO/OTA Type 42) and nine a distal tibia fracture (AO/OTA Type 43). Forty patients were treated with using the LSN concept and 17 patients with the BP concept. Median time to radiological fracture union was statistically significant shorter (p=0.04) in the LSN group with 19 weeks compared to 27 weeks in the BP-group. Time to full weight bearing was 10 weeks in both groups. A total (including implant removal) of 35 reoperations were performed in the LSN-group and 18 in the BP-group. Wound healing disorders (deep surgical site infections) were seen less the LSN group in 3/40 (7.5%) compared to the BP-group with 3/17 (17.6%). In the LSN group, there was no statistical difference in time to union or weight bearing between a percutaneous or mini open approach. ConclusionStable osteosynthesis of simple distal meta or diaphyseal tibia fractures leads to faster radiologic fracture healing without an increase in complications or number of revisions compared to bridge plating. If a percutaneous reduction is not feasible for the insertion of a lag screw, a mini-open approach does not lead to a delay in fracture healing.

Healing of Atypical Subtrochanteric Femur Fractures After Cephalomedullary Nailing: Which Factors Predict Union?

The purpose of this study was to determine the healing rate and time to union of atypical subtrochanteric fractures treated with cephalomedullary nailing. Retrospective review, descriptive, and analytic study. Six level 1 trauma centers. The study included 42 patients with 48 displaced, atypical, bisphosphonate-associated subtrochanteric femur fractures who underwent surgical intervention. Cephalomedullary femur nailing. The main outcome measures were radiologic healing and time to union. The primary healing rate after cephalomedullary nailing of bisphosphonate-associated subtrochanteric femur fractures was 68.7% (33/48 patients). Mean time to union was 10.7 months. Malalignment was determined using the differences in neck-shaft angle (the difference between the normal side and the surgically repaired side) and sagittal angulation. These all proved to be significantly correlated with failure and delayed healing time. The cutoff points for neck-shaft angle, difference in neck-shaft angle, and sagittal angulation were 125.6, 4.4, and 5.5 degrees, respectively (receiver operating characteristic curve analysis). The healing rate of atypical subtrochanteric femur fractures treated with cephalomedullary nailing is lower than that previously reported for atypical femur fractures. The quality of fracture reduction proved to be the most important factor in bony union and time to union. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Evaluation of Outcome of Transpedicular Decompression and Instrumented Fusion in Thoracic and Thoracolumbar Tuberculosis.

Study DesignRetrospective analysis.PurposeWe evaluated the functional, neurological, and radiological outcome in patients with thoracic and thoracolumbar tuberculosis operated through the transpedicular approach.Overview of LiteratureFor surgical treatment of thoracic and thoracolumbar tuberculosis, the anterior approach has been the most popular because it allows direct access to the infected tissue, thereby providing good decompression. However, anterior fixation is not strong, and graft failure and loss of correction are frequent complications. The transpedicular approach allows circumferential decompression of neural elements along with three-column fixation attained via pedicle screws by the same approach.MethodsA total of 47 patients were diagnosed with tuberculosis of the thoracic or thoracolumbar region from August 2012 to August 2013. Of these, 28 patients had progressive neurological deterioration or increasing back pain despite conservative measures and underwent transpedicular decompression and pedicle screw fixation with posterior fusion. Antituberculosis therapy was given till signs of radiological healing were evident (9–16 months). Functional outcome (visual analog scale [VAS] score for back pain), neurological recovery (Frankel grading), and radiological improvement were evaluated preoperatively, immediate postoperatively, and at 3 months, 6 months, and 1 year.ResultsMean VAS score for back pain improved from 8.7 preoperatively to 1.1 at 1 year follow-up. Frankel grading preoperatively was grade B in 7, grade C in 11, and Grade D in 10 patients, which improved to grade D in 6 and grade E in 22 patients at the last follow-up. Radiological healing was evident in the form of reappearance of trabeculae formation, resolution of pus, fatty marrow replacement, and bony fusion in all patients. Mean correction of segmental kyphosis postoperatively was 10.5°. Mean loss of correction at final follow-up was 4.1°.ConclusionsTranspedicular decompression with instrumented fusion is a safe and effective approach for management of patients with thoracic and thoracolumbar tuberculosis.

The outcome of super-cutaneous locked plate fixation with percutaneous reduction of displaced intra-articular calcaneal fractures

IntroductionSupercutaneous (external) fixation with locking plate is utilized for fixation of long bone fractures. One retrospective study for open reduction and supercutaneous fixation of the calcaneus is reported. We prospectively evaluated the use of this method of fixation combined with percutaneous reduction. Materials and methodsBetween January 2014 and June 2015, 32 displaced calcaneus fractures in 30 patients were stabilized with percutaneous reduction and super-cutaneous fixation. They were 24 males and six females. The mean age was 37.9±5.7 years (21–55). All cases were closed. The time to surgery, complications, radiographic alignment, and time to radiographic union were recorded. Clinical results at the final follow-up were assessed by evaluating Bohler’s angles for the radiographic alignment, and the system of the American Orthopedic Foot and Ankle Society (AOFAS) for the functional outcome. ResultsAccording to the Sanders’ classification, two cases were type II, 17 cases were type III and 13 cases were type IV. The preoperative average Bohler’s angle was 10.57°±4.8. The postoperative X-ray films demonstrated that the average Bohler’s angle improved to 29.07°±5.9 (p<0.001). At the time of radiologic healing (about 3 months), the plates and screws were removed under general anesthesia. The average follow-up was 13.2 months (11–18). Four cases (type IV) showed mal-union and heel pain. According to (AOFAS) rating, the fine score was 87.1±17.1 points. ConclusionSuper-cutaneous fixation with percutaneous reduction of calcaneal fracture is an effective method in type II and III and can be effective with type IV but with less favorable results.

The use of locked plate as a definitive fixation for open supracondylar fracture of the femur with partial bone loss in polytraumatized patients

Background Open supracondylar fractures of the femur are complex injuries usually presenting in a polytraumatized patient. Partial circumferential bone loss may result at the time of injury or during debridement. The way in which the fracture is treated has a substantial influence on the local mechanical and biological environment, which in turn will influence the quantity and quality of the osteogenic response. Although early skeletal stabilization can stop the cycle of injury, remove nidus for infection, and halt ongoing hemorrhage, it may be prudent to delay definitive surgery until the patient’s general condition is optimized. Meanwhile, debridement and a preliminary spanning external fixator is used to stabilize the fracture. The use of a locked plate for the fixation of supracondylar fracture of the femur with partial bone loss creates a rigid biomechanical environment needed for healing and maintenance of alignment until fracture healing. Patients and methods Eighteen patients with open supracondylar fracture of the femur were treated between January 2009 and June 2011. All patients were treated surgically within the first 24 h. Radical soft tissue and bone debridement was performed. Thirteen patients underwent definitive fracture fixation using a laterally placed locked distal femur plate. Five patients had their fractures primarily stabilized by an external fixator until improvement of their general condition. Results Bone healing was obvious on follow-up radiographs in 10 patients without the need for supplementary surgical procedures at a mean of 16 (12–20) weeks. Seven patients with no progressive radiologic healing by 20 weeks’ follow-up underwent an iliac crest cancellous bone graft; healing was then realized radiologically after a mean of 12 (8–18) weeks. Using the IOWA knee functional score for final patient assessment, we found excellent results in 14 patients, good results in three patients, and fair results in one patient. Conclusion Generally stable polytraumatized patients should be treated with thorough initial debridement, local antibiotics, and early definitive fracture fixation using a locked distal femur plate. Critically unstable patients with hemorrhagic shock are to be treated with damage control until improvement in their general condition. Bone graft is to be delayed for 20 weeks as many fractures would successfully heal by that time, even with partial bone loss.

A Comparative evaluation of CBCT outcomes of two closed treatment methods in intracapsular condylar fractures

The cone beam computed tomography (CBCT) images of 2 closed treatments are compared for intracapsular condylar fractures (ICFs) to learn whether splint treatment could promote better radiologic outcomes. Fifty-four patients with 60 sides of ICF were divided into 2 groups. In the control group (C-group), patients had a liquid diet for 1month. In the trial group (T-group), patients wore splints with anterior elastic traction. Local CBCT images of the temporomandibular joint were obtained at T0 (mean 8.8days), T1 (mean 37.4days), and T3 (mean 3.3months) after trauma. Six parameters, including 2 horizontal, 1 sagittal, and 3 vertical distances, were calculated using the coordinates of 10 points marked on CBCT sections. Statistical analysis included intragroup comparison at T0, T1, and T3, and intergroup comparison among subgroups classified by age and ICF types. Compared to C-group, vertical distances were significantly changed in T-group, specifically in adults and patients with ICF type B. Significant changes at stage T1 were also observed in T-group. During the natural healing process, ICF healed in the displaced position and the stump tended to move closer to the joint fossa in the vertical dimension. Splint treatment with elastic traction was helpful to increase joint space and promote better radiologic healing shape.

Percutaneous cannulated screw fixation for pediatric epiphyseal ankle fractures.

BackgroundAnkle injuries are among the most common injuries in children. The aim of this study was to compare the efficacies of two percutaneous fixation methods after closed reduction in physeal ankle fractures.MethodsWe reviewed the cases of 24 patients with a mean age of 12.29 years; 16 were male, and 8 were female. Only patients with fractures of Salter-Harris types 2, 3, and 4 with displacements greater than 2 mm were included in the study. Patients were treated with closed reduction manipulation and percutaneous screw fixation. For each patient, either cannulated or headless full threaded compressive screws were used for percutaneous fixation. Radiological and clinical healing time, range of motion (ROM), American Orthopaedic Foot and Ankle Society (AOFAS) score and physeal arrest were then measured.ResultsThe mean follow-up time was 13 months. The mean time until cast removal was 3.5 weeks (range 2–5). A full ROM was achieved at an average of 5.7 weeks postoperatively (range 4–8). The radiologic healing time was 6.1 weeks (range 4–7). The patients’ clinical healing time averaged 6.8 weeks (range 5–8). Differences in radiologic healing time (p = 0.487), clinical healing time (p = 0.192), AOFAS score (p = 0.467), and complication rate (p = 0.519) between patients who received the headless compressive screw and those who received the cannulated screw for fixation were not statistically significant.ConclusionsWe demonstrate good clinical results with closed reduction and the percutaneous screw fixation method. Both cannulated and headless compressive screws can be used safely as a treatment method in physeal ankle fractures.

Nutritional rickets: vitamin D, calcium, and the genetic make-up.

The prevalence of vitamin D (vitD) deficiency presenting as rickets is increasing worldwide. Insufficient sun exposure, vitD administration, and/or calcium intake are the main causes. However, vitD system-related genes may also have a role. Prospective study: 109 rachitic children completed a 6-mo study period or until rachitic manifestations disappeared. Thirty children were selected as controls. Clinical and biochemical data were evaluated at baseline in patients and controls and biochemistry re-evaluated at radiological healing. Therapy was stratified in three different protocols. Fifty-four single-nucleotide polymorphisms (SNPs) of five vitD system genes (VDR, CP2R1, CYP27B1, CYP24A1, and GC) were genotyped and their association with clinical and biochemcial data was analyzed. Therapy response was similar in terms of radiological healing although it was not so in terms of biochemical normalization. Only VDR gene (promoter, start-codon, and intronic genotypes) was rickets-associated in terms of serum 25-OH-D, calcium, radiological severity and time needed to heal. Eight patients with sufficient calcium intake and 25-OH-D levels carried a VDR genotype lacking minor allele homozygous genotypes at SNPs spread along the gene. Although patients presented epidemiologic factors strongly contributing to rickets, genetic modulation affecting predisposition, severity, and clinical course is exerted, at least in part, by VDR gene polymorphic variation.

In vivo clinical and radiological effects of platelet-rich plasma on interstitial supraspinatus lesion: Case series

BackgroundRotator cuff tear (RCT) is a frequent condition of clinical relevance that can be managed with a symptomatic conservative treatment, but surgery is often needed. Biological components like leukocytes and platelet rich plasma (L-PRP) could represent an alternative curative method for interstitial RCT. HypothesesIt has been hypothesized that an ultrasound guided L-PRP injection in supraspinatus interstitial RCT could induce radiological healing. Material and methodsA prospective case series including 25 patients was performed in order to assess the effect of L-PRP infiltration into supraspinatus interstitial RCTs. Primary outcome was tear size change determined by magnetic resonance imaging arthrogram (MRA) before and 6 months after L-PRP infiltration. Secondary outcomes were Constant score, SANE score, and pain visual analog scale (VAS) after L-PRP infiltration. ResultsTear volume diminution was statistically significant (P=.007), and a >50% tear volume diminution was observed in 15 patients. A statistically significant improvement of Constant score (P<.001), SANE score (P=.001), and VAS (P<.001) was observed. In 21 patients, Constant score improvement reached the minimal clinical important difference of 10.4 points. DiscussionWe observed a statistically significant and clinically relevant effect on RCT size and clinical parameters after L-PRP infiltration. Such an important improvement of supraspinatus interstitial RCT with conservative management is uncommon, therefore intratendinous L-PRP infiltrations could have been beneficial. This encouraging result could pave the way for future randomized studies in order to formally determinate whether L-PRP infiltrations are a possible alternative to surgical treatment of interstitial RCT. Level of evidenceProspective observational study; Level of evidence II.

A solution to the vessel shortage during free vascularized fibular grafting for reconstructing infected bone defects of the femur: Bridging with vein transplantation

PurposeThe present study aimed to evaluate the feasibility and clinical efficacy of bridging vein transplantation to deal with the vessel shortage during free vascularized fibular grafting for reconstructing infected bone defects of the femur. MethodsTwelve patients (aged 15–58 years) with infected bone defects of the femur (between 6.0 and 18.0cm) were recruited in this study. Vacuum sealing drainage were applied after extensive debridement of the infected bone defects and irrigated with 0.9% sodium chloride solution for 1–2 weeks. After the drainage was clear and the focal infections were controlled, the free vascularized fibula was harvested for reconstructing the femoral bone defects. The vascularized fibula was grafted and fixated appropriately at the recipient site. The autogenous great saphenous vein was harvested, one end was anastomosed and bridged the vascular pedicles of the fibular grafts, and the other end anastomosed the artery and/or the vein in the recipient healthy site. ResultsMean length of vein transplantation with vascularized fibular graft was 10.2 cm (range 7–15cm). All patients had good radiological healing without recorded nonunion or malunion. No patient developed deep infection or implant failure. Primary bone healing was achieved in 10 patients; however, 2 grafted fibular formed pseudarthrosis with the recipient femoral and then healed after a secondary surgery. One patient suffered from graft stress fracture after bone healing and healed after external fixation. After the mean follow-up of 30 months (9–72 months), according to the Enneking scoring system, clinical outcomes were excellent in 7 patients, good in 4 and fair in one. The functional recovery rate of the lesion limb was 89.4%. ConclusionsFree vascularized fibular graft with vein transplantation bridged vascular pedicle can effectively repair the infected bone, improve blood supply to the bone defect site, and help control infection. It is a feasible and effective treatment for infected bone defects of the femur with poor soft tissue conditions, or blood supply vessel shortage.

Treatment of distal-third clavicular fractures (Neer type II-b) with a triple button device

ObjectiveThe purpose of this study is to describe the outcomes of using a triple button device for the treatment of displaced distal-third clavicle fractures (Neer type II-b). Material and methodA retrospective review was conducted on a series of patients between November 2011 and December 2014. Fourteen patients initially met the inclusion criteria, but 2 were excluded, leaving 12 patients (83.3% male; mean age 32.2 years) for the final analysis at a mean follow-up of 26±11.24 months (range, 12–48). Post-operative follow-up was performed at 2 weeks (two first months), and monthly thereafter, until was achieving clinically and radiological healing. The functional outcome was evaluated using the Constant score, and DASH score in the last follow-up. ResultsThe mean Constant Score was 95.5±5.2 points (range, 85–100), with a mean DASH score of 3.3±4.4 points (range, 0–12.5). The mean time to clinical healing was 10.3±3.1 weeks (range, 8–16), and the mean time to radiological healing was 13.6±2.6 weeks (range, 12–20). There were no major complications. There were 5 minor complications without clinical impact: 2 coracoclavicular calcifications, 1 hypertrophic scar, 1 patient with discomfort due to the device, and 1 superficial wound infection. All patients returned their previous activity. ConclusionGood clinical results can be achieved with the triple button device in unstable distal fractures of the clavicle, without the need to remove the hardware.

The importance of correct diagnosis and treatment in endo-periodontal lesions: a two cases comparison

This paper illustrates two endo-periodontal lesions treated with the same standardized protocols with different prognoses. In the first case, the endodontics and periodontal therapies were performed with clinical and radiological healing of the lesion. In the second case, the tooth had to be extracted because of repeated inflammatory processes. In order to investigate the reasons for failure, the extracted tooth was submitted to clearing process, followed by stereomicroscope observation. It revealed a vertical fracture running along the palatal root, not detectable by radiographic examination. This pathway between pulpal and periodontal tissues determined the negative prognosis of the treatment. CPD/Clinical Relevance: This report aims to highlight how root vertical fractures may not be readily detectable to the standard bi-dimensional radiograph.

Tuberculosis of dorsal and lumbar spine – Posterior decompression &amp; posterior stabilization

Introduction: Vertebral disease is the commonest form of skeletal tuberculosis, accounting for half of the cases. The most frequent sites of involvement are the thoracic and the thoracolumbar spine. Antituberculous chemotherapy remains the mainstay of treatment now that MRI allows early diagnosis. This conservative approach cannot, however, prevent the progression of a kyphotic deformity, and long-term rest is usually required to relieve severe back pain. These problems may be avoided by rigid internal stabilisation of the spine. Treatment options: Various methods have been described for spinal tuberculosis including 1) anterior decompression and fusion, 2) combined anterior and posterior fusion , 3) posterior decompression and fusion alone. Materials and methods: Prospective study done between April 2010 to August 2014. Eight patients had been operated with average age group of 60. Dorsal spine – 1 pt, Dorsolumbar – 5 pts, Lumbar – 2pts. Normal neurology but with kyphosis of 30 degree – 3 pts. ASIA grade B &C paralysis – 4 pts. Grade-A paralysis – 1 pt. Indications for surgery: Failure of conservative treatment and significant kyphotic deformity. Surgical Technique: Pedicle screw fixation done avoiding the infected vertebral segment and the screws were inserted in the adjacent vertebral bodies. Through transpedicular approach, body was approached poster laterally. Costotransversectomy and decompression was done for dorsal spine. If necessary root is sacrificed for better exposure. Next, the disc space was distracted and the infected end-plate, disc and soft tissue were meticulously debrided 1) Interbody fusion was done with bone graft, voids were filled with graft. Short segment stabilization was done with pedicle screw construction. 2) ATT was started. Follow up (Range from 8 months to 2 years) early mobilization from the bed with Taylor brace. Muscle strengthening exercises from 3rd week onwards. Bending after radiological healing. Results: Radiological and clinical improvement was noticed within one month in all patients. 10 degree of vertebral collapse was noticed in one patient. 2 patients – neurological recovery from B, to Grade D. 2 patients – Grade C recovered to Grade E. One patient with grade A didn’t show any improvement. Conclusion: Posterior decompression and stabilization in tuberculosis of dorsal, dorsolumbar and lumbar spine is a very useful alternate procedure. It is very safe surgery with good results, particularly in elderly individuals.

All-arthroscopic AMIC\xae (AT-AMIC\xae) technique with autologous bone graft for talar osteochondral defects: clinical and radiological results

PurposeAutologous Matrix-Induced Chondrogenesis (AMIC®) is known to provide satisfactory clinical results for the treatment of knee, hip, and ankle cartilage lesions. The purpose of this study was to evaluate clinical and radiological outcomes of patients treated with a new all-arthroscopic AMIC® (AT-AMIC®) technique with autologous bone graft for talar osteochondral defects at a follow-up of 24 months.MethodsTwenty patients underwent the AT-AMIC® procedure and autologous bone graft for type III and IV talar osteochondral lesions. Patients were evaluated pre-operatively and at 6, 12, and 24 months post-operatively using the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale, and the SF-12 (Short Form-12). Radiological assessment included computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance observation of cartilage repair tissue (MOCART).ResultsAll scores significantly improved (p < 0.05) with respect to pre-operative values after 6 months. Further improvements were detected at 24 months (AOFAS, from 57.1 ± 14.9 before surgery to 86.6 ± 10.9 after 24 months; VAS, from 8.1 ± 1.4 to 2.5 ± 2.2; SF-12, from 29.9 ± 4.1 to 48.5 ± 6.9 and from 43.8 ± 2.9 to 53.1 ± 3.9, respectively, for Physical and Mental component score). Lesion area significantly reduced from 111.1 ± 43.2 mm2 pre-operatively to 76.9 ± 38.1 mm2 (p < 0.05) at final follow-up as assessed by CT, and from 154.1 ± 93.6 to 94.3 ± 61.3 mm2 (p < 0.05) as assessed by MRI. The mean MOCART score was 42.8 ± 23.5 points and 50.9 ± 24.9 points, respectively, at 12 and 24 months after surgery (p < 0.05).ConclusionsAT-AMIC® with autologous bone grafting has proven to be a safe and effective minimal invasive technique, able to rapidly and significantly improve pain, function, and radiological healing of osteochondral talar lesions, with progressive further improvements up to 24 months. Orthopedic surgeons specialized in foot and ankle surgery should adopt the AT-AMIC® technique for the treatment of osteochondral talar lesions, which proved to be effective and minimally invasive, avoiding malleolar osteotomy with a low risk of complications.Level of evidenceIV.

Results of Bone Peg Grafting for Capitellar Osteochondritis Dissecans in Adolescent Baseball Players

Background: Bone peg grafting (BPG) has been advocated for early-stage humeral capitellar osteochondritis dissecans (COCD). However, the clinical and radiological results of BPG, along with its indications, have not been described in detail. Hypothesis: COCD classified as International Cartilage Repair Society (ICRS) osteochondritis dissecans (OCD) I or II in adolescent baseball players can be treated successfully by BPG. Study Design: Case series; Level of evidence, 4 Methods: Eleven male baseball players (age range at surgery, 13-16 years) who underwent BPG for COCD were enrolled in this study. No improvement had been seen in any patient after 6 months of preoperative nonthrowing observation. During surgery, 2 to 5 bone pegs were inserted into the COCD lesion after confirmation of lesion stability to the bony floor. All patients were directly evaluated at 12 and 24 months after surgery by physical findings, radiological prognosis, and magnetic resonance imaging (MRI). Results: Of the 11 patients, 10 could return to comparable baseball ability levels within 12 months. The Timmerman-Andrews score improved significantly from a mean ± SD of 171.8 ± 12.1 preoperatively to 192.3 ± 6.5 at the final observation. Radiological healing of the lesions was determined as complete in 8 patients and partial in 3. Patients possessing a centrally positioned lesion or a lesion <75% of the size of the capitellum tended most strongly to achieve complete radiological healing, while growth plate status appeared unrelated to outcome. The mean Henderson MRI score improved from 6.3 ± 1.5 to 4.8 ± 1.6 at 12 and 24 months after BPG, respectively. MRI findings also suggested that remodeling of COCD lesions had continued to up to 24 months postoperatively. Conclusion: BPG enabled 91% of COCD patients with ICRS OCD I or II to return to preoperative baseball abilities within 12 months. Integration of the grafted site may continue until at least 24 months postoperatively. An ICRS OCD I or II lesion with central positioning and/or occupying <75% of the size of the capitellum in the coronal plane is a good indication for BPG.

All-Arthroscopic AMIC for Osteochondral Lesions of the Talus

Category: Arthroscopy. Introduction/Purpose: Autologous Matrix-Induced Chondrogenesis (AMIC) technique has shown to provide satisfactory clinical results for the treatment of knee, hip and ankle cartilage lesions. The purpose of this study is to evaluate clinical and radiological outcomes of patients treated with a new All-arthroscopic AMIC (A-AMIC) technique for osteochondral defects of the talus at a minimum follow-up of 24 months (mean f.up, 41 months). Methods: 20 patients underwent A-AMIC procedure for type III and IV osteochondral lesions of the talus. Patients were evaluated pre-operatively and at 6, 12 and 24 months post-operatively using AOFAS score (American Orthopaedic Foot and Ankle Society), VAS (Visual Analog Scale) and SF-12 (Short Form -12). Radiological assessment included CT-Scan and MR. Results: All the scores significantly improved with respect to pre-operative values already after 6 months, with further improvements up to 24 months (AOFAS, from 57.1±14.9 before surgery to 86.6±10.9 after 24 months; VAS, from 8.1±1. to 2.5±2.2; SF-12, from 29.9±4.1 to 48.5±6.9 and from 43.8±2.9 to 53.1±3.9 respectively for PCS and MCS). Lesion size volume significantly reduced from 810±536.3 mm3 pre-operatively to 453±310.6 mm3 at final follow-up as assessed by CT-scan, and from 1251 mm3 to 489 mm3 as assessed by MR. MOCART score (magnetic resonance observation of cartilage repair tissue) was 42.8±22.9 and 50.9±24.9 at 12 and 24 months, respectively. Conclusion: Our study demonstrates that A-AMIC can be considered a safe, scarcely invasive and effective technique able to rapidly and significantly improve pain and function and radiological healing of lesions, with progressive further improvements at least up to 24 months.

Tratamiento de fracturas de tercio distal de clavícula (tipo ii-b de Neer) con sistema de triple botón

ObjectiveThe purpose of this study is to describe the outcomes of using a triple button device for the treatment of displaced distal-third clavicle fractures (Neer, type ii-b). Material and methodA retrospective review was conducted on a series of patients between November 2011 and December 2014. Fourteen patients initially met the inclusion criteria, but 2 were excluded, leaving 12 patients (83.3% male; mean age 32.2 years) for the final analysis at a mean follow-up of 26±11.24 months (range, 12-48). Post-operative follow-up was performed at 2 weeks (two first months), and monthly thereafter, until was achieving clinically and radiological healing. The functional outcome was evaluated using the Constant score, and DASH score in the last follow-up. ResultsThe mean Constant Score was 95.5±5.2 points (range, 85-100), with a mean DASH score of 3.3±4.4 points (range, 0-12.5). The mean time to clinical healing was10.3±3.1 weeks (range, 8-16), and the mean time to radiological healing was 13.6±2.6 weeks (range, 12-20). There were no major complications. There were 5 minor complications without clinical impact: 2 coracoclavicular calcifications, 1 hypertrophic scar, 1 patient with discomfort due to the device, and 1 superficial wound infection. All patients returned their previous activity. ConclusionGood clinical results can be achieved with the triple button device in unstable distal fractures of the clavicle, without the need to remove the hardware.

P334. Evolution of a long-term follow-up cohort of Crohn’s disease with complex perianal fistula: from antibiotic to combined AZA and anti-TNF based treatment ending up clinical and radiological healing with or without stoma

P334. Evolution of a long-term follow-up cohort of Crohn’s disease with complex perianal fistula: from antibiotic to combined AZA and anti-TNF based treatment ending up clinical and radiological healing with or without stoma

Association of plasma cytokines with radiological recovery in pulmonary tuberculosis patients

Objective/BackgroundThe characterization of tuberculosis (TB) patients as slow or fast responders post anti-TB treatment has always been a matter of tremendous interest as slow responders are most likely to relapse and/or develop complications. Pulmonary tissue healing as assessed with radiology is the only available tool for tissue recovery but is not predictive at intake. The objective of the current study was to assess biomarkers associated with fast and slow recovery in TB patients at recruitment. MethodsPulmonary TB patients (N=15) were assessed for radiological recovery serially in parallel with clinical signs and symptoms, hematological parameters, and plasma cytokines at 0months, 6months, 12months, and 24months. On the basis of differential radiological healing, patients were characterized into slow (>12months), intermediate (<12months), and fast (<6months) responders. ResultsBaseline plasma cytokines (interleukin [IL]-2, -4, -6, -10, tumor necrosis factor-α, and interferon-γ) were determined using cytometric bead array. IL-2 and -4 were able to accurately differentiate slow and fast responders into two distinct clusters using hierarchal clustering analysis. Compared with fast responders, slow responders showed significantly high IL-2 and -4 at baseline (p=.001 Mann–Whitney U test). ConclusionIn-depth analysis of cytokines and its association with radiological recovery in TB patients may be useful in monitoring TB patients postchemotherapy for both clinicians and TB control program.