Aim: Tissue injury leads to platelets migration and release of growth factors (GF): Platelet-Derived GF (PDGF) and Transforming GF-beta (TGF-b) that are particularly important for the bone repair process. The purpose of our study is to evaluate the new bone formation with the use of AGF-bone graft combination and to estimate the concentrations of PDGF-AB and TGF-b2 during the procedure.

Methods: AGF-bone graft combination was used in 34 patients with long bone defects (24) and spinal fusion (10). TGF-b2 and PDGF-AB concentrations were assessed in samples from blood. Aliquots were taken at each stage of AGF preparation (whole blood, buffy coat, AGF, wound drain) and analyzed for TGF-b2, PDGF-AB concentration and platelet counts. ELISA was performed to quantify concentrations of active PDGF-AB and TGF-b2. Postoperative evaluation was clinical and radiological (radiographs, tomograms, QCT).

Results: Mean follow up time was 9 months. Signs of bone union were apparent in radiographs 3–6 months after the index procedure. Average platelet count increased from 212x106 cells/ml to 680x106 cells/ml (buffy coat) and to 1280x106 cells/ml (AGF concentrate), resulting in a 604% increase. A 480% increase of PDGF-AB levels and a 320% increase of TGF-b2 levels in AGF concentrate comparing to whole blood levels was determined. TGF-b2 and PDGF-AB levels were also detected in samples collected from the wound drains, in increased levels comparing to the AGF concentrates.

Conclusions: In all cases the clinical results were very encouraging with augmented osteogenesis, whereas the laboratory results (increased values of TGF-b2 and PDGF-AB in subsequent stages of the procedure) practically predicted the clinical success.

Purpose: We present the results of subacromial decompression and repair of the rotator cuff through a minimal deltoid-on approach.

Material and Method: Eighty-seven patients with longstanding shoulder pain were evaluated in two years (1999–2000) in our department. In sixty -eight of them symptoms were due to impigment syndrome. Eight patients with follow up time less than six months were excluded from this study, twenty were treated conservatively and the remaining forty (22 female, 18 male, mean age 50.3) underwent surgery. Three x-ray views were obtained in all patients, i.e. standard AP, true AP, and subacromial space projection. MRI was also obtained in all patients. MRI revealed calcific tendinitis in fifteen patients, osteophytes of the acromioclavicular joint in thirteen, a hooked (type III) acromion in ten and partial tear of the supraspinatus tendon in nineteen. In five of them there was also a partial tear of the infraspinatus. Finally, seven patients were suffering of a full thickness tear of the supraspinatus tendon. All patients were operated through a minimal deltoid-on approach. Acromioplasty and coracoacromial ligament dissection was performed in all. In patients with osteoarthritis of the acromioclavicular joint, osteophytes were carefully removed. Calcific deposits were also removed in all patients. In eighteen patients tears of the rotator cuff were detected and repaired using bone anchors.

Results: All patients were examined six months postoperatively. Results were evaluated with CONSTANT SCORE and with a questionnaire for patient’s satisfaction. Thirty-seven patients were very satisfied with the result and three were satisfied. As for Constant score, pain improved at an average of 7.8 points, daily activities by 5.4, and range of movement by 4.2 points. Results were evaluated by the examiner as excellent in thirty-six patients (90%) and very good in four patients.

Conclusion: Deltoid-on approach, in patients with impingement syndrome of the shoulder provides adequate exposure for the surgical repair with minimal trauma and a very low rate of complications.

Purpose: The purpose of this study was to evaluate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) isolates in the Orthopaedic Department of a new University Hospital, two years from its opening.

Material and Methods: Forty-three consecutive S. aureus isolates, collected from cultures (pus 90%) from consecutive orthopaedic inpatients were included in the study. Resistance to antimicrobial agents was assessed by the disk diffusion method. The mecA-gene was detected by PCR assay, whereas molecular typing of the isolates was performed by PFGE.

Results: Only 5 of the 43 strains (11.6%) expressed high level resistance to oxacillin (MIC ≥ 64mg/L). All these isolates possessed mecA-gene and exhibited resistance, except oxacillin, to more than four classes antimicrobial groups. The remaining 38 isolates (34 beta-lactamase positive) were susceptible to oxacillin (MIC ≤ 2mg/D, and expressed a less resistant type than that of MRSA. Molecular typing by PFGE showed apparent heterogeneity among isolates and the absence of predominant clones. Conclusions: The 11.6% prevalence of MRSA is well below the reported average in the literature. Apparently the isolates originated from different sources of contamination. All patients had previous hospitalizations, where they acquired the infections and subsequently transferred the MRSAs to our department.

Precautions and measures taken in the wards limited the spread and dissemination of the isolates as demonstrated by the heterogeneity and the absence of predominant clones. These findings further reiterate the value of the low-cost, standard preventive procedures to control nosocomial infections in a high-risk orthopaedic department.

Purpose: We assessed the consequences of the permanent lesions after multiple compartment syndrome of the tibia. We also assessed the socioeconomic consequences during the period of secondary operations and rehabilitation.

Material and Methods: We followed 20 prospective patients (pts) who were referred to our department after multiple compartment syndrome of the tibia. We present the patiens’ causes, the socioeconomic consequences and the way the condition affects the quality of patiens’ lives. We also assessed the morbidity of the patients and we present the number and the severity of the reconstructive operations which were needed.

The cause was RTA in 13 pts, accident at work in six and in one patient the result of a reconstruction osteotomy and external fixation. The opening of the compartments was done in nine pts but in two of them we caught the condition at an early stage on time. The consequences were a dropped foot in 13 pts, a club foot in two pts, cavus foot in eight pts, clawing of toes in 13 pts, ankle stiffness in six pts, plantar numbness anaesthesia in 12 pts, plantar callosities in five pts and chronic infections in eight pts. The number of reconstructive operations was from one to ten with a hospitalization duration from one month to five years. Only two pts were able to work an easy job and two pts went back to their previous job, those in whom we had opened the compartments in time. In one pts an amputation below the knee was done. The rest of the pts are unemployed or work as assistant.

Conclusion: The permanent lesions after a multiple compartment syndrome of the tibia are very serious for the functioning of the limb, the quality of the pts’s live life and their work. It is very important to prevent this condition by opening all compartments in time (or at a very early stage).

We evaluated the clinical outcome of IM nailing for the treatment of femoral shaft pseudarthrosis in patients who had multiple failed plate osteosyntheses. From January 2000 untill April 2001, 20 (19 male-1 female, mean age 28) patients were treated because of femoral shaft non-union in our institution. All patients had two or more failed plate osteosyntheses. There were no septic non-unions in this group. Eight patients had an established non-union on an average of nine months post-op and the remaining eleven had radiological and clinical evidence of implant failure. There was no segmental bone loss, hi all patients the implants were removed and nailing was performed. Extensive periosteal stripping, bone necrosis and soft-tissue scaring were constant findings in all patients. Twelve patients received interlocking nails. Eight femurs were grafted with iliac crest bone graft. All patients were followed by serial x-rays until union.

There were no postoperative complications. All pseudarthroses were healed within an average of 9.7 months (8–12). Non-unions which received bone graft (eight out of twenty) in day one, were healed faster than those which didn’t. There were no re-operations among these patients. Among the remaining ten patients five were grafted five to six months postoperatively and three had had nail dynamization.

IM nailing for femoral shaft non-unions after multiple failed plate osteosyntheses is a safe and effective method of treatment. Autologous bone graft reduces healing time and re-operation rate.

Purpose: The efficacy of nasal salmon calcitonin (CT) in preventing bone loss after a hip fracture and in reducing the incidence of further contralateral hip fractures was evaluated.

Material and Methods: Fifty women aged 70–80 years who sustained a pertrochanteric fracture were randomly allocated to Group A (200 IU of nasal salmon calcitonin daily for three months) and Group B (placebo). Biochemical bone markers (1st, 7th, 15th, 45th and 90th day post injury) and bone mineral density of the lumbar spine and the intact contralateral hip (4th and 90th postoperative day, and one year after the fracture) were measured.

Results: Patients in the calcitonin group showed statistically significantly higher total (p< 0,005) and bone alkaline phosphatase (p< 0,002) and osteocalcin (p< 0, 05) levels on the 15th day, while statistically significantly lower uCTX values on the 15th (p< 0,045), 45th (p< 0,002) and 90th (p< 0,002) day and uHpr/Cr values on the 15th (p< 0,015) and on the 45th (p< 0.05) day post injury. In the placebo group patients showed a statistically significant reduction (all p values < 0.05) of bone density values at 3 months and one-year post surgery while in the calcitonin group no significant changes from baseline. When the two groups were compared, patients in the calcitonin group showed statistically significantly higher bone mineral density values (all p values < 0.05), in all recorded sites, at 3 months and one-year post operatively. After a four years clinical follow-up, five patients (5/25, 20%) sustained a new fracture of the contralateral hip in the placebo group.

Conclusion: Nasal salmon calcitonin prevented early bone loss in these patients and may have a protective role on the occurrence of a new fracture of the contralateral hip in the same patient.