PubMed · 13242607
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R S SIFFERT. 1955. Experimental bone transplants.. https://pubmed.ncbi.nlm.nih.gov/13242607/
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This study describes a new method for the treatment of osteochondritis dissecans (OCD) in the medial talar dome. Ten cadaveric lower extremities were used to develop and evaluate a retrograde osteochondral grafting technique applying computer-assisted surgery. With the help of a computed tomography (CT)-based navigation system, a guide wire was placed from the lateral talar process into the posteromedial talar trochlea where OCD lesions are predominantly located. Cannulated reamers and arthroscopic shavers were used for the preparation of the recipient hole. The grafts, with diameters of 4.5 mm, 6.5 mm or 8.5 mm were harvested from the lateral femoral trochlea and inserted in a retrograde fashion. The last five cadavers were analyzed for accuracy of surface reconstruction and graft stability. For this purpose a medial malleolar osteotomy and a CT scan was performed. We found steps in the joint surface to range from 0.5 mm to 1.5 mm (mean 0.9 mm, SD 0.4) with the graft always below the surrounding cartilage. Graft subsidence occurred at an applied force of 26.4 +/- 4.6 N. This study indicates that osteochondral cylinders can be inserted in a retrograde fashion to reconstruct the posteromedial talus. Good surface congruency and sufficient graft stability can be achieved.
INTRODUCTION: Chondrosarcomas are malignant tumours and need to be treated aggressively including ablative surgery. Bovée et al. and Mankin have recently drawn attention to a less aggressive behaviour of chondrosarcomas of the phalanges compared with those of other localizations including the metacarpals. MATERIALS AND METHODS: An 12 year follow-up of a patient with a chondrosarcoma of the middle phalanx of the index finger is presented. The lesion was curetted initially, and a repeat curettage was performed 4 years later. Finally, 8 years later the phalanx was excised and reconstructed with an osteocartilaginous allograft. Histologically, the lesion changed from a chondrosarcoma grade I to grade II. RESULT: The patient continues to be free of recurrence and metastases 4 years after the final resection. CONCLUSION: The potential for systemic disease of chondrosarcomas of the phalanges is probably much lower than in chondrosarcomas of other localizations, and therefore digit-sparing techniques may be considered rather than ablative procedures.
Pain drawings have been used in spine surgery for diagnostic use and psychological evaluation of fusion candidates; they have rarely been used to evaluate pain status after spinal fusion. This study is a 5-year follow-up on a randomised clinical trial assigning patients to posterolateral spinal fusion with or without pedicle screw instrumentation. Patients were mailed a pain drawing and questionnaires including questions regarding work, social status, smoking status, the Dallas Pain Questionnaire (DPQ), and the Low Back Pain Rating Scale (LBPRS). Pain drawings were scored using a visual inspection method and a surface-based point scoring and evaluated for the presence of donor site pain. Pain drawings from 109 patients (87% of the initially included patients), 56 men and 53 women, mean age at follow-up 51 years, were analysed. Fifty-three patients had undergone an instrumented fusion and 56 a non-instrumented fusion. Some presence of low back pain was marked by 79% and leg pain by 69%. Sixty-two percent of the pain drawings were classified as "organic" and 38% as "non-organic". There was no difference between the instrumented and the uninstrumented group. DPQ and LBPRS scores were higher in the non-organic group ( P=0.007). Using the point scoring, no difference between the instrumented and the uninstrumented group was seen. The results of the point scoring were found to correlate with the DPQ and LBPRS scores ( P=0.001). Working patients (39%) had significantly better scores than the rest. Ten percent of the patients had donor site pain. Twenty percent of spinal fusion patients are totally pain free at 5-year follow-up. Ten percent still experience donor site pain. In general, instrumentation does not affect the amount and localisation of pain 5 years after lumbar spinal fusion surgery. The pain drawing seems to be a valuable tool when following spinal fusion patients, but its use as prognostic marker in connection with fusion surgery needs further investigation.