C. Chillemi

Epidemiology of isolated acromioclavicular joint dislocation.

Background. Acromioclavicular (AC) joint dislocation is a common shoulder problem. However, information about the basic epidemiological features of this condition is scarce. The aim of this study is to analyze the epidemiology of isolated AC dislocation in an urban population. Materials and Methods. A retrospective database search was performed to identify all patients with an AC dislocation over a 5-year period. Gender, age, affected side and traumatic mechanism were taken into account. X-rays were reviewed by two of the authors and dislocations were classified according to the Rockwoods criteria. Results. A total of 108 patients, with a mean age of 37.5 years were diagnosed with AC dislocation. 105 (97.2%) had an isolated AC dislocation, and 3 (2.8%) were associated with a clavicle fracture. The estimated incidence was 1.8 per 10000 inhabitants per year and the male-female ratio was 8.5 : 1. 50.5% of all dislocations occurred in individuals between the ages of 20 and 39 years. The most common traumatic mechanism was sport injury and the most common type of dislocation was Rockwood type III. Conclusions. Age between 20 and 39 years and male sex represent significant demographic risk factors for AC dislocation.

Primary synovial chondromatosis of the shoulder: clinical, arthroscopic and histopathological aspects

Primary synovial chondromatosis is an uncommon condition, and involvement of the glenohumeral joint is rare. Currently, the recommended treatment is arthroscope-assisted synovectomy and removal of the loose bodies. We report a case with the clinical findings, radiographic features, arthroscopic technique for treatment of this disease and the main histological appearance of the removed loose bodies. We believe this is an easy and safe method for management of this disorder and that the support of an experienced pathologist is necessary to avoid differential diagnostic problems with the uncommon malignant transformation.

Muscle Involvement in Rheumatoid Arthritis: An Ultrastructural Study

An electron microscopic investigation has been carried out on muscle bioptic samples from patients affected by rheumatoid arthritis (RA). This study was undertaken to seek further ultrastructural alterations affecting striated muscles in RA pathology. Bioptic samples were collected on a total of 30 surgical interventions of hip (10), knee (8), and foot (12). This yielded three muscle types: gluteus maximus, vastus lateralis, and extensor digitorum communis. Muscle samples from 12 patients with no RA stigmata, selected to match RA patients by age and gender, constituted the control group. Tissue samples were prepared both for conventional histochemical methods and according to conventional electron microscopic procedures, including morphometric analysis. Although to a different extent in each sample, in muscles from RA vs. controls the authors observed the simultaneous presence of discrete muscular alterations such as wider separation of myofibrils, myelin figures, dilated sarcotubular system, pleomorphic mitochondria, myofibril flaking, and lipofuscin deposition in the subsarcolemmal region. In addition to a progressive atrophy, the above findings are suggestive of rheumatoid myositis and lend further support to the still poorly documented presence of an idiopathic inflammatory myopathy and inclusion body myositis associated with RA.An electron microscopic investigation has been carried out on muscle bioptic samples from patients affected by rheumatoid arthritis (RA). This study was undertaken to seek further ultrastructural alterations affecting striated muscles in RA pathology. Bioptic samples were collected on a total of 30 surgical interventions of hip (10), knee(8), and foot (12). This yielded three muscle types: gluteus maximus, vastus lateralis, and extensor digitorum communis. Muscle samples from 12 patients with no RA stigmata, selected to match RA patients by age and gender, constituted the control group. Tissue samples were prepared both for conventional histochemical methods and according to conventional electron microscopic procedures, including morphometric analysis. Although to a different extent in each sample, in muscles from RA vs. controls the authors observed the simultaneous presence of discrete muscular alterations such as wider separation of myofibrils, myelin figures, dilated sarcotubular system, pleomorphic mitochondria, myofibril flaking, and lipofuscin deposition in the subsarcolemmal region. In addition to a progressive atrophy, the above findings are suggestive of rheumatoid myositis and lend further support to the still poorly documented presence of an idiopathic inflammatory myopathy and inclusion body myositis associated with RA.

Grammont inverted prosthesis for the treatment of cuff tear arthropathy: a 6-year follow-up study.

This study evaluated mid-term functional results of the Grammont inverted prosthesis for the treatment of shoulder osteoarthritis associated with massive cuff rupture. Twenty-eight patients with a minimum of 6 years of follow-up were evaluated. Clinical evaluation was performed on all patients preoperatively and at follow-up using the Constant score. Radiologic assessment included radiographs and magnetic resonance imaging preoperatively and radiographs at follow-up. Constant score improved from 27.4 preoperatively to 64.6 postoperatively. The inverted prosthesis is attractive and remains one of the options for treating cuff tear arthropathy. However, glenoid loosening remains a serious problem.

Regnauld Procedure in the Surgical Treatment of Metatarsalgia: Interpretation of Follow-Up X-Ray Imaging

In lesser ray metatarsalgia (rays 2 through 5) due to an altered Lelievres metatarsal formula (depending on the respective lengths of the metatarsals), the resection of metatarsal heads aims at restoring a correct metatarsal support. This being a destructive procedure, metatarsal head resection is best indicated in the treatment of severe forefoot deformities such as those resulting from rheumatoid arthritis. In all metatarsalgias that recognize biomechanical origin, the enclavement procedure, according to Regnaulds original report, should be preferred. The aim of this study is analysis of the radiographic evolution of the metatarsal epiphysis following the Regnauld procedure on the basis of anatomic and pathological events occurring during the attachment process. The procedure was performed on 31 feet and the patients were followed-up for 24 months postoperatively. The enclavement process evolved favorably in all cases. It consists of four anatomic/pathologic phases corresponding to typical radiographic features. While graft consolidation is achieved in 3 to 4 months postoperatively, complete recovery of the metatarsal bony architecture and functional adaptation requires 18 to 24 months.

Kienböck's disease with negative ulnar variance: surgical treatment with ulnar lengthening

Abstract The aim of the study was to analyse the results of surgical treatment of ulnar lengthening in patients with negative ulnar variance and Kienböcks disease. We report 5 case treated from 1994 to 1998. We evaluated pain, range of motion, functional disability and the progression of the disease by radiologically assessing the lunate and the ulnar variance. The minimum follow-up was 3–5 years. The patients treated by ulnar lengthening had no pain and obtained a good range of motion. No ulnar nonunions were reported and only one patient had residual ulna minus variant at follow-up examination. We recommend an ulnar lengthening procedure for patients with negative ulnar variance and Kienböcks disease.