Gabriele Campochiaro

Morphological study: Ultrastructural aspects of articular cartilage and sub-chondral bone in patients affected by post-traumatic shoulder instability.

Post‐traumatic shoulder instability is a frequent condition in active population, representing one of most disabling pathologies, due to altered balance involving joints. No data are so far available on early ultrastructural osteo‐chondral damages, associated with the onset of invalidating pathologies, like osteoarthritis‐OA. Biopsies of glenoid articular cartilage and sub‐chondral bone were taken from 10 adult patients underwent arthroscopic stabilization. Observations were performed under Transmission Electron Microscopy‐TEM in tangential, arcuate and radial layers of the articular cartilage and in the sub‐chondral bone. In tangential and arcuate layers chondrocytes display normal and very well preserved ultrastructure, probably due to the synovial liquid supply; otherwise, throughout the radial layer (un‐calcified and calcified) chondrocytes show various degrees of degeneration; occasionally, in the radial layer evidences of apoptosis/autophagy were also observed. Concerning sub‐chondral bone, osteocytes next to the calcified cartilage also show signs of degeneration, while osteocytes farther from the osteo‐chondral border display normal ultrastructure, probably due to the bone vascular supply. The ultrastructural features of the osteo‐chondral complex are not age‐dependent. This study represents the first complete ultrastructural investigation of the articular osteo‐chondral complex in shoulder instability, evaluating the state of preservation/viability of both chondrocytes and osteocytes throughout the successive layers of articular cartilage and sub‐chondral bone. Preliminary observations here collected represent the morphological basis for further deepening of pathogenesis related to shoulder instability, enhancing the relationship between cell shape and microenvironment; in particular, they could be useful in understanding if the early surgical treatment in shoulder instability could avoid the onset of OA. Anat Rec, 300:1208–1218, 2017.

Humeral shaft non-union after intramedullary nailing

BackgroundThe humerus shaft is one of the sites with the largest probability of developing pseudoarthrosis after fracture. We present the results of nine patients with atrophic pseudoarthrosis of humeral shaft treated with angular stability plate associated with allograft and platelet-rich plasma (PRP), after a first treatment with intramedullary nail to correct the fracture.Material and MethodsFrom January 2012 to December 2014, nine patients were treated for atrophic pseudoarthrosis (PSA) of humeral shaft treated previously using intramedullary nail; seven humeral diaphysis fractures were located in the middle–proximal third and two in the middle third. In one case, a reverse shoulder prosthesis implant was associated to treat a co-existent rotator cuff massive lesion. The mean time between injury and treatment of non-union was 32 weeks (min 16–max 180); all patients were evaluated with Constant, DASH and UCLA score.ResultsAt the final follow-up (23.7 months), the mean Dash score was 22.25 pt, the Constant score was 64 pt, and the UCLA score value was 27 pt. The average pain value was 2 for the arm interested and 0 into PSA focus. Radiographic healing was obtained at 7 months.ConclusionsThe humeral shaft non-union is an invalidating problem which affects the daily living. Our treatment with plate, cortical bone graft, and PRP can build a high-stability structure that can help healing and graft integration.

Ultrastructural aspects of articular cartilage and sub- chondral bone in patients affected by post-traumatic shoulder instability: preliminary observations

Post traumatic shoulder instability is a frequent condition in young active popula- tion. Notwithstanding a lot of data have been collected on capsular-legament lesions and gleno-humeral defects, no data are available on early ultrastructural ostheo-condral damages that are known to be highly associated with the onset of invalidating pathologies, like osteoarthritis (OA). Thus, the mechanisms of joint instability and the identification of which components in the articular complex are primarily affected in instability are of clinical significance, particularly in the light of deepening knowledge on the onset/development of OA. In the present study, biopsies of the articular cartilage and sub-chondral bone were taken from 10 patients (aged 26-40) underwent surgery in Policlinico of Modena. The withdrawals were immediately fixed and embedded for Transmission Electron Microscopy (TEM). The observations were per- formed in tangential, arcuate, and radial layers of the articular cartilage as well as in sub-chondral bone. TEM observations showed that chondrocytes in the superficial layers (i.e. tangential and arcuate) display normal and very well preserved ultrastruc- ture, probably due to synovial liquid supply; otherwise, chondrocytes in the radial layer (not only in calcified but also in the un-calcified one) show various degrees of degeneration, with cytoplasm partially coerced and variously-sized vacuoles, both signs of suffering; occasionally, in the radial layer, chondrocytes with morphological signs of apoptosis or autophagy were also observed. As far as sub-chondral bone is concerned, osteocytes next the deeper calcified cartilage (within 80-100 micra from the cement line) also show evidences of degeneration, while osteocytes more dis- tant from the osteo-chondral border display normal ultrastructure probably due to the vascular bone supply. In all patients of the study, the ultrastructural features of osteo-chondral complex are not depending on age. The present study represents the first ultrastructural investigation of the articular osteo-chondral complex in shoulder instability, evaluating the state of preservation/viability of both chondrocytes and osteocytes throughout the successive layers of the articular cartilage and sub-chondral bone. These preliminary observations are the basis to understand if the early surgical treatment in shoulder instability could avoid the onset of OA.