Large skeletal defects of the upper extremity pose a serious clinical problem with potentially deleterious effects on both function and viability of the limb. Recent advances in the microsurgical techniques involved in free vascularized bone transfers for complex limb injuries have dramatically improved limb salvage and musculoskeletal reconstruction. This study evaluates the clinical and radiographic results of 18 patients who underwent reconstruction of large defects of the long bones of the upper extremity with free vascularized fibular bone grafts. Mean patient age was 27 years (7-43 years) and mean follow-up was 4 years (1-10 years). The results confirm the value of vascularized fibular grafts for bridging large bone defects in the upper extremity.
SummaryBacteria have been found to grow predominantly in biofilms. The initial stage includes the attachment of bacteria to the substratum. Bacterial growth and division then leads to the colonization of the surrounding area and the formation of the biofilm. The environment in a biofilm is not homogeneous; the bacteria in a multispecies biofilm are not randomly distributed, but rather are organized to best meet their needs.Although there is an initial understanding on the mechanisms of biofilm-associated antimicrobial resistance, this topic is still under investigation. A variety of approaches are being explored to overcome biofilm-associated antimicrobial resistance. A greater understanding of biofilm processes should lead to novel, effective control strategies for biofilm control and a resulting improvement in patient management.
Fourteen cases of an anterior inferior angle fracture of the axis treated in the Orthopaedic Department of the University of Athens from January 1970 to December 1992 were analysed. The mean follow-up time was 8.5 years. The so-called "tear drop" fracture of the axis composes a special entity characterised by an avulsed fragment, of varying size, from the anterior inferior angle of the body of the axis as a result of hyperextension. This type of injury is not a frequent one, representing 3% of the cervical spine trauma in our Department. There were eight men and six women with a mean age of 47 years. Road traffic accident is by far the most common mode of aetiology. The stability of this lesion is questioned by certain authors, resulting in disagreement concerning the choice of treatment to be followed. All the patients in our series were treated conservatively, consisting at the beginning with Glisson traction and then the use of a simple cervical collar. The rotation of the detached fragment, its anterior displacement, the posterior displacement of the vertebral body as well as the presence of instability at the C1-3 levels were analysed. The high incidence of co-existing lesions at the same or at a more distal level is discussed. This study revealed that there was no significant displacement of the vertebral body, and thus disturbance of the posterior ligaments, rendering the fracture stable.(ABSTRACT TRUNCATED AT 250 WORDS)
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