The mechanical strength of connective tissues is dependent on the integrity of their fibrillar collagen frameworks. The objective of the present study was to assess type-II collagen damage (denaturation) in the adult human intervertebral disc compared with articular cartilage, in order to determine whether damage to this molecule may vary in different anatomical sites in the same person. A new immunochemical assay was used to measure the amounts of denatured and total type-II collagen in the annulus fibrosus and nucleus pulposus of the L5-S1 disc and in cartilage from the femoral condyles of the same individuals (n = 7). Denaturation of type-II collagen was significantly higher in both the annulus fibrosus and the nucleus pulposus than in articular cartilage. Such increased damage to type-II collagen in the adult disc may have relevance to the more pronounced degenerative changes observed in this tissue compared with articular cartilage.
ABSTRACT. The cause of postoperative failure after the treatment of femoral intertrochanteric fracture with proximal femoral nail antirotation (PFNA) was analyzed, and the reoperative methods were examined. Nine failures of 308 femoral intertrochanteric fracture patients with PFNA were treated with femoral prosthesis total hip replacement (THR) and reoperative internal fixation. All nine patients were analyzed to determine the cause of failure. The causes of failed internal fixation in the intertrochanteric-fractured patients included perforation of the helical blade into the hip joint in three cases, cuttingout of the helical blade exit outside in two cases, and hip varus as a result of cutting-out the helical blade in two cases. Seven patients with failed internal fixation were treated with THR. Two patients who had femoral shaft fractures at the end of the nail were treated with longer PFNA. Faulty operative procedures, unsatisfactory reductions, serious osteoporosis, and incorrect positioning of the helical blade were the most important factors responsible for the failed internal fixation. Satisfactory results were achieved with THR and refixation relative to the causes of the failed internal fixation.
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