S Bonaga’s research while affiliated with University of Padua and other places

Angiodysplastic lesions of the extremities are very often of great interest for the orthopedist, involving not only bones with length discrepancy, but also joints with hemarthrosis and synovial hypertrophy. We describe 4 patients with cutaneous hemangiomatosis in the lower limb and a concomitant knee arthropathy. Like in other arthropathies, the articular damage is rapidly invasive and leads to progressive damage in the joint if not adequately diagnosed and treated. We treated the 4 patients at different ages, corresponding to different stages of intra-articular involvement. The preoperative management included MRI and diagnostic arthroscopy. All patients underwent an open synovectomy. All our patients were reviewed at a clinical and radiographic follow-up after 10 years. In all patients, the range of motion was improved or at least not worsened after surgery, in spite of a larger extent of cutaneous lesions. X-ray and MRI confirmed clinical data showing no recurrence of the lesion inside the joint and no progression of the articular damage. The clinical outcomes were very good or good in the patients treated early, poorer in the patient operated on at an adult age. The importance of an early and precise diagnosis and of an accurate preoperative planning must be underlined.

Twenty-nine children with fractures of the anterior tibial spine were reviewed from 3, 5 to 32 years after injury (average period of follow-up 12, 8 years). The aim was to assess long-term results regarding the residual articular function and stability. All patients were evaluated clinically and with the Lysholm and Tegner score. Eight of them were tested by KT 1000 Artrometer and Cybex 350. The overall functional results were quite good but four patients (13.7%) reported a subjective knee instability while a condition of objective laxity (positive anterior drawer and Lachman test) was found in eleven (37,9%). Lysholm and Tegner score were worse in most displaced fractures and in older children (over twelve). The results of strumentaI evaluation had evidenced that the fractured knees showed a statistically significant anterior laxity (p<0.05; sig level: 0 0182) and that the average laxity on the affected side was of 7 millimetres (s d.=1 82 mm) against 4.7 millimetres (s.d.=1 25 mm) on the other side. Only one patient had evident muscular weakness while five patients presented paradoxically greater muscular strength of the fractured limb (functional compensation). No degenerative changes or other pathological findings were found in the affected knee at the follow-up X-ray examination.

Traumatic lesions of the triradiate cartilage (TC) are a rare occurrence and at a high risk for premature closure with consequent acetabular dysplasia and subdislocation of the femoral epiphysis. Based on their experience (5 cases: 2 type II and 3 type V according to the Salter-Harris classification system) and on the literature, the authors affirm that the most significant prognostic factors of this acetabular dysplasia are the age of the patient (under 10 years) and the type of lesion (Salter-Harris type V). After emphasizing how difficult it is to make a diagnosis (which is often made later on), the authors take into consideration some traumatic lesions of the pelvis and hip which by means of different mechanisms may influence the TC: fracture of the ilio- and ischio-pubic branches, fracture of the neck and detachment of the proximal epiphysis of the femur, traumatic dislocation of the hip. These lesions are often the only indirect sign of lesion, even severe ones, of the TC, and require accurate diagnostic testing (ultrasonography, CAT, MRI).

The authors report their experience in the treatment of complex fractures of the tibial plateau (epi-metaphyseal and comminuted bicondylar and spinotuberosity fractures) using the Kerboull epiphyseal plate and autogenous cancellous bone grafts if sinking occurs. It is not always possible to perfectly restore joint anatomy and stability. Plate fixation ensures solidity by not exposing the load-bearing axis, eliminating the risk that the tibial plate will later give way and thereby allowing early mobilization and rapid functional recovery of the knee. The authors emphasize the importance of both consensual treatment of possible ligament tears and preservation, when possible, of the meniscus. They claim that the frequent complications can only be prevented by careful preliminary assessment of general and local conditions which may absolutely or relatively contraindicate this type of surgery.

Seventy-one patients treated for fracture of the surgical neck of the humerus by osteosynthesis with Kirschner wires inserted percutaneously were followed up. The method is described in detail, and its indications and limitations are discussed. The clinical and radiographic results were extremely positive, with minimal complications and a much reduced work load on the part of the surgical team.

The authors report the long-term results of the non-surgical treatment of 15 cases of traumatic dislocation of the hip during the growth age, followed-up after an average of 14 years (5-26 years). There were 14 cases of posterior dislocation and 1 case of anterior dislocation (the latter complicated by ischemia due to compression of the common femoral artery), in patients aged from 3.5 to 15 years (average age 11 years). All of the cases were treated by non-surgical reduction under general anesthesia in an emergency situation, and a plaster cast which was worn for 30-55 days. At long-term follow-up the results were evaluated as follows good, with complete healing, in 67% of the cases; fair, with moderate, non-symptomatic radiographic arthritic changes, in 26%; poor in only 1 case (7%) which was complicated by necrosis of the femoral head. Post-traumatic arthrosis and cephalic necrosis were observed in patients aged more than 10 years, and where fracture was associated with the dislocation, indicating trauma of considerable intensity. The duration of immobilization in a plaster cast and no weight-bearing did not influence the results. Traumatic hip dislocation during the growth age has a better prognosis as compared to that occurring during adult age. Particularly favorable prognostic factors are age under 10 years and the absence of fractures associated with the dislocation.

The experience regarding the treatment of bifocal fractures at the Orthopedic Clinic of the University of Padua during a five-year period (1980-1985) is reported. The bloodless method has been abandoned in favor of modern osteosynthesis techniques, which have permitted a shorter healing time, with fewer cases of hospitalization and a more favorable outcome.

The collateral ulnar ligament of the first metacarpo-phalangeal joint was studies in anatomical specimens in order to evaluate the relationship between pathological anatomy of the lesion and joint laxity. The clinical and X-ray evaluation of the valgus stretched joint led to the correct indications for treatment.

The authors consider the conservative treatment of acromioclavicular dislocation and present a revision of 59 cases treated by Desault bandage and thoraco-brachial cast (mean follow up 46 mos). The indications to conservative treatment are pointed out and the good functional results are stressed.

We have inspected 79 heel thalamic fractures, that have been treated conservatively, at an average follow-up of 8.8 years since trauma. In addition to the clinical examination, every patient was subjected to podoscopy and radiographic examination in two projections. The functional result was extremely positive in 80% of cases, without a significant relation with the severity of anatomic deformations, that are almost always present. We conclude therefore that the functional result is only partly related to the entity of clinical and radiographic pictures and that the conservative treatment gave good results in most cases, without the risks of a surgical treatment in this anatomic site.