Purpose: The purpose of this study is to analyze the anatomo-radiological results, the clinical results, and complications of minimally displaced fractures of the proximal humerus, treated by immediate, ambulatory self-passive mobilization, followed by a strengthening and propioceptive training program.

Materials and Methods: 12 patients, 7 females and 5 males, mean age 56.91 (SD: 15.76) were reviewed retrospectively at a mean of 28.33 months follow-up. All the patients were mobilized the day after the first visit, i.e. the day after the fracture in 7 patients (58.3%), up to 7 days after the fracture in 4 patients and 3 weeks after the fracture in one late referral. Over an average period of 5.8 months, an average 45.41 (SD: 20.83) sessions of rehabilitation, with a therapist, for each patient, were recorded. The patients were recommended to perform four sessions of self rehabilitation a day. Clinical evaluation included a questionnaire covering subjective evaluation, Activities of Daily Living (ADL) by means of the ASA index and the Constant’s score, and type and duration of rehabilitation. The radiological evaluation included review of the X-rays, from the initial traumatic event to the last follow up X-ray. An AP view with three rotations, outlet view and axillary view were performed for each patient. The fracture type, displacement, interval for union, glenohumeral osteoarthritis (according to the Samilson classification), type of acromion and osteoporosis, were recorded. Special attention was paid in detecting joint stiffness, algodystrophy, neurological impairment, malunion, further displacement, signs of avascular necrosis and post-traumatic osteoarthritis.

Results: The mean non adjusted Constant’s score at last follow up was 88.33 over 100 (SD: 11.45) an average of 96.01% compared to the contralateral side. 83% of patients were pain free, and 17% reported mild pain. Active motion was very satisfactory averaging 96.23% in forward flexion, 89.86% in external rotation with the hand at the side, and 90.22% in external rotation at 90° abduction, and a difference of 1.46 vertebral levels in active internal rotation, as compared to the contralateral shoulder. Passive motion was also analyzed in the same way. Power of the affected shoulder in forward elevation was on average 90.19% of the contralateral side. Impingement was tested by the Neer, Hawkins and Yocum signs: 4 patients (33.3%) reported at least one positive sign of impingement. The Jobe and Palm up tests were negative in 100% of patients. 11 patients were very satisfied and 1 patient satisfied. Joint stiffness developed in one case (8.3%), with 100° of forward elevation, 50° external rotation with the hand at the side, 50° external rotation at 90° abduction. No algodystrophy, no neurological impairment, no further displacement, no signs of avascular necrosis, no post-traumatic progression of osteoarthritis, were observed in any case. Union was achieved in all the 12 patients, in 2 cases with some degree of angulation.

Conclusions: Very good functional and radiological results were obtained with immediate passive mobilization of minimally displaced fractures of the proximal humerus. It is a safe method as all the fractures united and the rate of complication was very low especially without joint stiffness or RSD and with very good patient satisfaction.

Background: Osteoarthritis (OA) is a common phenomena in the population. About 80% of the patients more than 55 years of age have reontgenographic signs of OA, while 25% have clinical signs. Eventually OA leads to joint destruction, which may necessitate joint replacement.

Aims: Our goal was to evaluate the synovial reaction in 10 patients who suffered from arthritis and thus underwent total knee replacement operation.

Methods: Ten patients with arthritis of the knee joint (8 with OA and 2 with rheumatoid arthritis (RA) who underwent total knee replacement were evaluated.

Age ranged between 66 and 79 years (mean 71 years). A control group consisted of 6 cadaver knees (mean age 31 years) with no previous history of knee problems.

All the patients in the research group were graded functionally for their knee score by the system of Hospital for Special Surgery Functional Score.

Additional plain X-ray score on a three point scale was performed. During surgery macroscopic changes on the articular surface of all three compartments were recorded on a four point scale. Synovial specimens were taken from each compartment for microscopic examination.

Results: In the research group the average knee score was 54. The macroscopic changes were found predominantly in the medial compartment. No correlation was found between microscopic and histological changes in the synovia. However, a statistically significant correlation between radiological changes in the medial and lateral compartments and macroscopic changes was noted. In the OA patients the ratio of T to B cells was 60% in favor of the B cells, in contrast to RA which was 75% in favor of T cells. In the control group the common find-ing was a thickened sub-synovial fat layer in the patello-femoral (PF) compartment.

Conclusions: Inflammatory reaction in the synovia is graded by the lymphocytic infiltration into the synovia. In OA this is usually mild. However, the predominant reaction is fibrosis. There is no correlation between this fibrotic reaction and overt radiological or macroscopic findings. The thick subsynovial fat layer found in the PF compartment in the control group has not been described previously in the literature and should be the focus of further investigations.

In vitamin D-fed chicks 1,25-dihydroxyvitamin D3 and 24,25-dihydroxyvitamin D3 were implanted into experimentally-produced fractures of the mid-tibia. The mechanical and biochemical properties of the tibia were evaluated for two weeks, including torsion tests, measurement of alkaline phosphatase activity, 45Ca incorporation, and Ca2+ content. Both dihydroxylated metabolites of vitamin D3 had a direct effect on endochondral bone formation. 24,25(OH)2D3 strengthened the callus, and raised alkaline phosphate activity in the first seven days after fracture. 1,25(OH)2D3 decreased the strength of the callus concomitant with a reduction in 45Ca incorporation. It is suggested that local application of 24,25(OH)2D3 into fractures may accelerate healing and prevent non-union.

The levels of the active metabolites of vitamin D were measured in the callus and in the epiphyseal growth plate of chicks given radioactive cholecalciferol during fracture healing. Those levels were correlated with the histological findings. Three groups of chicks were studied: a control group with no fracture, chicks with fractures fixed by Kirschner wire, and chicks with unfixed fractures. A significant increase in the levels of the active metabolites was found in the callus during the first few days after fracture. The levels of 25-hydroxycholecalciferol [25(OH)D3] and of 24,25-dihydroxycholecalciferol [24,25(OH)2D3] were higher when there was no fixation, while those of 1,25-dihydroxycholecalciferol [1,25(OH)2D3] were higher after fixation. The concentrations of these metabolites in the proximal epiphysis of the tibia were similar to those found in the callus. Based on these findings it is suggested that the active metabolites of vitamin D are directly involved in the process of fracture repair.

Premature fusion of the triradiate cartilage was obtained surgically in 10 three-week-old rabbits, and compared with isolated fusion of the ilio-ischial and of the ilio-pubic limbs of the triradiate cartilage in two further groups of 10 rabbits. Complete fusion caused acetabular dysplasia five weeks after operation in all animals and hip dislocation at nine weeks in half of them; ilio-ischial fusion had a comparable effect. Ilio-pubic fusion had only a minimal effect on acetabular development. The posterior position of the ilio-ischial limb in the acetabulum and its predominance in the formation of the triradiate cartilage in quadrupeds may have contributed to its decisive effect on acetabular development.