Aims

To assess the impact of the declaration of the state of emergency due to the COVID-19 pandemic on the number of visits to a traumatology emergency department (ED), and on their severity.

Mesenchymal stem cells (MSCs) are self-renewing, multipotent cells that could potentially be used to repair injured cartilage in diseases. The objetive was to analyze different sources of human MSCs to find a suitable alternative source for the isolation of MSCs with high chondrogenic potential.

Femoral bone marrow, adipose tissue from articular and subcutaneous locations (hip, knee, hand, ankle and elbow) were obtained from 35 patients who undewent different types of orthopedic surgery (21 women, mean age 69.83 ± 13.93 (range 38–91) years. Neoplasic and immunocompromised patients were refused. The Ethical Committee for Clinical Research of the Government of Aragón (CEICA) approved the study and all patients provided informed consent. Cells were conjugated wiith monoclonal antibodies. Cell fluorescence was evaluated by flow cytometry using a FACSCalibur flow cytometer and analysed using CellQuest software (Becton Dickinson). Chondrogenic differentiation of human MSCs from the various tissues at P1 and P3 was induced in a 30-day micropellet culture [Pittenger et al., 1999]. To evaluate the differentiation of cartilaginous pellet cultures, samples were fixed embedded in paraffin and cut into 5- υm-thick slices. The slices were treated with hematoxylin-eosin and safranin O (Sigma-Aldrich). Each sample was graded according to the Bern Histological Grading Scale [Grogan et al., 2006], which is a visual scale that incorporates three parameters indicative of cartilage quality: uniform and dark staining with safranin O, cell density or extent of matrix produced and cellular morphology (overall score 0–9). Stained sections were evaluated and graded by two different researchers under a BX41 dual viewer microscope or a Nikon TE2000-E inverted microscope with the NIS-Elements software. Statistics were calculated using bivariate analysis. Pearson's χ2 or Fisher's exact tests were used to compare the Bern Scores of various tissues. To evaluate the cell proliferation, surface marker expression and tissue type results, ANOVA or Kruskal-Wallis tests were used, depending on the data distribution. Results were considered to be significant when p was < 0.05.

MSCs from all tissues analysed had a fibroblastic morphology, but their rates of proliferation varied. Subcutaneous fat derived MSCs proliferated faster than bone marrow. MSCs from Hoffa fat, hip and knee subcutaneous proliferated slower than MSCs from elbow, ankle and hand subcutaneous. Flow cytometry: most of cells lacked expression of CD31, CD34, CD36, CD117 (c-kit), CD133/1 and HLA-DR. At same time 95% of cells expressed CD13, CD44, CD59, CD73, CD90, CD105, CD151 y CD166. Fenotype showed no differences in cells from different anatomic places. Cells from hip and knee subcutaneous showed a worst differentiation to hyaline cartilage. Hoffa fat cells showed high capacity in transforming to hyaline cartilage.

Cells from different anatomic places show different chondrogenic potential that has to be considered to choose the cells source.

Introduction. Progenitor cells with osteochondrogenic potential have been identified within adipose tissue. These cells present diversity of characteristics that can be explained by differences in tissue origin, isolation methods and culture conditions. Mesenchymal stem cells (MSC) have been isolated from many tissues. MSC have been shown to exhibit tissue protective and regenerative properties.

Methods. Hoffa’s fat samples were obtained from four patients (mean age 44 years), five rabbits (New Zeland aged 12 weeks) and five sheeps (Rasa aragonesa aged 22 weeks). Cells were obtained by means of enzimatic and mechanical digestion. The suspension was centrifuged and washed twice with phosphate buffered saline. The resultant pellet was resuspended and plated in culture medium (37°C, CO2 5%). Cellular markers were studied with specific monoclonal antibodies (CD13, CD44, CD49d, CD90, CD105, CD117).

Results:

Human cells: CD13+ (94–99%), CD44+ (87–99), CD49d (14–70%), CD90+ (92–99%), CD105+ (90–97%), CD 117-BD+ (2–22%).

Conclusions: MSC from human, rabbits and sheeps present differences in cellular concentration and markers.

Dimensions of the 60 male human lumbar vertebrae were quantified on their digitalised lateral images, and related to them across the five vertebral levels (range of 20–40 years). Vertebra dimensions’ were defined and referred to the upper endplate. Linear dimensions (mm) were: the length of the whole vertebra and of the spinous process; the anterior/posterior body heights, and the upper/lower endplate lengths. For each of the measurements L3/L1, L3/l2, L3/L4, L3/L5 ratios were calculated. The inclination angle (°) of the lower-end-plate was further calculated.

Significant differences were shown by a randomized complete blocks design, post-hoc test (Student-Newman-Keuls), (α< .05). Anterior bodies’ heights ratios progressively decreased from L1 to L5 level, which means a relative increase of the anterior bodies’ heights. Posterior bodies’ heights ratios progressively increased from L1 to L5 level, which means a relative decrease of the posterior bodies’ heights. Lower-endplates inclination angle significantly and progressively increased from L1 to L5 vertebral level. For L1 and L2 (𝛉< 0°), it means that vertebrae are ventrally wedged, whereas L3, L4, L5 vertebrae are dorsally wedged (𝛉< 0°). It could be suggested that individual vertebra morphology contributes to shape the anterior convexity of the lumbar curvature along with the intervertebral discs. Spinous process and vertebral lengths ratios significantly decreased from L1 to L2, and significantly increased from L4 to L5, but no differences between L1vs. L5 neither for L2 vs. L4. It shows that lengths of the spinous process and vertebrae define two segments with same trends at the lumbar spine, the upper L1 and L2 segment; and the lower L4 and L5, which join together at L3 vertebra. This design allows to drawn the concavity of the lower back while standing upright and its convexity while flexing forward.

Introduction and objectives: This is a complex type of lesion that is frequently confused with Monteggia fracture. The objective of this paper is to analyse the experience of the Hospital Cl co San Carlos, in Madrid, in the management of the transolecranon fracture-dislocation of the elbow.

Methods and material: Between 1988 and 2001 a total of 23 cases have been revised, 7 of them presenting an oblique simple fracture of the olecranon and the other 16 cases with a comminute one (with fracture of the coronoid process in 9 patients). There was also a radial head fracture associated in 7 patients. Two cases showed ulnar nerve palsy before surgery. Fifthteen of the 21 cases were males and 8 females, with a mean age of 37, 3 years (range: 17–71). The mean follow up was of 56 months (range: 22–122 months). The etiology was a traffic accident (bicycle, motorbike, car) in the 47, 6%, a casual fall in the 23, 8%, a sport accident in the 14, 2% and a precipitation in the 9, 5%. All of them were treated with open reduction and internal fixation, with plate and screws in 17 cases and tension-band wiring in 4 patients. When a radial head fracture was associated, reconstruction was performed with screws in 5 cases and radial head excision in 1 case. Anatomic reduction was achieved in 11 cases.

Results: With the scale of Broberg and Morrey, excellent result was obtained in 6 cases, good in 8, fair in 6, and poor in the remaining 3. The most frequent complication was loss of motion (6 cases), followed by non-union in 2 cases (with hardware fatigue failure in 1 of them) and infection in other case. The two cases with preoperative ulnar nerve palsy resolved over a period of 4 months. Eleven patients needed a reoperation, performing a new internal fixation with bone grafting in 2 cases, a radial head prosthesis implanting in 1 case, and hardware removal in 8 cases.

Discussion and Conclusions: Although the transolecra-non fracture-dislocation of the elbow can be included in several classifications (AO, de Cotton, de Schatzker, etc.), none of them accommodate it satisfactorily, because of the complexity of the lesion. Our results show a statistically significative relation (p < 0.05) between the anatomic reduction obtained and excellent or good results and a high frequency of joint stiffness in this severe lesion.