Today's News

Friday, March 17, 2000

Orthopaedists tell international contributions

Significant advances in orthopaedic care that the international community has developed were highlighted at a symposium Thursday. Surgical innovators presented their work in the fields of tumor surgery, joint replacement, research, trauma and spine surgery. A recurring theme in the presentations was the importance of soft tissues in orthopaedic procedures.

D. Luis Muscolo, MD, of Buenos Aires, Argentina, discussed surgical treatment of massive bone loss, which he described as "one of the major challenges for orthopaedics 2000." The aim of an allograft, or biologic reconstruction, is to preserve limb function and provide progressive incorporation.

Dr. Muscolo listed five ways to avoid allograft failure: preservation of cartilage viability, increased anatomical matching and joint alignment, increased stability by suturing allograft and auto soft tissues, partial epiphysis preservation and avoiding immune response that results in chronic rejection.

According to Dr. Muscolo, potential future advances in the treatment of massive bone loss include whole joint vascularized composite allographs, xenographs (bone from different species) and tissue engineering.

Progress in total hip replacement (THR) has been through a series of successes and failures, explained Erwin W. Morscher, MD, of Basel, Switzerland. Innovations in THR have been in the areas of new designs, surfaces, materials, operative techniques and quality control. Dr. Morscher stated that most failures of innovations were due to new, unexpected side effects.

Hain Stein, MD, of Haifa, Israel, discussed advances in the understanding of the mechanism of fracture healing. A key concept to this understanding is that soft tissue integrity is crucial because callus forms first at the site of the muscle bed and blood supply. Equally important is the knowledge that distraction of fractured bone induces rapid, efficient, periosteal and endosteal callus formation. Thus, optimal healing can be achieved by preserving soft tissue and applying external distraction.

Arsene J. Grosse, MD, of Strasbourg, France presented results of a study of 112 cases of complex fractures of the femur treated at the Centre de Traumatologie et d'Orthopedie in Strasbourg between 1990 and 1999. The fractures treated in this study were severel comminuted fractures, in which the comminution involved a major segment of the diaphysis. The fractures had varied gaps and demonstrated an absence of contact between the proximal and distal surfaces

Dr. Grosse and his colleagues employed locking nail systems to treat these complex fractures because these devices control rotation, varus/valgus and avoid the risk of shortening. Use of these systems resulted in a consistent rate of fracture healing, without malunion in rotation, varus/valgus angulation, and without shortening. Dr. Grosse and his colleagues also obtained a full range of motion with locking nail systems.

John C. Y. Leong, MD, from Hong Kong, discussed his work in the treatment of difficult spinal problems, particularly kyphosis and scoliosis. The key to treating kyphosis is to stabilize the deformity, adjusting for the degree of severity of the deformity, then decompress. For rigid curves in scoliosis patients, Dr. Leong stated that "shortening of the spinal column is a safe and effective method of correcting severe cases." He added the caveat that in a procedure such as this, surgical expertise is mandatory.

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Last modified 17/March/2000 by IS