T he risk of articular penetration during tibial nailing is well known, but the incidence of unrecognised damage to joint cartilage has not been described. We have identified this complication in the treatment of tibial fractures, described the anatomical structures at risk and examined the most appropriate site of entry for tibial nailing in relation to the shape of the bone, the design of the nail and the surgical approach.We studied the relationship between the intra-articular structures of the knee and the entry point used for nailing in 54 tibiae from cadavers. The results showed that the safe zone in some bones is smaller than the size of standard reamers and the proximal part of some nails. The structures at risk are the anterior horns of the medial and lateral menisci, the anterior part of the medial and lateral plateaux and the ligamentum transversum. This was confirmed by observations made after nailing 12 pairs of cadaver knees. A retrospective radiological analysis of 30 patients who had undergone tibial nailing identified eight at risk according to the entry point and the size of the nail. Unrecognised articular penetration and damage during surgery were confirmed in four.Although intramedullary nailing has been shown to be a successful method for treating fractures of the tibia, one of the most common problems after bony union is pain in the knee. Unrecognised intra-articular injury of the knee may be one cause of this.

ABSTRACT:The goal of this study was to determine whether inactivating specific cytokines in seminal plasma improves sperm motility in men affected by spinal cord injury (SCI). For this purpose, we used monoclonal antibodies to interleukin 6 (IL6), interleukin 1 beta (IL1-␤), and tumor necrosis factor alpha (TNF-␣), all 3 cytokines having been previously detected at high concentrations in the seminal plasma of patients with SCI. In a group of 17 SCI men with low sperm motility (mean Ϯ SE, 20.1% Ϯ 3.1%), treatment with the 3 monoclonal antibodies at the median neutralization dose concentrations for 1.0 to 1.5 hours improved sperm motility in all cases. Effectiveness was higher in those specimens with a pretreatment sperm motility between 11% and 30% (from 19.3% Ϯ 1.4% to 41.9% Ϯ 4.9%, P Ͻ .0002), suggesting that pretreatment sperm motility might represent an indicator of cell damage and, therefore, a factor that influences monoclonal antibody effectiveness. To the best of our knowledge, these results represent the first rational treatment for improving low sperm motility in these severely affected patients.Key words: Infertility, ejaculation, semen, IL1-␤, IL6, TNF-␣. J Androl 2004;25:922-925P atients with spinal cord injury (SCI) have impaired sexual function and a unique sperm profile characterized by normal to high sperm concentrations and abnormally low sperm motility (Brackett et al, 1996b(Brackett et al, , 1997. The cause of this condition is unknown but might be related to abnormalities in the seminal plasma. Activated Tcell subpopulations were identified in the semen of these patients (Basu et al, 2002), and abnormal concentrations of cytotoxic cytokines were found in seminal plasma of SCI men with low sperm motility (Basu et al, 2004). To determine whether elevated cytokines contribute to low sperm motility in men with SCI, this study evaluated the usefulness of specific monoclonal antibodies to improve sperm motility by blocking cytokine activity in fresh semen samples. Miami, Fla). The mean (ϮSEM) age of subjects was 35.2 Ϯ 2.2 years (range 21 to 43 years). All subjects were past the acute phase of injury, and their mean time postinjury was 13.3 Ϯ 3.8 years (range 3 to 32 years). Levels of injury were C5 to C6 in 5 subjects, T1 to T7 in 6 subjects, and T8 to T12 in 6 subjects. Each subject had undergone at least 4 ejaculations spaced 4 to 8 weeks apart prior to semen collection for this study. All subjects were in good health and did not have any condition, other than SCI, known to interfere with fertility. Materials and Methods Subjects Semen Collection and AnalysisOnly antegrade semen (ie, no retrograde semen) was collected from subjects by the standard method of penile vibratory stimulation (Brackett, 1999) because semen quality can be altered in retrograde ejaculates or if semen is collected by electroejaculation . Semen analysis was performed according to World Health Organization criteria (1999). Each semen specimen was first allowed to liquefy at room temperature. Sperm parameters were assessed b...

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Men with spinal cord injury (SCI) have a unique semen profile characterized by normal sperm concentrations but abnormally low sperm motility. Previous studies showed that elevated concentrations of cytokines in the seminal plasma of these men contribute to this condition. For example, when elevated concentrations of interlekin-1b (IL-1b), IL-6, and tumor necrosis factor-a (TNF-a) were immunoneutralized in the semen of men with SCI, sperm motility improved. The present study investigated if these cytokines act on sperm cell receptors to inhibit sperm motility. Semen was collected from men with SCI and from healthy non-SCI men. Sperm were separated from the seminal plasma by centrifugation. Eight identical aliquots of 5000 sperm suspended in 50 mL of seminal plasma were prepared for each subject. Agents were added to the aliquots in order to neutralize IL-1b, IL-6, and TNF-a at the receptor level. In SCI subjects, sperm motility improved in each treatment group compared with the untreated group, but statistical significance was reached only when neutralizing agents to all 3 cytokines were added. Improvement was less pronounced in subjects with close to normal semen cytokine concentrations or close to normal pretreatment sperm motility. In control subjects, IL1b, IL-6, and TNF-a were within normal values, and addition of receptor blockers to semen had no effect on sperm motility. These data support the hypothesis that cytokines act at the level of the sperm receptor to inhibit sperm motility. These data further support the notion that inactivating semen cytokines leads to improved sperm motility in SCI men. Our goal is to develop this finding into a treatment for low sperm motility in men with SCI.Key words: Infertility, ejaculation, semen, TNF-a, IL-1b, and IL-6. J Androl 2007;28:717-721 M en with spinal cord injury (SCI) have a unique semen profile characterized by normal sperm concentration but abnormally low sperm motility (Brackett et al, 1996(Brackett et al, , 1997DeForge et al, 2005;Brown et al, 2006). Factors in the seminal plasma contribute to this condition. For example, previous studies showed elevated concentrations of white blood cells and activated T-cell subpopulations in the semen of men with SCI (Basu et al, 2002). Additionally, elevated concentrations of cytotoxic cytokines were found in the seminal plasma of these men . When the elevated cytokine concentrations were immunoneutralized with monoclonal antibodies added to the semen, sperm motility improved (Cohen et al, 2004).The present study was undertaken to determine if cytokine receptors are involved in mediating the effects of cytokines on sperm motility in men with SCI. Materials and Methods SubjectsSubjects were men with traumatic SCI and healthy non-SCI subjects. All subjects were participants in the Male Fertility Research Program of the Miami Project to Cure Paralysis at the University of Miami Miller School of Medicine, Miami, Fla. The mean (6 SEM) age of SCI subjects was 31.9 6 2.3 years (range, 20-42). All SCI subjects were ...

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