The osteomyelitis diagnosis score should help to avoid the false description of a clinical presentation as "osteomyelitis". A safe diagnosis is essential for the aetiology, treatment and outcome studies of osteomyelitis.

We attempted to characterise the biological quality and regenerative potential of chondrocytes in osteochondritis dissecans (OCD). Dissected fragments from ten patients with OCD of the knee (mean age 27.8 years (16 to 49)) were harvested at arthroscopy. A sample of cartilage from the intercondylar notch was taken from the same joint and from the notch of ten patients with a traumatic cartilage defect (mean age 31.6 years (19 to 52)). Chondrocytes were extracted and subsequently cultured. Collagen types 1, 2, and 10 mRNA were quantified by polymerase chain reaction. Compared with the notch chondrocytes, cells from the dissecate expressed similar levels of collagen types 1 and 2 mRNA. The level of collagen type 10 message was 50 times lower after cell culture, indicating a loss of hypertrophic cells or genes. The high viability, retained capacity to differentiate and metabolic activity of the extracted cells suggests preservation of the intrinsic repair capability of these dissecates. Molecular analysis indicated a phenotypic modulation of the expanded dissecate chondrocytes towards a normal phenotype. Our findings suggest that cartilage taken from the dissecate can be reasonably used as a cell source for chondrocyte implantation procedures.

This prospective study served as a quality control of a revision concept for case of post-traumatic infection following open reduction and internal fixation in fracture treatment. It is based on clinical and microbiological criteria and has two aims: (1) eradication of the infection and avoidance of development of chronic osteitis; (2) maintenance of internal fixation, if possible. Thirty-four patients were recruited in this study. Surgical revisions were performed according to a consistent concept (debridement, irrigation, local chemotherapy, drainage) in defined time intervals (2 days). The operation site had to be bacteriologically clean after four revisions. Otherwise, the implant had to be removed. Both aims were reached in 11 cases: management of infection with maintenance of internal fixation. In 23 cases the implant material had to be removed. Nevertheless the infection was eliminated in all these patients without exception. The following risk factors for mandatory implant removal were evaluated: diabetes, arteriosclerosis, alcoholism, nicotine. This revision concept helps in the management of acute postoperative osteitis following ORIF in fracture treatment and in avoiding the development of chronic osteitis.

No abstract

In this paper we report the first successful allogeneic vascularized transplantation of a fresh and perfused human knee joint. A 17-year-old male had lost his knee in a motorvehicle accident. The graft was harvested from a multiorgan donor, perfused with 41 UW solution and transplanted within 21 h. Osteosyntheses were performed employing intramedullary nails. Immunosuppression was based mainly on two drugs: cyclosporin A and azathioprine. Five months after the operation the patient is fully mobilized, and the graft perfusion still intact. Osteotomies of the femur and tibia demonstrate callus formation and osseous consolidation.