Congenital insensitivity to pain is a rare condition with an abnormality of interpretation of painful stimuli. This case report illustrates how a sequence of injuries after no or trivial trauma incapacitated a young boy. Especially the bilateral collapse and dislocation of the hip is an unusual sequela of this disorder.

No abstract

Carpal crush lesions are very rare. Most of these complex lesions are characterized by longitudinal splitting of the carpus and adjacent metacarpal bones. These traumatic axial carpal lesions can be classified according to the site of the interruption in the carpal arch. Their common element is that the central column, consisting of the lunate and capitate bones and the third metacarpal bone remains stable (Elias et al. 1989).A crush lesion is described in which an axial splitting of the carpus occured between the central and ulnar columns. The radiographs showed a dislocation not previously described viz. a volar displacement of the navicular, lunate, capitate, trapezoid and trapezium bones in relation to the triquetral, hamate and pisiform bones.The treatment comprised longitudinal distraction, closed repositioning and stabilization by means of external fixation. Anatomical repositioning was achieved. The merits of external fixation in these complex lesions are: 1) accessibility of the soft tissues for treatment; 2) prevention of secondary carpal collapse. The latter is a complication frequently observed in plastercast immobilization after closed repositioning of carpal dislocations and dislocation fractures (Adkison and Chapman, 1982).This case demonstrates that excellent functional and radioanatomical results can be achieved without open repositioning, ligament suturing or plastic repair of ligaments.

Objective: To investigate whether fibrin glue is a suitable transport medium for transplantation of chondrocytes.Material and methods: Chips of cartilage from the knees of six-weeks-old New Zealand rabbits were dissolved in collagenase. The loose chondrocytes obtained were mixed with Tissucol@ fibrin glue and cultured in RPMI medium with 10% FCS. The cell concentration ranged from Sx105 to 2~1 0~ per ml. Every day a sample was examined with conventional optic microscopy, autoradiography and electron microscopy.Results: On day one the cells were distributed homogeneously over the fibrin glue, without a pericellular matrix. From day two all solitary cells showed a fine round (chondrocyte) shape and were surrounded by a matrix that stained intensively with alcian blue. Labeling with 355 revealed silver granules round the cells as a sign of matrix production. Electron microscopically the cells contained dark secretion granules. From the third day cells in metaphase were seen as a sign of fission. This time, cell numbers and clusters formation increased, simultaneously with the dissolution of the fibrin glue. A direct relation with the cell concentration existed. After 7 days, 20-30% of the fibrin glue had dissolved.Conclusion: Fibrin glue is a suitable biological transport medium for chondrocyte transplantation, but rapid dissolution of the glue at high cell concentrations may create difficulties for fixation of the transplant.Development of a technique for use of femoral intramedullary bone grafts at revision surgery-a biomechanical and histological study in goats As a solution for a major intramedullary femoral bone loss a technique was developed with which by impaction of a spongy bone allograft a cylindrical intramedullary graft in goat femurs was obtained. Subsequently, a cemented total hip prosthesis was implanted. The objectives were a) to obtain information concerning the stability of such prostheses and b) to make a histological study of the consolidation and incorporation of the graft.To begin with, the stability immediately after implantation was studied in vitro in 4 femurs using roentgen stereophotogrammatic analysis. With the aid of a test bank, loads of 0, 200, 500, 800 N and 0 N, respectively, were imposed. The principal movements were axial rotation around the longitudinal axis of the prosthesis (max 2.1 degrees) and displacement in the distal direction (subsidence, max 0.500 mm).In vivo, the above reconstruction procedure was carried out in 14 goats. The goats were killed after 6 (seven goats) or 12 weeks (seven goats). Of the seven goats per group, four were used for biomechanical and three for histological investigation. During the biomechanical testing, one femur in the 6 week group was lost due to a technical problem. One specimen from the 12-week group showed loosening. In the other specimens the major movements were once again axial rotation and subsidence. The ranges of movement increased with heavier loads. The greatest rotation measured was 0.24 degrees with a load of 800 N. In nonweight-b...

No abstract