A RARE COMPLICATION OF CALCANEAL FRACTURE – CALCANEAL NON-UNION. CASE REPORT

The aim was to study published reports of postoperative intra-articular calcaneus fractures non-union complications after ORIF, determinate the main reasons for such complications and study the ways to improve the treatment results/ We retrospectively studied anamnestic data, medical history from 2018, and the treatment process of our patient in 2019- 2020 with calcaneus ORIF post-operative non-union. The patient was managed by secondary ORIF with autogenous bone marrow grafting after removal of broken retainers. At 6 months, the result was evaluated as good according to the AOFAS scale, (89–80 points for AOFAS). Non-union after calcaneus fracture ORIF management is an extremely rare complication. Controlled randomized trials with a larger sample size and longer follow-up are required for plausible evidence and systematization of treatment principles.

Paroxysmal nocturnal hemoglobinuria (PNH): An atypical case report

Introduction: Paroxysmal nocturnal hemoglobinuria (PNH) also called Marchiafava-Micheli syndrome is a rare disease (1.3 case per million inviduals). It is a clonal disorder caused by a medullary stem cells acquired mutations on the PIG-A gene, inducing a partial or general deficit of proteins linking to cell membrane through a glycophosphatidylinositol (GPI) anchor.Case presentation: We confirmed the diagnosis of PNH in a 35-year-old woman presenting a relatively well tolerated but progressive pancytopenia and also a concomitant cyanocobalamin deficiency. The diagnosis was classically obtained through flow cytometry determination of specific disease markers on red blood cells (CD55; CD59; FLAER). After a CD34 selected grafting from his fully HLA-compatible brother as donor, the patient entered in a sustained complete remission of PNH syndrome.Conclusion: After bone-marrow grafting, prolonged complete remission (cure) of PNH presenting primarily as a medullary insufficiency, may be obtained.

Autologous Concentrated Bone Marrow Grafting for the Treatment of Osteonecrosis of the Humeral Head: A Report of Five Shoulders in Four Cases

Five shoulders in four patients affected by advanced osteonecrosis of the humeral head were treated with autologous concentrated bone marrow grafting. Bone marrow sample was aspirated from the iliac crests, concentrated by a centrifugation technique, and injected into the necrotic site. The shoulders were evaluated radiologically with X-ray scoring and clinically with measurement of range of motion and pain score (visual analogue scale, VAS). The mean follow-up period was 49.4 (range, 24–73) months. The concentration ratio of nucleated cells was calculated and the number of transplanted mesenchymal stem cells (MSC) was estimated by a colony-forming assay. All four shoulders with stage 3 disease achieved joint sparing. One shoulder with stage 4 disease required replacement surgery. Clinical evaluation of the spared joints showed improvement in range of motion in two cases and deterioration in two cases. VAS scores were 0 after surgery in three cases. The mean concentration ratio was 2.73, and the mean number of transplanted MSC was 1125. The outcomes of autologous concentrated bone marrow grafting for advanced osteonecrosis of the humeral head were varied. Further research is needed to determine the effectiveness and the indications of the present surgery.