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Osteoarthritis (??) is characterized by cartilage breakdown and subchondral sclerosis. Micro-fractures of the calcified tissues have been, also, detected, but their exact role has not been elucidated yet. This study was to examine the frequency of cracks during OA progression and to correlate them with the underlying cellular modifications and matrix metalloproteinase-2 (MMP-2) expression using histological/immunohistological methods. Overall, 20 patients and 3 controls (9 specimens per patient), aged 60–89 years, diagnosed with hip/knee OA were included. The development of cracks was examined in 138 sections, whereas the expression of MMP-2 was examined in 69 additional sections. Based on Mankin score, three groups of OA severity were analyzed: Group I (mild) was constituted of sections with score 1–5 while Groups II (moderate) and III (severe) with score 6–7 and greater or equal to 8, respectively. Demographic characteristics did not reveal any association between the number of microdefects and age or body mass index (BMI). Cartilage micro-cracks were increased during moderate and severe OA, while bone cracks were increased during mild and severe OA. In knee OA, cartilage cracks were not correlated with Mankin score, whereas in hip OA they appeared association with severity score. Bone cracks were positively correlated with matrix apoptotic osteocytes and osteoblastic cells, but not with osteoclasts. MMP-2 immunostaining was increasing by OA severity in the osteochondral unit. Similarly, MMP-2 was expressed on the microcracks’ wall mainly in Group III. Our data displayed that bone cracks during primary OA stages, represent an early adaptative mechanism aiming to maintain cartilage integrity. Accumulation of bone defects and concomitant increase of apoptotic osteocytes activated an abnormal remodeling due to osteoblastic activity, in which MMP-2 played a pivotal role, leading to subchondral sclerosis promoting further osteochondral deformities.

Management of posttraumatic segmental bone loss as a result of severe open injuries of the lower extremity, high-energy closed injuries, and following failed initial treatment of complex fractures that develop pseudarthrosis continues to challenge reconstructive surgeons. There are numerous strategies for dealing with such injuries but the outcome is unpredictable. The procedure is rarely only one stage and complications frequently arise. In most cases the reconstruction process is long and difficult and amputation must be part of the decision-making process. All traditional treatment strategies have advantages and major drawbacks. To overcome some limitations, biologic treatments have been developed based on specific pathways of bone physiology and healing.

The lower limbs of children aged 3–9 years present varying knock-knee deformities that have a direct impact on the diversification of the load-bearing axis of the valgus limb and on the modification of gait kinematics. The purpose of our study was to establish the reference values of knee alignment in a Greek population and whether this is linked to a change in the physical activity of children depending on the severity of the genu valgum. Using a clinical method, we measured both the tibiofemoral (TF) angle and the intermalleolar (IM) distance of the lower extremities of normal children. Subsequently, forms of the Netherlands Physical Activity Questionnaire (NPAQ) for young children and the Baecke questionnaire on habitual physical activity, modified especially for children, were completed by the parents. We examined both the development of the TF angle and the IM distance in relation to age and the degree of restriction of physical activity in relation to the severity of the genu valgum. We analysed 316 unaffected lower extremities in children aged 3–9 years. The average value of the TF angle starts around 7° at the age of 3 years and gradually decreases to 4° at the age of 7–8 years. The average value of the IM distance ranges over 3.5 cm at the age of 3 years and progressively decreases to 2 cm at the age of 7–8 years. Physical activity appears to be influenced by sex and the severity of the genu valgum. We provide age-specific values for limb alignment and joint orientation of the lower extremity in children aged 3–9 years. A statistical correlation between all indexes (sport, leisure time and total) of the Baecke and the NPAQs and measurements of genu valgum was noted depending on the severity of the valgus deformity. The level of evidence is the level II Prognostic Study.

In contrast to what was believed in the past, nonspecific low back pain is a fairly frequent condition in children, whose pathophysiology remains unclear as yet. Although many factors have been implicated in its development, results are often contradictory.

The aim of this report is the appraisal of a possible correlation of trunk asymmetry assessed with a scoliometer and lateralization of the brain as expressed by handedness in a school aged population. Many (8245) students (4173 girls and 4072 boys), 6-18 years of age were examined. A checklist was completed for each student including handedness and trunk asymmetry. The standing forward bending test was performed using the Pruijs scoliometer and the examined children were divided into three groups for each of the three examined regions (mid-thoracic, thoracolumbar and lumbar) according to the recorded asymmetry (no asymmetry, 2-7° and ≥7°). Ninety-one per cent of children were right-handed, while 9% were left-handed. A significant statistical correlation of trunk asymmetry and handedness was found both in boys and girls in the group of asymmetry 2-7° at mid-thoracic (p < 0.038) but not at thoracolumbar and at lumbar region. These findings show that there is significant correlation of mild mid-thoracic asymmetry and the dominant brain hemisphere in terms of handedness, in children who are entitled at risk of developing scoliosis. These findings are implicating the possible aetiopathogenic role of cerebral cortex function in the determination of the thoracic surface morphology of the trunk.

The effect of a modified Boston brace with anti-rotatory blades on idiopathic scoliotic curves, mainly right thoracic with a compensatory left lumbar, was studied. Method and Material: Twenty-eight scoliotic children divided into three sub-groups according to the curve type were included in the study. Cobb angle and rotation was measured on posteroanterior spinal radiographs taken during the first examination and also during the follow-up with the children in and out of the brace. Results: Ten curves improved, 13 remained stable and 5 increased (Cobb angle change >5° compared with the initial measurement). The brace treatment had more affect on the double curves, while single curves remained unaffected. Rotation remained unchanged in all curve types except in the lumbar component of double (right thoracic-left lumbar) curves. Discussion: These findings indicate that in curves with a compensatory component (e.g. main thoracic with compensatory lumbar curve), a deforming rotatory force, which is blocked by the de-rotatory action of the blades of the above-modified Boston brace, is present and seems to be more active in the lumbar spine. It is hypothesized that this deforming rotatory force seems to be a major aetiological factor for double curves. In conclusion the conservative treatment using this brace is beneficially affecting the natural history of IS in children.