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BACKGROUND: We created a Multicenter Survey for Italian orthopedics surgeons on how they approach leg length discrepancy when dealing with primary total hip arthroplasty. Aim of the study was to show how surgeons manage LLD and follow literature recommendations during clinical practice. METHODS: The Survey was composed of 25 questions divided in 4 sections: surgeon's profile, preoperative and intraoperative evaluation, postoperative management. In this paper, we report the absolute and relative frequencies of answers to section on "postoperative management." Then, regarding the treatment of residual LLD, we reported whether trauma surgeons and experts in replacement surgery had higher odds ratios for providing "literature-based" answers compared to orthopedics physicians. RESULTS: Only four questions received more than 70% agreement on one of the answers. The OR for giving the "literature-based" answer, taking OP as the reference group was 1.57 for TR and 1.72 for RS for 10 mm LLD at first follow-up (FU) and 1.23 TR and 1.32 RS when 20 mm. When 10 mm LLD at 3 months FU the OR was 0.88 TR and 1.15 RS. The OR for treatment of LLD after the first examination of a new patient was 2.16 TR and 1.85 RS. CONCLUSIONS: LLD is a debated topic with no definitive recommendations. Many decisions still depend on tradition. Treatment of LLD during clinical practice often differs from literature recommendations.

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We have evaluated the reliability of the measurement of radiological indicators in developmental dysplasia of the hip. Three observers each independently assessed 60 pelvic radiographs from infants aged from 3 to 36 months. Errors from the true value of a single measurement made by a single observer (E1), of the average of two measurements by a single observer (E2), and of the average of two single measurements by two different observers (E3) were established for the acetabular index of Hilgenreiner, for the assessment of superior and lateral femoral displacement and for indicators of pelvic alignment. The errors for the assessment of the acetabular index were E1 +/- 5 degrees, E2 +/- 5 degrees, and E3 +/- 3.5 degrees. There was a significant correlation between the presence of an acetabular notch on the radiograph and an increased error in measurement (p = 0.01). Yamamuro's measurement of lateral femoral displacement was more reliable than the Hilgenreiner distance. The errors of indicators of pelvic alignment showed a correlation with the age of the infant; the quotient of pelvic rotation was more reliable after seven months of age (p < 0.0001). The errors of the measurement of the symphysis os-ischium angle tended to increase with age and those of the measurement of the index of pelvic tilt decreased with skeletal maturation (p = 0.002).

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Controversies surround the view that the blood-bone ionic equilibrium is controlled by ionic changes at a so called "bone membrane" that display a pump-leak mechanism able to maintain a concentration gradient for chloride in addition to that for calcium, sodium and potassium. On the other hand it is known that a chloride-bicarbonate transport is active at bone cells membrane to control cytosolic pH. We tested the hypothesis that a modification of the chloride concentration of the culture medium, as well as a block of the chloride-bicarbonate transport by an anionic channels blocker, in an experimental model that keeps intact the bone membrane, may influence the bone cells activity and that the influence may be quantitatively different to that previously observed in isolated bone cells. The experimental model is the intact fetal rat limb bone, cultured for 24 hours in a simplified medium at different chloride concentrations obtained by substituting chloride with isethionate. Alkaline phosphatase activity released in the medium was measured as a marker of osteoblasts activity. By progressively reducing the chloride concentration from 117 mM to 29 mM, alkaline phosphatase activity was found unchanged. By dramatically reducing the medium chloride concentration to the range 14-0 mM, alkaline phosphatase activity was significantly (p = 0.0002) inhibited by 31.58%.(ABSTRACT TRUNCATED AT 250 WORDS)

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Diabetes and osteoporosis are linked. The question remains, however, as to whether insulin has any direct effect on bone formation. To test this hypothesis we have measured, as a marker of osteoblast activity, alkaline phosphatase (ALP) released by rat limb intact bones incubated in the presence and in the absence of physiological concentration of insulin. The results indicate that insulin significantly (p less than 0.012) increases ALP by a mean value of 48% (from 5.4% to 215%) over matched controls. We conclude that insulin has a direct stimulatory effect on osteoblast activity, and that in the absence of this effect, as in diabetes, bone loss might occur.

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