The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Feb 1999
The functional outcome of operative treatment of ununited fractures of the humeral diaphysis in older patients.
Twenty-two elderly patients (average age, seventy-two years) who had an atrophic, unstable, ununited fracture of the humeral diaphysis were managed with plate-and-screw fixation and application of an autogenous bone graft from the iliac crest. Fifteen of the patients had had at least one previous operation in an attempt to obtain union of the fracture. One patient had an active infection and two had a quiescent infection, all with Staphylococcus epidermidis. ⋯ An unstable, united fracture of the humeral diaphysis can be extremely disabling and may threaten the ability of an elderly patient to function independently. Operative treatment can be very successful when the techniques of plate-and-screw fixation are modified to address osteopenia and relative or absolute loss of bone. Healing of the fracture substantially improves function and the degree of independence
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J Bone Joint Surg Am · Feb 1999
Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head.
We reviewed the long-term results of core decompression for the treatment of nontraumatic osteonecrosis of the femoral head, performed in thirty-four patients (fifty-four hips) between January 1, 1981, and June 30, 1995. Twenty patients (59 percent) had bilateral involvement. The mean age of the patients at the time of presentation was thirty-eight years (range, twenty-two to eighty-three years). ⋯ Our findings suggest that core decompression is a safe and effective procedure for the treatment of stage-I or stage-IIA sclerotic disease. These data also demonstrate the importance of differentiating between stage-IIA sclerotic disease and stage-IIA cystic or sclerocystic disease. We believe that core decompression has a limited role in the operative management of patients who have evidence of cystic changes in the femoral head on plain radiographs.