The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Dec 1994
ReviewRecurrence of giant-cell tumors of the long bones after curettage and packing with cement.
The nine-year experience with sixty patients who had had a giant-cell tumor of a long bone was reviewed to determine the rate of recurrence after treatment with curettage and packing with polymethylmethacrylate cement. The demographic characteristics, including the age and sex of the patient and the site of the tumor, were similar to those that have been reported for other large series. An average of four years (range, two to ten years) after the operation, the over-all rate of initial local recurrence was 25 per cent (fifteen of sixty patients). ⋯ Higher rates of recurrence were also noted for patients who had had a pathological fracture (three of six), those who had had a Stage-III tumor according to the classification of Campanacci et al. (six of sixteen), and those who had not had adjuvant treatment with either a high-speed burr or phenol (eight of nineteen). Patients who had had an initial recurrence after packing with cement had a low rate of secondary recurrence when the initial recurrence had been treated with a wide resection or a second intralesional procedure (zero of ten and one of five patients, respectively), after an average of three years (range, ten months to eight years). No patient had a multicentric tumor or metastasis.(ABSTRACT TRUNCATED AT 250 WORDS)
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J Bone Joint Surg Am · Dec 1994
Results after replantation and revascularization in the upper extremity in children.
The rates of survival of the amputated part and the functional outcomes were studied retrospectively after seventy-three replantations and eighty-nine revascularizations in the upper extremity in 120 children. All operations were performed between January 1974 and December 1988 after partial and complete amputations at various levels. The ages of the patients ranged from three days to sixteen years. ⋯ We did not find any relationship between the age of the patient and the rate of survival of the amputated part after revascularization; however, there was a significantly higher rate of survival (p , 0.02) after replantation in children who were less than nine years old (77 per cent [twenty-four of thirty-one parts]) compared with the rate in those who were nine to sixteen years old (52 per cent [twenty-two of forty-two parts]). The viability of the digit was in jeopardy after twenty-nine (40 per cent) of the seventy-three replantations and nineteen (21 per cent) of the eighty-nine revascularizations. Immediate reoperation resulted in the salvage of only two of the twenty-one replanted parts and six of the twelve revascularized parts that had a reoperation.(ABSTRACT TRUNCATED AT 400 WORDS)
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J Bone Joint Surg Am · Sep 1994
Case ReportsThe semimembranosus-tibial collateral ligament bursa. Anatomical study and magnetic resonance imaging.
A bursa that was deep to the tibial collateral ligament and adjacent to the semimembranosus tendon was studied in fifty cadaveric knees; a vinyl solution was injected into four of the specimens in order to facilitate a study of the relationship between the bursa and its surrounding structures. The bursa had the shape of an inverted U: the superficial arm was an elliptical pocket that was located between the semimembranosus tendon and the tibial collateral ligament, and the deep arm was a triangular pocket that was located between the semimembranosus tendon and the medial tibial condyle. The bursa measured, on the average, twenty-one millimeters in its greatest anteroposterior dimension and ten millimeters in its greatest superoinferior dimension. Magnetic resonance images were made of two patients, and they showed fluid in the bursa.
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J Bone Joint Surg Am · Jun 1994
Comparative StudyThe usefulness of C-reactive protein levels in the identification of concurrent septic arthritis in children who have acute hematogenous osteomyelitis. A comparison with the usefulness of the erythrocyte sedimentation rate and the white blood-cell count.
Thirty-six children who had bacteriologically confirmed acute hematogenous osteomyelitis but did not have concurrent septic arthritis, and ten children who had confirmed acute hematogenous osteomyelitis and concurrent septic arthritis, were followed for one year to compare the changes in the C-reactive protein level in the blood, the erythrocyte sedimentation rate, and the white blood-cell count. In both groups, the mean C-reactive-protein values were high (eighty-four milligrams per liter in the children who had septic arthritis and osteomyelitis and sixty-five milligrams per liter in those who had osteomyelitis only) at the time of admission to the hospital. ⋯ The erythrocyte sedimentation rate showed the same tendency, but the difference in the rates between the groups did not become evident until the fifth to fourteenth days after admission. A normal erythrocyte sedimentation rate (less than twenty millimeters per hour) was reached in 25 +/- 12 days in the children who had septic arthritis and in 17 +/- 10 days in those who did not (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)