International orthopaedics
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The current study investigates instrument breakages during both emergency and elective orthopaedic surgery. Over a 2 year period a total of 7,775 procedures were performed. We found that 14 instruments were broken during 12 operative cases. ⋯ Only one case had a consultant as the lead surgeon. In seven cases the broken bit of the surgical instrument was left in the patient. Documentation of this peri-operative complication was deficient, and the patient was often not informed.
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We treated 31 femoral shaft fractures in 28 children with a mean age of 6.7 (5-10) years with retrograde flexible intramedullary nailing. There were 16 isolated fractures, while 12 children had associated injuries. ⋯ At follow-up after a mean time lapse of 27 months there was no limb-length inequality exceeding 1 cm and no malunion. We feel that femoral fractures in patients aged 5-10 years can be safely treated with retrograde flexible intramedullary nailing with minimal risk of surgical complications.
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We treated surgically 12 patients with an old dislocation of the lower cervical spine. The time from injury to presentation averaged 3.5 (range 1.5-12) months, and the majority of the dislocations were between C4-5. Treatment started with 1 week of skull traction. ⋯ If this allowed reduction it was followed by a posterior fusion with plate fixation. If reduction was not achieved the traction was continued for a further week and then followed by anterior discectomy and fusion with plate fixation. The average follow-up was 34 (range 12-54) months, and all patients developed bone fusion and showed neurological improvement.
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We analysed 721 patients with primary malignant bone tumours treated in a single institution with regard to diagnosis, treatment and prognosis. From 1965 to 1974, 154 patients were treated, of whom 17% had no surgery, 36% underwent resection and 46% underwent amputation. Margins of resection were intralesional in 21%, 72% of patients received chemotherapy and overall survival rate was 24%. ⋯ From 1985 to 1994, 393 patients were treated, of whom 7% had no surgery, 77% underwent limb salvage procedures - mainly with endoprostheses - and 15% underwent amputation or resection-replantation. Margins of resection were intralesional in 12%, 68% of patients received chemotherapy and overall survival rate was 62%. Advancements in the treatment of primary malignant bone tumours justify limb salvage procedures in combination with highly effective polychemotherapy in specialised centres and has resulted in an overall survival rate of more than 60%.