International orthopaedics
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Comparative Study
Distraction osteogenesis by Ilizarov and unilateral external fixators in a canine model.
We studied distraction osteogenesis in canine experimental model using two types of external fixators, Ilizarov (n=6) or AO unilateral (n=9) external fixator. Distraction started 1 week after surgery (2 x 0.5 mm/day) and lasted for 3 weeks. Specimens were harvested from weeks 7 through 12. ⋯ No differences in histomorphometric parameters existed between the groups. In the study period, the bone formation was enhanced and prevailed in the distraction area. This study demonstrated the utility of the canine experimental model for the study of distraction osteogenesis.
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Bony metastases in patients with osteosarcoma are unusual and normally appear late in the course of the disease. We report our experience with eight such patients, four with solitary and four with multiple metastases. Those with solitary metastases were treated as new tumours with neoadjuvant chemotherapy and surgery. ⋯ Histology and response to neoadjuvant chemotherapy was similar in both the primary and metastatic lesions and is a predictive factor of outcome. Those with multiple metastases were treated by palliative measures, and none survived. We conclude that resection of solitary metastases from osteosarcoma after neoadjuvant chemotherapy can be curative.
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We developed a locking screw plate system for the stabilisation of distal radial fractures, which can be inserted through a standard volar approach and in which the locking mechanism allows early post-operative mobilisation. Forty-nine patients with 50 fractures underwent surgical treatment; 66% were type C fractures. ⋯ According to the scores of Gartland and Werley and Green and O'Brien, 92% and 68% respectively had an excellent or good outcome; 46% were radiologically identical to the uninjured side and in 42% the reduction remained unchanged after 2 years. The most frequent complication was rupture of the flexor pollicis longus tendon, which occurred in six cases (12%) at a mean of 10 months after operation.
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Between 1974 and 1999, we treated operatively 28 patients with a symptomatic mid-shaft clavicular non-union using AO osteosynthesis, including bone grafting. Nine patients had a wave-plate osteosynthesis and 19 a standard AO/ASIF osteosynthesis. The mean follow-up was 10 (2-25) years. ⋯ Pre-operatively, brachialgia was present in 12 patients. Of these patients, six were treated using standard osteosynthesis technique and six by wave-plate osteosynthesis. Post-operatively, patients treated by wave-plate osteosynthesis had no brachialgia and also had a higher Constant score than those patients treated using standard AO/ASIF techniques.