International orthopaedics
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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 treated 50 patients (average age 47.9 years) with a stabilized subcutaneous transposition of the ulnar nerve. The average follow-up period was 42.4 months. The indication was cubital tunnel syndrome in 19 patients and injuries around the elbow in 31 patients. ⋯ In the 31 patients with injuries around the elbow, there was only one patient with transient aggravation of parasthaesiae in the ulnar nerve region. Stabilized subcutaneous transposition is a simple and less invasive procedure that can facilitate decompression and prevent slipping back of the nerve. This procedure also can be applied to patients with injuries around the elbow that require ulnar nerve transfer.
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Whilst advances in cementing technique have led to improvement in the survival of cemented femoral stems in total hip arthroplasty (THA), cup failure due to aseptic loosening remains a major clinical problem. These observations have led to a move away from cemented cup designs, particularly in young patients, towards uncemented implants. The Plasmacup is a hemispherical, press-fit, cementless, titanium-shelled, acetabular component with a polyethylene liner. ⋯ Four cups had small radiographic areas of focal osteolysis and three had been revised (two for recurrent dislocation and one for deep sepsis; none were revised for aseptic loosening). The mean linear wear rate in this series was 0.14 mm/year. In conclusion, the Plasmacup shows satisfactory early stability, a wear rate similar to other uncemented cups, and favourable mid-term clinical function and survival rates.
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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.