International orthopaedics
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Hypoxaemia may cause postoperative confusion after operations for hip fractures in elderly patients. Twenty-two consecutive patients, with a median age of 73 years, had fractures fixed with a sliding hip screw within 48 hours of admission. ⋯ We have demonstrated that this complication occurs frequently on the first day and severe hypoxaemia can be prevented by supplementary oxygen therapy. Our results support the hypothesis that postoperative confusion can be caused by hypoxaemia.
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Preoperative chemotherapy before limb-sparing surgery for osteosarcoma is used to reduce the size of the tumour, facilitate removal and prevent distant metastases. Fifteen patients with osteosarcoma were treated with six different protocols. ⋯ Greatest control of the tumour was obtained with the intravenous use of cisplatin, three times at intervals of three weeks before surgery, compared to the use of adriamycin or methotrexate in other protocols. Prompt surgery after preoperative chemotherapy and postoperative chemotherapy are advised.
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Between 1986 and 1988, 27 patients with fractures of the thoracolumbar and lumbar spine were treated by fixateur interne (FI) instrumentation, and 24 were followed up for a mean of 25 months. Complications occurred in 13 cases, mostly due to loosening and corrosion. ⋯ The inferiority of FI instrumentation compared to plate fixation during follow up was mainly attributable to the complications. Reduction of the posterior wall fragments by the intact posterior longitudinal ligament was not consistent, so instrumented reduction is usually the method of choice.
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An 8 year old child was involved in a road accident and sustained a large wound in the left groin; radiographs showed a fracture with loss of the proximal femur. After skeletal traction for 80 days, there was bony regeneration of the proximal femur. At 8 months she was able to walk without support and her left leg was 2 cm only shorter than the right.
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Marked deformities of the skeleton may develop in the severe form of osteogenesis imperfecta. Internal fixation can be effective in the treatment and prevention of fractures and deformities. ⋯ Internal metal splints were introduced percutaneously to lie partially in, and partially alongside, the bone, to obtain fixation in the correct position. This treatment resulted in the prevention of refracture of the legs, while correction was maintained.