Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1992
Complications of high tibial osteotomy and internal fixation with staples.
Osteotomy for osteoarthritis of the knee has established itself well since its first description by Jackson and Waugh [8, 9]. Internal fixation with staples allows early functional treatment with only a minimum of operative intervention. Removal of the metal is optional. ⋯ The staples became loose intraoperatively in eight cases (4.5%); only once did a dislocated staple have to be reoperated on post-operatively. Further complications which are independent of the method of internal fixation are summarized in the article. Complications of surgery on the long bones of the leg are inevitable, but with only one postoperatively dislocated staple and one case of non-infected pseudarthrosis (i.e. a method-related complication rate of 1.1%), internal fixation with staples for high tibial osteotomy presents itself as a reliable and safe procedure.
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Arch Orthop Trauma Surg · Jan 1992
Biomechanical analysis of the mechanism of interlocking nail failure.
From December 1986 to May 1989, 412 patients with 274 femoral and 144 tibial fractures were treated with Grosse-Kempf interlocking nails at our hospital. 324 cases (78.6%) were followed-up for at least 1 year (average 23 months). There were 13 breakages in the locking nails in femora and none in tibiae. The recorded incidence of breakage in the femur is therefore 4.7% (13/274). ⋯ The site most at risk is the first screw hole of the distal third, especially if it is near the fracture site. Prevention of failure involves using a nail of larger diameter and sufficient length, improving the surgical drilling technique, and allowing only protected weight bearing. Management of nail breakage by insertion of a new implant and supplementary cancellous bone grafting can gain satisfactory results.
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Arch Orthop Trauma Surg · Jan 1992
Anterior cruciate ligament allograft transplantation for intraarticular ligamentous reconstruction.
A multiplicity of surgical operations have been developed in an attempt to achieve satisfactory function after anterior cruciate ligament (ACL) repair. None of these procedures have been able to reproduce the fiber organization anatomy of attachment site, vascularity, or function of the ACL. Twenty-nine foxhounds received a deep-frozen bone-ACL-bone allograft and a ligament augmentation device (LAD). ⋯ No bone ingrowth into the LAD was observed. Polarized light microscopy and periodic acid-schiff staining showed that the new bone-ligament substance interface had intact fiber orientation at the area of the ligament insertion. Microvascular examination using the Spalteholtz technique revealed revascularization and the importance of an infrapatellar fat pad for the nourishment of ACL allografts.
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Arch Orthop Trauma Surg · Jan 1992
Case ReportsFibrous dysplasia with locally aggressive malignant change.
This is a case report of a tumour which showed all the histological features of fibrous dysplasia without any features of high-grade malignancy, yet had become locally aggressive, causing cortical erosion and extension into soft tissue. Fibrous dysplasia is a well-recognised entity that encompasses monostotic lesions, polyostotic involvement and Albright's syndrome [6, 8]. Lesions in bone usually spare the epiphysis before puberty, but often involve the epiphyseal area after maturity and can progress during adult life [3]. Unless cystic [6, 10] or malignant change [7, 10, 11] occurs, fibrous dysplasia usually remains contained within bone.
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Between 1979 and 1990 reconstruction using a ceramic prosthesis with a polycrystal alumina segment and a monocrystal alumina stem was carried out in 65 patients after the resection of malignant or benign aggressive bone tumors. Resection of 18 osteosarcomas, 5 chondrosarcomas, 9 other sarcomas, 10 giant cell tumors, 20 metastatic bone tumors, and 3 other bone tumors was followed by replacement of 17 proximal femurs, 12 distal femurs, 12 proximal tibia, 11 proximal humeri, 3 distal radii, 5 midshafts of the long bone, 2 pelvises, and 3 other parts. Results were rated excellent in 4 cases, good in 43, fair in 13, and poor in 4. ⋯ Four skin ulcers, three dislocations, three loosenings, two infections, and two breaks were noted. Close interfacing between the ceramic prosthesis and the bone was observed radiologically in all cases with cementless fixation except in cases with high-grade malignancies in the knee joint. These results demonstrate that the ceramic prosthesis can be beneficial for the management of patients with benignly aggressive or low-grade malignant bone tumors who have retained adequate muscle strength around the joint even after tumor resection.