Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1999
Cryosurgery in long bones; an experimental study of necrosis and revitalization in rabbits.
Cryosurgery is an established adjuvant treatment of bone tumors which reduces the local recurrence rate. In this study, cryosurgical experiments were carried out in rabbits to study the temperature field, the extent of necrosis, and the revitalization process in order to optimize treatment. Intramedullary freezing of long bones with a closed liquid nitrogen cryoprobe and three consecutive sessions induces osteonecrosis down to the -10 degrees C isotherm without compromising the soft tissues. ⋯ In clinical practice, no profound periosteal bone apposition and a high risk for pathologic fractures during the remodelling phase were noted. Future research should focus on bone strength during the remodelling phase of cryosurgically treated long bones, to decide on the role of preventive osteosynthesis or postoperative restrictions. This animal model is not advised for these biomechanical experiments because of its profuse periosteal bone apposition.
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Arch Orthop Trauma Surg · Jan 1999
Case ReportsSciatic nerve injury associated with fracture of the femoral shaft.
The sciatic nerve escapes injury in most fractures of the femoral shaft. We report a case of sciatic nerve palsy associated with a fracture at the distal shaft of the femur. The common peroneal division of the sciatic nerve was lacerated by a bone fragment at the fracture site. Despite the delay in treatment, a satisfactory result was obtained.
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Arch Orthop Trauma Surg · Jan 1999
Comparative StudyConservative versus surgical treatment for femoral fracture after total or hemiarthroplasty of hip.
This retrospective study compared internal fixation of a femoral fracture following total or hemiarthroplasty of hip with conservative treatment. Sixteen patients were included in the study and classified according to Johannsen. Seven of these patients were treated conservatively by skeletal traction (group A), while the remaining nine patients underwent internal fixation by Mennen plate in conjunction with bone graft (group B). ⋯ Furthermore, two patients from group A in whom conservative treatment had failed underwent internal fixation, improving their final outcome. Regarding fracture distal to the tip of the prosthesis, there was no significant difference in final outcome between the groups. Our conclusion is that Mennen plate fixation should be considered the treatment of choice in femoral fracture around the tip of a prosthesis, and Mennen plate fixation for fracture distal to the tip should remain as a good option, especially for patients who would like to reduce the length of postoperative hospitalization.
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Arch Orthop Trauma Surg · Jan 1999
Combined Kirschner wire fixation in the treatment of Colles fracture. A prospective, controlled trial.
For surgical treatment of the unstable Colles fracture we developed a new form of osteosynthesis, which consists in a modification of the dynamic Kirschner wire fixation described by Kapandji. It allows early motion without the typical risk of palmar dislocation noted with the Kapandji method. We prefer this method in elderly patients with reduced bone quality. ⋯ A minor loss of reduction by dorsal impaction was observed in the follow-up evaluation, but it had no functional relevance. The most frequent complication was paraesthesia within the area of the superficial radial nerve. According to the NYOH score the following results were achieved: excellent 35%, good 50%, fair 10%, poor 5%.
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Arch Orthop Trauma Surg · Jan 1999
Comparative StudyErrors of computer-assisted migration analysis in conventional radiographs of femoral hip implants--an experimental study.
Several methods have been described in the literature in order to analyze migration of femoral hip implants in conventional radiographs. However, no measurements were done regarding the potential errors inherent in such unstandardized radiographs of daily routine. In order to quantify this lack of reproducibility, we carried out experimental examinations with radiographs of a hip revision prosthesis, where different variables of technical X-ray conditions and femoral positions were changed. ⋯ Significant errors for the migration analysis in the transverse and rotational planes were only found under conditions of varying the femoral position, and not under different technical X-ray conditions. From these experimental results, we derived the following criteria to minimize failure in a quantitative radiographic migration analysis: (1) the patient's leg has to be placed into an antirotation device to ensure identical object position; (2) the same source-to-film distance has to be used; (3) the central X-ray focus has to be localized on the center of the film-cassette; (4) film-screen systems should be of the same type and size; (5) the object has to be placed in the same position as in previous radiographs. As a conclusion, only if these standardization criteria are respected in the daily routine of conventional radiographs will an effective and meaningful use of migration analysis systems be possible to prove or to exclude mechanical failure of femoral hip implants in prospective longitudinal follow-up series.