Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyTreatment of proximal humerus fracture using multiple intramedullary flexible nails.
A total of 61 patients with a proximal humeral fracture was treated between January 1996 and March 1998 by closed reduction and fracture fixation with intramedullary Prévot (or Nancy) nails. Of these, 28 female and 25 male patients with a mean age of 52 years (range 3-91 years) were reviewed clinically and radiologically with a mean follow-up of 17 months (range 4-30 months). The mean Constant score was 63, the mean Neer score 74 and the mean visual analogue scale (VAS) 73. ⋯ This minimally invasive technique decreases the rate of occurrence of avascular necrosis of the humeral head. However, fractures are not sufficiently stabilised, mainly because of bone loss induced by impaction and osteoporosis. Bone loss remains an unsolved problem, and alternative methods such as the use of bone substitute combined with minimally invasive techniques should be studied.
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Pectoralis major rupture is a well-recognised but uncommon injury that rarely leads to complications. We present an unusual case where the resultant haematoma following a partial rupture became infected and caused problems with diagnosis. We are only aware of one previous report of this.
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Intramuscular hemangiomas are rare benign tumors, making up 0.8% of all hemangiomas. They are of interest to the surgeon because their location may present considerable therapeutic challenge since radiographic work-up of the soft- tissue mass by magnetic resonance imaging (MRI) may be suspicious for malignancy. The definitive diagnosis is made by histological study of the surgical and/or biopsy specimen. ⋯ Pain upon activity but also at rest as well as swelling were the major symptoms. The average duration of symptoms was 13 months (range 1 month to 5 years). After a mean follow- up of 3 years and 4 months (range 12 months to 9 years), one of the patients has developed a recurrence; all remaining patients enjoy pain relief without any recurrence.
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Arch Orthop Trauma Surg · Jan 2000
Case ReportsDevelopment of a solitary bone cyst--a report of a case suggesting its pathogenesis.
The origin and natural course of solitary bone cysts (SBC) still remain controversial. Knowledge of the process of cyst formation and enlargement would be helpful for investigating its pathogenesis. Only two papers have described a radiodense nidus of the diaphysis as a precursor. ⋯ This study reports a case in a patient with a tiny erosive lesion in the endosteal surface of the humeral metaphysis, which developed expansively into a typical large cyst over 6 years. Serial roentgenograms taken every year demonstrated the process of cyst enlargement. This is the first longitudinal study of a case with SBC documented from its onset.
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Arch Orthop Trauma Surg · Jan 2000
Case ReportsTotal knee arthroplasty in patients with inherited dwarfism--a report of five knee replacements in two patients with Morquio's disease type A and one with spondylo-epiphyseal dysplasia.
In Morquio's disease and in hereditary spondylo-epiphyseal dysplasia of longer duration, malalignment, instability and unfavourable anatomy are generally the main surgical problems, but as these patients nowadays do not have a reduced life expectancy, it is worthwhile giving them a functional replacement for their severely deformed and painful knees. We report three patients with inherited dwarfism, in whom a replacement of the knee was performed.