Canadian journal of surgery. Journal canadien de chirurgie
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To define the functional outcome and residual disability in adults treated for isolated femoral shaft fractures. ⋯ Primary reamed intramedullary nailing is an effective method of achieving consistent primary union in adults with femoral shaft fractures. However, the majority of patients will require secondary surgery. Most patients will be able to return to work after these injuries.
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A retrospective study was done of 22 patients with complex femoral (11) and tibial (11) shaft fractures treated with static interlocking nailing followed by dynamization, which was carried out on average 7.8 months later. The success rate was 54% with no significant difference between the healing of femoral and tibial fractures. ⋯ The authors found that static interlocking nailing without dynamization can still produce a high union rate, and if there is sparse callus formation during the healing process, indicating low osteogenesis, dynamization will result in fracture union in only half the cases. To improve the union rate, cancellous bone grafting may be necessary.
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The frequency of problems in the arm affected by surgery for breast cancer and the association of these problems with psychological distress were assessed among 223 women with newly diagnosed breast cancer 3 months after operation and again 15 months later among 201 of these same women. At 3 months after operation, 182 (82%) of the 223 patients reported at least one arm problem. Specific problems reported were swelling (24%), weakness (26%), some limitation in range of movement (32%), stiffness (40%), pain (55%) and numbness (58%), and these percentages had changed little 15 months later. ⋯ Compared with women reporting no arm problems, the adjusted odds ratios of having psychological distress at 3 months for women reporting one to two, three to four and five to six arm problems were 1.2, 2.3 and 3.1 respectively (chi 2 for trend = 9.5, p = 0.002). Arm problems are frequent after operation for breast cancer, and these problems appear to increase the likelihood of psychological distress. Women should be informed that arm problems are expected but non-threatening sequelae of initial surgical treatment for breast cancer.
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Only 52 cases of gastric volvulus have been reported in children and infants. The pathophysiology of the condition relates to an abnormal rotation of the stomach. ⋯ A diagnosis of mesenteroaxial gastric volvulus with eventration of the left hemidiaphram was made by means of plain-films and an upper gastrointestinal series. The child underwent laparotomy and gastrostomy, made a smooth recovery and was well 36 months postoperatively.