Acta Orthop Belg
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The aim of this study was to describe treatment -options and develop a follow-up regime for the -aneurysmal bone cyst, a neoplastic bone lesion with a noticeable recurrence rate. Reports of 28 patients and a mean follow-up of 42.2 months treated multidisciplinary were analysed. Data were complemented by a literature review including 790 patients. ⋯ Lesions most frequently affect long bones, spine and pelvis ; pain is the most common symptom. Treatment modalities vary, recurrences -occurred in 26.1% in our series, rates ranged from 0-60% in the literature, with the vast majority within 2 years. With regard to the findings we propose, irrespective of treatment, a follow-up regime including clinical survey and imaging, best with MRI, at 3 months, 6 months and at half-yearly intervals within the first two and yearly within the third to fifth year.
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Aim of the present study was to compare the outcomes between exchanging reamed nailing (ERN) and augmentative compression plating (ACP) in treatment of femoral shaft nonunion after intra-medullary nailing (IMN) retrospectively. A retrospective, multicentre study was performed with 188 patients (190 cases)with femoral shaft nonunion after IMN, who received therapy with either ERN (n = 92) for 44/92 (47.8%) cases of nonisthmal nonunions and 48/92 (52.2%) cases of isthmal nonunions or ACP (n = 98) for 48/98 (49%) cases of nonisthmal nonunions and 50/98 (51%) cases of isthmal nonunions. Operation time, intraoperative blood loss, time to union, union rate, postoperative draining volume and complication rate were compared between ERN and ACP group. ⋯ However, for nonisthmal nonunions, the mean operation time for ERN group was 126.8 ± 19.6 min in -comparison to ACP group (88.6 ± 15.2 min), significant difference was found between ERN group and ACP group (p = 0.021). ACP could obtain the higher bone union rate and shorter time to union than ERN in the treatment of femoral shaft nonunion after failed IMN. Especially for nonisthmal femoral shaft nonunions or isthmal.
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Radial head fractures are common injuries, occurring mostly in active young people 85%. Treatment of the more complex radial head fractures (Mason type III and IV), appear to be challenging and remain a subject of controversy. Replacement of the radial head with a metal prosthesis imitates the stabilizing role of the radial head and has been considered as the treatment of choice. ⋯ Mainly good clinical results are achieved with the -Judet bipolar radial head implant. Functional results after long term follow-up are, however less optimistic then the excellent results achieved after short- to mid-term follow-up. No clear link between radiological signs and functional results can be found.
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Comparative Study
Atypical femur fractures - Patient characteristics and results of intramedullary nailing for a series of 21 patients.
Atypical femoral fractures have been associated with long term use of bisphosphonates. Our study plan was to report the outcome of treatment for a series of -patients with an atypical femoral fracture and to compare the characteristics of those patients with a proximal femoral fracture. 21 atypical fractures were identified over a seven year period and these were compared with those of 2.547 hip fracture patients treated over the same time period at a single centre. The mean age of patients with an atypical fracture was on average nine years less than that for the hip fracture patients (72 as against 81 years, p = 0.002). ⋯ Patients with atypical fractures were more likely to be smokers (9/21(42.9%) versus 319/2547 (12.5%), p = 0.0001) and more likely to be on long term oral steroid therapy (8/21 (38.1%) versus 131/2547 (5.1%), p < 0.0001) in comparison to other hip fracture patients. All the atypical fractures were treated by intramedullary nailing and healed uneventfully apart from one fracture that developed non-union requiring revision nailing. Residual pain at one year from injury was more prevalent for patients with atypical fractures.
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The purpose of this study was to review the clinical results of carpal ligaments injuries with scaphoid nonunion. We hypothesized that scaphoid nonunion with carpal ligament injury is associated with clinical result. We retrospectively reviewed 60 cases of -Herbert screw fixation with bone graft for scaphoid nonunions. ⋯ At final follow-up evaluation, wrist function as evaluated by the Mayo wrist score was excellent in 34 patients, good in 16 patients, fair in 8 patients, and poor in 2 patients. Cases with both SL/LT ligaments injuries tended to have decreased wrist flexion-extension motion. Our results suggest that there is an indication for arthroscopy in scaphoid nonunion if surgical fixation is offered to avoid detrimental effects of an undiagnosed ligament tear.