La Chirurgia degli organi di movimento
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The authors illustrate the results of a series of 47 fractures of the odontoid process all treated according to two non-surgical methods, among the most diffused and accepted: Minerva plaster and halo-plaster. The various elements used to classify odontoid fractures are examined, as is their importance for prognosis. The conclusions refer to two essential points: 1) fractures with a higher risk of nonunion are Anderson type II, with posterior shifting, in elderly patients; 2) reduction and immobilization with a halo-plaster may be considered the first choice of a method for most of these fractures, in consideration of the limited risk of nonunion involved.
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The authors report a case of posterior inveterate sternoclavicular dislocation, which came to their observation after tangential resection of the clavicle. They discuss the surgical technique of reduction and stabilization and clinical results. CT scan was the method most-suited to evaluate dislocation of the clavicle.
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Comparative Study
Total en bloc spondylectomy for primary malignant vertebral tumors.
It is the purpose of this study to report our new surgical technique and the outcome of total en bloc spondylectomy (TES) to resect the primary spinal tumor as a whole in order to ensure oncological curability. TES consisting of en bloc laminectomy and en bloc corporectomy was performed on 7 patients with primary vertebral tumors between 1989 and 1993. There were 2 osteosarcomas, 1 malignant fibrous histiocytoma, 1 chondrosarcoma, 1 undifferentiated sarcoma, 1 solitary plasmocytoma, and 1 giant cell tumor. ⋯ None of the patients worsened neurologically after surgery and there was no local recurrence following TES, except for 1 patient who died 3 months postsurgery as a result of a tumor developing in the mediastinum. The advantage of TES is en bloc resection of the affected vertebrae by marginal or wide margin, not piecemeal pattern. This new surgical technique offers the most radical therapy of primary malignant tumors.
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The authors report 7 cases involving the surgical treatment of unstable pelvic ring fractures (Malgaigne type) using two compression bars, as described by Tile. The method was used only in cases where x-ray examination and CT scan revealed that the posterior branch of the fracture was located at the very medial aspect of the sacrum (fracture through the sacral foramina or even medial to the sacral foramina), and therefore could not be stabilized by using other devices.
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Case Reports Comparative Study
Scoliosis in Escobar syndrome (multiple pterygium syndrome). Description of two cases.
The authors report two cases of scoliosis in Escobar syndrome. Both of the patients were submitted to surgical treatment. A fair amount of correction was obtained in the first case, simple stabilization of the deformity was obtained in the second. Our experience confirms the fact that scoliosis may progress considerably in Escobar syndrome, requiring early surgical treatment.