Acta orthopaedica Scandinavica
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This retrospective study examines prognostic factors for post-metastasectomy survival in soft tissue sarcoma patients. Between 1976 and 1992, 274 consecutive patients (median age 49 [7-96] years) with pulmonary metastatic soft tissue sarcoma of the extremity or trunk wall (31 at presentation) were managed at the Mayo Clinic. 214 underwent pulmonary metastasectomy and 163 of these also received adjuvant chemotherapy. There were 195 local excisions, 14 lobectomies, and 5 pneumonectomies. 90 patients had solitary metastases, 184 patients had 2 or more metastases. 31% of patients had MFH tumors and 88% of all tumors were high grade. ⋯ Age > 50, MFH tumors, > or = 2 metastases, metastasis size > 2 cm, metastasis-free period < or = 18 months, and the use of adjuvant chemotherapy were univariately unfavorable factors. Size of metastasis > 2 cm, number of metastases > or = 2, and metastasis-free interval < or = 18 months were independently unfavorable for survival. In a prognostic system, patients with 0 risk factors had a 60% 5-year survival, those with 1, 2, or 3 of these factors had 30%, 20% and 0% survival, respectively.
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This is an assessment of a new device for treatment of intertrochanteric and subtrochanteric fractures. The Medoff sliding plate (MSP) allows compression in 3 different modes: along the femoral shaft, along the femoral neck or a combination of both. In this prospective series of 104 consecutive intertrochanteric fractures, dynamic compression was allowed only along the femoral shaft. ⋯ All were lag screw penetrations, 4 of which were considered to be due to unforced errors by the surgeons. The technical failure rate in this preliminary evaluation of the MSP is similar to that of the dynamic hip screw. Randomized trials comparing the MSP with other hip screw systems should follow to ascertain possible advantages of the MSP, with its various sliding modes in different types of fractures of the proximal femur.
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We studied the effect of quadriceps or hamstring contractions on the anterior tibial shear load to anterior cruciate ligament failure in an in vivo rat model. In both knees of 20 Wistar rats the joint capsule and ligaments, except the anterior cruciate ligaments, were cut and the menisci resected. In 10 rats the right ligament was loaded to failure by anterior translation of the tibia relative to the femur in a testing device during hamstring contraction induced by electrical stimulation of the ischiatic nerve. ⋯ During testing with quadriceps contraction, no differences in the structural properties were found, compared to testing with the quadriceps relaxed. Our findings show that hamstring contraction helps to resist anterior tibial shear force at 30 degrees knee flexion in rats thus protecting the anterior cruciate ligaments. Quadriceps contraction in this situation does not affect anterior shear force to ligament failure.
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In 1988, 1212 patients with an acute pelvic fracture were registered in Finnish hospitals for primary treatment. The overall incidence in women was 29/10(5) and in men 20/10(5). The female to male ratio was 2.9 in patients who were over 49 years of age, while in younger age groups the ratio was 0.5. ⋯ In half of the cases the mechanism of injury was a fall and in one quarter a traffic accident. Slightly more than half of the cases were stable and half of the cases were of moderate severity. The average length of hospital stay varied from 17 days in men to 21 days in women.
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During a 5-year period 1,307 patients with cervical hip fractures were operated on with Olmed screws. In 7 patients one or both screws migrated into the pelvis. 6 patients underwent a total hip arthroplasty without complications, 1 patient had a Girdlestone procedure.