Acta orthopaedica Scandinavica
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Wound healing complications, predisposing to deep infection, are common following prosthetic surgery of the elbow. 50 capitellocondylar elbow prostheses were inserted, using a lateral approach, in 42 patients with rheumatoid arthritis. The first 5 elbows were immobilized postoperatively for 5 days and the following 45 elbows for 12 days, because of delayed wound healing in 2 of the first 5 elbows. ⋯ The authors conclude that the lateral approach is safe to use in prosthetic surgery on the elbow. Early mobilization can delay wound healing, but this can be prevented by 2 weeks of postoperative immobilization.
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Case Reports
Ruptured pectoralis major tendon. A case report on delayed repair with muscle advancement.
A total rupture at the humeral insertion of the pectoralis major tendon was repaired 3 months after the injury by sutures through 3 pairs of drill holes in the crest of the greater tubercle. To unload the sutures and to facilitate early mobilization, the muscle was advanced by fascial detachment in the medial-inferior origin of the muscle. Full mobility was achieved in 1 month and full activity was allowed 1 month later.
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39 consecutive cases of whiplash injury of the neck were examined clinically and with MRI at a mean of 11 days after trauma. 26 of these showed changes on MRI with disc lesions in 25, 10 of which were classified as disc herniations, and a muscle lesion in 1 case. All had neck pain or headache. 29 cases had neurological deficits, mostly sensibility disturbances. 22 of the 26 cases with pathologic MRI findings had neurological signs, as had 7 of the 10 cases with disc herniation. The relationship between the MRI findings and the clinical symptoms and signs was poor.
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We report 3 patients with a second bone involved with osteosarcoma. They were found among approximately 200 cases of limb-sparing surgery with chemotherapy. 1 patient had the unusual finding of a positive MRI scan with all other routine tests negative. The first and then the second bone tumor were successfully removed with limb-sparing surgery. All 3 patients are doing well, with no evidence of disease.
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In the period 1984-1991, 33 lower limb reconstructions were performed with an uncemented Kotz modular femur tibia reconstruction (KMFTR) prosthesis after resection of 32 malignant bone tumors and 1 benign giant cell tumors. Tumor localization was proximal femur in 12, distal femur in 17, and proximal tibia in 4. ⋯ In 2 of the 4 patients undergoing combined distal femur and proximal tibia resection, a deep infection developed, and above-knee amputation was performed. One local recurrence occurred after proximal femur resection.