Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Oct 2003
Judet's quadricepsplasty, surgical technique, and results in limb reconstruction.
Quadricepsplasty has been described by Thompson and Judet to improve flexion in severely ankylosed knees. Judet's technique has potential advantages because it is less damaging to the quadriceps mechanism and addresses the problem of external fixator pin site tethering on the lateral side of the thigh. The outcome of Judet's quadricepsplasty was assessed in 10 consecutive patients who were treated with external fixation either as a primary treatment (three patients) or as a secondary treatment for nonunion or malunion (seven patients) in a limb reconstruction unit. ⋯ A minimal extension lag (10 degrees ) developed in one patient. Judet quadricepsplasty successfully increases flexion range with minimum impairment of quadriceps function. Familiarity with this technique might lower the surgeon's threshold for considering quadricepsplasty in patients with severe knee ankylosis after severe femoral fractures and in particular after a prolonged period of external fixation.
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The multimodality treatment approach for patients with Ewing's sarcoma during the last decades has dramatically improved patient long-term survival. With improved survival, late consequences and morbidity associated with treatment have become apparent. Among the morbidity associated with treatment is the increased risk of development of secondary malignancies. ⋯ At the mean followup of 15 years (range, 2-33 years) from diagnosis of Ewing's sarcoma and at a mean followup of 5 years (range, 0.5-28 years) from diagnosis of the second malignancy, 14 patients are alive (43%); however, patients with either sarcomas or hematopoietic secondary malignancies had not only a significantly shorter interval from secondary malignancy to followup (3.3 and 1.2 years, respectively, versus 7.3 years), but also a more dismal prognosis (eight of 12 or six of eight patients died, respectively, versus one of nine). Although the risk of having secondary malignancy develop after the treatment of a Ewing's sarcoma may be only slightly greater than the risk compared with other childhood cancers, patients with hematopoietic and radiation-induced secondary malignancies have a detrimental prognosis. Patients with Ewing's sarcoma need to be followed up carefully and frequently.
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Clin. Orthop. Relat. Res. · Oct 2003
Validity of index of suspicion for pulmonary embolism after hip arthroplasty.
Pulmonary embolism after total hip arthroplasty is problematic, and intravenous heparin treatment in the absence of pulmonary embolism carries risk. Algorithms for treating pulmonary embolism often cite clinical index of suspicion as a basis for initiating intravenous heparin, but most information regarding variables to predict pulmonary embolism originate from studies of patients rather than only from patients who had arthroplasty. We studied the hypothesis that a more homogenous subpopulation, patients who had total hip arthroplasty, may have findings more accurately predictive of pulmonary embolism. ⋯ No significant differences were found between patients with or without pulmonary embolism regarding subjective complaints, physical examination, blood gas results, electrocardiogram findings, radiographs of the chest, and imaging of the veins of the legs. All attempts to model these variables into an index of suspicion that accurately predicted pulmonary embolism were unsuccessful. We advise adherence to established treatment algorithms rather than clinical suspicion when deciding whether to initiate heparin therapy.
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Clin. Orthop. Relat. Res. · Oct 2003
Pathologic fracture as a complication in the treatment of Ewing's sarcoma.
The purpose of the current study was to define the outcome of patients with Ewing's sarcoma who sustained a fracture either at initial presentation or subsequent to multimodal treatment, and to identify parameters that may influence the treatment of these patients. The age of the 21 males and 14 females who sustained a fracture during the treatment for Ewing's sarcoma averaged 15 years (range, 4-30 years) at diagnosis. Fourteen patients presented with a pathologic fracture, whereas 21 patients had a fracture develop subsequent to the initial treatment at a mean of 4 years (range, 1-19 years). ⋯ Therefore, a fracture at presentation may not mandate amputation. However, it occurs frequently subsequent to initial multimodal treatment because of delayed fracture healing. Because conservative or minimal osteosynthesis have high failure rates, more aggressive resection and reconstruction have to be considered carefully.
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Clin. Orthop. Relat. Res. · Oct 2003
Case ReportsRotationplasty after failed limb-sparing tumor surgery: a report of two cases.
Rotationplasty was used in two cases of failed limb salvage in adults after tumor resection and reconstruction. Each patient had distal femoral osteosarcoma, one treated with osteoarticular allograft reconstruction, the other with a custom endoprosthetic reconstruction. Both patients had failure attributable to infection, and after multiple surgeries, elected to have rotationplasty. ⋯ One patient died of metastatic disease 29 months after rotationplasty, the other had no problems 50 months after rotationplasty. Although rotationplasty offers a functional improvement over transfemoral amputation in the salvage of failed tumor reconstructions, only 10 such cases have been reported in adults. Rotationplasty should be considered in selected patients for whom an amputation is being considered after failed limb salvage surgery.