Clinical orthopaedics and related research
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The femoral neck fracture remains one of the unsolved fractures. It is a fracture with a high incidence of nonunion and avascular necrosis. One hundred twenty-one mostly young adult patients with femoral neck fractures were treated by Knowles pins internal fixation. ⋯ There was no significant difference in avascular necrosis rates among age groups. Nonunion and avascular necrosis occurred mainly in displaced fractures. Knowles pinning offers the advantages of few technical failures, early weight bearing, high union rate, and low complication rate.
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Clin. Orthop. Relat. Res. · Sep 1991
Review Multicenter Study Clinical TrialLocal control and survival from the Cooperative Osteosarcoma Study Group studies of the German Society of Pediatric Oncology and the Vienna Bone Tumor Registry.
The use of aggressive chemotherapy undoubtedly has brought about a dramatic increase in the cure rate of osteosarcoma. The authors' investigations have increased the authors' knowledge of chemotherapy for osteosarcoma, the differential efficacy of currently used agents, and the pronounced schedule dependency and relative route independency of their efficiency. The authors were able to confirm the prognostic significance of tumor response after preoperative chemotherapy. ⋯ The authors' efforts to steadily increase metastasis-free survival rates by intensifying chemotherapy in this series of studies, however, have been only moderately successful. Still, chemotherapy-related acute toxicity is considerable and increases with aggressiveness of treatment, and the manifestations of late toxicity may continue to increase with follow-up time. Future trials should be targeted toward exploration of the minimum indispensable amount of toxic treatment yielding comparable or even better results than those currently attainable.
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Clin. Orthop. Relat. Res. · Sep 1991
Neoadjuvant chemotherapy for nonmetastatic osteosarcoma of the extremities.
Between September 1986 and December 1988, 125 patients with osteosarcoma of the extremities entered the second neoadjuvant study at the authors' institution. Patients received preoperatively two cycles of methotrexate (MTX) intravenously, followed by cisplatinum (CDP) intraarterially, plus adriamycin (ADM) intravenously. After surgery, the patients classified as "good responders" (more than 90% tumor necrosis) received ADM, MTX, and CDP, while the "poor responders" (less than 90% tumor necrosis) had a longer chemotherapy that included ifosfamide and etoposide (VP-16) in addition to MTX, ADM, and CDP. ⋯ Compared with the first neoadjuvant study at the authors' institution that used only MTX and CDP preoperatively, the percentage of limb salvages, "good responders," and continuously disease-free survival at two years was significantly higher in the second Rizzoli neoadjuvant study (85%, 74%, and 87% versus 77%, 52%, and 59%). Systemic toxicity because of chemotherapy was superimposable. A retrospective analysis of the real dose intensity for each patient demonstrated a correlation between the intensity of chemotherapy and prognosis.
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Telangiectatic osteosarcoma is a rare variant of osteosarcoma. In the original report from the authors' institution, a poor prognosis was noted. The authors have updated their experience with this entity. ⋯ The prognosis in the present series seems to be the same as that for conventional osteosarcoma. Adjuvant chemotherapy seems to help in salvaging patients with metastatic disease. However, in this small series, survival of patients without metastasis is apparently not influenced by whether they received chemotherapy.
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Clin. Orthop. Relat. Res. · Sep 1991
ReviewIIB osteosarcoma. Current management, local control, and survival statistics--The Netherlands.
Guarded optimism is justified in light of the results of treatment of IIB osteosarcoma in the Netherlands. This is due to improvements in diagnostic imaging techniques, staging, adjuvant chemotherapy, and surgical treatment. Five-year survival rates have increased from 25% to 80%. ⋯ An international gathering of data on the overall treatment of IIB osteosarcoma is advocated to find answers on the above-mentioned questions. A noninvasive adjustable-lengthening prosthesis is mentioned as a Dutch solution to leg-length discrepancy. This prosthesis can be used after limb-saving surgery in young children.