Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Oct 1986
Limb salvage and prosthetic joint reconstruction for low-grade and selected high-grade sarcomas of bone after wide resection and replacement by autoclaved [corrected] autogeneic grafts.
Wide resection is an acceptable alternative to amputation for the management of primary sarcomas of the long bones or pelvis. The resected bone can be debrided of gross tumor tissue, autoclaved, and then replaced over intramedullary fixation to reconstruct the limb anatomically. The procedure can be combined with prosthetic reconstruction of adjacent joints with sufficient strength to allow early unprotected weight-bearing. ⋯ There were no late fatigue fractures of the grafts. The technique does not compromise the margins for adequate tumor resection. It preserves a graft strong enough to support a joint arthroplasty and to allow early weight-bearing with a low risk of pseudarthrosis or late fatigue fracture.
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The juvenile fracture of Tillaux is an ankle joint avulsion fracture of the anterior distal tibial tubercle in adolescents, produced by external rotation force applied to the foot. Data from five patients with the juvenile fracture of Tillaux were reviewed. In four of the patients, an initial closed reduction was unsuccessful and had to be followed by open reduction and internal fixation of the displaced fragment. ⋯ Results were compared with data from five major series of patients who had sustained this fracture. Nonoperative treatment was indicated for the undisplaced fractures but may give less than optimal results in initially displaced fractures. In cases where there was displacement of the fragment after closed reduction, open reduction and internal fixation of the displaced fracture gave excellent functional result.
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A 26-year-old man sustained a scapulothoracic dissociation (STD) as a result of severe shoulder girdle trauma. In this recently described syndrome, multiple fractures of the upper extremity and closed disruption of the scapula from the thorax are combined with damage to the local neurovascular structures. The occurrence of blunt subclavian arterial injury and STD indicates the possibility of severe brachial plexus lesions.
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Clin. Orthop. Relat. Res. · Jul 1986
Corrective osteotomy of the spine in ankylosing spondylitis. Experience with 66 cases.
Of 66 cases of corrective lumbar osteotomy for ankylosing spondylitis, 59 were men and seven were women with a follow-up period of two to 30 years after surgery. Their ages ranged from 19 to 55 years. The deformity was corrected by a one-stage posterior osteotomy and decompression of the posterior elements of the spine. ⋯ These patients were pleased with the cosmetic results, improved gait, and ability to look straight ahead. In addition to the expanded field of vision, there was general improvement in the cardiorespiratory and gastrointestinal functions plus a better mental attitude. Patients over 55 years of age, patients with aortic calcification, poor medical risks, and patients with ankylosed hips (untreated with total hip arthroplasties) are contraindications for this operation.
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Clin. Orthop. Relat. Res. · Jul 1986
Biography Historical ArticleThe classic. Disc degeneration and low back pain. Ian Macnab.