International orthopaedics
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Between 1974 and 1999, we treated operatively 28 patients with a symptomatic mid-shaft clavicular non-union using AO osteosynthesis, including bone grafting. Nine patients had a wave-plate osteosynthesis and 19 a standard AO/ASIF osteosynthesis. The mean follow-up was 10 (2-25) years. ⋯ Pre-operatively, brachialgia was present in 12 patients. Of these patients, six were treated using standard osteosynthesis technique and six by wave-plate osteosynthesis. Post-operatively, patients treated by wave-plate osteosynthesis had no brachialgia and also had a higher Constant score than those patients treated using standard AO/ASIF techniques.
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The BiCONTACT femoral stem for cementless fixation is being used without any technical modification after 15 years. The long-term results should be evaluated in this study. A consecutive series was continuously monitored in a prospective follow-up study. ⋯ Clinical results were somewhat compromised by a higher-than-average rate of cup loosening (uncoated threaded cup). The average Harris hip score at follow-up was 84.3 points. Interestingly, no femoral osteolysis could be detected, even in cases with severe acetabular osteolyses, indicating sealing of the stem interface by tight osseointegration of the proximally-coated stem.
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Bony metastases in patients with osteosarcoma are unusual and normally appear late in the course of the disease. We report our experience with eight such patients, four with solitary and four with multiple metastases. Those with solitary metastases were treated as new tumours with neoadjuvant chemotherapy and surgery. ⋯ Histology and response to neoadjuvant chemotherapy was similar in both the primary and metastatic lesions and is a predictive factor of outcome. Those with multiple metastases were treated by palliative measures, and none survived. We conclude that resection of solitary metastases from osteosarcoma after neoadjuvant chemotherapy can be curative.
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We developed a locking screw plate system for the stabilisation of distal radial fractures, which can be inserted through a standard volar approach and in which the locking mechanism allows early post-operative mobilisation. Forty-nine patients with 50 fractures underwent surgical treatment; 66% were type C fractures. ⋯ According to the scores of Gartland and Werley and Green and O'Brien, 92% and 68% respectively had an excellent or good outcome; 46% were radiologically identical to the uninjured side and in 42% the reduction remained unchanged after 2 years. The most frequent complication was rupture of the flexor pollicis longus tendon, which occurred in six cases (12%) at a mean of 10 months after operation.
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We treated 50 patients (average age 47.9 years) with a stabilized subcutaneous transposition of the ulnar nerve. The average follow-up period was 42.4 months. The indication was cubital tunnel syndrome in 19 patients and injuries around the elbow in 31 patients. ⋯ In the 31 patients with injuries around the elbow, there was only one patient with transient aggravation of parasthaesiae in the ulnar nerve region. Stabilized subcutaneous transposition is a simple and less invasive procedure that can facilitate decompression and prevent slipping back of the nerve. This procedure also can be applied to patients with injuries around the elbow that require ulnar nerve transfer.