International orthopaedics
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Comparative Study
Distraction osteogenesis by Ilizarov and unilateral external fixators in a canine model.
We studied distraction osteogenesis in canine experimental model using two types of external fixators, Ilizarov (n=6) or AO unilateral (n=9) external fixator. Distraction started 1 week after surgery (2 x 0.5 mm/day) and lasted for 3 weeks. Specimens were harvested from weeks 7 through 12. ⋯ No differences in histomorphometric parameters existed between the groups. In the study period, the bone formation was enhanced and prevailed in the distraction area. This study demonstrated the utility of the canine experimental model for the study of distraction osteogenesis.
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The current study investigates instrument breakages during both emergency and elective orthopaedic surgery. Over a 2 year period a total of 7,775 procedures were performed. We found that 14 instruments were broken during 12 operative cases. ⋯ Only one case had a consultant as the lead surgeon. In seven cases the broken bit of the surgical instrument was left in the patient. Documentation of this peri-operative complication was deficient, and the patient was often not informed.
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We treated 31 femoral shaft fractures in 28 children with a mean age of 6.7 (5-10) years with retrograde flexible intramedullary nailing. There were 16 isolated fractures, while 12 children had associated injuries. ⋯ At follow-up after a mean time lapse of 27 months there was no limb-length inequality exceeding 1 cm and no malunion. We feel that femoral fractures in patients aged 5-10 years can be safely treated with retrograde flexible intramedullary nailing with minimal risk of surgical complications.
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We treated surgically 12 patients with an old dislocation of the lower cervical spine. The time from injury to presentation averaged 3.5 (range 1.5-12) months, and the majority of the dislocations were between C4-5. Treatment started with 1 week of skull traction. ⋯ If this allowed reduction it was followed by a posterior fusion with plate fixation. If reduction was not achieved the traction was continued for a further week and then followed by anterior discectomy and fusion with plate fixation. The average follow-up was 34 (range 12-54) months, and all patients developed bone fusion and showed neurological improvement.