Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1990
Case ReportsTibial hypo-/aplasia with preaxial syn- and polydactyly.
Tibial hypo-/aplasia with preaxial syn- and polydactyly is a rare autosomal dominant condition. Fewer than 20 cases have so far been described. One is presented here.
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Arch Orthop Trauma Surg · Jan 1990
Reaming versus non-reaming in medullary nailing: interference with cortical circulation of the canine tibia.
Medullary nails have only been used with reluctance in the treatment of open fractures since reaming interferes with the cortical circulation. The technique of interlocking offers the interesting possibility of inserting a relatively stiff nail which does not necessarily require reaming. ⋯ Nail insertion without reaming provided clear advantages for the bone's blood supply, while reaming disturbed perfusion in two-thirds of the cortical area and regionally extended through the entire thickness of the cortex. The disturbance without reaming was limited to the inner layer of the cortex and involved only one-third of the cortical cross-section.
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Arch Orthop Trauma Surg · Jan 1990
Comparative StudyDisplaced distal radius fractures. A comparative study of early results following external fixation, functional bracing in supination, or dorsal plaster immobilization.
A comparison of the radiographical and functional results after displaced distal radius fractures in 41 patients treated by external fixation (EF), 36 patients treated by functional bracing in supination (FUSU), and 49 patients treated by dorsal plaster immobilization (DPI) was performed. The rate of initial complications after EF was 53%, compared with 22% after FUSU and 14% after DPI. The radiographical result after EF was significantly better than after nonoperative treatment, but the functional result after 3 and 6 months demonstrated no significant difference between the three series. Consequently, EF and FUSU do not restore wrist function faster than conventional plaster treatment (DPI), but EF improves the radiographical result, though the rate of complications is higher.
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Arch Orthop Trauma Surg · Jan 1990
Separate centre of ossification of the lateral malleolus with instability of the ankle joint.
Four cases of recurrent instability of the ankle joint are reported. The instability was associated with a separate centre of ossification of the lateral malleolus and abnormal movement between the ossicle and the distal fibula. All patients were successfully treated by surgery: two underwent internal fixation and ligamentous reconstruction and two, ligamentous reconstruction after removal of the ossicle.
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According to one principle of surgery, the transplantation of vital tissue is the best method of reconstructing a defect. Because of absent immunologic reactions, high osteogenic potency, and preserved stability, transplantation of autogenous bone shows the best results. Necrosis of transplanted bone, leading inevitably to absorption and remodeling of the graft, can be avoided if microsurgically vascularized autogenous bone segments are transferred. ⋯ Demineralized bone matrix can be used if biomechanical stability is not required. Its ability to induce osteogenesis without a major immune reaction or the risk of transmitting diseases justifies its clinical application. Further intensive research in these areas is unavoidable.