Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyTibial shaft malunion treated with reamed intramedullary nailing: a revised technique.
Thirty-seven consecutive adult tibial shaft malunions which had not undergone surgical treatment were prospectively treated with reamed intramedullary nailing. Indications for this treatment modality included a malunion of a tibial shaft which had only been conservatively treated, lesion level fitting for traditional or locked reamed intramedullary nail fixation, less than 2 cm shortening, and without evidence of deep infection at present. The malunions were treated with fibulotomy, closed wedge tibial osteotomy, open reaming of the marrow cavity, stable reamed intramedullary nail stabilization with or without supplementation, and cancellous bone grafting. ⋯ Good exposure of the bony segments to ream the marrow cavity precisely can avoid cortical perforation. Gentle dissection of the soft tissues may lower the infection rate. Concomitant cancellous bone grafting can improve the union rate.
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We report a case of a nerve sheath ganglion of the ulnar nerve at the canal of Guyon. This case involved a ganglion which was confined to the epineurium of the ulnar nerve. and it was completely excised without any damage to the nerve fiber. A nerve-sheath ganglion is rare, but it should be considered in the differential diagnosis of any tumor which is causing neural disturbance.
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyThe pelvic external fixation: the mid-term results of 41 patients treated with a newly designed fixator.
The purpose of this study was to evaluate the clinical and radiological results of unstable pelvic fractures treated with a new external fixation device. Between May 1992 and May 1998, 43 patients with unstable pelvic fractures were treated with a new anterior pelvic external fixator. Two died, and therefore 41 patients' results were evaluated. ⋯ The fixator can be used alone in patients with type B pelvic injuries such as open book and lateral compression. However, it does not provide sufficient stability for severely displaced type C injuries when applied alone. Nevertheless, it may be helpful for fixing type C injuries like a posterior iliac fracture without dislocation of the sacroiliac joint.
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Arch Orthop Trauma Surg · Jan 2000
Transtrochanteric rotational osteotomy for osteonecrosis of the femoral head with preoperative superselective angiography.
A prospective radiologic and scintigraphic study was made of 15 joints in 12 patients who underwent transtrochanteric rotational osteotomy of the femoral head after identifying by preoperative superselective angiography which arteries should be preserved during surgery. The preoperative superselective angiography revealed that the blood supply to the femoral head was provided by the medial femoral circumflex artery in 12 joints and a branch of the internal iliac artery in 3 joints. ⋯ At the follow-up examination made after at least 2 years, there were no cases of collapse of the new femoral head weight-bearing site, and also there were no cases with a large cold area in the femoral head on the scintigram obtained 2 months postoperatively. For this operative procedure, the nutrient arteries of the femoral head should be confirmed by preoperative superselective angiography, and it is essential that these arteries be preserved during surgery.
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Arch Orthop Trauma Surg · Jan 2000
Case ReportsHuman leukocyte antigen (HLA) phenotypes in siblings with osteosarcoma.
Osteosarcoma was detected in two siblings. Their human leukocyte antigen (HLA) phenotypes were completely identical, although they were different from those of osteosarcoma patients in previous reports. ⋯ These cases suggest that genetic similarity may influence the development of osteosarcoma. Ascertainment of the HLA phenotypes in siblings with osteosarcoma might be a useful strategy to facilitate the early diagnosis of this tumor.