[Analysis of a continuous series of 500 surgically treated bony metastases].
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Biomedical subjects
Publications and source records attributed to M Katzner.
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A series of 228 bone metastases of breast cancer in the limbs was operated continuously in the same division from 1965 to 1989. The consistent analysis of epidemiology, techniques and results allowed regularly improving the accuracy of surgical indications, which are now properly codified and preferably include arthroplasties and closed-focus osteosynthesis.
Case report of a central midshaft osteosarcoma of the femur, treated conservatively under Rosen procedure. Bone resection was followed by reconstruction with a deep frozen (-196 degrees) conserved massive homograft, fixed by an interlocked Kuntscher's nail. The purpose of this paper is to expose the advantages of this type of fixation, V.S. conventional nails, or plates. X-Ray showed a bridging bone spindle between host and graft cortical bone, induced by initial stability of the nail, and a rapid fusion after secondary dynamisation of the nail, by removing one screw. We obtained an early functional recovery and a complete and rapid autonomy necessary to allow social and school reinsertion, whatever should the medium or long term presumed survival be.
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The authors have analysed the results of 300 operations for metastases in bone carried out in the last 20 years. The best results were obtained where prosthetic replacement was possible, and where deposits in long bones were treated by closed intramedullary fixation. This type of surgery gives satisfactory, comfortable function and should be part of a multidisciplinary approach in the management of patients with cancer.
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Case report of pelvic dislocation of a total hip prosthesis cup on an acetabular signal metastasis, occurred 22 months after surgery.
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Complications occurred in 220 out of 2018 total hip replacement operations (10.9%) and were responsible for 35 post-operative deaths (1.73%). They included early vascular accidents (3.6%), post-operative dislocations (2.47%) and late aseptic prosthesis loosening (3%). Sepsis was uncommon (1.28%). Other complications were exceptional and unforeseable.
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The authors have treated 182 fractures of the calcaneus. Ninety-nine of these were operated on and plated. The results were studied in 75 cases with a follow up of 1 to 6 years. The technique used a lateral approach; a plate was always used, sometimes with a heterogeneous bone graft (Kiel bone). The operation was followed by 3 weeks of plaster cast fixation followed by mobilisation of the foot. A good functional result was obtained in 82 p. 100 of cases, but a satisfactory anatomical reduction in only 73 p. 100. Some mobility of the subtalar joint was conserved in 73 p. 100 of cases. The indications are described. This type of operation should be performed in displaced fractures with 2, 3 or 4 fragments. In more comminuted fractures the authors consider that primary arthrodesis is advisable. Conservative treatment is indicated in slightly displaced fractures or when local conditions make operation inadvisable.
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Between 1973 and 1980 the authors inserted 100 large prostheses of the upper end of the femur. The first seven were used for intertrochanteric fractures but a high rate of complication was encountered and the method abandoned. Of the remaining prostheses 50 were used following resection of the upper end of the femur for metastatic or primary tumours and the remainder for revision of previous hip arthroplasties. Relief of pain was universal and a satisfactory functional result was obtained in two thirds of the patients. No loosening of the cup was encountered.
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Data from a series of 45 internal fixations for malignant secondary tumors of the humerus are analyzed. The tumors occurred late in the evolution of the cancer, and represented 24% of appendicular bone metastases for which operations were performed. Statistics of the patients, fractures, treatment, and results are presented and conclusions drawn. Prognosis should be related to the types of primary tumor. Blind nailing or pinning is recommended, and indications for preventive osteosynthesis are discussed.
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