[Total hip arthroplasties with special long prothesis following resection of the upper femoral shaft 62 cases. Technic, indications and results (author's transl)].
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Biomedical subjects
Publications and source records attributed to M Katzner.
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477 cases of femoral head arthroplasty for fresh femoral neck fractures were reviewed to study the various factors modifying life prognosis during the first six months (age, associated disorders, type of prothesis, postoperative complications). Certain of these factors were found to affect prognosis unfavorably: bad general health, alcoholism, psychiatric or neoplasic disease, diabetes, and also, to a less degree, senility, neurologic and sensorial disturbances, cardiac deficiency. A rate table makes it possible to make a prognosis on the basis of these different factors.
Ender's closed nailing was initially described for osteosynthesis of trochanteric fractures in elderly people. The authors performed about 500 cases, advanced their indications, and applied this technic to two particular types of lesions, segmental fractures of the femur including the neck and shaft, and metastatic fractures of upper femur. They discuss their indications, technical problems and results.
The authors treated 74 humeral shaft fractures with "hanging cast" technique. They study the benefits and difficulties of the method, compared to other orthopaedic and surgical possibilities. Stiffness of the shoulder represent the most important part of 12% bad results. There are only 3% pseudarthrosis. It is a simple and safe treatment, with appliance to most humeral shaft fractures in cooperant patients.
The authors analyse a series of 70 bimalleolar fractures treated surgically with a follow up of 3 to 8 years. The late functional and radiological result was favourable in 85.7% of cases. They were able to determine from this series a certain number of unfavourable factors on which surgery has a better influence than immobilisation: e.g. fractures with a large displacement, impaction of the roof of the mortar, open fractures. Complications were rare; in 50% they were the result of technical errors avoidable with experience. The indications are noted; the authors consider that certain fracture should be operated straight away, that others should not be operated on, and that finally, an intermediate group should first be treated by immobilisation.
The authors present a series of 18 femoral and humeral metastases of bronchial origin treated by surgery. They study the results and recommend "closed wound" osteosynthesis, underlying the antalgic character of the intervention which does not modify the already limited survival.
Present-day techniques used in the surgical treatment of bony metastases of the limbs are described in relation to a series of 116 cases. Emphasis is laid on the possibilities of osteosynthesis or preventive arthroplasty.
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The authors advocate the technique of blind medullary nailing with reaming of the medullary canal followed by a several weeks-traction in the treatment of compound fractures of the femoral shaft. This method is specially indicated in bursts of the bone, when no stability can be obtained after osteosynthesis and was used in 44 cases. In the same time blind nailing without traction was applied to 272 cases. The results were: sepsis: 0; non-unions: 0; malunions: 5; stiff knees: 3.
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Thirteen metastatic fractures and metastasis of upper extremity of the femur have been treated by Enders' blind nailing in the Orthopaedic Surgery Department of Strasbourg University Hospital. Either very bad general status or major bone destructions made any other surgical care impossible. The author's purpose of relieving of pain and easy nursing was always obtained and some patients were able to walk after radiotherapy.
The authors report 26 cases of open bimalleolar fractures and discuss the various possibilities of treatment. Immediate internal fixation is indicated for types I or II of openings, being the best prevention of sepsis. These osteosynthesis should be the same as for closed fractures: screwing with or without associated AO plate and repair of peroneotibial ligaments.
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The authors report 57 cases of osteosynthesis for trochanterodiaphysial and subtrochanteric fractures. They analyse the types of fracture in relation to age, methods of treatment used and the results. They emphasize the poor prognosis after 70 years. They suggest close wound intramedullary nailing whenever possible and osteosynthesis on non-fractured metastasis in order to prevent fracture.
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