Surgical management of thoracic malignancy in childhood: eight years' experience in Leeds.
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Child↗
Biomedical subjects
R S Sneath
Publications and source records attributed to R S Sneath.
Endoprosthetic replacement of the humerus and elbow joint.
Between 1969 and 1985 26 patients with destructive lesions of the distal humerus were treated by endoprosthetic replacement; each implant was custom-made and incorporated part of the distal humerus or the entire bone as well as a hinged total elbow replacement. Recurrence occurred in three of the patients with tumours, and three prostheses were removed because of deep infection in patients with previously compound injuries of the elbow. Another three loosened without infection, but none needed revision or removal and no amputations resulted. Other complications included nerve palsies, but the only deaths were from metastases. A useful range of elbow movement, with a stable arm and good hand function, was achieved in every patient.
Arm Injuries↗
Endoprosthetic replacement of the proximal femur and acetabulum. A survival analysis.
A series of 81 patients has been reviewed to determine the value of endoprosthetic replacement of the proximal femur and hip in the treatment of bone tumours. Standard statistical methods were used to evaluate the survival of the replacements and the patients. Taking removal of the prosthesis, irrespective of the cause, as the criterion for failure the survival of the replacements was found to be 63 per cent after 10 years. If deaths are regarded as failures, then the survival value falls to 48 per cent. The survival of patients with chondrosarcoma and osteoclastoma treated by endoprosthetic replacement compares favourably with survival after amputation or excision of the tumour.
Adolescent↗
Growing endoprostheses for primary malignant bone tumors.
Twenty years of experience with the use of growing endoprostheses for limb salvage in skeletally immature patients is reported. Alternatives for the management of primary malignant bone tumors in this group of patients are amputation, rotationplasty, and allograft or autograft reconstruction. The development of the currently used implant is charted, with commentary on the complications and difficulties which gave rise to design changes. Over this period, 123 expanding endoprostheses have been inserted in 108 patients in this institution, and the results of a series of 54 consecutive distal femoral replacements are reported. The mean functional score was 72%, and the local recurrence rate was 11%. The technique was successful in maintaining limb-length equality. We conclude that in specialized centers of orthopedic oncology that utilize an endoprosthesis with proven reliability of the expansion mechanism, the short- and long-term results of this technique justify its continued use.
Adolescent↗