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PubMed1976

[Morbid anatomy and pathogenesis of spondylolysis and spondylolysthesis in childhood (author's transl)].

Histologic findings of 4 cases of spondylolysis and spondylolisthesis in childhood and their pathogenetic interpretation. The microscopic changes in the lateral gap of the vertebral arch in children are explained as due to stress in the growing intervertebral bones, as fatigue fractures in the widest sense, with a tendency to pathologic union and fibro-cartilagineous pseudarthrosis. During pathogenesis we distinguish between the "primary lysis", a stage of repair followed by defective healing and the resulting spondylolysis.

Adolescent↗

PubMed1992

[Scaphoid bone].

The scaphoid is the most important carpal bone due to the frequency of its pathological involvement. Two points of radiological anatomy are stressed: the presence of the scaphoid tubercle whose projection gives rise to the scaphoid ring, the solid radio-capitatum ligament which bridges the scaphoid. Scaphoid fracture represents 70% of all carpal bone fractures and its presence must therefore be meticulously investigated on appropriate x-rays or on tomographies or CT scans, rather than by the classical repeat examination a fortnight later. CT provides good analysis of scaphoid fragments when consolidation is delayed (pseudarthrosis), allowing earlier and more justified indications for surgery. The wrist ligaments are poorly visualised by MRI at the present time; but it allows study of the cartilage and, most importantly, is a decisive examination when there is a doubt about bone vitality.

Arthrography↗

PubMed1992

[Excision of the proximal row of the carpal bones. Apropos of 21 patients].

Twenty one patients have been reviewed with a mean follow-up of 4.6 years. If we except one acute case, the main indications were scaphoid pseudarthrosis (13 cases), Kienbock's disease (4 cases), carpal instability (3 cases) all accompanied by wrist arthrosis. The results were considered excellent and good in 65 per cent of the cases. Pain was improved in 90 per cent of the patients. Average mobility was 71 degrees (76 degrees before operation). Strength was improved in 19 per cent of cases but remained less than the normal side in 60 per cent. Among 15 manual workers 11 went back to the same work and 4 to an adjusted work.

Adult↗

PubMed1992

Diagnostic and therapeutic technology assessment. Distraction/compression osteosynthesis with the Ilizarov device.

Although the Ilizarov device (and technique) to treat problematic fractures and bone deformities has been used since the 1950s in the former Soviet Union, the technique was not introduced to the United States until 1984. Since that time, the technique has become increasingly popular because, in comparison with the alternatives, the Ilizarov technique involves only one surgical procedure and it appears to have fewer complications. In addition, the Ilizarov technique was designed to correct multiple deformities simultaneously. The DATTA panelists thought that the technique was established in terms of safety and effectiveness as a treatment of limb length deformity, bone defects, and angular/rotational deformity of the long bones. The panelists thought that it was promising in terms of safety and effectiveness as a treatment of pseudarthrosis. However, this overall endorsement of the technique was tempered by comments that the technique was associated with a lengthy learning curve, was very labor intensive, and required a large degree of patient cooperation.

American Medical Association↗

PubMed1992

[Intramedullary nailing of unstable proximal humeral fractures].

Unstable subcapital fractures and dislocation fractures of the humerus can usually be set by closed reduction. Stabilization of these fractures by intramedullary pins is a method which avoids damage to the soft tissues around the shoulder. Since 1985, elastic steel pins with special features have been in use. The last 20 mm of the tip of the pins is angulated at 15 degrees, and the distal end is curved in a special way for the last 20 mm. According to our experience, the results after using this method in the treatment of unstable fractures of the surgical neck (ASIF type A II/2) and dislocation fractures (ASIF type A III/2) are fair to very good. For unstable fractures (ASIF type C I/2) and other dislocation fractures (ASIF type C III/2), the method is only suitable if good reduction is possible. Between the end of February 1985 and the end of December 1990, 101 fractures of the proximal end of the humerus were treated by closed reduction and fixation with intramedullary pins. Following fractures in the anatomical neck, aseptic necrosis of the fragment of the head leads to unfavorable results. In two patients, pseudarthrosis with poor function developed. Disturbance of wound healing, postoperative hematoma, infection, myositis ossificans, or Sudeck's desease have not been observed.

Adolescent↗

PubMed1992

[Recent fractures of the humeral shaft in adults. Role of surgical treatment using screwed plates. Apropos of 35 cases surgically treated].

Thirty five cases of recent fractures of the adult humeral shaft were treated by using A0 plating technics. Most of the results were satisfactory (91 per cent of good and excellent results). A few post-operative complications were observed: two deep infections, one radial nerve palsy, no pseudarthrosis. Once indicated, internal fixation using plating is the best surgical technic for the authors of the present study.

Adolescent↗

PubMed1992

Pediatric applications of the Ilizarov method.

Since mid-1987, more than 250 applications of the Ilizarov technique have been successful in treating a variety of pediatric orthopedic problems. The principles of the method are the same in adults and children. Careful preoperative planning and close follow-up evaluation during distraction are important to success. Complication rates are high but improving as experience is gained with the technique. Most complications can be managed such that the ultimate success is not jeopardized. The Ilizarov technique has wide application in the treatment of difficult deformities. The method is useful for treatment of limb-length discrepancy projected to be greater than 5 cm and in limb-length discrepancy combined with angular deformity. The method is applicable to angular deformities such as in adolescent Blount's disease and congenital tibial pseudarthrosis, especially conditions where bone transport may be needed to gain length. In resistant or recurrent clubfeet, the Ilizarov technique is useful as an alternative to osteotomy of the mid- and hindfoot or both. The method may even be indicated for lengthening limbs in selected patients with short stature.

Adolescent↗

PubMed1975

[Compression arthrodesis of the knee joint].

The results of 42 cases of compression arthrodesis of the knee joint during a 5.5 years period are reviewed. Main indications were degenerative, rheumatoid and posttraumatic arthrosis and tuberculosis of the knee joint. Other differential indications and the operative procedure following the Charnley-Müller method are described. The complications - pseudarthrosis, infection, false rotation - are discussed.

Adult↗

PubMed2006

Outcome of Girdlestone's resection arthroplasty following complications of proximal femoral fractures.

Twenty two patients who underwent a Girdlestone resection arthroplasty of the hip (pseudarthrosis coxae) following failed operative treatment for hip trauma from 1993 to 2002 were retrospectively reviewed. The indications included failed osteosynthesis of fractures of the neck of the femur (n=8), septic hemiarthroplasty (n=9), aseptic loosening of hemiarthroplasty (n=3) and recurrent dislocation of a hemiarthroplasty (n=2). The mortality was 68.2% (15 patients, mean age: 78.8 years, 80% females) with a mean time interval between operation and death of 25.6 months. All the seven surviving Girdlestone patients had failed hemiarthroplasties previously. One of these had subsequently undergone re-implantation of a femoral prosthesis, and was excluded from the study. There were four females and two males. The age ranged from 62 to 94 years with a mean age of 79.6 years. There were 4 right-sided and 2 left-sided operations. The patients were followed-up for a mean 37.1 months (range : 6 months to 8 years). Pain relief was achieved in 100% patients with none to mild pain. All the patients had infection control. Four patients needed a frame support for walking, while the remaining two were chairbound. Overall 83.3% patients expressed their satisfaction with the Girdlestone procedure. The Girdlestone operation appears as a viable solution to achieve pain relief and to control infection at the cost of limited mobility in this specific subgroup of patients with failed operative treatment for hip trauma.

Aged↗

PubMed1991

Salvage and reconstructive surgery for spinal deformity using Cotrel-Dubousset instrumentation.

Sixty consecutive patients who underwent Cotrel-Dubousset instrumentation as part of their reconstructive surgery (failure of previous surgery) were reviewed. The average follow-up was 3 years (range, 2-4.5 years). There were no deaths or major neurologic problems. Pseudarthrosis occurred in six patients, all of whom had long fusion to the sacrum; all six were successfully repaired. Cotrel-Dubousset instrumentation provides a far superior method of correction of deformity and internal fixation than that available previously.

Adolescent↗

PubMed1991

Survivorship analysis of pedicle spinal instrumentation.

Between 1985 and 1989, the senior author performed 120 consecutive pedicle instrumentation cases--78 Steffee (VSP) procedures and 42 procedures using Cotrel-Dubousset instrumentation. Posterolateral or posterior fusions using autogenous iliac bone graft were performed across the instrumented vertebrae in all cases. Survivorship analysis was used to calculate a predicted cumulative rate of success for this series of patients over 10 years postoperative follow-up. The criteria of failure of pedicular instrumentation or "death" of an implant were defined as 1) screw bending, 2) screw breakage, 3) infection, 4) loosening of implants, 5) any rod or plate hardware problems, or 6) removal of hardware due to a neurologic complication. Out of 526 pedicle screws (175 Cotrel-Dubousset screws, 351 VSP screws) there were 22 problem screws (22/526 = 4.18%). Six screws had bent, none were infected, 16 screws had broken, and none were loose. The 22 problem screw events occurred in 12 patients. In seven patients, the instrumentation failure was an incidental radiographic finding, in that patients had a solid posterolateral fusion. The remaining five patients had screw breakage in association with a pseudarthrosis. Life table calculations predicted the survivorship of instrumentation without complications would be 80% at 10 years postoperative follow-up. Actuarial analysis predicted the survivorship of solid posterolateral fusion at 90% at 10 years follow-up. This survivorship rate is similar to those predicted at 10 years follow-up for other more widely used orthopedic surgical implants such as total hip arthroplasty components.

Actuarial Analysis↗

PubMedDate not supplied

[Infected, diaphyseal pseudoarthroses of limbs. Therapeutic problems in 17 cases. (Orthopedic-traumatology service of the University Hospital Center of Brazzaville-Congo].

Seventeen cases of infected pseudarthrosis have been registered between 1987 and 1991 in the Orthopaedic Ward of the University Hospital of Brazzaville (Congo). They are distributed as follows: eleven cases located in the leg, three in the humerus, and three others in the femur. Their analysis was especially concerned with the etiological aspects of the different cases, and with their specific therapeutic strategies. The authors' conclusion points to the urge to take deterrent steps to ward off the awful complications of the disease.

Adolescent↗

PubMed1991

[Application of Ilizarov's external fixator on the basis of biology].

Ilizarov's biology includes that, in the presence of tension and stress, both regeneration of bone and soft tissues with cellular proliferation and their biological synthesis become vigorous. The Ilizarov's external fixator has five functions namely: compression, distraction, de-angulation, derotation and translocation. The principles of this procedure include: corticotomy instead of conventional osteotomy, placement of 4-5 sets of 1.5 mm wires transfixed in the bones at different levels under tension of 70-110 kg on the circular rings without acute diastasis until the 5 th to 7th day, and then, callotasis-callus distraction. The quality and quantity of the regenerated bone within the widening distraction gap are closely related to the maximum preservation of bone marrow and periosseous blood supply, and a distraction of 1 mm per day and preferably done by 4 times 0.25 mm each time should be emphasized. Experiences in 17 cases of pseudarthrosis and unequal length of leg treated with Ilizarov's technique are presented.

Adolescent↗

PubMed1991

[The treatment of humeral shaft fractures. Results of a prospective AO multicenter study].

This prospective multicenter study conducted by the German section of the AO International analyzes 302 fractures of the humeral shaft, 170 (56%) of which were operated upon and 132 (44%), treated conservatively. Among those operated upon, 3.5% developed infections and 10% showed paresis of the radial nerve. In contrast, the only complication in the group treated conservatively was pseudarthrosis, in 1 case. However, further analysis revealed that complications were distributed unequally among the centers and the most complications were reported from only a few hospitals. We were able to contact 173 (57%) patients for follow-up. Results of operative and conservative treatment were compared for similar fractures. Both techniques resulted in predominantly good to excellent results. The somewhat inferior results in the group operated upon were explained by the higher percentage of associated local injuries and concomitant injuries to other organs. The results of this study were compared with those of other recent studies, and recommendations were established for the operative and conservative treatment of fractures of the humeral shaft.

Adolescent↗

PubMed1990

[Cinematography, a new diagnostic procedure in evaluation of the injured painful wrist joint].

By the X-ray Cineradiografie we are able to examine and to judge the dynamic of the wrist bones by 50 pictures/sec. in comparison to one another and also depending on their ligaments. We did an investigation of 170 patients with painful wrist. With the method we were able to make up a clear diagnosis and to propose the therapy. I.e.: If consecutive shortening of the radius after distal radius fracture resulting ingruency of the wrist joint is relevant, or a scaphoid pseudarthrosis is fixed elastically, or a scaphoic dissociation is effective. The variations were shown in comparison to normal circumstances.

Carpal Bones↗

PubMed1990

[The value of electromagnetic waves in delayed union. Apropos of 21 cases].

Healing was obtained in 21 fractures with delayed union or pseudarthrosis by stimulation of the bone with electromagnetic waves. The interest of this method lies in a number of factors: the apparatus Centicure is miniaturized and very easy to handle; the daily treatment is performed by the patient himself; and application may be split, allowing normal and even professional activity. The method requires no immobilization nor surgical electrode implantation, the cost of the treatment is low and the apparatus can be used for several patients. Bone healing was seen in 15 cases of the 19 reviewed after a brief treatment period. Stimulation by means of magnetic fields, on the other hand, has obvious drawbacks, including high costs.

Adolescent↗

PubMed1990

[Has the Ilizarov technique come of age in pediatric orthopedics?].

The Ilizarov method can be used for several applications: limb lengthening correction of axial malignement, pseudarthrosis, traumatology and in several sites: leg, foot, knee, femur, forearm and arm. The authors recall the principles and possibilities of this method and give details about its utilisation for each indication, and for their preferred indications: lengthening for marked disparity, complex trauma, progressive distraction of soft tissues, and for very young children.

Adolescent↗

PubMed1990

Free vascularized fibular graft for the treatment of a massive long-bone defect.

Free vascularized fibular grafts were used for reconstruction of massive long bone defects in 10 cases. The causes of the defects included 3 congenital pseudarthroses of the tibia, 2 traumatic bone defects, and 5 bone tumors. The average graft length was 13.2 cm (range 6-21 cm). Follow-up ranged from 4-18 months, with a mean of 8.5 months. Seven cases established bony union at graft host junctions within 3 months. Two congenital pseudarthroses of the tibia exhibited recurrence of neurofibromatosis at the proximal graft-host junctions; one was complicated by infection and had not yet obtained bony union on the patient's most recent visit. In 2 cases of bone tumor, the malignant tumor recurred; one of these patients underwent a below-elbow amputation. Early results indicate that the vascularized fibular graft is a useful alternative for reconstruction of some large bone defects. Adequate removal of the underlying lesion is essential if this procedure is to be used for treatment of congenital pseudarthrosis or for filling in the bone after resection of a tumor.

Adolescent↗