Biomedical subjects
Publications and source records attributed to G Fabry.
Sciatic nerve palsy following hip surgery is a rare but troublesome complication. Twenty cases of incomplete sciatic nerve lesions are presented and recommendations are made to prevent this potentially incapacitating lesion.
A hereditary form of multicentric osteolysis is described in an 11-year-old girl whose father is also affected. The results after corrective surgery on the foot with the Ilizarov fixator and the findings during arthroscopy of the knee are discussed. The literature is reviewed.
An isolated posterior dislocation of the radial head is a rare injury. We present a case report on an 11-year-old boy with a traumatic posterior radial head dislocation without fracture or bending of the ulna. The diagnosis can be difficult and should be supported with good radiographic images, since clinically the injury can be missed or misdiagnosed.
In a retrospective study 33 fractures of the dens were analyzed. Nonoperative treatment was successful in types I and III, but unsuccessful in 48.5% of type II fractures. In addition to the poor outcome factors of Schatzker, the classification of Roy-Camille is a valuable prognostic factor.
Fifty-eight children between age 6 and 18 years were treated for osteogenic sarcoma in the period 1962 to 1987. Fifty-one patients with no preoperative pulmonary metastases (group A) had an overall 5-year survival rate (T5) of 41%; they were subdivided into three subgroups. In subgroup A1 treated with surgery and/or radiotherapy (15 cases), the 5-year survival rate (T5) was 33.3%, as in the classical historical series. In subgroup A2 treated with surgery and postoperative chemotherapy (19 cases) the T5 was 38.8%. In subgroup A3 treated by surgery and pre- and postoperative chemotherapy (17 cases) the T5 was 66.6%, which was statistically the best therapy (p < 0.5). This confirms the general trend in orthopedic oncology. Further data proved the negative prognostic value of male sex, while the grade of tumor and the surgical margins were important factors, but not statistically significant. Seven patients with preoperative metastases (group B) had a T5 of 0%.
In a retrospective study, 21 simple bone cysts (SBC) treated by curettage (with or without bone grafting) are compared to 20 SBC treated by intralesional injections of methylprednisolone. Curettage led to 43% favourable results and 29% recurrences. Cortisone injections led to 90% favourable results and 5% recurrences. Combined therapy (curettage and injections) led to results comparable to injections only. In our experience, curettage and hydroxyapatite grafting led to 100% complete healing (only 2 cases). We recommend intralesional methylprednisolone injections because the method is easy, effective and safe.
Ilizarov's method of percutaneous transosseous osteosynthesis allows management of complex skeletal deformities using elastic external fixation, atraumatic corticotomy and gradual adaptations between bony fragments. One particular application, useful in the reconstruction of bony defects, is the "lift" or "bone transport" technique, in which in fact internal lengthening is carried out. Using some of their first cases as illustrations, the authors describe the technique and its potential problems.
Three cases of avascular necrosis of the scaphoid are reported. One patient, who was using corticosteroids on a regular basis, had other areas of bone necrosis. None of the patients had a history of trauma. All three patients were treated with proximal row carpectomy with satisfactory results.
An analysis of the follow-up results of 53 patients treated by an arthroscopic decompression (AD) and 53 patients treated by an open decompression (OD) is presented. Patients were evaluated pre- and postoperatively with the UCLA Shoulder Rating Scale, which includes an assessment of pain, function, range of motion, strength, and patient satisfaction. After an average of 20.1 months for the AD group and 27.3 months for the OD group, good or excellent results were found in 83.1% in the AD group and in 81.1% in the OD group. Patient satisfaction was 88.3% (AD) compared with 94.3% (OD). Results of decompression in both groups were not influenced by associated pathologies (acromioclavicular degeneration, frozen shoulder, calcified tendinitis, rotator cuff lesions).
A 24-year-old miner sustained wrist trauma in a car accident. The initial radiographs showed a dorsal rim fracture of the radius without any dislocation of the wrist. Fourteen days later, radiography revealed a total ulnar translation of the carpus. Open reduction was performed with a good clinical and radiographic result.
A family with syndactyly type II or synpolydactyly is described. The autosomal dominant inheritance is confirmed by this pedigree. In combination of this anomaly a brachymesophalangia of the fifth finger was inherited by most family members. The duplicated phalanx was resected and the syndactyly separated in the proband with excellent functional and cosmetic results.
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Sixty-two tibial diaphyseal nonunions in 60 patients were treated with a posterolateral bone graft over an 18-year period (1969-1987). The majority were complicated by severe soft tissue damage or segmental bone loss. Thirty-four had a deep infection. Primary healing was achieved in 92%. Three types of bone grafts have been used: from 1969 to 1978 either a whole iliac bone graft (10 tibiae) or a nonvascularized fibular graft (11 tibiae) was used. Since 1978 small iliac cancellous bone chips (41 remaining tibiae) were applied to the posterior surfaces of tibia and interosseous membrane. In three tibiae with major bone defects, cancellous allografts were added to the autogenous bone. The use of cortico-cancellous bone chips resulted in a shorter healing time, compared to a nonvascularized fibular graft or a massive corticocancellous bone block.
Synovial chondromatosis is extremely rare in small joints. The authors present a case of involvement of the fifth metacarpophalangeal joint, treated by removal of loose bodies and synovectomy.
An ulnar approach to the wrist is described. We used this technique for several reconstructive procedures in more than 30 cases.
Osteoid osteoma is a benign tumor frequently situated around the knee. It should therefore be considered as a possible cause of atraumatic knee pain in young adults. The mean interval from onset of symptoms to diagnosis is 14 months. Clinical symptoms are the most reliable diagnostic factors. Block resection is the treatment of choice. A retrospective study of 10 patients is presented.
The authors present a retrospective study of 14 triangular fibrocartilaginous lesions in 13 patients. Based on their radiographic and clinical observations a new classification is presented taking into account associated lesions in the wrist.
We describe a typical case of a phalangeal osteoid osteoma in the hand. The clinical (night pain with complete relief with aspirin, tender local swelling) and radiographic features (a zone of bone sclerosis surrounding a small area of translucency) were obvious. We performed an "en bloc" excision with histological confirmation of the diagnosis and complete relief of symptoms.