[Treatment of osteitis by exposed excision-graft using Papineau's method].
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Biomedical subjects
Publications and source records attributed to G Saillant.
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The authors present a new treatment technique of osteitis, which consists of an excision of necrotic bone followed by cancellous graft bone in two operations without a skin closure. This allows a simultaneous drying, cicatrization and consolidation. The post-operative treatment necessary in order to obtain a rapid healing is particularly detailed.
The authors analyse about one and a half years later, the results of 46 Papineau operations divided in three groups depending of the initial excision. The complete healing was obtained for 44 patients and by the sole Papineau operation in 70 p. 100 of the cases, with relatively short delays: 6 months without a solution of bone continuity, 9 months with a small solution of bone continuity, 11 months in the case of major solution of bone continuity. They insist on the absence of amputation, the small number of complications and in particular of interative fractures in this series.
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Four cases of epiphyseal tumours were treated by the authors by local resection. In two cases, there was a giant-cell tumour of the lower end of the femur, in one case a giant-cell tumour of the lower end of the radius and in one case a juxta-cortical sarcoma of the lower end of the radius. In the two cases involving the knees, resection preserved the articular surface and the subchondral bone. Reconstruction was achieved by a cortical autograft. In all cases, painless joint movement was preserved with satisfactory muscle power.
The authors report their experience concerning eleven cases of that original and frequent association of fractures. The ligamentous lesions associated with those fractures are considered, justifying the necessary dynamic X rays. The eleven cases are reviewed and a classification supported by an iconography is given, according to the unstability of the odontoid or of the pedicles. The complications after orthopaedic or surgical treatment are analysed and the authors give their conclusions. The proposed treatment is conservative when the fractures are neither displaced nor unstable, and surgical when one of the two fractures is unstable. The best procedure is bi-pedicular screwing associated with C1/C2 wiring.
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