[Juvenile bone cysts and their treatment].
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Biomedical subjects
Publications and source records attributed to R Ganz.
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63 slipped capital femoral epiphysis were treated either by a femoral neck osteotomy or by an intertrochanteric osteotomy. In almost all cases a normal anatomical relationship of the proximal capital femoral epiphysis to the neck of the femur was achieved. At an average follow-up of 10 years (2 to 19 years) 90% were rated good to excellent clinically. In 33 hips with a follow-up period of more than 10 years mild degenerative arthritis was present in 36%. Slipping of 60 degrees or less is best treated by an intertrochanteric osteotomy to avoid the higher complication rate in the femoral neck osteotomy.
Extrusion of the femoral head during late childhood and adolescence can be caused by tissue interposition following traumatic hip dislocation, inflammatory joint disease, or avascular necrosis with flattening of the femoral head. We report our experience of treatment by reorientation of the extruded femoral head with combined open-reduction and intertrochanteric osteotomy in seven young patients with Ficat stage III or IV avascular necrosis. Six of the seven patients showed improvement of pain and limp. They also had radiographic improvement of joint space and congruency, which suggests that the degenerative process and further surgery may be delayed.
In 27 cases of fracture after arthrodesis of the hip and knee, there was a characteristic location and appearance which depended upon whether or not metal implant was present. Fracture healing and preservation of motion of adjacent joints was achieved in all cases with internal fixation using the plating techniques described by the A-O group. There is also always the opportunity to decorticate and add supplementary bone grafts for an arthrodesis that had failed before the time of fracture. Metal implants should be removed when there is evidence of consolidation and maturation of bone at both the arthrodesis and fracture sites.
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