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At least 271 records · Page 15Linked to original sources
PubMed2005

Surgical treatment of malignant tumors of the foot and ankle.

BACKGROUND: The current study highlights the clinical features of tumors of the foot and ankle, and presents the clinical outcomes of treatment for 16 patients who were treated at the authors' institution, between 1989 and 1998. METHODS: Four tumors occurred in the ankle, three were in the hindfoot, three were in the midfoot, three were in the forefoot, and three were on the plantar surface of the foot. The median duration of symptoms before presentation was 12 months (range, 1-50 months). Fourteen patients were managed by limb-salvage procedures. Three patients were managed by ablative surgery, due to skin, neurovascular, and/or severe bone invasion. In the 9 patients who had wide local resections, local island flaps, split-thickness skin grafts, free vascularized latissimus dorsi flaps, and a free vascularized iliac crest flap were utilized to achieve wound closure. RESULTS: The patients were followed up for a mean of 74.2 months (range, 48-121 months). The overall survival of the whole group is 71 +/- 3.7 months. Currently, 12 patients are being followed up with no evidence of disease. Of the 14 patients who were managed by limb-salvage procedures, 6 have normal functional status. CONCLUSION: Wide resection of malignant tumors of the foot and ankle is considered technically difficult because of technical problems of soft-tissue coverage. However, utilization of local and free flaps provides sufficient closure following wide tumor resection of the foot and ankle, thus yielding satisfactory lower extremity function and local tumor control.

Adolescent↗
PubMed2005

Limb salvage in the skeletally immature patient.

The most common tumors of bone, osteosarcoma and Ewing sarcoma, commonly occur in the skeletally immature patient. Historically, amputation was the procedure of choice; however, improved oncologic outcome and technical advances in limb salvage surgery have made limb salvage therapy a feasible and valuable treatment option. Nevertheless, depending on the extent of the lesion within the long bone, it may be difficult to spare the physis, and hence, in the skeletally immature patient, resection of a sarcoma of bone can create a limb-length discrepancy and gait abnormalities. This article reviews the limb salvage options available for the skeletally immature patient who requires reconstruction of a segmental long bone defect.

Amputation, Surgical↗
PubMed1994

The clamshell incision: an improved approach to bilateral pulmonary and mediastinal tumor.

Median sternotomy has been the accepted approach for dealing with mediastinal tumors or bilateral pulmonary disease, but exposure to the lower lobes and to mediastinal tumors extensively involving a hemithorax is often limited. Based on the reported experience from double-lung transplantation, we explored the use of clamshell incisions for these difficult problems. From March 1991 to December 1993, we prospectively studied the utility of clamshell incisions in 90 patients for the following indications: bilateral pulmonary metastases (62 patients), primary lung carcinoma with mediastinal involvement (13 patients), primary tumors of the mediastinum (14 patients), and mesothelioma (1 patient). Bilateral anterior thoracotomies with a transverse sternotomy (clamshell incision) were employed in 71 patients and a unilateral anterior thoracotomy with partial or complete median sternotomy (hemiclamshell incision) was used in 19 patients. For closure, we used pericostal sutures and sternal wires, usually augmented by sternal K-wire stents or Steinmann pins to prevent sternal override. Exposure to all areas of the mediastinum, pericardium, pleura, and lung was excellent. Specifically, the clamshell incision afforded markedly better access to lower lobe disease and hemithoracic extension of mediastinal disease than that possible with median sternotomy. There were no deaths or significant morbidity, and all patients tolerated the incisions well without mechanical respiratory difficulties. There was one wound infection. There was no late sternal override and the cosmetic results were found to be excellent during a follow-up of 2 to 33 months. We conclude that clamshell incisions constitute an improved surgical approach for the management of bilateral pulmonary or combined pulmonary and mediastinal disease.

Bone Nails↗
PubMed1985

A manoeuvre to cover exposed metal using a de-epithelialised "turn-over" fasciocutaneous flap.

This paper describes a technical manoeuvre to accommodate an exposed metal implant used in the treatment of a fracture of the tibia within a "turn-over" de-epithelialised fasciocutaneous flap. The need for such a procedure in this particular case is commented upon. A discussion is also included on the nature of the blood supply to the integument based on available information.

Adolescent↗
PubMed1975

The results of operative treatment of trochanteric fractures of the femur.

One hundred and seventy trochanteric fractures of the femur treated by operative fixation are reviewed. The results of treatment are disappointing. The complication rate is high. The mortality rate should be assessed at 6 months after the fracture. From these results, it would appear that operative treatment does not offer the patient with a trochanteric fracture of the femur less morbidity, a lowered mortality rate or even a better result, when compared with operative treatment 25 years ago, or when compared with a recent review of conservative treatment from Inverness.

Aged↗
PubMed1975

The place and efficacy of operative management of fractured clavicle.

A study of 22 cases of operative fixation of the fractured clavicle has been made. This has shown that with internal fixation and onlay bone grafting, highly successful results can be attained. There were no cases of non-union and there have been no significant complications. The indications for such surgery are presented from the literature. It is clear that the operation is not commonly indicated, but when performed is safe and highly successful.

Adolescent↗
PubMed1981

The treatment of unstable intertrochanteric fractures of the hip: a prospective trial of 150 cases.

We report a prospective clinical trial of 150 cases for the treatment of unstable intertrochanteric fracture of the neck of the femur. Three methods were tested in our series--skeletal traction with a tibial pin, medial displacement osteotomy and valgus osteotomy--with 50 patients in each group. Our results showed no significant difference between those treated with the Dimon and Hughston osteotomy and those treated by the Sarmiento osteotomy. Conservative treatment of skeletal traction for unstable fracture was found to be well tolerated by the Chinese patient. A low mortality and morbidity rate was found in this series with an overall infection rate of 4 per cent.

Aged↗
PubMed1990

Subtrochanteric fractures following Gouffon pinning of subcapital femoral fractures.

Of the first 158 patients in a series of 292 consecutive patients treated for a femoral neck fracture with multiple pinning according to Gouffon's method (Howmedica Inc.), four (2.5 per cent) subsequently suffered a subtrochanteric fracture at the site of the distal pins. The configuration of the fractures was identical. These fractures occurred spontaneously while walking, and one occurred after slight direct trauma. Re-osteosynthesis was required in all four cases using a screw-plate device. If necessary, one or two pins were left in place to secure rotational stability. After a review of these cases and the literature, various modifications to Gouffon's method were introduced, and none of the following 134 patients suffered secondary fractures.

Aged↗
PubMed1991

Management of displaced supracondylar fractures of the humerus in children.

A series of 33 children with displaced supracondylar fractures of the humerus (SFH) were all treated operatively by open reduction and internal fixation or by closed reduction and percutaneous pinning. A follow-up study was performed on average 29 months (range 3-63 months) after the injury. In 18 per cent of cases primary neurovascular injury was observed and confirmed at operation. Of these patients 32 had open reduction and internal fixation by K-wires; in only one case was closed reduction and percutaneous pinning attempted. If there was preoperative neurological deficit, the nerves were visualized; however nerve suture was not required in our series. In one case we had to reconstruct both the brachial and radial arteries because of intimal lesions totally occluding the vessels. The average hospital stay was 9 days, including pin removal, which was usually performed about 4-5 weeks later, at the time of plaster removal. By Innocenti's criteria, 27 of 30 patients reviewed had an excellent result; three had a good result and three patients were lost to follow-up. There were no complications due to the operation, such as wound healing problems, infections or nerve lesions. In the light of our experience and of the good results, we recommend that displaced SFH be managed by open reduction and internal K-wire fixation. Percutaneous pinning is a good alternative method when closed reduction is successful at the first attempt.

Bone Nails↗
PubMed1992

Fractures of the distal clavicle: a case for fixation.

We present a series of 43 Neer type 2 fractures of the distal one-third of the clavicle. These displaced fractures are associated with a high incidence of non-union. In those patients treated non-operatively there was a higher incidence of local complications, residual shoulder dysfunction and non-union than in those treated by open reduction and internal fixation. We recommend that type 2 fractures should be treated by open reduction and internal fixation.

Adolescent↗
PubMed1993

The two-part proximal humeral fracture: a review of operative treatment using two techniques.

A review of 45 patients who have undergone surgery for two-part fractures of the proximal humerus (Neer Group III) is reported using two operative techniques, AO plating and intramedullary Rush pins. Good functional results were obtained using the former technique in seven out of eight of the patients under the age of 50 years who mainly sustained their original injury as a result of high-energy motor vehicle accidents. However, in the more common low-energy, osteoporotic fracture in the elderly population, results were unsatisfactory in 12 out of 14 cases where AO plating was used, usually as a result of fixation failure. The Rush pin technique produced more reliable results in this age group, with satisfactory functional scores being obtained in 16 out of 23 patients. It is suggested that the Rush pin technique is preferable to plate fixation in the more common osteoporotic insufficiency fracture in the elderly.

Adult↗