Aneurysmal bone cyst: the role of fibular graft in its treatment

Aneurysmal bone cyst is a relatively uncommon benign bone lesion for which curettage and cancellous bone grafting is a widely accepted method of treatment. This paper presents a report of eight patients with aneurysmal bone cysts; four in the humerus, three in the femur and one in the proximal phalanx of the index finger. Seven patients were treated by curettage and cancellous bone graft and one by autogenous fibular graft combined with cancellous allograft. Patients treated by cancellous bone grafting developed recurrence within a year. Three of these recurrent cysts were then treated by autogenous fibular graft combined with allograft. All four patients treated by fibular graft showed satisfactory healing of the cyst with no recurrence at three years' follow-up. Analysis of these patients suggests that recurrence of the aneurysmal bone cyst is very frequent after curettage and cancellous bone grafting. It is recommended that where total excision of the cyst is not feasible, the treatment of choice should be curettage and autogenous fibular bone grafting combined with cancellous bone graft. Removal of the fibula from its middle third does not cause any disability and the fibula regenerates completely within a period of three months

Diaphyseal fractures of the humerus treated by open reduction and internal fixation

This paper presents our experience with 57 patients of diaphyseal fractures of the humerus, treated by open reduction and fixation with dynamic compression plate. The indications for surgical treatment included delayed union in 29 patients, soft tissue interposition in 11, multiple injuries in 8, and radial nerve involvement in 9. Seven patients among the 19 who had routine exploration of the radial nerve palsy, took 6 to 12 weeks to recover. We recommend that fractures which do not show evidence of union in 6-8 weeks are unlikely to unite and should be treated by open reduction and internal fixation. Fractures with a gap between the fragments either in anteroposterior or in lateral radiographs and fractures with distraction of the fragments commonly have soft tissue interposition and should have primary open reduction and internal fixation. Exploration of the radial nerve during primary fixation of the fracture should only be done in patients presenting with radial nerve involvement

Beware of giant cell tumour - a case report

This case presents diagnostic problems encountered with a 20 year old man who presented with pain and a flexion deformity of the knee caused by a giant cell tumour of lower end of the femur. On initial presentation, the knee radiographs were considered normal and the patient was treated for internal derangement of the knee. The diagnosis of giant cell tumour was established after six months when the knee radiograph indicated a bony lesion in the medial condyle of the femur extending into the popiteal space. The purpose of this case presentation is to remind orthopaedic physicians of the possible existance of giant cell tumour formation in the interspacial area of the knee

Treatment of non-union with implanted direct current stimulator and bone grafting

This study presents the results of 38 cases of ununited long bone fracture treated by a totally implanted direct current bone growth stimulator and by bone grafting. The patients were grouped into A, B, C, and D. Ten patients in Group A and 10 patients in Group B were cases of non-union with an average duration of 1 year, and had no history of a previous bone grafting procedure. Eight patients in Group C and 10 patients in Group D were cases of non-union with an average duration of 2 1/2 years and had multiple previous unsuccessful attempts to achieve union. Patients in Group A were treated by a bone growth stimulator and internal fixation; in Group B, by internal fixation and bone grafting; in Group C, by a bone growth stimulator combined with internal fixation and bone grafting; and patients in Group D were treated by internal fixation and bone grafting. The success rate of sound bone union in Group A was 90%, in Group B 80%, in Group C 62.5%, and in Group D, 70%. This study suggests that the bone growth simulator, combined with internal fixation is a satisfactory method for the treatment of non-union operated first time and it avoids the need of bone grafting. The use of a bone growth stimulator, in conjunction with bone grafting in cases of non-union with a history of previous failed surgical procedures, did not make any difference to the results

Segmental and comminuted segmental femoral shaft fractures - a study of 33 cases

The results of a study of 33 cases of segmental and comminuted segmental femoral shaft fractures, treated under our care from January 1980 to December 1985, are presented and analysed. This paper provides a useful classification of this type of injury and compares the results of different types of treatment. Depending upon the severity of comminution, these fractures have been classified into: segmental fractures, split segmental fractures, and multifragmented segmental fractures. In this study 13 cases were treated by traction, six cases by AO intramedullary nail, nine cases by AO condylar plate and five cases by AO external fixator. By analyzing the results of different methods of treatment, it was found that segmental and split segmental fractures are best treated by internal fixation. Displaced unstable multifragmented segmental fractures are best treated by external fixation, while undisplaced stable fractures are best treated by traction. Cases of segmental and split segmental fractures, treated by traction, had unsatisfactory results because of angulation and shortening