Extramedullary fixation of 107 subtrochanteric fractures: a randomized multicenter trial of the Medoff sliding plate versus 3 other screw-plate systems.

We compared the efficacy of a load-sharing device, the Medoff sliding plate (MSP), with that of 3 other load-bearing screw-plate devices for the fixation of subtrochanteric fractures in a randomized multicenter trial of 107 elderly patients. 55 fractures were operated on with the MSP, and 52 with the dynamic hip screw (DHS) with or without a trochanteric stabilizing plate (TSP) or with the dynamic condylar screw (DCS). The patient material in the groups was similar regarding age, domestic situation, preinjury walking ability and fracture types. We followed the patients clinically and radiographically for a minimum of 1 year. There was no significant difference in walking ability or return rate to the home at follow-up. Fixation failure occurred in 1/55 fractures operated on with the MSP, in 3/32 with the DHS, in 3/12 with the DCS and in 2/8 with the DHS/TSR The difference in the rate of fixation failure was statistically significant, when the MSP group was compared to the 3 load-bearing devices in the other group (1 vs 8). On the basis of this experience, we think that the load-sharing principle of the MSP, which seems to facilitate fracture impaction and stability, appears to be a good alternative in extramedullary fixation of subtrochanteric fractures.

Changing epidemiology of tibial shaft fractures. 513 cases compared between 1971-1975 and 1986-1990.

We studied the epidemiological features of tibial shaft fractures during two 5-year periods, 1971-75 and 1986-90, in the county of Uppsala, Sweden. The incidence was higher in men than in women during both periods. In men aged 10-19 years, the fracture incidence was lower during the second period, with a reduction of fractures sustained in road traffic accidents. In women above 80 years, the fracture incidence was higher during the second period.

Anterior square-plate fixation of sacroiliac disruption. 2-8 years follow-up of 23 consecutive cases.

21 consecutive patients with 23 rotationally and vertically unstable sacroiliac joint disruptions were operated on through an anterior approach. Open reduction and internal fixation with a 2-hole square plate was performed. At follow-up after 5 (2-8) years, 18 patients were rated excellent or good and 3 patients poor. In all the cases the reduction of the SI-joints was maintained.

Arthrosis after surgically treated acetabular fractures. A retrospective study of 60 cases.

59 patients with 60 surgically treated acetabular fractures were followed up to 25 years. Coxarthrosis developed within 3 years in 23 fractured hips. There was a high correlation between nonanatomic reduction and posttraumatic arthrosis. The long-term results after an acetabular fracture can be predicted within 2-3 years of surgery.

The triradiate incision for acetabular fractures. A prospective study of 23 cases.

24 acetabular fractures, displaced in the dome, were operated on through the triradiate incision, and 23 were followed for at least 2 years. All but one fracture were anatomically reduced in the dome. At follow-up, 7 hips had developed arthrosis, all with comminuted fractures with separate osteochondral dome fragments. Heterotopic bone formation occurred in 13 hips: 10/14 with indomethacin prophylaxis had no heterotopic bone, whereas all 9 without indomethacin prophylaxis had. We conclude that the triradiate incision is suitable for surgical treatment of complex acetabular fractures, and that the heterotopic bone formation can be reduced by indomethacin prophylaxis.

Epidemiology of pelvic fractures in a Swedish county.

Epidemiologic features of pelvic fractures from 1976 to 1985 inclusive were studied in Skaraborg County, southwestern Sweden. The county had an average population of 269,000 inhabitants. During the 10-year period, 541 patients with pelvic fractures were treated in the hospital, and the incidence was 20 per 100,000. The incidence increased in the elderly, especially among women. Severe trauma dominated in age groups below 60 years, whereas moderate trauma dominated in older age groups. 81 percent were stable fractures of the pubic rami and 10 percent acetabular fractures. Associated injuries occurred in 21 percent of the patients, predominantly in those with severe trauma. The mean length of hospitalization was 3 weeks irrespective of whether or not the trauma was moderate or severe.

Carcinoma in situ of the vulva. Long term prognosis.

Seventy-four patients with carcinoma in situ (CIS) of the vulva were followed over a 10-year period. The mean age was 52.8 years (range 21 to 90 years). Pruritus was the most common symptom. Forty per cent of the women were asymptomatic. Twenty-three per cent had a history of carcinoma in situ of the uterine cervix. Single lesions of CIS were found in the perineal area in 22 per cent, in the labia major and minor in 23 per cent, and in the clitoris in 7 per cent. Forty-two per cent of the patients had CIS in two or more of those areas. Seven of 74 patients (10%) had previously been irradiated for pelvic malignant tumours. Three women developed invasive squamous cell carcinoma of the vulva, two of them were previously irradiated. All 74 patients were treated surgically in different ways. Out of 38 women with histologically free margins of surgery, 6 had recurrence of dysplasia or CIS.

Isolation and growth of human periodontal ligament cells in vitro.

The periodontal ligaments from single human teeth were dissected free of the root surface and plated into culture dishes. In each case two populations of cells were obtained: fibroblasts and epithelial cells. These two populations were separated and grown in culture. The epithelial nature of the epithelioid-appearing cells was confirmed by staining for keratin, exclusively an epithelial cell protein.