Subperiosteal resection of aneurysmal bone cysts of the distal fibula.

We describe the treatment by subperiosteal resection of an aneurysmal bone cyst in the distal fibula in eight patients and highlight the role of the periosteum in the regeneration of bone defects. The mean age of the patients was 13.5 years (12 to 17). Seven had an open growth plate. The mean size of the resected specimen was 5.12 cm (3.5 to 8.0). None of the patients received instillation of bone marrow, autogenous bone graft, allograft or any synthetic bone substitutes. All had complete regeneration of the bone defect within three to nine months, with no joint instability or recurrence. The mean length of follow-up was 11.5 years (2 to 18). At the final follow-up there was no difference in the range of movement, alignment or stability of the ankle when compared with the opposite side. The periosteum played a major role in the complete filling of the bone defects and avoided the morbidity of other techniques.

Primary pelvic hydatid cyst: an unusual cause of sciatica and foot drop.

STUDY DESIGN: A case report of primary pelvic hydatid cyst causing sciatica and foot drop. OBJECTIVE: To document the occurrence of primary pelvic hydatid cyst as one of the hidden causes of lower limb weakness and foot drop, and to recommend inclusion of the pelvic cavity when assessing sciatica and foot drop. SUMMARY OF BACKGROUND DATA: It is common to see foot drop caused by peripheral lesions around the knee or disc herniation in the lumbar spine, but if these sites were excluded, the pelvic cavity must be examined for hidden disease that may explain the cause of foot drop and sciatica. METHODS: The authors involved in the care and management of this patient were interviewed and all medical records, radiologic investigations, and related literature were reviewed. RESULTS: After exclusion of spinal and peripheral causes of foot drop, computed tomography of the pelvis showed a well-localized cystic swelling in the right side of the pelvis over the lumbosacral plexus roots. Surgical excision of the cyst resulted in partial recovery of the foot drop at 3 years of follow-up. CONCLUSION: Primary pelvic hydatid cyst rarely causes pressure on the lumbosacral plexus. This was a case of hydatid cyst in the pelvis causing sciatica and foot drop, and it indicates the pelvis as a hidden source of sciatica and foot drop. After surgical excision followed by 4 months' mebendazole therapy, there was no evidence of recurrence on long-term follow-up.

The treatment of displaced supracondylar fractures of the humerus in children. A comparison of three methods.

This retrospective study compares the long-term results of the treatment of 135 children with displaced extension-type supracondylar fractures of the humerus using 3 different methods. Closed reduction and percutaneous fixation was superior with excellent and good results in 87% and had the lowest incidence of poor results (8%). Open reduction and wire fixation, and closed reduction with a plaster cast gave excellent and good results in 74% and 60% respectively. Closed reduction and wire fixation is recommended as the treatment for grades II and III supracondylar fractures.

Tibial fractures in children: follow-up study.

One hundred seventeen children with tibial shaft fractures were treated by above knee cast with or without traction depending on stability. All fractures united in an average period of 37 days. Reevaluation after 3-10 years showed that initial shortening, fracture type, fracture location, and age of the patient affected growth acceleration, whereas the initial angular magnitude, direction, and planes, as well as the type of the fracture, the age of the patient, and length of follow-up period, affected correction of angulation. We concluded that: shortening can be compensated by growth acceleration; varus deformities can undergo spontaneous correlation whereas valgus deformity and posterior angulation partially persist and rotational deformities persist.

The Debrunner-Cech valgus osteotomy in osteoporotic four-part intertrochanteric fractures.

The main problems encountered in the management of comminuted four-part intertrochanteric fractures in the elderly are instability, severe osteoporosis and the need for early mobilization. Thirty-one patients, average age 75 years, with such fractures were operated on using a sliding blade-plate and the Debrunner-Cech valgus osteotomy. The follow-up was from 1-5 years with an average of 3.2 years. All patients were got out of bed on the first postoperative day and walked with help on the second day. The fractures united in 29 patients. The one exception occurred when the blade cut out of the neck; the operation was repeated with a good result. Two further patients died in the postoperative period. We conclude that this method is the best treatment for osteoporotic four-part intertrochanteric fractures.

Bilateral traumatic dislocation of the hips with ipsilateral femoral fracture.

A rare case of bilateral traumatic dislocation of the hip with ipsilateral femoral shaft fractures occurred in a 29-year-old man. Reduction was achieved by manipulation, despite the presence of a femoral shaft fracture on one side. A review of the literature reveals reports of three similar cases.

Remodeling after femoral shaft fractures in children treated by the modified blount method.

One hundred forty-one children with femoral shaft fractures in the 1-12-year age range were treated by simple skin traction without spica cast immobilization. All fractures united in an average traction period of 28 days. Clinical and radiological reevaluation 2-10 years after treatment showed that fracture location, age, and overriding significantly affected overgrowth, whereas the length of the follow-up period and the direction of angular deformity affected correction of angulation. The following conclusions were reached: Distraction should be avoided, and overriding of up to 15 mm can be compensated for by growth acceleration. Initial angular deformities of up to 20 degrees in the coronal plane and up to 30 degrees in the sagittal plane will end in a satisfactory outcome. Rotational deformity was not a problem following this method of treatment.

Active treatment of segmental defects of long bones with established infection. A prospective study.

Twenty-nine patients with chronically infected segmental defects of the tibia (15 cases), femur (7 cases), humerus (5 cases), and radius (2 cases) were treated during a six-year period (1975-1980). The defects were due to hematogenous osteomyelitis in six cases and trauma (vehicular accidents, crushing injuries, and gunshot wounds) in 23 cases. In 12 cases exposed bone was present owing to soft tissue and skin losses. Treatment consisting of stabilization of the fragments, thorough debridement, continuous irrigation, and cancellous bone grafting allowed early mobilization and achieved bony union with control of infection in all cases. Good to fair functional results were obtained in 22 of the 29 involved extremities.

Surgical treatment of pathological subtrochanteric fractures due to benign lesions in children and adolescents.

Twelve children and adolescents with pathological subtrochanteric fractures due to benign tumors or tumorlike lesions were treated by curettage, autologous cancellous bone graft, and internal fixation. The healing of the lesion and the fracture in nine patients was without complications. In the remaining three, the healing was complicated. In one, with nonunion and shortening due to 35 degrees varus deformity following conservative treatment, a 1-cm shortening due to 15 degrees varus deformity remained after surgery. In the same patient, a small recurrence was curetted when removing the plate and the screws. In the second, a stress fracture with varus deformity and shortening followed surgical treatment. These were corrected by valgus osteotomy. In both patients the final result was good. In the third, a femoral head collapse occurred. It was due to a lesion in the head that was overlooked on the initial roentgenogram. Although the fracture and the lesion were healed, the final result was poor. It was concluded that internal fixation of these fractures allows thorough curettage and bone grafting and results in the least amount of immobilization and the most rapid resolution of the lesion and the fracture.