A retrospective analysis of severe diaphyseal tibial fractures treated with external fixation.

This retrospective study examines consecutively treated tibial fractures managed with external fixation methods.

Fibrous dysplasia.

An overview of the spectrum and natural history of fibrous dysplasia is an essential prerequisite of management. Current medical interest has focused upon the intriguing pathogenesis of the bone lesions, the endocrinopathies, the cutaneous pigmentation, and malignant transformation. The mundane aspects of diagnosis and the complications of a soft bone disorder reside with the clinical orthopedist. Diagnosis is straightforward with the aid of biopsy. Conservatism in the surgical treatment of monostotic lesions and experience in the care of fractures and deformity in polyostotic fibrous dysplasia constitute the lessons learned in a series of over 50 patients with fibrous dysplasia.

Selective ascending lumbosacral venography in the assessment of lumbar-disc herniation. An anatomical study and clinical experience.

Epidural venography was performed in 110 patients with suspected lumbar-disc herniation by catheterization of the ascending lumbar and ascending sacral veins. The findings by venography and by myelography were compared with those revealed by operative exploration. Only sixty-one patients had venography, myelography, and operative exploration. In fifty of these patients with no previous disc surgery, the diagnostic accuracy of venography was 98 per cent and of myelography, 90 per cent. Venography had limited value in the other eleven patients who had had one or more prior disc operations because it did not distinguish between scarring and recurrent disc herniation at the levels previously explored. Selctive ascending lumbosacral venography is indicated both in patients who have not had a prior disc operation, as a guide to whether myelography should be performed when the clinical picture is ambiguous, and in patients whose myelogram is normal or equivocal but whose signs and symptoms are strongly suggestive of disc herniation.

Skeletal alterations following irradiation for Wilms' tumor: with particular reference to scoliosis and kyphosis.

The roentgenographic changes in the axial skeleton after irradiation for Wilms' tumor were studied in eighty-one patients. In addition to the initial alterations found in the individual vertebrae within the field of irradiation, spinal deformity subsequently developed in fifty-nine patients (pure scoliosis in thirty-eight, kyphoscoliosis in nineteen, and pure kyphosis in two). Unitl the adolescent growth spurt these deformities tended to remain slight, but some progression did occur. In seven patients the scoliosis became severe enough to require spine fusion. A Milwaukee brace used in three patients failed to correct the curve. The trapezoidal shape of the vertebrae and scarring of the soft tissues within the concavity made correction difficult. Recognizable roentgenographic alterations failed to develop in twenty-two patients who, in general, were older and had received less irradiation. There appeared to be a correlation between the amount of irradiation and the severity of the spinal deformity (p is less than 0.05) and between the age of irradiation and the amount of deformity (p is less than 0.02).