P. P. Casteleyn

Surgical treatment of acute type-V acromioclavicular injuries in athletes

SummaryIn a prospective study, 18 consecutive athletes with an acute type-V acromioclavicular sprain were treated with a coracoclavicular repair using a double velour Dacron graft. All patients were reviewed after a mean follow-up period of 6 years (range: 2–9 years). At follow-up, 12 patients (66.7%) showed a good or excellent result according to the Imatani evaluation system, and six patients (33.3%) demonstrated a fair or poor result according to the same system. Loss of reduction was encountered in eight shoulders (44.4%) despite an initial anatomical reduction. No correlation was seen between the overall scores at follow-up and the degree of residual dislocation, between the overall scores and the presence of coracoclavicular calcifications or ossifications, between the overall scores and the development of post-traumatic arthritic changes, or between the overall scores and the presence of osteolysis of the distal clavicle.

Treatment of isolated distal ulnar shaft fractures with below-elbow plaster cast

In a prospective study 52 patients with an isolated fracture of the distal ulna were treated with a below-elbow plaster cast. The histories of 46 patients were reviewed after a mean follow-up of 3.5 years (ranging from 10 months to 7 years). Forty-three fractures united. There were two non-unions. One fracture displaced while in the plaster, so that there was no longer any bone contact between the fragments. The fracture was consequently treated by open reduction and internal fixation. The type of fracture, the initial displacement (all fractures had bone contact) or the initial angulation (maximum 10 deg) was not found to influence the final clinical results. Below-elbow plaster cast appeared to produce satisfactory results in 89% of the patients.

Stress fracture of the radius following non-union of an isolated fracture of the ulna.

SummaryNon-union of the ulnar diaphysis after isolated ulnar shaft fracture is uncommon. Complications due to non-union of the ulna must therefore be very rare. A case of a stress fracture of the radius in a postmenopausal woman following an isolated ulnar shaft fracture and non-union is presented. The mechanism of the stress fracture and propositions for preventing non-union of the ulnar shaft after an isolated fracture in the osteoporotic patient are discussed.

Fractures of the Upper Tibia and Arthroscopic Techniques

Treatment and outcome of fractures of the upper part of the tibia are related to fracture type and associated lesions. An accurate anatomic reduction as well as a stable fixation allowing early mobilization are prerequisites for a successful result. Due to the high complication rate associated with open surgery for fractures of the tibial plateau, percutaneous techniques have become increasingly popular. Associated with fluoroscopy, arthroscopy has become a precious tool for diagnosis and fracture reduction over the past 15 years. Meanwhile, minimally invasive osteosynthesis techniques have evolved progressively. Concomitant use of external fixation has widened indications to less stable or bicondylar fractures, although severely comminuted and complex fractures in younger patients seem best suited to open treatment. The different techniques, advantages, and disadvantages as well as limitations, risks, and results of arthroscopy-guided percutaneous treatment are reviewed. The good short-term results obtained by pioneers were later confirmed in larger series. Midterm clinical and radiologic studies have demonstrated the stability of the results at more than 5 years.

Nonunion of a comminuted intra-articular wrist fracture after external fixation - A case report and review of the literature

SummaryNonunion is a very rare complication of a comminuted intra-articular wrist fracture treated by external fixation. The authors describe the likely reasons and the after-care, in order to avoid this complication.

Traction-suspension therapy for unstable glenoid neck fracture

further into the pelvis during this period. Certainly, at operation it could not be visualized, and no force was used in trying to locate it with the coupling screw, though the possibility does exist that it may have been pushed in unknowingly by the operating surgeon. The ease with which thrs may have occurred indicates that the screw may have tracked into the retroperifoneal region during some of the patient’s falls, a fact not fully appreciated from the preoperative radiograph (Figure I). The failure to use the compression screw during internal fixation made it impossible to extract the implant in one piece, as is usually possible when the fixation in the femoral head is poor. There is a feeling that compression should not be used in porotic bones for fear of the threads cutting oui, and that its use does not affect the outcome of a femoral neck fracture in terms of union (Fransden et al., 1984). Whereas these are logical assumptions, in view of the difficulty encountered in removing this screw, and the potential risks of penetrating acetabular screws (Keating et al., 1990). it is recommended that the compression screw be used in all fixations, but tightened only if the bone quality is judged to be adequate. Case reports 57

Our Experience with Frozen Allografts: First Short-Term Results

Since revision arthroplasty of hip and knee came to be performed, and cases frequently present a lack of good bone stock, the necessity of having a bone bank became obvious.

An unexpected cause of pathologic hip fracture: malignant fibrous histiocytoma

SummaryWe describe a case of a 68-year-old patient presenting with pathological hip fracture and multiple pulmonary metastases, who has been operated without a prior histological diagnosis. The hip lesion was thought to be a metastasis of an unknown primary tumor. The proximal part of the femur was resected and replaced by a Müller megaprosthesis. Histological analysis of the resected bone revealed a malignant fibrous histiocytoma, a rare but very aggressive bone tumor. The patient died three weeks after operation of widespread metastases. By presenting this case report, we want to stress the importance of pretreatment histological diagnosis of osteolytic bone lesions in older patients with metastases.ZusammenfassungFallbericht eines 68jährigen Patienten mit einer pathologischen Hüftfraktur und multiplen Lungenmetastasen, der ohne eine histologisch gesicherte Diagnose mit einer Müller-Prothese versorgt worden ist. Die Fraktur wurde als Metastase eines unbekannten primären Tumors aufgefaßt. Die Histologie des Resektates zeigte ein malignes fibröses Histiozytom — einen seltenen, aber sehr aggressiven Tumor. Der Patient ist postoperativ an den Komplikationen der Metastasierung verstorben. Bei der Präsentation dieses Falles verweisen wir auf die Bedeutung der präoperativen Histologie bei osteolytischen Prozessen und Metastasen hin.