Search

A series of 136 tibial fractures treated with locked Grosse-Kempf nailing is reviewed, evaluating the results according to rapidity of healing, functional recovery, and complications. Locked nailing proved so reliable that immediate mobilization was possible. There was only a 6% incidence of delayed union, including infections (3 cases, 2%) and nail breakage (2 cases, 1.5%). Several details of the operative technique that were decisive in the final result are discussed.

Twenty-two patients for a total of 26 synostoses submitted to surgical treatment at the Rizzoli Orthopaedic Institute were evaluated. Following a critical analysis of the results obtained with various methods of surgical correction, the authors propose what they believe to be the best types of treatment for this rare deformity.

The authors were able to establish a relationship between high patella (alta) and Osgood-Schlatter's disease. In a long-term study this was found in 38% of cases. There was also evidence of abnormalities of femoro-patellar relationship in 57% of cases, although only 14% of these had symptoms at the time of follow-up. Two alternative hypotheses on the pathogenesis of the disease are put forward, depending on whether the radiographic changes observed at follow-up were of a pre-existing constitutional type, or the direct result of the disease. This question can be resolved if in future cases a precise radiographic examination is carried out on both knees at the onset of the disease, using the exact technique described so that the relevant parameters can be determined.

The authors review 31 cases of fracture of the intercondylar tibial eminence in children and adolescents. In view of the constant relationship observed between the initial clinical and radiological findings and the final results, they advise that a clinical examination in narcosis be done in all cases in order to ascertain the existence or otherwise of ligamentous laxity, which is the determining factor in the end result. After emphasizing the differences as compared with these fractures in adults, the principal surgical techniques are reviewed, including the role of arthroscopy.

A new radiographic classification is proposed based on a study of 31 cases of congenital proximal radio-ulnar synostosis in which close correlation was observed between the clinical and radiographic pictures. The authors attempt to clarify some aspects of the pathogenesis of this rare disease.

This study is an evaluation of intertrochanteric osteotomy in cases of idiopathic osteonecrosis of the femoral head (I.O.F.H.) in patients too young to be suitable for prosthetic replacement. The variety of material, the length of follow-up, and the detailed evaluation on a points system, are sufficient for valid comparison with more recently introduced methods of treatment.

A critical review of the surgical treatment of 65 cases of infantile fibrous dysplasia demonstrated that "circumscribed" forms of the disease generally do not require any type of surgical treatment, while "extended" forms, as well as Albright's syndrome, require early surgical treatment aimed at preventing the development of skeletal deformities which are difficult to correct. Prophylactic intramedullary nailing with nails of suitable calibre most effectively achieves this goal.

The authors discuss the indications and describe the technique of arthromyolysis of the elbow in arthrogryposis and report 17 operations performed on 10 patients followed up after an average of 4.5 years. Their results show that this type of operation considerably improves passive mobility of the elbow and is capable of conferring adequate function on the limb, even without recourse to subsequent muscle transposition into the paralysed biceps.